Page 41 - APPENDICES for Fred Falten

Fem. 167.10 103.46 106.46 109.37 112.37 115.20 118.12 121.12 124.12 126.87 129.70 132.53 135.36 137.94 140.44 142.94 145.36 147.94 150.44 153.11 155.69 158.19 160.60 162.85 164.60 166.27 167.10 167.10 167.10 167.10 167.10 167.10 167.10 167.10 167.10 167.10
Plan N
Male 177.35 109.87 112.95 116.20 119.20 122.37 125.53 128.62 131.70 134.70 137.69 140.61 143.53 146.44 149.11 151.77 154.35 157.02 159.85 162.52 165.35 167.93 170.52 172.85 174.93 176.51 177.35 177.35 177.35 177.35 177.35 177.35 177.35 177.35 177.35 177.35

Fem.
Rates Effective January 1, 2021
Plan M
Male

Fem.
Plan L
Male

Fem.
Plan K
Male

Plan G+ Fem. Male

Fem. 271.14 173.43 178.26 183.09 187.67 192.42 197.09 201.75 206.42 211.00 215.33 219.75 223.91 228.08 231.82 235.49 239.24 243.07 246.90 250.73 254.40 258.06 261.48 264.81 267.56 269.81 271.14 271.14 271.14 271.14 271.14 271.14 271.14 271.14 271.14 271.14
Plan G
Male 289.38 185.01 190.17 195.34 200.34 205.33 210.33 215.33 220.33 225.16 229.91 234.49 238.99 243.40 247.40 251.32 255.23 259.48 263.48 267.56 271.56 275.39 279.14 282.55 285.55 287.97 289.38 289.38 289.38 289.38 289.38 289.38 289.38 289.38 289.38 289.38

3200 Highland Avenue, Downers Grove, IL 60515; 1-855-369-4835 (Request First Health Life Rates)
Plan F+ Fem. Male 11

Fem. 285.80 187.59 192.76 197.84 202.75 207.67 212.50 217.41 222.33 226.83 231.41 235.74 240.07 244.24 247.90 251.65 255.15 258.98 262.73 266.39 269.98 273.47 276.72 279.89 282.55 284.72 285.80 285.80 285.80 285.80 285.80 285.80 285.80 285.80 285.80 285.80
Plan F
First Health Life & Health Insurance Company
Male 306.54 201.25 206.75 212.17 217.41 222.66 227.83 233.07 238.24 243.15 248.07 252.82 257.40 261.90 265.81 269.81 273.64 277.72 281.64 285.55 289.47 293.22 296.80 300.13 303.05 305.29 306.54 306.54 306.54 306.54 306.54 306.54 306.54 306.54 306.54 306.54

Fem.
Plan D
Male

Fem.
Plan C Male Fem. 230.32 158.69 162.68 166.85 170.68 174.51 178.35 182.26 185.93 189.51 192.84 196.17 199.42 202.42 205.00 207.67 210.17 212.75 215.25 217.66 220.00 222.33 224.41 226.49 228.24 229.49 230.32 230.32 230.32 230.32 230.32 230.32 230.32 230.32 230.32 230.32

Pre-Existing Condition Limitations: None Plan B Male Fem. 248.32 173.01 171.01 134.53 175.43 137.45 179.84 140.28 184.09 142.94 188.26 145.53 192.34 148.02 196.42 150.44 200.59 152.77 204.25 154.85 208.00 156.69 211.50 158.60 215.00 160.10 218.16 161.52 221.08 162.52 223.91 163.35 226.58 164.43 229.41 165.43 232.07 166.52 234.66 167.60 237.24 168.52 239.65 169.52 241.99 170.52 244.24 171.35 245.98 172.01 247.

(CVS Group) Plan A Age Male 187.67 < 65 146.02 65 149.19 66 152.27 67 155.19 68 158.02 69 160.77 70 163.27 71 165.77 72 168.02 73 170.18 74 172.01 75 173.85 76 175.26 77 176.43 78 177.35 79 178.43 80 179.59 81 180.68 82 181.84 83 183.01 84 183.93 85 184.93 86 186.01 87 186.76 88 187.34 89 187.67 90 187.67 91 187.67 92 187.67 93 187.67 94 187.67 95 187.67 96 187.67 97 187.67 98 187.67 99 Note