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Self-Pay Insurance
for Faculty, Staff & Librarians — Self-Pay Rates

These rates are for employees in a leave-without-pay (LWOP) or reduction-in-force (RIF) situation. Medicare rates are not available to these subscribers.

2012 Rates Effective January 1, 2012

Medical rates

Uniform Medical Plan Classic Uniform Medical Plan CDHP w/HSA Group Health Classic Group Health Value Group Health CDHP w/HSA Kaiser Permanente Classic Kaiser Permanente CDHP w/HSA
Subscriber
$531.11
$485.22
$550.48
$501.58
$482.92
$538.18
$481.27
Subscriber & Spouse/QDP
1,056.69
961.45
1,095.43
997.63
957.35
1,070.83
953.55
Subscriber & Child(ren)
925.30
856.97
959.19
873.62
853.32
937.67
850.06
Full Family
1,450.88
1,274.87
1,504.14
1,369.67
1,269.42
1,470.32
1,264.01

Dental rates (with medical)

  Uniform Dental Plan, administered by WDS DeltaCare,
administered by WDS		 Willamette Dental
Subscriber Only
$45.20
$39.53
$42.68
Subscriber & Spouse/QDP
90.40
79.06
85.36
Subscriber & Child(ren)
90.40
79.06
85.36
Full Family
135.60
118.59
128.04

Dental rates (without medical)**

  Uniform Dental Plan, administered by WDS DeltaCare,
administered by WDS		 Willamette Dental
Subscriber Only
$50.73
$45.06
$48.21
Subscriber & Spouse/QDP
95.93
84.59
90.89
Subscriber & Child(ren)
95.93
84.59
90.89
Full Family
141.13
124.12
133.57

2011 Rates Through December 31, 2011

Medical rates

Group Health Classic Group Health Value Kaiser Permanente Classic Uniform Medical Plan PPO
Subscriber
$519.80
$479.29
$554.22
$509.63
Subscriber & Spouse/QDP
1,033.36
952.34
1,102.20
1,013.02
Subscriber & Child(ren)
904.97
834.08
965.21
887.17
Full Family
1,418.53
1,307.13
1,513.19
1,390.56

Dental rates (with medical)

  Uniform Dental Plan, administered by WDS DeltaCare,
administered by WDS		 Willamette Dental
Subscriber Only
$47.63
$39.53
$40.74
Subscriber & Spouse/QDP
95.26
79.06
81.48
Subscriber & Child(ren)
95.26
79.06
81.48
Full Family
142.89
118.59
122.22

Dental rates (without medical)**

  Uniform Dental Plan, administered by WDS DeltaCare,
administered by WDS		 Willamette Dental
Subscriber Only
$50.97
$43.63
$46.62
Subscriber & Spouse/QDP
95.50
80.82
86.80
Subscriber & Child(ren)
95.50
80.82
86.80
Full Family
140.03
118.01
126.98

*QDP = Qualified Domestic Partner

** Rates are subject to change.

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