COBRA — Dental

 
General COBRA Information
 

Delta Dental — Indemnity Plan
 
 

DeltaCare USA — Prepaid Plan
 




Delta Dental PPO — Indemnity Plan
COBRA Rates

Plan Level
Eligible Employee Category
Party Designation
Monthly COBRA Premium (102%)*
Basic Public Safety (R08), Excluded (E99),
Retired Annuitants
Single Person
$ 31.57
Two People
$ 59.64
Three or More
$119.76
Enhanced Level I Teaching Associates (R11), English Language Program Instructors (R13) Single Person
$ 38.41
Two People
$ 72.68
Three or More
$149.82
Enhanced Level II Physicians (R01), Faculty (R03),
CSUEU (R02,05,07,09), Academic Support (R04),
Skilled Crafts (R06), CMA Operating Engineers (R10),
Confidential (C99), Management Personnel Plan (M80), Executives (M98), FERP Annuitants
Single Person
$ 47.55
Two People
$ 89.72
Three or More
$175.27

*Rates are effective January 1, 2015, through December 31, 2015. COBRA premium rates are paid for by the participant. The CSU does not pay any portion of the COBRA premium.

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DeltaCare USA — Prepaid Plan
COBRA Rates

Plan Level
Eligible Employee Category
Party Designation
Monthly COBRA Premium (102%)*
Basic Public Safety (R08),
Excluded (E99), Teaching Associates (R11), English Language Program Instructors (R13), Retired Annuitants
Single Person
$ 20.72
Two People
$ 34.17
Three or More
$ 50.53
Enhanced

Physicians (R01), Faculty (R03),
CSUEU (R02,05,07,09), Academic Support (R04),
Skilled Crafts (R06), CMA Operating Engineers (Unit 10),
Confidential (C99),
Management (M80),
Executives (M98),
FERP Annuitants

Single Person
$ 27.52
Two People
$ 45.43
Three or More
$ 67.19

*Rates are effective January 1, 2015, through December 31, 2015. COBRA premium rates are paid for by the participant. The CSU does not pay any portion of the COBRA premium.

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Last Updated: January 8, 2015


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