Page 122 - Cover Letter & Evaluation for Carol Evans

Blue Cross Blue Shield of Arizona Medicare Supplement Premium Rate Information
(Non-Tobacco Use)

Rates are effective January 1, 2018
Blue Cross Blue Shield of Arizona can only raise your premium if we raise the premium for all policies like yours in Arizona.
Should this occur, you will receive a 30-day notice.

Early-enrollment Discount
If you enroll in a Senior Security or Senior Preferred plan at age 65 through 72, you receive an early-enrollment discount* on
your rate. When you are Medicare eligible at age 65 to 65½, you are automatically eligible for the lower BlueValue rate
and an early-enrollment discount. Even if you are past age 65½, you may still qualify for the lower premium BlueValue rate.
The BCBSAZ Medicare supplement application contains questions about your medical history and tobacco use, which helps
determine your rate.

Monthly Quarterly Semi-Annual Annually
Senior Security Plan A $99.86 $299.58 $599.16 $1,198.32
Senior Security Plan C $134.07 $402.21 $804.42 $1,608.84
Senior Security Plan D $120.80 $362.40 $724.80 $1,449.60
BlueValue rate Senior Security Plan F $139.66 $418.98 $837.96 $1,675.92
with 41% Senior Security Plan G $122.20 $366.60 $733.20 $1,466.40
early-enrollment Senior Security Plan N $96.36 $289.08 $578.16 $1,156.32
discount at
age 65 Senior Preferred Plan C $122.90 $368.70 $737.40 $1,474.80
Senior Preferred Plan D $107.54 $322.62 $645.24 $1,290.48
Senior Preferred Plan G $113.12 $339.36 $678.72 $1,357.44
Senior Preferred Plan N $83.80 $251.40 $502.80 $1,005.60

Monthly Quarterly Semi-Annual Annually
Senior Security Plan A $104.93 $314.79 $629.58 $1,259.16
Senior Security Plan C $140.89 $422.67 $845.34 $1,690.68
Senior Security Plan D $126.95 $380.85 $761.70 $1,523.40
BlueValue rate Senior Security Plan F $146.76 $440.28 $880.56 $1,761.12
with 38% Senior Security Plan G $128.42 $385.26 $770.52 $1,541.04
early-enrollment Senior Security Plan N $101.26 $303.78 $607.56 $1,215.12
discount at
age 66 Senior Preferred Plan C $129.15 $387.45 $774.90 $1,549.80
Senior Preferred Plan D $113.01 $339.03 $678.06 $1,356.12
Senior Preferred Plan G $118.88 $356.64 $713.28 $1,426.56
Senior Preferred Plan N $88.06 $264.18 $528.36 $1,056.72

Monthly Quarterly Semi-Annual Annually
Senior Security Plan A $111.70 $335.10 $670.20 $1,340.40
Senior Security Plan C $149.98 $449.94 $899.88 $1,799.76
Senior Security Plan D $135.14 $405.42 $810.84 $1,621.68
BlueValue rate Senior Security Plan F $156.23 $468.69 $937.38 $1,874.76
with 34% Senior Security Plan G $136.70 $410.10 $820.20 $1,640.40
early-enrollment
discount at Senior Security Plan N $107.80 $323.40 $646.80 $1,293.60
$1,649.76
$824.88
$412.44
Senior Preferred Plan C
$137.48
age 67
Senior Preferred Plan D $120.30 $360.90 $721.80 $1,443.60
Senior Preferred Plan G $126.55 $379.65 $759.30 $1,518.60
Senior Preferred Plan N $93.74 $281.22 $562.44 $1,124.88
*The early-enrollment discount is reduced annually through the age of 76. The change in discount occurs in the next month’s bill after your birthday.
When your discount no longer applies, you will be charged the BlueValue or Standard rate assigned to your Senior Security or Senior Preferred plan.

1