MONTHLY NON-TOBACCO PREMIUMS* ZIP CODES: 304-307, 310, 312, 315-319, 398 Plan A UM20 933.68 93.37 97.30 101.30 105.25 109.17 113.01 115.95 118.77 121.46 123.97 126.29 128.46 130.57 132.67 134.80 136.90 138.95 140.85 142.58 144.16 145.55 146.75 147.72 148.46 148.93 149.09
FEMALE Plan F Plan G UM23 UM24 1,515.56 1,264.64 151.56 126.46 157.94 131.78 164.41 137.18 170.85 142.55 177.21 147.87 183.43 153.05 188.20 157.03 192.79 160.86 197.14 164.49 201.23 167.90 205.00 171.05 208.51 173.99 211.93 176.84 215.36 179.70 218.80 182.57 222.22 185.42 225.55 188.19 228.61 190.76 231.43 193.11 234.00 195.25 236.26 197.13 238.19 198.76 239.78 200.07 240.96 201.06 241.73 201.69 242.01 201.94
MALE Plan M UM30 1,151.02 115.10 119.95 124.87 129.76 134.60 139.31 142.93 146.42 149.73 152.84 155.69 158.36 160.97 163.57 166.17 168.77 171.29 173.64 175.78 177.73 179.44 180.93 182.12 183.01 183.60 183.81
Issue Age Thru 64‡ 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90+
Plan A UM20 1,015.42 101.54 106.97 112.48 117.96 123.31 128.43 132.43 136.20 139.67 142.73 145.33 147.38 149.06 150.60 151.93 153.01 153.88 154.63 155.27 155.78 156.18 156.49 156.72 156.86 156.93 156.94
Plan F UM23 1,648.21 164.82 173.64 182.58 191.47 200.15 208.47 214.96 221.08 226.71 231.68 235.87 239.22 241.96 244.45 246.61 248.38 249.77 250.99 252.02 252.87 253.52 254.02 254.39 254.61 254.71 254.76
Plan G UM24 1,375.30 137.53 144.88 152.34 159.77 167.01 173.94 179.37 184.47 189.16 193.31 196.82 199.61 201.89 203.98 205.77 207.25 208.41 209.43 210.29 210.99 211.53 211.96 212.26 212.44 212.56 212.56
Plan M UM30 1,251.78 125.18 131.89 138.67 145.43 152.01 158.33 163.27 167.91 172.18 175.96 179.15 181.69 183.77 185.66 187.30 188.64 189.70 190.62 191.41 192.04 192.54 192.94 193.20 193.39 193.48 193.49
*See PREMIUM INFORMATION regarding Risk Class and Household Premium Discount rating. ‡Only individuals who are Disabled or have End Stage Renal Disease are eligible for coverage under the age of 65. To obtain annual, semiannual, and quarterly premiums, multiply the above-quoted premiums by 12, 6, and 3, respectively.
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MONTHLY TOBACCO PREMIUMS* ZIP CODES: 304-307, 310, 312, 315-319, 398 Plan A UM20 1,073.19 107.32 111.84 116.43 120.98 125.49 129.90 133.27 136.52 139.60 142.49 145.16 147.65 150.08 152.50 154.94 157.35 159.71 161.89 163.88 165.70 167.30 168.67 169.80 170.64 171.18 171.37
FEMALE Plan F Plan G UM23 UM24 1,742.02 1,453.61 174.21 145.36 181.53 151.47 188.97 157.68 196.38 163.85 203.69 169.97 210.84 175.92 216.33 180.49 221.60 184.90 226.59 189.07 231.30 192.99 235.63 196.61 239.67 199.99 243.60 203.26 247.54 206.55 251.49 209.85 255.43 213.12 259.25 216.31 262.77 219.27 266.02 221.96 268.97 224.43 271.56 226.58 273.79 228.45 275.60 229.97 276.96 231.11 277.85 231.83 278.17 232.11
MALE Plan M UM30 1,323.02 132.30 137.88 143.53 149.15 154.72 160.12 164.29 168.30 172.10 175.68 178.96 182.02 185.02 188.01 191.00 193.99 196.89 199.58 202.05 204.29 206.25 207.96 209.33 210.36 211.03 211.28
Issue Age Thru 64‡ 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90+
Plan A UM20 1,167.15 116.71 122.95 129.29 135.58 141.74 147.62 152.22 156.55 160.54 164.06 167.04 169.40 171.33 173.10 174.63 175.87 176.87 177.74 178.47 179.05 179.52 179.88 180.14 180.30 180.38 180.40
Plan F UM23 1,894.50 189.45 199.59 209.86 220.08 230.06 239.62 247.08 254.12 260.58 266.30 271.12 274.97 278.12 280.98 283.46 285.49 287.09 288.49 289.68 290.65 291.41 291.98 292.40 292.66 292.77 292.83
Plan G UM24 1,580.80 158.08 166.53 175.11 183.64 191.96 199.93 206.17 212.03 217.43 222.20 226.23 229.44 232.06 234.46 236.51 238.21 239.56 240.72 241.71 242.51 243.14 243.64 243.98 244.19 244.32 244.32
Plan M UM30 1,438.83 143.88 151.60 159.39 167.16 174.73 181.99 187.66 193.00 197.91 202.26 205.92 208.84 211.23 213.40 215.29 216.83 218.04 219.10 220.01 220.74 221.31 221.77 222.07 222.28 222.39 222.40
*See PREMIUM INFORMATION regarding Risk Class and Household Premium Discount rating. ‡Only individuals who are Disabled or have End Stage Renal Disease are eligible for coverage under the age of 65. To obtain annual, semiannual, and quarterly premiums, multiply the above-quoted premiums by 12, 6, and 3, respectively.
