Monthly Premiums for COBRA Participants and Dependents
Current Employee and Pre-Medicare Former Employee Rates
Plan Year January 1, 2011 - December 31, 2011
| HEALTH PLANS | MEMBER | SPOUSE* | CHILD* | CHILDREN* |
| HealthChoice High Option | $458.47 | $696.39 | $232.76 | $359.12 |
| HealthChoice Basic | $399.47 | $610.45 | $205.86 | $317.02 |
| HealthChoice S-Account | $390.21 | $573.99 | $193.98 | $297.74 |
| HealthChoice USA | $702.60 | $702.60 | $230.74 | $355.84 |
| CommunityCare Standard HMO | $787.79 | $1,126.51 | $393.88 | $630.22 |
| CommunityCare Alternative HMO | $543.31 | $776.91 | $271.67 | $434.64 |
| GlobalHealth Standard HMO | $373.89 | $613.24 | $196.98 | $314.12 |
| GlobalHealth Alternative HMO | $339.93 | $557.51 | $179.13 | $285.58 |
| PacifiCare Standard HMO | $700.15 | $1,006.68 | $349.82 | $559.84 |
| PacifiCare Alternative HMO | $482.86 | $694.24 | $241.24 | $386.08 |
| DENTAL PLANS | MEMBER | SPOUSE* | CHILD* | CHILDREN* |
| HealthChoice Dental | $30.44 | $30.44 | $25.38 | $65.85 |
| Assurant Freedom Preferred | $29.41 | $29.24 | $21.93 | $58.96 |
| Assurant Heritage Plus with SBA (Prepaid) | $11.97 | $ 9.04 | $ 7.75 | $15.50 |
| Assurant Heritage Secure (Prepaid) | $ 7.34 | $ 6.10 | $ 5.30 | $10.59 |
| CIGNA Dental Care Plan (Prepaid) | $ 9.45 | $ 6.18 | $ 7.22 | $15.63 |
| Delta Dental PPO | $31.76 | $31.76 | $27.64 | $69.93 |
| Delta Dental Premier | $36.23 | $36.23 | $31.52 | $79.76 |
| Delta Dental PPO – Choice | $14.22 | $32.27 | $32.54 | $78.97 |
| VISION PLANS | MEMBER | SPOUSE* | CHILD* | CHILDREN* |
| Humana/CompBenefits VisionCare Plan | $6.90 | $5.16 | $3.64 | $ 4.55 |
| Primary Vision Care Services (PVCS) | $9.44 | $8.16 | $8.67 | $10.97 |
| Superior Vision Services | $7.12 | $7.04 | $6.73 | $ 6.73 |
| UnitedHealthcare Vision | $8.34 | $5.91 | $4.68 | $ 7.12 |
| Vision Service Plan (VSP) | $8.94 | $5.99 | $5.73 | $12.89 |
*It is OSEEGIB’s policy that for any benefit continued under COBRA, one person must always pay the primary member premium. In cases where a spouse, child, or children are insured under a particular benefit and the member did not keep coverage, one person will always be billed at the primary member rate.
Last Modified on 11/21/2011