Benefits Administration Manual

Consolidated Omnibus Budget Reconciliation Act (COBRA)

421. Insurance Plan Addresses and Phone Numbers

Send Enrollment forms and premium payments to the following addresses:

 

Delta Dental Plans

For Delta Premier and Delta Preferred Provider (PPO) enrollees, send the STD. 692 and premium payments to:

Wolfpack Insurance Services, Inc.

P.O. Box 833

Belmont, CA 94002-0833

Attn: COBRA - State of California

1-800-296-0192

You may also fax the STD. 692 to (650) 591-4022

 

Pre-Paid Dental Plans

For DeltaCare USA enrollees, send the STD. 692 and premium payments to:

Wolfpack Insurance Services, Inc.

P.O. Box 833

Belmont, CA 94002-0833

Attn: COBRA - State of California

1-800-296-0192

You may also fax the STD. 692 to (650) 591-4022

SafeGuard

P.O. Box 30910

Laguna Hills, CA 92654-0910

Attn: COBRA UNIT

Billing and Eligibility

1-800-880-1800

Premier Access

8890 Cal Center Drive

Sacramento, CA 95826

Attn: COBRA UNIT

1-888-534-3466

Western Dental

530 South Main Street, 6^th Floor

Orange, CA 92868

Attn: COBRA UNIT

1-866-859-7525

 

Union Trust Dental Plans

Unit 6

CCPOA Benefit Trust Fund

2515 Venture Oaks Way, Suite 200

Sacramento, CA 95833

1-800-468-6486

Unit 5 (Dental enrollments only)

CAHP Dental Trust

2030 V Street

Sacramento, CA 95818

1-800-734-2247

 

Vision Plan

VSP

Attn: COBRA UNIT - Mailstop 229

P.O. Box 997100

Sacramento, CA 95899-7100

You may also fax the STD. 700 to (916) 463-9031 Ext.4636

1-800-852-7600

Updated February 14, 2011 at 4:20 PM.