| 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) | $221 | $442 | $466 |
| 30 (total days: 122) | $473 | $946 | $1,083 |
| 45 (total days: 137) | $662 | $1,324 | $1,542 |
| 60 (total days: 152) | $864 | $1,728 | $2,037 |
| 75 (total days: 167) | $1,085 | $2,170 | $2,575 |
| 90 (total days: 182) | $1,320 | $2,640 | $3,149 |
| 105 (total days: 197) | $1,571 | $3,142 | $3,761 |
| 120 (total days: 212) | $1,839 | $3,678 | $4,414 |
| 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) | $414 | $828 | $1,011 |
| 30 (total days: 122) | $890 | $1,780 | $2,172 |
| 45 (total days: 137) | $1,247 | $2,494 | $3,042 |
| 60 (total days: 152) | $1,631 | $3,262 | $3,980 |
| 75 (total days: 167) | $2,047 | $4,094 | $4,995 |
| 90 (total days: 182) | $2,493 | $4,986 | $6,083 |
| 105 (total days: 197) | $2,971 | $5,942 | $7,250 |
| 120 (total days: 212) | $3,483 | $6,966 | $8,500 |
| 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) | $1,123 | $2,246 | $2,741 |
| 30 (total days: 122) | $2,409 | $4,818 | $5,878 |
| 45 (total days: 137) | $3,372 | $6,744 | $8,228 |
| 60 (total days: 152) | $4,415 | $8,830 | $10,773 |
| 75 (total days: 167) | $5,539 | $11,078 | $13,514 |
| 90 (total days: 182) | $6,744 | $13,488 | $16,456 |
| 105 (total days: 197) | $8,038 | $16,076 | $19,612 |
| 120 (total days: 212) | $9,426 | $18,852 | $22,999 |
| Monthly Premiums (ASET) | |||
|---|---|---|---|
| Option A | Option B | Option C | |
| Single | $68.75 | $55.25 | $42.00 |
| Couple | 137.75 | $110.75 | $83.50 |
| Family | $164.00 | $131.50 | $99.50 |
