Premiums Organized by Age Group

 

EasySelect EasySelect Quote is designed to provide you a quick overview of available plans and their premiums for 30 days. Elite Network PPO and Premier plans are Underwritten by CHUBB American Insurance Company, USA offer pre-existing conditions coverage. These plans require a minimum durations of 90 days purchase in irrespective of visitors’ length of stay in the United States.

All other plans require minimum of 30 days purchase in irrespective of visitors’ length of stay in the United States.

  • Without Pre-Existing
  • Pre-Existing
Without Pre-Existing
  • 1 0-17
  • 2 18-29
  • 3 30-39
  • 4 40-49
  • 5 50-59
  • 6 60-69
  • 7 70-79
  • 8 80+
1 0-17
Select Plan Fixed Benefits | Teladoc | First Health

MINIMUM PURCHASE REQUIRED 1 MONTH

*(pre-ex acute onset coverage included)

New Sickness Deductible$25,000Max (Per Sickness)$50,000 Max (Per Sickness)$75,000 Max (Per Sickness)$100,000 Max (Per Sickness)$150,000 Max (Per Sickness)$250,000 Max (per Sickness)
$100$16.00$25.00$31.25$37.00
$75$26.97$35.19$43.41$51.63$68.07
$250$24.01$30.87$37.73$44.59$58.31
$500$22.34$28.72$35.10$41.48$54.24$79.76
$1,000$36.71$48.00$70.58
$5,000$37.24
$10,000$21.58

Advantage Plan* | Teladoc Benefit | FirstHealth PPO Network Benefits
New Sickness Deductible$25,000Max (Per Sickness)$50,000 Max (Per Sickness)$75,000 Max (Per Sickness)$100,000 Max (Per Sickness)$150,000 Max (Per Sickness)$250,000 Max (per Sickness)
$250$92.63
$500$78.00

CHUBB Standard | Fixed Benefits
New Sickness Deductible$25,000Max (Per Sickness)$50,000 Max (Per Sickness)$75,000 Max (Per Sickness)$100,000 Max (Per Sickness)$150,000 Max (Per Sickness)$250,000 Max (per Sickness)
$75$36.19$53.10$61.85
$250$31.75$45.86$52.92

ELITE Network (80/20) (Recommended Plan)
New Sickness Deductible$25,000Max (Per Sickness)$50,000 Max (Per Sickness)$75,000 Max (Per Sickness)$100,000 Max (Per Sickness)$150,000 Max (Per Sickness)$250,000 Max (per Sickness)
$500$97.50
2 18-29
Select Plan Fixed Benefits | Teladoc | First Health

MINIMUM PURCHASE REQUIRED 1 MONTH

*(pre-ex acute onset coverage included)

New Sickness Deductible$25,000Max (Per Sickness)$50,000 Max (Per Sickness)$75,000 Max (Per Sickness)$100,000 Max (Per Sickness)$150,000 Max (Per Sickness)$250,000 Max (per Sickness)
$100$16.00$25.00$31.25$37.00
$75$26.97$35.19$43.41$51.63$68.07
$250$24.01$30.87$37.73$44.59$58.31
$500$22.34$28.72$35.10$41.48$54.24$79.76
$1,000$36.71$48.00$70.58
$5,000$37.24
$10,000$21.58

Advantage Plan* | Teladoc Benefit | FirstHealth PPO Network Benefits
New Sickness Deductible$25,000Max (Per Sickness)$50,000 Max (Per Sickness)$75,000 Max (Per Sickness)$100,000 Max (Per Sickness)$150,000 Max (Per Sickness)$250,000 Max (per Sickness)
$250$92.63
$500$78.00

CHUBB Standard | Fixed Benefits
New Sickness Deductible$25,000Max (Per Sickness)$50,000 Max (Per Sickness)$75,000 Max (Per Sickness)$100,000 Max (Per Sickness)$150,000 Max (Per Sickness)$250,000 Max (per Sickness)
$75$36.19$53.10$61.85
$250$31.75$45.86$52.92

