Areas & Rates (Copay)
Area 1 Area 2 Area 3 Area 4 Area 5
MONTHLY CO-PAY PLAN RATES FOR RATING AREA II
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 | $174.72 | $163.48 | $157.96 | $150.97 | $135.47 | $122.46 | $110.45 | $91.88 | $77.72 | $67.46 | $59.87 | $50.78 |
| Age 66 | $188.91 | $176.64 | $170.62 | $163.00 | $146.06 | $131.85 | $118.75 | $98.50 | $83.03 | $71.81 | $63.52 | $53.62 |
| Age 67 | $194.83 | $182.14 | $175.91 | $168.01 | $150.48 | $135.78 | $122.21 | $101.26 | $85.24 | $73.64 | $65.04 | $54.79 |
| Age 68 | $200.62 | $187.51 | $181.08 | $172.91 | $154.80 | $139.62 | $125.60 | $103.94 | $87.40 | $75.41 | $66.54 | $55.95 |
| Age 69 | $206.27 | $192.75 | $186.11 | $177.70 | $159.03 | $143.35 | $128.90 | $106.57 | $89.50 | $77.15 | $68.00 | $57.08 |
| Age 70-74 | $239.29 | $226.19 | $219.53 | $211.36 | $192.45 | $175.97 | $160.37 | $135.68 | $116.18 | $101.48 | $90.19 | $75.63 |
| Age 75-79 | $278.79 | $265.25 | $258.21 | $249.68 | $229.37 | $211.29 | $193.88 | $165.84 | $143.25 | $125.82 | $112.15 | $93.80 |
| Age 80-84 | $336.85 | $322.48 | $314.76 | $305.25 | $282.46 | $261.80 | $241.79 | $208.85 | $181.69 | $160.23 | $143.17 | $119.34 |
| Age 85+ | $358.85 | $344.06 | $336.04 | $325.93 | $301.98 | $280.25 | $259.26 | $224.44 | $195.54 | $172.58 | $154.26 | $128.41 |
| 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 |