| |
PLAN A
$50,000 / incident |
PLAN B
$100,000 / incident |
| Deductible* Per Policy Period |
| Age |
$50 |
$250 |
$500 |
$1000 |
$50 |
$250 |
$500 |
$1000 |
| 0-5 |
$225 |
$180 |
$162 |
$144 |
$315 |
$252 |
$227 |
$202 |
| 6-18 |
$48 |
$38 |
$34 |
$30 |
$67 |
$53 |
$48 |
$43 |
| 19-29 |
$50 |
$40 |
$36 |
$32 |
$70 |
$56 |
$50 |
$45 |
| 30-39 |
$66 |
$53 |
$48 |
$42 |
$93 |
$74 |
$67 |
$59 |
| 40-49 |
$101 |
$81 |
$73 |
$65 |
$142 |
$113 |
$102 |
$91 |
| 50-59 |
$171 |
$137 |
$123 |
$110 |
$240 |
$192 |
$173 |
$153 |
| 60-64 |
$200 |
$160 |
$144 |
$128 |
$280 |
$224 |
$202 |
$179 |
| 65-69 |
$325 |
$260 |
$234 |
$208 |
$455 |
$364 |
$328 |
$291 |
| 70-79 |
$547 |
$438 |
$394 |
$350 |
N/A |
N/A |
N/A |
N/A |
| 80+** |
$563 |
$450 |
$405 |
$360 |
N/A |
N/A |
N/A |
N/A |
*A $250 Emergency Room deductible will also apply, but will be waived if admitted to
the hospital.
**Medical Expense benefit is reduced to $10,000 for ages 80+. |
| |
PLAN A
$50,000 / incident |
PLAN B
$100,000 / incident |
| Deductible* Per Policy Period |
| Age |
$50 |
$250 |
$500 |
$1000 |
$50 |
$250 |
$500 |
$1000 |
| 0-5 |
$93 |
$74 |
$67 |
$59 |
$130 |
$104 |
$94 |
$83 |
| 6-18 |
$27 |
$21 |
$19 |
$17 |
$37 |
$30 |
$27 |
$24 |
| 19-29 |
$28 |
$22 |
$20 |
$18 |
$39 |
$31 |
$28 |
$25 |
| 30-39 |
$37 |
$30 |
$27 |
$24 |
$52 |
$41 |
$37 |
$33 |
| 40-49 |
$57 |
$45 |
$41 |
$36 |
$79 |
$64 |
$57 |
$51 |
| 50-59 |
$95 |
$76 |
$68 |
$61 |
$133 |
$106 |
$96 |
$85 |
| 60-64 |
$110 |
$88 |
$79 |
$70 |
$154 |
$123 |
$111 |
$99 |
| 65-69 |
$210 |
$168 |
$151 |
$135 |
$294 |
$235 |
$212 |
$188 |
| 70-79 |
$302 |
$241 |
$217 |
$193 |
N/A |
N/A |
N/A |
N/A |
| 80+** |
$310 |
$248 |
$223 |
$198 |
N/A |
N/A |
N/A |
N/A |
*A $250 Emergency Room deductible will also apply, but will be waived if admitted to
the hospital.
**Medical Expense benefit is reduced to $10,000 for ages 80+. |
1) Additional Accidental Death & Dismemberment Coverage
2) Hazardous Activity Coverage |
This will increase your Basic Plan Premium as follows:
Add One Optional Upgrade - Multiply Basic Plan Premium by 1.20
Add Both Optional Upgrades - Multiply Basic Plan Premium by 1.30
|
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