ELITE Network (80/20) (Recommended Plan)
New Sickness Deductible$25,000Max (Per Sickness)$50,000 Max (Per Sickness)$75,000 Max (Per Sickness)$100,000 Max (Per Sickness)$150,000 Max (Per Sickness)$250,000 Max (per Sickness)
$500$97.50
3 30-39
Select Plan | Fixed Benefits | Teladoc | First Health

MINIMUM PURCHASE REQUIRED 1 MONTH

*(pre-ex acute onset coverage included)

New Sickness Deductible$25,000Max (Per Sickness)$50,000 Max (Per Sickness)$75,000 Max (Per Sickness)$100,000 Max (Per Sickness)$150,000 Max (Per Sickness)$250,000 Max (per Sickness)
$100$18.00$30.00$37.50$42.00
$75$30.87$39.11$47.34$55.58$72.05
$250$27.44$34.30$41.16$48.02$61.74
$500$25.53$31.91$38.29$44.67$57.43$82.95
$1,000$39.53$50.82$73.40
$5,000$38.73
$10,000$22.48

Advantage Plan* | FirstHealth PPO Network Benefits | Teladoc Benefit
New Sickness Deductible$25,000Max (Per Sickness)$50,000 Max (Per Sickness)$75,000 Max (Per Sickness)$100,000 Max (Per Sickness)$150,000 Max (Per Sickness)$250,000 Max (per Sickness)
$250$113.62
$500$95.68

CHUBB Standard | Fixed Benefits
New Sickness Deductible$25,000Max (Per Sickness)$50,000 Max (Per Sickness)$75,000 Max (Per Sickness)$100,000 Max (Per Sickness)$150,000 Max (Per Sickness)$250,000 Max (per Sickness)
$75$40.22$57.15$73.38
$250$35.28$49.39$62.80

ELITE Network (80/20) (Recommended Plan)
New Sickness Deductible$25,000Max (Per Sickness)$50,000 Max (Per Sickness)$75,000 Max (Per Sickness)$100,000 Max (Per Sickness)$150,000 Max (Per Sickness)$250,000 Max (per Sickness)
$500$119.60
4 40-49
Select Plan | Fixed Benefits | Teladoc | First Health

MINIMUM PURCHASE REQUIRED 1 MONTH

*(pre-ex acute onset coverage included)

New Sickness Deductible$25,000Max (Per Sickness)$50,000 Max (Per Sickness)$75,000 Max (Per Sickness)$100,000 Max (Per Sickness)$150,000 Max (Per Sickness)$250,000 Max (per Sickness)
$100$19.00$31.00$38.75$43.00
$75$34.75$43.02$51.28$59.55$76.08
$250$30.87$37.73$44.59$51.45$65.17
$500$28.72$35.10$41.48$47.86$60.62$86.14
$1,000$42.36$53.66$76.26
$5,000$40.22
$10,000$23.34

Advantage Plan* | FirstHealth PPO Network Benefit
New Sickness Deductible$25,000Max (Per Sickness)$50,000 Max (Per Sickness)$75,000 Max (Per Sickness)$100,000 Max (Per Sickness)$150,000 Max (Per Sickness)$250,000 Max (per Sickness)
$250$135.67
$500$114.25

CHUBB Standard | Fixed Benefits
New Sickness Deductible$25,000Max (Per Sickness)$50,000 Max (Per Sickness)$75,000 Max (Per Sickness)$100,000 Max (Per Sickness)$150,000 Max (Per Sickness)$250,000 Max (per Sickness)
$75$44.25$61.24$81.64
$250$38.81$52.92$69.86

ELITE Network (80/20) (Recommended Plan)
New Sickness Deductible$25,000Max (Per Sickness)$50,000 Max (Per Sickness)$75,000 Max (Per Sickness)$100,000 Max (Per Sickness)$150,000 Max (Per Sickness)$250,000 Max (per Sickness)
$500$142.81
5 50-59
Select Plan | Fixed Benefits | Teladoc | First Health

