COBRA Premium Rates
MEDICAL INSURANCE |
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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 |
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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 |
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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 |
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Plan Code |
Plan Name |
1 Party |
2 Party |
3 Party |
|---|---|---|---|---|
| Vision Service Plan (VSP) | $6.33 | $11.76 | $12.62 | |