|

|
Effective:
Currency: |
1/1/2004
US$ |
|
|
| |
| Age |
IN |
IN+Amb |
IN+Amb+P.M |
IN |
IN+Amb |
IN+Amb+P.M |
| |
|
Optional:
MedNet Clinics
Doctors Visits & Dental Care |
|
Optional:
MedNet Clinics
Doctors Visits & Dental Care |
| 14d
- 17y |
134 |
184 |
245 |
83 |
133 |
194 |
| 18y - 35y |
322 |
460 |
574 |
160 |
298 |
412 |
| 36y
- 45y |
356 |
494 |
608 |
183 |
321 |
435 |
| 46y - 55y |
471 |
609 |
723 |
244 |
382 |
496 |
| 56y
- 60y |
650 |
788 |
902 |
327 |
465 |
579 |
| 61y - 65y |
791 |
929 |
1043 |
419 |
557 |
671 |
| 66y
- 70y |
978 |
1235 |
1532 |
496 |
753 |
1050 |
| 71y - 75y |
1216 |
1473 |
1770 |
633 |
890 |
1187 |
| 76y
- 80y |
1490 |
1747 |
2044 |
754 |
1011 |
1308 |
| 81y - + |
1692 |
1949 |
2246 |
879 |
1136 |
1433 |
| *
Adherents with no GR |
| 76y
- 80y |
2205 |
2462 |
2758 |
1101 |
1359 |
1656 |
| 81y - + |
2509 |
2766 |
3062 |
1289 |
1546 |
1843 |
|
| Age |
IN |
IN+Amb |
IN+Amb+P.M |
IN |
IN+Amb |
IN+Amb+P.M |
| 14d
- 17y |
327 |
390 |
478 |
303 |
366 |
454 |
| 18y - 35y |
795 |
962 |
1126 |
740 |
908 |
1072 |
| 36y
- 45y |
864 |
1032 |
1196 |
797 |
965 |
1129 |
| 46y - 55y |
1140 |
1308 |
1472 |
1025 |
1193 |
1357 |
| 56y
- 60y |
1627 |
1795 |
1959 |
1602 |
1770 |
1934 |
| 61y - 65y |
1963 |
2131 |
2295 |
1794 |
1962 |
2126 |
| 66y
- 70y |
2425 |
2733 |
3166 |
1898 |
2206 |
2638 |
| 71y - 75y |
3034 |
3342 |
3775 |
2689 |
2997 |
3429 |
| 76y
- 80y |
3733 |
4042 |
4475 |
3324 |
3633 |
4066 |
| 81y - + |
4340 |
4649 |
5082 |
4001 |
4310 |
4743 |
| *
Adherents with no GR |
| 76y
- 80y |
5561 |
5869 |
6302 |
4947 |
5255 |
5687 |
| 81y - + |
6470 |
6778 |
7211 |
5963 |
6271 |
6703 |
|
|
|
2
|
3.75%
|
| 3 |
7.75% |
|
4 |
11.75% |
| 5 |
15.75% |
|
6+ |
19.75% |
|
| Adhesion Fees: US$
10. |