MINIMUM PURCHASE REQUIRED 1 MONTH

*(pre-ex acute onset coverage included)

New Sickness Deductible$25,000Max (Per Sickness)$50,000 Max (Per Sickness)$75,000 Max (Per Sickness)$100,000 Max (Per Sickness)$150,000 Max (Per Sickness)$250,000 Max (per Sickness)
$100$28.00$43.00$53.75$59.00
$75$43.03$56.94$70.85$84.76$112.58
$250$36.02$48.02$60.02$72.02$96.02
$500$33.51$44.67$55.83$66.99$89.31$133.95
$1,000$59.29$79.05$118.57
$5,000$62.49
$10,000$36.30

Advantage Plan* | FirstHealth PPO Network Benefit | Teladoc Benefit
New Sickness Deductible$25,000Max (Per Sickness)$50,000 Max (Per Sickness)$75,000 Max (Per Sickness)$100,000 Max (Per Sickness)$150,000 Max (Per Sickness)$250,000 Max (per Sickness)
$250$203.49
$500$171.36

CHUBB Standard | Fixed Benefits
New Sickness Deductible$25,000Max (Per Sickness)$50,000 Max (Per Sickness)$75,000 Max (Per Sickness)$100,000 Max (Per Sickness)$150,000 Max (Per Sickness)$250,000 Max (per Sickness)
$75$58.57$87.18$109.22
$250$49.39$74.09$91.73

ELITE Network (80/20) (Recommended Plan)
New Sickness Deductible$25,000Max (Per Sickness)$50,000 Max (Per Sickness)$75,000 Max (Per Sickness)$100,000 Max (Per Sickness)$150,000 Max (Per Sickness)$250,000 Max (per Sickness)
$500$214.20
6 60-69
Select Plan Fixed Benefits | Teladoc | First Health

MINIMUM PURCHASE REQUIRED 1 MONTH

*(pre-ex acute onset coverage included)

New Sickness Deductible$25,000 Max (Per Sickness)$50,000 Max (Per Sickness)$75,000 Max (Per Sickness)$100,000 Max (Per Sickness)$150,000 Max (Per Sickness)$250,000 Max (per Sickness)
$100$35.00$54.00$67.50$84.00
$75$51.24$65.10$78.96$92.82$120.54
$250$42.87$54.88$66.89$78.90$102.92
$500$39.88$51.05$62.22$73.39$95.73$140.41
$1,000$64.96$84.74$124.30
$5,000$65.50
$10,000$38.03

Advantage Plan* | FirstHealth PPO Network Benefit | Teladoc Benefit
New Sickness Deductible$25,000Max (Per Sickness)$50,000 Max (Per Sickness)$75,000 Max (Per Sickness)$100,000 Max (Per Sickness)$150,000 Max (Per Sickness)$250,000 Max (per Sickness)
$75$66.96$95.46$117.66
$250$56.45$81.14$98.78

CHUBB Standard | Fixed Benefits
New Sickness Deductible$25,000Max (Per Sickness)$50,000 Max (Per Sickness)$75,000 Max (Per Sickness)$100,000 Max (Per Sickness)$150,000 Max (Per Sickness)$250,000 Max (per Sickness)
$75$58.57$87.18$109.22
$250$49.39$74.09$91.73

ELITE Network (80/20) (Recommended Plan)
New Sickness Deductible$25,000Max (Per Sickness)$50,000 Max (Per Sickness)$75,000 Max (Per Sickness)$100,000 Max (Per Sickness)$150,000 Max (Per Sickness)$250,000 Max (per Sickness)
$500$307.93
7 70-79
Select Plan Fixed Benefits | Teladoc, First Health

MINIMUM PURCHASE REQUIRED 1 MONTH

*(pre-ex acute onset coverage included)

New Sickness Deductible$25,000 Max (Per Sickness)$50,000 Max (Per Sickness)$75,000 Max (Per Sickness)$100,000 Max (Per Sickness)$150,000 Max (Per Sickness)
$250$145.09$161.21$177.33$193.45
$500$134.97$149.97$164.96$179.96
$1,000$159.25

