Page 46 - APPENDICES for Fred Falten

Mutual of Omaha Insurance Company
(Mutual of Omaha Group) Rates Effective January 1, 2021
3300 Mutual of Omaha Plaza, Omaha, NE 68175; 1-800-667-2937
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.
< 65 305.67 265.25 438.37 380.43 117.39 101.87 365.03 316.78 148.91 129.48 275.29 238.90
65 203.77 176.84 292.25 253.62 78.26 67.92 243.36 211.19 63.67 55.36 183.53 159.28
66 203.77 176.84 292.25 253.62 78.26 67.92 243.36 211.19 63.67 55.36 183.53 159.28
67 203.77 176.84 292.25 253.62 78.26 67.92 243.36 211.19 63.67 55.36 183.53 159.28
68 208.46 180.91 298.96 259.46 80.06 69.48 248.95 216.04 65.45 56.92 187.75 162.94
69 212.83 184.70 305.26 264.91 81.75 70.94 254.18 220.58 67.23 58.46 191.69 166.36
70 216.87 188.22 311.04 269.94 83.30 72.29 259.00 224.78 69.02 60.02 195.34 169.52
71 220.78 191.60 316.64 274.80 84.80 73.59 263.67 228.82 70.80 61.56 198.85 172.57
72 224.54 194.86 322.03 279.47 86.23 74.85 268.16 232.71 72.58 63.11 202.23 175.51
73 228.24 198.08 327.34 284.07 87.67 76.08 272.57 236.55 74.48 64.76 205.58 178.41
74 231.90 201.24 332.58 288.62 89.07 77.29 276.94 240.33 76.36 66.40 208.86 181.25
75 235.48 204.36 337.74 293.10 90.44 78.49 281.22 244.06 78.24 68.04 212.11 184.07
76 239.01 207.43 342.80 297.49 91.80 79.67 285.45 247.72 80.14 69.68 215.28 186.83
77 242.57 210.52 347.92 301.93 93.16 80.85 289.71 251.41 82.03 71.32 218.49 189.61
78 246.17 213.64 353.06 306.40 94.54 82.05 293.99 255.14 85.30 74.17 221.72 192.42
79 249.77 216.76 358.22 310.87 95.93 83.25 298.28 258.86 88.58 77.02 224.96 195.23
80 253.28 219.82 363.27 315.26 97.28 84.42 302.49 262.52 91.87 79.89 228.13 197.98
81 256.71 222.78 368.17 319.51 98.60 85.56 306.57 266.05 95.15 82.74 231.22 200.65
82 260.06 225.69 372.99 323.69 99.88 86.67 310.59 269.54 98.43 85.59 234.21 203.26
83 263.14 228.37 377.41 327.53 101.06 87.70 314.26 272.73 104.54 90.90 237.01 205.68
84 265.95 230.80 381.42 331.00 102.14 88.63 317.61 275.63 110.63 96.21 239.51 207.86
85 268.61 233.11 385.23 334.32 103.15 89.52 320.77 278.40 116.74 101.51 241.92 209.94
86 271.29 235.44 389.08 337.67 104.19 90.42 323.99 281.17 122.84 106.82 244.33 212.04
87 274.00 237.79 392.99 341.04 105.23 91.32 327.22 283.98 128.94 112.12 246.78 214.16
88 276.75 240.17 396.89 344.44 106.28 92.24 330.50 286.82 130.62 113.59 249.24 216.30
89 279.51 242.57 400.87 347.90 107.34 93.16 333.80 289.70 132.32 115.06 251.74 218.46
90 282.03 244.75 404.49 351.02 108.31 94.00 336.81 292.30 134.04 116.55 254.00 220.44
91 284.56 246.95 408.12 354.19 109.29 94.85 339.84 294.94 135.78 118.07 256.29 222.42
92 287.12 249.16 411.80 357.37 110.26 95.70 342.90 297.57 137.54 119.61 258.59 224.41
93 289.71 251.42 415.50 360.59 111.26 96.56 345.99 300.27 139.34 121.16 260.92 226.44
94 292.31 253.68 419.23 363.83 112.26 97.42 349.09 302.96 141.15 122.73 263.26 228.48
95 294.95 255.96 423.02 367.11 113.27 98.30 352.25 305.69 142.97 124.33 265.64 230.53
96 297.60 258.27 426.83 370.42 114.29 99.18 355.41 308.45 144.84 125.95 268.03 232.61
97 300.28 260.59 430.67 373.74 115.31 100.08 358.61 311.22 146.72 127.58 270.44 234.70
98 302.98 262.94 434.54 377.11 116.36 100.98 361.83 314.02 148.63 129.25 272.88 236.82
99 305.67 265.25 438.37 380.43 117.39 101.87 365.03 316.78 150.56 130.92 275.29 238.90
Notes: Rates are 12% lower if you are eligible for the household discount premium.

16