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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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