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Apply Online Now - Electronic
Application
Index | Plan
Limitations | Locate
Providers | Brochure & Application
Plan Benefits:
Elect Premiere | Elect Preferred | Elect
HSA | Elect Value Option
Plan Rates:
Elect Premiere | Elect Preferred | Elect
HSA | Elect Value Option
Elect Value Option Rates
Effective date : 1/1/2010
Valid thru : 12/31/2010
Counties :
Available in all counties
| Family Status : |
Applicant |
Applicant and Spouse |
Applicant and Family |
Applicant and Child(ren) |
| Age |
Deductible : 2500 |
| 0-17 |
75.00 |
N/A |
N/A |
N/A |
| 18-20 |
95.00 |
191.00 |
276.00 |
172.00 |
| 21-24 |
99.00 |
197.00 |
286.00 |
177.00 |
| 25-29 |
114.00 |
229.00 |
343.00 |
206.00 |
| 30-34 |
130.00 |
259.00 |
389.00 |
233.00 |
| 35-39 |
143.00 |
285.00 |
428.00 |
257.00 |
| 40-44 |
180.00 |
361.00 |
505.00 |
325.00 |
| 45-49 |
211.00 |
422.00 |
591.00 |
380.00 |
| 50-54 |
283.00 |
566.00 |
708.00 |
510.00 |
| 55-59 |
347.00 |
694.00 |
798.00 |
624.00 |
| 60-64 |
403.00 |
805.00 |
886.00 |
725.00 |
| 65+ |
403.00 |
805.00 |
886.00 |
725.00 |
| Age |
Deductible : 5000 |
| 0-17 |
48.00 |
N/A |
N/A |
N/A |
| 18-20 |
60.00 |
121.00 |
175.00 |
109.00 |
| 21-24 |
62.00 |
125.00 |
181.00 |
112.00 |
| 25-29 |
73.00 |
145.00 |
218.00 |
131.00 |
| 30-34 |
82.00 |
164.00 |
247.00 |
148.00 |
| 35-39 |
90.00 |
181.00 |
271.00 |
163.00 |
| 40-44 |
114.00 |
229.00 |
320.00 |
206.00 |
| 45-49 |
134.00 |
268.00 |
375.00 |
241.00 |
| 50-54 |
180.00 |
359.00 |
449.00 |
323.00 |
| 55-59 |
220.00 |
440.00 |
506.00 |
396.00 |
| 60-64 |
255.00 |
511.00 |
562.00 |
460.00 |
| 65+ |
255.00 |
511.00 |
562.00 |
460.00 |
| Age |
Deductible : 7500 |
| 0-17 |
33.00 |
N/A |
N/A |
N/A |
| 18-20 |
42.00 |
83.00 |
121.00 |
75.00 |
| 21-24 |
43.00 |
86.00 |
125.00 |
78.00 |
| 25-29 |
50.00 |
100.00 |
150.00 |
90.00 |
| 30-34 |
57.00 |
114.00 |
170.00 |
102.00 |
| 35-39 |
62.00 |
125.00 |
187.00 |
112.00 |
| 40-44 |
79.00 |
158.00 |
221.00 |
142.00 |
| 45-49 |
92.00 |
185.00 |
259.00 |
166.00 |
| 50-54 |
124.00 |
248.00 |
310.00 |
223.00 |
| 55-59 |
152.00 |
303.00 |
349.00 |
273.00 |
| 60-64 |
176.00 |
352.00 |
388.00 |
317.00 |
| 65+ |
176.00 |
352.00 |
388.00 |
317.00 |
| Age |
Deductible : 10000 |
| 0-17 |
24.00 |
N/A |
N/A |
N/A |
| 18-20 |
31.00 |
61.00 |
89.00 |
55.00 |
| 21-24 |
32.00 |
63.00 |
92.00 |
57.00 |
| 25-29 |
37.00 |
74.00 |
110.00 |
66.00 |
| 30-34 |
42.00 |
83.00 |
125.00 |
75.00 |
| 35-39 |
46.00 |
92.00 |
138.00 |
83.00 |
| 40-44 |
58.00 |
116.00 |
162.00 |
104.00 |
| 45-49 |
68.00 |
136.00 |
190.00 |
122.00 |
| 50-54 |
91.00 |
182.00 |
228.00 |
164.00 |
| 55-59 |
111.00 |
223.00 |
256.00 |
201.00 |
| 60-64 |
129.00 |
259.00 |
285.00 |
233.00 |
| 65+ |
129.00 |
259.00 |
285.00 |
233.00 |
* - not all of the zip codes are eligible in this county
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