| Advantage Plan |
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| Monthly Rates |
Member's
Age | Member | Member
& Spouse | Member &
Child(ren) | Family | | Under 30 | $52.00 | $85.00 | $131.00 | $165.00 | | 30-34 | $63.00 | $105.00 | $142.00 | $184.00 | | 35-39 | $69.00 | $116.00 | $148.00 | $196.00 | | 40-44 | $76.00 | $129.00 | $155.00 | $208.00 | | 45-49 | $84.00 | $142.00 | $163.00 | $221.00 | | 50-54 | $92.00 | $156.00 | $171.00 | $235.00 | | 55-59 | $106.00 | $180.00 | $185.00 | $260.00 | | 60-64 | $135.00 | $231.00 | $215.00 | $311.00 | | 65+ * | $175.00 | $302.00 | $254.00 | $381.00 | | | | * Renewal only. Coverage terminates at age 70. | | |
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| Advantage Plus Plan | | | | Monthly Rates | Member's
Age | Member | Member
& Spouse | Member &
Child(ren) | Family | | Under 30 | $86.00 | $148.00 | $227.00 | $289.00 | | 30-34 | $105.00 | $183.00 | $247.00 | $324.00 | | 35-39 | $117.00 | $204.00 | $259.00 | $345.00 | | 40-44 | $131.00 | $228.00 | $272.00 | $369.00 | | 45-49 | $145.00 | $252.00 | $286.00 | $393.00 | | 50-54 | $161.00 | $279.00 | $302.00 | $420.00 | | 55-59 | $189.00 | $327.00 | $330.00 | $468.00 | | 60-64 | $246.00 | $427.00 | $388.00 | $569.00 | | 65+ * | $325.00 | $567.00 | $466.00 | $708.00 |
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| * Renewal only. Coverage terminates at age 70. |
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| Top |
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| Dental Plan | | | Member | Member & Spouse | Member &
Child(ren) | Family | | Monthly | $18 | $36 | $50 | $67 | | | | Coverage terminates at age 70. | | |
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