Advantage Plan* | FirstHealth PPO Network Benefit | Teladoc Benefit
New Sickness Deductible$25,000Max (Per Sickness)$50,000 Max (Per Sickness)$75,000 Max (Per Sickness)$100,000 Max (Per Sickness)$150,000 Max (Per Sickness)
$250$681.26
$500$573.70

CHUBB Standard, Fixed Benefits
New Sickness Deductible$25,000Max (Per Sickness)$50,000 Max (Per Sickness)$75,000 Max (Per Sickness)$100,000 Max (Per Sickness)$150,000 Max (Per Sickness)
$250$230.00$276.36
$500$196.00$235.20

ELITE Network (80/20) (Recommended Plan)
New Sickness Deductible$25,000Max (Per Sickness)$50,000 Max (Per Sickness)$75,000 Max (Per Sickness)$100,000 Max (Per Sickness)$150,000 Max (Per Sickness)
$500$717.12
8 80+
Select Plan Fixed Benefits | Teladoc | First Health

MINIMUM PURCHASE REQUIRED 1 MONTH

*(pre-ex acute onset coverage included)

New Sickness Deductible$25,000 Max (Per Sickness)$50,000 Max (Per Sickness)$75,000 Max (Per Sickness)$100,000 Max (Per Sickness)$150,000 Max (Per Sickness)
$250$176.99$202.37$227.75$253.13
$500$164.64$188.25$211.86$235.47
$1,000$208.39

Advantage Plan*, FirstHealth PPO Network Benefit, Teladoc Benefit
New Sickness Deductible$25,000Max (Per Sickness)$50,000 Max (Per Sickness)$75,000 Max (Per Sickness)$100,000 Max (Per Sickness)$150,000 Max (Per Sickness)
250$875.91
$500$737.61

CHUBB Standard, Fixed Benefits
New Sickness Deductible$25,000Max (Per Sickness)$50,000 Max (Per Sickness)$75,000 Max (Per Sickness)$100,000 Max (Per Sickness)$150,000 Max (Per Sickness)
$250$289.10$361.62
$500$258.72$323.40

ELITE Network (80/20) (Recommended Plan)
New Sickness Deductible$25,000Max (Per Sickness)$50,000 Max (Per Sickness)$75,000 Max (Per Sickness)$100,000 Max (Per Sickness)$150,000 Max (Per Sickness)
$500$922.01
Pre-Existing
  • 1 0-17
  • 2 18- 29
  • 3 30-39
  • 4 40-49
  • 5 50-59
  • 6 60-69
  • 7 70-79
  • 8 80+
1 0-17
Choice Plan Fixed Benefits | Teladoc | First Health

MINIMUM PURCHASE REQUIRED 1 MONTH.

*Acute onset definition for pre-existing

Maximum New Sickness Coverage
New Sickness Deductible
Maximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$25,000$75$1,000$75$24.83
$250$1,500$250$22.30
$500$1,750$500$20.74
$50,000$75$1,500$75$31.11
$250$2,000$250$27.44
$500$2,500$500$25.53
$75,000$75$2,500$75$37.38
$250$3,500$250$32.58
$500$4,500$500$30.31
$100,000$75$3,500$75$43.66
$250$4,500$250
$500$5,500$500
$1,000$6,500$1,000
$150,000$75$4,500$75$56.21
$250$5,500$250
$500$6,500$500
$1,000$7,500$1,000
$250,000$500$7,000$500$63.81
$1,000$9,000$1,000
$5,000$13,000$5,000
$10,000$15,000$10,000

Advantage Plan* | FirstHealth PPO Network Benefit | Teladoc Benefit
Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$150,000$250$25,000$1,500$112.39
$500$25,000$1,500$94.64

CHUBB Premier Plan | Fixed Benefits

MINIMUM PURCHASE REQUIRED 3 MONTHS (90 days),

Broad pre-ex new and pre-ex considered the same.

Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$100,000$75$20,000$1,000$62.88
$75$40,000$5,000$61.98
$250$20,000$1,000$54.33
$250$40,000$5,000$53.56
$150,000$75$30,000$1,000$81.26
$75$60,000$5,000
$250$30,000$1,000
$250$60,000$5,000

ELITE Network (80/20) (Recommended Plan)
Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$150,000$500$25,000$1,500$118.30
2 18- 29
Choice Plan Fixed Benefits | Teladoc | First Health

MINIMUM PURCHASE REQUIRED 1 MONTH.

*Acute onset definition for pre-existing

Maximum New Sickness Coverage
New Sickness Deductible
Maximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$25,000$75$1,000$75$26.97
$250$1,500$250$24.01
$500$1,750$500$22.34
$50,000$75$1,500$75$35.19
$250$2,000$250$30.87
$500$2,500$500$28.72
$75,000$75$2,500$75$43.41
$250$3,500$250$37.73
$500$4,500$500$35.10
$100,000$75$3,500$75$51.63
$250$4,500$250$44.59
$500$5,500$500$41.48
$1,000$6,500$1,000$36.71
$150,000$75$4,500$75$68.07
$250$5,500$250$58.31
$500$6,500$500$54.24
$1,000$7,500$1,000$48.00
$250,000$500$7,000$500$79.76
$1,000$9,000$1,000$70.58
$5,000$13,000$5,000$37.24
$10,000$15,000$10,000$21.58

Advantage Plan*| FirstHealth PPO Network Benefit | Teladoc Benefit
Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$150,000$250$25,000$1,500$120.41
$500$25,000$1,500$101.40

CHUBB Premier Fixed Benefits

MINIMUM PURCHASE REQUIRED 3 MONTHS (90 days),

Broad pre-ex new and pre-ex considered the same.

Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$100,000$75$20,000$1,000$74.35
$75$40,000$5,000$73.28
$250$20,000$1,000$64.21
$250$40,000$5,000$63.29
$150,000$75$30,000$1,000$86.59
$75$60,000$5,000$85.35
$250$30,000$1,000$74.09
$250$60,000$5,000$73.03

ELITE Network (80/20) (Recommended Plan)
Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$150,000$500$25,000$1,500$126.75
3 30-39
Choice Plan Fixed Benefits | Teladoc | First Health

MINIMUM PURCHASE REQUIRED 1 MONTH.

*Acute onset definition for pre-existing

Maximum New Sickness Coverage
New Sickness Deductible
Maximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$25,000$75$1,000$75$30.87
$250$1,500$250$27.44
$500$1,750$500$25.53
$50,000$75$1,500$75$39.11
$250$2,000$250$34.30
$500$2,500$500$31.91
$75,000$75$2,500$75$47.34
$250$3,500$250$41.16
$500$4,500$500$38.29
$100,000$75$3,500$75$55.58
$250$4,500$250$48.02
$500$5,500$500$44.67
$1,000$6,500$1,000$39.53
$150,000$75$4,500$75$72.05
$250$5,500$250$61.74
$500$6,500$500$57.43
$1,000$7,500$1,000$50.82
$250,000$500$7,000$500$82.95
$1,000$9,000$1,000$73.40
$5,000$13,000$5,000$38.73
$10,000$15,000$10,000$22.48

Advantage Plan*| FirstHealth PPO Network Benefit | Teladoc Benefit
Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$150,000$250$25,000$1,500$147.71
$500$25,000$1,500$124.38

CHUBB Premier Fixed Benefits

MINIMUM PURCHASE REQUIRED 3 MONTHS (90 days),

Broad pre-ex new and pre-ex considered the same.

Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$100,000$75$20,000$1,000$80.01
$75$40,000$5,000$78.87
$250$20,000$1,000$69.15
$250$40,000$5,000$68.16
$150,000$75$30,000$1,000$102.74
$75$60,000$5,000$101.27
$250$30,000$1,000$87.92
$250$60,000$5,000$86.66

ELITE Network (80/20) (Recommended Plan)
Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$150,000$500$25,000$1,500$155.48
4 40-49
Choice Plan Fixed Benefits | Teladoc | First Health

MINIMUM PURCHASE REQUIRED 1 MONTH.

*Acute onset definition for pre-existing

Maximum New Sickness Coverage
New Sickness Deductible
Maximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$25,000$75$1,000$75$34.75
$250$1,500$250$30.87
$500$1,750$500$28.72
$50,000$75$1,500$75$43.02
$250$2,000$250$37.73
$500$2,500$500$35.10
$75,000$75$2,500$75$51.28
$250$3,500$250$44.59
$500$4,500$500$41.48
$100,000$75$3,500$75$59.55
$250$4,500$250$51.45
$500$5,500$500$47.86
$1,000$6,500$1,000$42.36
$150,000$75$4,500$75$76.08
$250$5,500$250$65.17
$500$6,500$500$60.62
$1,000$7,500$1,000$53.66
$250,000$500$7,000$500$86.14
$1,000$9,000$1,000$76.26
$5,000$13,000$5,000$40.22
$10,000$15,000$10,000$23.34

Advantage Plan*| FirstHealth PPO Network Benefit | Teladoc Benefit
Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
150,000$250$25,000$1,500$176.37
$500$25,000$1,500$148.52

CHUBB Premier Fixed Benefits

MINIMUM PURCHASE REQUIRED 3 MONTHS (90 days),

Broad pre-ex new and pre-ex considered the same.

Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$100,000$75$20,000$1,000$85.74
$75$40,000$5,000$84.51
$250$20,000$1,000$74.09
$250$40,000$5,000$73.03
$150,000$75$30,000$1,000$114.30
$75$60,000$5,000$112.66
$250$30,000$1,000$97.80
$250$60,000$5,000$96.40

ELITE Network (80/20) (Recommended Plan)
Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$150,000$500$25,000$1,500$185.65
5 50-59
Choice Plan Fixed Benefits | Teladoc | First Health

MINIMUM PURCHASE REQUIRED 1 MONTH.

*Acute onset definition for pre-existing

Maximum New Sickness Coverage
New Sickness Deductible
Maximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$25,000$75$1,000$75$43.03
$250$1,500$250$36.02
$500$1,750$500$33.51
$50,000$75$1,500$75$56.94
$250$2,000$250$48.02
$500$2,500$500$44.67
$75,000$75$2,500$75$70.85
$250$3,500$250$60.02
$500$4,500$500$55.83
$100,000$75$3,500$75$84.76
$250$4,500$250$72.02
$500$5,500$500$66.99
$1,000$6,500$1,000$59.29
$150,000$75$4,500$75$112.58
$250$5,500$250$96.02
$500$6,500$500$89.31
$1,000$7,500$1,000$79.05
$250,000$500$7,000$500$133.95
$1,000$9,000$1,000$118.57
$5,000$13,000$5,000$62.49
$10,000$15,000$10,000$36.30

Advantage Plan*| FirstHealth PPO Network Benefit | Teladoc Benefit
Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$150,000$250$25,000$1,500$262.64
$500$25,000$1,500$221.17

CHUBB Premier Fixed Benefits

MINIMUM PURCHASE REQUIRED 3 MONTHS (90 days),

Broad pre-ex new and pre-ex considered the same.

Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$100,000$75$20,000$1,000$122.05
$75$40,000$5,000$120.30
$250$20,000$1,000$103.72
$250$40,000$5,000$102.24
$150,000$75$30,000$1,000$152.91
$75$60,000$5,000$150.73
$250$30,000$1,000$128.42
$250$60,000$5,000$126.58

ELITE Network (80/20) (Recommended Plan)
Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$150,000$500$25,000$1,500$278.46
6 60-69
Choice Plan Fixed Benefits | Teladoc | First Health

MINIMUM PURCHASE REQUIRED 1 MONTH.

