Page 6

              Page 4 Effective February 1, 2012
$500
$1,000
$1,500
$2,500
$5,000
$1,200
$2,000
$5,200
$500
$1,000
$1,500
$2,500
$5,000
$1,200
$2,000
$5,200
100.45
85.40
77.00
64.40
49.35
80.85
57.05
41.30
0
100.45
85.05
77.00
63.70
49.70
80.85
57.05
41.30
93.10
79.10
71.05
58.80
45.85
75.25
51.80
37.45
1
93.10
78.75
71.05
58.80
45.85
74.90
51.80
37.80
88.20
75.25
67.55
56.70
43.75
69.30
47.95
35.35
2
87.50
74.90
67.55
56.70
43.75
69.30
47.95
35.35
87.50
74.90
67.55
56.70
43.40
68.95
47.60
35.35
3
87.50
74.90
67.20
55.65
43.75
68.95
47.60
35.35
87.15
74.90
67.20
55.65
43.40
68.95
47.60
34.65
4
87.15
74.20
67.20
55.65
43.75
68.95
47.60
35.35
87.15
74.20
67.20
55.65
43.40
68.95
47.60
34.65
5
87.15
74.20
66.85
55.65
43.40
68.25
46.90
35.35
86.45
74.20
66.85
55.65
43.40
68.25
47.60
34.65
6
86.45
74.20
66.85
55.30
43.40
68.25
46.90
34.65
86.45
74.20
66.85
55.30
43.40
68.25
46.90
34.65
7
86.45
73.50
66.85
55.30
43.40
68.25
46.90
34.65
86.45
73.50
66.85
55.30
43.40
68.25
46.90
34.65
8
86.45
73.50
66.85
55.30
43.40
68.25
46.90
34.65
86.45
73.50
66.85
55.30
43.40
68.25
46.90
34.65
9
86.45
73.50
66.85
55.30
43.40
68.25
46.90
34.65
86.45
74.20
66.85
55.30
43.40
68.25
46.90
34.65
10
86.45
73.50
66.85
55.30
43.40
68.25
46.90
34.65
87.50
74.90
67.55
56.70
43.75
68.95
47.60
35.35
11
88.55
75.60
68.25
57.05
44.80
69.65
47.95
35.70
88.90
75.60
68.95
57.05
44.80
69.65
48.65
35.70
12
91.00
77.35
70.35
58.45
45.85
71.05
49.35
36.75
90.30
76.65
69.30
57.75
45.15
70.35
49.00
35.70
13
93.45
79.45
72.45
59.85
46.90
72.80
50.75
37.45
91.00
77.35
70.35
58.45
45.50
71.05
49.35
36.05
14
96.25
81.55
74.20
61.25
48.65
74.20
51.45
38.85
92.05
78.75
71.05
59.50
45.85
71.75
49.70
36.75
15
98.00
84.35
75.60
63.35
49.35
75.60
52.85
39.55
93.45
79.45
72.45
59.85
46.90
72.80
50.75
37.10
16
100.45
86.10
77.35
64.75
51.10
77.35
53.90
40.60
94.50
80.85
72.80
60.90
47.60
73.50
51.10
37.45
17
104.30
88.90
80.15
66.85
52.85
80.15
55.65
42.00
96.25
82.25
74.20
61.60
48.65
77.35
53.55
39.55
18
110.60
94.50
85.05
70.70
55.65
87.50
60.55
45.50
99.05
84.70
76.30
63.70
49.70
79.10
54.60
41.30
19
119.00
101.15
91.35
76.65
60.90
93.10
64.40
49.00
100.45
85.40
77.35
64.75
50.75
80.15
55.30
41.65
20
138.95
118.65
106.75
89.95
70.70
108.50
74.90
57.05
102.20
87.15
78.75
65.80
51.45
81.20
55.65
42.00
21
145.25
123.55
112.00
93.80
74.20
112.35
77.35
59.50
103.25
88.55
79.45
66.85
52.50
82.25
56.70
42.70
22
150.85
128.45
116.20
96.95
77.00
116.20
80.15
61.25
104.30
89.25
80.85
67.20
52.85
82.60
57.40
43.05
23
152.25
130.20
117.60
98.00
78.05
117.60
81.55
61.95
106.05
90.65
81.55
68.25
53.55
83.30
57.75
43.40
24
154.00
131.25
118.65
99.40
78.75
119.00
81.90
63.35
107.10
92.05
82.95
69.30
54.60
84.70
58.45
43.75
25
157.85
134.40
121.80
102.20
80.85
121.45
83.30
64.05
108.85
93.10
84.35
70.35
55.30
85.40
59.50
44.80
26
159.25
136.15
122.85
102.90
81.90
122.85
84.70
