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Group Name: Angeles Contractors Inc.
Group Number: 236178
Rate Effective Period: 8/1/2017 - 7/31/2018
Monthly Rates by Age

Proposed Rates
HMO HMO
Platinum Advantage 20-40/30% Gold Advantage 30-50/30%
Age Rate Age Rate
<21 $206.08 <21 $185.07
21 $324.54 21 $291.45
22 $324.54 22 $291.45
23 $324.54 23 $291.45
24 $324.54 24 $291.45
25 $325.84 25 $292.62
26 $332.33 26 $298.44
27 $340.12 27 $305.44
28 $352.77 28 $316.81
29 $363.16 29 $326.13
30 $368.35 30 $330.80
31 $376.14 31 $337.79
32 $383.93 32 $344.79
33 $388.80 33 $349.16
34 $393.99 34 $353.82
35 $396.59 35 $356.15
36 $399.18 36 $358.48
37 $401.78 37 $360.82
38 $404.38 38 $363.15
39 $409.57 39 $367.81
40 $414.76 40 $372.47
41 $422.55 41 $379.47
42 $430.02 42 $386.17
43 $440.40 43 $395.50
44 $453.38 44 $407.16
45 $468.64 45 $420.85
46 $486.81 46 $437.18
47 $507.26 47 $455.54
48 $530.62 48 $476.52
49 $553.67 49 $497.21
50 $579.63 50 $520.53
51 $605.27 51 $543.55
52 $633.50 52 $568.91
53 $662.06 53 $594.56
54 $692.89 54 $622.25
55 $723.72 55 $649.93
56 $757.15 56 $679.95
57 $790.90 57 $710.26
58 $826.93 58 $742.61
59 $844.78 59 $758.64
60 $880.80 60 $791.00
61 $911.96 61 $818.97
62 $932.40 62 $837.34
63 $958.04 63 $860.36
64+ $973.62 64+ $874.35
Children Under 21 Children Under 21
Number Rate Number Rate
1 $206.08 1 $185.07
2 $412.16 2 $370.14
3+ $618.24 3+ $555.21

Printed 5/8/2017 7
Quote Number CA236178 www.uhcwest.com or www.myuhc.com