Monthly COBRA Premiums for Medicare Eligible Members
Plan Year January 1, 2012 - December 31, 2012
| MEDICARE SUPPLEMENT PLANS | ||||
| HealthChoice Employer PDP High Option With Part D | $332.54 per enrolled person | |||
| HealthChoice Employer PDP Low Option With Part D | $273.02 per enrolled person | |||
| HealthChoice High Option Without Part D | $391.01 per enrolled person | |||
| HealthChoice Low Option Without Part D | $330.30 per enrolled person | |||
| UnitedHealthcare Senior Supplement High Option | $398.76 per enrolled person | |||
| UnitedHealthcare Senior Supplement Low Option | $357.63 per enrolled person | |||
| MEDICARE ADVANTAGE PRESCRIPTION DRUG PLANS (MA-PD) | ||||
| CommunityCare Senior | $230.00 per enrolled person | |||
| Generations HealthCare | $191.95 per enrolled person | |||
| UnitedHealthcare Group Medicare Advantage (Formerly Secure Horizons) |
$243.65 per enrolled person | |||
| DENTAL PLANS | MEMBER | SPOUSE* | CHILD* | CHILDREN* |
| HealthChoice Dental | $30.80 | $30.80 | $25.38 | $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 the policy of the Oklahoma State and Education Employees Group Insurance Board 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 retain coverage, one person will always be billed at the primary member rate.
Last Modified on 08/29/2011