| Applicant. Select your monthly premium based on your sex and age. |
| 19 - 25 |
$240.00 |
| 26 - 29 |
$251.00 |
| 30 - 45 |
$282.00 |
| 46 - 55 |
$535.00 |
| 56 - 64 |
$864.00 |
| 65+ |
$1,073.00 |
|
| 19 - 25 |
$240.00 |
| 26 - 29 |
$467.00 |
| 30 - 45 |
$506.00 |
| 46 - 55 |
$565.00 |
| 56 - 64 |
$875.00 |
| 65+ |
$1,049.00 |
|
| |
|
| Spouse. Select your spouse’s monthly premium based on his or her sex and age. |
| 19 - 25 |
$240.00 |
| 26 - 29 |
$251.00 |
| 30 - 45 |
$282.00 |
| 46 - 55 |
$535.00 |
| 56 - 64 |
$864.00 |
| 65+ |
$1,073.00 |
|
| 19 - 25 |
$240.00 |
| 26 - 29 |
$467.00 |
| 30 - 45 |
$506.00 |
| 46 - 55 |
$565.00 |
| 56 - 64 |
$875.00 |
| 65+ |
$1,049.00 |
|
| |
|
| Children. Select the number of children under the age of 18. |
| 1 |
$240.00 |
| 2 |
$480.00 |
| 3 |
$720.00 |
| 4 |
$960.00 |
| 5 |
$1,200.00 |
|
|
