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Calculate Your Premium for HealthSave Product
Step 1 of 3: Select Coverage Options
Type of Coverage:
Single
Two-Party
Family (3-6 family members)
Family (7 or more family members)
Age of Oldest Family Member:
(Oldest applicant must be age 19 or older.)
Estimated Monthly Medical Premium
Step 2 of 3: Choose a Deductible and Out-of-Pocket Maximum level.
(Deductibles and Out-of-Pocket Maximums are calculated on a Calendar Year basis.)
Deductibles
Out-of-Pocket
Maximums
$1300 *
$2600
$3900
$7800
$1500
$3000
$5000
$10000
$2500
$5000
$3500
$7000
$5000
$10000
$5000
$10000
* Deductible amount will change yearly based on government regulations.
Step 3 of 3: Calculate Premium
Estimated Monthly Premium
Select Value
Select Med
Select Care
$97.00
$105.00
$116.00
Estimated Monthly Dental Premium
Estimated Monthly Premium
Annual Max Benefit
750
1000
1500
$35.00
$39.00
$38.00
Additional Information About Estimated Monthly Premiums
1.
These are only estimated monthly premiums and are subject to change based on underwriting review.
2.
Premium rates are based on the age of the oldest family member. The enrollment application must
be written with the oldest family member as the applicant.
3.
Premiums under these plans are subject to adjustment each January 1, if your original effective date is
January 1 through June 30, or each July 1, if your original effective date is July 1 through December 31.
4.
Premiums will increase on the first of the month following the birthday on which the Subscriber (policy
holder) moves from one age category to another.
The age catagories are as follows: 0 to 19 years, 20 to 24 years, 25 to 29 years, 30 to 34 years, 35 to
39 years, 40 to 44 years, 45 to 49 years, 50 to 54 years, 55 to 59 years, 60 to 64 years, 65 to 69 years,
70 to 74 years, 75 to 79 years, 80 to 84 years, and 85 years of age or older.
