COBRA Premium Rates

MEDICAL INSURANCE     

Plan Code

Plan Name

1 Party

2 Party

3 Party

205 BlueShield HMO  $689.63 $1,379.26 $1,793.05
146  BlueShield NetValue Advantage  $589.07 $1,178.14 $1,531.58
056  Kaiser (CA)  $621.53 $1,243.05 $1,615.97
**  Kaiser Out-of-State  $893.99 $1,787.98 $2,324.38
278  PERSCARE  $1,050.16 $2,100.32 $2,730.42
045  PERS Select  $472.38  $944.76  $1,228.19 
222  PERS Choice  $646.74 $1,293.48 $1,681.53

DENTAL INSURANCE     

Plan Code

Plan Name

1 Party

2 Party

3 Party

004  Delta Basic  $30.50 $57.62 $115.71
181  Delta Enhanced I  $37.12 $70.22 $144.76
007  Delta Enhanced II  $45.95 $86.68 $169.35
012  DeltaCare USA Basic  $20.72 $34.18 $50.53
013  DeltaCare USA Enhanced  $27.52 $45.43 $67.19

VISION PLAN     

Plan Code

Plan Name

1 Party

2 Party

3 Party

004  Vision Service Plan (VSP)  $7.65  $7.65  $7.65 

RETIREE VOLUNTARY VISION PLAN     

Plan Code

Plan Name

1 Party

2 Party

3 Party

  Vision Service Plan (VSP)  $6.33  $11.76  $12.62