Department of Personnel Administration  
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  Navigation 		Consolidated Omnibus Budget Reconciliation Act (COBRA)

420. Dental/Vision COBRA Premiums

The following COBRA premiums are effective as of January 1, 2008:

Dental Plans 1 Party 2 Party 3 Party
Delta Premier (Enhanced Plan)
Excluded employees and their dependents		 $50.99 $102.01 $143.97
Delta Premier (Basic Plan)
Rank and File employees		 $48.96 $86.76 $126.16
Delta Premier (Basic Plan)
Dependents of Rank and File employees*		 $41.81 $63.31 $83.23
Delta Preferred Provider (PPO)
Rank and File/Excluded employees and their dependents		 $41.62 $82.20 $124.35
DeltaCare USA
Rank and File/Excluded employees and their dependents		 $17.70 $29.04 $40.17
SafeGuard (Standard)
Rank and File employees and their dependents 		$15.41 $24.97 $34.98
Safeguard (Enhanced)
Excluded employees and their dependents		 $15.08 $25.52 $31.44
 
Vision Plan 1 Party 2 Party 3 Party
Vision Service Plan (VSP) $9.37 $9.37 $9.37

*Dependents of rank and file employees have a lower level of coverage under the Delta Premier - Basic Plan and pay a lower premium for dependent only coverage.

For Bargaining Unit 5 employees, contact CAHP for dental premiums information. Unit 5 employees have vision coverage through Vision Service Plan (VSP) and the vision premiums that are reflected above apply. For Bargaining Unit 6 employees, contact CCPOA for dental and vision premiums information.

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