Cobra Rates

2021-2022 COBRA RATES (SUBJECT TO CHANGE)

As of July 1, 2021

MEMBER $1,106.25 ANNUALLY
INDIVIDUAL (SPOUSE/CHILD)         $1100.99 ANNUALLY
MEMBER + ONE DEPENDENT         $1,610.54
+ TWO DEPENDENTS $1,239.91
ADDITIONAL DEPENDENTS         $ 735.62

2021-2022  RETIREE COVERAGE RATES

RETIREE…………………………. …………………………   $510.00
RETIREE SPOUSE/ELIGIBLE DEPENDENT…….   $740.00

 QUALIFYING COBRA EVENTS

QUALIFYING EVENTPEOPLE ELIGIBLECOVERAGE UP TOBENEFITS COVERED
TERMINATION(FOR ANY REASON OTHER THAN MISCONDUCT/FMLA/MILITARY LEAVEYOU, YOUR SPOUSE, YOUR CHILDREN18 MONTHS
SAME BENEFITS AS YOU RECEIVED WHEN AN ACTIVE MEMBER
YOUR WORKING HOURS ARE REDUCEDYOU, YOUR SPOUSE, YOUR CHILDREN18 MONTHS
SAME BENEFITS AS YOU RECEIVED WHEN AN ACTIVE MEMBER
YOU DIEYOUR COVERED SPOUSE AND DEPENDENTS36 MONTHSDENTAL,VISION, MEDICAL REIMBURSEMENT($500 MAXIMUM/FAMILY)
YOU DIVORCE YOUR COVERED SPOUSE 36 MONTHSDENTAL,VISION, MEDICAL REIMBURSEMENT
YOUR DEPENDENT CHILD NO LONGER QUALIFIES AS AN ELIGIBLE DEPENDENTYOUR COVERED DEPENDENTS36 MONTHS
DENTAL,VISION**

**ACTIVE MEMBERS CAN INCLUDE CLAIMS FOR THESE COBRA COVERED DEPENDENTS ON MEDICAL REIMBURSEMENT CLAIMS

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