| Monthly Premiums (Education Sector) | ||||
|---|---|---|---|---|
| *Includes Emergency Travel | Health Wise | Health Wise Plus | Total Health* | Ultimate Health* |
| Direct pay drug coverage maximum of $1,200 per calendar year | ||||
| Single | $81.25 | $104.00 | $118.00 | $140.75 |
| Couple | $157.75 | $203.50 | $230.75 | $275.75 |
| Family | $187.25 | $242.25 | $275.00 | $329.75 |
| Direct pay drug coverage maximum of $2,000 per calendar year | ||||
| Single | $110.50 | $133.25 | $148.25 | $170.50 |
| Couple | $216.25 | $262.00 | $291.25 | $336.00 |
| Family | $257.25 | $312.25 | $348.00 | $401.50 |
| Annual Premiums (Education Sector) | |||
|---|---|---|---|
| Additional days for a single trip (over 92-day base travel included with the Total Health and Ultimate Health options) | Single | Couple | Family |
| 15 (total days: 107) | $260 | $520 | $575 |
| 30 (total days: 122) | $556 | $1,112 | $1,243 |
| 45 (total days: 137) | $779 | $1,558 | $1,743 |
| 60 (total days: 152) | $1,020 | $2,040 | $2,281 |
| 75 (total days: 167) | $1,280 | $2,560 | $2,856 |
| 90 (total days: 182) | $1,558 | $3,116 | $3,450 |
| 105 (total days:197) | $1,856 | $3,712 | $4,063 |
| 120 (total days: 212) | $2,175 | $4,350 | $4,695 |
| Monthly Premiums (Education Sector) | |||
|---|---|---|---|
| Option A | Option B | Option C | |
| Single | $64.50 | $52.75 | $39.50 |
| Couple | $129.25 | $105.00 | $79.00 |
| Family | $154.00 | $121.75 | $94.50 |
| Annual Premiums | ||
|---|---|---|
| Age of insured person | Single | Family |
| 0 - 29 | $105 | $209 |
| 30 - 39 | $109 | $218 |
| 40 - 49 | $112 | $224 |
| 50 - 59 | $133 | $266 |
| 60 - 65 | $174 | $348 |
| 66 - 74 | $242 | $484 |
| 75 + | $349 | $697 |
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