 CoventryOne Authorized Agent |
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CoventryOne POS $4,000 - $5,000 Deductible Plan Insurance Options
Monthly Rates** - Effective 08/01/2011
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 counties
**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- 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 August 1, 2011 through September 30, 2011
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$30 Copay Plan $5,000 Deductible |
$35 Copay Plan $5,000 Deductible |
$45 Copay Plan $5,750 Deductible w/ $0 Brand Rx Ded. |
$45 Copay Plan $5,750 Deductible w/ $1000 Brand Rx Ded |
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 |
|
|
|
$189.84 |
$189.84 |
$145.42 |
$145.42 |
$141.07 |
$141.07 |
$122.71 |
$122.71 |
$229.33 |
$229.33 |
$157.03 |
$157.03 |
|
|
|
115.30 |
115.30 |
87.27 |
87.27 |
84.65 |
84.65 |
73.64 |
73.64 |
122.72 |
122.72 |
94.22 |
94.22 |
|
|
|
74.89 |
74.89 |
61.46 |
61.46 |
59.62 |
59.62 |
51.86 |
51.86 |
68.29 |
68.29 |
65.98 |
65.98 |
|
|
|
74.89 |
74.89 |
61.46 |
61.46 |
59.62 |
59.62 |
51.86 |
51.86 |
68.29 |
68.29 |
65.98 |
65.98 |
|
|
|
73.15 |
78.58 |
60.03 |
63.91 |
58.23 |
62.00 |
50.65 |
53.93 |
68.29 |
72.73 |
64.45 |
67.12 |
|
|
|
71.41 |
82.19 |
58.60 |
66.33 |
56.84 |
64.34 |
49.45 |
55.97 |
68.29 |
75.28 |
62.91 |
67.12 |
|
|
|
69.67 |
84.40 |
57.17 |
67.80 |
55.46 |
65.77 |
48.24 |
57.21 |
68.29 |
75.28 |
61.38 |
67.95 |
|
|
|
62.11 |
85.23 |
47.22 |
67.59 |
45.81 |
65.57 |
39.85 |
57.04 |
68.58 |
90.26 |
51.37 |
67.95 |
|
|
|
62.80 |
88.47 |
47.74 |
67.59 |
46.31 |
65.57 |
40.28 |
57.04 |
89.35 |
99.68 |
51.95 |
73.18 |
|
|
|
63.51 |
90.74 |
48.28 |
69.32 |
46.84 |
67.24 |
47.74 |
58.49 |
70.14 |
102.23 |
52.54 |
75.05 |
|
|
|
64.02 |
95.09 |
48.67 |
72.63 |
47.21 |
70.46 |
41.07 |
61.29 |
70.69 |
107.13 |
52.95 |
78.65 |
|
|
|
64.52 |
99.44 |
49.05 |
75.97 |
47.58 |
73.69 |
41.39 |
64.10 |
71.25 |
109.69 |
53.37 |
82.25 |
|
|
|
67.90 |
103.73 |
52.92 |
78.68 |
51.33 |
76.32 |
44.65 |
66.39 |
76.08 |
112.71 |
56.16 |
85.80 |
|
|
$30 Copay Plan $5,000 Deductible |
$35 Copay Plan $5,000 Deductible |
$45 Copay Plan $5,750 Deductible |
$45 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 |
|
|
|
88.42 |
105.62 |
53.31 |
80.11 |
51.72 |
77.71 |
44.99 |
67.60 |
76.67 |
114.78 |
56.60 |
87.37 |
|
|
|
68.96 |
106.53 |
53.74 |
81.78 |
52.13 |
79.33 |
45.35 |
69.01 |
77.27 |
117.17 |
57.04 |
88.12 |
|
|
|
69.76 |
107.59 |
54.36 |
83.37 |
52.73 |
80.87 |
45.87 |
70.35 |
78.17 |
119.45 |
57.70 |
89.00 |
|
|
|
72.07 |
108.64 |
56.16 |
85.64 |
54.48 |
83.08 |
47.39 |
72.27 |
80.75 |
122.71 |
59.61 |
89.87 |
|
|
|
76.54 |
109.70 |
58.62 |
88.31 |
56.87 |
85.67 |
49.47 |
74.52 |
84.11 |
125.00 |
63.31 |
90.74 |
|
|
|
81.01 |
111.31 |
62.06 |
92.17 |
60.20 |
89.41 |
52.37 |
77.78 |
89.01 |
130.49 |
67.01 |
92.07 |
|
|
|
84.38 |
115.56 |
64.64 |
95.63 |
62.70 |
92.76 |
54.55 |
80.69 |
92.73 |
135.36 |
69.80 |
95.59 |
|
|
|
85.51 |
120.18 |
65.50 |
96.92 |
63.53 |
94.02 |
55.27 |
81.79 |
93.96 |
137.20 |
70.73 |
99.41 |
|
|
|
86.63 |
124.81 |
66.37 |
98.65 |
64.38 |
95.69 |
56.00 |
83.24 |
95.20 |
139.64 |
71.66 |
103.24 |
|
|
|
89.49 |
129.56 |
68.99 |
99.24 |
66.92 |
96.27 |
58.22 |
83.74 |
98.79 |
142.30 |
74.03 |
107.17 |
|
|
|
93.72 |
132.76 |
72.25 |
100.95 |
70.09 |
97.93 |
60.97 |
85.19 |
103.46 |
144.76 |
77.52 |
109.82 |
|
|
|
97.86 |
134.45 |
75.44 |
102.23 |
73.18 |
99.17 |
63.66 |
86.27 |
108.02 |
146.59 |
80.95 |
111.21 |
|
|
|
102.52 |
137.26 |
