CP4000 CRITICAL CARE AND INTENSIVE CARE Individual Rates for Monthly Bankdraft
Critical Care Rider
Individual
1 Parent Family
2 Parent Family
Ages 18 - 44 Ages 45 - 54 Ages 55 - 64 Ages 65 - 69*
$275 $350 $475 $550
$300 $375 $500 $550
$438 $551 $738 $826
Intensive Care Rider (Not available in TN)
Individual
1 Parent Family
2 Parent Family
Ages 18 - 44 Ages 45 - 54 Ages 55 - 64 Ages 65 - 69*
$792
$864
$1260 $1584 $2124 $2376
$1008 $1368 $1584
$1080 $1440 $1584
CP4000 CRITICAL CARE AND INTENSIVE CARE Rates for Payroll Deduction
Critical Care Rider
Individual
1 Parent Family
2 Parent Family
Ages 18 - 64
$250
$275
$401
Intensive Care Rider
Individual
1 Parent Family
2 Parent Family
Ages 18 - 64
$720
$792
$1152
10
FOR AGENT USE ONLY
AGT-CP4000 0216
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