Salem-Keizer Public Schools
COBRA Rates 2024-25
COBRA benefits are administered by Benefit Help Solutions (BHS).
Phone: 1-800-556-3137
COBRA Rates 10/01/2024 through 09/30/2025
COBRA is the abbreviation for Consolidated Omnibus Budget Reconciliation Act.
COBRA Medical Insurance
Medical Plan Options | Employee Only | Employee & Spouse or Domestic Partner | Employee & Child(ren) | Employe & Spouse or Domestic Partner & Child(ren) |
---|---|---|---|---|
Moda Medical Plan 1 | $809.19 | $1,780.22 | $1,537.50 | $2,508.57 |
Moda Medical Plan 2 | $750.62 | $1,651.44 | $1,426.27 | $2,327.07 |
Moda Medical Plan 3 | $704.23 | $1,549.33 | $1,338.10 | $2,183.21 |
Moda Medical Plan 4 | $664.97 | $1,462.95 | $1,263.47 | $2,061.47 |
Moda Medical Plan 5 | $614.27 | $1,351.40 | $1,167.14 | $1,904.29 |
Moda Medical Plan 6 | $626.57 | $1378.47 | $1,190.53 | $1,942.43 |
Moda Medical Plan 7 | $584.78 | $1286.52 | $1,111.12 | $1,812.87 |
Kaiser Medical Plan 1 | $736.09 | $1619.40 | $1,398.58 | $2,281.89 |
Kaiser Medical Plan 2A | $607.27 | $1336.86 | $1,153.77 | $1,883.47 |
Kaiser Medical Plan 2B | $587.99 | $1294.43 | $1,117.14 | $1,823.67 |
Kaiser Med Plan 3 (HSA eligible) | $448.54 | $987.38 | $851.88 | $1,390.75 |
COBRA Dental Insurance
Dental Plan Options | Employee Only | Employee & Spouse or Domestic Partner | Employee & Child(ren) | Employe & Spouse or Domestic Partner & Child(ren) |
---|---|---|---|---|
Moda Delta Dental Plan 1 | $68.89 | $136.47 | $151.75 | $224.73 |
Moda Delta Dental Plan 5 | $60.85 | $120.53 | $134.03 | $198.49 |
Moda Delta Dental Plan 6 (no ortho) | $46.45 | $91.96 | $93.34 | $142.60 |
Moda Exclusive PPO INCENTIVE Delta Dental | $59.72 | $118.29 | $131.54 | $194.80 |
Moda Exclusive PPO Delta dental | $40.24 | $79.71 | $88.64 | $131.29 |
Kaiser Dental | $74.94 | $164.91 | $142.42 | $232.36 |
Willamette Dental | $47.92 | $95.86 | $102.11 | $153.18 |
COBRA Vision Insurance
Vision Plan Options | Employee Only | Employee & Spouse or Domestic Partner | Employee & Child(ren) | Employe & Spouse or Domestic Partner & Child(ren) |
---|---|---|---|---|
Moda Vision Opal | $22.26 | $48.94 | $42.22 | $68.95 |
Moda Vision Pearl | $18.16 | $40.02 | $35.54 | $56.36 |
Moda Vision Quartz | $12.83 | $28.26 | $24.38 | $39.76 |
VSP Choice Plus Plan | $14.43 | $31.76 | $27.43 | $44.74 |
VSP Choice Plan | $7.02 | $15.44 | $13.34 | $21.75 |
Kaiser Vision (Only available with Kaiser Medical) | $8.65 | $19.04 | $16.44 | $26.83 |