Monthly Premiums for COBRA Participants and Dependents
Current Employee and Pre-Medicare Former Employee Rates
Plan Year January 1, 2012 - December 31, 2012
| HEALTH PLANS | MEMBER | SPOUSE* | CHILD* | CHILDREN* |
| HealthChoice High | $458.47 | $696.39 | $232.76 | $359.12 |
| HealthChoice High Alternative | $458.47 | $696.39 | $232.76 | $359.12 |
| HealthChoice Basic | $399.47 | $610.45 | $205.86 | $317.02 |
| HealthChoice Basic Alternative | $399.47 | $610.45 | $205.86 | $317.02 |
| HealthChoice S-Account | $390.21 | $553.37 | $193.98 | $297.74 |
| HealthChoice USA | $702.60 | $702.60 | $230.74 | $355.84 |
| CommunityCare Standard HMO | $819.28 | $1,171.55 | $409.63 | $655.41 |
| CommunityCare Alternative HMO | $565.04 | $807.98 | $282.52 | $452.02 |
| CommunityCare Wellness Alternative Plus HMO | $539.54 | $807.98 | $282.52 | $452.02 |
| GlobalHealth Standard HMO | $410.90 | $673.93 | $216.52 | $345.21 |
| GlobalHealth Alternative HMO | $373.56 | $612.69 | $196.86 | $313.85 |
| GlobalHealth Wellness Alternative Plus HMO | $348.06 | $612.69 | $196.86 | $313.85 |
| UnitedHealthcare Standard HMO | $784.18 | $1,127.47 | $391.80 | $627.01 |
| UnitedHealthcare Alternative HMO | $540.80 | $777.57 | $270.20 | $432.42 |
| UnitedHealthcare Wellness Alternative Plus HMO | $515.30 | $777.57 | $270.20 | $432.42 |
| DENTAL PLANS | MEMBER | SPOUSE* | CHILD* | CHILDREN* |
| HealthChoice Dental | $30.80 | $30.80 | $25.68 | $66.63 |
| 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 | $34.31 | $34.29 | $29.85 | $75.52 |
| Delta Dental Premier | $39.13 | $39.13 | $34.05 | $86.15 |
| Delta Dental PPO – Choice | $15.36 | $34.86 | $35.13 | $85.27 |
| 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 | $7.28 | $7.24 | $6.85 | $ 14.08 |
| 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