Individual and Family Health Insurance Rates New Business Rates Effective January 1, 2018 * *rates subject to change A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association 225436.1017
Illinois Rating Area Descriptions Rating Area Rating Area Description 1 Chicago - Central, IL 2 Chicago - North, IL 3 Chicago - West, IL 4 Chicago - South, IL 5 Rockford, IL 6 Quad Cities, IL 7 Peoria, IL 8 Bloomington, IL 9 Champaign, IL 10 Springfield, IL 11 East St. Louis, IL 12 St. Louis, IL 13 Southern, IL Rates Effective January 1, 2018 Page 1 of 44
Illinois County Mapping County Rating Area County Rating Area Adams 10 Lee 5 Alexander 13 Livingston 8 Bond 11 Logan 10 Boone 5 Macon 10 Brown 10 Macoupin 11 Bureau 6 Madison 12 Calhoun 11 Marion 13 Carroll 5 Marshall 7 Cass 10 Mason 10 Champaign 9 Massac 13 Christian 10 McDonough 7 Clark 9 McHenry 2 Clay 13 McLean 8 Clinton 11 Menard 10 Coles 9 Mercer 6 Cook 1 Monroe 12 Crawford 13 Montgomery 11 Cumberland 9 Morgan 10 DeKalb 5 Moultrie 10 DeWitt 8 Ogle 5 Douglas 9 Peoria 7 Dupage 3 Perry 13 Edgar 9 Piatt 9 Edwards 13 Pike 10 Effingham 13 Pope 13 Fayette 13 Pulaski 13 Ford 9 Putnam 7 Franklin 13 Randolph 11 Fulton 7 Richland 13 Gallatin 13 Rock Island 6 Greene 11 Saline 13 Grundy 4 Sangamon 10 Hamilton 13 Schuyler 10 Hancock 6 Scott 10 Hardin 13 Shelby 10 Henderson 6 St. Clair 12 Henry 6 Stark 7 Iroquois 9 Stephenson 5 Jackson 13 Tazewell 7 Jasper 13 Union 13 Jefferson 13 Vermilion 9 Jersey 11 Wabash 13 Jo Daviess 5 Warren 6 Johnson 13 Washington 11 Kane 3 Wayne 13 Kankakee 4 White 13 Kendall 4 Whiteside 6 Knox 7 Will 4 Lake 2 Williamson 13 LaSalle 7 Winnebago 5 Lawrence 13 Woodford 7 Rates Effective January 1, 2018 Page 1 of 1
Illinois Off Exchange (Gold) Chicago - Central, IL Blue Precision Gold HMO SM Blue Choice Preferred Gold PPO SM Blue FocusCare Gold SM 208 207 204 211 Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $318.58 $318.58 $322.48 $322.48 $346.75 $346.75 $292.11 $292.11 15 $346.90 $346.90 $351.15 $351.15 $377.57 $377.57 $318.07 $318.07 16 $357.73 $357.73 $362.11 $362.11 $389.35 $389.35 $328.00 $328.00 17 $368.56 $368.56 $373.07 $373.07 $401.14 $401.14 $337.93 $337.93 18 $380.22 $380.22 $384.87 $384.87 $413.83 $413.83 $348.62 $348.62 19 $391.88 $391.88 $396.67 $396.67 $426.52 $426.52 $359.31 $359.31 20 $403.95 $403.95 $408.90 $408.90 $439.66 $439.66 $370.39 $370.39 21 $416.45 $416.45 $421.54 $421.54 $453.26 $453.26 $381.84 $381.84 22 $416.45 $416.45 $421.54 $421.54 $453.26 $453.26 $381.84 $381.84 23 $416.45 $416.45 $421.54 $421.54 $453.26 $453.26 $381.84 $381.84 24 $416.45 $416.45 $421.54 $421.54 $453.26 $453.26 $381.84 $381.84 25 $418.11 $418.11 $423.23 $423.23 $455.08 $455.08 $383.37 $383.37 26 $426.44 $426.44 $431.66 $431.66 $464.14 $464.14 $391.01 $391.01 27 $436.44 $436.44 $441.78 $441.78 $475.02 $475.02 $400.17 $400.17 28 $452.68 $452.68 $458.22 $458.22 $492.70 $492.70 $415.06 $415.06 29 $466.01 $466.01 $471.71 $471.71 $507.20 $507.20 $427.28 $427.28 30 $472.67 $536.10 $478.45 $542.66 $514.45 $583.49 $433.39 $491.55 31 $482.66 $547.44 $488.57 $554.14 $525.33 $595.83 $442.55 $501.95 32 $492.66 $558.77 $498.69 $565.61 $536.21 $608.17 $451.72 $512.34 33 $498.90 $565.86 $505.01 $572.78 $543.01 $615.88 $457.45 $518.83 34 $505.57 $573.42 $511.75 $580.43 $550.26 $624.11 $463.56 $525.77 35 $508.90 $624.83 $515.13 $632.47 $553.89 $680.06 $466.61 $572.90 36 $512.23 $628.92 $518.50 $636.61 $557.51 $684.51 $469.67 $576.65 37 $515.56 $633.01 $521.87 $640.75 $561.14 $688.97 $472.72 $580.41 38 $518.89 $637.10 $525.24 $644.89 $564.77 $693.42 $475.77 $584.16 39 $525.56 $645.28 $531.99 $653.17 $572.02 $702.32 $481.88 $591.66 40 $532.22 $686.24 $538.73 $694.64 $579.27 $746.91 $487.99 $629.22 41 $542.22 $699.13 $548.85 $707.69 $590.15 $760.94 $497.16 $641.04 42 $551.79 $711.49 $558.54 $720.19 $600.57 $774.38 $505.94 $652.36 43 $565.12 $728.67 $572.03 $737.58 $615.08 $793.08 $518.16 $668.12 44 $581.78 $750.14 $588.90 $759.32 $633.21 $816.46 $533.43 $687.81 45 $601.35 $792.94 $608.71 $802.64 $654.51 $863.04 $551.38 $727.05 46 $624.67 $823.69 $632.31 $833.77 $679.89 $896.51 $572.76 $755.24 47 $650.91 $858.29 $658.87 $868.79 $708.45 $934.16 $596.82 $786.96 48 $680.89 $897.82 $689.22 $908.81 $741.08 $977.19 $624.31 $823.22 49 $710.46 $936.81 $719.15 $948.27 $773.27 $1,019.63 $651.42 $858.96 50 $743.78 $983.42 $752.88 $995.45 $809.53 $1,070.36 $681.97 $901.70 51 $776.68 $1,026.92 $786.18 $1,039.48 $845.34 $1,117.70 $712.13 $941.58 52 $812.91 $1,074.82 $822.85 $1,087.97 $884.77 $1,169.84 $745.35 $985.51 53 $849.55 $1,123.28 $859.95 $1,137.02 $924.66 $1,222.58 $778.96 $1,029.94 54 $889.12 $1,175.59 $899.99 $1,189.97 $967.72 $1,279.52 $815.23 $1,077.90 55 $928.68 $1,214.90 $940.04 $1,229.76 $1,010.78 $1,322.30 $851.51 $1,113.94 56 $971.57 $1,271.01 $983.46 $1,286.56 $1,057.46 $1,383.37 $890.84 $1,165.39 57 $1,014.88 $1,327.67 $1,027.30 $1,343.91 $1,104.60 $1,445.04 $930.55 $1,217.34 58 $1,061.11 $1,388.14 $1,074.09 $1,405.12 $1,154.91 $1,510.86 $972.93 $1,272.79 59 $1,084.01 $1,418.11 $1,097.28 $1,435.45 $1,179.84 $1,543.47 $993.93 $1,300.26 60 $1,130.24 $1,452.13 $1,144.07 $1,469.90 $1,230.16 $1,580.50 $1,036.32 $1,331.46 61 $1,170.22 $1,503.50 $1,184.54 $1,521.89 $1,273.67 $1,636.41 $1,072.97 $1,378.56 62 $1,196.46 $1,537.21 $1,211.09 $1,556.01 $1,302.22 $1,673.10 $1,097.03 $1,409.47 63 $1,229.36 $1,579.48 $1,244.39 $1,598.80 $1,338.03 $1,719.10 $1,127.20 $1,448.22 64 $1,249.35 $1,605.16 $1,264.62 $1,624.80 $1,359.78 $1,747.06 $1,145.52 $1,471.77 65+ $1,249.35 $1,605.16 $1,264.62 $1,624.80 $1,359.78 $1,747.06 $1,145.52 $1,471.77 Rates Effective January 1, 2018 Page 3 of 44
Illinois Off Exchange (Gold) Chicago - North, IL Blue Precision Gold HMO SM Blue Choice Preferred Gold PPO SM 208 207 204 Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $301.86 $301.86 $305.55 $305.55 $348.72 $348.72 15 $328.69 $328.69 $332.71 $332.71 $379.72 $379.72 16 $338.95 $338.95 $343.09 $343.09 $391.57 $391.57 17 $349.21 $349.21 $353.48 $353.48 $403.42 $403.42 18 $360.26 $360.26 $364.66 $364.66 $416.19 $416.19 19 $371.30 $371.30 $375.85 $375.85 $428.95 $428.95 20 $382.75 $382.75 $387.43 $387.43 $442.17 $442.17 21 $394.58 $394.58 $399.41 $399.41 $455.84 $455.84 22 $394.58 $394.58 $399.41 $399.41 $455.84 $455.84 23 $394.58 $394.58 $399.41 $399.41 $455.84 $455.84 24 $394.58 $394.58 $399.41 $399.41 $455.84 $455.84 25 $396.16 $396.16 $401.01 $401.01 $457.67 $457.67 26 $404.05 $404.05 $409.00 $409.00 $466.79 $466.79 27 $413.52 $413.52 $418.58 $418.58 $477.73 $477.73 28 $428.91 $428.91 $434.16 $434.16 $495.50 $495.50 29 $441.54 $441.54 $446.94 $446.94 $510.09 $510.09 30 $447.85 $507.96 $453.33 $514.17 $517.38 $586.82 31 $457.32 $518.70 $462.92 $525.04 $528.32 $599.23 32 $466.79 $529.44 $472.50 $535.91 $539.26 $611.63 33 $472.71 $536.15 $478.50 $542.71 $546.10 $619.39 34 $479.03 $543.31 $484.89 $549.96 $553.40 $627.66 35 $482.18 $592.02 $488.08 $599.27 $557.04 $683.94 36 $485.34 $595.90 $491.28 $603.19 $560.69 $688.41 37 $488.50 $599.78 $494.47 $607.11 $564.34 $692.89 38 $491.65 $603.65 $497.67 $611.04 $567.98 $697.37 39 $497.97 $611.40 $504.06 $618.88 $575.28 $706.32 40 $504.28 $650.22 $510.45 $658.17 $582.57 $751.16 41 $513.75 $662.43 $520.03 $670.53 $593.51 $765.27 42 $522.82 $674.13 $529.22 $682.38 $603.99 $778.79 43 $535.45 $690.41 $542.00 $698.86 $618.58 $797.60 44 $551.23 $710.76 $557.98 $719.46 $636.82 $821.11 45 $569.78 $751.31 $576.75 $760.50 $658.24 $867.96 46 $591.88 $780.45 $599.12 $790.00 $683.77 $901.62 47 $616.74 $813.23 $624.28 $823.18 $712.49 $939.48 48 $645.15 $850.69 $653.04 $861.10 $745.31 $982.76 49 $673.16 $887.63 $681.40 $898.49 $777.67 $1,025.44 50 $704.73 $931.79 $713.35 $943.19 $814.14 $1,076.45 51 $735.90 $973.01 $744.90 $984.91 $850.15 $1,124.07 52 $770.23 $1,018.39 $779.65 $1,030.85 $889.81 $1,176.50 53 $804.95 $1,064.31 $814.80 $1,077.33 $929.92 $1,229.55 54 $842.44 $1,113.87 $852.74 $1,127.50 $973.23 $1,286.80 55 $879.92 $1,151.12 $890.69 $1,165.20 $1,016.53 $1,329.83 56 $920.57 $1,204.28 $931.83 $1,219.02 $1,063.49 $1,391.25 57 $961.60 $1,257.97 $973.37 $1,273.36 $1,110.89 $1,453.27 58 $1,005.40 $1,315.26 $1,017.70 $1,331.35 $1,161.49 $1,519.46 59 $1,027.10 $1,343.65 $1,039.67 $1,360.09 $1,186.56 $1,552.26 60 $1,070.90 $1,375.90 $1,084.00 $1,392.73 $1,237.16 $1,589.51 61 $1,108.78 $1,424.56 $1,122.35 $1,441.99 $1,280.92 $1,645.73 62 $1,133.64 $1,456.50 $1,147.51 $1,474.32 $1,309.64 $1,682.63 63 $1,164.81 $1,496.55 $1,179.06 $1,514.86 $1,345.65 $1,728.90 64 $1,183.74 $1,520.89 $1,198.23 $1,539.49 $1,367.52 $1,757.01 65+ $1,183.74 $1,520.89 $1,198.23 $1,539.49 $1,367.52 $1,757.01 Rates Effective January 1, 2018 Page 4 of 44
