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Questions? 770-396-4318


CoventryOne POS $45 Copay Health Insurance Options
With Dental Insurance Monthly Rates - Effective 05/01/2012
Area 4 - Use these rates if you live in Bulloch, Chattooga, Coffee, Floyd, Gilmer, Heard, Houston, Long, Macon, Polk, Taylor and Upson 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 May 1, 2012 through July 31, 2012
$45 Copay with Dental
$1,750 Deductible
With Brand Rx Deductible*		 $45 Copay With Dental
$2,750 Deductible
With Brand Rx Deductible*		 $45 Copay With Dental
$3,750 Deductible
With Brand Rx Deductible*		 $45 Copay With Dental
$5,750 Deductible
With Brand Rx Deductible*
Age Male Female Male Female Male Female Male Female
6-16** $100.04 $100.04 $80.20 $80.20 $71.62 $71.62 $65.40 $65.40
17** 97.70 104.30 78.32 83.61 69.94 74.67 63.86 68.18
18** 95.35 108.46 76.44 86.94 68.26 77.65 62.33 70.90
19 87.36 111.01 70.03 88.99 62.54 79.48 57.11 72.57
20 81.93 112.61 65.68 90.27 58.65 80.62 53.56 73.61
21 82.89 112.61 66.45 90.27 59.34 80.62 54.18 73.61
22 83.85 115.49 67.21 92.58 60.03 82.68 54.81 75.49
23 84.49 121.03 67.73 97.02 60.48 86.65 55.23 79.12
24 85.12 126.57 68.24 101.46 60.94 90.61 55.65 82.74
25 90.66 130.08 72.68 104.28 64.91 93.13 59.27 85.04
Age Male Female Male Female Male Female Male Female
$45 Copay with Dental
$1,750 Deductible
With Drug Deductible*		 $45 Copay With Dental
$2,750 Deductible
With Drug Deductible*		 $45 Copay With Dental
$3,750 Deductible
With Drug Deductible*		 $45 Copay With Dental
$5,750 Deductible
With Drug Deductible*
Age Male Female Male Female Male Female Male Female
26 $91.41 $132.00 $73.28 $105.82 $65.44 $94.50 $59.76 $86.29
27 92.16 134.56 73.88 107.87 65.98 96.33 60.24 87.96
28 93.22 135.84 74.73 108.89 66.74 97.25 60.94 88.80
29 96.31 137.22 77.21 110.00 68.95 98.24 62.96 89.70
30 98.55 138.50 79.00 111.03 70.55 99.16 64.42 90.54
31 102.28 140.53 81.99 112.65 73.22 100.60 66.86 91.86
32 106.54 145.85 85.41 116.92 76.27 104.42 69.64 95.34
33 107.92 151.71 86.52 121.62 77.26 108.61 70.55 99.17
34 109.42 157.57 87.71 126.32 78.33 112.81 71.53 103.00
35 113.04 165.03 90.62 132.29 80.93 118.15 73.89 107.88
36 118.37 167.91 94.89 134.60 84.74 120.21 77.38 109.76
37 123.59 170.04 99.07 136.31 88.48 121.73 80.79 111.15
38 129.45 173.66 103.77 139.21 92.67 124.33 84.62 113.52
39 134.88 176.43 108.12 141.43 96.56 126.31 88.17 115.33
40 138.50 183.99 111.03 147.50 99.16 131.72 90.54 120.28
Age Male Female Male Female Male Female Male Female
$45 Copay with Dental
$1,750 Deductible
With Drug Deductible*		 $45 Copay With Dental
$2,750 Deductible
With Drug Deductible*		 $45 Copay With Dental
$3,750 Deductible
With Drug Deductible*		 $45 Copay With Dental
$5,750 Deductible
With Drug Deductible*
Age Male Female Male Female Male Female Male Female
41 $143.83 $186.66 $115.30 $149.63 $102.97 $133.63 $94.02 $122.02
42 147.45 191.77 118.20 153.73 105.56 137.29 96.39 125.36
43 152.67 197.10 122.39 158.00 109.30 141.11 99.80 128.84
44 158.00 206.69 126.66 165.69 113.11 147.97 103.28 135.11
45 162.91 217.34 130.59 174.23 116.63 155.60 106.49 142.08
46 174.26 227.99 139.69 182.77 124.75 163.22 113.91 149.04
47 186.27 239.93 149.32 192.34 133.36 171.77 121.77 156.84
48 197.74 249.31 158.51 199.86 141.56 178.49 129.26 162.98
49 209.16 254.93 167.67 204.36 149.74 182.51 136.73 166.65
50 223.22 259.07 178.94 207.68 159.81 185.47 145.92 169.36
51 235.75 273.62 155.99 219.35 168.78 195.89 154.11 178.87
52 247.10 281.93 198.08 226.01 176.90 201.84 161.53 184.30
53 267.17 288.86 214.17 231.56 191.27 206.80 174.65 188.83
54 284.41 305.64 227.99 245.01 203.61 218.81 185.92 199.80
55 321.43 340.50 257.67 272.96 230.12 243.77 210.12 222.58
Age Male Female Male Female Male Female Male Female
$45 Copay with Dental
$1,750 Deductible
With Drug Deductible*		 $45 Copay With Dental
$2,750 Deductible
With Drug Deductible*		 $45 Copay With Dental
$3,750 Deductible
With Drug Deductible*		 $45 Copay With Dental
$5,750 Deductible
With Drug Deductible*
Age Male Female Male Female Male Female Male Female
56 $343.80 $359.68 $275.61 $288.33 $246.13 $257.50 $224.74 $235.12
57 366.18/ 375.55 293.54 301.06 262.15 268.86 239.37 245.50
58 388.44 385.78 311.39 309.26 278.09 276.19 253.92 252.18
59 408.05 403.46 327.11 323.43 292.13 288.85 266.74 263.74
60 432.34 423.39 346.58 339.41 309.52 303.11 282.62 276.77
61 446.40 437.02 357.85 350.34 319.59 312.87 291.81 285.68
62 458.33 450.13 367.42 360.84 328.13 322.25 299.61 294.25
63 470.05 462.70 376.81 370.92 336.52 331.26 307.27 302.47

*CoventryOne monthly rates effective 5-1-12 to 7-31-12 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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