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Group Name: Angeles Contractors Inc.
Group Number: 06U7556
Rate Effective Period: 8/1/2017 - 7/31/2018
Monthly Rates by Age

Proposed Rates
PPO
Gold Select Plus Select Plus Direct 20/750/80% Plan AK-R8
Age Rate
<21 $232.45
21 $366.06
22 $366.06
23 $366.06
24 $366.06
25 $367.52
26 $374.85
27 $383.63
28 $397.91
29 $409.62
30 $415.48
31 $424.26
32 $433.05
33 $438.54
34 $444.40
35 $447.33
36 $450.25
37 $453.18
38 $456.11
39 $461.97
40 $467.82
41 $476.61
42 $485.03
43 $496.74
44 $511.39
45 $528.59
46 $549.09
47 $572.15
48 $598.51
49 $624.50
50 $653.78
51 $682.70
52 $714.55
53 $746.76
54 $781.54
55 $816.31
56 $854.02
57 $892.09
58 $932.72
59 $952.85
60 $993.49
61 $1,028.63
62 $1,051.69
63 $1,080.61
64+ $1,098.18
Children Under 21
Number Rate
1 $232.45
2 $464.90
3+ $697.35

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