| $250 Deductible | $500 Deductible | $1,000 Deductible | $2,500 Deductible | $5,000 Deductible | ||||||
| Age | Male | Female | Male | Female | Male | Female | Male | Female | Male | Female |
| 14 days to 9* | $652 | $652 | $600 | $600 | $516 | $516 | $373 | $373 | $250 | $250 |
| 10-18* | $913 | $913 | $854 | $854 | $751 | $751 | $569 | $569 | $401 | $401 |
| 19-24 | $901 | $1,649 | $845 | $1,563 | $748 | $1,407 | $575 | $1,122 | $410 | $838 |
| 25-29 | $1,009 | $2,046 | $948 | $1,948 | $843 | $1,765 | $651 | $1,428 | $469 | $1,090 |
| 30-34 | $1,247 | $2,210 | $1,179 | $2,108 | $1,055 | $1,918 | $832 | $1,561 | $611 | $1,192 |
| 35-39 | $1,560 | $2,352 | $1,482 | $2,246 | $1,340 | $2,047 | $1,075 | $1,669 | $808 | $1,276 |
| 40-44 | $2,007 | $2,630 | $1,917 | $2,518 | $1,748 | $2,302 | $1,430 | $1,889 | $1,099 | $1,452 |
| 45-49 | $2,665 | $3,145 | $2,558 | $3,020 | $2,351 | $2,776 | $1,959 | $2,309 | $1,539 | $1,803 |
| 50-54 | $3,600 | $3,884 | $3,470 | $3,743 | $3,214 | $3,465 | $2,724 | $2,928 | $2,184 | $2,331 |
| 55-59 | $4,825 | $4,738 | $4,669 | $4,581 | $4,356 | $4,267 | $3,757 | $3,659 | $3,075 | $2,967 |
| 60-64 | $5,930 | $5,451 | $5,758 | $5,288 | $5,406 | $4,954 | $4,734 | $4,311 | $3,947 | $3,561 |
| 65-69 | $8,998 | $7,847 | $8,670 | $7,519 | $8,016 | $6,861 | $6,233 | $5,187 | $5,407 | $4,565 |
| 70 | $10,610 | $9,173 | $10,277 | $8,851 | $9,613 | $8,187 | $7,580 | $6,153 | $6,575 | $5,319 |
| 71 | $11,107 | $9,612 | $10,775 | $9,282 | $10,111 | $8,617 | $7,983 | $6,488 | $6,925 | $5,608 |
| 72 | $11,532 | $9,977 | $11,204 | $9,648 | $10,547 | $8,991 | $8,330 | $6,776 | $7,226 | $5,856 |
| 73 | $11,970 | $10,344 | $11,645 | $10,019 | $10,993 | $9,369 | $8,690 | $7,063 | $7,538 | $6,105 |
| 74 | $12,553 | $10,839 | $12,227 | $10,514 | $11,576 | $9,863 | $9,153 | $7,438 | $7,940 | $6,430 |
| *First 2 children age 14 days to 9 are free only when both parents are insured under the plan. The dependent child rate is only available when parent (guardian) is insured under the plan. Dependent children alone must pay the age 19 to 24 Male rate. | ||||||||||
| $250 Deductible | $500 Deductible | $1,000 Deductible | $2,500 Deductible | $5,000 Deductible | ||||||
| Age | Male | Female | Male | Female | Male | Female | Male | Female | Male | Female |
| 14 days to 9* | $509 | $509 | $468 | $468 | $402 | $402 | $291 | $291 | $196 | $196 |
| 10-18* | $712 | $712 | $665 | $665 | $585 | $585 | $444 | $444 | $313 | $313 |
| 19-24 | $702 | $1,286 | $658 | $1,219 | $583 | $1,098 | $448 | $876 | $320 | $654 |
