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HEALTH > PMP Monthly Premiums
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PLAN A
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| Age |
Male |
Female |
Child/Dep. |
 |
| <1 |
$200 |
$200 |
$200 |
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Other Plans
|
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|
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|
| 1-18 |
$100 |
$100 |
$100 |
| 19 |
$89 |
$107 |
$89 male
$101 female |
| 20 |
$89 |
$117 |
$89 male
$101 female |
| 21 |
$89 |
$119 |
$89 male
$101 female |
| 22 |
$89 |
$121 |
N/A |
| 23 |
$90 |
$123 |
N/A |
| 24 |
$92 |
$136 |
N/A |
| 25 |
$95 |
$128 |
N/A |
| 26 |
$97 |
$132 |
N/A |
| 27 |
$99 |
$133 |
N/A |
| 28 |
$102 |
$140 |
N/A |
| 29 |
$105 |
$142 |
N/A |
| 30 |
$107 |
$144 |
N/A |
| 31 |
$110 |
$148 |
N/A |
| 32 |
$113 |
$149 |
N/A |
| 33 |
$117 |
$149 |
N/A |
| 34 |
$120 |
$149 |
N/A |
| 35 |
$120 |
$150 |
N/A |
| 36 |
$121 |
$153 |
N/A |
| 37 |
$126 |
$155 |
N/A |
| 38 |
$128 |
$158 |
N/A |
| 39 |
$129 |
$162 |
N/A |
| 40 |
$134 |
$167 |
N/A |
| 41 |
$138 |
$170 |
N/A |
| 42 |
$143 |
$175 |
N/A |
| 43 |
$148 |
$178 |
N/A |
| 44 |
$156 |
$181 |
N/A |
| 45 |
$160 |
$184 |
N/A |
| 46 |
$166 |
$187 |
N/A |
| 47 |
$172 |
$191 |
N/A |
| 48 |
$176 |
$195 |
N/A |
| 49 |
$185 |
$200 |
N/A |
| 50 |
$194 |
$206 |
N/A |
| 51 |
$202 |
$211 |
N/A |
| 52 |
$208 |
$216 |
N/A |
| 53 |
$210 |
$220 |
N/A |
| 54 |
$225 |
$225 |
N/A |
| 55 |
$234 |
$228 |
N/A |
| 56 |
$241 |
$234 |
N/A |
| 57 |
$249 |
$239 |
N/A |
| 58 |
$259 |
$246 |
N/A |
| 59 |
$271 |
$257 |
N/A |
| 60 |
$298 |
$281 |
N/A |
| 61 |
$309 |
$290 |
N/A |
| 62 |
$319 |
$302 |
N/A |
| 63 |
$331 |
$313 |
N/A |
| 64 |
$343 |
$327 |
N/A |
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Optional Rider
Dental: $ 6.00 per member * Optical: $ 5.00 per member
FORM NO: PMP/MK/DADE/ RATEWRKSHTH7 (07/07)
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