| Applicant. Select your monthly premium based on your sex and age. |
| 19 - 29 |
$153 |
| 30 - 45 |
$208 |
| 46 - 55 |
$286 |
| 56 - 64 |
$498 |
| 65+ |
$696 |
|
| 19 - 29 |
$344 |
| 30 - 45 |
$349 |
| 46 - 55 |
$428 |
| 56 - 64 |
$613 |
| 65+ |
$680 |
|
| |
|
| Spouse. Select your spouse’s monthly premium based on his or her sex and age. |
| 19 - 29 |
$153 |
| 30 - 45 |
$208 |
| 46 - 55 |
$286 |
| 56 - 64 |
$498 |
| 65+ |
$696 |
|
| 19 - 29 |
$344 |
| 30 - 45 |
$349 |
| 46 - 55 |
$428 |
| 56 - 64 |
$613 |
| 65+ |
$680 |
|
| |
|
| Children. Select the number of children under the age of 18. |
| 1 |
$185 |
| 2 |
$370 |
| 3 |
$555 |
| 4 |
$740 |
| 5 |
$925 |
|
|
Total Monthly Premium = Applicant Monthly Premium + Spouse’s Monthly Premium + Children’s Monthly Premium.
