STATE OF CONNECTICUT
COMPTROLLER
OFFICE OF
THE STATE 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 |
MARK OJAKIAN DEPUTY COMPTROLLER |
COMPTROLLER'S MEMORANDUM NO. 2001-30
May 4, 2001
TO THE HEADS OF ALL STATE AGENCIES
| ATTENTION: | Personnel and Payroll Officers |
| SUBJECT: | 2001- 2002 COBRA Continuation Coverage Rates |
The following MONTHLY rates for COBRA continuation coverage are effective July1,2001:
| Plan | Individual |
One Dependent |
Family |
|---|---|---|---|
| Blue Cross State Preferred | $399.44 | $878.77 | $1,078.49 |
| Blue Cross Out of Area | $389.65 | $857.23 | $1,052.06 |
| State BlueCare POS | $280.78 | $617.71 | $758.09 |
| State BlueCare POE | $266.43 | $586.16 | $719.37 |
| State BlueCare POE Plus | $254.44 | $559.77 | $686.99 |
| Health Net Charter POS | $290.48 | $639.05 | $784.28 |
| Health Net Charter HMO | $282.38 | $621.23 | $762.42 |
| Health Net Passport HMO | $276.71 | $608.75 | $747.11 |
| ConnectiCare POS Open Access | $273.98 | $602.76 | $739.75 |
| ConnectiCare HMO Open Access | $255.60 | $562.32 | $690.12 |
| ConnectiCare HMO Personal Care Plan | $229.31 | $504.47 | $619.13 |
| Anthem Blue Cross Indemnity Dental A & C | $25.48 | $77.83 | $77.83 |
| Anthem Blue Cross Indemnity Dental A , B, & C | $32.25 | $90.47 | $90.47 |
| CIGNA Dental | $16.27 | $35.80 | $43.94 |
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 all plans except CIGNA Dental. 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. Form CO-1022-1 CIGNA 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.
Payroll and personnel office staff with questions concerning this matter should call the Retirement and Benefit Services Division, Health Care Analysis Unit, at (860) 702-3535.
Very truly yours,
Nancy Wyman
State Comptroller
NW/NM/WPM
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