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), except SFSU Headstart E99,
Retired Annuitants
Single Person
$ 32.37
Two People
$ 61.16
Three or More
$122.81
Enhanced Level I Teaching Associates (R11), CMA Operating Engineers (R10), SFSU Headstart Employees (Unit 12 & SFSU Headstart E99) Single Person
$ 39.40
Two People
$ 74.53
Three or More
$153.64
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
$ 48.77
Two People
$ 92.00
Three or More
$179.74

*Rates are effective January 1, 2011, through December 31, 2011. 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), CMA Operating Engineers (R10),
Excluded (E99) including SFSU Headstart (E99), Teaching Associates (R11), Retired Annuitants
Single Person
$ 20.12
Two People
$ 33.19
Three or More
$ 49.07
Enhanced Faculty (R03),
CSUEU (R02,05,07,09), Academic Support (R04),
Skilled Crafts (R06),
Confidential (C99),
Management (M80),
Executives (M98),
FERP Annuitants
Single Person
$ 26.72
Two People
$ 44.13
Three or More
$ 65.25

*Rates are effective January 1, 2011, through December 31, 2011. 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: February 24, 2011


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