 CoventryOne Authorized Agent |
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CoventryOne POS $5,000 - $5,750 Deductible Plan Insurance Options
Monthly Rates** - Effective 07/01/2013 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 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.
*Note- Families of 4 or more members get a 10% discount
---------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 enrolling with effective dates from July 1, 2013 through August 31, 2013
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$45 Copay Plan $5,750 Deductible w/ $1000 Brand Rx Ded |
$45 Copay Plan $5,750 Deductible w/ $0 Brand Rx Ded |
$35 Copay Plan $5,750 Deductible |
$30 Copay Plan $5,750 Deductible |
Fusion 100%/50% $5,000 Deductible |
$5,000 Single Ded. $10,500 Fam. Ded. |
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|
|
Male |
Female |
Male |
Female |
Male |
Female |
Male |
Female |
Male |
Female |
Male |
Female |
|
|
|
$154.29 |
$154.29 |
$176.87 |
$176.87 |
$182.86 |
$182.86 |
$238.71 |
$238.71 |
$262.32 |
$262.32 |
$197.46 |
$197.46 |
|
|
|
92.58 |
92.58 |
106.12 |
106.12 |
109.72 |
109.72 |
143.23 |
143.23 |
157.39 |
157.39 |
118.47 |
118.47 |
|
|
|
64.39 |
64.39 |
73.81 |
73.81 |
76.31 |
76.31 |
99.62 |
99.62 |
109.47 |
109.47 |
82.40 |
82.40 |
|
|
|
64.39 |
64.39 |
73.81 |
73.81 |
76.31 |
76.31 |
99.62 |
99.62 |
109.47 |
109.47 |
82.40 |
82.40 |
|
|
|
62.88 |
67.13 |
72.08 |
76.96 |
74.52 |
79.56 |
97.29 |
103.87 |
106.91 |
114.14 |
80.47 |
85.91 |
|
|
|
61.37 |
69.81 |
70.35 |
80.02 |
72.74 |
82.73 |
94.95 |
108.00 |
104.34 |
118.68 |
78.54 |
89.34 |
|
|
|
56.23 |
71.46 |
64.46 |
81.91 |
66.64 |
84.68 |
87.00 |
110.55 |
95.60 |
121.48 |
71.96 |
91.44 |
|
|
|
52.73 |
72.48 |
60.45 |
83.09 |
62.50 |
85.90 |
81.59 |
112.14 |
89.65 |
123.23 |
67.49 |
92.76 |
|
|
|
53.35 |
72.48 |
61.16 |
83.09 |
63.23 |
85.90 |
82.54 |
112.14 |
90.70 |
123.23 |
68.28 |
92.76 |
|
|
|
53.97 |
74.34 |
61.86 |
85.21 |
63.96 |
88.10 |
83.50 |
115.01 |
91.75 |
126.38 |
69.07 |
95.13 |
|
|
|
54.38 |
77.90 |
62.34 |
89.30 |
64.45 |
92.32 |
84.13 |
120.52 |
92.45 |
132.44 |
69.59 |
99.69 |
|
|
|
54.79 |
81.47 |
62.81 |
93.39 |
64.94 |
96.55 |
84.77 |
126.04 |
93.15 |
138.50 |
70.12 |
104.26 |
|
|
|
58.36 |
83.73 |
66.90 |
95.98 |
69.16 |
99.23 |
90.29 |
129.54 |
99.21 |
142.35 |
74.68 |
107.15 |
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|
|
Male |
Female |
Male |
Female |
Male |
Female |
Male |
Female |
Male |
Female |
Male |
Female |
|
|
$45 Copay Plan $5,750 Deductible w/ $1000 Brand Rx Ded |
$45 Copay Plan $5,750 Deductible w/ $0 Brand Rx Ded |
$35 Copay Plan $5,750 Deductible |
$30 Copay Plan $5,750 Deductible |
Fusion 100%/50% $5,000 Deductible |
$5,000 Single Ded. $10,500 Fam. Ded. |
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|
Male |
