| Monthly Premium for $15,000 of Coverage | ||||
| Attained Age | Member Only | Member + Spouse/Domestic Partner | Member + Children | Member + Spouse /Domestic Partner + Children |
| <25 | $7.95 | $15.60 | $12.00 | $19.65 |
| 25–29 | $8.40 | $16.65 | $12.30 | $20.70 |
| 30–34 | $10.35 | $20.25 | $14.25 | $24.30 |
| 35–39 | $11.25 | $22.65 | $15.30 | $26.70 |
| 40–44 | $13.50 | $27.60 | $17.55 | $31.65 |
| 45–49 | $19.50 | $40.65 | $23.55 | $44.55 |
| 50–54 | $27.60 | $58.80 | $31.50 | $62.70 |
| 55–59 | $38.25 | $82.80 | $42.30 | $86.70 |
| 60–64 | $51.15 | $111.90 | $55.05 | $115.65 |
| 65–69 | $68.70 | $153.00 | $72.75 | $157.05 |