Docstoc

MCHA Standard Premium Rates

Document Sample
MCHA Standard Premium Rates Powered By Docstoc
					Minnesota Comprehensive Health Association (MCHA)
                                                                                                                            MCHA Standard Premium Rates
PO Box 9310, Minneapolis, MN 55440-9310                                                                                                          Effective July 1, 2010
1-866-894-8053
                                                                                                         The premium rates are subject to change on July 1, 2011.

                      $500 Deductible           $1,000 Deductible          $2,000 Deductible           High Deductible           $5,000 Deductible          $10,000 Deductible
                             Plan                      Plan                       Plan               Health Plan (HDHP)                 Plan                       Plan
                       Male or Female             Male or Female             Male or Female             Male or Female             Male or Female             Male or Female
            Age      Quarterly    Monthly      Quarterly    Monthly       Quarterly Monthly          Quarterly    Monthly       Quarterly    Monthly        Quarterly Monthly
       Under 15      $1,002.69 $334.23           $753.66 $251.22            $615.36 $205.12            $594.24 $198.08            $447.18 $149.06            $317.58 $105.86
         15 - 29     $1,021.65 $340.55           $765.15 $255.05            $624.45 $208.15            $603.57 $201.19            $448.41 $149.47            $321.00 $107.00
         30 - 34     $1,147.89 $382.63           $851.43 $283.81            $692.13 $230.71            $664.11 $221.37            $500.43 $166.81            $361.74 $120.58
         35 - 39     $1,203.30 $401.10           $898.89 $299.63            $737.43 $245.81            $701.97 $233.99            $524.97 $174.99            $377.97 $125.99
         40 - 44     $1,341.57 $447.19         $1,004.43 $334.81            $824.58 $274.86            $791.28 $263.76            $581.67 $193.89            $419.88 $139.96
         45 - 49     $1,649.88 $549.96         $1,233.72 $411.24           $1012.38 $337.46            $970.92 $323.64            $721.08 $240.36            $518.70 $172.90
         50 - 54     $2,154.75 $718.25         $1,606.95 $535.65          $1,314.78 $438.26          $1,255.95 $418.65            $943.98 $314.66            $679.83 $226.61
         55 - 59     $2,721.03 $907.01         $2,034.03 $678.01          $1,638.15 $546.05          $1,567.35 $522.45          $1,189.05 $396.35            $853.17 $284.39
         60 - 64     $3,003.42 $1,001.14       $2,251.80 $750.60          $1,836.09 $612.03          $1,762.29 $587.43          $1,333.35 $444.45            $949.26 $316.42
            65+      $3,006.03 $1,002.01       $2,255.94 $751.98          $1,843.59 $614.53          $1,768.86 $589.62          $1,336.38 $445.46            $950.25 $316.75

         1 Child    $927.39 $309.13          $675.06 $225.02             $506.73 $168.91            $486.99 $162.33              $370.71 $123.57            $268.89 $89.63
      2 Children $1,854.78 $618.26 $1,350.12 $450.04 $1,013.46 $337.82                              $973.98 $324.66              $741.42 $247.14            $537.78 $179.26
     3+ Children $2,782.17 $927.39 $2,025.18 $675.06 $1,520.19 $506.73 $1,460.97 $486.99 $1,112.13 $370.71                                                  $806.67 $268.89
       Important All plans:
          Notes    • Premiums are established for the insured person and the insured person’s spouse based on the age of the insured person and the age of the insured person’s
                         spouse as of the 1st of the month following the age change.
                       • All policyholders with contracts in force before July 1, 2004, pay the “MCHA Standard Premium Rates.” Contracts issued on or after July 1, 2004, pay the
                         “MCHA Standard Premium Rates” or “MCHA Tobacco-User Premium Rates” based on the policyholder’s/spouse’s use of tobacco as identified on the
                         MCHA application.

                    High Deductible Health Plan (HDHP) is a Federally qualified plan for a health savings account (HSA):
                      • $3,000 Individual annual deductible/out-of-pocket, $6,000 Family annual deductible/out-of-pocket.

                    Plan Changes: Plan changes can be made only one time per calendar year (MCHA Customer Service must receive plan change requests by the 10th day
                    of the previous month, for the change to be recognized the 1st of the following month).
                       • Policyholders can move to a lower deductible plan only on January 1.
                       • Policyholders can move to a higher deductible plan anytime during the year as of the 1st of the month.