Illinois Off Exchange (Gold) Blue Precision Gold HMO SM 208 207 Chicago - West, IL Blue Choice Preferred Gold PPO SM 204 Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $312.91 $312.91 $316.74 $316.74 $341.24 $341.24 15 $340.73 $340.73 $344.89 $344.89 $371.57 $371.57 16 $351.36 $351.36 $355.66 $355.66 $383.17 $383.17 17 $361.99 $361.99 $366.42 $366.42 $394.76 $394.76 18 $373.45 $373.45 $378.02 $378.02 $407.25 $407.25 19 $384.90 $384.90 $389.61 $389.61 $419.74 $419.74 20 $396.76 $396.76 $401.62 $401.62 $432.68 $432.68 21 $409.03 $409.03 $414.04 $414.04 $446.06 $446.06 22 $409.03 $409.03 $414.04 $414.04 $446.06 $446.06 23 $409.03 $409.03 $414.04 $414.04 $446.06 $446.06 24 $409.03 $409.03 $414.04 $414.04 $446.06 $446.06 25 $410.67 $410.67 $415.69 $415.69 $447.84 $447.84 26 $418.85 $418.85 $423.97 $423.97 $456.76 $456.76 27 $428.67 $428.67 $433.91 $433.91 $467.47 $467.47 28 $444.62 $444.62 $450.06 $450.06 $484.87 $484.87 29 $457.71 $457.71 $463.31 $463.31 $499.14 $499.14 30 $464.25 $526.56 $469.93 $533.00 $506.28 $574.22 31 $474.07 $537.69 $479.87 $544.27 $516.98 $586.36 32 $483.89 $548.83 $489.81 $555.54 $527.69 $598.50 33 $490.02 $555.78 $496.02 $562.58 $534.38 $606.09 34 $496.57 $563.21 $502.64 $570.10 $541.52 $614.19 35 $499.84 $613.70 $505.95 $621.21 $545.08 $669.25 36 $503.11 $617.72 $509.27 $625.28 $548.65 $673.63 37 $506.38 $621.74 $512.58 $629.35 $552.22 $678.02 38 $509.66 $625.76 $515.89 $633.41 $555.79 $682.40 39 $516.20 $633.79 $522.52 $641.54 $562.93 $691.16 40 $522.75 $674.03 $529.14 $682.27 $570.06 $735.04 41 $532.56 $686.69 $539.08 $695.09 $580.77 $748.84 42 $541.97 $698.82 $548.60 $707.37 $591.03 $762.07 43 $555.06 $715.69 $561.85 $724.45 $605.30 $780.48 44 $571.42 $736.79 $578.41 $745.80 $623.15 $803.48 45 $590.64 $778.82 $597.87 $788.35 $644.11 $849.32 46 $613.55 $809.03 $621.06 $818.93 $669.09 $882.26 47 $639.32 $843.01 $647.14 $853.32 $697.19 $919.32 48 $668.77 $881.84 $676.95 $892.63 $729.31 $961.66 49 $697.81 $920.13 $706.35 $931.39 $760.98 $1,003.42 50 $730.53 $965.91 $739.47 $977.73 $796.66 $1,053.35 51 $762.85 $1,008.64 $772.18 $1,020.98 $831.90 $1,099.94 52 $798.43 $1,055.69 $808.20 $1,068.60 $870.71 $1,151.25 53 $834.43 $1,103.28 $844.64 $1,116.78 $909.96 $1,203.15 54 $873.29 $1,154.66 $883.97 $1,168.79 $952.34 $1,259.18 55 $912.15 $1,193.27 $923.30 $1,207.87 $994.71 $1,301.28 56 $954.28 $1,248.38 $965.95 $1,263.66 $1,040.66 $1,361.39 57 $996.82 $1,304.03 $1,009.01 $1,319.99 $1,087.05 $1,422.07 58 $1,042.22 $1,363.43 $1,054.97 $1,380.11 $1,136.56 $1,486.85 59 $1,064.71 $1,392.86 $1,077.74 $1,409.90 $1,161.09 $1,518.94 60 $1,110.12 $1,426.28 $1,123.70 $1,443.73 $1,210.61 $1,555.39 61 $1,149.38 $1,476.73 $1,163.45 $1,494.80 $1,253.43 $1,610.40 62 $1,175.15 $1,509.84 $1,189.53 $1,528.31 $1,281.53 $1,646.51 63 $1,207.47 $1,551.35 $1,222.24 $1,570.33 $1,316.77 $1,691.78 64 $1,227.09 $1,576.58 $1,242.12 $1,595.87 $1,338.18 $1,719.29 65+ $1,227.09 $1,576.58 $1,242.12 $1,595.87 $1,338.18 $1,719.29 Rates Effective January 1, 2018 Page 5 of 44
Illinois Off Exchange (Gold) Chicago - South, IL Blue Precision Gold HMO SM Blue Choice Preferred Gold PPO SM 208 207 204 Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $304.60 $304.60 $308.33 $308.33 $341.18 $341.18 15 $331.68 $331.68 $335.73 $335.73 $371.51 $371.51 16 $342.03 $342.03 $346.21 $346.21 $383.10 $383.10 17 $352.38 $352.38 $356.69 $356.69 $394.70 $394.70 18 $363.53 $363.53 $367.98 $367.98 $407.18 $407.18 19 $374.68 $374.68 $379.26 $379.26 $419.67 $419.67 20 $386.23 $386.23 $390.95 $390.95 $432.61 $432.61 21 $398.17 $398.17 $403.04 $403.04 $445.99 $445.99 22 $398.17 $398.17 $403.04 $403.04 $445.99 $445.99 23 $398.17 $398.17 $403.04 $403.04 $445.99 $445.99 24 $398.17 $398.17 $403.04 $403.04 $445.99 $445.99 25 $399.76 $399.76 $404.66 $404.66 $447.77 $447.77 26 $407.73 $407.73 $412.72 $412.72 $456.69 $456.69 27 $417.28 $417.28 $422.39 $422.39 $467.39 $467.39 28 $432.81 $432.81 $438.11 $438.11 $484.79 $484.79 29 $445.55 $445.55 $451.01 $451.01 $499.06 $499.06 30 $451.93 $512.57 $457.45 $518.85 $506.19 $574.13 31 $461.48 $523.41 $467.13 $529.82 $516.90 $586.27 32 $471.04 $534.25 $476.80 $540.79 $527.60 $598.41 33 $477.01 $541.02 $482.85 $547.64 $534.29 $605.99 34 $483.38 $548.25 $489.29 $554.96 $541.43 $614.09 35 $486.57 $597.41 $492.52 $604.71 $544.99 $669.14 36 $489.75 $601.32 $495.74 $608.67 $548.56 $673.52 37 $492.94 $605.23 $498.97 $612.63 $552.13 $677.91 38 $496.12 $609.14 $502.19 $616.59 $555.70 $682.29 39 $502.49 $616.96 $508.64 $624.51 $562.83 $691.05 40 $508.86 $656.13 $515.09 $664.15 $569.97 $734.92 41 $518.42 $668.45 $524.76 $676.63 $580.67 $748.72 42 $527.58 $680.26 $534.03 $688.58 $590.93 $761.95 43 $540.32 $696.69 $546.93 $705.21 $605.20 $780.35 44 $556.25 $717.22 $563.05 $726.00 $623.04 $803.35 45 $574.96 $758.14 $581.99 $767.42 $644.00 $849.18 46 $597.26 $787.54 $604.56 $797.18 $668.98 $882.11 47 $622.34 $820.62 $629.96 $830.66 $697.08 $919.16 48 $651.01 $858.42 $658.98 $868.92 $729.19 $961.50 49 $679.28 $895.70 $687.59 $906.66 $760.85 $1,003.26 50 $711.14 $940.26 $719.83 $951.77 $796.53 $1,053.17 51 $742.59 $981.85 $751.68 $993.86 $831.76 $1,099.76 52 $777.23 $1,027.65 $786.74 $1,040.23 $870.56 $1,151.06 53 $812.27 $1,073.99 $822.21 $1,087.12 $909.81 $1,202.95 54 $850.10 $1,124.00 $860.50 $1,137.75 $952.18 $1,258.97 55 $887.92 $1,161.58 $898.79 $1,175.79 $994.55 $1,301.07 56 $928.94 $1,215.23 $940.30 $1,230.10 $1,040.48 $1,361.16 57 $970.34 $1,269.40 $982.22 $1,284.93 $1,086.87 $1,421.84 58 $1,014.54 $1,327.22 $1,026.95 $1,343.46 $1,136.37 $1,486.60 59 $1,036.44 $1,355.87 $1,049.12 $1,372.46 $1,160.90 $1,518.69 60 $1,080.64 $1,388.41 $1,093.86 $1,405.39 $1,210.40 $1,555.13 61 $1,118.86 $1,437.52 $1,132.55 $1,455.10 $1,253.22 $1,610.14 62 $1,143.95 $1,469.74 $1,157.94 $1,487.72 $1,281.32 $1,646.23 63 $1,175.40 $1,510.16 $1,189.78 $1,528.63 $1,316.55 $1,691.50 64 $1,194.51 $1,534.71 $1,209.12 $1,553.49 $1,337.97 $1,719.01 65+ $1,194.51 $1,534.71 $1,209.12 $1,553.49 $1,337.97 $1,719.01 Rates Effective January 1, 2018 Page 6 of 44
Illinois Off Exchange (Gold) Blue Precision Gold HMO SM 208 207 Rockford, IL Blue Choice Preferred Gold PPO SM 204 Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $312.50 $312.50 $316.33 $316.33 $393.76 $393.76 15 $340.28 $340.28 $344.45 $344.45 $428.76 $428.76 16 $350.90 $350.90 $355.20 $355.20 $442.14 $442.14 17 $361.53 $361.53 $365.95 $365.95 $455.53 $455.53 18 $372.96 $372.96 $377.53 $377.53 $469.94 $469.94 19 $384.40 $384.40 $389.10 $389.10 $484.35 $484.35 20 $396.25 $396.25 $401.10 $401.10 $499.28 $499.28 21 $408.50 $408.50 $413.50 $413.50 $514.72 $514.72 22 $408.50 $408.50 $413.50 $413.50 $514.72 $514.72 23 $408.50 $408.50 $413.50 $413.50 $514.72 $514.72 24 $408.50 $408.50 $413.50 $413.50 $514.72 $514.72 25 $410.14 $410.14 $415.15 $415.15 $516.78 $516.78 26 $418.31 $418.31 $423.42 $423.42 $527.07 $527.07 27 $428.11 $428.11 $433.35 $433.35 $539.43 $539.43 28 $444.04 $444.04 $449.48 $449.48 $559.50 $559.50 29 $457.11 $457.11 $462.71 $462.71 $575.97 $575.97 30 $463.65 $525.87 $469.32 $532.31 $584.21 $662.61 31 $473.45 $536.99 $479.25 $543.56 $596.56 $676.62 32 $483.26 $548.11 $489.17 $554.82 $608.91 $690.63 33 $489.39 $555.06 $495.37 $561.85 $616.63 $699.39 34 $495.92 $562.48 $501.99 $569.36 $624.87 $708.73 35 $499.19 $612.91 $505.30 $620.40 $628.99 $772.27 36 $502.46 $616.92 $508.61 $624.46 $633.11 $777.32 37 $505.73 $620.93 $511.91 $628.53 $637.22 $782.38 38 $508.99 $624.94 $515.22 $632.59 $641.34 $787.44 39 $515.53 $632.97 $521.84 $640.71 $649.58 $797.55 40 $522.07 $673.15 $528.45 $681.39 $657.81 $848.18 41 $531.87 $685.79 $538.38 $694.18 $670.17 $864.11 42 $541.27 $697.91 $547.89 $706.45 $682.00 $879.38 43 $554.34 $714.77 $561.12 $723.51 $698.47 $900.62 44 $570.68 $735.83 $577.66 $744.83 $719.06 $927.16 45 $589.88 $777.81 $597.09 $787.33 $743.26 $980.06 46 $612.75 $807.98 $620.25 $817.86 $772.08 $1,018.06 47 $638.49 $841.91 $646.30 $852.21 $804.51 $1,060.82 48 $667.90 $880.70 $676.07 $891.47 $841.57 $1,109.69 49 $696.91 $918.94 $705.43 $930.18 $878.11 $1,157.88 50 $729.59 $964.66 $738.51 $976.46 $919.29 $1,215.49 51 $761.86 $1,007.33 $771.18 $1,019.65 $959.95 $1,269.25 52 $797.40 $1,054.32 $807.15 $1,067.22 $1,004.73 $1,328.46 53 $833.35 $1,101.85 $843.54 $1,115.33 $1,050.03 $1,388.35 54 $872.15 $1,153.16 $882.82 $1,167.27 $1,098.93 $1,453.00 55 $910.96 $1,191.72 $922.11 $1,206.30 $1,147.83 $1,501.59 56 $953.04 $1,246.76 $964.70 $1,262.02 $1,200.84 $1,570.94 57 $995.52 $1,302.34 $1,007.70 $1,318.27 $1,254.37 $1,640.97 58 $1,040.87 $1,361.66 $1,053.60 $1,378.32 $1,311.51 $1,715.71 59 $1,063.33 $1,391.05 $1,076.34 $1,408.07 $1,339.82 $1,752.74 60 $1,108.68 $1,424.43 $1,122.24 $1,441.86 $1,396.95 $1,794.80 61 $1,147.89 $1,474.81 $1,161.94 $1,492.86 $1,446.36 $1,858.29 62 $1,173.63 $1,507.88 $1,187.99 $1,526.33 $1,478.79 $1,899.95 63 $1,205.90 $1,549.34 $1,220.65 $1,568.30 $1,519.45 $1,952.19 64 $1,225.50 $1,574.53 $1,240.50 $1,593.80 $1,544.16 $1,983.94 65+ $1,225.50 $1,574.53 $1,240.50 $1,593.80 $1,544.16 $1,983.94 Rates Effective January 1, 2018 Page 7 of 44
Illinois Off Exchange (Gold) Quad Cities, IL Blue Choice Preferred Gold PPO SM 204 Age Non Tobacco Tobacco 0-14 $337.22 $337.22 15 $367.19 $367.19 16 $378.65 $378.65 17 $390.11 $390.11 18 $402.46 $402.46 19 $414.80 $414.80 20 $427.58 $427.58 21 $440.81 $440.81 22 $440.81 $440.81 23 $440.81 $440.81 24 $440.81 $440.81 25 $442.57 $442.57 26 $451.39 $451.39 27 $461.96 $461.96 28 $479.16 $479.16 29 $493.26 $493.26 30 $500.31 $567.46 31 $510.89 $579.46 32 $521.47 $591.46 33 $528.09 $598.95 34 $535.14 $606.95 35 $538.67 $661.37 36 $542.19 $665.70 37 $545.72 $670.03 38 $549.24 $674.36 39 $556.30 $683.02 40 $563.35 $726.38 41 $573.93 $740.03 42 $584.07 $753.10 43 $598.17 $771.29 44 $615.81 $794.02 45 $636.52 $839.32 46 $661.21 $871.87 47 $688.98 $908.49 48 $720.72 $950.34 49 $752.02 $991.61 50 $787.28 $1,040.94 51 $822.10 $1,086.98 52 $860.45 $1,137.69 53 $899.24 $1,188.98 54 $941.12 $1,244.35 55 $983.00 $1,285.96 56 $1,028.40 $1,345.35 57 $1,074.24 $1,405.33 58 $1,123.17 $1,469.33 59 $1,147.42 $1,501.05 60 $1,196.35 $1,537.07 61 $1,238.67 $1,591.44 62 $1,266.44 $1,627.12 63 $1,301.26 $1,671.86 64 $1,322.43 $1,699.04 65+ $1,322.43 $1,699.04 Rates Effective January 1, 2018 Page 8 of 44
