2011-04 MOO rates.pdf - Google Drive

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

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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

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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

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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

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