VISION RIDER
Age
Individual
Individual + Spouse* Individual + Child(ren)
Family
3 - 17
$2.99
18 - 39 40 - 54 55 - 64 65 - 74 75 - 99
$3.81
$7.61
$9.50
$14.50
$8.16
$16.31
$13.25
$22.48
$8.70
$17.40
$12.89
$22.48
$10.15
$20.30
$11.35
$21.75
$10.15
$20.30
$11.35
$21.75
HEARING RIDER
Age
Individual
Individual + Spouse* Individual + Child(ren)
Family
3 - 17
$1.01
18 - 39 40 - 54 55 - 64 65 - 74 75 - 99
$0.67
$1.33
$2.59
$3.67
$1.33
$2.67
$3.47
$5.25
$2.50
$5.00
$3.88
$6.67
$3.50
$7.00
$3.91
$7.50
$4.17
$8.33
$3.82
$7.92
* In CA, Spouse or Registered Domestic Partner; In DC, Spouse, Domestic Partner, or Civil Union Partner; In OR, Domestic Partner
Both “Individual + Child(ren)” and “Family” rates include up to three children. Additional children are charged the age 3-17 rate per person. Premiums are subject to change. Premium rates based on $1,000, $1,500, $3,000 or $5,000 Policy Year Maximum. Rate based off the age of the eldest/oldest applicant. Benefit exclusions and limitations apply.
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