MONTHLY NON-TOBACCO PREMIUMS* ZIP CODES: 304-307, 310, 312, 315-319, 398
FEMALE MALE Plan A Plan F Plan G Plan M Issue Plan A Plan F Plan G UM20 UM23 UM24 UM30 Age UM20 UM23 UM24 833.64 1,208.20 1,008.16 960.46 906.63 1,313.94 1,096.38 Thru 64** 83.36 120.82 100.82 96.05 90.66 131.40 109.64 65 86.88 125.91 105.05 100.10 95.51 138.43 115.50 66 90.44 131.06 109.36 104.20 100.42 145.55 121.45 67 93.98 136.20 113.64 108.28 105.32 152.64 127.36 68 97.47 141.27 117.88 112.32 110.10 159.56 133.14 69 100.91 146.23 122.01 116.25 114.67 166.19 138.66 70 103.52 150.03 125.18 119.27 118.24 171.37 142.99 71 106.04 153.69 128.24 122.18 121.61 176.25 147.06 72 108.44 157.16 131.14 124.94 124.70 180.73 150.80 73 110.69 160.42 133.85 127.53 127.44 184.69 154.10 74 112.76 163.42 136.36 129.92 129.75 188.04 156.90 75 114.70 166.23 138.70 132.14 131.59 190.70 159.13 76 116.58 168.95 140.97 134.32 133.09 192.89 160.95 77 118.46 171.68 143.25 136.49 134.46 194.87 162.61 78 120.35 174.43 145.54 138.66 135.65 196.60 164.04 79 122.23 177.15 147.81 140.83 136.62 198.00 165.21 80 124.06 179.80 150.02 142.94 137.39 199.11 166.14 81 125.75 182.25 152.07 144.89 138.07 200.09 166.96 82 127.30 184.50 153.94 146.68 138.63 200.92 167.65 83 128.71 186.55 155.65 148.31 139.09 201.58 168.20 84 129.95 188.34 157.15 149.73 139.45 202.11 168.64 85 131.03 189.89 158.45 150.97 139.73 202.51 168.98 86 131.90 191.15 159.50 151.97 139.93 202.79 169.21 87 132.55 192.09 160.29 152.71 140.05 202.97 169.36 88 132.97 192.71 160.79 153.20 140.11 203.06 169.44 89 133.12 192.93 160.98 153.38 140.13 203.09 169.45 90+ *See PREMIUM INFORMATION regarding Risk Class and Household Premium Discount rating.
Plan M UM30 1,044.54 104.45 110.05 115.71 121.35 126.85 132.12 136.24 140.11 143.68 146.83 149.49 151.61 153.34 154.93 156.29 157.41 158.29 159.07 159.73 160.25 160.67 161.00 161.22 161.37 161.44 161.46
To obtain annual, semiannual, and quarterly premiums, multiply the above-quoted premiums by 12, 6, and 3, respectively. **Only individuals who are Disabled or have End Stage Renal Disease are eligible for coverage under the age of 65. RP51.12.B-GA
2
U8183_GA_0011R
MONTHLY TOBACCO PREMIUMS* ZIP CODES: 304-307, 310, 312, 315-319, 398
FEMALE MALE Plan A Plan F Plan G Plan M Issue Plan A Plan F Plan G UM20 UM23 UM24 UM30 Age UM20 UM23 UM24 958.21 1,388.73 1,158.81 1,103.98 1,510.28 1,260.21 Thru 64** 1,042.10 95.82 138.87 115.88 110.40 104.21 151.03 126.02 65 99.86 144.72 120.75 115.06 109.78 159.11 132.76 66 103.96 150.65 125.70 119.77 115.43 167.30 139.60 67 108.02 156.55 130.62 124.46 121.06 175.45 146.40 68 112.04 162.38 135.50 129.10 126.55 183.40 153.03 69 115.98 168.08 140.24 133.62 131.80 191.02 159.38 70 118.99 172.45 143.89 137.10 135.91 196.97 164.36 71 121.89 176.66 147.40 140.44 139.78 202.58 169.03 72 124.64 180.64 150.73 143.61 143.34 207.73 173.33 73 127.23 184.39 153.85 146.59 146.48 212.29 177.13 74 129.61 187.84 156.73 149.34 149.14 216.14 180.34 75 131.84 191.06 159.43 151.89 