 |
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.
|