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MONTHLY NON-TOBACCO PREMIUMS* ZIP CODES: 300-303, 308-309, 311, 313-314, 399 Plan A UM20 1,021.55 102.16 106.46 110.83 115.16 119.45 123.65 126.86 129.95 132.89 135.64 138.18 140.55 142.86 145.16 147.48 149.78 152.02 154.10 156.00 157.73 159.25 160.56 161.63 162.43 162.94 163.12
FEMALE Plan F Plan G UM23 UM24 1,658.20 1,383.67 165.83 138.36 172.80 144.18 179.88 150.10 186.93 155.96 193.89 161.79 200.70 167.45 205.92 171.80 210.93 176.00 215.69 179.98 220.17 183.71 224.29 187.15 228.13 190.37 231.88 193.48 235.63 196.61 239.39 199.75 243.13 202.87 246.78 205.90 250.13 208.72 253.22 211.28 256.02 213.63 258.49 215.68 260.61 217.46 262.34 218.90 263.64 219.99 264.48 220.67 264.79 220.94
MALE Plan M UM30 1,259.36 125.94 131.24 136.63 141.97 147.27 152.42 156.38 160.20 163.82 167.23 170.35 173.26 176.12 178.97 181.81 184.65 187.41 189.98 192.32 194.46 196.33 197.96 199.26 200.24 200.88 201.11
Issue Age Thru 64‡ 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90+
Plan A UM20 1,110.99 111.10 117.04 123.06 129.06 134.92 140.52 144.89 149.02 152.82 156.16 159.00 161.25 163.09 164.77 166.23 167.41 168.36 169.18 169.89 170.44 170.88 171.22 171.47 171.63 171.70 171.72
Plan F UM23 1,803.34 180.33 189.99 199.76 209.49 218.99 228.09 235.19 241.89 248.05 253.48 258.07 261.74 264.74 267.46 269.82 271.75 273.27 274.61 275.74 276.66 277.38 277.93 278.33 278.57 278.69 278.74
Plan G UM24 1,504.74 150.48 158.52 166.68 174.81 182.73 190.31 196.25 201.83 206.97 211.51 215.34 218.40 220.89 223.17 225.13 226.75 228.03 229.14 230.08 230.84 231.44 231.91 232.24 232.44 232.56 232.57
Plan M UM30 1,369.60 136.96 144.30 151.72 159.12 166.32 173.24 178.63 183.71 188.38 192.53 196.01 198.79 201.06 203.13 204.93 206.39 207.55 208.56 209.43 210.12 210.67 211.10 211.39 211.59 211.69 211.70
*See PREMIUM INFORMATION regarding Risk Class and Household Premium Discount rating. ‡Only individuals who are Disabled or have End Stage Renal Disease are eligible for coverage under the age of 65. To obtain annual, semiannual, and quarterly premiums, multiply the above-quoted premiums by 12, 6, and 3, respectively.
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MONTHLY TOBACCO PREMIUMS* ZIP CODES: 300-303, 308-309, 311, 313-314, 399 Plan A UM20 1,174.20 117.42 122.37 127.39 132.37 137.30 142.12 145.82 149.37 152.74 155.91 158.83 161.55 164.20 166.85 169.52 172.16 174.74 177.13 179.30 181.29 183.04 184.55 185.78 186.70 187.29 187.50
FEMALE Plan F Plan G UM23 UM24 1,905.98 1,590.42 190.60 159.04 198.62 165.73 206.76 172.52 214.86 179.27 222.87 185.96 230.69 192.47 236.69 197.48 242.45 202.30 247.92 206.87 253.07 211.16 257.81 215.11 262.22 218.81 266.53 222.39 270.84 225.99 275.16 229.60 279.47 233.18 283.65 236.67 287.50 239.90 291.05 242.85 294.28 245.55 297.12 247.91 299.55 249.96 301.54 251.61 303.03 252.86 304.00 253.65 304.35 253.96
MALE Plan M UM30 1,447.54 144.75 150.86 157.04 163.19 169.28 175.19 179.75 184.14 188.30 192.21 195.80 199.15 202.43 205.71 208.98 212.25 215.42 218.36 221.06 223.52 225.66 227.53 229.03 230.16 230.89 231.16
Issue Age Thru 64‡ 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90+
Plan A UM20 1,277.00 127.70 134.52 141.45 148.34 155.08 161.51 166.54 171.29 175.65 179.50 182.76 185.34 187.46 189.39 191.07 192.43 193.51 194.46 195.27 195.90 196.42 196.81 197.10 197.27 197.36 197.37
Plan F UM23 2,072.80 207.28 218.37 229.61 240.80 251.71 262.17 270.33 278.03 285.11 291.36 296.63 300.85 304.30 307.42 310.14 312.36 314.11 315.64 316.94 318.00 318.83 319.46 319.92 320.20 320.33 320.39
Plan G UM24 1,729.59 172.96 182.21 191.59 200.93 210.03 218.75 225.57 231.99 237.89 243.11 247.52 251.04 253.90 256.52 258.77 260.63 262.10 263.38 264.46 265.34 266.03 266.57 266.94 267.17 267.31 267.32
Plan M UM30 1,574.25 157.42 165.87 174.39 182.89 191.17 199.12 205.33 211.17 216.53 221.29 225.30 228.49 231.11 233.49 235.55 237.23 238.56 239.73 240.72 241.51 242.14 242.65 242.97 243.20 243.32 243.33
*See PREMIUM INFORMATION regarding Risk Class and Household Premium Discount rating. ‡Only individuals who are Disabled or have End Stage Renal Disease are eligible for coverage under the age of 65. To obtain annual, semiannual, and quarterly premiums, multiply the above-quoted premiums by 12, 6, and 3, respectively.
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