Page 9 - The Legacy School Benefit Booklet 2021-2022
P. 9
Member Rates
BlueChoice BlueChoice
Age HMO HSA BlueFund Age HMO HSA BlueFund
Silver Plan $3,000 Silver Plan $3,000
0-14 $216.53 40 $361.74
15 $235.78 41 $368.53
16 $243.14 42 $375.04
17 $250.50 43 $384.10
18 $258.42 44 $395.42
19 $266.35 45 $408.72
20 $274.56 46 $424.58
21 $283.05 47 $442.41
22 $283.05 48 $462.79
23 $283.05 49 $482.88
24 $283.05 50 $505.53
25 $284.18 51 $527.89
26 $289.84 52 $552.51
27 $296.64 53 $577.42
28 $307.68 54 $604.31
29 $316.73 55 $631.20
30 $321.26 56 $660.36
31 $328.05 57 $689.79
32 $334.85 58 $721.21
33 $339.09 59 $736.78
34 $343.62 60 $768.20
35 $345.89 61 $795.37
36 $348.15 62 $813.20
37 $350.42 63 $835.56
38 $352.68 64 $849.15
39 $357.21 65+ $849.15
Effective Date: 02/01/2021
