Premiums/Rates — Dental

Delta Dental PPO — Indemnity Plan

Plan Level
Eligible Employee Category
Party Designation
Monthly Premium*
Basic Public Safety (R08), Excluded (E99, except class 1237),
Retired Annuitants
Single
$29.90
Double
$56.49
Multiple
$113.44
Enhanced Level I Excluded (E99, class 1237 only), Operating Engineers (R10), Teaching Associates Only (R11),
Head Start Employees (SFSU) (R12)
Single
$36.39
Double
$68.84
Multiple
$141.92
Enhanced Level II Physicians (R01),
Faculty (R03),
CSUEU (R02, 05, 07, 09),
Academic Support (R04), Skilled Crafts (R06), Confidential (C99),
Management (M80), Executives (M98),
FERP Annuitants
Single
$45.05
Double
$84.98
Multiple
$166.03

*Rates are effective January 1, 2013, through December 31, 2013, and are paid by the CSU.

DeltaCare USA — Prepaid Plan

Plan Level
Eligible Employee Category
Party Designation
Monthly Premium*
Basic Public Safety (R08), Operating Engineers (R10), Teaching Associates Only (R11),Head Start Employees (SFSU) (R12),
Excluded (E99),
Retired Annuitants
Single
$20.31
Double
$33.51
Multiple
$49.54
Enhanced Physicians (R01),
Faculty(R03),
CSUEU (R02, 05, 07, 09),
Academic Support (R04), Skilled Crafts (R06), Confidential (C99), Management (M80),
Executives (M98),
FERP Annuitants
Single
$26.98
Double
$44.54
Multiple
$65.87

*Rates are effective January 1, 2013, through December 31, 2013, and are paid by the CSU.

   

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Last Updated: January 24 , 2013


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