79.03 |
104.37 |
76.67 |
101.24 |
66.69 |
88.07 |
113.17 |
149.66 |
84.80 |
113.54 |
|
|
|
106.79 |
139.51 |
82.32 |
106.08 |
79.86 |
102.90 |
69.47 |
89.52 |
116.23 |
152.11 |
88.33 |
115.40 |
|
|
|
109.70 |
145.69 |
84.36 |
110.76 |
81.83 |
107.44 |
71.19 |
93.46 |
127.63 |
166.87 |
90.74 |
120.51 |
|
|
|
113.92 |
147.86 |
87.60 |
112.41 |
84.98 |
109.04 |
73.92 |
94.86 |
132.53 |
169.37 |
94.23 |
122.31 |
|
|
|
116.80 |
150.61 |
89.83 |
114.50 |
87.14 |
111.07 |
75.80 |
96.62 |
135.89 |
172.52 |
96.62 |
124.58 |
|
|
|
120.88 |
153.07 |
93.97 |
116.36 |
91.16 |
112.88 |
79.30 |
98.19 |
140.64 |
175.33 |
99.99 |
126.61 |
|
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$30 Copay Plan $5,000 Deductible |
$35 Copay Plan $5,000 Deductible |
$45 Copay Plan $5,750 Deductible |
$45 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 |
|
|
|
127.70 |
155.78 |
103.37 |
118.43 |
100.27 |
114.88 |
87.23 |
99.93 |
141.80 |
178.44 |
105.63 |
128.86 |
|
|
|
137.26 |
160.46 |
112.39 |
121.98 |
109.03 |
118.33 |
94.84 |
102.93 |
173.67 |
205.22 |
113.54 |
132.73 |
|
|
|
146.83 |
168.58 |
123.63 |
133.42 |
119.93 |
129.43 |
104.33 |
112.59 |
185.77 |
215.61 |
121.45 |
139.44 |
|
|
|
158.95 |
176.70 |
136.01 |
144.85 |
131.93 |
140.52 |
114.77 |
122.23 |
198.58 |
225.98 |
129.83 |
146.16 |
|
|
|
164.97 |
182.94 |
149.60 |
158.61 |
145.12 |
153.86 |
126.24 |
133.85 |
208.72 |
233.96 |
136.46 |
151.32 |
|
|
|
173.12 |
188.86 |
164.56 |
162.80 |
159.63 |
157.93 |
138.86 |
137.38 |
216.00 |
241.54 |
143.20 |
156.22 |
|
|
|
178.61 |
199.21 |
165.14 |
179.82 |
160.19 |
174.44 |
139.35 |
151.74 |
1254.86 |
267.23 |
142.41 |
164.78 |
|
|
|
192.76 |
209.16 |
165.72 |
185.20 |
160.76 |
179.65 |
139.84 |
156.28 |
277.18 |
280.57 |
152.94 |
169.34 |
|
|
|
200.17 |
219.63 |
172.90 |
190.57 |
167.73 |
184.87 |
145.90 |
160.81 |
288.87 |
294.62 |
158.45 |
173.90 |
|
|
|
209.33 |
230.62 |
179.69 |
195.95 |
174.31 |
190.08 |
151.63 |
165.35 |
303.31 |
309.37 |
165.27 |
178.46 |
|
|
|
220.02 |
232.78 |
189.55 |
201.33 |
183.87 |
195.30 |
159.95 |
169.89 |
310.58 |
324.79 |
173.22 |
183.02 |
|
|
|
231.73 |
234.95 |
200.65 |
206.70 |
194.64 |
200.51 |
169.32 |
174.42 |
337.80 |
343.55 |
181.93 |
187.58 |
|
|
|
243.00 |
245.46 |
213.15 |
212.08 |
206.76 |
205.73 |
179.86 |
178.96 |
355.54 |
360.11 |
190.31 |
192.14 |
|
|
|
254.27 |
255.58 |
223.53 |
221.27 |
216.83 |
214.64 |
188.62 |
186.72 |
373.27 |
369.21 |
198.69 |
199.67 |
|
|
|
260.72 |
261.44 |
229.97 |
227.25 |
223.08 |
220.44 |
194.06 |
191.76 |
383.41 |
369.21 |
203.49 |
204.03 |
|
|
|
272.89 |
272.91 |
241.41 |
237.51 |
234.18 |
230.39 |
203.71 |
200.42 |
401.48 |
369.21 |
212.54 |
212.55 |
|
|
|
309.97 |
285.51 |
254.13 |
249.69 |
246.52 |
242.21 |
214.45 |
210.70 |
460.31 |
423.09 |
240.12 |
221.93 |
|
|
|
324.68 |
293.02 |
262.26 |
257.66 |
254.41 |
249.94 |
221.31 |
217.43 |
483.41 |
427.93 |
251.06 |
227.52 |
|
|
|
340.07 |
299.55 |
269.22 |
265.28 |
261.16 |
257.34 |
227.18 |
223.86 |
507.59 |
427.93 |
262.51 |
232.37 |
|
|
|
356.14 |
305.81 |
276.02 |
272.59 |
267.75 |
264.42 |
232.92 |
230.02 |
532.85 |
427.93 |
274.47 |
237.03 |
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|
Male |
Female |
Male |
Female |
Male |
Female |
Male |
Female |
Male |
Female |
Male |
Female |
|
|
$30 Copay Plan $5,000 Deductible |
$35 Copay Plan $5,000 Deductible |
$45 Copay Plan $5,750 Deductible |
$45 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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