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. 2003-20

June 6, 2003

TO THE HEADS OF ALL STATE AGENCIES

ATTENTION: Personnel and Payroll Officers, Chief Administrative Officers, Business Managers
SUBJECT: 2003-2004 COBRA Continuation Coverage Rates and Procedural Change

The following MONTHLY rates for COBRA continuation coverage are effective July 1,2003:

 

PLAN INDIVIDUAL SUBSCRIBER & ONE DEPENDENT FAMILY
Blue Cross State Preferred $524.27 $1,153.40 $1,415.53
Blue Cross Out of Area $511.42 $1,125.12 $1,380.83
State BlueCare POS $368.52 $810.74 $994.99
State BlueCare POE $349.71 $769.36 $944.21
State BlueCare POE Plus $333.96 $734.72 $901.69
Health Net Charter POS $348.61 $766.93 $941.24
Health Net Charter HMO $338.88 $745.55 $914.99
Health Net Passport HMO $332.08 $730.58 $896.62
ConnectiCare POS Open Access $333.88 $734.53 $901.47
ConnectiCare HMO Open Access $311.48 $685.25 $840.99
ConnectiCare HMO Personal Care Plan $279.43 $614.74 $754.46
Anthem Blue Cross Indemnity Dental A & C $28.47 $86.97 $86.97
Anthem Blue Cross Indemnity Dental A , B, & C $36.04 $101.09 $101.09
CIGNA Dental $18.85 $41.47 $50.89

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 medical and dental plans. 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. Your agency business office can order CO-1022A through the state's forms management program, Vanguard Direct, (800) 369-0570. 

Effective July 1, 2003, Anthem's COBRA Continuation Unit will begin administering COBRA for CIGNA Dental. Therefore, discontinue use of CO-1022-1. Form CO-1022A should be used for all COBRA events. For CIGNA Dental, in Section I, Present Coverage, under plan, print or type CIGNA Dental and the monthly charge. 

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

Very truly yours,

Nancy Wyman
State Comptroller

NW/SW/wpm  

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