151.25 219.20 182.91 76 133.99 194.19 162.04 154.39 152.97 221.71 184.99 77 136.16 197.34 164.65 156.88 154.56 223.99 186.91 78 138.34 200.49 167.29 159.38 155.92 225.97 188.55 79 140.50 203.62 169.90 161.87 157.03 227.59 189.90 80 142.60 206.67 172.44 164.30 157.92 228.86 190.97 81 144.54 209.48 174.79 166.54 158.70 229.98 191.90 82 146.32 212.07 176.94 168.60 159.35 230.94 192.70 83 147.94 214.42 178.91 170.47 159.87 231.70 193.33 84 149.37 216.49 180.63 172.11 160.28 232.31 193.83 85 150.60 218.26 182.12 173.53 160.61 232.76 194.23 86 151.61 219.71 183.33 174.68 160.84 233.10 194.50 87 152.35 220.80 184.24 175.53 160.98 233.30 194.67 88 152.84 221.50 184.82 176.09 161.05 233.40 194.76 89 153.01 221.76 185.04 176.30 161.07 233.44 194.77 90+ *See PREMIUM INFORMATION regarding Risk Class and Household Premium Discount rating.
Plan M UM30 1,200.63 120.06 126.50 133.00 139.49 145.80 151.86 156.60 161.05 165.15 168.77 171.83 174.27 176.26 178.08 179.65 180.93 181.94 182.84 183.59 184.20 184.68 185.05 185.31 185.48 185.56 185.58
To obtain annual, semiannual, and quarterly premiums, multiply the above-quoted premiums by 12, 6, and 3, respectively. **Only individuals who are Disabled or have End Stage Renal Disease are eligible for coverage under the age of 65. RP51.12.B-GA
3
U8183_GA_0011R
MONTHLY NON-TOBACCO PREMIUMS* ZIP CODES: 300-303, 308-309, 311, 313-314, 399
Plan A UM20 912.10 91.21 95.05 98.95 102.82 106.65 110.40 113.27 116.03 118.65 121.11 123.37 125.49 127.55 129.61 131.68 133.74 135.73 137.59 139.28 140.82 142.18 143.36 144.31 145.02 145.48 145.65
FEMALE MALE Plan F Plan G Plan M Issue Plan A Plan F Plan G UM23 UM24 UM30 Age UM20 UM23 UM24 1,321.91 1,103.05 1,050.86 991.96 1,437.61 1,199.57 Thru 64** 132.19 110.30 105.09 99.20 143.76 119.96 65 137.76 114.94 109.52 104.50 151.46 126.37 66 143.40 119.65 114.00 109.88 159.25 132.88 67 149.02 124.34 118.47 115.23 167.01 139.35 68 154.57 128.98 122.89 120.46 174.58 145.67 69 159.99 133.49 127.19 125.46 181.83 151.71 70 164.15 136.96 130.50 129.37 187.49 156.45 71 168.16 140.31 133.68 133.06 192.83 160.90 72 171.95 143.48 136.70 136.44 197.74 164.99 73 175.52 146.45 139.54 139.43 202.07 168.61 74 178.80 149.19 142.15 141.96 205.74 171.67 75 181.87 151.76 144.58 143.97 208.65 174.11 76 184.85 154.24 146.96 145.61 211.05 176.09 77 187.84 156.73 149.34 147.12 213.21 177.91 78 190.84 159.24 151.71 148.42 215.10 179.47 79 193.82 161.72 154.09 149.47 216.64 180.76 80 196.72 164.14 156.39 150.32 217.85 181.78 81 199.40 166.38 158.53 151.06 218.92 182.67 82 201.86 168.43 160.49 151.68 219.82 183.42 83 204.10 170.30 162.27 152.18 220.55 184.03 84 206.07 171.94 163.83 152.57 221.13 184.51 85 207.76 173.36 165.18 152.88 221.56 184.88 86 209.14 174.51 166.27 153.10 221.88 185.14 87 210.17 175.37 167.09 153.24 222.07 185.30 88 210.84 175.92 167.62 153.30 222.17 185.39 89 211.09 176.13 167.82 153.32 222.20 185.40 90+ *See PREMIUM INFORMATION regarding Risk Class and Household Premium Discount rating.
