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  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