BCBS GA - BlueValue PPO Monthly Rates - Effective October 1, 2009

RATES - AREAS 1 & 2 - Use these rates if you live in Baldwin, Barrow, Bartow, Ben Hill, Berrien, Bibb, Bleckley, Brooks, Burke, Butts, Calhoun, Cherokee, Clarke, Clayton, Cobb, Colquitt, Columbia, Cook, Coweta, Crawford, Crisp, Dekalb, Dodge, Dougherty, Douglas, Elbert, Emanuel, Fayette, Forsyth, Fulton, Glascock, Grady, Greene, Gwinnett, Hancock, Henry, Houston, Irwin, Jackson, Jasper, Jefferson, Jenkins, Johnson, Jones, Laurens, Lanier, Lee, Lincoln, Lowndes, McDuffie, Madison, Montgomery, Monroe, Morgan, Newton, Oconee, Oglethorpe, Paulding, Peach, Pulaski, Putnam, Randolph, Richmond, Rockdale, Screven, Spalding, Taliaferro, Telfair, Terrell, Thomas, Tift, Treutlen, Turner, Twiggs, Walton, Warren, Washington, Wheeler, Wilcox, Wilkinson, Wilkes, and Worth Counties

These rates are available for applicants enrolling October 1, 2009 through December 31, 2009.

BLUE VALUE
PLAN 1,000

BLUE VALUE
PLAN 2,000

BLUE VALUE
PLAN 3,000

BLUE VALUE
PLAN 3,500

BLUE VALUE
PLAN 5,000

BLUE VALUE
PLAN 10,000

Age

Male

Female

Family

Male

Female

Family

Male

Female

Family

Male

Female

Family

Male

Female

Family

Male

Female

Family

0-19

$148.70

$684.79

$113.43

$522.35

$89.09

$383.19

$87.14

$329.75

$76.82

$291.71

$52.34

$198.06

20-24

160.41

201.31

787.93

122.36

153.56

601.03

96.11

120.62

427.02

94.00

117.97

342.54

82.87

104.00

301.98

56.46

70.86

205.74

25-29

192.33

243.18

895.25

146.71

185.50

682.89

115.24

145.70

491.79

112.71

142.50

406.83

99.36

125.63

358.66

67.70

85.59

244.36

30-34

204.04

312.48

1034.80

155.64

238.36

789.34

122.25

187.22

566.28

119.57

183.11

464.55

105.41

161.43

409.54

71.82

109.98

279.03

35-39

260.35

368.78

914.82

198.59

281.31

697.82

155.99

220.96

522.55

152.56

216.11

468.68

134.50

190.52

413.19

91.63

129.80

281.51

40-44

304.14

402.47

864.61

231.99

307.00

659.52

182.22

241.14

510.92

178.22

235.85

488.05

157.12

207.92

430.26

107.05

141.66

293.14

45-49

392.20

493.58

100.96

299.17

376.50

763.53

234.99

295.75

595.69

229.83

289.24

575.75

202.62

254.99

507.58

138.04

173.73

345.82

50-54

480.43

541.38

1095.44

366.47

412.97

835.60

287.85

324.37

652.88

281.53

317.25

632.81

248.20

279.69

557.88

169.10

190.55

380.09

55-59

598.33

613.41

1226.33

456.40

467.90

935.44

358.49

367.52

730.92

350.62

359.46

708.38

309.11

316.89

624.51

210.60

215.90

425.48

60-64

835.25

734.20

1477.70

637.13

560.04

1127.18

500.44

439.90

881.23

489.46

430.24

854.74

431.50

379.30

753.54

293.99

258.42

513.39

65+*

1015.56

895.09

1699.38

774.66

682.77

1296.28

608.47

536.29

1013.67

595.11

524.52

983.71

524.65

462.41

867.23

357.45

315.05

590.85

* For those not eligible for Medicare

RATES - AREA 3 - Use these rates if you live in Appling, Atkinson, Bacon, Baker, Banks, Brantley, Bryan, Bulloch, Camden, Candler, Carroll, Catoosa, Charlton, Chatham, Chattahoochee, Chattooga, Clay, Clinch, Coffee, Dade, Dawson, Decatur, Dooly, Early, Echols, Effingham, Evans, Fannin, Floyd, Franklin, Gilmer, Glynn, Gordon, Habersham, Hall, Haralson, Harris, Hart, Heard, Jeff Davis, Lamar, Liberty, Long, Lumpkin, McIntosh, Macon, Marion, Meriwether, Miller, Mitchell, Murray, Muscogee, Pickens, Pierce, Pike, Polk, Quitman, Rabun, Schley, Seminole, Stephens, Stewart, Sumter, Talbot, Tattnall, Taylor, Toombs, Towns, Troup, Union, Upson, Walker, Ware, Wayne, Webster, Whitfield or White County.

These rates are available for applicants enrolling October 1, 2009 through December 31, 2009.

BLUE VALUE
PLAN 1,000

BLUE VALUE
PLAN 2,000

BLUE VALUE
PLAN 3,000

BLUE VALUE
PLAN 3,500

BLUE VALUE
PLAN 5,000

BLUE VALUE
PLAN 10,000

Age

Male

Female

Family

Male

Female

Family

Male

Female

Family

Male

Female

Family

Male

Female

Family

Male

Female

Family

0-19

$136.80

$630.01

$104.35

$480.57

$81.97

$352.54

$80.17

$303.37

$70.67

$267.45

$48.15

$182.22

20-24

147.58

185.21

724.90

112.57

141.28

552.95

88.42

110.97

392.86

86.48

108.53

315.13

76.24

95.68

277.82

51.94

65.19

189.28

25-29

176.95

223.73

823.63

134.97

170.66

628.26

106.02

134.05

452.45

103.69

131.10

374.29

91.41

115.58

329.97

62.28

78.75

224.81

30-34

187.72

287.48

952.02

143.19

219.29

726.20

112.47

172.24

520.98

110.00

168.46

427.38

96.98

148.52

376.78

66.07

101.19

256.70

35-39

239.52

339.28

841.63

182.70

258.80

641.99

143.51

203.28

480.75

140.36

198.82

431.19

123.74

175.28

380.13

84.30

119.42

258.99

40-44

279.81

370.27

795.44

213.43

282.44

606.76

167.65

221.85

470.05

163.97

216.98

449.00

144.55

191.29

395.84

98.48

130.33

269.69

45-49

360.83

454.10

920.88

275.24

346.38

702.44

216.19

272.07

548.03

211.44

266.10

529.69

186.41

234.59

466.97

127.00

159.83

318.15

50-54

441.99

498.07

1007.80

337.15

379.93

768.75

264.82

298.42

600.65

259.01

291.87

582.18

228.34

257.31

513.25

155.57

175.31

349.68

55-59

550.46

564.34

1128.23

419.89

430.47

860.61

329.81

338.12

672.44

322.57

330.70

651.71

284.38

291.54

574.55

193.75

198.63

391.44

60-64

768.43

675.46

1359.48

586.16

515.24

1037.01

460.41

404.70

810.73

450.30

395.82

786.36

396.98

348.95

693.25

270.47

237.74

472.32

65+*

934.31

823.48

1563.43

712.69

628.15

1192.58

559.79

493.39

932.58

547.50

482.56

905.01

482.68

425.42

797.86

328.85

289.84

543.59

* For those not eligible for Medicare