Page 50 - APPENDICES for Fred Falten

UnitedHealthcare Insurance Company
(UnitedHealth Group) Rates Effective January 1, 2021
680 Blair Mill Road, Horsham, PA 19044; 1-800-523-5800
Pre-Existing Condition Limitations: Yes- Limitation provision is 3 months/3 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.
< 65 190.00 190.00 272.75 272.75 341.00 341.00 343.00 343.00 262.50 262.50 103.00 103.00 181.50 181.50 244.50 244.50
65 131.25 131.25 188.50 188.50 236.00 236.00 237.25 237.25 181.50 181.50 71.25 71.25 125.50 125.50 169.00 169.00
66 142.50 142.50 204.50 204.50 255.75 255.75 257.25 257.25 197.00 197.00 77.25 77.25 136.25 136.25 183.50 183.50
67 142.50 142.50 204.50 204.50 255.75 255.75 257.25 257.25 197.00 197.00 77.25 77.25 136.25 136.25 183.50 183.50
68 142.50 142.50 204.50 204.50 255.75 255.75 257.25 257.25 197.00 197.00 77.25 77.25 136.25 136.25 183.50 183.50
69 142.50 142.50 204.50 204.50 255.75 255.75 257.25 257.25 197.00 197.00 77.25 77.25 136.25 136.25 183.50 183.50
70 158.25 158.25 227.25 227.25 284.25 284.25 285.75 285.75 218.75 218.75 85.75 85.75 151.25 151.25 203.75 203.75
71 158.25 158.25 227.25 227.25 284.25 284.25 285.75 285.75 218.75 218.75 85.75 85.75 151.25 151.25 203.75 203.75
72 158.25 158.25 227.25 227.25 284.25 284.25 285.75 285.75 218.75 218.75 85.75 85.75 151.25 151.25 203.75 203.75
73 158.25 158.25 227.25 227.25 284.25 284.25 285.75 285.75 218.75 218.75 85.75 85.75 151.25 151.25 203.75 203.75
74 158.25 158.25 227.25 227.25 284.25 284.25 285.75 285.75 218.75 218.75 85.75 85.75 151.25 151.25 203.75 203.75
75 174.00 174.00 250.00 250.00 312.75 312.75 314.25 314.25 240.75 240.75 94.25 94.25 166.50 166.50 224.25 224.25
76 174.00 174.00 250.00 250.00 312.75 312.75 314.25 314.25 240.75 240.75 94.25 94.25 166.50 166.50 224.25 224.25
77 174.00 174.00 250.00 250.00 312.75 312.75 314.25 314.25 240.75 240.75 94.25 94.25 166.50 166.50 224.25 224.25
78 174.00 174.00 250.00 250.00 312.75 312.75 314.25 314.25 240.75 240.75 94.25 94.25 166.50 166.50 224.25 224.25
79 174.00 174.00 250.00 250.00 312.75 312.75 314.25 314.25 240.75 240.75 94.25 94.25 166.50 166.50 224.25 224.25
80 190.00 190.00 272.75 272.75 341.00 341.00 343.00 343.00 262.50 262.50 103.00 103.00 181.50 181.50 244.50 244.50
81 190.00 190.00 272.75 272.75 341.00 341.00 343.00 343.00 262.50 262.50 103.00 103.00 181.50 181.50 244.50 244.50
82 190.00 190.00 272.75 272.75 341.00 341.00 343.00 343.00 262.50 262.50 103.00 103.00 181.50 181.50 244.50 244.50
83 190.00 190.00 272.75 272.75 341.00 341.00 343.00 343.00 262.50 262.50 103.00 103.00 181.50 181.50 244.50 244.50
84 190.00 190.00 272.75 272.75 341.00 341.00 343.00 343.00 262.50 262.50 103.00 103.00 181.50 181.50 244.50 244.50
85 190.00 190.00 272.75 272.75 341.00 341.00 343.00 343.00 262.50 262.50 103.00 103.00 181.50 181.50 244.50 244.50
86 190.00 190.00 272.75 272.75 341.00 341.00 343.00 343.00 262.50 262.50 103.00 103.00 181.50 181.50 244.50 244.50
87 190.00 190.00 272.75 272.75 341.00 341.00 343.00 343.00 262.50 262.50 103.00 103.00 181.50 181.50 244.50 244.50
88 190.00 190.00 272.75 272.75 341.00 341.00 343.00 343.00 262.50 262.50 103.00 103.00 181.50 181.50 244.50 244.50
89 190.00 190.00 272.75 272.75 341.00 341.00 343.00 343.00 262.50 262.50 103.00 103.00 181.50 181.50 244.50 244.50
90 190.00 190.00 272.75 272.75 341.00 341.00 343.00 343.00 262.50 262.50 103.00 103.00 181.50 181.50 244.50 244.50
91 190.00 190.00 272.75 272.75 341.00 341.00 343.00 343.00 262.50 262.50 103.00 103.00 181.50 181.50 244.50 244.50
92 190.00 190.00 272.75 272.75 341.00 341.00 343.00 343.00 262.50 262.50 103.00 103.00 181.50 181.50 244.50 244.50
93 190.00 190.00 272.75 272.75 341.00 341.00 343.00 343.00 262.50 262.50 103.00 103.00 181.50 181.50 244.50 244.50
94 190.00 190.00 272.75 272.75 341.00 341.00 343.00 343.00 262.50 262.50 103.00 103.00 181.50 181.50 244.50 244.50
95 190.00 190.00 272.75 272.75 341.00 341.00 343.00 343.00 262.50 262.50 103.00 103.00 181.50 181.50 244.50 244.50
96 190.00 190.00 272.75 272.75 341.00 341.00 343.00 343.00 262.50 262.50 103.00 103.00 181.50 181.50 244.50 244.50
97 190.00 190.00 272.75 272.75 341.00 341.00 343.00 343.00 262.50 262.50 103.00 103.00 181.50 181.50 244.50 244.50
98 190.00 190.00 272.75 272.75 341.00 341.00 343.00 343.00 262.50 262.50 103.00 103.00 181.50 181.50 244.50 244.50
99 190.00 190.00 272.75 272.75 341.00 341.00 343.00 343.00 262.50 262.50 103.00 103.00 181.50 181.50 244.50 244.50
Notes: These plans are available to all New Hampshire Medicare recipients who are members of AARP . Discounts available for Multi-Insured (7%), Electronic Funds Transfer ($2.00 per
household per month), and Annual Pay ($24 per household per year).
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