CoventryOne Authorized Agent
 


CoventryOne POS $2,000 - $2,750 Deductible Plan Insurance Options
Monthly Rates** - Effective 7/01/2013 through 8/31/2013
Area 1 -Banks, Barrow, Bartow, Butts, Chattahoochee, Cherokee, Clarke, Clayton, Cobb, Coweta, Dawson, Dekalb, Douglas, Effingham, Fayette,
Forsyth, Fulton, Glascock, Greene, Gwinnett, Harris, Henry, Jackson, Jasper, Jefferson, Jenkins, Liberty, Madison, Marion, Meriwether, Morgan,
Muscogee, Newton, Oconee, Oglethorpe, Paulding, Pike, Putnam, Rockdale, Screven, Stewart, Talbot, Walton, Warren, Webster or Wilkes counties
**CoventryOne monthly rates effective 4-1-13 to 5-31-13 are issued for illustrative purposes only. Rates are subject to change. Call for specific rates and availability. All applicants are subject to
medical underwriting and approval by Coventry Health Care of Georgia, Inc. Refer to plan documents for a complete list of coverage, limitations and exclusions.



*Note- Deduct 5% if 3 members apply; 15% for 4-5 members or 20% for 6+ family members applying
---------Add 10% to premium if you are a tobacco user under age 40
---------Add 20% to premium if you are a tobacco user over age 40
These rates are available for applicants with effective dates of July 1, 2013 through August 31, 2013
CoventryOne $45
Copay Plan $2,750 Deductible
$1K Rx Deductible
CoventryOne $45
Copay Plan $2,750 Deductible $0 Prescription Ded.
CoventryOne
$35 Copay Plan
$2,750 Deductible
CoventryOne
$30 Copay Plan
$2,750 Deductible

Age

Male

Female

Male

Female

Male

Female

Male

Female

Age

0**

$189.66

$189.66

$212.24

$212.24

$215.83

$215.83

$301.69

$301.69

0**

1**

113.80

113.80

127.34

127.34

129.50

129.50

181.02

181.02

1**

2-5**

79.15

79.15

88.57

88.57

90.07

90.07

125.91

125.91

2-5**

6-16**

79.15

79.15

88.57

88.57

90.07

90.07

125.91

125.91

6-16**

17*

77.30

82.52

86.50

92.35

87.96

93.91

122.96

131.27

17*

18*

75.44

85.81

84.42

96.03

85.85

97.65

120.01

136.50

18*

19

69.12

87.84

77.35

98.29

78.66

99.95

109.95

139.72

19

20

64.82

89.10

72.54

99.70

73.77

101.39

103.11

141.73

20

21

65.58

89.10

73.39

99.70

74.63

101.39

104.32

141.73

21

22

66.34

91.38

74.24

102.25

75.49

103.98

105.53

145.35

22

23

66.85

95.76

74.80

107.16

76.07

108.97

106.33

152.32

23

24

67.35

100.14

75.37

112.06

76.64

113.96

107.13

159.29

24

25

71.73

102.92

80.27

115.17

81.63

117.12

114.11

163.72

25

Age

Male

Female

Male

Female

Male

Female

Male

Female

Age
CoventryOne $45
Copay Plan $2,750 Deductible
$1K Rx Deductible
CoventryOne $45
Copay Plan $2,750 Deductible $0 Prescription Ded.
CoventryOne
$35 Copay Plan
$2,750 Deductible
CoventryOne
$30 Copay Plan
$2,750 Deductible

