Section 400
- 401. General Information
- 402. Qualified Beneficiary
- 403. Initial General COBRA Notice
- 404. COBRA Qualifying Events
- 405. Retiree Benefit Plan Alternate Coverage
- 406. Leaves of Absence
- 407. Loss of Group Coverage in Anticipation of a Qualifying Event
- 408. COBRA Election Notice and Election Form
- 409. COBRA Qualifying Event Notification Responsibilities
- 410. Notice of Unavailability of Continuation Coverage
- 411. Election Period
- 412. Length of COBRA Coverage
- 413. COBRA Premiums
- 414. Gross Misconduct
- 415. Noncompliance Penalties and Fines
- 416. Open Enrollment Period
- 417. COBRA in Retirement
- 418. Loss of COBRA Continuation Coverage
- 419. Completion of COBRA Enrollment Forms
- 420. Dental/Vision COBRA Premiums
- 421. Insurance Plan Addresses
- View all Section 400
Attachments
- A - Sample Initial General COBRA Notice
- B - Sample COBRA Election Notice
- C - Sample COBRA Continuation Election Form
- D - Sample Notice of Unavailability of Continuation Coverage
- E - Initial General COBRA Notice Log
- F - COBRA Election Notice Log
- G - Monthly COBRA Status Report
- H - COBRA Calendar
BAM
Benefits Administration Manual
Consolidated Omnibus Budget Reconciliation Act (COBRA)
420. Dental/Vision COBRA Premiums
| COBRA Premiums Effective as of January 1, 2012 | |||
|---|---|---|---|
| Benefit | COBRA Premium for | ||
| Employee Only | Employee & 1 Dep. | Employee & 2+ Dep. | |
| Dental Plans | |||
| Delta Dental Premier Enhanced Plan Excluded employees and their dependents |
$57.68 | $115.80 | $163.60 |
| Delta Dental Premier Basic Rank and file employees |
$55.36 | $98.41 | $143.29 |
| Delta Dental Premier Basic Dependents of rank and file employees* |
$47.22 | $71.72 | $94.39 |
| Delta Dental Preferred Provider Option Rank and file and excluded employees and their dependents |
$47.01 | $93.22 | $141.23 |
| DeltaCare USA Rank and file and excluded employees and their dependents |
$18.07 | $29.65 | $41.01 |
| SafeGuard Standard Rank and file employees and their dependents |
$16.91 | $27.40 | $38.37 |
| SafeGuard Enhanced Excluded employees and their dependents |
$17.26 | $29.20 | $35.98 |
| Premier Access Excluded employees and their dependents |
$16.96 | $27.48 | $38.48 |
| Western Dental Excluded employees and their dependents |
$15.01 | $24.78 | $35.15 |
| Vision Plans | |||
| Vision Service Plan (VSP) | $8.81 | $8.81 | $8.81 |
*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.
Updated December 28, 2011 at 1:28 PM.