CoventryOne
POS Qualified High Deductible Plan Monthly Rates
Effective 3/16/08
Monthly
Rates shown are effective 3-16-2008 and issued for illustrative
purposes only. All applicants are subject to medical underwriting
and approval by Coventry Health Care of Georgia, Inc.
NOTE:
FOR ALL PLANS, CALCULATE THE PREMIUM FOR THE AGE OF EACH
FAMILY MEMBER - IF THERE ARE 4 OR MORE MEMBERS TO BE COVERED IN
YOUR FAMILY, A 10% FAMILY DISCOUNT WILL BE GIVEN (tobacco users,
add 20%)
RATES
- AREA 1
- Use
these rates if your zip code is in Banks, Barrow, Bartow, Butts,
Carroll, Cherokee, Clarke, Clayton, Cobb, Coweta, Dawson, Dekalb,
Douglas, Fayette, Forsyth, Fulton, Gordon, Greene, Gwinnett, Haralson,
Heard, Henry, Jackson, Jasper, Madison, Meriwether, Morgan, Newton,
Oconee, Oglethorpe, Paulding, Pike, Rockdale, Spalding, Troup,
Walton or Wilkes County in Georgia
These
rates are available for applicants with effective dates from March
16, 2008 to June 15, 2008.
| $1,250/$5,000 DEDUCTIBLE | $3,000/$5,500 DEDUCTIBLE | $5,000/$10,000 DEDUCTIBLE | ||||
| Age | Male | Female | Male | Female | Male | Female |
| > 1 | $248 | $248 | $168 | $168 | $131 | $131 |
| 1-19 | 113 | 113 | 76 | 76 | 59 | 59 |
| 20-24 | 113 | 162 | 76 | 112 | 59 | 87 |
| 25-29 | 124 | 207 | 84 | 141 | 65 | 109 |
| 30-34 | 152 | 225 | 102 | 154 | 80 | 119 |
| 35-39 | 176 | 241 | 119 | 164 | 93 | 127 |
| 40-44 | 202 | 281 | 138 | 191 | 107 | 148 |
| 45-49 | 281 | 338 | 191 | 229 | 148 | 179 |
| 50-54 | 383 | 406 | 261 | 276 | 201 | 215 |
| 55-59 | 494 | 455 | 338 | 309 | 262 | 241 |
| 60-64 | 675 | 529 | 461 | 360 | 357 | 279 |
RATES
- AREA 2
-
Use
these rates if your zip code is in Aiken, Atkinson, Baldwin, Bibb,
Bleckley, Brantley, Burke, Chattooga, Columbia, Crawford, Dooly,
Floyd, Gilmer, Habersham, Hall, Houston, Jones, Lamar, Lincoln,
Lumpkin, Macon, McDuffie, Monroe, Peach, Pickens, Pierce, Polk,
Richmond, Taylor, Twiggs, Union, Upson, Ware, White or Wilkinson
County
These
rates are available for applicants with effective dates from March
16, 2008 to June 15, 2008.
| $1,250/$5,000 DEDUCTIBLE | $3,000/$6,000 DEDUCTIBLE | $5,000/$10,000 DEDUCTIBLE | ||||
| Age | Male | Female | Male | Female | Male | Female |
| > 1 | $272.80 | $272.80 | $184.80 | $184.80 | $144.10 | $144.10 |
| 1-19 | 124.30 | 124.30 | 83.60 | 83.60 | 64.90 | 64.90 |
| 20-24 | 124.30 | 178.20 | 83.60 | 123.20 | 64.90 | 95.70 |
| 25-29 | 136.40 | 227.70 | 92.40 | 155.10 | 71.50 | 119.90 |
| 30-34 | 167.20 | 247.50 | 112.20 | 169.40 | 88.00 | 130.90 |
| 35-39 | 193.60 | 265.10 | 130.90 | 180.40 | 102.30 | 139.70 |
| 40-44 | 222.20 | 309.10 | 151.80 | 210.10 | 117.70 | 162.80 |
| 45-49 | 309.10 | 371.80 | 210.10 | 251.90 | 162.80 | 196.60 |
| 50-54 | 421.30 | 446.60 | 287.10 | 303.60 | 221.10 | 236.50 |
| 55-59 | 543.40 | 500.50 | 371.80 | 339.90 | 288.20 | 265.10 |
| 60-64 | 742.50 | 581.90 | 507.10 | 396.00 | 392.70 | 306.90 |
RATES
- AREA 3
- Use
these rates if your zip code is in Appling, Bryan, Bulloch, Candler,
Chatham, Coffee, Effingham, Emanuel, Evans, Liberty, Long, McIntosh,
Screven or Wayne County.
These
rates are available for applicants with effective dates from March
16, 2008 to June 15, 2008.
| $1,250/$5,000 DEDUCTIBLE | $3,000/$6,000 DEDUCTIBLE | $5,000/$10,000 DEDUCTIBLE | ||||
| Age | Male | Female | Male | Female | Male | Female |
| > 1 | $235.60 | $235.60 | $159.60 | $159.60 | $124.45 | $124.45 |
| 1-19 | 107.35 | 107.35 | 72.20 | 72.20 | 56.05 | 56.05 |
| 20-24 | 107.35 | 153.90 | 72.20 | 106.40 | 56.05 | 82.65 |
| 25-29 | 117.80 | 196.65 | 79.80 | 133.95 | 61.75 | 103.55 |
| 30-34 | 144.40 | 213.75 | 96.90 | 146.30 | 76.00 | 113.05 |
| 35-39 | 167.20 | 228.95 | 113.05 | 155.80 | 88.35 | 120.65 |
| 40-44 | 191.90 | 266.95 | 131.10 | 181.45 | 101.65 | 140.60 |
| 45-49 | 266.95 | 321.10 | 181.45 | 217.55 | 140.60 | 170.05 |
| 50-54 | 363.85 | 385.70 | 247.95 | 262.20 | 190.95 | 204.25 |
| 55-59 | 469.30 | 432.25 | 321.10 | 293.55 | 248.90 | 228.95 |
| 60-64 | 641.25 | 502.55 | 437.95 | 342.00 | 339.15 | 265.05 |
| Click here to view the CoventryOne HSA Plan Benefits | Click here to view the CoventryOne Individual Plan Benefits | |||||||||||
| Click here to have an enrollment kit mailed or e-mailed to you Be sure to specify which plan(s) you're interested in | ||||||||||||
|
CLICK HERE
TO DOWNLOAD AND PRINT AN APPLICATION (Adobe Acrobat reader is necessary to download this file.) Click here to download the free Adobe Acrobat reader |
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