Page 8 - The Legacy School Benefit Booklet 2021-2022

Member Rates

BlueChoice HSA BlueChoice HSA
Age BlueFund Silver Plan Age BlueFund Silver Plan
$1,500 $1,500
0-14 $230.62 40 $385.28
15 $251.12 41 $392.51
16 $258.96 42 $399.45
17 $266.80 43 $409.09
18 $275.24 44 $421.15
19 $283.68 45 $435.32
20 $292.43 46 $452.21
21 $301.47 47 $471.20
22 $301.47 48 $492.80

23 $301.47 49 $514.31
24 $301.47 50 $538.43
25 $302.68 51 $562.24
26 $308.71 52 $588.47
27 $315.94 53 $615.00
28 $327.70 54 $643.64
29 $337.34 55 $672.28
30 $342.17 56 $703.33
31 $349.40 57 $734.68
32 $356.64 58 $768.15
33 $361.16 59 $784.73

34 $365.98 60 $818.19
35 $368.40 61 $847.13
36 $370.81 62 $866.12
37 $373.22 63 $889.94
38 $375.63 64 $904.41
39 $380.46 65+ $904.41
Effective Date: 02/01/2021