CoventryOne Authorized Agent
  
Questions? 770-396-9517


CoventryOne POS $45 Copay Health Insurance Options
Monthly Rates - Effective 07/01/2013 08/31/2013
Area 5 - Use these rates if you live in Bibb, Bleckley, Candler, Crawford, Dooly, Emanuel, Jones, Lamar,
McIntosh, Monroe, Spalding, Twiggs and Wilkinson 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
These rates are available for applicants with effective dates of July 1, 2013 through August 31, 2013
$45 Copay $1,750 Deductible With Brand Prescription Deductible* $45 Copay $2,750 Deductible With Brand Prescription Deductible* $45 Copay $3,750 Deductible With Brand Prescription Deductible* $45 Copay $5,750 Deductible With Brand Prescription Deductible*
Age Male Female Male Female Male Female Male Female
0** 248.94 248.94 199.15 199.15 177.63 177.63 162.01 162.01
1** 149.36 149.36 119.49 119.49 106.58 106.58 97.21 97.21
2-5** 103.89 103.89 83.11 83.11 74.13 74.13 67.61 67.61
6-16** 103.89 103.89 83.11 83.11 74.13 74.13 67.61 67.61
17** 101.46 108.32 81.16 86.65 72.39 77.29 66.03 70.49
18** 99.02 112.63 79.22 90.10 70.66 80.37 64.44 73.30
19 90.72 115.29 72.58 92.23 64.74 82.26 59.04 75.03
20 85.08 116.95 68.06 93.55 60.71 83.45 55.37 76.11
21 86.08 116.95 68.86 93.55 61.42 83.45 56.02 76.11
22 87.07 119.93 69.66 95.94 62.13 85.58 56.67 78.05
23 87.74 125.69 70.19 100.55 62.60 89.68 57.10 81.80
24 88.40 131.44 70.72 105.15 63.08 93.79 57.53 85.54
25 94.15 135.09 75.32 108.07 67.18 96.39 61.28 87.92
Age Male Female Male Female Male Female Male Female
$45 Copay $1,750 Deductible With Brand Prescription Deductible* $45 Copay $2,750 Deductible With Brand Prescription Deductible* $45 Copay $3,750 Deductible With Brand Prescription Deductible* $45 Copay $5,750 Deductible With Brand Prescription Deductible*
Age Male Female Male Female Male Female Male Female
26 94.93 137.08 75.94 109.66 67.74 97.81 61.78 89.21
27 95.70 139.74 76.56 111.79 68.29 99.71 62.28 90.94
28 96.81 141.07 77.45 112.85 69.08 100.66 63.00 91.80
29 100.02 142.50 80.01 114.00 71.37 101.68 65.09 92.74
30 102.34 143.83 81.87 115.06 73.02 102.63 66.60 93.60
31 106.21 145.93 84.97 116.74 75.79 104.13 69.12 94.97
32 110.64 151.47 88.51 121.17 78.95 108.08 72.00 98.57
33 112.08 157.55 89.66 126.04 79.97 112.42 72.94 102.53
34 113.63 163.64 90.90 130.91 81.08 116.76 73.95 106.49
35 117.39 171.38 93.91 137.10 83.76 122.29 76.40 111.53
36 122.92 174.37 98.33 139.49 87.71 124.42 80.00 113.48
37 128.34 176.58 102.67 141.26 91.58 126.00 83.52 114.92
38 134.43 180.34 107.54 144.27 95.92 128.68 87.48 117.37
39 140.07 183.22 112.05 146.57 99.94 130.73 91.16 119.24
40 143.83 191.08 115.06 152.86 102.63 136.34 93.60 124.35
Age Male Female Male Female Male Female Male Female
$45 Copay $1,750 Deductible With Brand Prescription Deductible* $45 Copay $2,750 Deductible With Brand Prescription Deductible* $45 Copay $3,750 Deductible With Brand Prescription Deductible* $45 Copay $5,750 Deductible With Brand Prescription Deductible*
Age Male Female Male Female Male Female Male Female
41 149.36 193.84 119.49 155.07 106.58 138.31 97.21 126.15
42 153.13 199.15 122.50 159.32 109.26 142.10 99.65 129.61
43 158.55 204.68 126.83 163.74 113.13 146.05 103.18 133.21
44 164.08 214.64 131.26 171.71 117.08 153.15 106.78 139.69
45 169.17 225.71 135.33 180.56 120.71 161.05 110.09 146.89
46 181.01 236.77 144.80 189.41 129.15 168.94 117.80 154.09
47 193.40 249.16 154.71 199.32 138.00 177.78 125.86 162.15
48 205.35 258.90 164.27 207.11 146.52 184.76 133.64 168.49
49 217.19 264.76 173.74 211.80 154.97 188.92 141.34 172.31
50 231.79 269.08 185.43 215.25 165.39 191.99 150.85 175.11
51 244.85 284.12 195.87 227.29 174.71 202.73 159.34 184.91
52 256.57 292.75 205.25 234.20 183.07 208.89 166.98 190.52
53 277.48 299.94 221.98 239.95 197.99 214.02 180.59 195.20
54 295.41 317.43 236.32 253.93 210.78 226.49 192.25 206.58
55 333.80 353.60 267.03 282.88 238.18 252.31 217.24 230.12
Age Male Female Male Female Male Female Male Female
$45 Copay $1,750 Deductible With Brand Prescription Deductible* $45 Copay $2,750 Deductible With Brand Prescription Deductible* $45 Copay $3,750 Deductible With Brand Prescription Deductible* $45 Copay $5,750 Deductible With Brand Prescription Deductible*
Age Male Female Male Female Male Female Male Female
56 357.03 373.52 285.62 298.81 254.76 266.52 232.36 243.08
57 380.27 390.01 304.21 312.00 271.33 278.28 247.48 253.81
58 403.39 400.63 322.71 320.49 287.83 285.86 262.53 260.73
59 423.75 418.99 338.99 335.19 302.36 298.97 275.77 272.68
60 448.98 439.68 359.17 351.74 320.36 313.73 292.19 286.14
61 463.58 453.84 370.85 363.07 330.78 323.83 301.70 295.36
62 475.97 467.45 380.77 373.95 339.62 333.54 309.76 304.22
63-64 414.46 429.17 331.56 343.33 295.73 306.23 259.73 279.30

*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.
**Policies including children age 18 and under will not be issued without a parent or legal guardian as one of the covered members.



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