2011-12 COBRA Application
This application is due within 60 days of the loss of your benefits.
2011-12 COBRA Rates (effective 11/1/11)
Delta Dental:
Single: $28.95
Single + 1: Not Available
Family $85.88
Eyemed:
Single $6.60
Single +1 $12.54
Family $18.36
All rates above include a 2% administrative fee, which is waived if you pay via PayPal
Important Information About Your COBRA Continuation Coverage Rights
Detailed information about your COBRA rights, including what continuation of coverage is, how long coverage can be continued or extended, who is eligible, costs, etc.
Form to Switch COBRA Options
This form allows you to switch your COBRA coverage options.
cobraform2011.12.pdf
