STATE OF CONNECTICUT
COMPTROLLER
55 ELM STREET
HARTFORD, CONNECTICUT 06106-1775
DEPUTY COMPTROLLER
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STATE OF CONNECTICUT |
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| 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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