Page 7 - 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-subgroup- 00257961-0001-0002
Commercial Benefit Rates

Medical + Medical +
Age Band Total Pharmacy Dental Vision Age Band Total Pharmacy Dental Vision
0 $234.55 $219.50 $15.05 $0.00 33 $343.74 $343.74 $0.00 $0.00
1 $234.55 $219.50 $15.05 $0.00 34 $348.33 $348.33 $0.00 $0.00
2 $234.55 $219.50 $15.05 $0.00 35 $350.63 $350.63 $0.00 $0.00
3 $234.55 $219.50 $15.05 $0.00 36 $352.92 $352.92 $0.00 $0.00
4 $234.55 $219.50 $15.05 $0.00 37 $355.22 $355.22 $0.00 $0.00
5 $234.55 $219.50 $15.05 $0.00 38 $357.51 $357.51 $0.00 $0.00
6 $234.55 $219.50 $15.05 $0.00 39 $362.11 $362.11 $0.00 $0.00
7 $234.55 $219.50 $15.05 $0.00 40 $366.70 $366.70 $0.00 $0.00
8 $234.55 $219.50 $15.05 $0.00 41 $373.58 $373.58 $0.00 $0.00
9 $234.55 $219.50 $15.05 $0.00 42 $380.18 $380.18 $0.00 $0.00
10 $234.55 $219.50 $15.05 $0.00 43 $389.36 $389.36 $0.00 $0.00
11 $234.55 $219.50 $15.05 $0.00 44 $400.84 $400.84 $0.00 $0.00
12 $234.55 $219.50 $15.05 $0.00 45 $414.33 $414.33 $0.00 $0.00
13 $234.55 $219.50 $15.05 $0.00 46 $430.40 $430.40 $0.00 $0.00
14 $234.55 $219.50 $15.05 $0.00 47 $448.47 $448.47 $0.00 $0.00
15 $254.06 $239.01 $15.05 $0.00 48 $469.13 $469.13 $0.00 $0.00
16 $261.52 $246.47 $15.05 $0.00 49 $489.50 $489.50 $0.00 $0.00
17 $268.98 $253.93 $15.05 $0.00 50 $512.46 $512.46 $0.00 $0.00
18 $277.02 $261.97 $15.05 $0.00 51 $535.12 $535.12 $0.00 $0.00
19 $270.00 $270.00 $0.00 $0.00 52 $560.09 $560.09 $0.00 $0.00
20 $278.32 $278.32 $0.00 $0.00 53 $585.34 $585.34 $0.00 $0.00
21 $286.93 $286.93 $0.00 $0.00 54 $612.60 $612.60 $0.00 $0.00
22 $286.93 $286.93 $0.00 $0.00 55 $639.85 $639.85 $0.00 $0.00
23 $286.93 $286.93 $0.00 $0.00 56 $669.41 $669.41 $0.00 $0.00
24 $286.93 $286.93 $0.00 $0.00 57 $699.25 $699.25 $0.00 $0.00
25 $288.08 $288.08 $0.00 $0.00 58 $731.10 $731.10 $0.00 $0.00
26 $293.82 $293.82 $0.00 $0.00 59 $746.88 $746.88 $0.00 $0.00
27 $300.70 $300.70 $0.00 $0.00 60 $778.73 $778.73 $0.00 $0.00
28 $311.89 $311.89 $0.00 $0.00 61 $806.27 $806.27 $0.00 $0.00
29 $321.07 $321.07 $0.00 $0.00 62 $824.35 $824.35 $0.00 $0.00
30 $325.67 $325.67 $0.00 $0.00 63 $847.02 $847.02 $0.00 $0.00
31 $332.55 $332.55 $0.00 $0.00 64 $860.79 $860.79 $0.00 $0.00
32 $339.44 $339.44 $0.00 $0.00 65+ $860.79 $860.79 $0.00 $0.00

Medicare Supplemental Benefit Rates
Medical +
Age Band Total Pharmacy Dental Vision
All $540.36 $540.36 $0.00 $0.00

Reference Number: NA