COM1536-10510
Minnesota Comprehensive Health Association (MCHA)
                                                                                                               MCHA Tobacco-User Premium Rates
PO Box 9310, Minneapolis, MN 55440-9310                                                                                                        Effective July 1, 2010
1-866-894-8053
                                                                                                       The premium rates are subject to change on July 1, 2011.

                     $500 Deductible           $1,000 Deductible          $2,000 Deductible          High Deductible           $5,000 Deductible         $10,000 Deductible
                           Plan                       Plan                      Plan               Health Plan (HDHP)                 Plan                      Plan
                      Male or Female             Male or Female            Male or Female             Male or Female             Male or Female            Male or Female
          Age      Quarterly    Monthly       Quarterly    Monthly       Quarterly Monthly         Quarterly    Monthly       Quarterly    Monthly       Quarterly Monthly
     Under 15      $1,283.43 $427.81            $964.68 $321.56            $787.65 $262.55           $760.62 $253.54            $572.40 $190.80           $406.50 $135.50
       15 - 29     $1,307.70 $435.90            $979.38 $326.46            $799.29 $266.43           $772.56 $257.52            $573.96 $191.32           $410.88 $136.96
       30 - 34     $1,469.31 $489.77          $1,089.84 $363.28            $885.93 $295.31           $850.05 $283.35            $640.56 $213.52           $463.02 $154.34
       35 - 39     $1,540.23 $513.41          $1,150.59 $383.53            $943.92 $314.64           $898.53 $299.51            $671.97 $223.99           $483.81 $161.27
       40 - 44     $1,717.20 $572.40          $1,285.68 $428.56          $1,055.46 $351.82         $1,012.83 $337.61            $744.54 $248.18           $537.45 $179.15
       45 - 49     $2,111.85 $703.95          $1,579.17 $526.39          $1,295.85 $431.95         $1,242.78 $414.26            $922.98 $307.66           $663.93 $221.31
       50 - 54     $2,758.08 $919.36          $2,056.89 $685.63          $1,682.91 $560.97         $1,607.61 $535.87          $1,208.28 $402.76           $870.18 $290.06
       55 - 59     $3,482.91 $1,160.97        $2,603.55 $867.85          $2,096.82 $698.94         $2,006.22 $668.74          $1,521.99 $507.33          $1,092.06 $364.02
       60 - 64     $3,844.38 $1,281.46        $2,882.31 $960.77          $2,350.20 $783.40         $2,255.73 $751.91          $1,706.70 $568.90          $1,215.06 $405.02
          65+      $3,847.71 $1,282.57        $2,887.59 $962.53          $2,359.80 $786.60         $2,264.13 $754.71          $1,710.57 $570.19          $1,216.32 $405.44

       1 Child    $927.39 $309.13           $675.06 $225.02             $506.73 $168.91 $486.99 $162.33                        $370.71 $123.57            $268.89 $89.63
    2 Children $1,854.78 $618.26 $1,350.12 $450.04 $1,013.46 $337.82 $973.98 $324.66                                           $741.42 $247.14            $537.78 $179.26
   3+ Children $2,782.17 $927.39 $2,025.18 $675.06 $1,520.19 $506.73 $1,460.97 $486.99 $1,112.13 $370.71                                                  $806.67 $268.89
     Important All plans:
        Notes    • Premiums are established for the insured person and the insured person’s spouse based on the age of the insured person and the age of the insured person’s
                       spouse as of the 1st of the month following the age change.
                     • All policyholders with contracts in force before July 1, 2004, pay the “MCHA Standard Premium Rates.” Contracts issued on or after July 1, 2004, pay the
                       “MCHA Standard Premium Rates” or “MCHA Tobacco-User Premium Rates” based on the policyholder’s/spouse’s use of tobacco as identified on the
                       MCHA application.

                  High Deductible Health Plan (HDHP) is a Federally qualified plan for a health savings account (HSA):
                    • $3,000 Individual annual deductible/out-of-pocket, $6,000 Family annual deductible/out-of-pocket.

                  Plan Changes: Plan changes can be made only one time per calendar year (MCHA Customer Service must receive plan change requests by the 10th day
                  of the previous month, for the change to be recognized the 1st of the following month).
                     • Policyholders can move to a lower deductible plan only on January 1.
                     • Policyholders can move to a higher deductible plan anytime during the year as of the 1st of the month.

				
DOCUMENT INFO