| 25-29 | $787 | $1,596 | $739 | $1,519 | $657 | $1,376 | $508 | $1,114 | $366 | $851 |
| 30-34 | $973 | $1,724 | $920 | $1,644 | $822 | $1,495 | $649 | $1,218 | $477 | $930 |
| 35-39 | $1,217 | $1,835 | $1,156 | $1,752 | $1,044 | $1,597 | $838 | $1,302 | $630 | $995 |
| 40-44 | $1,626 | $2,129 | $1,553 | $2,039 | $1,416 | $1,865 | $1,158 | $1,529 | $889 | $1,176 |
| 45-49 | $2,159 | $2,547 | $2,072 | $2,446 | $1,904 | $2,247 | $1,586 | $1,870 | $1,246 | $1,461 |
| 50-54 | $2,916 | $3,146 | $2,812 | $3,032 | $2,604 | $2,806 | $2,207 | $2,371 | $1,768 | $1,887 |
| 55-59 | $3,957 | $3,885 | $3,828 | $3,755 | $3,572 | $3,500 | $3,080 | $3,000 | $2,523 | $2,434 |
| 60-64 | $4,863 | $4,470 | $4,722 | $4,335 | $4,433 | $4,063 | $3,882 | $3,534 | $3,237 | $2,921 |
| 65-69 | $7,378 | $6,435 | $7,110 | $6,165 | $6,573 | $5,626 | $5,111 | $4,253 | $4,433 | $3,743 |
| 70 | $8,806 | $7,614 | $8,530 | $7,346 | $7,979 | $6,795 | $6,291 | $5,107 | $5,457 | $4,414 |
| 71 | $9,219 | $7,978 | $8,943 | $7,704 | $8,392 | $7,152 | $6,626 | $5,385 | $5,747 | $4,654 |
| 72 | $9,572 | $8,281 | $9,299 | $8,008 | $8,754 | $7,463 | $6,914 | $5,624 | $5,997 | $4,861 |
| 73 | $9,935 | $8,586 | $9,665 | $8,316 | $9,125 | $7,776 | $7,213 | $5,862 | $6,257 | $5,067 |
| 74 | $10,419 | $8,997 | $10,148 | $8,726 | $9,608 | $8,186 | $7,597 | $6,174 | $6,590 | $5,336 |
| *First 2 children age 14 days to 9 are free only when both parents are insured under the plan. The dependent child rate is only available when parent (guardian) is insured under the plan. Dependent children alone must pay the age 19 to 24 Male rate. | ||||||||||
| Age | Option 1 | Option 2 |
| 19 to 29 | $130 | $230 |
| 30-39 | $210 | $370 |
| 40-44 | $310 | $545 |
| 45-49 | $450 | $790 |
| 50-54 | $570 | $1000 |
| 55-59 | $770 | $1350 |
| 60-64 | $585 | $1025 |
| 65-69 | $315 | Not Available |
| Dependent Child | $85 | Not Available |
| US Citizen | $348 |
| All Others | $492 |
| 14 days - 59 years | $250 |
| Rates effective through 08/31/2010 |
| Rates include Surplus Lines Taxes and Fees when applicable. |
|
THIS MEDICAL AND DENTAL IS UNDERWRITTEN BY SYNDICATE 4141 AT LLOYD'S, LONDON. THIS LIFE INSURANCE IS UNDERWRITTEN BY SYNDICATE 308, ALSO AT LLOYD?S. THE INSURANCE IS AVAILABLE TO MEMBERS OF THE ATLAS/INTERNATIONAL CITIZEN GROUP INSURANCE TRUST, HAMILTON, BERMUDA. LLOYD'S IS AN APPROVED NON-ADMITTED INSURER IN ALL STATES OF THE UNITED STATES, EXCEPT KENTUCKY AND ILLINOIS WHERE THEY ARE ADMITTED. CLAIMS UNDER THIS INSURANCE MAY NOT BE MADE AGAINST ANY STATE GUARANTY FUND. |
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