Page 22 - MedigapFreedom Plan Information

QCC Insurance Company MedigapFreedom Premium Information
QCC Insurance Company can only raise your premium if we raise the premium for all policies like yours in our service area. We will not change your premium or cancel your policy because of poor health. These monthly rates are subject to change with the approval of the Pennsylvania Insurance Department.
MONTHLY NON-TOBACCO PREMIUMS
$131.08 $159.06 $200.80 $75.37 $181.55 $68.15 $139.97 $119.16 $144.60 $182.55 $68.52 $165.05 $61.95 $127.25
$137.04 $166.30 $209.77 $78.80 $189.66 $71.25 $146.69 $124.58 $151.18 $190.70 $71.64 $172.42 $64.77 $133.35
$148.61 $180.33 $227.89 $85.45 $206.04 $77.26 $160.62 $135.10 $163.94 $207.17 $77.69 $187.31 $70.24 $146.02
$160.42 $194.66 $246.57 $92.24 $222.93 $83.40 $174.93 $145.84 $176.97 $224.15 $83.86 $202.67 $75.82 $159.03
$169.48 $205.66 $263.94 $97.46 $238.64 $88.11 $188.74 $154.08 $186.97 $239.95 $88.60 $216.94 $80.10 $171.58
$177.60 $215.50 $280.56 $102.12 $253.67 $92.33 $202.04 $161.45 $195.91 $255.06 $92.84 $230.61 $83.94 $183.67
$185.71 $225.35 $300.18 $106.78 $271.40 $96.55 $218.00 $168.82 $204.86 $272.89 $97.08 $246.73 $87.77 $198.18
$189.40 $229.83 $313.44 $108.91 $283.39 $98.47 $228.77 $172.18 $208.94 $284.95 $99.01 $257.63 $89.52 $207.97
(continued)
*This includes people under 65 on Medicare due to disability.
Non-Tobacco rates apply to applications submitted during the six-month open enrollment or in a guaranteed issue situation. Applicants NOT enrolling during the six- month open enrollment period or in a guaranteed issue situation will be evaluated for tobacco usage and charged the corresponding tobacco or non-tobacco rates.
MALE
Attained Age
FEMALE
Plan B
Plan F
Plan F-HD
Plan G
Plan G-HD
Plan N
Plan B
Plan F
Plan F-HD
Plan G
Plan N
$119.16
$144.60
$182.55
$68.52
$165.05
$61.95
$127.25
$129.68
$157.36
$198.17
$74.57
$179.17
$67.42
$139.11
$140.85
$170.91
$216.17
$80.99
$195.45
$73.23
$152.93
$188.01
$237.79
$89.09
$214.99
$80.55
$168.22
71
72
$150.28
$182.36
$232.64
$86.41
$210.34
$78.13
$165.82
$165.31
$200.60
$255.91
$95.06
$231.38
$85.94
$182.41
73
74
$158.20
$191.97
$247.93
$90.97
$224.16
$82.24
$178.03
$174.02
$211.16
$272.72
$100.06
$246.58
$90.47
$195.83
75
76
$164.81
$199.99
$263.38
$94.77
$238.13
$85.68
$190.35
$181.29
$219.99
$289.72
$104.25
$261.95
$94.25
$209.39
77
78
$171.10
$207.62
$279.17
$98.38
$252.41
$88.95
$203.25
$188.21
$228.39
$307.09
$108.22
$277.65
$97.85
$223.58
79
80
FORM #18803 Page 2
Plan G-HD
Plan A
Plan A
Under 65*
$131.08
$159.06
$200.80
$75.37
$181.55
$68.15
$139.97
65-67
68
$142.65
$173.10
$217.99
$82.02
$197.09
$74.16
$153.02
69
70
$154.93