CoventryOne Authorized Agent
 


CoventryOne POS $3,000 - $3,750 Deductible Plan Insurance Options
Monthly Rates** for Effective Date Between 7/1/2013 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
If you do not live in one of these counties, please click here to find your rates


*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

CoventryOne $45 Copay Plan $3,750 Ded with Drug Deductible**

CoventryOne
$45 Copay $3,750 Deductible with
No Drug Deductible**
CoventryOne
$35 Copay Plan
$3,750 Deductible**
CoventryOne
$30 Copay Plan
$3,750 Deductible**

CoventryOne
Fusion 100%/50%
$3,000 Deductible**

HDHP (HSA)
$3,000 Single Ded.
$5,000 Fam. Ded.**
Age Male Female Male Female Male Female Male Female Male Female Male Female Age
0** $169.17 $169.17 $191.74 $191.74 $206.96 $206.96 $273.86 $273.86 $282.48 $282.48 $298.25 $298.25 0**
1** 101.50 101.50 115.05 115.05 124.18 124.18 164.31 164.31 169.49 169.49 178.95 178.95 1**
2-5** 70.60 70.60 80.02 80.02 86.37 86.37 114.29 114.29 117.89 117.89 124.47 124.47 2-5**
6-16** 70.60 70.60 80.02 80.02 86.37 86.37 114.29 114.29 117.89 117.89 124.47 124.47 6-16**
17** 68.95 73.61 78.15 83.43 84.35 90.05 111.61 119.16 115.13 122.91 121.55 129.77 17**
18** 67.29 76.54 76.27 86.75 82.32 93.64 108.93 123.91 112.36 127.81 118.64 134.94 18**
19 61.65 78.34 69.88 88.80 75.43 95.85 99.81 126.83 102.95 130.82 108.70 138.12 19
20 57.82 79.47 65.53 90.08 70.73 97.23 93.60 128.65 96.55 132.70 101.94 140.11 20
21 58.49 79.47 66.30 90.08 71.56 97.23 94.69 128.65 97.68 132.70 103.13 140.11 21
22 59.17 81.50 67.07 92.38 72.39 99.71 95.79 131.94 98.81 136.09 104.32 143.69 22
23 59.62 85.41 67.58 96.81 72.94 104.49 96.52 138.27 99.56 142.62 105.12 150.58 23
24 60.07 89.32 68.09 101.24 73.49 109.27 97.25 144.60 100.31 149.15 105.91 157.48 24
25 63.98 91.80 72.52 104.05 78.28 112.31 103.58 148.61 106.84 153.29 112.81 161.85 25
Age Male Female Male Female Male Female Male Female Male Female Male Female Age

CoventryOne $45 Copay Plan $3,750 Ded with Drug Deductible**

CoventryOne
$45 Copay $3,750 Deductible with
No Drug Deductible**
CoventryOne
$35 Copay Plan
$3,750 Deductible**
CoventryOne
$30 Copay Plan
$3,750 Deductible**

CoventryOne
Fusion 100%/50%
$3,000 Deductible**

HDHP (HSA)
$3,000 Single Ded.
$5,000 Fam. Ded.**
Age Male Female Male Female Male Female Male Female Male Female Male Female Age
26 $64.51 $93.16 $73.12 $105.59 $78.92 $113.97 $104.43 $150.80 $170.72 $155.55 $113.73 $164.24 26
27 65.04 94.96 73.71 107.63 79.56 116.17 105.28 153.73 108.60 158.57 114.66 167.42 27
28 65.79 95.86 74.57 108.65 80.48 117.28 106.50 155.19 109.85 160.07 115.99 169.01 28
29 67.97 96.84 77.04 109.76 83.15 118.47 110.03 156.77 113.49 161.70 119.83 170.73 29
30 69.55 97.74 78.83 110.78 85.08 119.58 112.59 158.23 116.13 163.21 122.62 172.32 30
31 72.18 99.17 81.81 112.40 88.30 121.32 116.85 160.54 120.52 165.60 127.25 174.84 31
32 75.19 102.93 85.22 116.66 91.98 125.92 121.71 166.63 125.55 171.87 132.56 181.47 32
33 76.16 107.06 86.33 121.35 93.18 130.98 123.30 173.32 127.18 178.78 134.28 188.76 33
34 77.22 111.20 87.52 126.04 94.47 136.04 125.00 180.02 128.94 185.68 136.14 196.05 34
35 79.77 116.46 90.42 132.00 97.59 142.48 129.14 188.54 133.20 194.47 140.64 205.33 35
36 83.53 118.49 94.68 134.31 102.19 144.96 135.22 191.82 139.48 197.86 147.27 208.91 36
37 87.22 120.00 98.85 136.01 106.70 146.80 141.19 194.26 145.63 200.37 153.77 211.56 37
38 91.35 122.55 103.54 138.91 111.76 149.93 147.88 198.39 152.54 204.64 161.06 216.07 38
39 95.19 124.51 107.89 141.12 116.45 152.32 154.09 201.56 158.94 207.91 167.82 219.51 39
40 97.74 129.85 110.78 147.17 119.58 158.85 158.23 210.20 163.21 216.82 172.32 228.93 40
41 101.50 131.73 115.05 149.30 124.18 161.15 164.31 213.24 169.49 219.96 178.95 232.24 41
42 104.06 135.33 117.94 153.39 127.30 165.57 168.45 219.09 173.76 225.98 183.46 238.60 42
43 107.74 139.09 122.12 157.66 131.81 170.17 174.42 225.17 179.91 232.26 189.95 245.23 43
Age Male Female Male Female Male Female Male Female Male Female Male Female Age

