PPO Plan

Area 1 (Portland)

Prevailing Benefits
Age Insured
Only		 Insured &
Spouse		 Insured & Spouse & Child (ren) Insured & Child (ren)

Monthly rates effective January 1, 2010
Monthly family rates are based on the age of primary applicant
Under 25 $275 $578 $785 $454
25 - 29 299 629 854 494
30 - 34 303 637 864 500
35 - 39 324 680 924 535
40 - 44 365 768 1043 603
45 - 49 442 930 1262 730
50 - 54 506 1062 1442 835
55 - 59 529 1112 1509 873
60 - 64 542 1138 1545 894
65 and older 548 1151 1562 904
Low Cost Benefits
Age Insured
Only		 Insured &
Spouse		 Insured & Spouse & Child (ren) Insured & Child (ren)

Monthly rates effective January 1, 2010
Monthly family rates are based on the age of primary applicant
Under 25 $205 $431 $585 $339
25 - 29 223 469 637 368
30 - 34 226 475 645 373
35 - 39 241 508 688 398
40 - 44 272 573 777 450
45 - 49 330 693 941 545
50 - 54 377 792 1075 622
55 - 59 394 829 1126 651
60 - 64 404 849 1152 667
65 and older 409 858 1165 674

Area 2 (Eugene)

Prevailing Benefits
Age Insured
Only		 Insured &
Spouse		 Insured & Spouse & Child (ren) Insured & Child (ren)

Monthly rates effective January 1, 2010
Monthly family rates are based on the age of primary applicant
Under 25 $268 $563 $765 $443
25 - 29 291 613 832 481
30 - 34 295 621 842 487
35 - 39 316 663 899 521
40 - 44 356 749 1017 588
45 - 49 431 905 1230 712
50 - 54 492 1035 1404 813
55 - 59 516 1083 1471 851
60 - 64 528 1109 1505 871
65 and older 534 1122 1523 881
Low Cost Benefits
Age Insured
Only		 Insured &
Spouse		 Insured & Spouse & Child (ren) Insured & Child (ren)

Monthly rates effective January 1, 2010
Monthly family rates are based on the age of primary applicant
Under 25 $199 $420 $570 $330
25 - 29 218 457 620 359
30 - 34 220 462 628 363
35 - 39 235 494 671 388
40 - 44 265 558 758 439
45 - 49 322 675 917 531
50 - 54 367 772 1048 607
55 - 59 384 808 1096 635
60 - 64 393 827 1123 650
65 and older 398 837 1136 657

Area 3 (Salem)

Prevailing Benefits
Age Insured
Only		 Insured &
Spouse		 Insured & Spouse & Child (ren) Insured & Child (ren)

Monthly rates effective January 1, 2010
Monthly family rates are based on the age of primary applicant
Under 25 $256 $538 $730 $423
25 - 29 278 584 793 459
30 - 34 281 592 803 465
35 - 39 301 633 859 497
40 - 44 340 715 970 561
45 - 49 412 864 1173 679
50 - 54 470 987 1341 776
55 - 59 492 1034 1403 813
60 - 64 503 1059 1437 832
65 and older 510 1070 1453 841
Low Cost Benefits
Age Insured
Only		 Insured &
Spouse		 Insured & Spouse & Child (ren) Insured & Child (ren)

Monthly rates effective January 1, 2010
Monthly family rates are based on the age of primary applicant
Under 25 $190 $400 $544 $315
25 - 29 208 436 591 343
30 - 34 210 442 599 347
35 - 39 225 472 640 370
40 - 44 253 533 724 419
45 - 49 307 645 875 507
50 - 54 350 737 999 578
55 - 59 367 771 1047 606
60 - 64 375 789 1071 620
65 and older 380 798 1083 627

Area 4 (Bend/Klamath Falls)

Prevailing Benefits
Age Insured
Only		 Insured &
Spouse		 Insured & Spouse & Child (ren) Insured & Child (ren)

Monthly rates effective January 1, 2010
Monthly family rates are based on the age of primary applicant
Under 25 $288 $608 $824 $477
25 - 29 315 660 896 519
30 - 34 318 668 907 526
35 - 39 340 715 970 561
40 - 44 384 806 1095 634
45 - 49 464 976 1325 767
50 - 54 531 1116 1513 876
55 - 59 556 1168 1585 918
60 - 64 569 1195 1623 939
65 and older 575 1208 1641 950
Low Cost Benefits
Age Insured
Only		 Insured &
Spouse		 Insured & Spouse & Child (ren) Insured & Child (ren)

