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ACTIVE EMPLOYEE GROUP COBRA RATES
PLAN YEAR 2005


State Monthly Active Group - with Plan Revisions
State Monthly Active Group - without Plan Revisons
Chapter 172 Part-Time State Monthly Active COBRA Group
Local Monthly Active Group - Education Employers - with RX coverage
Local Monthly Active Group - Education Employers - without RX coverage
Local Monthly Active Group - Local Government Employers- with RX coverage
Local Monthly Active Group - Local Government Employers - without RX coverage
Chapter 172 Part-Time Local Monthly Active COBRA Group




COBRA STATE MONTHLY ACTIVE GROUP
WITH PLAN REVISIONS

DEPARTMENT OF THE TREASURY-DIVISION OF PENSIONS AND BENEFITS
NEW JERSEY STATE HEALTH BENEFITS PROGRAM

RATES EFFECTIVE 1/1/2005 TO 12/31/2005

PLAN/COVERAGE DESCRIPTION

COBRA RATES

NJ PLUS-#101

Single

$300.60

Member & Spouse/Domestic Partner

$655.21

Family

$779.87

Parent & Child

$452.23

TRADITIONAL-#102

Single

$491.87

Member & Spouse/Domestic Partner

$1,052.74

Family

$1,252.93

Parent & Child

$726.51

AETNA, INC-#119

Single

$288.21

Member & Spouse/Domestic Partner

$636.52

Family

$740.32

Parent & Child

$425.58

CIGNA HEALTHCARE-#120

Single

$344.43

Member & Spouse/Domestic Partner

$751.31

Family

$896.07

Parent & Child

$517.02

OXFORD-#128

Single

$313.12

Member & Spouse/Domestic Partner

$688.81

Family

$814.05

Parent & Child

$469.71

AMERIHEALTH-#133

Single

$322.25

Member & Spouse/Domestic Partner

$717.03

Family

$835.04

Parent & Child

$475.74

HEALTH NET-#134

Single

$351.34

Member & Spouse/Domestic Partner

$765.36

Family

$929.09

Parent & Child

$538.98

PRESCRIPTION DRUG PROGRAM-#202

Single

$105.43

Member & Spouse/Domestic Partner

$240.98

Family

$253.12

Parent & Child

$140.71

VISION CARE

 

Single

$0.55

Member & Spouse/Domestic Partner

$1.16

Family

$1.59

Parent & Child

$0.87

**Traditional Plan deductible $250, NJ Plus and HMO office visit copay $10



COBRA - STATE MONTHLY ACTIVE GROUP
FOR PARTICIPANTS NOT SUBJECT TO PLAN CHANGES
DEPARTMENT OF THE TREASURY-DIVISION OF PENSIONS AND BENEFITS
NEW JERSEY STATE HEALTH BENEFITS PROGRAM
RATES EFFECTIVE 1/1/2005 TO 12/31/2005

PLAN/COVERAGE DESCRIPTION

COBRA RATES

NJ PLUS-#001

Single

$308.19

Member & Spouse/Domestic Partner

$671.75

Family

$799.54

Parent & Child

$463.65

TRADITIONAL-#002

Single

$507.31

Member & Spouse/Domestic Partner

$1,085.80

Family

$1,292.28

Parent & Child

$749.33

AETNA, INC-#019

Single

$295.54

Member & Spouse/Domestic Partner

$652.69

Family

$759.13

Parent & Child

$436.39

CIGNA HEALTHCARE-#020

Single

$353.25

Member & Spouse/Domestic Partner

$770.54

Family

$919.00

Parent & Child

$530.25

OXFORD-#028

Single

$321.13

Member & Spouse/Domestic Partner

$706.42

Family

$834.85

Parent & Child

$481.71

AMERIHEALTH-#033

Single

$330.49

Member & Spouse/Partner

$735.36

Family

$856.39

Parent & Child

$487.90

HEALTH NET-#034

Single

$360.34

Member & Spouse/Partner

$784.96

Family

$952.88

Parent & Child

$552.77

PRESCRIPTION DRUG PROGRAM-#201

Single

$115.11

Member & Spouse/Partner

$263.10

Family

$276.35

Parent & Child

$153.64

Vision Care

Single $0.55
Member & Spouse/Partner $1.16
Family $1.59
Parent & Child $0.87
Traditional Plan deducible $100, NJ Plus and HMO office visit copy $5