Age

Male

Female

Male

Female

Male

Female

Male

Female

Age

26

$72.32

$104.44

$80.93

$116.87

$82.30

$118.85

$115.05

$166.13

26

27

72.91

106.46

81.59

119.14

82.98

121.15

115.98

169.35

27

28

73.76

107.48

82.54

120.27

83.93

122.30

117.33

170.96

28

29

76.20

108.57

85.27

121.49

86.72

123.55

121.21

172.70

29

30

77.97

109.58

87.25

122.63

88.73

124.70

124.03

174.31

30

31

80.92

111.18

90.55

124.42

92.09

126.53

128.72

176.86

31

32

84.29

115.40

94.33

129.13

95.93

131.32

134.09

183.56

32

33

85.39

120.04

95.55

134.32

97.17

136.60

135.83

190.94

33

34

86.57

124.67

96.87

139.51

98.52

141.87

137.71

198.31

34

35

89.44

130.57

100.08

146.11

101.78

148.59

142.27

207.70

35

36

93.65

132.85

104.80

148.66

106.57

151.18

148.97

211.32

36

37

97.78

134.53

109.42

150.55

111.27

153.10

155.54

214.00

37

38

102.42

137.40

114.61

153.75

116.55

156.36

162.91

218.56

38

39

106.72

139.59

119.42

156.21

121.44

158.85

169.75

222.05

39

40

109.58

145.58

122.63

162.90

124.70

165.66

174.31

231.57

40

41

113.80

147.68

127.34

165.26

129.50

168.06

181.02

234.92

41

42

116.66

151.73

130.55

169.79

132.76

172.67

185.58

241.35

42

43

120.79

155.95

135.17

174.51

137.46

177.46

192.15

248.06

43

Age

Male

Female

Male

Female

Male

Female

Male

Female

Age
CoventryOne $45
Copay Plan $2,750 Deductible
$1K Rx Deductible
CoventryOne $45
Copay Plan $2,750 Deductible $0 Prescription Ded.
CoventryOne
$35 Copay Plan
$2,750 Deductible
CoventryOne
$30 Copay Plan
$2,750 Deductible

Age

Male

Female

Male

Female

Male

Female

Male

Female

Age

44

$125.01

$163.53

$139.89

$183.00

$142.26

$186.09

$198.85

$260.13

44

45

128.89

171.96

144.23

192.43

146.67

195.69

205.02

273.54

45

46

137.91

180.39

154.32

201.86

156.93

205.28

219.36

286.94

46

47

147.35

189.83

164.88

212.43

167.68

216.02

234.38

301.96

47

48

156.45

197.25

175.07

220.73

178.04

224.46

248.86

313.76

48

49

156.45

197.25

175.07

220.73

178.04

224.46

248.86

313.76

49

50

176.60

205.00

197.62

229.41

200.96

233.29

280.91

326.10

50

51

186.54

216.47

208.75

242.23

212.28

246.34

296.73

344.33

51

52

195.48

223.04

218.75

249.59

222.45

253.82

310.95

354.79

52

53

211.41

228.52

236.57

255.72

240.58

260.05

336.29

363.51

53

54

225.07

241.84

251.86

270.63

256.12

275.21

358.01

384.69

54

55

254.32

269.41

284.59

301.47

289.41

306.58

404.54

428.54

55

56

272.02

284.58

304.40

318.45

309.55

323.84

432.70

452.67

56

57

289.72

297.14

324.20

332.51

329.69

338.14

460.85

472.65

57

58

307.34

305.23

343.92

341.56

349.74

347.34

488.88

485.53

58

59

322.85

319.22

361.28

357.22

367.39

363.27

513.55

507.78

59

60

342.07

334.99

382.78

374.86

389.26

381.21

544.12

532.86

60

61

353.19

345.78

395.23

386.93

401.93

393.48

561.82

550.02

61

62

362.64

356.15

405.80

398.53

412.67

405.28

576.84

566.51

62

63-64

315.77

326.98

353.35

365.90

359.34

372.09

502.29

520.12

63-64

Age

Male

Female

Male

Female

Male

Female

Male

Female

Age
CoventryOne $45
Copay Plan $2,750 Deductible
$1K Rx Deductible
CoventryOne $45
Copay Plan $2,750 Deductible $0 Prescription Ded.
CoventryOne
$35 Copay Plan
$2,750 Deductible
CoventryOne
$30 Copay Plan
$2,750 Deductible

**CoventryOne monthly rates effective 7-1-13 to 8-31-13 are issued for illustrative purposes only. Rates are subject to change. Call for specific rates and availability. All applicants are subject to
medical underwriting and approval by Coventry Health Care of Georgia, Inc. Refer to plan documents for a complete list of coverage, limitations and exclusions.

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Insurance Now
5 Dunwoody Pk., Suite 113
Atlanta, GA 30338

Call Holly or Chris at
(770) 396-9517

Outside of the Atlanta area,
call toll-free:
1-877-711-8376.
Email: holly@insurance-now.com

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