Monthly Premium Rates and Payment Instructions for COBRA Continuation
Effective October 1, 2008 - September 30, 2009
Medical Plans
| Coverage type | Family Members Covered | Monthly Cost |
|---|---|---|
| Kaiser Medical Plan 1 w/RX 1 | Self | $360.63 |
| Self plus spouse or DP | $793.42 | |
| Self plus child(ren) | $685.22 | |
| Family | $1117.99 | |
| ODS Medical Plan 3 w/Rx A | Self | $427.27 |
| Self plus spouse or DP | $940.01 | |
| Self plus child(ren) | $811.82 | |
| Family | $1,324.54 | |
| ODS Medical Plan 6 w/Rx A | Self | $374.09 |
| Self plus spouse or DP | $823.01 | |
| Self plus child(ren) | $710.78 | |
| Family | $1,159.69 | |
| ODS Medical Plan 8 w/Rx A | Self | $313.62 |
| Self plus spouse or DP | $689.98 | |
| Self plus child(ren) | $595.88 | |
| Family | $972.22 |
Vision Plans
| Coverage type | Coverage Level | Monthly Cost |
|---|---|---|
| ODS Vision Plan 5 | Self | $7.70 |
| Self plus spouse or DP | $16.94 | |
| Self plus child(ren) | $14.64 | |
| Family | $23.87 | |
| Kaiser Plan 5 | Self | $7.71 |
| Self plus spouse or DP | $16.97 | |
| Self plus child(ren) | $14.67 | |
| Family | $23.92 |
Dental
| Coverage type | Coverage Level | Monthly Cost |
|---|---|---|
| Willamette Dental Plan 8 NO ortho | Self | $43.47 |
| Self plus spouse or DP | $86.09 | |
| Self plus child(ren) | $87.39 | |
| Family | $133.48 | |
| Kaiser Dental Plan 7 NO ortho | Self | $59.39 |
| Self plus spouse or DP | $130.67 | |
| Self plus child(ren) | $112.84 | |
| Family | $184.12 | |
| ODS Dental Plan 5 NO ortho | Self | $39.25 |
| Self plus spouse or DP | $77.70 | |
| Self plus child(ren) | $78.89 | |
| Family | $120.48 |