COMPTROLLER'S SEAL STATE OF CONNECTICUT

STATE OF CONNECTICUT

NANCY WYMAN
COMPTROLLER

OFFICE OF THE STATE COMPTROLLER
55 ELM STREET
HARTFORD, CONNECTICUT 06106-1775

MARK OJAKIAN
DEPUTY COMPTROLLER

COMPTROLLER'S MEMORANDUM NO. 2001-30

May 4, 2001

TO THE HEADS OF ALL STATE AGENCIES

ATTENTION: Personnel and Payroll Officers
SUBJECT: 2001- 2002 COBRA Continuation Coverage Rates

The following MONTHLY rates for COBRA continuation coverage are effective July1,2001:

Plan Individual One
Dependent
Family
Blue Cross State Preferred $399.44 $878.77 $1,078.49
Blue Cross Out of Area $389.65 $857.23 $1,052.06
State BlueCare POS $280.78 $617.71 $758.09
State BlueCare POE $266.43 $586.16 $719.37
State BlueCare POE Plus $254.44 $559.77 $686.99
Health Net Charter POS $290.48 $639.05 $784.28
Health Net Charter HMO $282.38 $621.23 $762.42
Health Net Passport HMO $276.71 $608.75 $747.11
ConnectiCare POS Open Access $273.98 $602.76 $739.75
ConnectiCare HMO Open Access $255.60 $562.32 $690.12
ConnectiCare HMO Personal Care Plan $229.31 $504.47 $619.13
Anthem Blue Cross Indemnity Dental A & C $25.48 $77.83 $77.83
Anthem Blue Cross Indemnity Dental A , B, & C $32.25 $90.47 $90.47
CIGNA Dental $16.27 $35.80 $43.94

All Rates include a 2% Administrative fee

Form CO-1022A (revised 5/2001) Group Health Insurance Continuation Coverage Election, is to be used to notify employees and/or beneficiaries of their right to continue health benefits for all plans except CIGNA Dental. It is important that both sides of the form are given to the employee/beneficiary. Do not use previous versions of this form; they should be discarded. Form CO-1022-1 CIGNA Dental COBRA Application, (revised 11/97) is to be used to notify those enrolled in CIGNA Dental. Your agency business office can order both forms through the state's forms management program, Vanguard Direct, 1- (800) 369-0570. 

Payroll and personnel office staff with questions concerning this matter should call the Retirement and Benefit Services Division, Health Care Analysis Unit, at (860) 702-3535. 

Very truly yours, 

Nancy Wyman 

State Comptroller

 NW/NM/WPM

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