CoventryOne Authorized Agent
 


CoventryOne POS $2,000 - $2,750 Deductible Plan Insurance Options
Monthly Rates** - Effective 8/01/2011
Area 1 - Use these rates if you live in Banks, Barrow, Bartow, Bibb, Bleckley, Burke, Butts, Cherokee,
Clayton, Cobb, Columbia, Coweta, Crawford, Dawson, Dekalb, Dooly, Douglas, Fayette,
Forsyth, Fulton, Glascock, Greene, Gwinnett, Henry, Houston, Jackson, Jasper, Jefferson, Jenkins, Jones, Lamar, Lincoln,
Macon, McDuffie, Meriwether, Monroe, Morgan, Newton, Paulding, Peach, Pike, Pulaski, Putnam, Richmond,
Rockdale, Spalding, Taylor, Troup, Twiggs, Upson, Walton, Warren or Wilkinson county
**CoventryOne monthly rates effective 5-1-11 to 7-31-11 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- 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 August 1, 2011 through September 30, 2011
CoventryOne
$30 Copay Plan
$2,500 Deductible
CoventryOne
$35 Copay Plan
$2,500 Deductible
CoventryOne $45
Copay Plan $2,750 Deductible $0 Prescription Ded.
CoventryOne $45
Copay Plan $2,750 Deductible $1K Rx Deductible

Age

Male

Female

Male

Female

Male

Female

Male

Female

Age

0

$239.93

$239.93

$171.64

$171.64

$166.48

$166.48

$150.85

$150.85

0

1

145.59

145.59

103.00

103.00

99.90

99.90

90.52

90.52

1

2-5

93.84

93.84

71.65

71.65

69.49

69.49

62.97

62.97

2-5

6-16

93.84

93.84

71.65

71.65

69.49

69.49

62.97

62.97

6-16

17

91.66

98.56

69.98

74.71

67.88

72.46

61.50

95.66

17

18

98.49

103.19

68.32

77.69

66.26

75.36

60.04

68.28

18

19

87.29

106.01

66.65

79.52

64.64

77.12

58.57

69.88

19

20

78.50

107.22

56.43

80.64

54.73

78.21

49.59

70.86

20

21

79.37

111.81

57.05

80.64

55.34

78.21

50.14

70.86

21

22

80.27

114.68

57.70

82.70

55.96

80.21

50.71

72.68

22

23

80.91

120.17

58.16

86.67

56.41

84.06

51.11

76.16

23

24

81.55

125.67

58.61

90.63

56.85

87.90

51.51

79.65

24

25

85.81

131.09

61.86

93.17

60.00

90.37

54.36

81.88

25
CoventryOne
$30 Copay Plan
$2,500 Deductible
CoventryOne
$35 Copay Plan
$2,500 Deductible
CoventryOne $45
Copay Plan $2,750 Deductible $0 Prescription Ded.
CoventryOne $45 Copay Plan $2,750 Deductible
$1K Rx Deductible

Age

Male

Female

Male

Female

Male

Female

Male

Female

Age

26

86.48

133.49

62.34

94.88

60.46

92.02

54.78

83.38

26

27

87.15

134.64

62.83

96.86

60.94

93.94

55.22

85.12

27

28

88.17

135.98

63.56

98.73

61.65

95.75

55.86

86.76

28

29

91.08

137.31

65.66

101.43

63.68

98.38

57.70

89.14

29

30

96.73

138.64

69.20

104.94

67.12

101.78

60.82

92.22

30

31

102.38

140.68

73.24

109.54

71.04

106.25

64.37

96.27

31

32

106.65

146.05

76.30

113.63

74.00

110.21

67.05

99.86

32

33

108.07

151.89

77.31

115.17

74.99

111.70

67.95

101.21

33

34

109.49

157.74

78.33

117.22

75.97

113.69

68.84

103.02

34

35

113.11

163.75

81.36

118.21

78.93

114.65

71.52

103.88

35

36

118.45

167.79

85.23

120.24

82.66

116.62

74.90

105.67

36

37

123.68

169.93

88.8

121.78

86.31

118.12

78.20

107.03

37

38

129.57

173.48

93.23

124.33

90.43

120.59

81.94

109.26

38

39

134.96

176.32

97.11

126.36

94.19

122.56

85.34

111.05

39

40

138.64

184.13

99.83

131.18

96.83

127.23

87.74

115.29

40

41

143.97

186.88

103.68

133.13

100.56

129.12

91.12

116.99

41

42

147.62

190.35

106.30

135.61

103.10

131.53

93.42

119.18

42

43

152.78

193.45

111.19

137.81

107.84

133.66

97.72

121.11

43
CoventryOne
$30 Copay Plan
$2,500 Deductible
CoventryOne
$35 Copay Plan
$2,500 Deductible
CoventryOne $45
Copay Plan $2,750 Deductible $0 Prescription Ded.
CoventryOne $45 Copay Plan $2,750 Deductible
$1K Rx Deductible

Age

Male

Female

Male

Female

Male

Female

Male

Female

Age

44

161.39

196.88

122.32

140.26

118.64

136.04

107.50

123.27

44

45

173.48

202.79

133.11

144.69

129.10

140.34

116.98

127.16

45

46

185.57

213.06

146.43

158.25

142.02

153.49

128.69

139.07

46

47

198.37

223.32

161.08

171.82

156.23

166.65

141.56

151.00

47

48

208.49

231.20

177.18

188.14

171.84

182.48

155.71

165.35

48

49

218.80

238.69

194.89

194.50

189.03

188.65

171.28

170.94

49

50

226.81

251.76

197.14

228.33

191.21

221.46

173.25

200.67

50

51

244.93

264.34

199.39

233.21

193.39

226.19

175.23

204.95

51

52

254.42

277.58

208.20

238.08

201.93

230.92

182.97

209.23

52

53

266.16

291.46

216.54

242.95

210.02

235.64

190.30

213.52

53

54

279.85

295.22

228.63

247.83

221.75

240.37

200.93

217.80

54

55

294.85

298.97

242.23

252.70

234.94

245.10

212.88

222.08

55

56

309.28

312.42

257.57

257.57

249.82

249.82

226.36

226.36

56

57

323.71

325.39

270.30

268.91

262.16

260.82

237.54

236.33

57

58

331.97

332.89

278.21

276.29

269.84

267.98

244.50

242.81

58

59

347.55

347.58

292.24

288.95

283.45

280.26

256.83

253.94

59

60

395.04

363.72

309.61

303.18

300.30

294.05

272.10

266.44

60

61

413.88

373.34

319.64

312.98

310.02

303.56

280.91

275.06

61

62

433.59

381.69

328.24

322.37

318.36

312.67

288.46

283.31

62

63

454.17

389.72

336.62

331.35

326.49

321.38

295.84

291.20

63

Age

Male

Female

Male

Female

Male

Female

Male

Female

Age
CoventryOne
$30 Copay Plan
$2,500 Deductible
CoventryOne
$35 Copay Plan
$2,500 Deductible
CoventryOne $45
Copay Plan $2,750 Deductible $0 Prescription Ded.
CoventryOne $45 Copay Plan $2,750 Deductible
$1K Rx Deductible

**CoventryOne monthly rates effective 5-1-11 to 7-31-11 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.

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Insurance Now
5 Dunwoody Pk., Suite 113
Atlanta, GA 30338

Call Holly, Bob 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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