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*Dependents of Represented employees have a lower level of coverage under the Delta Premier Basic Plan, and pay a lower premium for dependent only coverage.
Rank-and-file employees and their eligible dependents
Excluded employees and their eligible dependents
*Benefits Provided by SafeGuard Health Plans, Inc., a MetLife company
Note: Dental benefits for Bargaining Unit 6 (BU6) employees are provided through the CCPOA Health Benefits Trust. Exception: BU6 employees who are non-CCPOA members may only enroll into Western Dental.
*Vision benefits for BU6 employees are provided through the CCPOA Health Benefits Trust.
Please mail the Dental Plan Enrollment Authorization (STD. 692) forms to the corresponding dental carrier’s COBRA unit, and the Vision Plan Direct Payment Authorization (STD. 703) forms to VSP:
Wolfpack Insurance Services, Inc.P.O. Box 833Belmont, CA 94002-0833(888) 837-7511
Attn: COBRA Unit8890 Cal Center DriveSacramento, CA 95826(888) 534-3466
Attn: SOC COBRA Billing P.O. Box 13724 Philadelphia, PA 19101-3724 (800) 880-1800
*Benefits provided by SafeGuard Health Plans, Inc., a MetLife company.
Attn: Group Services530 South Main Street, 1st FloorOrange, CA 92868(866) 859-7525
Attn: COBRA Unit MS 422P.O. Box 997100Sacramento, CA 95899-7100(800) 400-4569