65.10
110.25
94.50
85.05
71.05
55.65
86.45
59.85
45.15
27
161.00
137.90
124.60
104.65
82.60
124.60
85.75
66.15
112.70
96.60
87.15
72.80
57.40
88.20
60.90
45.85
28
165.55
141.05
127.75
106.75
84.70
127.40
88.20
67.55
115.15
98.35
88.90
74.20
58.45
89.25
62.65
46.90
29
169.40
145.25
130.55
109.55
87.15
130.55
90.30
69.30
118.30
101.15
91.35
76.65
60.55
91.35
63.70
48.65
30
171.15
146.30
131.95
111.30
88.20
131.60
91.00
70.00
120.75
103.25
93.45
78.40
61.60
93.45
64.75
49.00
31
175.35
150.15
135.10
113.40
90.30
135.10
93.80
72.45
122.85
106.05
95.20
80.15
63.00
94.85
66.50
50.75
32
179.55
153.30
138.95
116.20
92.40
138.95
95.55
73.85
127.05
108.85
98.35
82.25
64.75
97.30
67.55
51.80
33
183.75
157.15
142.10
119.00
94.50
142.10
98.35
75.60
130.55
112.00
101.15
84.70
66.85
100.45
69.65
53.55
34
187.60
161.00
145.25
121.80
96.95
145.95
101.15
78.05
135.80
116.20
105.35
88.20
69.65
103.95
72.45
55.65
35
187.60
161.00
145.95
121.80
96.95
145.95
101.15
78.40
138.95
119.70
108.50
91.00
71.75
107.10
74.90
57.40
36
190.75
163.45
148.05
123.90
98.35
149.10
103.25
79.80
142.80
123.90
112.00
93.45
73.50
110.25
77.00
58.80
37
193.90
166.60
150.15
126.00
100.10
152.60
106.05
81.90
149.45
128.45
116.20
97.30
77.00
115.15
80.85
61.60
38
198.80
170.80
154.35
129.85
102.90
156.10
108.85
84.00
155.40
134.05
121.10
102.20
80.85
119.70
83.30
64.75
39
203.70
174.30
158.20
132.65
105.35
160.65
111.65
86.45
163.80
140.70
127.75
107.80
85.05
124.60
87.50
68.25
40
210.00
179.90
163.10
137.20
108.85
164.50
114.45
88.55
170.10
146.30
132.65
112.00
88.55
128.80
91.00
70.70
41
214.20
184.45
166.95
140.00
111.65
168.35
117.60
91.00
176.40
151.90
137.90
116.20
92.05
134.40
94.85
73.50
42
218.40
187.95
170.10
143.15
113.40
172.20
120.40
93.45
185.50
159.95
144.90
122.15
96.60
141.75
100.10
78.40
43
224.35
192.85
175.35
146.65
116.55
176.75
123.55
96.25
194.25
167.65
151.90
127.75
100.80
148.40
104.65
81.55
44
230.65
198.10
179.55
150.85
119.70
181.65
127.05
98.35
206.15
177.45
160.65
135.80
107.10
156.45
111.30
87.15
45
237.65
204.40
185.15
155.40
123.55
186.55
130.90
101.50
215.25
185.50
168.00
142.10
112.70
164.50
116.55
92.05
46
243.25
209.65
189.70
159.25
126.00
191.45
134.40
103.60
224.00
193.55
175.35
148.05
116.90
172.20
122.15
96.25
47
249.20
214.90
194.60
163.45
129.50
196.70
137.55
106.40
235.20
203.00
183.75
154.70
122.50
181.30
128.45
100.80
48
255.85
220.85
200.20
168.00
133.00
201.95
142.10
109.55
246.40
212.80
192.15
162.05
128.45
190.40
134.75
106.40
49
262.85
227.15
205.80
172.90
136.50
207.90
146.30
112.70
262.15
225.75
204.75
173.25
136.85
201.60
143.50
112.70
50
272.65
234.85
213.15
179.55
142.10
215.25
151.55
116.90
273.35
235.55
213.50
179.90
142.45
211.05
149.80
117.95
51
279.30
241.15
219.10
183.75
145.60
221.20
155.40
120.40
284.20
245.35
221.90
187.60
148.40
220.85
156.45
122.85
52
286.65
247.45
224.70
189.00
149.45
226.45
159.95