Illinois Off Exchange (Gold) Blue Precision Gold HMO SM 208 207 Peoria, IL Blue Choice Preferred Gold PPO SM 204 Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $324.89 $324.89 $328.87 $328.87 $391.41 $391.41 15 $353.77 $353.77 $358.10 $358.10 $426.20 $426.20 16 $364.81 $364.81 $369.27 $369.27 $439.50 $439.50 17 $375.85 $375.85 $380.45 $380.45 $452.80 $452.80 18 $387.75 $387.75 $392.49 $392.49 $467.13 $467.13 19 $399.64 $399.64 $404.53 $404.53 $481.46 $481.46 20 $411.95 $411.95 $416.99 $416.99 $496.29 $496.29 21 $424.69 $424.69 $429.89 $429.89 $511.64 $511.64 22 $424.69 $424.69 $429.89 $429.89 $511.64 $511.64 23 $424.69 $424.69 $429.89 $429.89 $511.64 $511.64 24 $424.69 $424.69 $429.89 $429.89 $511.64 $511.64 25 $426.39 $426.39 $431.61 $431.61 $513.69 $513.69 26 $434.89 $434.89 $440.21 $440.21 $523.92 $523.92 27 $445.08 $445.08 $450.52 $450.52 $536.20 $536.20 28 $461.64 $461.64 $467.29 $467.29 $556.16 $556.16 29 $475.23 $475.23 $481.05 $481.05 $572.53 $572.53 30 $482.03 $546.72 $487.92 $553.41 $580.71 $658.65 31 $492.22 $558.28 $498.24 $565.11 $592.99 $672.57 32 $502.41 $569.84 $508.56 $576.81 $605.27 $686.50 33 $508.78 $577.06 $515.01 $584.12 $612.95 $695.20 34 $515.58 $584.77 $521.89 $591.92 $621.13 $704.49 35 $518.98 $637.20 $525.32 $644.99 $625.23 $767.65 36 $522.37 $641.37 $528.76 $649.21 $629.32 $772.68 37 $525.77 $645.54 $532.20 $653.44 $633.41 $777.71 38 $529.17 $649.71 $535.64 $657.66 $637.51 $782.73 39 $535.96 $658.05 $542.52 $666.10 $645.69 $792.78 40 $542.76 $699.83 $549.40 $708.39 $653.88 $843.11 41 $552.95 $712.98 $559.72 $721.70 $666.16 $858.95 42 $562.72 $725.57 $569.60 $734.45 $677.93 $874.12 43 $576.31 $743.10 $583.36 $752.19 $694.30 $895.23 44 $593.30 $765.00 $600.56 $774.36 $714.76 $921.62 45 $613.26 $808.64 $620.76 $818.54 $738.81 $974.20 46 $637.04 $840.00 $644.83 $850.28 $767.46 $1,011.98 47 $663.80 $875.28 $671.92 $885.99 $799.70 $1,054.48 48 $694.37 $915.60 $702.87 $926.80 $836.54 $1,103.05 49 $724.53 $955.36 $733.39 $967.05 $872.86 $1,150.95 50 $758.50 $1,002.89 $767.78 $1,015.16 $913.79 $1,208.22 51 $792.05 $1,047.25 $801.74 $1,060.06 $954.21 $1,261.66 52 $829.00 $1,096.10 $839.14 $1,109.51 $998.73 $1,320.51 53 $866.38 $1,145.52 $876.97 $1,159.54 $1,043.75 $1,380.05 54 $906.72 $1,198.87 $917.81 $1,213.53 $1,092.36 $1,444.32 55 $947.07 $1,238.95 $958.65 $1,254.11 $1,140.96 $1,492.61 56 $990.81 $1,296.18 $1,002.93 $1,312.04 $1,193.66 $1,561.55 57 $1,034.98 $1,353.96 $1,047.64 $1,370.52 $1,246.87 $1,631.16 58 $1,082.12 $1,415.63 $1,095.36 $1,432.95 $1,303.66 $1,705.45 59 $1,105.48 $1,446.18 $1,119.00 $1,463.88 $1,331.81 $1,742.27 60 $1,152.62 $1,480.89 $1,166.72 $1,499.00 $1,388.60 $1,784.07 61 $1,193.39 $1,533.27 $1,207.99 $1,552.03 $1,437.72 $1,847.18 62 $1,220.15 $1,567.64 $1,235.07 $1,586.82 $1,469.95 $1,888.59 63 $1,253.70 $1,610.75 $1,269.03 $1,630.45 $1,510.37 $1,940.52 64 $1,274.07 $1,636.94 $1,289.67 $1,656.97 $1,534.92 $1,972.07 65+ $1,274.07 $1,636.94 $1,289.67 $1,656.97 $1,534.92 $1,972.07 Rates Effective January 1, 2018 Page 9 of 44
Illinois Off Exchange (Gold) Blue Precision Gold HMO SM 208 207 Bloomington, IL Blue Choice Preferred Gold PPO SM 204 Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $306.37 $306.37 $310.12 $310.12 $349.37 $349.37 15 $333.61 $333.61 $337.69 $337.69 $380.43 $380.43 16 $344.02 $344.02 $348.23 $348.23 $392.30 $392.30 17 $354.43 $354.43 $358.77 $358.77 $404.18 $404.18 18 $365.65 $365.65 $370.12 $370.12 $416.96 $416.96 19 $376.86 $376.86 $381.47 $381.47 $429.75 $429.75 20 $388.47 $388.47 $393.23 $393.23 $442.99 $442.99 21 $400.49 $400.49 $405.39 $405.39 $456.70 $456.70 22 $400.49 $400.49 $405.39 $405.39 $456.70 $456.70 23 $400.49 $400.49 $405.39 $405.39 $456.70 $456.70 24 $400.49 $400.49 $405.39 $405.39 $456.70 $456.70 25 $402.09 $402.09 $407.01 $407.01 $458.52 $458.52 26 $410.10 $410.10 $415.12 $415.12 $467.66 $467.66 27 $419.71 $419.71 $424.85 $424.85 $478.62 $478.62 28 $435.33 $435.33 $440.66 $440.66 $496.43 $496.43 29 $448.15 $448.15 $453.63 $453.63 $511.04 $511.04 30 $454.56 $515.56 $460.12 $521.87 $518.35 $587.91 31 $464.17 $526.46 $469.85 $532.90 $529.31 $600.34 32 $473.78 $537.36 $479.58 $543.93 $540.27 $612.78 33 $479.79 $544.17 $485.66 $550.83 $547.12 $620.54 34 $486.19 $551.44 $492.14 $558.19 $554.43 $628.83 35 $489.40 $600.88 $495.39 $608.23 $558.08 $685.21 36 $492.60 $604.82 $498.63 $612.21 $561.74 $689.70 37 $495.81 $608.75 $501.87 $616.20 $565.39 $694.19 38 $499.01 $612.69 $505.11 $620.18 $569.04 $698.67 39 $505.42 $620.55 $511.60 $628.14 $576.35 $707.64 40 $511.83 $659.95 $518.09 $668.02 $583.66 $752.57 41 $521.44 $672.34 $527.82 $680.57 $594.62 $766.70 42 $530.65 $684.22 $537.14 $692.59 $605.12 $780.25 43 $543.46 $700.74 $550.11 $709.32 $619.74 $799.09 44 $559.48 $721.40 $566.33 $730.22 $638.00 $822.64 45 $578.31 $762.56 $585.38 $771.89 $659.47 $869.58 46 $600.73 $792.13 $608.08 $801.82 $685.04 $903.30 47 $625.97 $825.40 $633.62 $835.49 $713.81 $941.24 48 $654.80 $863.42 $662.81 $873.98 $746.70 $984.59 49 $683.24 $900.91 $691.59 $911.94 $779.12 $1,027.35 50 $715.27 $945.74 $724.03 $957.31 $815.66 $1,078.46 51 $746.91 $987.57 $756.05 $999.65 $851.74 $1,126.17 52 $781.76 $1,033.64 $791.32 $1,046.28 $891.47 $1,178.70 53 $817.00 $1,080.24 $826.99 $1,093.45 $931.66 $1,231.84 54 $855.05 $1,130.54 $865.51 $1,144.37 $975.04 $1,289.21 55 $893.09 $1,168.34 $904.02 $1,182.64 $1,018.43 $1,332.31 56 $934.34 $1,222.31 $945.77 $1,237.26 $1,065.47 $1,393.85 57 $975.99 $1,276.79 $987.93 $1,292.41 $1,112.97 $1,455.98 58 $1,020.45 $1,334.95 $1,032.93 $1,351.28 $1,163.66 $1,522.30 59 $1,042.47 $1,363.76 $1,055.23 $1,380.45 $1,188.78 $1,555.16 60 $1,086.93 $1,396.49 $1,100.23 $1,413.57 $1,239.47 $1,592.47 61 $1,125.38 $1,445.88 $1,139.14 $1,463.57 $1,283.31 $1,648.80 62 $1,150.61 $1,478.30 $1,164.68 $1,496.38 $1,312.09 $1,685.77 63 $1,182.25 $1,518.95 $1,196.71 $1,537.53 $1,348.16 $1,732.12 64 $1,201.47 $1,543.65 $1,216.17 $1,562.53 $1,370.10 $1,760.29 65+ $1,201.47 $1,543.65 $1,216.17 $1,562.53 $1,370.10 $1,760.29 Rates Effective January 1, 2018 Page 10 of 44
Illinois Off Exchange (Gold) Champaign, IL Blue Choice Preferred Gold PPO SM 204 Age Non Tobacco Tobacco 0-14 $366.81 $366.81 15 $399.42 $399.42 16 $411.89 $411.89 17 $424.35 $424.35 18 $437.78 $437.78 19 $451.20 $451.20 20 $465.11 $465.11 21 $479.49 $479.49 22 $479.49 $479.49 23 $479.49 $479.49 24 $479.49 $479.49 25 $481.41 $481.41 26 $491.00 $491.00 27 $502.51 $502.51 28 $521.21 $521.21 29 $536.55 $536.55 30 $544.23 $617.26 31 $555.73 $630.31 32 $567.24 $643.37 33 $574.43 $651.52 34 $582.11 $660.23 35 $585.94 $719.42 36 $589.78 $724.13 37 $593.61 $728.84 38 $597.45 $733.55 39 $605.12 $742.97 40 $612.79 $790.13 41 $624.30 $804.98 42 $635.33 $819.20 43 $650.67 $838.98 44 $669.85 $863.71 45 $692.39 $912.99 46 $719.24 $948.39 47 $749.45 $988.22 48 $783.97 $1,033.75 49 $818.02 $1,078.64 50 $856.38 $1,132.30 51 $894.26 $1,182.39 52 $935.97 $1,237.54 53 $978.17 $1,293.34 54 $1,023.72 $1,353.56 55 $1,069.27 $1,398.82 56 $1,118.66 $1,463.43 57 $1,168.53 $1,528.67 58 $1,221.75 $1,598.29 59 $1,248.12 $1,632.79 60 $1,301.35 $1,671.97 61 $1,347.38 $1,731.11 62 $1,377.59 $1,769.92 63 $1,415.47 $1,818.59 64 $1,438.47 $1,848.16 65+ $1,438.47 $1,848.16 Rates Effective January 1, 2018 Page 11 of 44
Illinois Off Exchange (Gold) Springfield, IL Blue Choice Preferred Gold PPO SM 204 Age Non Tobacco Tobacco 0-14 $376.81 $376.81 15 $410.30 $410.30 16 $423.11 $423.11 17 $435.91 $435.91 18 $449.70 $449.70 19 $463.50 $463.50 20 $477.78 $477.78 21 $492.56 $492.56 22 $492.56 $492.56 23 $492.56 $492.56 24 $492.56 $492.56 25 $494.53 $494.53 26 $504.38 $504.38 27 $516.20 $516.20 28 $535.41 $535.41 29 $551.17 $551.17 30 $559.05 $634.08 31 $570.87 $647.49 32 $582.69 $660.89 33 $590.08 $669.27 34 $597.96 $678.21 35 $601.90 $739.02 36 $605.84 $743.85 37 $609.78 $748.70 38 $613.73 $753.53 39 $621.61 $763.21 40 $629.49 $811.66 41 $641.31 $826.90 42 $652.64 $841.51 43 $668.40 $861.84 44 $688.10 $887.24 45 $711.25 $937.86 46 $738.83 $974.23 47 $769.87 $1,015.14 48 $805.33 $1,061.91 49 $840.30 $1,108.02 50 $879.71 $1,163.15 51 $918.62 $1,214.59 52 $961.47 $1,271.25 53 $1,004.82 $1,328.57 54 $1,051.61 $1,390.44 55 $1,098.40 $1,436.93 56 $1,149.13 $1,503.30 57 $1,200.36 $1,570.31 58 $1,255.03 $1,641.83 59 $1,282.12 $1,677.27 60 $1,336.80 $1,717.52 61 $1,384.08 $1,778.27 62 $1,415.11 $1,818.14 63 $1,454.03 $1,868.13 64 $1,477.68 $1,898.51 65+ $1,477.68 $1,898.51 Rates Effective January 1, 2018 Page 12 of 44
Illinois Off Exchange (Gold) East St. Louis, IL Blue Choice Preferred Gold PPO SM 204 Age Non Tobacco Tobacco 0-14 $349.96 $349.96 15 $381.07 $381.07 16 $392.96 $392.96 17 $404.86 $404.86 18 $417.66 $417.66 19 $430.47 $430.47 20 $443.74 $443.74 21 $457.46 $457.46 22 $457.46 $457.46 23 $457.46 $457.46 24 $457.46 $457.46 25 $459.29 $459.29 26 $468.44 $468.44 27 $479.42 $479.42 28 $497.26 $497.26 29 $511.90 $511.90 30 $519.22 $588.90 31 $530.20 $601.36 32 $541.18 $613.81 33 $548.04 $621.59 34 $555.36 $629.89 35 $559.02 $686.37 36 $562.68 $690.86 37 $566.34 $695.35 38 $570.00 $699.85 39 $577.32 $708.83 40 $584.64 $753.83 41 $595.62 $767.99 42 $606.14 $781.56 43 $620.78 $800.43 44 $639.08 $824.03 45 $660.58 $871.04 46 $686.20 $904.82 47 $715.02 $942.82 48 $747.95 $986.25 49 $780.43 $1,029.08 50 $817.03 $1,080.28 51 $853.17 $1,128.06 52 $892.97 $1,180.68 53 $933.23 $1,233.91 54 $976.69 $1,291.38 55 $1,020.15 $1,334.56 56 $1,067.26 $1,396.19 57 $1,114.84 $1,458.43 58 $1,165.62 $1,524.86 59 $1,190.78 $1,557.78 60 $1,241.56 $1,595.16 61 $1,285.47 $1,651.58 62 $1,314.30 $1,688.61 63 $1,350.43 $1,735.04 64 $1,372.38 $1,763.25 65+ $1,372.38 $1,763.25 Rates Effective January 1, 2018 Page 13 of 44
Illinois Off Exchange (Gold) St. Louis, IL Blue Choice Preferred Gold PPO SM 204 Age Non Tobacco Tobacco 0-14 $339.86 $339.86 15 $370.07 $370.07 16 $381.63 $381.63 17 $393.18 $393.18 18 $405.62 $405.62 19 $418.06 $418.06 20 $430.94 $430.94 21 $444.27 $444.27 22 $444.27 $444.27 23 $444.27 $444.27 24 $444.27 $444.27 25 $446.04 $446.04 26 $454.93 $454.93 27 $465.59 $465.59 28 $482.92 $482.92 29 $497.14 $497.14 30 $504.24 $571.91 31 $514.91 $584.01 32 $525.57 $596.10 33 $532.23 $603.66 34 $539.34 $611.72 35 $542.89 $666.57 36 $546.45 $670.93 37 $550.00 $675.30 38 $553.56 $679.66 39 $560.67 $688.38 40 $567.77 $732.09 41 $578.44 $745.84 42 $588.65 $759.01 43 $602.87 $777.34 44 $620.64 $800.25 45 $641.52 $845.91 46 $666.40 $878.72 47 $694.39 $915.62 48 $726.38 $957.80 49 $757.92 $999.39 50 $793.46 $1,049.12 51 $828.56 $1,095.52 52 $867.21 $1,146.62 53 $906.31 $1,198.32 54 $948.51 $1,254.12 55 $990.72 $1,296.06 56 $1,036.48 $1,355.92 57 $1,082.68 $1,416.36 58 $1,131.99 $1,480.87 59 $1,156.43 $1,512.84 60 $1,205.74 $1,549.14 61 $1,248.39 $1,603.93 62 $1,276.38 $1,639.89 63 $1,311.48 $1,684.99 64 $1,332.81 $1,712.38 65+ $1,332.81 $1,712.38 Rates Effective January 1, 2018 Page 14 of 44
