$250 Deductible

$500 Deductible

$1,000 Deductible

$2,500 Deductible

Age

Male

Female

Male

Female

Male

Female

Male

Female

14 days to 9*

First 2 free, then $400

First 2 free, then $360

First 2 free, then $270

First 2 free, then $240

10 to 18*

$420

$380

$290

$260

19-24

$928

$1,522

$823

$1,427

$648

$1,026

$572

$909

25-29

$1,023

$1,675

$923

$1,575

$716

$1,134

$630

$1,004

30-34

$1,097

$1,871

$972

$1,746

$756

$1,301

$671

$1,152

35-39

$1,276

$2,081

$1,076

$1,881

$833

$1,440

$738

$1,274

40-44

$1,417

$1,728

$1,197

$1,508

$927

$1,170

$824

$1,040

45-49

$1,553

$1,891

$1,323

$1,661

$1,026

$1,292

$909

$1,143

50-54

$1,860

$2,058

$1,620

$1,818

$1,260

$1,418

$1,148

$1,287

55-59

$2,239

$2,239

$1,989

$1,989

$1,489

$1,489

$1,409

$1,409

60-64

$3,171

$2,991

$2,921

$2,741

$2,421

$2,241

$2,233

$2,053

65-69

$6,534

$5,679

$6,284

$5,429

$5,784

$4,929

$4,517

$3,662

70

$7,993

$6,919

$7,743

$6,669

$7,243

$6,169

$5,710

$4,636

71

$8,368

$7,242

$8,118

$6,992

$7,618

$6,492

$6,014

$4,888

72

$8,772

$7,589

$8,522

$7,339

$8,022

$6,839

$6,337

$5,154

73

$9,194

$7,945

$8,944

$7,695

$8,444

$7,195

$6,674

$5,425

74

$9,641

$8,325

$9,391

$8,075

$8,891

$7,575

$7,030

$5,714

$250 Deductible

$500 Deductible

$1,000 Deductible

$2,500 Deductible

Age

Male

Female

Male

Female

Male

Female

Male

Female

14 days to 9*

First 1 free, then $280

First 1 free, then $250

First 1 free, then $190

First 1 free, then $170

10 to 18*

$260

$230

$170

$150

19-25

$529

$732

$469

$676

$369

$499

$326

$441

25-29

$583

$806

$526

$749

$408

$551

$359

$487

30-34

$625

$890

$554

$819

$431

$617

$382

$547

35-39

$727

$1,003

$613

$889

$475

$682

$421

$604

40-44

$808

$985

$682

$860

$528

$667

$470

$593

45-49

$885

$1,078

$754

$947

$585

$736

$518

$652

50-54

$1,060

$1,173

$923

$1,036

$718

$808

$654

$734

55-59

$1,276

$1,276

$1,134

$1,134

$849

$849

$803

$803

60-64

$2,130

$2,027

$1,880

$1,777

$1,380

$1,277

$1,273

$1,170

65-69

$4,047

$3,560

$3,797

$3,310

$3,297

$2,810

$2,575

$2,087

70

$4,879

$4,266

$4,629

$4,016

$4,129

$3,516

$2,629

$2,116

71

$5,092

$4,450

$4,842

$4,200

$4,342

$3,700

$2,767

$2,125

72

$5,323

$4,648

$5,073

$4,398

$4,573

$3,898

$2,973

$2,298

73

$5,563

$4,851

$5,313

$4,601

$4,813

$4,101

$3,188

$2,476

74

$5,818

$5,068

$5,568

$4,818

$5,068

$4,318

$3,418

$2,668

*First child age 14 days to 9 years is free only when both parents are insured under the Premier Plan. The Dependent Child rate is only available when parent (guardian) is insured under the Premier Plan. Dependent children alone must pay the age 19 to 24 rate.

$1,000 Deductible

$2,500 Deductible

$5,000 Deductible

Age

Male

Female

Male

Female

Male

Female

14 days to 18*

$210

$185

$150

19-39

$261

$413

$232

$365

$175

$274

40-49

$325

$405

$285

$360

$215

$270

50-59

$470

$470

$445

$445

$335

$335

60-69

$1,820

$1,550

$815

$800

$610

$600

70-74

$2,790

$2,400

$1,300

$1,125

$1,000

$850

*The Dependent Child rate is only available when parent (guardian) is insured under the Risk Share Plan. Dependent children alone must pay the age 19 to 24 rate.

A one-time, non-refundable Policy Fee is required with each Application for the Risk-Share Plan.