Plan M UM30 1,142.85 114.29 120.41 126.60 132.77 138.78 144.55 149.06 153.30 157.20 160.65 163.56 165.88 167.78 169.51 171.00 172.23 173.19 174.04 174.76 175.33 175.79 176.15 176.39 176.55 176.64 176.65
To obtain annual, semiannual, and quarterly premiums, multiply the above-quoted premiums by 12, 6, and 3, respectively. **Only individuals who are Disabled or have End Stage Renal Disease are eligible for coverage under the age of 65.
RP51.12.B-GA
4
U8183_GA_0011R
MONTHLY TOBACCO PREMIUMS* ZIP CODES: 300-303, 308-309, 311, 313-314, 399
Plan A UM20 1,048.39 104.84 109.26 113.74 118.18 122.58 126.90 130.19 133.36 136.38 139.20 141.81 144.24 146.61 148.98 151.36 153.72 156.02 158.15 160.09 161.87 163.43 164.78 165.88 166.69 167.22 167.41
FEMALE MALE Plan F Plan G Plan M Issue Plan A Plan F Plan G UM23 UM24 UM30 Age UM20 UM23 UM24 1,519.43 1,267.87 1,207.88 1,652.42 1,378.82 Thru 64** 1,140.18 151.94 126.79 120.79 114.02 165.24 137.88 65 158.34 132.12 125.89 120.11 174.09 145.26 66 164.82 137.53 131.04 126.29 183.04 152.73 67 171.29 142.91 136.17 132.45 191.96 160.17 68 177.67 148.25 141.25 138.46 200.67 167.44 69 183.90 153.44 146.20 144.21 209.00 174.38 70 188.68 157.43 150.00 148.70 215.51 179.83 71 193.28 161.27 153.66 152.94 221.65 184.94 72 197.64 164.92 157.12 156.83 227.28 189.65 73 201.75 168.33 160.39 160.27 232.27 193.80 74 205.52 171.48 163.39 163.18 236.48 197.32 75 209.05 174.43 166.18 165.48 239.83 200.13 76 212.47 177.29 168.92 167.37 242.58 202.41 77 215.91 180.15 171.65 169.10 245.07 204.50 78 219.36 183.03 174.38 170.60 247.24 206.29 79 222.78 185.89 177.11 171.81 249.01 207.77 80 226.12 188.67 179.76 172.79 250.40 208.94 81 229.20 191.25 182.22 173.63 251.63 209.97 82 232.03 193.60 184.47 174.35 252.67 210.83 83 234.60 195.75 186.51 174.91 253.51 211.53 84 236.86 197.63 188.31 175.37 254.17 212.08 85 238.81 199.26 189.86 175.72 254.67 212.51 86 240.39 200.58 191.12 175.98 255.03 212.80 87 241.58 201.58 192.05 176.13 255.26 212.99 88 242.35 202.21 192.67 176.21 255.37 213.09 89 242.63 202.45 192.89 176.23 255.41 213.10 90+ *See PREMIUM INFORMATION regarding Risk Class and Household Premium Discount rating.
Plan M UM30 1,313.63 131.36 138.40 145.52 152.61 159.52 166.15 171.33 176.21 180.69 184.65 188.00 190.67 192.85 194.84 196.56 197.96 199.07 200.04 200.87 201.53 202.06 202.47 202.75 202.94 203.03 203.05
To obtain annual, semiannual, and quarterly premiums, multiply the above-quoted premiums by 12, 6, and 3, respectively. **Only individuals who are Disabled or have End Stage Renal Disease are eligible for coverage under the age of 65.
RP51.12.B-GA
5
U8183_GA_0011R
