Dependents, including a former spouse, who lose retiree dental coverage, may continue retiree dental coverage for up to 36 months through the COBRA provision. The dependent will be billed for 102% of the premium under this option.

FY17 Retiree Dental COBRA Notice, Rates and Application docx format of cobraretireedentalFY17.docx
 – use this form to apply for Retiree Dental COBRA health insurance benefits if your coverage was terminated before May 1, 2017.

FY18 Retiree Dental COBRA Notice, Rates and Application docx format of cobraretireedentalFY18.docx
– use this form to apply for Retiree Dental COBRA health insurance benefits if your coverage is terminated on or after May 1, 2017.


This information provided by the Group Insurance Commission .