COBRA and Retiree Medical Plan Rates

Effective July 1, 2012

Coverage

Single

Parent Child

Parent Children

Subscriber Spouse

Family

Keystone HMO 15

$ 542.65

$ 759.70

$    976.76

$ 1,085.29

$ 1,627.94

Personal Choice 20/30/70

$ 640.67

$ 896.93

$ 1,153.20

$ 1,281.33

$ 1,922.00

COBRA and Retiree Rider (Prescription /Vision and Dental) Rates

Effective July 1, 2012

These benefits are available to retirees who were not eligible for a Union Health and Welfare benefit while employed.  Eligible retirees include members of the Commonwealth Association of School Administrators (CASA), The School Police Association of Philadelphia (SPAP) and Non-Represented employees. 

These premiums are in ADDITON to the base medical premiums listed above.

Coverage

Single

Parent Child

Parent Children

Subscriber Spouse

Family

Select Drug with $100 Biennial Vision program administered by Davis Vision

         $10 Generic
         $15 Brand
         $25 Formulary

$ 136.76

$ 355.57

$ 355.57

$ 355.57

$ 355.57

United Concordia Flex Dental

$ 40.40

$ 72.72

$ 72.72

 $ 91.63

$ 91.63