Female |
Male |
Female |
Male |
Female |
Male |
Female |
Male |
Female |
Male |
Female |
|
|
|
$58.84 |
$84.96 |
$67.45 |
$97.40 |
$69.73 |
$100.69 |
$91.03 |
$131.45 |
$100.03 |
$144.45 |
$75.30 |
$108.73 |
|
|
|
59.32 |
86.61 |
68.00 |
99.28 |
70.30 |
102.64 |
91.77 |
134.00 |
100.85 |
147.25 |
75.91 |
110.84 |
|
|
|
60.00 |
87.43 |
68.78 |
100.23 |
71.11 |
103.62 |
92.83 |
135.27 |
102.01 |
148.65 |
76.79 |
111.89 |
|
|
|
61.99 |
88.32 |
71.06 |
101.25 |
73.47 |
104.68 |
95.91 |
136.65 |
105.39 |
150.16 |
79.33 |
113.03 |
|
|
|
63.43 |
89.15 |
72.71 |
102.19 |
75.18 |
105.65 |
98.14 |
137.92 |
107.84 |
151.56 |
81.18 |
114.09 |
|
|
|
65.83 |
90.45 |
75.46 |
103.68 |
78.02 |
107.20 |
101.85 |
139.94 |
111.92 |
153.78 |
84.25 |
115.75 |
|
|
|
68.58 |
93.88 |
78.61 |
107.61 |
81.27 |
111.26 |
106.09 |
145.24 |
116.58 |
159.60 |
87.76 |
120.14 |
|
|
|
69.47 |
97.65 |
79.63 |
111.94 |
82.33 |
115.73 |
107.47 |
151.08 |
118.10 |
166.02 |
88.90 |
124.97 |
|
|
|
70.43 |
101.42 |
80.73 |
116.26 |
83.46 |
120.20 |
108.96 |
156.91 |
119.73 |
172.43 |
90.13 |
129.79 |
|
|
|
72.76 |
106.22 |
83.40 |
121.76 |
86.23 |
125.89 |
112.57 |
164.34 |
123.70 |
180.59 |
93.11 |
135.94 |
|
|
|
76.19 |
108.07 |
87.33 |
123.89 |
90.29 |
128.08 |
117.87 |
167.20 |
129.53 |
183.74 |
97.50 |
138.31 |
|
|
|
79.55 |
109.45 |
91.19 |
125.46 |
94.27 |
129.71 |
123.07 |
169.33 |
135.24 |
186.07 |
101.80 |
140.06 |
|
|
|
83.32 |
111.78 |
95.51 |
128.13 |
98.74 |
132.47 |
128.90 |
172.93 |
141.65 |
190.03 |
106.63 |
143.05 |
|
|
|
86.82 |
113.56 |
99.52 |
130.18 |
102.89 |
134.58 |
134.31 |
175.69 |
147.60 |
193.06 |
111.10 |
145.33 |
|
|
|
89.15 |
118.43 |
102.19 |
135.76 |
105.65 |
140.35 |
137.92 |
183.22 |
151.56 |
201.34 |
114.09 |
151.56 |
|
|
|
92.58 |
120.14 |
106.12 |
137.72 |
109.72 |
142.39 |
143.23 |
185.88 |
157.39 |
204.26 |
118.47 |
153.75 |
|
|
|
94.91 |
123.44 |
108.79 |
141.49 |
112.48 |
146.29 |
146.83 |
190.97 |
161.35 |
209.85 |
121.46 |
157.96 |
|
|
|
98.27 |
126.86 |
112.65 |
145.43 |
116.46 |
150.35 |
152.03 |
196.27 |
167.07 |
215.68 |
125.76 |
162.35 |
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|
|
Male |
Female |
Male |
Female |
Male |
Female |
Male |
Female |
Male |
Female |
Male |
Female |
|
|
$45 Copay Plan $5,750 Deductible w/ $1000 Brand Rx Ded |
$45 Copay Plan $5,750 Deductible w/ $0 Brand Rx Ded |
$35 Copay Plan $5,750 Deductible |
$30 Copay Plan $5,750 Deductible |
Fusion 100%/50% $5,000 Deductible |
$5,000 Single Ded. $10,500 Fam. Ded. |
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|
|
Male |
Female |
Male |
Female |
Male |
Female |
Male |
Female |
Male |
Female |
Male |
Female |
|
|
|
$101.70 |
$133.04 |
$116.58 |
$152.50 |
$120.52 |
$157.66 |
$157.34 |
$205.82 |
$172.90 |
$226.17 |
$130.14 |
$170.25 |
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|