LOCAL MONTHLY ACTIVE GROUP- EDUCATION EMPLOYERS
(FOR EMPLOYERS WITHOUT A PRESCRIPTION DRUG PLAN)
DEPARTMENT OF THE TREASURY-DIVISION OF PENSIONS AND BENEFITS
NEW JERSEY STATE HEALTH BENEFITS PROGRAM
RATES EFFECTIVE 1/1/2005 TO 12/31/2005

PLAN/COVERAGE
DESCRIPTION

COBRA
RATES

NJ PLUS-#001

Single

$331.48

Member & Spouse/Domestic Partner

$737.76

Family

$858.39

Parent & Child

$489.47

TRADITIONAL-#002

Single

$474.77

Member & Spouse/Domestic Partner

$1,030.64

Family

$1,206.08

Parent & Child

$690.78

AETNA, INC-#019

Single

$404.36

Member & Spouse/Domestic Partner

$874.71

Family

$984.15

Parent & Child

$554.27

CIGNA HEALTHCARE-#020

Single

$463.37

Member & Spouse/Domestic Partner

$995.20

Family

$1,146.72

Parent & Child

$649.52

OXFORD-#028

Single

$386.95

Member & Spouse/Domestic Partner

$851.21

Family

$1,005.98

Parent & Child

$580.42

AMERIHEALTH-#033

Single

$471.18

Member & Spouse/Domestic Partner

$1,048.42

Family

$1,220.94

Parent & Child

$695.57

HEALTH NET-#034

Single

$471.47

Member & Spouse/Domestic Partner

$1,027.07

Family

$1,246.80

Parent & Child

$723.31



LOCAL MONTHLY ACTIVE GROUP- EDUCATION EMPLOYERS
(FOR EMPLOYERS WITH A PRESCRIPTION DRUG PLAN)

DEPARTMENT OF THE TREASURY-DIVISION OF PENSIONS AND BENEFITS
NEW JERSEY STATE HEALTH BENEFITS PROGRAM
RATES EFFECTIVE 1/1/2005 TO 12/31/2005

PLAN/COVERAGE
DESCRIPTION

COBRA
RATES

NJ PLUS-#001

Single

$297.00

Member & Spouse/Domestic Partner

$661.01

Family

$769.10

Parent & Child

$438.55

TRADITIONAL-#002

Single

$397.24

Member & Spouse/Domestic Partner

$866.38

Family

$1,012.72

Parent & Child

$579.53

AETNA, INC-#019

Single

$295.54

Member & Spouse/Domestic Partner

$652.69

Family

$759.13

Parent & Child

$436.39

CIGNA HEALTHCARE-#020

Single

$353.25

Member & Spouse/Domestic Partner

$770.54

Family

$919.00

Parent & Child

$530.25

OXFORD-#028

Single

$321.13

Member & Spouse/Domestic Partner

$706.42

Family

$834.85

Parent & Child

$481.71

AMERIHEALTH-#033

Single

$330.49

Member & Spouse/Domestic Partner

$735.36

Family

$856.39

Parent & Child

$487.90

HEALTH NET-#034

Single

$360.34

Member & Spouse/Domestic Partner

$784.96

Family

$952.88

Parent & Child

$552.77

PRESCRIPTION DRUG PROGRAM-#201

Single

$119.80

Member & Spouse/Domestic Partner

$273.89

Family

$287.97

Parent & Child

$159.95

*Closed to new enrollments for the 2004 plan year.

**Domestic Partner coverage is only available to employees or retirees of a local employer that has adopted by resolution the health benefit provisions of the Domestic Partnership Act, Chapter 246, P.L. 2003.

LOCAL MONTHLY ACTIVE GROUP- LOCAL GOVERNMENT EMPLOYERS
(FOR EMPLOYERS WITHOUT A PRESCRIPTION DRUG PLAN)

DEPARTMENT OF THE TREASURY-DIVISION OF PENSIONS AND BENEFITS
NEW JERSEY STATE HEALTH BENEFITS PROGRAM
RATES EFFECTIVE 1/1/2005 TO 12/31/2005

