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

$212.35

$977.90

$193.29

$193.29

$890.13

$165.89

$165.89

$763.94

$147.66

$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

$195.36

$899.67

$177.83

$177.83

$818.92

$152.62

$152.62

$702.82

$135.85

$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





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2009 Rates
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