Member |
Non-Tobacco User
| Insurance Amount |
Monthly Premium Ages |
| > 50 |
51 - 60 |
61 - 69 |
| $50k |
$3.75 |
$17.50 |
$32.50 |
| $100k |
$7.50 |
$35.00 |
$65.00 |
| $150k |
$11.25 |
$52.50 |
$97.50 |
| $200k |
$15.00 |
$70.00 |
$130.00 |
| $250k |
$18.75 |
$87.50 |
$162.50 |
|
Tobacco User
| Monthly Premium Ages |
| > 50 |
51 - 60 |
61 - 69 |
| $6.75 |
$33.50 |
$65.00 |
| $13.50 |
$67.00 |
$130.00 |
| $20.25 |
$100.50 |
$195.00 |
| $27.00 |
$134.00 |
$260.00 |
| $33.75 |
$167.50 |
$325.00 |
|
| |
Dependent Spouse |
Non-Tobacco User
| Insurance Amount |
Monthly Premium Ages |
| > 50 |
51 - 60 |
61 - 69 |
| $25k |
$1.90 |
$8.75 |
$16.25 |
| $50k |
$3.80 |
$17.50 |
$32.50 |
| $75k |
$5.70 |
$26.25 |
$48.75 |
| $100k |
$7.60 |
$35.00 |
$65.00 |
| $125k |
$9.50 |
$43.75 |
$81.25 |
| $150k |
$11.40 |
$52.50 |
$97.50 |
| $175k |
$13.30 |
$61.25 |
$113.75 |
| $200k |
$15.20 |
$70.00 |
$130.00 |
| $225k |
$17.10 |
$78.75 |
$146.25 |
| $250k |
$19.00 |
$87.50 |
$162.50 |
|
Tobacco User
| Monthly Premium Ages |
| > 50 |
51 - 60 |
61 - 69 |
| $3.45 |
$16.75 |
$32.50 |
| $6.90 |
$33.50 |
$65.00 |
| $10.35 |
$50.25 |
$97.50 |
| $13.80 |
$67.00 |
$130.00 |
| $17.25 |
$83.75 |
$162.50 |
| $20.70 |
$100.50 |
$195.00 |
| $24.15 |
$117.25 |
$227.50 |
| $27.60 |
$134.00 |
$260.00 |
| $31.05 |
$150.75 |
$292.50 |
| $34.50 |
$167.50 |
$325.00 |
|
|
Rates are based on the member's or spouse's attained age, and monthly premium rates increase as the member or
spouse reaches a new age bracket. It will be necessary for you to increase your allotment or your monthly premium
payment at that time. If you fail to pay the increase in monthly premium, your coverage will be continued, but on
a reduced benefit schedule.
|
| |
Dependent Children |
| Member's Insurance Amount |
Children's Insurance Amount at age 14 days to 6 months |
Children's Insurance Amount at age 6 months to 21 years
(or age 25 if a full time student) |
| $50k |
Not available |
Not available |
| $100k |
$1,000 |
$5,000 |
| $150k |
$1,500 |
$7,500 |
| $200k |
$2,000 |
$10,000 |
| $250k |
$2,500 |
$12,500 |
|
|
Children are eligible to continue their coverage after they pass the age of eligibility by enrolling in
MBA’s dependent continuation program.
|
