Authorized Kaiser Agent

Rates are only for Atlanta, Georgia and surrounding areas Questions? Call Chris, Holly or Bob at 770-396-9517

2009 HSA Personal Plans Atlanta Monthly Premiums - Rates effective 09/02/2009 - 12/01/2009

HSA Self-Only Plans
	$3,500 Deductible 100%			$5,000 Deductible 100%			$3,500 Deductible 80%
age*	Male	Female		Male	Female		Male	Female
0-2	$91	$99		$77	$80		$85	$91
3-11	91	99		77	80		85	91
12-19	91	99		77	80		85	91
20-24	105	151		89	128		101	143
25-29	132	192		109	163		123	182
30-34	139	243		116	206		129	229
35-39	162	272		138	230		151	259
40-44	183	268		156	226		172	253
45-49	229	285		195	240		215	270
50-54	266	323		224	272		251	304
55-59	345	371		292	313		325	348
60-64**	453	428		381	359		426	400

 

HSA Family Plan Option 1 (3,500 Ded 100% Coinsurance)
	Subscriber/ Child*		Subscriber/ Children*		Subscriber/ Spouse*	Subscriber/ Spouse/Child*	Subscriber/ Spouse/Children*
age*	Male	Female	Male	Female	M or F	M or F	M or F
12-19	$182	$190	$238	$249	$248	$340	$415
20-24	208	300	273	392	326	434	531
25-29	259	381	340	502	416	549	672
30-34	271	480	358	631	473	619	757
35-39	318	539	418	710	553	717	879
40-44	363	530	474	697	617	796	972
45-49	453	562	595	743	693	911	1113
50-54	524	635	690	838	758	1012	1239
55-59	681	731	898	960	921	1262	1542
60-64**	895	840	1175	1106	1202	1653	2016

HSA Family Plan Option 2 (5,000 Ded 100% Coinsurance)
	Subscriber/ Child*		Subscriber/ Children*		Subscriber/ Spouse*	Subscriber/ Spouse/Child*	Subscriber/ Spouse/Children*
age*	Male	Female	Male	Female	M or F	M or F	M or F
12-19	$140	$146	$183	$192	$192	$266	$326
20-24	159	229	210	301	253	342	418
25-29	199	294	262	385	323	431	528
30-34	209	369	275	487	368	487	593
35-39	244	415	320	545	430	563	688
40-44	278	407	367	535	480	625	762
45-49	347	433	457	569	538	714	873
50-54	402	488	530	642	591	795	972
55-59	524	563	690	738	717	989	1210
60-64**	686	645	902	849	934	1294	1582

HSA Family Plan Option 3 (3,500 Ded 80% Coinsurance)
	Subscriber/ Child*		Subscriber/ Children*		Subscriber/ Spouse*	Subscriber/ Spouse/Child*	Subscriber/ Spouse/Children*
age*	Male	Female	Male	Female	M or F	M or F	M or F
12-19	$159	$168	$209	$221	$220	$301	$368
20-24	183	263	242	348	287	386	471
25-29	228	335	300	443	367	488	595
30-34	239	424	318	557	418	549	671
35-39	281	474	368	626	487	636	778
40-44	320	467	421	617	545	706	860
45-49	401	496	526	655	610	806	989
50-54	463	561	609	739	668	900	1098
55-59	602	644	792	845	812	1121	1367
60-64**	790	743	1036	976	159	1464	1788

HSA Family Plan Option 4 (5,000 Ded 80% Coinsurance)
	Subscriber/ Child*		Subscriber/ Children*		Subscriber/ Spouse*	Subscriber/ Spouse/Child*	Subscriber/ Spouse/Children*
age*	Male	Female	Male	Female	M or F	M or F	M or F
12-19	$123	$128	$162	$170	$170	$235	$287
20-24	142	202	186	266	224	301	368
25-29	176	259	229	340	285	382	467
30-34	185	324	243	429	323	430	525
35-39	216	364	283	483	376	497	607
40-44	245	361	323	472	421	550	676
45-49	307	381	404	501	472	633	771
50-54	354	430	467	566	518	700	859
55-59	462	493	607	650	629	874	1070
60-64**	605	569	796	749	822	1143	1397

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Click here to apply online
* Family coverage is based on the age of the oldest family member applying. (The oldest family member applying is the "subscriber.") **If you are 65 or older, please inquire about our coverage for Medicare-eligible members at 404-364-7001.
Fax your completed application to our fax: 770-396-4318

To receive your Personal Plans enrollment kit, call Bob, Holly or Chris at (770) 396-9517 or Email: holly@insurance-now.com