Area 1 Area 2 Area 3 Area 4 Area 5
MONTHLY CO-PAY PLAN RATES FOR RATING AREA V
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 | $221.80 | $207.15 | $199.94 | $190.82 | $170.60 | $153.64 | $137.99 | $113.77 | $95.30 | $81.90 | $71.99 | $60.16 |
Age 66 | $240.31 | $224.33 | $216.46 | $206.50 | $184.42 | $165.90 | $148.80 | $122.39 | $102.20 | $87.58 | $76.77 | $63.85 |
Age 67 | $248.03 | $231.48 | $223.34 | $213.04 | $190.19 | $171.01 | $153.32 | $125.98 | $105.09 | $89.95 | $78.76 | $65.39 |
Age 68 | $255.59 | $238.48 | $230.08 | $219.44 | $195.82 | $176.01 | $157.74 | $129.49 | $107.91 | $92.28 | $80.70 | $66.88 |
Age 69 | $262.95 | $245.33 | $236.64 | $225.68 | $201.32 | $180.90 | $162.04 | $132.91 | $110.66 | $94.54 | $82.61 | $68.35 |
Age 70-74 | $306.05 | $288.93 | $280.26 | $269.62 | $244.93 | $223.44 | $203.09 | $170.87 | $145.44 | $126.30 | $111.56 | $92.56 |
Age 75-79 | $357.56 | $339.90 | $330.71 | $319.58 | $293.09 | $269.49 | $246.79 | $210.23 | $180.77 | $158.02 | $140.20 | $116.26 |
Age 80-84 | $433.28 | $414.52 | $404.46 | $392.06 | $362.35 | $335.38 | $309.29 | $266.31 | $230.90 | $202.89 | $180.65 | $149.56 |
Age 85+ | $461.97 | $442.69 | $432.20 | $419.02 | $387.79 | $359.44 | $332.07 | $286.66 | $248.97 | $219.00 | $195.15 | $161.42 |
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 |