SDSURF Human Resources

COBRA Rates

Plan	One Party	Two Party	Family
Health Net HMO	$545.27	$1,172.29	$1,608.50
Health Net PPO	$853.58	$1,835.08	$2,517.89
Vision Service Plan	$6.32	$9.26	$16.32
Kaiser Permanente	$382.93	$765.86	$1,083.63
United Concordia DHMO Dental	$13.06	$24.07	$38.25
United Concordia PPO Dental	$45.27	$88.76	$151.92
Employee Assistance Program	$2.20	$2.20	$2.20

In most situations, when you or a family member loses SDSURF paid group coverage, a COBRA election notice will automatically be sent to you.
The monthly cost for the first 18 months is 102% of the applicable monthly premium.
If you become eligible for COBRA you may be eligible for an extension of health coverage only beyond the initial 18 months. The monthly cost during the extension is 110% of the applicable monthly premium.
Within 60 days of your COBRA coverage, if you are disabled as determined by the Social Security Administration, you may qualify for an extension of coverage beyond the initial 18 months. The monthly cost for months 19 through 29 is up to 150% of the applicable monthly premium.
Monthly rates are subject to change every January 1.
If you are enrolled in Kaiser or Health Net HMO and move outside the service area but within the U.S., you will be enrolled in Health Net's PPO plan, and the PPO rates will apply to you.
Vision Service Plan enrollment is limited to those who are enrolled in one of the Health Net plan options.
If you move outside of the U.S., COBRA coverage will not be available to you. Contact HR at benefits@foundation.sdsu.edu for alternate coverage options.
For more information on COBRA, including information on COBRA's election and payment deadlines, visit SDSU Research Foundation's website at: http://www.foundation.sdsu.edu/hr/benefits/cobra.html.