Illinois Off Exchange (Gold) Southern, IL Blue Choice Preferred Gold PPO SM 204 Age Non Tobacco Tobacco 0-14 $417.75 $417.75 15 $454.89 $454.89 16 $469.09 $469.09 17 $483.28 $483.28 18 $498.57 $498.57 19 $513.86 $513.86 20 $529.70 $529.70 21 $546.08 $546.08 22 $546.08 $546.08 23 $546.08 $546.08 24 $546.08 $546.08 25 $548.27 $548.27 26 $559.19 $559.19 27 $572.30 $572.30 28 $593.59 $593.59 29 $611.07 $611.07 30 $619.80 $702.98 31 $632.91 $717.85 32 $646.02 $732.71 33 $654.21 $742.00 34 $662.95 $751.91 35 $667.31 $819.33 36 $671.68 $824.69 37 $676.05 $830.06 38 $680.42 $835.42 39 $689.16 $846.15 40 $697.89 $899.86 41 $711.00 $916.77 42 $723.56 $932.96 43 $741.04 $955.49 44 $762.88 $983.65 45 $788.54 $1,039.78 46 $819.13 $1,080.10 47 $853.53 $1,125.46 48 $892.85 $1,177.31 49 $931.62 $1,228.43 50 $975.31 $1,289.55 51 $1,018.45 $1,346.59 52 $1,065.96 $1,409.40 53 $1,114.01 $1,472.95 54 $1,165.89 $1,541.54 55 $1,217.77 $1,593.08 56 $1,274.01 $1,666.66 57 $1,330.81 $1,740.96 58 $1,391.42 $1,820.25 59 $1,421.46 $1,859.55 60 $1,482.07 $1,904.17 61 $1,534.49 $1,971.52 62 $1,568.90 $2,015.72 63 $1,612.04 $2,071.15 64 $1,638.24 $2,104.82 65+ $1,638.24 $2,104.82 Rates Effective January 1, 2018 Page 15 of 44
Illinois Off Exchange (Silver) Chicago - Central, IL Blue Precision Silver HMO SM BlueCare Direct Silver SM Blue Choice Preferred Silver PPO SM 206 212 102 203 Blue FocusCare Silver SM 210 Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $304.65 $304.65 $289.41 $289.41 $297.36 $297.36 $330.78 $330.78 $245.99 $245.99 15 $331.73 $331.73 $315.14 $315.14 $323.79 $323.79 $360.19 $360.19 $267.85 $267.85 16 $342.08 $342.08 $324.98 $324.98 $333.89 $333.89 $371.43 $371.43 $276.21 $276.21 17 $352.43 $352.43 $334.81 $334.81 $344.00 $344.00 $382.67 $382.67 $284.57 $284.57 18 $363.58 $363.58 $345.41 $345.41 $354.88 $354.88 $394.78 $394.78 $293.57 $293.57 19 $374.74 $374.74 $356.00 $356.00 $365.77 $365.77 $406.88 $406.88 $302.58 $302.58 20 $386.28 $386.28 $366.97 $366.97 $377.04 $377.04 $419.42 $419.42 $311.90 $311.90 21 $398.23 $398.23 $378.32 $378.32 $388.70 $388.70 $432.39 $432.39 $321.55 $321.55 22 $398.23 $398.23 $378.32 $378.32 $388.70 $388.70 $432.39 $432.39 $321.55 $321.55 23 $398.23 $398.23 $378.32 $378.32 $388.70 $388.70 $432.39 $432.39 $321.55 $321.55 24 $398.23 $398.23 $378.32 $378.32 $388.70 $388.70 $432.39 $432.39 $321.55 $321.55 25 $399.82 $399.82 $379.83 $379.83 $390.26 $390.26 $434.12 $434.12 $322.84 $322.84 26 $407.79 $407.79 $387.40 $387.40 $398.03 $398.03 $442.77 $442.77 $329.27 $329.27 27 $417.35 $417.35 $396.48 $396.48 $407.36 $407.36 $453.15 $453.15 $336.98 $336.98 28 $432.88 $432.88 $411.23 $411.23 $422.52 $422.52 $470.01 $470.01 $349.52 $349.52 29 $445.62 $445.62 $423.34 $423.34 $434.96 $434.96 $483.85 $483.85 $359.81 $359.81 30 $451.99 $512.65 $429.39 $487.02 $441.18 $500.38 $490.77 $556.63 $364.96 $413.94 31 $461.55 $523.49 $438.47 $497.32 $450.50 $510.96 $501.15 $568.40 $372.68 $422.69 32 $471.11 $534.33 $447.55 $507.61 $459.83 $521.54 $511.52 $580.17 $380.39 $431.44 33 $477.08 $541.10 $453.23 $514.05 $465.66 $528.16 $518.01 $587.53 $385.22 $436.91 34 $483.45 $548.33 $459.28 $520.92 $471.88 $535.21 $524.93 $595.37 $390.36 $442.75 35 $486.64 $597.49 $462.31 $567.62 $474.99 $583.20 $528.39 $648.75 $392.93 $482.44 36 $489.82 $601.40 $465.33 $571.33 $478.10 $587.01 $531.85 $653.00 $395.51 $485.60 37 $493.01 $605.32 $468.36 $575.05 $481.21 $590.83 $535.30 $657.25 $398.08 $488.76 38 $496.20 $609.23 $471.39 $578.77 $484.32 $594.65 $538.76 $661.50 $400.65 $491.92 39 $502.57 $617.05 $477.44 $586.20 $490.54 $602.28 $545.68 $669.99 $405.80 $498.23 40 $508.94 $656.22 $483.49 $623.41 $496.76 $640.52 $552.60 $712.52 $410.94 $529.87 41 $518.50 $668.55 $492.57 $635.12 $506.09 $652.55 $562.98 $725.90 $418.66 $539.82 42 $527.66 $680.36 $501.27 $646.34 $515.03 $664.08 $572.92 $738.73 $426.05 $549.35 43 $540.40 $696.79 $513.38 $661.95 $527.47 $680.12 $586.76 $756.57 $436.34 $562.62 44 $556.33 $717.33 $528.51 $681.46 $543.02 $700.16 $604.06 $778.87 $449.20 $579.20 45 $575.05 $758.26 $546.29 $720.34 $561.28 $740.11 $624.38 $823.31 $464.32 $612.25 46 $597.35 $787.66 $567.48 $748.28 $583.05 $768.81 $648.59 $855.23 $482.32 $635.99 47 $622.43 $820.74 $591.31 $779.70 $607.54 $801.10 $675.83 $891.15 $502.58 $662.70 48 $651.11 $858.55 $618.55 $815.62 $635.53 $838.00 $706.97 $932.20 $525.73 $693.23 49 $679.38 $895.83 $645.41 $851.04 $663.12 $874.39 $737.67 $972.69 $548.56 $723.34 50 $711.24 $940.40 $675.68 $893.38 $694.22 $917.90 $772.26 $1,021.08 $574.29 $759.32 51 $742.70 $982.00 $705.57 $932.90 $724.93 $958.50 $806.42 $1,066.24 $599.69 $792.91 52 $777.35 $1,027.81 $738.48 $976.42 $758.74 $1,003.21 $844.03 $1,115.98 $627.66 $829.90 53 $812.39 $1,074.14 $771.77 $1,020.44 $792.95 $1,048.44 $882.09 $1,166.29 $655.96 $867.31 54 $850.22 $1,124.17 $807.71 $1,067.96 $829.88 $1,097.26 $923.16 $1,220.61 $686.51 $907.70 55 $888.05 $1,161.75 $843.65 $1,103.67 $866.80 $1,133.95 $964.24 $1,261.42 $717.06 $938.05 56 $929.07 $1,215.41 $882.62 $1,154.64 $906.84 $1,186.33 $1,008.78 $1,319.68 $750.17 $981.38 57 $970.49 $1,269.59 $921.96 $1,206.11 $947.26 $1,239.21 $1,053.75 $1,378.51 $783.62 $1,025.13 58 $1,014.69 $1,327.42 $963.96 $1,261.05 $990.41 $1,295.65 $1,101.74 $1,441.30 $819.31 $1,071.82 59 $1,036.60 $1,356.07 $984.77 $1,288.27 $1,011.79 $1,323.62 $1,125.52 $1,472.41 $836.99 $1,094.95 60 $1,080.80 $1,388.61 $1,026.76 $1,319.18 $1,054.93 $1,355.38 $1,173.52 $1,507.74 $872.69 $1,121.23 61 $1,119.03 $1,437.73 $1,063.08 $1,365.84 $1,092.25 $1,403.32 $1,215.03 $1,561.07 $903.55 $1,160.89 62 $1,144.12 $1,469.96 $1,086.91 $1,396.46 $1,116.74 $1,434.78 $1,242.27 $1,596.07 $923.81 $1,186.91 63 $1,175.58 $1,510.38 $1,116.80 $1,434.86 $1,147.45 $1,474.24 $1,276.43 $1,639.96 $949.21 $1,219.55 64 $1,194.69 $1,534.94 $1,134.96 $1,458.19 $1,166.10 $1,498.21 $1,297.17 $1,666.62 $964.65 $1,239.38 65+ $1,194.69 $1,534.94 $1,134.96 $1,458.19 $1,166.10 $1,498.21 $1,297.17 $1,666.62 $964.65 $1,239.38 Rates Effective January 1, 2018 Page 16 of 44
Illinois Off Exchange (Silver) Chicago - North, IL Blue Precision Silver HMO SM BlueCare Direct Silver SM Blue Choice Preferred Silver PPO SM 206 212 102 203 Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $288.65 $288.65 $274.22 $274.22 $299.05 $299.05 $332.67 $332.67 15 $314.31 $314.31 $298.59 $298.59 $325.63 $325.63 $362.24 $362.24 16 $324.12 $324.12 $307.91 $307.91 $335.80 $335.80 $373.54 $373.54 17 $333.93 $333.93 $317.23 $317.23 $345.96 $345.96 $384.85 $384.85 18 $344.50 $344.50 $327.27 $327.27 $356.91 $356.91 $397.03 $397.03 19 $355.06 $355.06 $337.31 $337.31 $367.85 $367.85 $409.20 $409.20 20 $366.00 $366.00 $347.70 $347.70 $379.19 $379.19 $421.81 $421.81 21 $377.32 $377.32 $358.46 $358.46 $390.92 $390.92 $434.86 $434.86 22 $377.32 $377.32 $358.46 $358.46 $390.92 $390.92 $434.86 $434.86 23 $377.32 $377.32 $358.46 $358.46 $390.92 $390.92 $434.86 $434.86 24 $377.32 $377.32 $358.46 $358.46 $390.92 $390.92 $434.86 $434.86 25 $378.83 $378.83 $359.89 $359.89 $392.48 $392.48 $436.60 $436.60 26 $386.38 $386.38 $367.06 $367.06 $400.30 $400.30 $445.29 $445.29 27 $395.44 $395.44 $375.66 $375.66 $409.68 $409.68 $455.73 $455.73 28 $410.15 $410.15 $389.64 $389.64 $424.92 $424.92 $472.69 $472.69 29 $422.22 $422.22 $401.11 $401.11 $437.43 $437.43 $486.61 $486.61 30 $428.26 $485.74 $406.85 $461.45 $443.69 $503.23 $493.56 $559.80 31 $437.32 $496.01 $415.45 $471.21 $453.07 $513.87 $504.00 $571.64 32 $446.37 $506.28 $424.05 $480.96 $462.45 $524.51 $514.44 $583.48 33 $452.03 $512.70 $429.43 $487.06 $468.32 $531.16 $520.96 $590.87 34 $458.07 $519.54 $435.17 $493.57 $474.57 $538.26 $527.92 $598.76 35 $461.09 $566.12 $438.03 $537.82 $477.70 $586.52 $531.40 $652.45 36 $464.11 $569.83 $440.90 $541.34 $480.83 $590.36 $534.88 $656.72 37 $467.13 $573.54 $443.77 $544.86 $483.95 $594.20 $538.35 $660.99 38 $470.15 $577.24 $446.64 $548.38 $487.08 $598.04 $541.83 $665.26 39 $476.18 $584.66 $452.37 $555.42 $493.34 $605.72 $548.79 $673.80 40 $482.22 $621.77 $458.11 $590.68 $499.59 $644.17 $555.75 $716.58 41 $491.28 $633.45 $466.71 $601.78 $508.97 $656.27 $566.19 $730.04 42 $499.95 $644.64 $474.96 $612.41 $517.96 $667.86 $576.19 $742.94 43 $512.03 $660.21 $486.43 $627.20 $530.47 $683.99 $590.10 $760.88 44 $527.12 $679.67 $500.76 $645.69 $546.11 $704.15 $607.50 $783.31 45 $544.86 $718.45 $517.61 $682.52 $564.48 $744.33 $627.94 $828.00 46 $565.99 $746.31 $537.69 $708.99 $586.37 $773.19 $652.29 $860.11 47 $589.76 $777.65 $560.27 $738.77 $611.00 $805.66 $679.68 $896.23 48 $616.92 $813.48 $586.08 $772.80 $639.15 $842.78 $710.99 $937.52 49 $643.71 $848.80 $611.53 $806.36 $666.90 $879.38 $741.87 $978.23 50 $673.90 $891.03 $640.20 $846.48 $698.17 $923.13 $776.66 $1,026.90 51 $703.71 $930.44 $668.52 $883.92 $729.06 $963.96 $811.01 $1,072.32 52 $736.54 $973.85 $699.71 $925.15 $763.07 $1,008.92 $848.84 $1,122.34 53 $769.74 $1,017.75 $731.25 $966.86 $797.47 $1,054.41 $887.11 $1,172.94 54 $805.59 $1,065.15 $765.31 $1,011.89 $834.60 $1,103.51 $928.42 $1,227.56 55 $841.43 $1,100.76 $799.36 $1,045.72 $871.74 $1,140.41 $969.73 $1,268.61 56 $880.30 $1,151.60 $836.28 $1,094.02 $912.01 $1,193.08 $1,014.52 $1,327.20 57 $919.54 $1,202.94 $873.56 $1,142.79 $952.66 $1,246.27 $1,059.75 $1,386.36 58 $961.42 $1,257.73 $913.35 $1,194.84 $996.05 $1,303.03 $1,108.02 $1,449.51 59 $982.17 $1,284.88 $933.06 $1,220.63 $1,017.55 $1,331.16 $1,131.94 $1,480.80 60 $1,024.06 $1,315.71 $972.85 $1,249.92 $1,060.94 $1,363.10 $1,180.21 $1,516.33 61 $1,060.28 $1,362.25 $1,007.27 $1,294.13 $1,098.47 $1,411.32 $1,221.95 $1,569.96 62 $1,084.05 $1,392.79 $1,029.85 $1,323.15 $1,123.10 $1,442.96 $1,249.35 $1,605.16 63 $1,113.86 $1,431.09 $1,058.17 $1,359.53 $1,153.98 $1,482.64 $1,283.70 $1,649.30 64 $1,131.96 $1,454.36 $1,075.38 $1,381.64 $1,172.76 $1,506.74 $1,304.58 $1,676.12 65+ $1,131.96 $1,454.36 $1,075.38 $1,381.64 $1,172.76 $1,506.74 $1,304.58 $1,676.12 Rates Effective January 1, 2018 Page 17 of 44
