Areas & Rates (Copay)
Area 1 Area 2 Area 3 Area 4 Area 5
MONTHLY CO-PAY PLAN RATES FOR RATING AREA I
Effective October 1st, 2018 the Administration Fee is included in the premiums listed below.
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| Plan Deductible | $0 | $100 | $150 | $250 | $500 | $750 | $1,000 | $1,500 | $2,000 | $2,500 | $3,000 | $4,000 |
| Age 65 | $154.53 | $144.77 | $139.96 | $133.88 | $120.40 | $109.10 | $98.66 | $82.51 | $70.20 | $61.27 | $54.67 | $46.77 |
| Age 66 | $166.88 | $156.22 | $150.97 | $144.34 | $129.62 | $117.26 | $105.86 | $88.26 | $74.81 | $65.05 | $57.84 | $49.22 |
| Age 67 | $172.03 | $160.99 | $155.55 | $148.70 | $133.46 | $120.67 | $108.87 | $90.64 | $76.73 | $66.64 | $59.17 | $50.25 |
| Age 68 | $177.06 | $165.66 | $160.04 | $152.97 | $137.22 | $124.00 | $111.81 | $92.99 | $78.60 | $68.18 | $60.47 | $51.25 |
| Age 69 | $181.98 | $170.22 | $164.42 | $157.13 | $140.89 | $127.26 | $114.69 | $95.28 | $80.44 | $69.69 | $61.74 | $52.23 |
| Age 70-74 | $210.69 | $199.30 | $193.50 | $186.41 | $169.97 | $155.63 | $142.08 | $120.59 | $103.64 | $90.86 | $81.05 | $68.38 |
| Age 75-79 | $245.04 | $233.27 | $227.13 | $219.73 | $202.08 | $186.34 | $171.18 | $146.82 | $127.18 | $112.01 | $100.14 | $84.18 |
| Age 80-84 | $295.54 | $283.03 | $276.31 | $268.04 | $248.24 | $230.26 | $212.86 | $184.21 | $160.60 | $141.93 | $127.10 | $106.38 |
| Age 85+ | $314.64 | $301.80 | $294.82 | $286.02 | $265.20 | $246.30 | $228.06 | $197.78 | $172.65 | $152.68 | $136.75 | $114.27 |
| OPTIONAL BENEFIT RATES | |
| Optional Benefit | Monthly Rate |
| Additional Skilled Nursing | $7.68 |
| Private Duty Nursing | $8.87 |
| At Home Recovery | $19.49 |
| Comprehensive Wellness | $14.18 |