COBRA Premiums on Health, Dental, and Vision

Eligibility and Length of Coverage

18- Month Coverage

The following events qualify an employee and/or family member(s) enrolled in Health, Dental and Vision for up to 18 months of continued coverage:

Termination of employment for reasons other than gross misconduct. Termination includes voluntary or involuntary termination if there is a loss of coverage. Termination also includes retirement.

29- Month Disability Extension

Certain qualified individuals can extend COBRA continuation coverage due to a disability. If a qualified beneficiary is determined by the Social Security Administration (pursuant to Title II or Title XVI of the Social Security Administration) to have been disabled on the date of termination or reduction in hours, or within the first 60 days of continuation coverage due to such event, continuation coverage may be provided for up to 29 months, instead of 18 months. This extension does not apply to HCRA enrollment.

A disability extension may be elected independently for each qualified beneficiary (the disabled person or any family member). To qualify for the additional 11 months of coverage, the carrier must be notified within 60 days of the date Social Security made the disability determination and before the end of the initial 18- month period. If Social Security makes a determination of disability prior to the date employment ends or hours are reduced, then CSU must be notified within 60 days of the date employment ends or hours are reduced. CSU (or the carrier) must be notified within 30 days if the Social Security disability determination expires.

Individuals who qualify for the disability extension, but who are not part of the family unit that includes the disabled person, may continue to be charged 102% of the applicable group rate. (This situation might occur, for example, if there is a divorce or legal separation, or if the disabled person does not elect to continue coverage for the additional 11- month period.) Individuals who qualify for the disability extension, who are part of the family unit that include the disabled person, may be charged up to 150% of the applicable group rate for the 19th through the 29th month. The cost of coverage during the 19th through 29th month extension period will be 150% of the monthly group cost. If a second qualifying event occurs during the disability extension, the 30th through 36th month should be charged at 102%

36- Month

The following events qualify eligible qualified beneficiaries enrolled in the Health, Dental, and/or Vision plans for continued coverage for up to a maximum of 36 months:

  1. Death of covered employee/retiree;
  2. Divorce or legal separation of  a spouse (or dissolution of domestic partnership) from a covered employee/retiree;
  3. Termination of a child’s dependent status (e.g., dependent reaches age 26);
  4. Covered employee/retiree’s entitlement to Medicare (Health Only); or
  5. Moving out of the household (Health Only).

Health Plans Monthly Premium Rates (2021)

This table shows the cost of the monthly COBRA premium based on 1 party, 2 party, and 3 party coverage for each of the different plans offered

Dental Plans Monthly Premium Rates (2021)

Table showing Dental plans and the monthly COBRA Premium for 1 party, 2 parties, and 3 or more parties.

Table showing the different prices for DeltaCare that is only available to California Residents

Vision Plan Monthly Premium Rates (2021)

Vision Cobra Rates by number of persons covered.


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Service ID: 50291
Tue 5/25/21 3:54 PM
Wed 5/26/21 1:32 PM