COBRA Group Continuation Coverage for Dental and Vision Plan Premiums
2026 COBRA Group Continuation Coverage for Dental and Vision Plan Premiums
Please refer to the Benefits Administration Manual (BAM) COBRA Section 400 for complete instructions on the completion and submission of COBRA documents.
Cobra participants are responsible for the total cost of the plan plus an additional 2%. This includes the amount you were paying as an employee as well as the portion of the cost paid by the State.
State-Sponsored Dental Plans
Delta Dental
|
Plan Type |
Covered Persons |
Single |
2-Party |
Family |
|
Preferred Provider Option (PPO) |
Employees and Dependents |
$48.66 |
$94.94 |
$143.03 |
|
PPO plus Premier Basic |
Represented Employees |
$57.71 |
$101.05 |
$146.26 |
|
PPO plus Premier Enhanced |
Excluded Employees and Dependents |
$57.77 |
$114.05 |
$160.37 |
DeltaCare USA
|
Plan Type |
Covered Persons |
Single |
2-Party |
Family |
|
Standard |
Employees and Dependents |
$19.83 |
$32.54 |
$45.01 |
MetLife
|
Plan Type |
Covered Persons |
Single |
2-Party |
Family |
|
Standard |
Employees and Dependents |
$14.13 |
$22.89 |
$32.05 |
|
Enhanced |
Excluded Employees and Dependents |
$16.38 |
$27.72 |
$34.15 |
Premier Access
|
Plan Type |
Covered Persons |
Single |
2-Party |
Family |
|
Standard |
Employees and Dependents |
$14.49 |
$23.48 |
$32.88 |
Western Dental
|
Plan Type |
Covered Persons |
Single |
2-Party |
Family |
|
Standard |
Employees and Dependents |
$16.09 |
$26.54 |
$37.65 |
Employees in BU6 should contact the California Correctional Peace Officers Association (CCPOA) Benefits Trust Fund at (916) 779-6300 or (800) 468-6486.
State-Sponsored Vision Plans
Vision Service Plan (VSP)
|
Plan Type |
Covered Persons |
Single |
2-Party |
Family |
|
Basic |
Excluded and Represented employees and their eligible dependents[1] |
$8.26 |
$8.26 |
$8.26 |
|
Premier |
Excluded and Represented employees and their eligible dependents[2] |
$17.06 |
$25.69 |
$36.22 |
[1] Vision benefits for BU6 employees are provided through the CCPOA Health Benefits Trust.
[2] Vision benefits for BU6 employees are provided through the CCPOA Health Benefits Trust.
COBRA Carrier Contact Information for State-Sponsored Dental and Vision Plans
Please mail or email the Dental Plan Enrollment Authorization (STD. 692) forms to the corresponding dental carrier’s COBRA unit:
Delta Dental of California/DeltaCare USA
Enrollment Form Submission
P.O. Box 537011
Sacramento, CA 95853-7011
Email: IsolvedCobra@delta.org
Support for COBRA enrolled members:
Participants: 800-594-6957
Employers: 866-320-3040
Email: crmail@isolvedhcm.com
MetLife[1]
Attn: SOC COBRA Billing
P.O. Box 13724
Philadelphia, PA 19101-3724
Benefit questions: (800) 880-1800
Billing questions: (949) 471-2222
Premier Access
8890 Cal Center Drive
Sacramento, CA 95826
Phone: (888) 534-3466
Western Dental
Attn: Group Services Department
530 South Main Street
Orange, CA 92868
Phone: (866) 859-7525
Please mail, email, or fax vision COBRA forms (STD. 700 for Basic COBRA and STD. 774 for Premier COBRA) to VSP directly:
Vision Service Plan (VSP)
Attn: CLIENT ADMINISTRATIVE SERVICES, MS 229
PO Box 997100
Sacramento, CA 95899-7100
Email: stateofca@vsp.com
Fax: 916-389-8304
[1] Benefits provided by SafeGuard Health Plans, Inc., a MetLife company.