Premiums for Health Plus Plans - Scott & White Health Plan

Health Plus 2009 Premiums

	Saver $5000 Includes Rx	Saver $3000 Includes Rx	Portfolio $5000 without Rx / with Rx	Portfolio $2500 without Rx / with Rx	Portfolio $1500 without Rx / with Rx	Portfolio $750 without Rx / with Rx	Health Plus VI without Rx / with Rx	Health Plus V without Rx / with Rx
Male Adult
To 29	$54	$71	$76 / $84	$85 / $93	$90 / $98	$98 / $106	$112 / $120	$146 / $154
30-34	$70	$91	$100 / $113	$112 / $125	$119 / $132	$129 / $142	$133 / $146	$170 / $183
35-39	$87	$112	$123 / $141	$138 / $156	$147 / $165	$159 / $177	$162 / $180	$204 / $222
40-44	$113	$143	$143 / $166	$159 / $182	$169 / $192	$184 / $207	$192 / $215	$240 / $263
45-49	$151	$188	$185 / $216	$206 / $237	$220 / $251	$237 / $268	$248 / $279	$305 / $336
50-54	$206	$252	$242 / $281	$271 / $310	$289 / $328	$313 / $352	$334 / $373	$402 / $441
55-59	$285	$345	$320 / $369	$358 / $407	$382 / $431	$414 / $463	$482 / $531	$574 / $623
60-64	$387	$460	$410 / $470	$460 / $520	$449 / $551	$532 / $592	$670 / $730	$795 / $855
65+	$539	$633	$550 / $639	$615 / $704	$656 / $745	$710 / $799	$684 / $773	$810 / $889
Female Adult
To 29	$149	$184	$152 / $172	$173 / $191	$185 / $203	$200 / $218	$293 / $311	$355 / $373
30-34	$172	$211	$188 / $211	$211 / $234	$225 / $248	$243 / $266	$314 / $337	$379 / $402
35-39	$163	$203	$189 / $215	$212 / $238	$226 / $252	$245 / $271	$317 / $343	$381 / $407
40-44	$163	$204	$201 / $235	$224 / $258	$239 / $273	$258 / $292	$327 / $361	$395 / $429
45-49	$186	$231	$230 / $272	$256 / $298	$273 / $315	$294 / $336	$352 / $394	$423 / $465
50-54	$233	$285	$280 / $332	$312 / $364	$333 / $385	$359 / $411	$397 / $449	$476 / $528
55-59	$282	$341	$336 / $399	$374 / $437	$399 / $462	$430 / $493	$494 / $557	$590 / $653
60-64	$353	$423	$397 / $465	$444 / $512	$474 / $542	$512 / $580	$604 / $672	$717 / $785
65+	$474	$559	$501 / $587	$560 / $646	$597 / $683	$646 / $732	$618 / $704	$734 / $820
Per child*	$62	$80	$75 / $83	$84 / $92	$89 / $97	$97 / $105	$113 / $121	$146 / $154

* A child is a member of the family between the age of 0 and 25 years of age, that is a dependent of the contract holder of a policy. Children away at college can be covered on the plan, if their legal residence is with the contract holder.

Optional Dental Coverage** - Single: $23, Family: $69
(All plans except Health Plus V. Dental is included in the Health Plus V premium)

Optional Life Coverage** - Single: $6, Family: $12

**Dental and Life coverage is underwritten by MetLife. (Metropolitan Life Company, New York, NY, 10010) All prices are subject to change with notice.

10/15/2008