Page 10 - NAPA 2021-2022

How to Calculate Your Rate
Please see below for an example of how to calculate your rate. For families, each member will
be rated individually and these rates will be combined to form a family rate. For children under
the age of 21 only the three oldest children will be counted. For dependents age 21-25 each
dependent will be counted.

Here is an example showing how to calculate the total premium for three subscribers based on their
individual family circumstances. The table on the left is an Example Individual Member Rate table
similar to the Individual Member Rate table on the prior page. The tables on the right show three
example calculations for subscribers with different members covered.

These are not your rates. These are given here only to illustrate Example Member-Level Rate
calculations

Example Individual Member Rates- Example Rates for Three Subscribers
Member Level Billed 1
Name Relationship Age Member Rate
Rate Subscriber #1 will enroll all Family Members
0-14 $154 John Smith Self 41 $326

18 $184 Jane Smith Spouse 41 $326
21 $243 Tom Smith Child 21 $243
55 $680 Mary Smith Child 19 $154
65+ $729 Dan Smith Child 11 $154

1 This table represents examples rates. These do not represent Nick Smith Child 8 $154
the rates for the quoted pairs for the group. Kim Smith Child 2 $0

Total Subscriber #1 Rate: $1,357

**To determine your rate you
Subscriber #2 will enroll all Spouse/Partner
would use your age as of the Joe Jones Self 55 $680
coverage effective date. This Jill Jones Spouse 41 $326
AgeSAMPLE
also applies to any dependents Total Subscriber #2 Rate: $1,006
being covered.

Subscriber #3 enrolls Self only
Mark Moe Self 19 $184

Total Subscriber #2 Rate: $184