BlueValue Select 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
SELECT 500

BLUE VALUE
SELECT 750

BLUE VALUE
SELECT 1,000

BLUE VALUE
SELECT 1,500

Age

Male

Female

Family

Male

Female

Family

Male

Female

Family

Male

Female

Family

0-19

$212.35

$977.90

$193.29

$890.13

$165.89

$763.94

$147.66

$680.01

20-24

229.07

287.48

1125.19

208.51

261.68

1024.20

178.95

224.58

879.00

159.29

199.91

782.43

25-29

274.65

347.27

1278.44

250.00

316.10

1163.69

214.56

271.29

998.72

190.99

241.48

889.00

30-34

291.38

446.23

1477.73

265.22

406.18

1345.10

227.62

348.59

1154.41

202.62

310.30

1027.58

35-39

371.78

526.63

1306.39

338.41

479.36

1189.13

290.44

411.41

1020.55

258.53

366.21

908.43

40-44

434.32

574.74

1234.69

395.33

523.15

1123.87

339.29

448.99

964.54

302.01

399.66

858.57

45-49

560.08

704.85

1429.40

509.81

641.59

1301.10

437.53

550.63

1116.65

389.46

490.14

993.97

50-54

686.06

773.11

1564.32

624.49

703.72

1423.91

535.96

603.96

1222.05

477.07

537.60

1087.79

55-59

854.43

875.96

1751.24

777.74

797.34

1594.06

667.48

684.30

1368.07

594.15

609.12

1217.77

60-64

1192.77

1048.45

2110.19

1085.71

954.35

1920.79

931.79

819.05

1648.49

829.42

729.07

1467.38

65+*

1450.24

1278.21

2426.77

1320.08

1163.49

2208.95

1132.93

998.54

1895.80

1008.46

888.84

1687.52

* 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
SELECT 500

BLUE VALUE
SELECT 750

BLUE VALUE
SELECT 1,000

BLUE VALUE
SELECT 1,500

Age

Male

Female

Family

Male

Female

Family

Male

Female

Family

Male

Female

Family

0-19

$195.36

$899.67

$177.83

$818.92

$152.62

$702.82

$135.85

$625.81

20-24

210.74

264.48

1035.18

191.83

240.75

942.27

164.63

206.62

808.68

146.55

183.92

719.84

25-29

252.68

319.49

1176.16

230.00

290.81

1070.60

197.40

249.59

918.82

175.71

222.16

817.88

30-34

268.07

410.53

1359.51

244.01

373.48

1237.49

209.41

320.71

1062.05

186.41

285.47

945.37

35-39

342.04

484.50

1201.88

311.34

441.02

1094.00

267.20

378.49

938.91

237.85

336.91

835.76

40-44

399.57

528.76

1135.91

363.71

481.30

1033.96

312.15

413.07

887.38

277.85

367.69

789.89

45-49

515.27

648.46

1315.05

469.02

590.26

1197.01

402.53

506.58

1027.32

358.31

450.92

914.45

50-54

631.18

711.26

1439.17

574.53

647.42

1310.00

493.08

555.64

1124.29

438.91

494.60

1000.77

55-59

786.08

805.89

1611.14

715.52

733.55

1466.53

614.08

629.56

1258.63

546.62

560.39

1120.35

60-64

1097.35

964.58

1941.38

998.85

878.00

1767.13

857.25

753.53

1516.61

763.07

670.74

1349.99

65+*

1334.22

1175.95

2232.63

1214.47

1070.41

2032.24

1042.30

918.66

1744.13

927.79

817.73

1552.52

* For those not eligible for Medicare