| Monthly rates for Individuals & Families | ||||||||||||||
| Effective January 1, 2011 - December 31, 2011 | ||||||||||||||
| WiseEssentials™ Rx | WiseSimplicity™ | |||||||||||||
| Age Band Per Adult | $1850 Deductible | $2500 Deductible | $3500 Deductible | $10,000 Deductible | ||||||||||
| NON-SMOKER | SMOKER | NON-SMOKER | SMOKER | NON-SMOKER | SMOKER | NON-SMOKER | SMOKER | |||||||
| Under 25 | $126 | $148 | $108 | $126 | $96 | $114 | $62 | $71 | ||||||
| 25-29 | $144 | $166 | $122 | $142 | $110 | $128 | $69 | $80 | ||||||
| 30-34 | $165 | $191 | $140 | $162 | $126 | $146 | $80 | $93 | ||||||
| 35-39 | $197 | $230 | $168 | $196 | $151 | $176 | $95 | $111 | ||||||
| 40-44 | $231 | $271 | $197 | $231 | $177 | $208 | $112 | $132 | ||||||
| 45-49 | $291 | $336 | $248 | $287 | $223 | $258 | $141 | $163 | ||||||
| 50-54 | $356 | $414 | $304 | $354 | $273 | $318 | $173 | $201 | ||||||
| 55-59 | $414 | $480 | $354 | $410 | $318 | $368 | $201 | $234 | ||||||
| 60-64+ | $472 | $552 | $403 | $470 | $360 | $422 | $228 | $266 | ||||||
| Per Child** | $107 | $90 | $81 | $50 | ||||||||||
| WiseEssentials™ Copay | WiseChoices™ Prime | |||||||||||||
| Age Band Per Adult | $5000 Deductible | $7500 Deductible | $1500 Deductible | |||||||||||
| NON-SMOKER | SMOKER | NON-SMOKER | SMOKER | NON-SMOKER | SMOKER | |||||||||
| Under 25 | $86 | $101 | $70 | $83 | $203 | $238 | ||||||||
| 25-29 | $97 | $113 | $81 | $92 | $231 | $267 | ||||||||
| 30-34 | $112 | $131 | $91 | $107 | $265 | $308 | ||||||||
| 35-39 | $135 | $157 | $109 | $128 | $318 | $370 | ||||||||
| 40-44 | $158 | $185 | $129 | $152 | $372 | $436 | ||||||||
| 45-49 | $199 | $229 | $162 | $186 | $468 | $541 | ||||||||
| 50-54 | $243 | $283 | $198 | $230 | $573 | $667 | ||||||||
| 55-59 | $283 | $329 | $230 | $268 | $667 | $774 | ||||||||
| 60-64+ | $322 | $376 | $262 | $307 | $759 | $888 | ||||||||
| Per Child** | $71 | $59 | $171 | |||||||||||
| WiseSavings™ | ||||||||||||||
| Individual Options | Family Options | |||||||||||||
| Age Band Per Adult | $1840 Deductible | $3000 Deductible | $3680 Deductible | $6000 Deductible | ||||||||||
| NON-SMOKER | SMOKER | NON-SMOKER | SMOKER | NON-SMOKER | SMOKER | NON-SMOKER | SMOKER | |||||||
| Under 25 | $144 | $168 | $113 | $133 | $106 | $125 | $88 | $102 | ||||||
| 25-29 | $163 | $189 | $127 | $149 | $120 | $140 | $97 | $113 | ||||||
| 30-34 | $188 | $217 | $149 | $174 | $139 | $161 | $113 | $132 | ||||||
| 35-39 | $224 | $262 | $179 | $206 | $166 | $193 | $134 | $158 | ||||||
| 40-44 | $264 | $309 | $211 | $245 | $195 | $228 | $159 | $187 | ||||||
| 45-49 | $332 | $383 | $263 | $306 | $245 | $283 | $200 | $231 | ||||||
| 50-54 | $405 | $472 | $321 | $374 | $300 | $349 | $245 | $286 | ||||||
| 55-59 | $472 | $548 | $377 | $436 | $349 | $405 | $286 | $332 | ||||||
| 60-64+ | $537 | $628 | $423 | $498 | $397 | $465 | $323 | $378 | ||||||
| Per Child** | N/A | N/A | $90 | $72 | ||||||||||
| Most Popular Plans | Most Popular Plans | |||||||||||||
| Notes: | ||||||||||||||
| 1. LifeWise rates apply to each person enrolled in a plan based on chosen deductible amount, age and tobacco use. | ||||||||||||||
| 2. For children covered on their own plan, use the Under 25 rate. | ||||||||||||||
| 3. Eligible family members include you, your spouse, and your children under age 26. | ||||||||||||||
| 4. The deductible amounts listed are "per person, per calendar year". | ||||||||||||||
| 5. To qualify for the non-smoker rate, an individual must not have used any tobacco product during the past 12 months. | ||||||||||||||
| **Per child rate applies only to dependent children applying on the same plan as parent/legal guardian. | ||||||||||||||
| Questions: 1-800-877-8019 © Copyright 2011, Green Financial, All Rights Reserved | ||||||||||||||