Illinois Off Exchange (Silver) Chicago - West, IL Blue Precision Silver HMO SM BlueCare Direct Silver SM Blue Choice Preferred Silver PPO SM 206 212 102 203 Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $299.22 $299.22 $284.26 $284.26 $292.63 $292.63 $325.53 $325.53 15 $325.82 $325.82 $309.53 $309.53 $318.64 $318.64 $354.46 $354.46 16 $335.99 $335.99 $319.19 $319.19 $328.59 $328.59 $365.52 $365.52 17 $346.16 $346.16 $328.85 $328.85 $338.53 $338.53 $376.59 $376.59 18 $357.11 $357.11 $339.26 $339.26 $349.24 $349.24 $388.50 $388.50 19 $368.06 $368.06 $349.66 $349.66 $359.95 $359.95 $400.42 $400.42 20 $379.41 $379.41 $360.44 $360.44 $371.05 $371.05 $412.76 $412.76 21 $391.14 $391.14 $371.58 $371.58 $382.52 $382.52 $425.52 $425.52 22 $391.14 $391.14 $371.58 $371.58 $382.52 $382.52 $425.52 $425.52 23 $391.14 $391.14 $371.58 $371.58 $382.52 $382.52 $425.52 $425.52 24 $391.14 $391.14 $371.58 $371.58 $382.52 $382.52 $425.52 $425.52 25 $392.71 $392.71 $373.07 $373.07 $384.05 $384.05 $427.23 $427.23 26 $400.53 $400.53 $380.50 $380.50 $391.70 $391.70 $435.74 $435.74 27 $409.92 $409.92 $389.42 $389.42 $400.88 $400.88 $445.95 $445.95 28 $425.17 $425.17 $403.91 $403.91 $415.80 $415.80 $462.54 $462.54 29 $437.69 $437.69 $415.80 $415.80 $428.04 $428.04 $476.16 $476.16 30 $443.94 $503.52 $421.75 $478.35 $434.16 $492.43 $482.97 $547.78 31 $453.33 $514.17 $430.67 $488.46 $443.34 $502.84 $493.18 $559.37 32 $462.72 $524.82 $439.58 $498.58 $452.53 $513.25 $503.39 $570.95 33 $468.59 $531.47 $445.16 $504.90 $458.26 $519.76 $509.78 $578.19 34 $474.84 $538.57 $451.10 $511.64 $464.38 $526.70 $516.59 $585.91 35 $477.97 $586.86 $454.08 $557.51 $467.44 $573.93 $519.99 $638.44 36 $481.10 $590.70 $457.05 $561.16 $470.50 $577.68 $523.39 $642.62 37 $484.23 $594.54 $460.02 $564.81 $473.56 $581.44 $526.80 $646.80 38 $487.36 $598.38 $462.99 $568.46 $476.62 $585.20 $530.20 $650.98 39 $493.62 $606.06 $468.94 $575.76 $482.74 $592.71 $537.01 $659.34 40 $499.88 $644.54 $474.88 $612.31 $488.87 $630.34 $543.82 $701.20 41 $509.27 $656.65 $483.80 $623.81 $498.05 $642.18 $554.03 $714.37 42 $518.26 $668.25 $492.35 $634.84 $506.84 $653.53 $563.82 $726.99 43 $530.78 $684.39 $504.24 $650.17 $519.08 $669.31 $577.44 $744.55 44 $546.42 $704.56 $519.10 $669.33 $534.39 $689.04 $594.46 $766.49 45 $564.81 $744.76 $536.57 $707.52 $552.36 $728.35 $614.46 $810.22 46 $586.71 $773.64 $557.38 $734.96 $573.79 $756.59 $638.29 $841.64 47 $611.35 $806.13 $580.79 $765.82 $597.88 $788.37 $665.09 $876.99 48 $639.52 $843.26 $607.54 $801.10 $625.43 $824.69 $695.73 $917.39 49 $667.29 $879.88 $633.92 $835.89 $652.59 $860.50 $725.94 $957.23 50 $698.58 $923.66 $663.65 $877.48 $683.19 $903.31 $759.98 $1,004.85 51 $729.48 $964.51 $693.00 $916.29 $713.41 $943.27 $793.60 $1,049.30 52 $763.51 $1,009.51 $725.33 $959.03 $746.69 $987.27 $830.62 $1,098.25 53 $797.93 $1,055.02 $758.03 $1,002.27 $780.35 $1,031.78 $868.07 $1,147.76 54 $835.09 $1,104.15 $793.33 $1,048.94 $816.69 $1,079.83 $908.49 $1,201.21 55 $872.24 $1,141.07 $828.63 $1,084.02 $853.03 $1,115.93 $948.92 $1,241.38 56 $912.53 $1,193.77 $866.90 $1,134.08 $892.43 $1,167.47 $992.75 $1,298.71 57 $953.21 $1,246.99 $905.55 $1,184.64 $932.21 $1,219.52 $1,037.00 $1,356.60 58 $996.63 $1,303.79 $946.80 $1,238.60 $974.67 $1,275.06 $1,084.23 $1,418.39 59 $1,018.14 $1,331.93 $967.23 $1,265.33 $995.71 $1,302.58 $1,107.64 $1,449.01 60 $1,061.56 $1,363.89 $1,008.48 $1,295.69 $1,038.17 $1,333.84 $1,154.87 $1,483.78 61 $1,099.11 $1,412.13 $1,044.15 $1,341.52 $1,074.89 $1,381.02 $1,195.72 $1,536.26 62 $1,123.75 $1,443.79 $1,067.56 $1,371.60 $1,098.99 $1,411.98 $1,222.53 $1,570.70 63 $1,154.65 $1,483.49 $1,096.91 $1,409.32 $1,129.21 $1,450.81 $1,256.14 $1,613.90 64 $1,173.42 $1,507.61 $1,114.74 $1,432.23 $1,147.56 $1,474.40 $1,276.56 $1,640.14 65+ $1,173.42 $1,507.61 $1,114.74 $1,432.23 $1,147.56 $1,474.40 $1,276.56 $1,640.14 Rates Effective January 1, 2018 Page 18 of 44
Illinois Off Exchange (Silver) Chicago - South, IL Blue Precision Silver HMO SM BlueCare Direct Silver SM Blue Choice Preferred Silver PPO SM 206 212 102 203 Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $291.28 $291.28 $276.71 $276.71 $292.58 $292.58 $325.47 $325.47 15 $317.17 $317.17 $301.31 $301.31 $318.59 $318.59 $354.40 $354.40 16 $327.07 $327.07 $310.71 $310.71 $328.53 $328.53 $365.46 $365.46 17 $336.97 $336.97 $320.12 $320.12 $338.48 $338.48 $376.53 $376.53 18 $347.63 $347.63 $330.25 $330.25 $349.19 $349.19 $388.44 $388.44 19 $358.29 $358.29 $340.38 $340.38 $359.89 $359.89 $400.35 $400.35 20 $369.33 $369.33 $350.86 $350.86 $370.99 $370.99 $412.69 $412.69 21 $380.75 $380.75 $361.72 $361.72 $382.46 $382.46 $425.45 $425.45 22 $380.75 $380.75 $361.72 $361.72 $382.46 $382.46 $425.45 $425.45 23 $380.75 $380.75 $361.72 $361.72 $382.46 $382.46 $425.45 $425.45 24 $380.75 $380.75 $361.72 $361.72 $382.46 $382.46 $425.45 $425.45 25 $382.28 $382.28 $363.16 $363.16 $383.99 $383.99 $427.15 $427.15 26 $389.89 $389.89 $370.40 $370.40 $391.64 $391.64 $435.66 $435.66 27 $399.03 $399.03 $379.08 $379.08 $400.82 $400.82 $445.87 $445.87 28 $413.88 $413.88 $393.19 $393.19 $415.73 $415.73 $462.47 $462.47 29 $426.06 $426.06 $404.76 $404.76 $427.97 $427.97 $476.08 $476.08 30 $432.16 $490.15 $410.55 $465.64 $434.09 $492.35 $482.89 $547.69 31 $441.29 $500.52 $419.23 $475.49 $443.27 $502.76 $493.10 $559.27 32 $450.43 $510.88 $427.91 $485.34 $452.45 $513.17 $503.31 $570.86 33 $456.14 $517.36 $433.34 $491.49 $458.19 $519.68 $509.69 $578.09 34 $462.24 $524.27 $439.12 $498.05 $464.31 $526.62 $516.50 $585.81 35 $465.28 $571.27 $442.02 $542.71 $467.37 $573.83 $519.90 $638.34 36 $468.33 $575.01 $444.91 $546.26 $470.43 $577.59 $523.31 $642.51 37 $471.37 $578.75 $447.80 $549.82 $473.49 $581.35 $526.71 $646.70 38 $474.42 $582.49 $450.70 $553.37 $476.55 $585.10 $530.11 $650.87 39 $480.51 $589.97 $456.49 $560.47 $482.66 $592.61 $536.92 $659.23 40 $486.60 $627.43 $462.27 $596.05 $488.78 $630.24 $543.73 $701.08 41 $495.74 $639.21 $470.95 $607.25 $497.96 $642.07 $553.94 $714.25 42 $504.50 $650.50 $479.27 $617.98 $506.76 $653.42 $563.72 $726.87 43 $516.68 $666.21 $490.85 $632.90 $519.00 $669.20 $577.34 $744.42 44 $531.91 $685.85 $505.32 $651.56 $534.30 $688.92 $594.36 $766.36 45 $549.81 $724.98 $522.32 $688.73 $552.27 $728.23 $614.35 $810.09 46 $571.13 $753.09 $542.57 $715.44 $573.69 $756.47 $638.18 $841.50 47 $595.12 $784.72 $565.36 $745.49 $597.79 $788.24 $664.98 $876.85 48 $622.53 $820.87 $591.41 $779.83 $625.32 $824.55 $695.61 $917.24 49 $649.57 $856.52 $617.09 $813.69 $652.48 $860.36 $725.82 $957.07 50 $680.03 $899.13 $646.03 $854.18 $683.07 $903.16 $759.86 $1,004.68 51 $710.11 $938.90 $674.60 $891.96 $713.29 $943.11 $793.47 $1,049.12 52 $743.23 $982.70 $706.07 $933.56 $746.56 $987.10 $830.48 $1,098.06 53 $776.74 $1,027.00 $737.90 $975.65 $780.22 $1,031.61 $867.92 $1,147.57 54 $812.91 $1,074.83 $772.26 $1,021.09 $816.55 $1,079.65 $908.34 $1,201.01 55 $849.08 $1,110.77 $806.63 $1,055.23 $852.89 $1,115.75 $948.76 $1,241.17 56 $888.30 $1,162.07 $843.88 $1,103.97 $892.28 $1,167.28 $992.58 $1,298.49 57 $927.90 $1,213.87 $881.50 $1,153.18 $932.06 $1,219.31 $1,036.83 $1,356.38 58 $970.16 $1,269.16 $921.65 $1,205.71 $974.51 $1,274.85 $1,084.05 $1,418.16 59 $991.10 $1,296.56 $941.55 $1,231.73 $995.54 $1,302.37 $1,107.45 $1,448.77 60 $1,033.37 $1,327.67 $981.70 $1,261.29 $1,038.00 $1,333.62 $1,154.68 $1,483.53 61 $1,069.92 $1,374.63 $1,016.42 $1,305.90 $1,074.71 $1,380.79 $1,195.52 $1,536.01 62 $1,093.91 $1,405.45 $1,039.21 $1,335.18 $1,098.81 $1,411.75 $1,222.33 $1,570.44 63 $1,123.99 $1,444.10 $1,067.79 $1,371.89 $1,129.02 $1,450.57 $1,255.94 $1,613.63 64 $1,142.25 $1,467.58 $1,085.16 $1,394.20 $1,147.38 $1,474.15 $1,276.35 $1,639.86 65+ $1,142.25 $1,467.58 $1,085.16 $1,394.20 $1,147.38 $1,474.15 $1,276.35 $1,639.86 Rates Effective January 1, 2018 Page 19 of 44
Illinois Off Exchange (Silver) Blue Precision Silver HMO SM 206 Rockford, IL Blue Choice Preferred Silver PPO SM 102 203 Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $298.83 $298.83 $337.67 $337.67 $375.63 $375.63 15 $325.40 $325.40 $367.69 $367.69 $409.02 $409.02 16 $335.55 $335.55 $379.17 $379.17 $421.79 $421.79 17 $345.71 $345.71 $390.64 $390.64 $434.56 $434.56 18 $356.65 $356.65 $403.00 $403.00 $448.30 $448.30 19 $367.59 $367.59 $415.36 $415.36 $462.05 $462.05 20 $378.91 $378.91 $428.16 $428.16 $476.29 $476.29 21 $390.63 $390.63 $441.40 $441.40 $491.02 $491.02 22 $390.63 $390.63 $441.40 $441.40 $491.02 $491.02 23 $390.63 $390.63 $441.40 $441.40 $491.02 $491.02 24 $390.63 $390.63 $441.40 $441.40 $491.02 $491.02 25 $392.20 $392.20 $443.17 $443.17 $492.99 $492.99 26 $400.01 $400.01 $452.00 $452.00 $502.81 $502.81 27 $409.38 $409.38 $462.59 $462.59 $514.59 $514.59 28 $424.62 $424.62 $479.81 $479.81 $533.74 $533.74 29 $437.12 $437.12 $493.93 $493.93 $549.45 $549.45 30 $443.37 $502.87 $500.99 $568.23 $557.31 $632.10 31 $452.74 $513.50 $511.59 $580.24 $569.10 $645.47 32 $462.12 $524.14 $522.18 $592.26 $580.88 $658.83 33 $467.98 $530.78 $528.80 $599.77 $588.25 $667.19 34 $474.23 $537.87 $535.86 $607.78 $596.10 $676.10 35 $477.35 $586.09 $539.40 $662.27 $600.03 $736.72 36 $480.48 $589.93 $542.93 $666.60 $603.96 $741.54 37 $483.60 $593.77 $546.46 $670.94 $607.89 $746.36 38 $486.73 $597.61 $549.99 $675.28 $611.81 $751.19 39 $492.98 $605.28 $557.05 $683.95 $619.67 $760.83 40 $499.23 $643.70 $564.11 $727.37 $627.53 $809.13 41 $508.60 $655.80 $574.71 $741.03 $639.31 $824.33 42 $517.59 $667.38 $584.86 $754.12 $650.61 $838.89 43 $530.09 $683.50 $598.99 $772.33 $666.32 $859.15 44 $545.71 $703.64 $616.64 $795.10 $685.96 $884.47 45 $564.07 $743.79 $637.39 $840.46 $709.04 $934.94 46 $585.95 $772.63 $662.11 $873.05 $736.53 $971.19 47 $610.56 $805.08 $689.91 $909.72 $767.47 $1,011.98 48 $638.69 $842.17 $721.70 $951.63 $802.82 $1,058.60 49 $666.42 $878.74 $753.04 $992.95 $837.68 $1,104.57 50 $697.67 $922.46 $788.35 $1,042.35 $876.97 $1,159.53 51 $728.53 $963.26 $823.22 $1,088.46 $915.76 $1,210.81 52 $762.52 $1,008.20 $861.62 $1,139.23 $958.48 $1,267.30 53 $796.89 $1,053.65 $900.46 $1,190.60 $1,001.69 $1,324.43 54 $834.00 $1,102.72 $942.40 $1,246.04 $1,048.33 $1,386.11 55 $871.11 $1,139.59 $984.33 $1,287.70 $1,094.98 $1,432.46 56 $911.35 $1,192.22 $1,029.80 $1,347.18 $1,145.56 $1,498.62 57 $951.97 $1,245.37 $1,075.70 $1,407.23 $1,196.62 $1,565.42 58 $995.33 $1,302.09 $1,124.70 $1,471.33 $1,251.13 $1,636.72 59 $1,016.82 $1,330.20 $1,148.98 $1,503.09 $1,278.13 $1,672.05 60 $1,060.18 $1,362.12 $1,197.97 $1,539.15 $1,332.64 $1,712.17 61 $1,097.68 $1,410.30 $1,240.35 $1,593.60 $1,379.77 $1,772.73 62 $1,122.29 $1,441.92 $1,268.15 $1,629.32 $1,410.71 $1,812.48 63 $1,153.15 $1,481.57 $1,303.03 $1,674.13 $1,449.50 $1,862.32 64 $1,171.89 $1,505.66 $1,324.20 $1,701.35 $1,473.06 $1,892.60 65+ $1,171.89 $1,505.66 $1,324.20 $1,701.35 $1,473.06 $1,892.60 Rates Effective January 1, 2018 Page 20 of 44