Monthly rates effective January 1, 2010
Monthly family rates are based on the age of primary applicant
Under 25 $216 $453 $615 $356
25 - 29 234 492 668 386
30 - 34 237 498 677 391
35 - 39 253 533 723 419
40 - 44 286 601 817 472
45 - 49 346 728 988 572
50 - 54 395 832 1129 653
55 - 59 415 871 1182 684
60 - 64 424 891 1209 700
65 and older 429 901 1224 709

Area 5 (Coastal Areas)

Prevailing Benefits
Age Insured
Only		 Insured &
Spouse		 Insured & Spouse & Child (ren) Insured & Child (ren)

Monthly rates effective January 1, 2010
Monthly family rates are based on the age of primary applicant
Under 25 $256 $538 $730 $423
25 - 29 278 584 793 459
30 - 34 281 592 803 465
35 - 39 301 633 859 497
40 - 44 340 715 970 561
45 - 49 412 864 1173 679
50 - 54 470 987 1341 776
55 - 59 492 1034 1403 813
60 - 64 503 1059 1437 832
65 and older 510 1070 1453 841
Low Cost Benefits
Age Insured
Only		 Insured &
Spouse		 Insured & Spouse & Child (ren) Insured & Child (ren)

Monthly rates effective January 1, 2010
Monthly family rates are based on the age of primary applicant
Under 25 $190 $400 $544 $315
25 - 29 208 436 591 343
30 - 34 210 442 599 347
35 - 39 225 472 640 370
40 - 44 253 533 724 419
45 - 49 307 645 875 507
50 - 54 350 737 999 578
55 - 59 367 771 1047 606
60 - 64 375 789 1071 620
65 and older 380 798 1083 627

Area 6 (Eastern Oregon)

Prevailing Benefits
Age Insured
Only		 Insured &
Spouse		 Insured & Spouse & Child (ren) Insured & Child (ren)

Monthly rates effective January 1, 2010
Monthly family rates are based on the age of primary applicant
Under 25 $275 $578 $785 $454
25 - 29 299 629 854 494
30 - 34 303 637 864 500
35 - 39 324 680 924 535
40 - 44 365 768 1043 603
45 - 49 442 930 1262 730
50 - 54 506 1062 1442 835
55 - 59 529 1112 1509 873
60 - 64 542 1138 1545 894
65 and older 548 1151 1562 904
Low Cost Benefits
Age Insured
Only		 Insured &
Spouse		 Insured & Spouse & Child (ren) Insured & Child (ren)

Monthly rates effective January 1, 2010
Monthly family rates are based on the age of primary applicant
Under 25 $205 $431 $585 $339
25 - 29 223 469 637 368
30 - 34 226 475 645 373
35 - 39 241 508 688 398
40 - 44 272 573 777 450
45 - 49 330 693 941 545
50 - 54 377 792 1075 622
55 - 59 394 829 1126 651
60 - 64 404 849 1152 667
65 and older 409 858 1165 674

Area 7 (Medford)

Prevailing Benefits
Age Insured
Only		 Insured &
Spouse		 Insured & Spouse & Child (ren) Insured & Child (ren)

Monthly rates effective January 1, 2010
Monthly family rates are based on the age of primary applicant
Under 25 $303 $636 $863 $499
25 - 29 329 691 939 543
30 - 34 333 700 951 550
35 - 39 356 748 1016 588
40 - 44 402 845 1147 664
45 - 49 486 1023 1388 803
50 - 54 556 1168 1586 918
55 - 59 582 1224 1660 961
60 - 64 596 1252 1699 983
65 and older 602 1266 1719 994
Low Cost Benefits
Age Insured
Only		 Insured &
Spouse		 Insured & Spouse & Child (ren) Insured & Child (ren)

Monthly rates effective January 1, 2010
Monthly family rates are based on the age of primary applicant
Under 25 $226 $474 $644 $372
25 - 29 245 516 700 406
30 - 34 248 523 709 411
35 - 39 265 558 757 438
40 - 44 299 630 856 495
45 - 49 363 762 1035 599
50 - 54 415 871 1182 684
55 - 59 434 913 1238 717
60 - 64 444 934 1267 734
65 and older 449 944 1281 742