SPECIFIED DISEASE RIDER RATES
Individual and Spouse*
Individual and Child(ren)
Individual and Family**
Individual
18-29 30-39 40-49 50-64
$23.17 $34.87 $71.83 $159.27 $13.48 $20.28 $41.78 $92.64
$46.34 $69.74 $143.66 $318.54 $26.96 $40.57 $83.56 $185.29 $18.11 $27.26 $56.14 $124.49 $12.65 $19.04 $39.21 $86.94
$55.11 $66.81 $103.77 $191.21 $33.13 $39.94 $61.43 $112.30 $22.59 $27.16 $41.61 $75.78 $15.89 $19.08 $29.17 $53.03
$86.27 $109.67 $183.58 $358.46 $51.52 $65.14 $108.13 $209.85 $35.03 $44.18 $73.07 $141.41 $24.60 $30.99 $51.16 $98.89
Child**
$26.62
18-29 30-39 40-49 50-64
Child**
$16.38
18-29 30-39 40-49 50-64
$9.06
$13.63 $28.07 $62.25
Child**
$11.28
18-29 30-39 40-49 50-64
$6.32 $9.52
$19.60 $43.47
Child**
$7.97
Individual and Spouse*
Individual and Child(ren)
Individual and Family**
Individual
18-29 30-39 40-49 50-64
$25.79 $38.82 $79.96 $177.30 $16.10 $24.23 $49.92 $110.68 $11.68 $17.58 $36.21 $80.28
$51.59 $77.64 $159.93 $354.61 $32.20 $48.47 $99.83 $221.36 $23.36 $35.16 $72.41 $160.57 $17.90 $26.93 $55.48 $123.01
$62.82 $75.84 $116.98 $214.33 $40.84 $48.97 $74.65 $135.42 $30.30 $36.20 $54.82 $98.90 $23.59 $28.11 $42.38 $76.15
$97.87 $123.92 $206.20 $400.89 $63.12 $79.38 $130.75 $252.28 $46.63 $58.43 $95.69 $183.84 $36.20 $45.24 $73.78 $141.32
Child**
$30.85
18-29 30-39 40-49 50-64
Child**
$20.61
18-29 30-39 40-49 50-64
Child**
$15.51
18-29 30-39 40-49 50-64
$8.95
$13.47 $27.74 $61.51
Child**
$12.20
* In IL, spouse or civil union partner ** Family rates include up to four children. Additional children are charged the Child rate. Rider not available for children-only coverage.
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