Premium/Rates — COBRA

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COBRA premium rates are paid for by the participant. The CSU does not pay any portion of the COBRA premium. Rates are calculated at 102%.

CalPERS COBRA Group Continuation Coverage
Medical Rates for January 1, 2014 to December 31, 2014

Plan Code
Plan Name
Monthly COBRA Premium
Emp.
EE + 1
EE 2 +
181/195 Anthem Select HMO
$634.98
$1,269.96
$1,650.95
180/194 Anthem Traditional HMO
$683.77
$1,367.53
$1,777.80
141/205 Blue Shield Access+
$668.12
$1,336.24
$1,737.11
042/146 Blue Shield NetValue
$587.30
$1,174.59
$1,526.97
191 Blue Shield Access+ EPO
$668.12
$1,336.24
$1,737.11
184 Health Net Salud y Mas
$526.19
$1,052.37
$1,368.09
185 Health Net SmartCare
$645.03
$1,290.06
$1,677.07
056 Kaiser
$674.84
$1,349.68
$1,754.59
-- Kaiser Out-of-State*
$935.54
$1,871.09
$2,432.41
278 PERSCARE
$712.70
$1,425.41
$1,853.03
222 PERS Choice
$656.40
$1,312.80
$1,706.64
045 PERS Select
$606.85
$1,213.70
$1,577.81
207 PORAC**
$646.68
$1,209.72
$1,537.14
189 Sharp
$573.38
$1,146.77
$1,490.79
187 UnitedHealthCare
$665.12
$1,330.24
$1,729.32

*These premiums cover all regions of Kaiser out-of-state.

**Restricted to employees in Unit 8, State University Police Association (SUPA).


Delta Dental — Indemnity Plan
COBRA Rates For 2014

Plan Level
Eligible Employee Category
Party Designation
Monthly COBRA Premium (102%)*
Basic Public Safety (R08),
Excluded (E99),except SFSU Headstart E99 employees,
Retired Annuitants
Single Person
$32.03
Two People
$60.50
Three or More
$121.49
Enhanced Level I Teaching Associates Only (R11),
CMA Operating Engineers (R10),
Head Start Employees (R12 & SFSU Headstart E99), (R13)
Single Person
$38.97
Two People
$73.73
Three or More
$152.00
Enhanced Level II Physicians (R01),
Faculty (R03),
CSUEU (R02,05,07,09),
Academic Support (R04),
Skilled Crafts (R06) Confidential (C99),
Management Personnel Plan (M80),
Executives (M98),
FERP Annuitants
Single Person
$48.26
Two People
$91.01
Three or More
$177.82

*COBRA premium rates are paid for by the participant. The CSU does not pay any portion of the COBRA premium. Rates are effective through December 31, 2014.

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DeltaCare USA— Prepaid Plan
COBRA Rates For 2014

Plan Level
Eligible Employee Category
Party Designation
Monthly COBRA Premium (102%)*
Basic Public Safety (R08),
CMA Operating Engineers (R10),
Teaching Associates Only (R12), (R13)
(Excluded) E99, including SFSU Headstart (E99),
Retired Annuitants
Single Person
$20.72
Two People
$34.17
Three or More
$50.53
Enhanced Faculty (R03),
CSUEU (R02,05,07,09),
Academic Support (R04),
Skilled Crafts (R06),
Confidential (C99),
Management (MPP),
Executives (M98)
FERP Annuitants
Single Person
$27.52
Two People
$45.43
Three or More
$67.19

*COBRA premium rates are paid for by the participant. The CSU does not pay any portion of the COBRA premium. Rates are effective through December 31, 2014.

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Vision Service Plan (VSP)
COBRA Rates For 2014

Plan Level
Eligible Employee Category

Party Designation

Monthly COBRA Premium*
Basic All Employee Categories including FERP Annuitants
Single Person or More
$ 7.65
 
Basic Retired Annuitants Single Person
$6.33
Two People
$11.76
Three or More
$12.62

*COBRA premium rates are paid for by the participant. The CSU does not pay any portion of the COBRA premium. Please note, vision COBRA Rates are effective through December 31, 2014.

 

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Content Contact:
Benefits Insider
(562) 951-4411
Technical Contact:
webmaster@calstate.edu

Last Updated: December 19, 2012


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