Central Choice State Specific Plan Variations for Daily Surgical Benefit States State Variation Georgia & Virginia The Specified Injury Rider is not available. Missouri The Outpatient Sickness Rider and Surgery Plus is not available. Instead, the Surgery (CHPISS14) is used. North Carolina The Specified Injury Rider is not available. Pennsylvania The Surgery Plus is not available. Instead, the Surgery (CHPISS14-PA) is used.
California and South Dakota
The benefits are the same as the generic states, but are priced differently. The rates for these states are listed below
CA
Premier Choice
Select Choice Enhanced Choice Essential Choice
$210.65 $394.30 $333.93 $517.58
$180.28 $333.56 $278.19 $431.47
$91.01 $166.02 $144.40 $219.41
$66.69 $117.38 $98.61 $149.30
Single
Single w/Spouse Single/Children
Family
GA & VA
Premier Choice
Select Choice Enhanced Choice Essential Choice
$185.50 $366.00 $301.30 $481.80
$154.85 $304.70 $249.75 $399.60
$67.40 $129.80 $110.15 $172.55
$45.65 $86.30 $73.05 $113.70
Single
Single w/Spouse Single/Children
MO Single Family
Premier Choice
Select Choice Enhanced Choice Essential Choice
$165.40 $324.05 $258.95 $417.60
$141.40 $276.05 $220.03 $354.70
$60.60 $114.45 $93.10 $146.95
$42.50 $78.25 $65.65 $101.40
Single w/Spouse Single/Children
Family
NC
Premier Choice
Select Choice Enhanced Choice Essential Choice
$185.50 $366.00 $301.30 $481.80
$154.85 $304.70 $249.75 $399.60
$67.40 $129.80 $110.15 $172.55
$45.65 $86.30 $73.05 $113.70
Single
Single w/Spouse Single/Children
Family
PA
Premier Choice
Select Choice Enhanced Choice Essential Choice
$180.00 $353.25 $297.55 $470.80
$152.35 $297.95 $249.00 $394.60
$67.90 $129.05 $112.40 $173.55
$46.15 $85.55 $75.30 $114.70
Single
Single w/Spouse Single/Children
Family
SD
Premier Choice
Select Choice Enhanced Choice Essential Choice
$186.50 $366.25 $302.55 $482.30
$156.35 $305.95 $251.80 $401.40
$70.40 $134.05 $114.60 $178.25
$48.90 $91.05 $77.90 $120.05
Single
Single w/Spouse Single/Children
Family
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