BluePreferred Underwritten -- Maryland

Monthly Premium Rates Effective: January 1, 2007

* To Include a Maternity Benefit Add $126 To the Monthly Premium Rate

ACTUAL PREMIUM RATE MAY BE EITHER 25% OR 50% HIGHER THAN STATED PREMIUM RATES BASED ON THE MEDICAL UNDERWRITING RESULTS

Click on the desired link to go directly to the rates for that plan or scroll down.  Links below indicate member's In-Network/Out-of-Network deductibles and Insurance Carrier's share of coinsurance.

FOUR (4) PLAN OPTIONS AS LISTED BELOW

100/300 Deductible with 90/70 Coinsurance
300/500 Deductible with 90/70 Coinsurance
300/500 Deductible with 80/60 Coinsurance
500/750 Deductible with 80/60 Coinsurance

 

In Network: $100 Deductible, 90%/10% Coinsurance, $2,500 Out of Pocket
Out of Network: $300 Deductible, 70%/30% Coinsurance, $5,000 Out of Pocket
Prescription: $10/$25/$45 Copays, $100 Deductible, $1,500 Annual Max
AGE AT EFFECTIVE DATE INDIVIDUAL INDIVIDUAL & CHILDREN INDIVIDUAL & ADULT FAMILY
1-5 $160      
6-17 $143 $273 $286 $388
18-20 $208 $397 $417 $563
21 $213 $404 $424 $573
22 $216 $411 $431 $580
23 $223 $424 $445 $601
24 $226 $431 $452 $611
25 $230 $435 $458 $618
26 $237 $448 $472 $639
27 $240 $455 $479 $646
28 $243 $462 $486 $656
29 $250 $476 $501 $674
30 $254 $482 $507 $684
31 $261 $497 $521 $704
32 $264 $501 $528 $711
33 $271 $514 $542 $732
34 $274 $521 $548 $739
35 $281 $535 $562 $759
36 $284 $542 $569 $767
37 $291 $555 $583 $787
38 $298 $566 $596 $805
39 $302 $572 $603 $815
40 $308 $586 $617 $832
41 $322 $613 $645 $869
42 $339 $645 $679 $918
43 $354 $673 $707 $953
44 $371 $703 $741 $1,000
45 $388 $738 $776 $1,046
46 $405 $769 $810 $1,094
47 $422 $804 $845 $1,138
48 $443 $841 $886 $1,197
49 $463 $882 $928 $1,252
50 $484 $921 $969 $1,307
51 $505 $958 $1,010 $1,363
52 $529 $1,006 $1,059 $1,428
53 $553 $1,052 $1,106 $1,494
54 $577 $1,096 $1,154 $1,559
55 $605 $1,151 $1,210 $1,635
56 $633 $1,203 $1,265 $1,707
57 $664 $1,261 $1,327 $1,790
58 $691 $1,313 $1,382 $1,865
59 $725 $1,379 $1,451 $1,958
60 $756 $1,437 $1,513 $2,041
61 $791 $1,503 $1,581 $2,134
62 $829 $1,575 $1,658 $2,237
63 $866 $1,647 $1,733 $2,341
64 $905 $1,719 $1,809 $2,441
65 $946 $1,799 $1,892 $2,554
66 and over $991 $1,882 $1,981 $2,675
* To Include a Maternity Benefit Add $126 To the Monthly Premium Rate

 

In Network: $300 Deductible, 90%/10% Coinsurance, $2,500 Out of Pocket
Out of Network: $500 Deductible, 70%/30% Coinsurance, $5,000 Out of Pocket
Prescription: $10/$25/$45 Copays, $100 Deductible, $1,500 Annual Max
AGE AT EFFECTIVE DATE INDIVIDUAL INDIVIDUAL & CHILDREN INDIVIDUAL & ADULT FAMILY
1-5 $140      
6-17 $125 $239 $250 $339
18-20 $182 $347 $364 $492
21 $186 $353 $370 $500
22 $188 $359 $376 $507
23 $194 $370 $389 $525
24 $197 $376 $395 $534
25 $201 $380 $400 $540
26 $207 $391 $413 $558
27 $209 $398 $419 $564
28 $212 $404 $425 $572
29 $218 $416 $437 $588
30 $222 $421 $442 $597
31 $228 $434 $455 $615
32 $230 $437 $461 $621
33 $237 $449 $473 $639
34 $239 $455 $478 $646
35 $245 $467 $491 $663
36 $248 $473 $497 $669
37 $254 $485 $509 $687
38 $260 $494 $521 $703
39 $264 $499 $527 $711
40 $269 $512 $539 $726
41 $281 $535 $563 $759
42 $296 $563 $593 $801
43 $309 $587 $617 $832
44 $324 $614 $647 $873
45 $338 $645 $677 $913
46 $353 $671 $707 $955
47 $368 $702 $738 $993
48 $387 $734 $774 $1,044
49 $404 $770 $810 $1,093
50 $423 $804 $846 $1,141
51 $440 $836 $882 $1,189
52 $461 $878 $924 $1,246
53 $483 $918 $965 $1,304
54 $504 $956 $1,007 $1,361
55 $528 $1,005 $1,056 $1,427
56 $552 $1,049 $1,104 $1,490
57 $579 $1,100 $1,157 $1,562
58 $603 $1,146 $1,206 $1,628
59 $633 $1,203 $1,267 $1,708
60 $660 $1,254 $1,320 $1,780
61 $690 $1,311 $1,380 $1,862
62 $723 $1,375 $1,447 $1,952
63 $756 $1,437 $1,512 $2,042
64 $789 $1,500 $1,578 $2,129
65 $825 $1,570 $1,650 $2,229
66 and over $865 $1,642 $1,729 $2,334
* To Include a Maternity Benefit Add $126 To the Monthly Premium Rate  