Illinois Off Exchange (Silver) Quad Cities, IL Blue Choice Preferred Silver PPO SM 102 203 Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $289.18 $289.18 $321.69 $321.69 15 $314.89 $314.89 $350.29 $350.29 16 $324.72 $324.72 $361.22 $361.22 17 $334.55 $334.55 $372.15 $372.15 18 $345.13 $345.13 $383.93 $383.93 19 $355.72 $355.72 $395.70 $395.70 20 $366.68 $366.68 $407.90 $407.90 21 $378.02 $378.02 $420.51 $420.51 22 $378.02 $378.02 $420.51 $420.51 23 $378.02 $378.02 $420.51 $420.51 24 $378.02 $378.02 $420.51 $420.51 25 $379.53 $379.53 $422.19 $422.19 26 $387.09 $387.09 $430.60 $430.60 27 $396.16 $396.16 $440.70 $440.70 28 $410.91 $410.91 $457.10 $457.10 29 $423.00 $423.00 $470.55 $470.55 30 $429.05 $486.63 $477.28 $541.33 31 $438.12 $496.92 $487.37 $552.78 32 $447.20 $507.21 $497.47 $564.23 33 $452.87 $513.64 $503.77 $571.38 34 $458.91 $520.50 $510.50 $579.01 35 $461.94 $567.17 $513.87 $630.92 36 $464.96 $570.88 $517.23 $635.05 37 $467.99 $574.60 $520.59 $639.19 38 $471.01 $578.31 $523.96 $643.32 39 $477.06 $585.73 $530.69 $651.57 40 $483.11 $622.92 $537.41 $692.94 41 $492.18 $634.62 $547.51 $705.96 42 $500.87 $645.83 $557.18 $718.43 43 $512.97 $661.43 $570.63 $735.78 44 $528.09 $680.92 $587.46 $757.46 45 $545.86 $719.77 $607.22 $800.68 46 $567.03 $747.68 $630.77 $831.73 47 $590.84 $779.09 $657.26 $866.66 48 $618.06 $814.97 $687.54 $906.59 49 $644.90 $850.36 $717.39 $945.95 50 $675.14 $892.67 $751.03 $993.02 51 $705.00 $932.16 $784.25 $1,036.94 52 $737.89 $975.64 $820.84 $1,085.31 53 $771.16 $1,019.63 $857.84 $1,134.24 54 $807.07 $1,067.11 $897.79 $1,187.06 55 $842.98 $1,102.79 $937.74 $1,226.76 56 $881.92 $1,153.72 $981.05 $1,283.41 57 $921.23 $1,205.15 $1,024.79 $1,340.63 58 $963.19 $1,260.05 $1,071.46 $1,401.69 59 $983.98 $1,287.24 $1,094.59 $1,431.94 60 $1,025.94 $1,318.13 $1,141.27 $1,466.30 61 $1,062.23 $1,364.76 $1,181.64 $1,518.17 62 $1,086.05 $1,395.35 $1,208.13 $1,552.21 63 $1,115.91 $1,433.72 $1,241.35 $1,594.89 64 $1,134.06 $1,457.03 $1,261.53 $1,620.82 65+ $1,134.06 $1,457.03 $1,261.53 $1,620.82 Rates Effective January 1, 2018 Page 21 of 44
Illinois Off Exchange (Silver) Blue Precision Silver HMO SM 206 Peoria, IL Blue Choice Preferred Silver PPO SM 102 203 Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $310.68 $310.68 $335.66 $335.66 $373.39 $373.39 15 $338.29 $338.29 $365.49 $365.49 $406.58 $406.58 16 $348.85 $348.85 $376.90 $376.90 $419.27 $419.27 17 $359.41 $359.41 $388.31 $388.31 $431.96 $431.96 18 $370.78 $370.78 $400.59 $400.59 $445.62 $445.62 19 $382.15 $382.15 $412.88 $412.88 $459.29 $459.29 20 $393.93 $393.93 $425.60 $425.60 $473.44 $473.44 21 $406.12 $406.12 $438.77 $438.77 $488.09 $488.09 22 $406.12 $406.12 $438.77 $438.77 $488.09 $488.09 23 $406.12 $406.12 $438.77 $438.77 $488.09 $488.09 24 $406.12 $406.12 $438.77 $438.77 $488.09 $488.09 25 $407.74 $407.74 $440.52 $440.52 $490.04 $490.04 26 $415.86 $415.86 $449.30 $449.30 $499.80 $499.80 27 $425.61 $425.61 $459.83 $459.83 $511.52 $511.52 28 $441.45 $441.45 $476.94 $476.94 $530.55 $530.55 29 $454.44 $454.44 $490.98 $490.98 $546.17 $546.17 30 $460.94 $522.80 $498.00 $564.83 $553.98 $628.32 31 $470.69 $533.86 $508.53 $576.77 $565.69 $641.61 32 $480.43 $544.91 $519.06 $588.72 $577.41 $654.90 33 $486.53 $551.82 $525.64 $596.18 $584.73 $663.20 34 $493.02 $559.19 $532.66 $604.14 $592.54 $672.06 35 $496.27 $609.32 $536.17 $658.31 $596.44 $732.31 36 $499.52 $613.31 $539.68 $662.62 $600.35 $737.10 37 $502.77 $617.30 $543.19 $666.93 $604.25 $741.90 38 $506.02 $621.29 $546.70 $671.24 $608.16 $746.69 39 $512.52 $629.27 $553.72 $679.86 $615.97 $756.28 40 $519.02 $669.22 $560.74 $723.02 $623.77 $804.29 41 $528.76 $681.79 $571.27 $736.60 $635.49 $819.40 42 $538.10 $693.83 $581.36 $749.61 $646.72 $833.88 43 $551.10 $710.59 $595.40 $767.72 $662.33 $854.02 44 $567.34 $731.53 $612.95 $790.34 $681.86 $879.19 45 $586.43 $773.27 $633.58 $835.44 $704.80 $929.35 46 $609.17 $803.26 $658.15 $867.83 $732.13 $965.39 47 $634.76 $836.99 $685.79 $904.28 $762.88 $1,005.93 48 $664.00 $875.55 $717.38 $945.94 $798.02 $1,052.27 49 $692.83 $913.57 $748.53 $987.02 $832.68 $1,097.97 50 $725.32 $959.02 $783.63 $1,036.12 $871.72 $1,152.59 51 $757.41 $1,001.44 $818.30 $1,081.95 $910.28 $1,203.57 52 $792.74 $1,048.16 $856.47 $1,132.42 $952.75 $1,259.72 53 $828.48 $1,095.41 $895.08 $1,183.48 $995.70 $1,316.51 54 $867.06 $1,146.42 $936.76 $1,238.59 $1,042.07 $1,377.82 55 $905.64 $1,184.76 $978.45 $1,280.00 $1,088.43 $1,423.89 56 $947.47 $1,239.48 $1,023.64 $1,339.12 $1,138.71 $1,489.66 57 $989.70 $1,294.73 $1,069.27 $1,398.82 $1,189.47 $1,556.06 58 $1,034.78 $1,353.70 $1,117.97 $1,462.53 $1,243.65 $1,626.94 59 $1,057.12 $1,382.92 $1,142.11 $1,494.10 $1,270.49 $1,662.05 60 $1,102.20 $1,416.11 $1,190.81 $1,529.95 $1,324.67 $1,701.93 61 $1,141.19 $1,466.20 $1,232.93 $1,584.07 $1,371.52 $1,762.14 62 $1,166.77 $1,499.07 $1,260.57 $1,619.58 $1,402.27 $1,801.64 63 $1,198.85 $1,540.29 $1,295.23 $1,664.12 $1,440.83 $1,851.18 64 $1,218.36 $1,565.33 $1,316.31 $1,691.18 $1,464.27 $1,881.28 65+ $1,218.36 $1,565.33 $1,316.31 $1,691.18 $1,464.27 $1,881.28 Rates Effective January 1, 2018 Page 22 of 44
Illinois Off Exchange (Silver) Bloomington, IL Blue Precision Silver HMO SM Blue Choice Preferred Silver PPO SM 206 102 203 Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $292.97 $292.97 $299.61 $299.61 $333.29 $333.29 15 $319.01 $319.01 $326.24 $326.24 $362.91 $362.91 16 $328.97 $328.97 $336.42 $336.42 $374.24 $374.24 17 $338.93 $338.93 $346.61 $346.61 $385.57 $385.57 18 $349.65 $349.65 $357.57 $357.57 $397.77 $397.77 19 $360.38 $360.38 $368.54 $368.54 $409.97 $409.97 20 $371.48 $371.48 $379.90 $379.90 $422.60 $422.60 21 $382.97 $382.97 $391.64 $391.64 $435.67 $435.67 22 $382.97 $382.97 $391.64 $391.64 $435.67 $435.67 23 $382.97 $382.97 $391.64 $391.64 $435.67 $435.67 24 $382.97 $382.97 $391.64 $391.64 $435.67 $435.67 25 $384.50 $384.50 $393.21 $393.21 $437.41 $437.41 26 $392.16 $392.16 $401.04 $401.04 $446.13 $446.13 27 $401.35 $401.35 $410.44 $410.44 $456.58 $456.58 28 $416.29 $416.29 $425.72 $425.72 $473.57 $473.57 29 $428.54 $428.54 $438.25 $438.25 $487.51 $487.51 30 $434.67 $493.01 $444.52 $504.17 $494.49 $560.85 31 $443.86 $503.43 $453.92 $514.83 $504.94 $572.71 32 $453.05 $513.85 $463.32 $525.49 $515.40 $584.56 33 $458.80 $520.37 $469.19 $532.16 $521.93 $591.97 34 $464.93 $527.32 $475.46 $539.26 $528.90 $599.88 35 $467.99 $574.60 $478.59 $587.61 $532.39 $653.67 36 $471.05 $578.36 $481.72 $591.46 $535.87 $657.94 37 $474.12 $582.12 $484.86 $595.31 $539.36 $662.23 38 $477.18 $585.88 $487.99 $599.15 $542.84 $666.50 39 $483.31 $593.41 $494.26 $606.85 $549.82 $675.06 40 $489.44 $631.08 $500.52 $645.37 $556.79 $717.92 41 $498.63 $642.93 $509.92 $657.49 $567.24 $731.40 42 $507.44 $654.29 $518.93 $669.11 $577.26 $744.32 43 $519.69 $670.09 $531.46 $685.27 $591.20 $762.30 44 $535.01 $689.84 $547.13 $705.47 $608.63 $784.77 45 $553.01 $729.20 $565.53 $745.71 $629.11 $829.54 46 $574.46 $757.48 $587.47 $774.63 $653.50 $861.71 47 $598.58 $789.29 $612.14 $807.17 $680.95 $897.90 48 $626.16 $825.65 $640.34 $844.35 $712.32 $939.26 49 $653.35 $861.50 $668.15 $881.02 $743.25 $980.05 50 $683.99 $904.37 $699.48 $924.85 $778.11 $1,028.81 51 $714.24 $944.37 $730.42 $965.76 $812.52 $1,074.32 52 $747.56 $988.42 $764.49 $1,010.81 $850.43 $1,124.43 53 $781.26 $1,032.98 $798.96 $1,056.38 $888.77 $1,175.13 54 $817.64 $1,081.09 $836.16 $1,105.57 $930.15 $1,229.85 55 $854.02 $1,117.24 $873.37 $1,142.54 $971.54 $1,270.97 56 $893.47 $1,168.84 $913.71 $1,195.31 $1,016.42 $1,329.68 57 $933.30 $1,220.94 $954.44 $1,248.59 $1,061.73 $1,388.95 58 $975.81 $1,276.55 $997.91 $1,305.47 $1,110.09 $1,452.21 59 $996.87 $1,304.11 $1,019.45 $1,333.64 $1,134.05 $1,483.56 60 $1,039.38 $1,335.40 $1,062.92 $1,365.65 $1,182.41 $1,519.16 61 $1,076.15 $1,382.63 $1,100.52 $1,413.95 $1,224.23 $1,572.89 62 $1,100.27 $1,413.63 $1,125.20 $1,445.65 $1,251.68 $1,608.16 63 $1,130.53 $1,452.50 $1,156.14 $1,485.40 $1,286.10 $1,652.38 64 $1,148.91 $1,476.12 $1,174.92 $1,509.56 $1,307.01 $1,679.25 65+ $1,148.91 $1,476.12 $1,174.92 $1,509.56 $1,307.01 $1,679.25 Rates Effective January 1, 2018 Page 23 of 44
Illinois Off Exchange (Silver) Champaign, IL Blue Choice Preferred Silver PPO SM 102 203 Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $314.57 $314.57 $349.93 $349.93 15 $342.53 $342.53 $381.03 $381.03 16 $353.22 $353.22 $392.92 $392.92 17 $363.91 $363.91 $404.82 $404.82 18 $375.42 $375.42 $417.62 $417.62 19 $386.94 $386.94 $430.43 $430.43 20 $398.86 $398.86 $443.70 $443.70 21 $411.20 $411.20 $457.42 $457.42 22 $411.20 $411.20 $457.42 $457.42 23 $411.20 $411.20 $457.42 $457.42 24 $411.20 $411.20 $457.42 $457.42 25 $412.84 $412.84 $459.25 $459.25 26 $421.06 $421.06 $468.40 $468.40 27 $430.93 $430.93 $479.38 $479.38 28 $446.97 $446.97 $497.21 $497.21 29 $460.13 $460.13 $511.85 $511.85 30 $466.71 $529.34 $519.17 $588.84 31 $476.58 $540.53 $530.15 $601.30 32 $486.45 $551.73 $541.13 $613.75 33 $492.61 $558.72 $547.99 $621.53 34 $499.19 $566.18 $555.31 $629.83 35 $502.48 $616.95 $558.97 $686.30 36 $505.77 $620.98 $562.63 $690.79 37 $509.06 $625.03 $566.28 $695.29 38 $512.35 $629.06 $569.94 $699.78 39 $518.93 $637.14 $577.26 $708.76 40 $525.51 $677.59 $584.58 $753.76 41 $535.38 $690.32 $595.56 $767.91 42 $544.83 $702.51 $606.08 $781.48 43 $557.99 $719.48 $620.72 $800.36 44 $574.44 $740.68 $639.01 $823.94 45 $593.77 $782.94 $660.51 $870.95 46 $616.79 $813.31 $686.13 $904.73 47 $642.70 $847.46 $714.95 $942.73 48 $672.31 $886.50 $747.88 $986.15 49 $701.50 $925.00 $780.36 $1,028.98 50 $734.40 $971.02 $816.95 $1,080.17 51 $766.88 $1,013.97 $853.09 $1,127.95 52 $802.66 $1,061.27 $892.88 $1,180.57 53 $838.84 $1,109.12 $933.13 $1,233.79 54 $877.90 $1,160.77 $976.59 $1,291.25 55 $916.97 $1,199.58 $1,020.04 $1,334.42 56 $959.32 $1,254.98 $1,067.16 $1,396.06 57 $1,002.09 $1,310.93 $1,114.73 $1,458.29 58 $1,047.73 $1,370.64 $1,165.50 $1,524.71 59 $1,070.34 $1,400.22 $1,190.66 $1,557.62 60 $1,115.99 $1,433.82 $1,241.44 $1,595.00 61 $1,155.46 $1,484.54 $1,285.35 $1,651.42 62 $1,181.37 $1,517.82 $1,314.16 $1,688.44 63 $1,213.85 $1,559.56 $1,350.30 $1,734.87 64 $1,233.60 $1,584.91 $1,372.26 $1,763.08 65+ $1,233.60 $1,584.91 $1,372.26 $1,763.08 Rates Effective January 1, 2018 Page 24 of 44
