Areas & Rates (Copay)
Area 1 Area 2 Area 3 Area 4 Area 5
MONTHLY CO-PAY PLAN RATES FOR RATING AREA III
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 | $188.17 | $175.96 | $169.95 | $162.36 | $145.50 | $131.36 | $118.31 | $98.15 | $82.74 | $71.58 | $63.33 | $53.47 |
| Age 66 | $203.60 | $190.27 | $183.71 | $175.43 | $157.01 | $141.58 | $127.33 | $105.32 | $88.50 | $76.33 | $67.32 | $56.55 |
| Age 67 | $210.04 | $196.24 | $189.45 | $180.88 | $161.81 | $145.84 | $131.10 | $108.31 | $90.91 | $78.30 | $68.96 | $57.82 |
| Age 68 | $216.33 | $202.08 | $195.06 | $186.20 | $166.52 | $150.00 | $134.77 | $111.24 | $93.25 | $80.24 | $70.60 | $59.08 |
| Age 69 | $222.47 | $207.77 | $200.54 | $191.40 | $171.10 | $154.08 | $138.36 | $114.09 | $95.55 | $82.11 | $72.18 | $60.31 |
| Age 70-74 | $258.37 | $244.12 | $236.87 | $228.01 | $207.45 | $189.53 | $172.59 | $145.73 | $124.55 | $108.58 | $96.30 | $80.47 |
| Age 75-79 | $301.30 | $286.59 | $278.93 | $269.65 | $247.59 | $227.92 | $208.99 | $178.53 | $153.96 | $135.02 | $120.17 | $100.22 |
| Age 80-84 | $364.41 | $348.78 | $340.38 | $330.06 | $305.29 | $282.82 | $261.07 | $225.25 | $195.75 | $172.42 | $153.88 | $127.96 |
| Age 85+ | $388.30 | $372.25 | $363.51 | $352.53 | $326.50 | $302.88 | $280.07 | $242.23 | $210.82 | $185.83 | $165.94 | $137.84 |
| 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 |