 

In Network: $300 Deductible, 80%/20% Coinsurance, $2,500 Out of Pocket
Out of Network: $500Deductible, 60%/40% Coinsurance, $5,000 Out of Pocket
Prescription: $10/$25/$45 Copays, $100 Deductible, $1,500 Annual Max
AGE AT EFFECTIVE DATE INDIVIDUAL INDIVIDUAL & CHILDREN INDIVIDUAL & ADULT FAMILY
1-5 $122      
6-17 $109 $209 $219 $297
18-20 $159 $303 $318 $430
21 $162 $309 $324 $438
22 $165 $314 $329 $443
23 $170 $324 $340 $459
24 $172 $329 $346 $467
25 $175 $333 $350 $472
26 $181 $342 $361 $488
27 $183 $348 $366 $493
28 $185 $353 $372 $501
29 $191 $364 $382 $515
30 $194 $368 $387 $522
31 $199 $379 $398 $537
32 $202 $382 $403 $543
33 $207 $392 $414 $559
34 $209 $398 $418 $564
35 $215 $408 $429 $580
36 $217 $414 $434 $585
37 $222 $424 $445 $600
38 $228 $432 $455 $614
39 $231 $437 $460 $622
40 $235 $447 $471 $635
41 $246 $468 $492 $663
42 $259 $492 $518 $700
43 $270 $514 $540 $727
44 $283 $536 $566 $763
45 $296 $563 $592 $798
46 $309 $586 $618 $834
47 $322 $613 $645 $868
48 $338 $642 $676 $913
49 $353 $673 $708 $955
50 $370 $702 $739 $997
51 $385 $731 $771 $1,039
52 $403 $767 $807 $1,089
53 $422 $802 $843 $1,139
54 $440 $836 $880 $1,189
55 $462 $878 $922 $1,246
56 $482 $917 $965 $1,302
57 $506 $961 $1,011 $1,365
58 $527 $1,002 $1,054 $1,422
59 $553 $1,051 $1,107 $1,493
60 $577 $1,096 $1,153 $1,556
61 $603 $1,146 $1,205 $1,627
62 $632 $1,201 $1,264 $1,705
63 $660 $1,255 $1,321 $1,784
64 $689 $1,311 $1,379 $1,860
65 $721 $1,371 $1,442 $1,947
66 and over $756 $1,434 $1,510 $2,039
* To Include a Maternity Benefit Add $126 To the Monthly Premium Rate

 

In Network: $500 Deductible, 80%/20% Coinsurance, $2,500 Out of Pocket
Out of Network: $750 Deductible, 60%/40% Coinsurance, $4,000 Out of Pocket
Prescription: $10/$25/$45 Copays, $100 Deductible, $1,500 Annual Max
AGE AT EFFECTIVE DATE INDIVIDUAL INDIVIDUAL & CHILDREN INDIVIDUAL & ADULT FAMILY
1-5 $116      
6-17 $104 $198 $208 $282
18-20 $151 $288 $302 $408
21 $154 $293 $307 $415
22 $156 $298 $313 $421
23 $161 $307 $323 $436
24 $164 $313 $328 $443
25 $167 $316 $332 $448
26 $172 $325 $342 $463
27 $174 $330 $348 $468
28 $176 $335 $353 $475
29 $181 $346 $363 $488
30 $184 $350 $367 $496
31 $189 $360 $377 $510
32 $191 $363 $383 $515
33 $196 $372 $393 $531
34 $198 $377 $397 $536
35 $204 $388 $407 $550
36 $206 $393 $412 $555
37 $211 $402 $423 $570
38 $216 $410 $432 $583
39 $219 $414 $437 $590
40 $223 $425 $447 $603
41 $233 $444 $467 $629
42 $246 $467 $492 $664
43 $256 $487 $512 $690
44 $268 $509 $537 $724
45 $281 $535 $562 $757
46 $293 $556 $586 $792
47 $305 $582 $612 $824
48 $321 $609 $642 $866
49 $335 $639 $672 $906
50 $351 $666 $701 $946
51 $365 $693 $731 $986
52 $383 $728 $766 $1,034
53 $400 $761 $800 $1,081
54 $418 $793 $835 $1,128
55 $438 $833 $875 $1,183
56 $458 $870 $915 $1,235
57 $480 $912 $960 $1,295
58 $500 $950 $1,000 $1,350
59 $525 $998 $1,050 $1,416
60 $547 $1,040 $1,094 $1,476
61 $572 $1,087 $1,144 $1,544
62 $600 $1,140 $1,199 $1,618
63 $626 $1,191 $1,254 $1,693
64 $654 $1,244 $1,308 $1,765
65 $684 $1,301 $1,368 $1,847
66 and over $717 $1,361 $1,433 $1,935
* To Include a Maternity Benefit Add $126 To the Monthly Premium Rate

 

 

Maryland Blue Preferred Underwritten Prices
Effective 01/01/200
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© 2002 Benefit Choices Inc.