Greenville University
2022 Calendar Year COBRA Rates
QB = Qualified Beneficiary

$1,500 Max Out of Pocket Copay Plan
DENTAL PLAN
Coverage LevelMonthly Rate
QB Coverage LevelMonthly Rate
QB Only$411.97
QB Only$23.70
QB + Spouse$856.89
QB + Spouse$48.08
QB + Child(ren)$708.58
QB + Child(ren)$61.73
QB + Family$1,153.51
QB + Family$93.15





$5,000 Max Out of Pocket Copay Plan
Vision Plan
QB Coverage LevelMonthly Rate
QB Coverage LevelMonthly Rate
QB Only$361.46
QB Only$3.56
QB + Spouse$751.83
QB + Spouse$13.53
QB + Child(ren)$621.71
QB + Child(ren)$15.85
QB + Family$1,251.80
QB + Family$22.32





$7,900 Max Out of Pocket Copay Plan
HSA Bank Monthly Admin Fees
QB Coverage LevelMonthly Rate

$2.00
QB Only$343.37


QB + Spouse$714.21


QB + Child(ren)$590.60


QB + Family$856.90







$5,000 Deductible High Deductible Health Plan (HSA)


QB Coverage LevelMonthly Rate


QB Only$291.37


QB + Spouse$606.05


QB + Child(ren)$501.17


QB + Family$815.48