Untitled Document

Available Plans and Monthly Premiums (Effective July 1, 2005 - June 30, 2006) Extended Coverage (COBRA) Participant: For 18 and 36 months, pays the Total Premium + 2%; for 19-29 months of disability, pays the Total Premium + 50%.

Health Plans	One Person (You Only)	Plus One (You and One Family Member)	Family (You and Two or More Family Members)
COVA Care Basic l Extended Coverage 19-29 Months Disability	$384 $564	$710 $1044	$1036 $1524
COVA Care Plus Out-of-Network Extended Coverage 19-29 Months Disability	$393 $578	$722 $1062	$1053 $1548
COVA Care Plus Expanded Dental Extended Coverage 19-29 Months Disability	$395 $581	$732 $1077	$1071 $1575
COVA Care Plus Vision, Hearing and Expanded Dental Extended Coverage 19-29 Months Disability	$403 $593	$747 $1098	$1089 $1602
COVA Care Plus Out-of-Network and Expanded Dental Extended Coverage 19-29 Months Disability	$404 $594	$745 $1095	$1087 $1599
COVA Care Plus Out-of-Network and Vision, Hearing and Expanded Dental Extended Coverage 19-29 Months Disability	$412 $606	$759 $1116	$1106 $1626
Kaiser Permanente HMO Extended Coverage 19-29 Months Disability	$378 $557	$700 $1029	$1022 $1503