Monthly Premiums for COBRA Participants and Dependents
Plan Year January 1, 2013 - December 31, 2013
| HEALTH PLANS | MEMBER | SPOUSE* | CHILD* | CHILDREN* |
|---|---|---|---|---|
| HealthChoice High | $473.27 | $695.60 | $240.28 | $370.72 |
| HealthChoice High Alternative | $473.27 | $695.60 | $240.28 | $370.72 |
| HealthChoice Basic | $411.04 | $605.39 | $211.81 | $326.20 |
| HealthChoice Basic Alternative | $411.04 | $605.39 | $211.81 | $326.20 |
| HealthChoice S-Account | $390.21 | $525.75 | $193.98 | $297.74 |
| HealthChoice USA | $724.41 | $724.41 | $237.92 | $366.89 |
| CommunityCare HMO | $554.70 | $807.98 | $282.52 | $452.02 |
| GlobalHealth HMO | $406.82 | $667.22 | $214.38 | $341.78 |
| DENTAL PLANS | MEMBER | SPOUSE* | CHILD* | CHILDREN* |
| HealthChoice Dental | $32.01 | $32.01 | $27.44 | $68.30 |
| 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 | $41.47 | $41.47 | $36.11 | $91.33 |
| 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) | $9.11 | $6.10 | $5.84 | $13.14 |
*It is OMES EGID'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 12/10/2012