Page 34 - APPENDICES for Fred Falten

Accendo Insurance Company
(CVS Group) Rates Effective January 1, 2021
1021 Reams Fleming Boulevard, Franklin, TN 37064; 1-800-264-4000 (Request Accendo Rates)
Pre-Existing Condition Limitations: None
Age Plan A Plan B Plan C Plan D Plan F Plan F+ Plan G Plan G+ Plan K Plan L Plan M Plan N
Male Fem. Male Fem. Male Fem. Male Fem. Male Fem. Male Fem. Male Fem. Male Fem. Male Fem. Male Fem. Male Fem. Male Fem.
< 65 353.86 307.71 472.73 411.09 445.49 387.35 320.29 278.56
65 167.60 145.78 223.99 194.76 211.00 183.43 148.52 129.12
66 169.93 147.77 226.91 197.34 213.75 185.93 151.19 131.45
67 172.68 150.11 230.57 200.50 217.16 188.84 154.27 134.20
68 176.01 153.11 235.07 204.42 221.49 192.59 158.19 137.53
69 179.59 156.19 239.82 208.58 225.99 196.50 161.94 140.78
70 183.43 159.52 244.99 213.00 230.74 200.67 165.60 144.03
71 187.67 163.18 250.73 218.00 236.32 205.42 169.77 147.61
72 191.76 166.77 256.15 222.74 241.49 209.92 173.43 150.86
73 195.67 170.18 261.48 227.41 246.32 214.16 177.01 153.86
74 200.09 174.01 267.31 232.49 251.82 219.00 180.93 157.27
75 204.42 177.76 273.06 237.49 257.31 223.74 184.84 160.69
76 209.08 181.84 279.39 242.90 263.14 228.83 188.92 164.35
77 214.58 186.59 286.55 249.23 269.98 234.74 193.92 168.60
78 219.58 190.92 293.22 254.98 276.31 240.32 198.50 172.60
79 224.91 195.59 300.46 261.31 283.14 246.15 203.42 176.93
80 230.82 200.75 308.54 268.23 290.55 252.65 208.92 181.68
81 237.16 206.25 316.79 275.47 298.38 259.48 214.58 186.59
82 243.49 211.75 325.29 282.89 306.38 266.48 220.33 191.59
83 250.40 217.75 334.62 290.88 315.21 274.14 226.58 197.00
84 257.56 223.99 344.03 299.13 324.12 281.80 233.07 202.67
85 264.48 229.99 353.28 307.21 332.87 289.47 239.24 208.08
86 271.14 235.82 362.19 314.96 341.28 296.80 245.40 213.33
87 278.06 241.82 371.35 322.95 349.86 304.29 251.57 218.83
88 285.05 247.82 380.68 331.03 358.69 311.88 257.90 224.24
89 292.22 254.07 390.18 339.28 367.69 319.71 264.31 229.82
90 299.21 260.23 399.84 347.69 376.68 327.54 270.89 235.49
91 306.63 266.64 409.50 356.11 385.85 335.53 277.39 241.24
92 313.96 272.97 419.33 364.60 395.01 343.53 284.05 246.98
93 321.20 279.30 429.08 373.10 404.25 351.53 290.55 252.65
94 328.29 285.47 438.49 381.35 413.17 359.36 297.05 258.31
95 335.28 291.55 447.65 389.34 421.83 366.77 303.30 263.73
96 341.53 297.05 456.15 396.67 429.91 373.85 309.04 268.73
97 347.19 301.88 463.65 403.17 436.91 379.85 314.04 273.06
98 351.53 305.63 469.48 408.17 442.24 384.60 317.96 276.47
99 353.86 307.71 472.73 411.09 445.49 387.35 320.29 278.56
Notes: Forms are generally available to all medicare recipients in the state (for applicants not in an open enrollment period, simple yes/no underwriting applies). A discount factor of .86 is applied for
applicants eligible for the Household Discount.
4