|
Delta Dental — Indemnity Plan
COBRA Rates
|
Plan Level
|
Eligible Employee
Category
|
Party Designation
|
Monthly COBRA Premium
(102%)*
|
| Basic |
Public Safety (R08), Excluded (E99, except Teaching
Associates),
Retired Annuitants |
Single |
$ 27.49
|
| Double |
$ 51.93
|
| Multiple |
$104.28
|
| Enhanced Level I |
Teaching Associates (R11),
CMA Operating Engineers (R10) |
Single |
$ 33.46
|
| Double |
$ 63.29
|
| Multiple |
$130.45
|
| 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 |
Single |
$ 41.40
|
| Double |
$ 78.11
|
| Multiple |
$152.61
|
*Rates are effective through December 31, 2007. COBRA
premium rates are paid for by the participant. The CSU does not
pay any portion of the COBRA premium.
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PMI DeltaCare — Prepaid Plan
COBRA Rates
|
Plan Level
|
Eligible Employee
Category
|
Party Designation
|
Monthly COBRA Premium
(102%)*
|
| Basic |
Public Safety
(R08), CMA Operating Engineers (R10),
Excluded (E99), Teaching Associates
(R11), Retired Annuitants |
Single |
$ 17.88
|
| Double |
$ 29.50
|
| Multiple |
$ 43.61
|
| Enhanced |
Faculty
(R03),
CSUEU (R02,05,07,09), Academic Support (R04),
Skilled Crafts (R06),
Confidential (C99),
Management
(M80),
Executives (M98),
FERP |
Single |
$ 23.76
|
| Double |
$ 39.22
|
| Multiple |
$ 57.99
|
*Rates are effective through December 31, 2007. COBRA
premium rates are paid for by the participant. The CSU does not
pay any portion of the COBRA premium.
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|
