Areas & Rates (No Copay)
Area 1 Area 2 Area 3 Area 4 Area 5
MONTHLY NO CO-PAY PLAN RATES FOR RATING AREA IV
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 | $224.33 | $208.79 | $199.75 | $188.99 | $166.22 | $148.29 | $132.95 | $108.75 | $90.39 | $77.27 | $68.11 | $57.16 |
| Age 66 | $243.06 | $226.12 | $216.25 | $204.50 | $179.63 | $160.07 | $143.32 | $116.93 | $96.86 | $82.52 | $72.53 | $60.57 |
| Age 67 | $250.89 | $233.34 | $223.12 | $210.95 | $185.24 | $164.99 | $147.64 | $120.32 | $99.55 | $84.73 | $74.37 | $62.00 |
| Age 68 | $258.53 | $240.41 | $229.85 | $217.28 | $190.72 | $169.79 | $151.87 | $123.65 | $102.18 | $86.87 | $76.16 | $63.38 |
| Age 69 | $265.99 | $247.30 | $236.42 | $223.46 | $196.04 | $174.46 | $155.99 | $126.88 | $104.76 | $88.96 | $77.93 | $64.74 |
| Age 70-74 | $309.08 | $290.54 | $279.18 | $266.06 | $237.55 | $214.56 | $194.58 | $162.26 | $136.91 | $118.11 | $104.53 | $86.99 |
| Age 75-79 | $358.05 | $338.80 | $326.69 | $312.87 | $282.25 | $257.09 | $234.84 | $198.40 | $169.21 | $147.02 | $130.64 | $108.59 |
| Age 80-84 | $429.65 | $409.18 | $395.93 | $380.60 | $346.41 | $317.87 | $292.42 | $249.84 | $215.00 | $187.87 | $167.45 | $138.90 |
| Age 85+ | $450.01 | $429.57 | $416.58 | $401.11 | $366.60 | $337.46 | $311.18 | $266.98 | $230.55 | $201.90 | $180.08 | $149.25 |
| 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 |