BlueChoice Underwritten -- Maryland

"Low Option"

In Network: $20/$30 Copay, $700 Hospital Copay, $3,600/$7200/$11000 Out of Pocket
Prescription Drugs $150 Deductible $10/$25/$40 Copay $500 Max per year

Monthly Premium Rates Effective: January 1, 2007

AGE Ind. Ind. & Child(ren) Ind. & Adult Family
1-5 $153      
6-17 $137 $261 $287 $371
18-20 $193 $367 $406 $523
21 $197 $374 $413 $529
22 $200 $380 $419 $539
23 $203 $387 $427 $549
24 $206 $393 $433 $556
25 $210 $400 $440 $566
26 $213 $406 $446 $576
27 $216 $413 $456 $586
28 $219 $416 $462 $592
29 $223 $423 $469 $602
30 $230 $436 $482 $619
31 $237 $449 $496 $639
32 $243 $462 $509 $655
33 $250 $475 $525 $674
34 $256 $486 $538 $692
35 $263 $499 $552 $708
36 $269 $512 $565 $727
37 $276 $525 $578 $744
38 $282 $538 $594 $764
39 $289 $548 $607 $780
40 $296 $562 $621 $796
41 $309 $588 $647 $833
42 $325 $618 $684 $880
43 $338 $644 $710 $912
44 $355 $673 $747 $959
45 $372 $707 $779 $1,002
46 $388 $736 $816 $1,047
47 $404 $769 $848 $1,090
48 $425 $805 $892 $1,147
49 $444 $845 $931 $1,200
50 $464 $882 $974 $1,252
51 $484 $918 $1,017 $1,305
52 $507 $964 $1,063 $1,367
53 $530 $1,007 $1,112 $1,430
54 $553 $1,050 $1,162 $1,493
55 $579 $1,102 $1,218 $1,565
56 $605 $1,152 $1,271 $1,634
57 $636 $1,208 $1,334 $1,714
58 $662 $1,258 $1,390 $1,787
59 $695 $1,321 $1,459 $1,875
60 $724 $1,376 $1,522 $1,954
61 $758 $1,439 $1,591 $2,044
62 $793 $1,508 $1,667 $2,143
63 $830 $1,578 $1,743 $2,242
64 $866 $1,647 $1,818 $2,337
65 $906 $1,723 $1,901 $2,446
65+ $949 $1,802 $1,993 $2,562
Optional Dental $10 $20 $20 $30