Page 43 - APPENDICES for Fred Falten

HPHC Insurance Company
(Harvard Pilgrim Health Care Group) Rates Effective January 1, 2021
93 Worcester Street, Wellesley, MA 02481; 1-877-907-4742
Pre-Existing Condition Limitations: None
Plan A Plan B Plan C Plan D Plan F Plan F+ Plan G Plan G+ Plan K Plan L Plan M Plan N
Age
Male Fem. Male Fem. Male Fem. Male Fem. Male Fem. Male Fem. Male Fem. Male Fem. Male Fem. Male Fem. Male Fem. Male Fem.
< 65 335.00 335.00 502.00 502.00 368.00 368.00 365.00 365.00 355.00 355.00
65 184.00 184.00 227.00 227.00 155.00 155.00 188.00 188.00 160.00 160.00
66 187.00 187.00 230.00 230.00 172.00 172.00 190.00 190.00 163.00 163.00
67 191.00 191.00 239.00 239.00 181.00 181.00 193.00 193.00 167.00 167.00
68 198.00 198.00 246.00 246.00 189.00 189.00 203.00 203.00 177.00 177.00
69 202.00 202.00 254.00 254.00 198.00 198.00 209.00 209.00 181.00 181.00
70 207.00 207.00 266.00 266.00 206.00 206.00 216.00 216.00 185.00 185.00
71 216.00 216.00 271.00 271.00 214.00 214.00 221.00 221.00 192.00 192.00
72 222.00 222.00 277.00 277.00 222.00 222.00 226.00 226.00 201.00 201.00
73 225.00 225.00 284.00 284.00 232.00 232.00 230.00 230.00 205.00 205.00
74 227.00 227.00 290.00 290.00 241.00 241.00 237.00 237.00 208.00 208.00
75 234.00 234.00 296.00 296.00 250.00 250.00 241.00 241.00 214.00 214.00
76 237.00 237.00 302.00 302.00 260.00 260.00 245.00 245.00 217.00 217.00
77 244.00 244.00 310.00 310.00 271.00 271.00 247.00 247.00 223.00 223.00
78 246.00 246.00 315.00 315.00 281.00 281.00 253.00 253.00 229.00 229.00
79 252.00 252.00 320.00 320.00 292.00 292.00 256.00 256.00 232.00 232.00
80 335.00 335.00 502.00 502.00 368.00 368.00 365.00 365.00 355.00 355.00
81 335.00 335.00 502.00 502.00 368.00 368.00 365.00 365.00 355.00 355.00
82 335.00 335.00 502.00 502.00 368.00 368.00 365.00 365.00 355.00 355.00
83 335.00 335.00 502.00 502.00 368.00 368.00 365.00 365.00 355.00 355.00
84 335.00 335.00 502.00 502.00 368.00 368.00 365.00 365.00 355.00 355.00
85 335.00 335.00 502.00 502.00 368.00 368.00 365.00 365.00 355.00 355.00
86 335.00 335.00 502.00 502.00 368.00 368.00 365.00 365.00 355.00 355.00
87 335.00 335.00 502.00 502.00 368.00 368.00 365.00 365.00 355.00 355.00
88 335.00 335.00 502.00 502.00 368.00 368.00 365.00 365.00 355.00 355.00
89 335.00 335.00 502.00 502.00 368.00 368.00 365.00 365.00 355.00 355.00
90 335.00 335.00 502.00 502.00 368.00 368.00 365.00 365.00 355.00 355.00
91 335.00 335.00 502.00 502.00 368.00 368.00 365.00 365.00 355.00 355.00
92 335.00 335.00 502.00 502.00 368.00 368.00 365.00 365.00 355.00 355.00
93 335.00 335.00 502.00 502.00 368.00 368.00 365.00 365.00 355.00 355.00
94 335.00 335.00 502.00 502.00 368.00 368.00 365.00 365.00 355.00 355.00
95 335.00 335.00 502.00 502.00 368.00 368.00 365.00 365.00 355.00 355.00
96 335.00 335.00 502.00 502.00 368.00 368.00 365.00 365.00 355.00 355.00
97 335.00 335.00 502.00 502.00 368.00 368.00 365.00 365.00 355.00 355.00
98 335.00 335.00 502.00 502.00 368.00 368.00 365.00 365.00 355.00 355.00
99 335.00 335.00 502.00 502.00 368.00 368.00 365.00 365.00 355.00 355.00
Notes: No restrictions

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