Page 38 - APPENDICES for Fred Falten
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Anthem Health Plans of New Hampshire
(Anthem Inc Group) Rates Effective January 1, 2021
3000 Goffs Falls Rd, Manchester, NH 03111-0001; 1-800-232-1261
Pre-Existing Condition Limitations: Maximum Waiting Period: 6 Months
Maximum Lookback Period: 6 Months
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.
< 65 431.51 392.28 664.15 603.77 442.79 402.55 445.14 404.69
65 151.52 137.75 233.22 212.02 155.48 141.36 156.31 142.10
66 163.39 148.52 251.47 228.60 167.65 152.41 168.54 153.21
67 167.42 152.20 257.68 234.26 171.80 156.18 172.71 157.01
68 171.71 156.08 264.28 240.23 176.20 160.18 177.13 161.02
69 176.15 160.14 271.13 246.46 180.77 164.32 181.73 165.18
70 181.16 164.70 278.84 253.51 185.90 169.00 186.87 169.90
71 185.63 168.75 285.71 259.75 190.49 173.16 191.50 174.07
72 190.29 172.99 292.89 266.25 195.28 177.51 196.31 178.45
73 194.18 176.53 298.88 271.72 199.28 181.16 200.33 182.12
74 198.11 180.09 304.91 277.20 203.29 184.81 204.36 185.79
75 202.01 183.64 310.90 282.64 207.30 188.43 208.40 189.42
76 205.97 187.25 317.01 288.20 211.35 192.14 212.47 193.16
77 209.84 190.75 322.95 293.59 215.31 195.75 216.45 196.79
78 212.99 193.62 327.81 298.00 218.54 198.68 219.71 199.74
79 216.13 196.49 332.66 302.41 221.78 201.63 222.95 202.69
80 235.71 214.28 362.79 329.81 241.86 219.89 243.14 221.05
81 255.29 232.09 392.93 357.22 261.95 238.15 263.34 239.41
82 274.87 249.89 423.07 384.58 282.07 256.43 283.56 257.78
83 294.46 267.68 453.21 411.99 302.16 274.68 303.76 276.13
84 314.05 285.49 483.34 439.40 322.25 292.96 323.95 294.51
85 333.61 303.29 513.50 466.80 342.34 311.21 344.15 312.86
86 353.20 321.06 543.60 494.19 362.42 329.49 364.34 331.23
87 372.77 338.87 573.75 521.59 382.52 347.75 384.54 349.60
88 392.35 356.67 603.89 548.98 402.62 366.02 404.75 367.95
89 411.95 374.47 634.01 576.36 422.71 384.26 424.94 386.30
90 431.51 392.28 664.15 603.77 442.79 402.55 445.14 404.69
91 431.51 392.28 664.15 603.77 442.79 402.55 445.14 404.69
92 431.51 392.28 664.15 603.77 442.79 402.55 445.14 404.69
93 431.51 392.28 664.15 603.77 442.79 402.55 445.14 404.69
94 431.51 392.28 664.15 603.77 442.79 402.55 445.14 404.69
95 431.51 392.28 664.15 603.77 442.79 402.55 445.14 404.69
96 431.51 392.28 664.15 603.77 442.79 402.55 445.14 404.69
97 431.51 392.28 664.15 603.77 442.79 402.55 445.14 404.69
98 431.51 392.28 664.15 603.77 442.79 402.55 445.14 404.69
99 431.51 392.28 664.15 603.77 442.79 402.55 445.14 404.69
Notes: Discounts include $48 discount for annual premium payments, $2 discount for electronic funds transfer and Multi-Insured discount of 5% for resdidents from the same occupancy.
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