STATE EMPLOYEES
RETIREMENT COMMISSION
COMPTROLLER'S SEAL STATE OF CONNECTICUT 55 ELM STREET
HARTFORD, CONNECTICUT
06106-1775
TELEPHONE: (860) 702-3480
TELEFAX:(860) 702-3489
MEDICAL EXAMINING BOARD
for DISABILITY RETIREMENT
HEALTH CARE COST
CONTAINMENT COMMITTEE
STATE OF CONNECTICUT
RETIREMENT AND BENEFIT SERVICES DIVISION
OFFICE OF THE STATE COMPTROLLER

COMPTROLLER'S MEMORANDUM NO. 2000-25

May 10, 2000

TO THE HEADS OF ALL STATE AGENCIES

ATTENTION: Personnel and Payroll Officers
SUBJECT: 2000- 2001 COBRA Continuation Coverage Rates

The following MONTHLY rates for COBRA continuation coverage are effective July 1, 2000:

Plan Individual One Dependent Family
Blue Cross State Preferred $347.65 $764.83 $938.64
Blue Cross Out of Area $339.12 $746.06 $915.62
State BlueCare POS $244.36 $537.59 $659.78
State BlueCare POE $231.89 $510.14 $626.08
State BlueCare POE Plus $221.44 $487.17 $597.89
PHS Charter POS $226.05 $497.35 $610.37
PHS Charter HMO $219.75 $483.46 $593.31
PHS Passport HMO $215.33 $473.75 $581.41
MedSpan P.O.S $230.53 $507.18 $622.46
MedSpan P.O.E $207.40 $456.27 $559.97
ConnectiCare $192.38 $423.24 $519.44

Blue Cross Indemnity Dental A & C

$22.95 $70.10 $70.10

Blue Cross Indemnity Dental A, B & C

$29.06 $81.52 $81.52

CIGNA Dental

$15.65 $34.43 $42.25
All Rates include a 2% administrative fee

The above rates are unchanged from those in effect from July 1, 1999 - June 30, 2000.

Form CO-1022 (revised 5/99) "AGroup 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. This form is not being revised at this time. If a COBRA eligible person is enrolled in ConnectiCare, please use the Kaiser Permanente line on the form, and write in ConnectiCare.

It is important that both sides of the form are given to the employee/beneficiary. Previous versions of this form should be discarded. Form CO-1022-1 ACIGNA 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.

Questions concerning this matter should be directed to the Retirement and Benefit Services Division, Health Care Analysis Unit, at (860) 702-3535.

 

Very truly yours,

Nancy Wyman
State Comptroller

NW/SW/WM

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