AGE AT EFFECTIVE DATE

INDIVIDUAL

INDIVIDUAL & CHILD(REN)

INDIVIDUAL & ADULT

FAMILY

1-5

$114

_

_

_

6-17

$102

$174

$203

$270

18-20

$149

$253

$297

$397

21

$151

$257

$302

$404

22

$153

$261

$307

$411

23

$159

$270

$317

$424

24

$161

$275

$322

$431

AGE AT EFFECTIVE DATE

INDIVIDUAL

INDIVIDUAL & CHILD(REN)

INDIVIDUAL & ADULT

FAMILY

25

$163

$278

$327

$436

26

$168

$287

$337

$450

27

$171

$290

$342

$456

28

$174

$295

$346

$463

29

$178

$302

$357

$476

30

$181

$307

$361

$483

AGE AT EFFECTIVE DATE

INDIVIDUAL

INDIVIDUAL & CHILD(REN)

INDIVIDUAL & ADULT

FAMILY

31

$186

$317

$372

$495

32

$189

$320

$376

$503

33

$193

$329

$386

$516

34

$195

$332

$391

$522

35

$201

$342

$401

$535

36

$203

$344

$406

$543

37

$208

$354

$416

$554

38

$213

$361

$426

$569

39

$216

$367

$431

$575

40

$221

$374

$441

$590

AGE AT EFFECTIVE DATE

INDIVIDUAL

INDIVIDUAL & CHILD(REN)

INDIVIDUAL & ADULT

FAMILY

41

$231

$391

$461

$614

42

$242

$414

$486

$649

43

$253

$429

$505

$673

44

$265

$450

$530

$709

45

$278

$471

$554

$741

46

$290

$493

$580

$773

47

$302

$513

$605

$807

48

$317

$540

$634

$847

49

$332

$565

$664

$887

50

$346

$590

$694

$926

AGE AT EFFECTIVE DATE

INDIVIDUAL

INDIVIDUAL & CHILD(REN)

INDIVIDUAL & ADULT

FAMILY

51

$361

$614

$724

$966

52

$379

$644

$758

$1,013

53

$397

$673

$792

$1,057

54

$414

$703

$828

$1,105

55

$433

$738

$867

$1,157

56

$454

$770

$906

$1,212

57

$476

$807

$951

$1,271

58

$495

$842

$991

$1,323

59

$520

$885

$1,040

$1,390

60

$543

$921

$1,085

$1,449

AGE AT EFFECTIVE DATE

INDIVIDUAL

INDIVIDUAL & CHILD(REN)

INDIVIDUAL & ADULT

FAMILY

61

$567

$964

$1,135

$1,513

62

$594

$1,011

$1,189

$1,588

63

$622

$1,057

$1,244

$1,660

64

$622

$1,057

$1,244

$1,660

65

$622

$1,057

$1,244

$1,660

65

$622

$1,057

$1,244

$1,660

66 and over

$428

$1,020

$1,050

$1,465