Monthly COBRA Rates

The following rates are for September 1, 2021 through August 31, 2022

Personal Choice (PPO)

PlanCostCOBRA Admin
Fee - 2%
Monthly Total
Employee/Single $704.53 $14.09 $718.62
Employee Plus 1 $1,430.92 $28.62 $1,459.54
Employee Plus 2 or more $2,143.66 $42.87 $2,186.53

Keystone POS (HMO)

PlanCostCOBRA Admin
Fee - 2%
Monthly Total
Employee/Single $ 598.70 $ 11.97 $ 610.67
Employee Plus 1 $ 1,140.26 $ 22.81 $ 1,163.07
Employee Plus 2 or more $ 1,748.80 $ 34.98 $ 1,783.78

CVS Caremark (Prescription)

PlanCostCOBRA Admin
Fee - 2%
Monthly Total
Employee/Single $ 221.82 $ 4.44 $ 226.26
Employee Plus 1 $ 625.52 $ 12.51 $ 638.03
Employee Plus 2 or more $ 625.52 $ 12.51 $ 638.03

Delta PPO/Preferred (Dental)

PlanCostCOBRA Admin
Fee - 2%
Monthly Total
Employee/Single $ 38.06 $ 0.76 $ 38.82
Family $ 100.47 $ 2.01 $ 102.48

Delta Care (Dental)

PlanCostCOBRA Admin
Fee - 2%
Monthly Total
Employee/Single $ 18.08 $ 0.36 $ 18.44
Single and One $ 30.98 $ 0.62 $ 31.60
Family $ 47.02 $ 0.94 $ 47.96

United Concordia/Concordia Plus (Dental)

PlanCostCOBRA Admin
Fee - 2%
Monthly Total
Employee/Single $ 19.43 $ 0.39 $ 19.82
Employee & Spouse or Child/Children $ 36.44 $ 0.73 $ 37.17
Family (including child(ren) $ 57.86 $ 1.16 $ 59.02