Page 6 - Habitat for Humanity 2020 Benefit Guide

Run Date: 03/2020

BENEFIT AND RATE SCHEDULE

HABITAT FOR HUMANITY OF MICHIGAN
Rate Effective: 07/2020 Renewal July

Customer ID: 257961 Group Division: 007042408-0000
Commercial Benefit Rates

Medical + Medical +
Age Band Total Pharmacy Dental Age Band Total Pharmacy Dental
0 $273.57 $258.52 $15.05 33 $404.85 $404.85 $0.00
1 $273.57 $258.52 $15.05 34 $410.26 $410.26 $0.00
2 $273.57 $258.52 $15.05 35 $412.96 $412.96 $0.00
3 $273.57 $258.52 $15.05 36 $415.67 $415.67 $0.00
4 $273.57 $258.52 $15.05 37 $418.37 $418.37 $0.00
5 $273.57 $258.52 $15.05 38 $421.07 $421.07 $0.00
6 $273.57 $258.52 $15.05 39 $426.48 $426.48 $0.00
7 $273.57 $258.52 $15.05 40 $431.89 $431.89 $0.00
8 $273.57 $258.52 $15.05 41 $440.00 $440.00 $0.00
9 $273.57 $258.52 $15.05 42 $447.77 $447.77 $0.00
10 $273.57 $258.52 $15.05 43 $458.58 $458.58 $0.00
11 $273.57 $258.52 $15.05 44 $472.10 $472.10 $0.00
12 $273.57 $258.52 $15.05 45 $487.99 $487.99 $0.00
13 $273.57 $258.52 $15.05 46 $506.91 $506.91 $0.00
14 $273.57 $258.52 $15.05 47 $528.20 $528.20 $0.00
15 $296.55 $281.50 $15.05 48 $552.53 $552.53 $0.00
16 $305.34 $290.29 $15.05 49 $576.53 $576.53 $0.00
17 $314.13 $299.08 $15.05 50 $603.56 $603.56 $0.00
18 $323.59 $308.54 $15.05 51 $630.26 $630.26 $0.00
19 $318.00 $318.00 $0.00 52 $659.66 $659.66 $0.00
20 $327.80 $327.80 $0.00 53 $689.40 $689.40 $0.00
21 $337.94 $337.94 $0.00 54 $721.50 $721.50 $0.00
22 $337.94 $337.94 $0.00 55 $753.61 $753.61 $0.00
23 $337.94 $337.94 $0.00 56 $788.41 $788.41 $0.00
24 $337.94 $337.94 $0.00 57 $823.56 $823.56 $0.00
25 $339.29 $339.29 $0.00 58 $861.07 $861.07 $0.00
26 $346.05 $346.05 $0.00 59 $879.66 $879.66 $0.00
27 $354.16 $354.16 $0.00 60 $917.17 $917.17 $0.00
28 $367.34 $367.34 $0.00 61 $949.61 $949.61 $0.00
29 $378.15 $378.15 $0.00 62 $970.90 $970.90 $0.00
30 $383.56 $383.56 $0.00 63 $997.60 $997.60 $0.00
31 $391.67 $391.67 $0.00 64 $1,013.82 $1,013.82 $0.00
32 $399.78 $399.78 $0.00 65+ $1,013.82 $1,013.82 $0.00

Medicare Supplemental Benefit Rates
Medical +
Age Band Total Pharmacy Dental
All $845.35 $845.35 $0.00

Reference Number: 58155267