| Monthly Premiums (ASET) | ||||
|---|---|---|---|---|
| Health Wise | Health Wise Plus | |||
| Direct pay drug coverage maximum of $1,200 per calendar year | ||||
| Single | $95.50 | $116.75 | ||
| Couple | $186.00 | $228.75 | ||
| Family | $225.75 | $277.00 | ||
| Direct pay drug coverage maximum of $2,000 per calendar year | ||||
| Single | $133.00 | $154.25 | ||
| Couple | $261.75 | $304.50 | ||
| Family | $315.75 | $366.75 | ||
- Under Age 75
- Age 75 to 84
- Age 85 and Over
| Monthly Premiums (ASET) | ||||
|---|---|---|---|---|
| Total Health | Ultimate Health | |||
| Direct pay drug coverage maximum of $1,200 per calendar year | ||||
| Single | $114.25 | $136.75 | ||
| Couple | $223.75 | $268.25 | ||
| Family | $267.25 | $320.25 | ||
| Direct pay drug coverage maximum of $2,000 per calendar year | ||||
| Single | $151.50 | $173.00 | ||
| Couple | $298.50 | $314.50 | ||
| Family | $357.25 | $408.75 | ||
| Monthly Premiums (ASET) | ||||
|---|---|---|---|---|
| Total Health | Ultimate Health | |||
| Direct pay drug coverage maximum of $1,200 per calendar year | ||||
| Single | $162.00 | $183.75 | ||
| Couple | $318.50 | $361.75 | ||
| Family | $384.25 | $436.00 | ||
| Direct pay drug coverage maximum of $2,000 per calendar year | ||||
| Single | $203.25 | $224.00 | ||
| Couple | $401.75 | $443.50 | ||
| Family | $485.00 | $535.00 | ||
| Monthly Premiums (ASET) | ||||
|---|---|---|---|---|
| Total Health | Ultimate Health | |||
| Direct pay drug coverage maximum of $1,200 per calendar year | ||||
| Single | $304.50 | $325.50 | ||
| Couple | $602.75 | $644.75 | ||
| Family | $731.00 | $781.50 | ||
| Direct pay drug coverage maximum of $2,000 per calendar year | ||||
| Single | $353.75 | $375.25 | ||
| Couple | $702.25 | $745.50 | ||
| Family | $850.25 | $902.25 | ||
- Under Age 75
- Age 75 to 84
- Age 85 and Over
| Annual Premiums (ASET) | |||
|---|---|---|---|
| Additional days for a single trip (over 92-day base travel included with the Total Health and Ultimate Health options) | Under age 75 | ||
| Single | Couple | Family | |
| 15 (total days: 107) | $239 | $479 | $506 |
| 30 (total days: 122) | $513 | $1,025 | $1,174 |
| 45 (total days: 137) | $717 | $1,435 | $1,672 |
| 60 (total days: 152) | $937 | $1,873 | $2,209 |
| 75 (total days: 167) | $1,176 | $2,353 | $2,792 |
| 90 (total days: 182) | $1,431 | $2,863 | $3,415 |
| 105 (total days: 197) | $1,703 | $3,407 | $4,078 |
| 120 (total days: 212) | $1,993 | $3,988 | $4,786 |
| Annual Premiums (ASET) | |||
|---|---|---|---|
| Additional days for a single trip (over 92-day base travel included with the Total Health and Ultimate Health options) | Age 75 to 84 | ||
| Single | Couple | Family | |
| 15 (total days: 107) | $449 | $897 | $1,096 |
| 30 (total days: 122) | $965 | $1,930 | $2,355 |
| 45 (total days: 137) | $1,352 | $2,704 | $3,298 |
| 60 (total days: 152) | $1,768 | $3,537 | $4,415 |
| 75 (total days: 167) | $2,220 | $4,439 | $5,416 |
| 90 (total days: 182) | $2,703 | $5,406 | $6,596 |
| 105 (total days: 197) | $3,221 | $6,443 | $7,860 |
| 120 (total days: 212) | $3,777 | $7,553 | $9,215 |
| Annual Premiums (ASET) | |||
|---|---|---|---|
| Additional days for a single trip (over 92-day base travel included with the Total Health and Ultimate Health options) | Age 85 and over | ||
| Single | Couple | Family | |
| 15 (total days: 107) | $1,218 | $2,435 | $2,972 |
| 30 (total days: 122) | $2,612 | $5,224 | $6,373 |
| 45 (total days: 137) | $3,656 | $7,312 | $8,921 |
| 60 (total days: 152) | $4,787 | $9,574 | $11,681 |
| 75 (total days: 167) | $6,005 | $12,011 | $14,653 |
| 90 (total days: 182) | $7,312 | $14,624 | $17,842 |
| 105 (total days: 197) | $8,715 | $17,430 | $21,264 |
| 120 (total days: 212) | $10,220 | $20,440 | $24,936 |
| Monthly Premiums (ASET) | |||
|---|---|---|---|
| Option A | Option B | Option C | |
| Single | $61.50 | $49.50 | $37.50 |
| Couple | $123.25 | $99.25 | $74.75 |
| Family | $146.75 | $117.75 | $89.00 |
