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
$30.95
Double
$58.47
Multiple
$117.41
Enhanced Level I Teaching Associates Only (R11),
English Language Program Instructors (R13)
Single
$37.66
Double
$71.25
Multiple
$146.88
Enhanced Level II Physicians (R01),
Faculty (R03),
CSUEU (R02, 05, 07, 09),
Academic Support (R04), Skilled Crafts (R06), Operating Engineers (R10), Confidential (C99),
Management (M80), Executives (M98),
FERP Annuitants
Single
$46.62
Double
$87.96
Multiple
$171.83

*Rates are effective January 1, 2015, through December 31, 2015, and are paid by the CSU.

DeltaCare USA — Prepaid Plan

Plan Level
Eligible Employee Category
Party Designation
Monthly Premium*
Basic Public Safety (R08), Teaching Associates Only (R11), English Language Program Instructors (R13),
Retired Annuitants
Single
$20.31
Double
$33.50
Multiple
$49.54
Enhanced Physicians (R01),
Faculty(R03),
CSUEU (R02, 05, 07, 09),
Academic Support (R04), Skilled Crafts (R06), Operating Engineers (R10), Confidential (C99), Management (M80),
Executives (M98),
FERP Annuitants
Single
$26.98
Double
$44.54
Multiple
$65.87

*Rates are effective January 1, 2015, through December 31, 2015, and are paid by the CSU.

   

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Last Updated: November 25, 2014


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