|
104.85 |
139.89 |
120.19 |
160.36 |
124.26 |
165.79 |
162.22 |
216.43 |
178.26 |
237.83 |
134.18 |
179.03 |
|
|
|
112.19 |
146.75 |
128.60 |
168.22 |
132.96 |
173.92 |
173.57 |
227.04 |
190.73 |
249.49 |
143.57 |
187.80 |
|
|
|
119.87 |
154.43 |
137.41 |
177.03 |
142.06 |
183.02 |
185.45 |
238.92 |
203.79 |
262.55 |
153.40 |
197.63 |
|
|
|
127.28 |
160.47 |
145.90 |
183.94 |
150.84 |
190.17 |
196.91 |
248.26 |
216.38 |
272.81 |
162.88 |
205.35 |
|
|
|
134.61 |
164.10 |
154.31 |
188.11 |
159.53 |
194.48 |
208.26 |
253.88 |
228.86 |
278.99 |
172.27 |
210.00 |
|
|
|
143.66 |
166.77 |
164.68 |
191.18 |
170.26 |
197.65 |
222.27 |
258.02 |
244.24 |
283.53 |
183.85 |
213.43 |
|
|
|
151.76 |
176.10 |
173.96 |
201.87 |
179.85 |
208.70 |
234.79 |
272.45 |
258.00 |
299.39 |
194.21 |
225.36 |
|
|
|
159.03 |
181.45 |
182.29 |
208.00 |
188.47 |
215.04 |
246.03 |
280.72 |
270.36 |
308.48 |
203.51 |
232.21 |
|
|
|
171.99 |
185.91 |
197.15 |
213.11 |
203.83 |
220.32 |
266.08 |
287.62 |
292.39 |
316.06 |
220.10 |
237.91 |
|
|
|
183.10 |
196.74 |
209.88 |
225.53 |
216.99 |
233.16 |
283.27 |
304.38 |
311.28 |
334.48 |
234.31 |
251.78 |
|
|
|
206.89 |
219.17 |
237.16 |
251.23 |
245.19 |
259.74 |
320.09 |
339.08 |
351.74 |
372.60 |
264.77 |
280.47 |
|
|
|
221.29 |
231.51 |
253.67 |
265.38 |
262.26 |
274.37 |
342.37 |
358.17 |
376.22 |
393.59 |
283.19 |
296.27 |
|
|
|
235.69 |
241.73 |
270.18 |
277.09 |
279.33 |
286.48 |
364.64 |
373.98 |
400.70 |
410.96 |
301.62 |
309.35 |
|
|
|
250.02 |
248.31 |
286.61 |
284.64 |
296.31 |
294.28 |
386.82 |
384.17 |
425.07 |
422.15 |
319.97 |
317.77 |
|
|
|
262.64 |
259.69 |
301.07 |
297.69 |
311.27 |
307.77 |
406.34 |
401.78 |
446.52 |
441.51 |
336.11 |
332.34 |
|
|
|
278.28 |
272.52 |
318.99 |
312.39 |
329.80 |
322.97 |
430.53 |
421.62 |
473.10 |
463.31 |
356.12 |
348.75 |
|
|
|
287.33 |
281.29 |
329.37 |
322.45 |
340.52 |
333.37 |
44.53 |
435.20 |
488.49 |
478.23 |
367.71 |
359.98 |
|
|
|
295.01 |
289.73 |
338.17 |
332.12 |
349.63 |
343.37 |
456.42 |
448.25 |
501.55 |
492.57 |
377.53 |
370.78 |
|
|
|
256.88 |
266.00 |
294.47 |
304.92 |
304.44 |
315.25 |
397.43 |
411.54 |
436.73 |
452.23 |
328.74 |
340.41 |
|
|
|
Male |
Female |
Male |
Female |
Male |
Female |
Male |
Female |
Male |
Female |
Male |
Female |
|
|
$45 Copay Plan $5,750 Deductible w/ $1000 Brand Rx Ded |
$45 Copay Plan $5,750 Deductible w/ $0 Brand Rx Ded |
$35 Copay Plan $5,750 Deductible |
$30 Copay Plan $5,750 Deductible |
Fusion 100%/50% $5,000 Deductible |
$5,000 Single Ded. $10,500 Fam. Ded. |
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 5 Dunwoody Park S., Suite 113 Atlanta, GA 30338 |
(770) 396-9517 Outside of the Atlanta area, call toll-free: 1-877-711-8376. Email: holly@insurance-now.com |
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