| Monthly Premiums (ASET) | ||||
|---|---|---|---|---|
| Health Wise | Health Wise Plus | |||
| Direct pay drug coverage maximum of $1,200 per calendar year | ||||
| Single | $97.50 | $119.25 | ||
| Couple | $190.00 | $233.50 | ||
| Family | $230.50 | $282.75 | ||
| Direct pay drug coverage maximum of $2,000 per calendar year | ||||
| Single | $135.75 | $157.50 | ||
| Couple | $267.25 | $310.75 | ||
| Family | $322.25 | $374.50 | ||
- 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 | $116.75 | $139.50 | ||
| Couple | $228.50 | $273.75 | ||
| Family | $272.75 | $327.00 | ||
| Direct pay drug coverage maximum of $2,000 per calendar year | ||||
| Single | $154.75 | $176.50 | ||
| Couple | $304.75 | $348.50 | ||
| Family | $364.75 | $417.25 | ||
| Monthly Premiums (ASET) | ||||
|---|---|---|---|---|
| Total Health | Ultimate Health | |||
| Direct pay drug coverage maximum of $1,200 per calendar year | ||||
| Single | $165.50 | $187.50 | ||
| Couple | $325.25 | $369.25 | ||
| Family | $392.25 | $445.00 | ||
| Direct pay drug coverage maximum of $2,000 per calendar year | ||||
| Single | $207.50 | $228.75 | ||
| Couple | $410.00 | $452.75 | ||
| Family | $495.00 | $546.25 | ||
| Monthly Premiums (ASET) | ||||
|---|---|---|---|---|
| Total Health | Ultimate Health | |||
| Direct pay drug coverage maximum of $1,200 per calendar year | ||||
| Single | $310.75 | $332.25 | ||
| Couple | $615.25 | $658.25 | ||
| Family | $746.25 | $797.75 | ||
| Direct pay drug coverage maximum of $2,000 per calendar year | ||||
| Single | $361.00 | $383.00 | ||
| Couple | $716.75 | $761.00 | ||
| Family | $868.00 | $921.00 | ||
- 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) | $251 | $502 | $530 |
| 30 (total days: 122) | $538 | $1,076 | $1,231 |
| 45 (total days: 137) | $752 | $1,504 | $1,753 |
| 60 (total days: 152) | $982 | $1,964 | $2315 |
| 75 (total days: 167) | $1,233 | $2,466 | $2,927 |
| 90 (total days: 182) | $1,500 | $3,000 | $3,579 |
| 105 (total days: 197) | $1,785 | $3,570 | $4,274 |
| 120 (total days: 212) | $2,089 | $4,178 | $5,016 |
| 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) | $471 | $942 | $1,149 |
| 30 (total days: 122) | $1,012 | $2,024 | $2,468 |
| 45 (total days: 137) | $1,417 | $2,834 | $3,456 |
| 60 (total days: 152) | $1,853 | $3,706 | $4,522 |
| 75 (total days: 167) | $2,326 | $4,652 | $5,676 |
| 90 (total days: 182) | $2,833 | $5,666 | $6,913 |
| 105 (total days: 197) | $3,376 | $6,752 | $8,238 |
| 120 (total days: 212) | $3,958 | $7,916 | $9,659 |
| 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) | $1,277 | $2,554 | $3,115 |
| 30 (total days: 122) | $2,738 | $5,476 | $6,680 |
| 45 (total days: 137) | $3,832 | $7,664 | $9,350 |
| 60 (total days: 152) | $5,017 | $10,034 | $12,242 |
| 75 (total days: 167) | $6,294 | $12,588 | $15,357 |
| 90 (total days: 182) | $7,664 | $15,328 | $18,700 |
| 105 (total days: 197) | $9,134 | $18,268 | $22,287 |
| 120 (total days: 212) | $10,711 | $21,422 | $26,136 |
| Monthly Premiums (ASET) | |||
|---|---|---|---|
| Option A | Option B | Option C | |
| Single | $66.25 | $53.50 | $40.25 |
| Couple | $132.75 | $106.50 | $80.50 |
| Family | $157.75 | $127.00 | $96.00 |
