 |
(NOTE: On-line documents are in Portable Document Format (PDF) and
require
Adobe Acrobat Reader to view, unless otherwise noted.)
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, 2013 to December 31, 2013
|
Plan Code |
Plan
Name |
Monthly COBRA Premium |
|
Emp. |
EE + 1 |
EE 2 + |
| 205 |
Blue Shield HMO |
$689.63 |
$1,379.26 |
$1,793.05 |
| 141 |
Blue Shield Advantage |
$689.63 |
$1,379.26 |
$1,793.05 |
| 042 |
Blue Shield NetValue |
$589.07 |
$1,178.14 |
$1,531.58 |
| 146 |
Blue Shield NetValue Advantage |
$589.07 |
$1,178.14 |
$1,531.58 |
| 056 |
Kaiser |
$621.53 |
$1,243.05 |
$1,615.97 |
| -- |
Kaiser Out-of-State* |
$893.99 |
$1,787.98 |
$2,324.38 |
| 278 |
PERSCARE |
$1,050.16 |
$2,100.32 |
$2,730.42 |
| 222 |
PERS Choice |
$646.74 |
$1,293.48 |
$1,681.53 |
| 045 |
PERS Select |
$472.38 |
$944.76 |
$1,228.19 |
| 207 |
PORAC** |
$592.62 |
$1,109.76 |
$1,409.64 |
*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 2013
|
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 |
$30.50 |
| Two People |
$57.62 |
| Three or More |
$115.71 |
| Enhanced Level I |
Teaching Associates Only (R11),
CMA Operating Engineers (R10),
Head Start Employees (R12 & SFSU Headstart E99) |
Single Person |
$37.12 |
| Two People |
$70.22 |
| Three or More |
$144.76 |
| 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 |
$45.95 |
| Two People |
$86.68 |
| Three or More |
$169.35 |
*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, 2013.
back to top
DeltaCare USA— Prepaid Plan
COBRA Rates For 2013
|
Plan Level |
Eligible Employee
Category |
Party Designation |
Monthly COBRA Premium
(102%)* |
| Basic |
Public Safety
(R08),
CMA Operating Engineers (R10),
Teaching Associates Only (R12),
(Excluded) E99, including SFSU Headstart (E99),
Retired Annuitants |
Single Person |
$20.72 |
| Two People |
$34.18 |
| 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, 2013.
back to top
Vision Service Plan (VSP)
COBRA Rates For 2013
|
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, 2013.
back to top
|
