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Dental plan premiums With medical coverage Managed Care Plans Preferred Provider Organization (PPO) Plans DeltaCare Willamette Uniform Dental Plan Dental Group Monthly premiums Subscriber only $41.50 $48.87 $48.92 Subscriber & spouse $83.00 $97.74 $97.84 Subscriber & children $83.00 $97.74 $97.84 Subscriber, spouse, & children $124.50 $146.61 $146.76 Dental plan premiums Dental coverage only Managed Care Plans Preferred Provider Organization (PPO) Plans DeltaCare Willamette Uniform Dental Plan Dental Group Monthly premiums Subscriber only $47.46 $54.83 $54.88 Subscriber & spouse $88.96 $103.70 2

Employer Group Ended Participation (2024) - Page 2 Employer Group Ended Participation (2024) Page 1 Page 3