Illinois Off Exchange (Silver) Springfield, IL Blue Choice Preferred Silver PPO SM 102 203 Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $323.13 $323.13 $359.46 $359.46 15 $351.86 $351.86 $391.41 $391.41 16 $362.84 $362.84 $403.63 $403.63 17 $373.82 $373.82 $415.84 $415.84 18 $385.65 $385.65 $429.00 $429.00 19 $397.48 $397.48 $442.16 $442.16 20 $409.73 $409.73 $455.78 $455.78 21 $422.40 $422.40 $469.88 $469.88 22 $422.40 $422.40 $469.88 $469.88 23 $422.40 $422.40 $469.88 $469.88 24 $422.40 $422.40 $469.88 $469.88 25 $424.09 $424.09 $471.76 $471.76 26 $432.54 $432.54 $481.16 $481.16 27 $442.67 $442.67 $492.43 $492.43 28 $459.15 $459.15 $510.76 $510.76 29 $472.66 $472.66 $525.80 $525.80 30 $479.42 $543.76 $533.31 $604.89 31 $489.56 $555.26 $544.59 $617.68 32 $499.70 $566.76 $555.87 $630.47 33 $506.03 $573.94 $562.92 $638.46 34 $512.79 $581.61 $570.43 $646.99 35 $516.17 $633.75 $574.19 $704.99 36 $519.55 $637.90 $577.95 $709.61 37 $522.93 $642.05 $581.71 $714.23 38 $526.31 $646.20 $585.47 $718.84 39 $533.07 $654.50 $592.99 $728.07 40 $539.82 $696.05 $600.51 $774.29 41 $549.96 $709.12 $611.78 $788.83 42 $559.68 $721.65 $622.59 $802.77 43 $573.19 $739.08 $637.63 $822.16 44 $590.09 $760.86 $656.42 $846.39 45 $609.94 $804.27 $678.51 $894.68 46 $633.60 $835.46 $704.82 $929.37 47 $660.21 $870.55 $734.42 $968.41 48 $690.62 $910.65 $768.25 $1,013.02 49 $720.61 $950.20 $801.61 $1,057.01 50 $754.40 $997.47 $839.20 $1,109.60 51 $787.77 $1,041.59 $876.33 $1,158.68 52 $824.52 $1,090.18 $917.20 $1,212.73 53 $861.69 $1,139.33 $958.55 $1,267.40 54 $901.82 $1,192.39 $1,003.19 $1,326.42 55 $941.95 $1,232.26 $1,047.83 $1,370.77 56 $985.45 $1,289.17 $1,096.23 $1,434.09 57 $1,029.38 $1,346.64 $1,145.10 $1,498.01 58 $1,076.27 $1,407.97 $1,197.25 $1,566.24 59 $1,099.50 $1,438.37 $1,223.10 $1,600.05 60 $1,146.39 $1,472.88 $1,275.25 $1,638.45 61 $1,186.94 $1,524.98 $1,320.36 $1,696.40 62 $1,213.55 $1,559.17 $1,349.96 $1,734.43 63 $1,246.92 $1,602.04 $1,387.08 $1,782.13 64 $1,267.20 $1,628.09 $1,409.64 $1,811.10 65+ $1,267.20 $1,628.09 $1,409.64 $1,811.10 Rates Effective January 1, 2018 Page 25 of 44
Illinois Off Exchange (Silver) East St. Louis, IL Blue Choice Preferred Silver PPO SM 102 203 Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $300.11 $300.11 $333.85 $333.85 15 $326.79 $326.79 $363.52 $363.52 16 $336.99 $336.99 $374.87 $374.87 17 $347.19 $347.19 $386.22 $386.22 18 $358.17 $358.17 $398.44 $398.44 19 $369.16 $369.16 $410.66 $410.66 20 $380.53 $380.53 $423.31 $423.31 21 $392.30 $392.30 $436.40 $436.40 22 $392.30 $392.30 $436.40 $436.40 23 $392.30 $392.30 $436.40 $436.40 24 $392.30 $392.30 $436.40 $436.40 25 $393.87 $393.87 $438.15 $438.15 26 $401.72 $401.72 $446.88 $446.88 27 $411.13 $411.13 $457.35 $457.35 28 $426.43 $426.43 $474.37 $474.37 29 $438.99 $438.99 $488.34 $488.34 30 $445.27 $505.02 $495.32 $561.79 31 $454.68 $515.70 $505.79 $573.67 32 $464.10 $526.38 $516.26 $585.55 33 $469.98 $533.05 $522.81 $592.97 34 $476.26 $540.17 $529.79 $600.89 35 $479.40 $588.60 $533.28 $654.77 36 $482.53 $592.45 $536.78 $659.05 37 $485.67 $596.31 $540.27 $663.34 38 $488.81 $600.16 $543.76 $667.63 39 $495.09 $607.87 $550.74 $676.20 40 $501.36 $646.46 $557.72 $719.13 41 $510.78 $658.60 $568.20 $732.63 42 $519.80 $670.24 $578.23 $745.58 43 $532.36 $686.42 $592.20 $763.58 44 $548.05 $706.65 $609.66 $786.09 45 $566.49 $746.97 $630.17 $830.94 46 $588.46 $775.94 $654.60 $863.16 47 $613.17 $808.53 $682.10 $899.41 48 $641.42 $845.77 $713.52 $940.85 49 $669.27 $882.50 $744.50 $981.70 50 $700.66 $926.41 $779.42 $1,030.54 51 $731.65 $967.38 $813.89 $1,076.13 52 $765.78 $1,012.51 $851.86 $1,126.33 53 $800.30 $1,058.16 $890.26 $1,177.11 54 $837.57 $1,107.44 $931.72 $1,231.92 55 $874.84 $1,144.46 $973.18 $1,273.11 56 $915.25 $1,197.32 $1,018.13 $1,331.92 57 $956.04 $1,250.70 $1,063.51 $1,391.29 58 $999.59 $1,307.66 $1,111.96 $1,454.66 59 $1,021.17 $1,335.89 $1,135.96 $1,486.06 60 $1,064.71 $1,367.94 $1,184.40 $1,521.72 61 $1,102.37 $1,416.33 $1,226.29 $1,575.54 62 $1,127.09 $1,448.08 $1,253.79 $1,610.86 63 $1,158.08 $1,487.90 $1,288.26 $1,655.16 64 $1,176.90 $1,512.10 $1,309.20 $1,682.07 65+ $1,176.90 $1,512.10 $1,309.20 $1,682.07 Rates Effective January 1, 2018 Page 26 of 44
Illinois Off Exchange (Silver) St. Louis, IL Blue Choice Preferred Silver PPO SM 102 203 Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $291.45 $291.45 $324.22 $324.22 15 $317.36 $317.36 $353.04 $353.04 16 $327.27 $327.27 $364.06 $364.06 17 $337.17 $337.17 $375.08 $375.08 18 $347.84 $347.84 $386.94 $386.94 19 $358.51 $358.51 $398.81 $398.81 20 $369.56 $369.56 $411.10 $411.10 21 $380.99 $380.99 $423.81 $423.81 22 $380.99 $380.99 $423.81 $423.81 23 $380.99 $380.99 $423.81 $423.81 24 $380.99 $380.99 $423.81 $423.81 25 $382.51 $382.51 $425.51 $425.51 26 $390.13 $390.13 $433.99 $433.99 27 $399.27 $399.27 $444.16 $444.16 28 $414.13 $414.13 $460.69 $460.69 29 $426.32 $426.32 $474.25 $474.25 30 $432.42 $490.45 $481.03 $545.58 31 $441.56 $500.82 $491.20 $557.12 32 $450.71 $511.19 $501.37 $568.66 33 $456.42 $517.67 $507.73 $575.87 34 $462.52 $524.59 $514.51 $583.56 35 $465.57 $571.62 $517.90 $635.88 36 $468.61 $575.36 $521.29 $640.04 37 $471.66 $579.11 $524.68 $644.21 38 $474.71 $582.85 $528.07 $648.37 39 $480.81 $590.33 $534.85 $656.69 40 $486.90 $627.81 $541.63 $698.38 41 $496.04 $639.60 $551.81 $711.50 42 $504.81 $650.90 $561.55 $724.07 43 $517.00 $666.62 $575.12 $741.56 44 $532.24 $686.27 $592.07 $763.41 45 $550.15 $725.42 $611.99 $806.97 46 $571.48 $753.55 $635.72 $838.26 47 $595.48 $785.20 $662.42 $873.47 48 $622.91 $821.37 $692.94 $913.70 49 $649.96 $857.04 $723.03 $953.38 50 $680.44 $899.68 $756.93 $1,000.82 51 $710.54 $939.48 $790.41 $1,045.08 52 $743.69 $983.30 $827.28 $1,093.83 53 $777.21 $1,027.63 $864.58 $1,143.15 54 $813.41 $1,075.49 $904.84 $1,196.38 55 $849.60 $1,111.45 $945.10 $1,236.39 56 $888.84 $1,162.78 $988.76 $1,293.49 57 $928.46 $1,214.62 $1,032.83 $1,351.15 58 $970.75 $1,269.94 $1,079.88 $1,412.69 59 $991.71 $1,297.35 $1,103.19 $1,443.19 60 $1,034.00 $1,328.48 $1,150.23 $1,477.82 61 $1,070.57 $1,375.47 $1,190.92 $1,530.09 62 $1,094.58 $1,406.31 $1,217.62 $1,564.39 63 $1,124.67 $1,444.98 $1,251.10 $1,607.41 64 $1,142.97 $1,468.48 $1,271.43 $1,633.55 65+ $1,142.97 $1,468.48 $1,271.43 $1,633.55 Rates Effective January 1, 2018 Page 27 of 44
Illinois Off Exchange (Silver) Southern, IL Blue Choice Preferred Silver PPO SM 102 203 Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $358.25 $358.25 $398.52 $398.52 15 $390.09 $390.09 $433.94 $433.94 16 $402.27 $402.27 $447.49 $447.49 17 $414.45 $414.45 $461.03 $461.03 18 $427.56 $427.56 $475.62 $475.62 19 $440.67 $440.67 $490.21 $490.21 20 $454.25 $454.25 $505.31 $505.31 21 $468.30 $468.30 $520.94 $520.94 22 $468.30 $468.30 $520.94 $520.94 23 $468.30 $468.30 $520.94 $520.94 24 $468.30 $468.30 $520.94 $520.94 25 $470.17 $470.17 $523.03 $523.03 26 $479.54 $479.54 $533.44 $533.44 27 $490.78 $490.78 $545.95 $545.95 28 $509.04 $509.04 $566.26 $566.26 29 $524.03 $524.03 $582.93 $582.93 30 $531.52 $602.85 $591.27 $670.62 31 $542.76 $615.60 $603.77 $684.80 32 $554.00 $628.35 $616.27 $698.98 33 $561.02 $636.31 $624.09 $707.84 34 $568.52 $644.81 $632.42 $717.30 35 $572.26 $702.62 $636.59 $781.61 36 $576.01 $707.22 $640.76 $786.72 37 $579.76 $711.83 $644.93 $791.84 38 $583.50 $716.42 $649.09 $796.96 39 $591.00 $725.62 $657.43 $807.19 40 $598.49 $771.69 $665.76 $858.43 41 $609.73 $786.18 $678.27 $874.56 42 $620.50 $800.07 $690.25 $890.01 43 $635.48 $819.39 $706.92 $911.50 44 $654.22 $843.54 $727.76 $938.37 45 $676.23 $891.67 $752.24 $991.91 46 $702.45 $926.25 $781.41 $1,030.37 47 $731.95 $965.15 $814.23 $1,073.65 48 $765.67 $1,009.61 $851.74 $1,123.10 49 $798.92 $1,053.46 $888.73 $1,171.88 50 $836.38 $1,105.87 $930.40 $1,230.18 51 $873.38 $1,154.78 $971.56 $1,284.59 52 $914.12 $1,208.65 $1,016.88 $1,344.52 53 $955.33 $1,263.14 $1,062.72 $1,405.13 54 $999.82 $1,321.97 $1,112.21 $1,470.57 55 $1,044.31 $1,366.17 $1,161.70 $1,519.74 56 $1,092.55 $1,429.27 $1,215.36 $1,589.93 57 $1,141.25 $1,492.98 $1,269.54 $1,660.81 58 $1,193.23 $1,560.98 $1,327.36 $1,736.45 59 $1,218.99 $1,594.68 $1,356.01 $1,773.93 60 $1,270.97 $1,632.94 $1,413.84 $1,816.50 61 $1,315.92 $1,690.70 $1,463.85 $1,880.75 62 $1,345.43 $1,728.60 $1,496.67 $1,922.92 63 $1,382.42 $1,776.14 $1,537.82 $1,975.79 64 $1,404.90 $1,805.02 $1,562.82 $2,007.92 65+ $1,404.90 $1,805.02 $1,562.82 $2,007.92 Rates Effective January 1, 2018 Page 28 of 44
