Page 8 - Empowered Learning for Dyslexic Children Benefits Guide 2022-2023

The Legacy School
Health Insurance Summary Comparison

Effective Date:
February 1, 2022
BlueChoice BlueChoice BlueChoice
Plus HMO HSA HMO HSA
Benefits
Gold $1,000 Silver $1,500 Bronze $6,100
BlueFund BlueFund

14 & under $283.42 $244.24 $195.74
15 $308.61 $265.95 $213.14
16 $318.24 $274.25 $219.79
17 $327.87 $282.55 $226.44
18 $338.25 $291.49 $233.61
19 $348.62 $300.43 $240.77
20 $359.37 $309.69 $248.19
21 $370.48 $319.27 $255.87
22 $370.48 $319.27 $255.87
23 $370.48 $319.27 $255.87
24 $370.48 $319.27 $255.87
25 $371.96 $320.55 $256.89
26 $379.37 $326.93 $262.01
27 $388.26 $334.59 $268.15
28 $402.71 $347.05 $278.13
29 $414.57 $357.26 $286.32
30 $420.49 $362.37 $290.41
31 $429.39 $370.03 $296.55
32 $438.28 $377.70 $302.69
33 $443.84 $382.49 $306.53
34 $449.76 $387.59 $310.63
35 $452.73 $390.15 $312.67
36 $455.69 $392.70 $314.72
37 $458.65 $395.26 $316.77
38 $461.62 $397.81 $318.81
39 $467.55 $402.92 $322.91
40 $473.47 $408.03 $327.00
41 $482.36 $415.69 $333.14
42 $490.89 $423.03 $339.03
43 $502.74 $433.25 $347.22
44 $517.56 $446.02 $357.45
45 $534.97 $461.03 $369.48
46 $555.72 $478.91 $383.81
47 $579.06 $499.02 $399.92
48 $605.73 $522.01 $418.35
49 $632.04 $544.67 $436.51
50 $661.68 $570.22 $456.98
51 $690.95 $595.44 $477.20
52 $723.18 $623.22 $499.46
53 $755.78 $651.31 $521.97
54 $790.97 $681.64 $546.28
55 $826.17 $711.97 $570.59
56 $864.33 $744.86 $596.94
57 $902.86 $778.06 $623.56
58 $943.98 $813.50 $651.96
59 $964.36 $831.06 $666.03
60 $1,005.48 $866.50 $694.43
61 $1,041.05 $897.15 $718.99
62 $1,064.39 $917.26 $735.11
63 $1,093.66 $942.49 $755.33
64 & Over $1,111.44 $957.81 $767.61
The actual rates for this census are determined by the carrier, only after submission of completed applications. Changes in census data or effective date
may affect rates and benefits may also contain limitations and exclusions. Actual results will vary based on insurer-specific underwriting guidelines and
utilization. This is not a contract and does not replace the master policy or any other insurer documentation. Rates and benefits cannot be guaranteed in
Blue Harbor Benefits
(410) 825-3569