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