PLAN/COVERAGE
DESCRIPTION

COBRA
RATES

NJ PLUS-#001

Single

$372.32

Member & Spouse/Domestic Partner

$828.62

Family

$964.12

Parent & Child

$549.76

TRADITIONAL-#002

Single

$524.03

Member & Spouse/Domestic Partner

$1,137.62

Family

$1,331.29

Parent & Child

$762.45

AETNA, INC-#019

Single

$404.36

Member & Spouse/Domestic Partner

$874.71

Family

$984.15

Parent & Child

$554.27

CIGNA HEALTHCARE-#020

Single

$463.37

Member & Spouse/Domestic Partner

$995.20

Family

$1,146.72

Parent & Child

$649.52

OXFORD-#028

Single

$386.95

Member & Spouse/Domestic Partner

$851.21

Family

$1,005.98

Parent & Child

$580.42

AMERIHEALTH-#033

Single

$471.18

Member & Spouse/Domestic Partner

$1,048.42

Family

$1,220.94

Parent & Child

$695.57

HEALTH NET-#034

Single

$471.47

Member & Spouse/Domestic Partner

$1,027.07

Family

$1,246.80

Parent & Child

$723.31


LOCAL MONTHLY ACTIVE GROUP-LOCAL GOVERNMENT EMPLOYERS
(FOR EMPLOYERS WITH A PRESCRIPTION DRUG PLAN)
DEPARTMENT OF THE TREASURY-DIVISION OF PENSIONS AND BENEFITS
NEW JERSEY STATE HEALTH BENEFITS PROGRAM
RATES EFFECTIVE 1/1/2005 TO 12/31/2005

PLAN/COVERAGE
DESCRIPTION

COBRA
RATES

NJ PLUS-#001

Single

$330.70

Member & Spouse/Domestic Partner

$736.07

Family

$856.43

Parent & Child

$488.33

TRADITIONAL-#002

Single

$448.45

Member & Spouse/Domestic Partner

$978.10

Family

$1,143.32

Parent & Child

$654.28

AETNA, INC-#019

Single

$295.54

Member & Spouse/Domestic Partner

$652.69

Family

$759.13

Parent & Child

$436.39

CIGNA HEALTHCARE-#020

Single

$353.25

Member & Spouse/Domestic Partner

$770.54

Family

$919.00

Parent & Child

$530.25

OXFORD-#028

Single

$321.13

Member & Spouse/Domestic Partner

$706.42

Family

$834.85

Parent & Child

$481.71

AMERIHEALTH-#033

Single

$330.49

Member & Spouse/Domestic Partner

$735.36

Family

$856.39

Parent & Child

$487.90

HEALTH NET-#034

Single

$360.34

Member & Spouse/Domestic Partner

$784.96

Family

$952.88

Parent & Child

$552.77

PRESCRIPTION DRUG PROGRAM-#201

Single

$119.80

Member & Spouse/Domestic Partner

$273.89

Family

$287.97

Parent & Child

$159.95




CHAPTER 172 PART-TIME STATE MONTHLY ACTIVE COBRA GROUP
DEPARTMENT OF THE TREASURY-DIVISION OF PENSIONS AND BENEFITS
NEW JERSEY STATE HEALTH BENEFITS PROGRAM
RATES EFFECTIVE 1/1/2005 TO 12/31/2005

PLAN/COVERAGE
DESCRIPTION

COBRA
EMPLOYEE MONTHLY RATE

NJ PLUS-#001

Single

$330.66

Member & Spouse/ Domestic Partner

$720.74

Family

$857.86

Parent & Child

$497.46

PRESCRIPTION DRUG PROGRAM-#201

Single

$115.97

Member & Spouse/Domestic Partner

$265.08

Family

$278.42

Parent & Child

$154.79



CHAPTER 172 PART-TIME LOCAL MONTHLY ACTIVE COBRA GROUP
DEPARTMENT OF THE TREASURY-DIVISION OF PENSIONS AND BENEFITS
NEW JERSEY STATE HEALTH BENEFITS PROGRAM
RATES EFFECTIVE 1/1/2005 TO 12/31/2005

PLAN/COVERAGE
DESCRIPTION

COBRA
EMPLOYEE MONTHLY RATE

NJ PLUS-#001

Single

$339.00

Member & Spouse/Domestic Partner*

$738.92

Family

$879.50

Parent & Child

$510.01

PRESCRIPTION DRUG PROGRAM-#201

Single

$126.62

Member & Spouse/Domestic Partner*

$289.42

Family

$303.99

Parent & Child

$169.00

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Copyright State of New Jersey, 1996-2003
Division of Pensions and Benefits
PO Box 295
Trenton, NJ 08625-0295

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Last Updated: November 15, 2004