123.90
299.95
258.65
233.80
197.05
155.75
232.40
165.20
129.85
53
292.60
253.05
229.25
193.55
152.60
231.35
163.80
126.70
315.70
271.95
245.70
206.85
163.80
245.35
173.95
136.50
54
300.30
259.35
235.20
197.75
156.10
237.65
168.00
130.55
336.70
290.15
262.50
221.20
175.35
261.45
185.50
145.60
55
309.75
268.10
242.90
204.75
161.70
245.70
173.95
134.75
352.45
304.15
274.40
231.00
183.05
276.15
195.30
152.60
56
316.75
274.05
248.85
209.30
165.55
252.35
179.20
138.95
368.90
318.50
287.00
241.15
191.10
289.80
205.10
159.95
57
324.80
280.70
254.80
214.90
169.75
259.35
184.45
142.80
385.35
332.50
300.30
251.65
199.50
302.40
213.85
166.60
58
332.50
288.05
261.10
219.45
173.60
266.70
189.00
146.30
402.50
347.55
313.95
262.85
207.90
317.45
224.70
174.30
59
341.95
296.10
268.45
225.75
178.50
274.75
195.30
150.85
426.30
368.20
331.80
278.60
219.80
335.65
237.30
184.45
60
355.60
306.95
278.60
234.50
185.15
285.25
203.00
156.45
442.40
382.90
344.40
289.10
228.55
347.20
245.70
191.10
61
364.00
314.30
285.25
239.75
189.35
291.90
207.20
160.30
458.85
396.55
357.70
299.95
237.30
358.40
253.40
197.40
62
371.35
320.60
291.20
244.65
193.55
297.15
210.70
163.80
480.90
415.80
374.85
314.30
248.85
373.45
264.60
206.15
63
384.65
332.50
301.70
253.40
200.20
306.60
217.70
168.35
503.30
435.05
392.00
328.65
260.40
388.85
275.10
215.25
64
397.60
343.70
311.50
262.15
207.20
314.65
223.30
173.60
546.35
471.80
424.90
356.30
282.10
421.05
298.55
233.10
*65-69
420.70
364.00
330.40
277.20
219.45
333.55
236.95
183.40
606.20
523.25
471.80
395.50
312.90
467.95
331.45
258.65
*70-74
458.85
397.60
359.80
302.05
239.75
363.30
258.65
200.90
677.60
584.85
527.45
442.40
349.65
523.25
371.00
289.10
*75+
496.65
430.85
390.60
327.60
260.40
393.75
280.35
217.70
All rates within this booklet are those for non-tobacco users. If you use tobacco, multiply the non-tobacco rate by a factor of 1.26 and round to nearest penny.
* Rates for ages 65 and over apply only if the person is not Medicare eligible. Persons eligible for Medicare are not eligible for any CHIP plan once they reach Medicare age.
FEBRUARY 2012 RATE AREA A - The City of Chicago, Cook County only.
MONTHLY AFTER TAX CREDIT PREMIUM RATE FOR STANDARD TAA (PLAN PHPC (T)) or PBGC (PLAN PHPB (P)) AND THE TAA/PBGC HIGH DEDUCTIBLE OPTIONS (PLANS PHDB and PHDC)
The full rate must be paid until the Advance Tax Credit Option is available through the Internal Revenue Service. If you pay the full rate, you can still claim a 65% tax credit of the amount paid on your tax return at the end of the year. The "AFTER TAX CREDIT" rate is the monthly rate that you will pay if you elect to take the Advance Tax Credit Option, once it is available.
Male Rates - Deductible Option
Female Rates - Deductible Option
Standard Plans
High Deductible Health Plans
Attained Age
Standard Plans
High Deductible Health Plans
Non-Tobacco User