CoventryOne $45 Copay Plan $3,750 Ded with Drug Deductible**

CoventryOne
$45 Copay $3,750 Deductible with
No Drug Deductible**
CoventryOne
$35 Copay Plan
$3,750 Deductible**
CoventryOne
$30 Copay Plan
$3,750 Deductible**

CoventryOne
Fusion 100%/50%
$3,000 Deductible**

HDHP (HSA)
$3,000 Single Ded.
$5,000 Fam. Ded.**
Age Male Female Male Female Male Female Male Female Male Female Male Female Age
44 $111.50 $145.86 $126.38 $165.32 $136.41 $178.45 $180.50 $236.13 $186.19 $243.56 $196.58 $257.16 44
45 114.96 153.38 130.30 173.85 140.64 187.64 186.10 248.30 191.96 256.11 202.68 270.42 45
46 123.00 160.90 139.42 182.37 150.48 196.84 199.12 260.47 205.39 268.67 216.86 283.67 46
47 131.43 169.32 148.96 191.91 160.78 207.14 212.76 274.10 219.46 282.73 231.71 298.52 47
48 139.55 175.94 158.17 199.41 170.72 215.24 225.90 284.81 233.01 293.78 246.03 310.18 48
49 147.59 179.92 167.29 203.93 180.56 220.11 238.93 291.26 246.45 300.43 260.21 317.21 49
50 157.51 182.85 178.53 207.25 192.70 223.70 254.99 296.01 263.02 305.33 277.71 322.38 50
51 166.39 193.08 188.59 218.84 203.56 236.21 269.35 312.56 277.83 322.40 293.35 340.41 51
52 174.36 198.94 197.62 225.49 213.31 243.38 282.26 322.06 291.14 332.20 307.40 350.75 52
53 188.57 203.83 213.73 231.03 230.69 249.36 305.26 329.97 314.87 340.36 332.45 359.36 53
54 200.75 215.71 227.53 244.49 245.59 263.90 324.98 349.20 335.21 360.19 353.93 380.31 54
55 226.84 240.29 257.11 272.36 277.51 293.98 367.21 389.00 378.77 401.25 399.92 423.65 55
56 242.63 253.83 275.00 287.70 296.83 310.53 392.77 410.91 405.14 423.85 427.76 447.51 56
57 258.41 265.03 292.90 300.40 316.14 324.24 418.33 429.04 431.50 442.55 455.60 467.26 57
58 274.13 272.25 310.71 308.58 335.37 333.07 443.77 440.73 457.74 454.60 483.30 479.99 58
59 287.96 284.73 326.39 322.72 352.29 348.34 466.17 460.93 480.84 475.44 507.69 501.99 59
60 305.10 298.79 345.82 338.66 373.26 365.54 493.92 483.69 509.47 498.92 537.92 526.78 60
61 315.03 308.41 357.07 349.57 385.41 377.31 509.98 499.27 526.04 514.99 555.41 543.75 61
62 323.45 317.66 366.61 360.05 395.71 388.62 523.62 514.24 540.10 530.43 570.26 560.05 62
63-64 281.65 291.65 319.23 3360.56 344.57 356.80 455.94 472.13 470.30 487.00 496.56 514.19 63-64
Age Male Female Male Female Male Female Male Female Male Female Male Female Age

CoventryOne $45 Copay Plan $3,750 Ded with Drug Deductible**

CoventryOne
$45 Copay $3,750 Deductible with
No Drug Deductible**
CoventryOne
$35 Copay Plan
$3,750 Deductible**
CoventryOne
$30 Copay Plan
$3,750 Deductible**

CoventryOne
Fusion 100%/50%
$3,000 Deductible**

HDHP (HSA)
$3,000 Single Ded.
$5,000 Fam. Ded.**
 *CoventryOne monthly rates effective 6-1-13 to 6-30-13 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.



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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