New York State Association of REALTORS® NYSAR Comprehensive EPO $40 Plan with $10 Generic Only Rx Medical & Prescription Plan Rates – 3rd Quarter 2009* Sole Proprietor Rates
Rating Region Buffalo Central I Central II Central III East Mid-Hudson Nassau Suffolk New York City North Country New York Metro Rest of NY Rochester Single Husband & Wife Parent & Child(ren) Family Single
Groups 2-50 Rates
Husband Parent & & Wife Child(ren) Family
$217.91 $298.81 $298.81 $298.81 $266.29 $295.05 $342.09 $326.22 $302.04 $336.45 $304.73 $205.00
$435.80 $597.62 $597.62 $597.62 $532.56 $590.09 $684.17 $652.45 $604.07 $672.87 $609.44 $410.00
$427.38 $586.49 $586.49 $586.49 $522.53 $579.09 $671.60 $640.41 $592.83 $660.49 $598.12 $402.01
$629.82 $864.30 $864.30 $864.30 $770.04 $853.39 $989.71 $943.75 $873.65 $973.35 $881.43 $592.44
$189.48 $259.83 $259.83 $259.83 $231.55 $256.56 $297.47 $283.67 $262.64 $292.56 $264.98 $178.26
$378.96 $519.67 $519.67 $519.67 $463.10 $513.12 $594.93 $567.35 $525.28 $585.11 $529.95 $356.52
$371.64 $509.99 $509.99 $509.99 $454.38 $503.56 $584.00 $556.88 $515.51 $574.34 $520.11 $349.58
$547.67 $751.56 $751.56 $751.56 $669.60 $742.08 $860.62 $820.65 $759.69 $846.39 $766.46 $515.16
Please complete the information below and attach this rate sheet to your NYSAR Health Plan Application form. This signifies your acknowledgement and acceptance of the monthly premium rates as presented. Group Name: ________________________________________________________________________ Print Name: _________________________________________________________________________ Signature: __________________________________________________ Date: ___________________
*Rates shown above are monthly rates valid for effective dates beginning July 1, 2009 through September 30, 2009. MVP Rating Regions by County: Buffalo – Niagara, Erie Central I – Delaware, Herkimer, Lewis, Madison, Oneida, Otsego Central II – Cayuga, Jefferson, Onondaga, Oswego Central III – Broome, Chenango, Chemung, Cortland, Tioga, Tompkins, Schuyler East – Albany, Columbia, Fulton, Greene, Hamilton, Montgomery, Rensselaer, Saratoga, Schenectady, Schoharie, Warren, Washington Mid-Hudson – Dutchess, Orange, Putnam, Sullivan, Ulster Nassau-Suffolk – Nassau, Suffolk New York City – Queens, Bronx, Kings, Richmond, New York North Country – Clinton, Essex, Franklin, St. Lawrence NY Metro – Rockland, Westchester Rest of NY–Chautauqua, Cattaraugus, Allegany Rochester – Genesee, Livingston, Monroe, Ontario, Orleans, Seneca, Steuben, Wayne, Wyoming, Yates