*Acute onset definition for pre-existing

Maximum New Sickness Coverage
New Sickness Deductible
Maximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$25,000$75$1,000$75$51.24
$250$1,500$250$42.87
$500$1,750$500$39.88
$50,000$75$1,500$75$65.10
$250$2,000$250$54.88
$500$2,500$500$51.05
$75,000$75$2,500$75$78.96
$250$3,500$250$66.89
$500$4,500$500$62.22
$100,000$75$3,500$75$92.82
$250$4,500$250$78.90
$500$5,500$500$73.39
$1,000$6,500$1,000$64.96
$150,000$75$4,500$75$120.54
$250$5,500$250$102.92
$500$6,500$500$95.73
$1,000$7,500$1,000$84.74
$250,000$500$7,000$500$140.41
$1,000$9,000$1,000$124.30
$5,000$13,000$5,000$65.50
$10,000$15,000$10,000$38.03

Advantage Plan*| FirstHealth PPO Network Benefit | Teladoc Benefit
Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$150,000$250$25,000$1,500$380.29
$500$25,000$1,500$320.25

CHUBB Premier Fixed Benefits

MINIMUM PURCHASE REQUIRED 3 MONTHS (90 days),

Broad pre-ex new and pre-ex considered the same.

Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$100,000$75$20,000$1,000$133.65
$75$40,000$5,000$131.74
$250$20,000$1,000$113.60
$250$40,000$5,000$111.98
$150,000$75$30,000$1,000$164.73
$75$60,000$5,000$162.38
$250$30,000$1,000$138.30
$250$60,000$5,000$136.32

ELITE Network (80/20)(Recommended Plan)
Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$150,000$500$25,000$1,500$400.31
7 70-79
Choice Plan Fixed Benefits | Teladoc | First Health

MINIMUM PURCHASE REQUIRED 1 MONTH.

*Acute onset definition for pre-existing

Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$25,000$250$1,500$250$145.09
$500$1,750$500$134.97
$50,000$250$2,000$250$161.21
$500$2,500$500$149.97
$75,000$250$3,500$250$177.33
$500$4,500$500$164.96
$100,000$250$4,500$250$193.45
$500$5,500$500$179.96
$1,000$6,500$1,000$159.25

Advantage Plan*| FirstHealth PPO Network Benefit | Teladoc Benefit
Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$75,000$250$20,000$1,500$919.70
$500$20,000$1,500$774.49

CHUBB Premier Fixed Benefits

MINIMUM PURCHASE REQUIRED 3 MONTHS (90 days),

Broad pre-ex new and pre-ex considered the same.

Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$100,000$250$15,000$1,000$373.09
$250$25,000$5,000$367.56
$500$15,000$1,000$317.52
$500$25,000$5,000$312.82

ELITE Network (80/20) (Recommended Plan)
Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$75,000$500$20,000$1,500$968.11
8 80+
Choice Plan Fixed Benefits | Teladoc | First Health

MINIMUM PURCHASE REQUIRED 1 MONTH.

*Acute onset definition for pre-existing

Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$25,000$250$1,500$250$145.09
$500$1,750$500$134.97
$50,000$250$2,000$250$161.21
$500$2,500$500$149.97
$75,000$250$3,500$250$177.33
$500$4,500$500$164.96
$100,000$250$4,500$250$193.45
$500$5,500$500$179.96
$1,000$6,500$1,000$159.25

Advantage Plan*| FirstHealth PPO Network Benefit | Teladoc Benefit
Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$75,000$250$20,000$1,500$919.70
$500$20,000$1,500$774.49

CHUBB Premier Fixed Benefits

MINIMUM PURCHASE REQUIRED 3 MONTHS (90 days),

Broad pre-ex new and pre-ex considered the same.

Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$100,000$250$15,000$1,000$373.09
$250$25,000$5,000$367.56
$500$15,000$1,000$317.52
$500$25,000$5,000$312.82

ELITE Network (80/20) (Recommended Plan)
Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$75,000$500$20,000$1,500$968.11