PREMIUMS (in US$) |
For |
||||||||||
AGE BANDS |
0-3 |
4-18 |
19-25 |
26-30 |
31-35 |
36-40 |
41-45 |
46-50 |
51-55 |
56-60 |
|
| MAJOR MEDICAL PLAN |
585 | 585 | 732 | 807 | 884 | 961 | 1,035 | 1,111 | 1,293 | 1,373 | 1,482 |
| US$1,000,000 Benefit Option |
150 | 150 | 150 | 150 | 150 | 150 | 150 | 150 | 150 | 150 | 150 |
| Additional Room & Board Option (per US$50 increase) |
30 | 30 | 30 | 30 | 30 | 30 | 30 | 40 | 40 | 40 | 50 |
| US$50,000 Surgeon's Fee Option |
53 | 53 | 65 | 71 | 77 | 83 | 88 | 93 | 103 | 109 | 120 |
| ADDITIONAL BENEFIT PLANS |
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| Dental Plan |
250 | 500 | 500 | 500 | 500 | 500 | 500 | 500 | 500 | 500 | 500 |
| Personal Accident Plan |
Rate for Class 1 Occupation - $1.00 per 1,000 Rate for Class 2 Occupation - $1.25 per 1,000 Rate for Class 3 Occupation is available on request |
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| Travel Plan |
85 | 85 | 85 | 85 | 85 | 85 | 85 | 85 | 85 | 85 | 85 |
| Rental Car Protection |
Not available below age 23 | 75 for ages 23 to75 | |||||||||
NOTE: