| Applicant. Select your monthly premium based on your sex and age. |
| 19 - 29 |
$194 |
| 30 - 45 |
$222 |
| 46 - 55 |
$388 |
| 56 - 64 |
$617 |
| 65+ |
$830 |
|
| 19 - 29 |
$383 |
| 30 - 45 |
$378 |
| 46 - 55 |
$439 |
| 56 - 64 |
$726 |
| 65+ |
$811 |
|
| |
|
| Spouse. Select your spouse’s monthly premium based on his or her sex and age. |
| 19 - 29 |
$194 |
| 30 - 45 |
$222 |
| 46 - 55 |
$388 |
| 56 - 64 |
$617 |
| 65+ |
$830 |
|
| 19 - 29 |
$383 |
| 30 - 45 |
$378 |
| 46 - 55 |
$439 |
| 56 - 64 |
$726 |
| 65+ |
$811 |
|
| |
|
| Children. Select the number of children under the age of 18. |
| 1 |
$195 |
| 2 |
$390 |
| 3 |
$585 |
| 4 |
$780 |
| 5 |
$975 |
|
|
Total Monthly Premium = Applicant Monthly Premium + Spouse’s Monthly Premium + Children’s Monthly Premium.