Illinois Off Exchange (Bronze) Chicago - Central, IL Blue Precision Bronze HMO SM Blue Choice Preferred Bronze PPO SM Blue FocusCare Bronze SM 205 202 201 209 Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $237.46 $237.46 $270.00 $270.00 $245.53 $245.53 $200.60 $200.60 15 $258.56 $258.56 $294.00 $294.00 $267.35 $267.35 $218.43 $218.43 16 $266.63 $266.63 $303.18 $303.18 $275.70 $275.70 $225.25 $225.25 17 $274.71 $274.71 $312.36 $312.36 $284.04 $284.04 $232.07 $232.07 18 $283.40 $283.40 $322.24 $322.24 $293.03 $293.03 $239.41 $239.41 19 $292.09 $292.09 $332.12 $332.12 $302.02 $302.02 $246.75 $246.75 20 $301.09 $301.09 $342.36 $342.36 $311.32 $311.32 $254.36 $254.36 21 $310.40 $310.40 $352.94 $352.94 $320.95 $320.95 $262.22 $262.22 22 $310.40 $310.40 $352.94 $352.94 $320.95 $320.95 $262.22 $262.22 23 $310.40 $310.40 $352.94 $352.94 $320.95 $320.95 $262.22 $262.22 24 $310.40 $310.40 $352.94 $352.94 $320.95 $320.95 $262.22 $262.22 25 $311.64 $311.64 $354.36 $354.36 $322.24 $322.24 $263.27 $263.27 26 $317.85 $317.85 $361.41 $361.41 $328.66 $328.66 $268.52 $268.52 27 $325.30 $325.30 $369.88 $369.88 $336.36 $336.36 $274.81 $274.81 28 $337.41 $337.41 $383.65 $383.65 $348.88 $348.88 $285.04 $285.04 29 $347.34 $347.34 $394.94 $394.94 $359.15 $359.15 $293.43 $293.43 30 $352.31 $399.59 $400.59 $454.35 $364.28 $413.17 $297.62 $337.57 31 $359.76 $408.03 $409.06 $463.96 $371.98 $421.91 $303.92 $344.70 32 $367.20 $416.48 $417.53 $473.57 $379.69 $430.64 $310.21 $351.84 33 $371.86 $421.76 $422.83 $479.57 $384.50 $436.10 $314.14 $356.30 34 $376.83 $427.40 $428.47 $485.98 $389.64 $441.93 $318.34 $361.06 35 $379.31 $465.72 $431.30 $529.55 $392.20 $481.55 $320.44 $393.43 36 $381.79 $468.76 $434.12 $533.01 $394.77 $484.70 $322.53 $396.01 37 $384.28 $471.82 $436.94 $536.48 $397.34 $487.86 $324.63 $398.58 38 $386.76 $474.86 $439.77 $539.95 $399.91 $491.01 $326.73 $401.16 39 $391.73 $480.96 $445.41 $546.88 $405.04 $497.31 $330.93 $406.31 40 $396.69 $511.49 $451.06 $581.60 $410.18 $528.88 $335.12 $432.10 41 $404.14 $521.10 $459.53 $592.52 $417.88 $538.82 $341.41 $440.22 42 $411.28 $530.31 $467.65 $602.99 $425.26 $548.34 $347.45 $448.00 43 $421.21 $543.12 $478.94 $617.55 $435.53 $561.58 $355.84 $458.82 44 $433.63 $559.12 $493.06 $635.75 $448.37 $578.13 $366.33 $472.34 45 $448.22 $591.02 $509.65 $672.03 $463.46 $611.11 $378.65 $499.29 46 $465.60 $613.94 $529.42 $698.09 $481.43 $634.81 $393.33 $518.65 47 $485.16 $639.73 $551.65 $727.41 $501.65 $661.48 $409.85 $540.43 48 $507.51 $669.20 $577.06 $760.91 $524.76 $691.95 $428.74 $565.33 49 $529.54 $698.26 $602.12 $793.96 $547.55 $721.99 $447.35 $589.88 50 $554.38 $733.00 $630.36 $833.46 $573.22 $757.92 $468.33 $619.23 51 $578.90 $765.42 $658.24 $870.32 $598.58 $791.44 $489.05 $646.62 52 $605.90 $801.12 $688.95 $910.92 $626.50 $828.36 $511.86 $676.78 53 $633.22 $837.24 $720.00 $951.99 $654.74 $865.70 $534.94 $707.29 54 $662.71 $876.23 $753.53 $996.32 $685.24 $906.02 $559.85 $740.23 55 $692.19 $905.53 $787.06 $1,029.64 $715.73 $936.31 $584.76 $764.98 56 $724.17 $947.35 $823.42 $1,077.19 $748.78 $979.56 $611.77 $800.31 57 $756.45 $989.58 $860.12 $1,125.21 $782.16 $1,023.22 $639.04 $835.99 58 $790.90 $1,034.66 $899.30 $1,176.46 $817.79 $1,069.83 $668.14 $874.07 59 $807.97 $1,056.99 $918.71 $1,201.86 $835.44 $1,092.92 $682.57 $892.93 60 $842.43 $1,082.35 $957.89 $1,230.70 $871.07 $1,119.15 $711.67 $914.36 61 $872.23 $1,120.64 $991.77 $1,274.23 $901.88 $1,158.73 $736.85 $946.70 62 $891.78 $1,145.76 $1,014.01 $1,302.80 $922.10 $1,184.71 $753.37 $967.93 63 $916.30 $1,177.27 $1,041.89 $1,338.62 $947.45 $1,217.29 $774.08 $994.54 64 $931.20 $1,196.41 $1,058.82 $1,360.39 $962.85 $1,237.08 $786.66 $1,010.71 65+ $931.20 $1,196.41 $1,058.82 $1,360.39 $962.85 $1,237.08 $786.66 $1,010.71 Rates Effective January 1, 2018 Page 29 of 44
Illinois Off Exchange (Bronze) Chicago - North, IL Blue Precision Bronze HMO SM Blue Choice Preferred Bronze PPO SM 205 202 201 Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $224.99 $224.99 $271.54 $271.54 $246.93 $246.93 15 $244.99 $244.99 $295.68 $295.68 $268.88 $268.88 16 $252.64 $252.64 $304.91 $304.91 $277.27 $277.27 17 $260.28 $260.28 $314.13 $314.13 $285.66 $285.66 18 $268.52 $268.52 $324.07 $324.07 $294.70 $294.70 19 $276.75 $276.75 $334.01 $334.01 $303.74 $303.74 20 $285.28 $285.28 $344.31 $344.31 $313.10 $313.10 21 $294.11 $294.11 $354.95 $354.95 $322.78 $322.78 22 $294.11 $294.11 $354.95 $354.95 $322.78 $322.78 23 $294.11 $294.11 $354.95 $354.95 $322.78 $322.78 24 $294.11 $294.11 $354.95 $354.95 $322.78 $322.78 25 $295.28 $295.28 $356.37 $356.37 $324.07 $324.07 26 $301.16 $301.16 $363.47 $363.47 $330.53 $330.53 27 $308.22 $308.22 $371.99 $371.99 $338.28 $338.28 28 $319.69 $319.69 $385.84 $385.84 $350.86 $350.86 29 $329.10 $329.10 $397.19 $397.19 $361.19 $361.19 30 $333.81 $378.61 $402.87 $456.94 $366.36 $415.52 31 $340.87 $386.61 $411.39 $466.60 $374.10 $424.31 32 $347.93 $394.62 $419.91 $476.26 $381.85 $433.10 33 $352.34 $399.62 $425.24 $482.30 $386.69 $438.59 34 $357.04 $404.96 $430.91 $488.74 $391.86 $444.44 35 $359.40 $441.27 $433.75 $532.56 $394.44 $484.29 36 $361.75 $444.15 $436.59 $536.05 $397.02 $487.46 37 $364.10 $447.05 $439.43 $539.54 $399.60 $490.63 38 $366.45 $449.93 $442.27 $543.02 $402.19 $493.80 39 $371.16 $455.71 $447.95 $549.99 $407.35 $500.14 40 $375.87 $484.64 $453.63 $584.91 $412.52 $531.90 41 $382.92 $493.74 $462.15 $595.90 $420.26 $541.89 42 $389.69 $502.47 $470.31 $606.42 $427.69 $551.46 43 $399.10 $514.60 $481.67 $621.07 $438.01 $564.78 44 $410.86 $529.77 $495.87 $639.38 $450.93 $581.42 45 $424.69 $559.99 $512.55 $675.85 $466.10 $614.60 46 $441.16 $581.71 $532.43 $702.06 $484.17 $638.43 47 $459.69 $606.14 $554.79 $731.55 $504.51 $665.24 48 $480.86 $634.06 $580.35 $765.25 $527.75 $695.89 49 $501.74 $661.60 $605.55 $798.48 $550.67 $726.11 50 $525.27 $694.51 $633.95 $838.21 $576.49 $762.23 51 $548.51 $725.23 $661.99 $875.28 $601.99 $795.95 52 $574.09 $759.06 $692.87 $916.11 $630.07 $833.08 53 $599.97 $793.29 $724.11 $957.41 $658.47 $870.64 54 $627.91 $830.23 $757.83 $1,002.00 $689.14 $911.18 55 $655.85 $857.99 $791.55 $1,035.50 $719.80 $941.65 56 $686.15 $897.62 $828.11 $1,083.33 $753.05 $985.14 57 $716.73 $937.63 $865.02 $1,131.62 $786.62 $1,029.05 58 $749.38 $980.34 $904.42 $1,183.17 $822.45 $1,075.93 59 $765.56 $1,001.50 $923.95 $1,208.70 $840.20 $1,099.15 60 $798.20 $1,025.53 $963.35 $1,237.71 $876.03 $1,125.52 61 $826.44 $1,061.80 $997.42 $1,281.49 $907.02 $1,165.34 62 $844.96 $1,085.61 $1,019.78 $1,310.22 $927.35 $1,191.46 63 $868.20 $1,115.46 $1,047.82 $1,346.25 $952.85 $1,224.22 64 $882.33 $1,133.60 $1,064.85 $1,368.14 $968.34 $1,244.13 65+ $882.33 $1,133.60 $1,064.85 $1,368.14 $968.34 $1,244.13 Rates Effective January 1, 2018 Page 30 of 44
Illinois Off Exchange (Bronze) Chicago - West, IL Blue Precision Bronze HMO SM Blue Choice Preferred Bronze PPO SM 205 202 201 Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $233.23 $233.23 $265.71 $265.71 $241.63 $241.63 15 $253.96 $253.96 $289.33 $289.33 $263.11 $263.11 16 $261.89 $261.89 $298.36 $298.36 $271.32 $271.32 17 $269.81 $269.81 $307.39 $307.39 $279.53 $279.53 18 $278.35 $278.35 $317.12 $317.12 $288.37 $288.37 19 $286.89 $286.89 $326.84 $326.84 $297.22 $297.22 20 $295.73 $295.73 $336.91 $336.91 $306.38 $306.38 21 $304.87 $304.87 $347.33 $347.33 $315.85 $315.85 22 $304.87 $304.87 $347.33 $347.33 $315.85 $315.85 23 $304.87 $304.87 $347.33 $347.33 $315.85 $315.85 24 $304.87 $304.87 $347.33 $347.33 $315.85 $315.85 25 $306.09 $306.09 $348.72 $348.72 $317.12 $317.12 26 $312.19 $312.19 $355.67 $355.67 $323.43 $323.43 27 $319.51 $319.51 $364.01 $364.01 $331.01 $331.01 28 $331.40 $331.40 $377.55 $377.55 $343.33 $343.33 29 $341.15 $341.15 $388.67 $388.67 $353.44 $353.44 30 $346.03 $392.47 $394.22 $447.13 $358.49 $406.60 31 $353.35 $400.77 $402.56 $456.59 $366.07 $415.20 32 $360.67 $409.07 $410.90 $466.04 $373.65 $423.80 33 $365.24 $414.25 $416.11 $471.95 $378.39 $429.17 34 $370.12 $419.79 $421.66 $478.25 $383.45 $434.90 35 $372.56 $457.43 $424.44 $521.13 $385.97 $473.90 36 $375.00 $460.42 $427.22 $524.54 $388.50 $477.00 37 $377.44 $463.42 $430.00 $527.96 $391.03 $480.10 38 $379.87 $466.41 $432.78 $531.37 $393.55 $483.20 39 $384.75 $472.40 $438.34 $538.19 $398.61 $489.41 40 $389.63 $502.39 $443.89 $572.36 $403.66 $520.48 41 $396.95 $511.82 $452.23 $583.11 $411.24 $530.25 42 $403.96 $520.87 $460.22 $593.41 $418.50 $539.62 43 $413.72 $533.45 $471.33 $607.74 $428.61 $552.65 44 $425.91 $549.17 $485.23 $625.65 $441.25 $568.94 45 $440.24 $580.50 $501.55 $661.35 $456.09 $601.40 46 $457.31 $603.01 $521.00 $686.99 $473.78 $624.73 47 $476.52 $628.34 $542.88 $715.85 $493.68 $650.96 48 $498.47 $657.28 $567.89 $748.82 $516.42 $680.95 49 $520.12 $685.83 $592.55 $781.34 $538.84 $710.52 50 $544.51 $719.95 $620.34 $820.21 $564.11 $745.87 51 $568.59 $751.79 $647.78 $856.49 $589.07 $778.86 52 $595.12 $786.86 $678.00 $896.45 $616.54 $815.19 53 $621.94 $822.34 $708.56 $936.86 $644.34 $851.95 54 $650.91 $860.63 $741.56 $980.49 $674.35 $891.62 55 $679.87 $889.41 $774.56 $1,013.28 $704.35 $921.43 56 $711.27 $930.49 $810.33 $1,060.08 $736.88 $963.99 57 $742.98 $971.97 $846.45 $1,107.33 $769.73 $1,006.96 58 $776.82 $1,016.24 $885.01 $1,157.77 $804.79 $1,052.83 59 $793.59 $1,038.17 $904.11 $1,182.76 $822.16 $1,075.55 60 $827.43 $1,063.08 $942.67 $1,211.14 $857.22 $1,101.36 61 $856.70 $1,100.69 $976.01 $1,253.98 $887.55 $1,140.32 62 $875.91 $1,125.36 $997.89 $1,282.09 $907.44 $1,165.89 63 $899.99 $1,156.31 $1,025.33 $1,317.35 $932.40 $1,197.94 64 $914.61 $1,175.11 $1,041.99 $1,338.77 $947.55 $1,217.42 65+ $914.61 $1,175.11 $1,041.99 $1,338.77 $947.55 $1,217.42 Rates Effective January 1, 2018 Page 31 of 44
Illinois Off Exchange (Bronze) Chicago - South, IL Blue Precision Bronze HMO SM Blue Choice Preferred Bronze PPO SM 205 202 201 Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $227.04 $227.04 $265.67 $265.67 $241.59 $241.59 15 $247.22 $247.22 $289.28 $289.28 $263.06 $263.06 16 $254.93 $254.93 $298.31 $298.31 $271.27 $271.27 17 $262.65 $262.65 $307.34 $307.34 $279.48 $279.48 18 $270.96 $270.96 $317.06 $317.06 $288.33 $288.33 19 $279.27 $279.27 $326.79 $326.79 $297.17 $297.17 20 $287.88 $287.88 $336.86 $336.86 $306.33 $306.33 21 $296.78 $296.78 $347.28 $347.28 $315.80 $315.80 22 $296.78 $296.78 $347.28 $347.28 $315.80 $315.80 23 $296.78 $296.78 $347.28 $347.28 $315.80 $315.80 24 $296.78 $296.78 $347.28 $347.28 $315.80 $315.80 25 $297.97 $297.97 $348.67 $348.67 $317.06 $317.06 26 $303.90 $303.90 $355.61 $355.61 $323.38 $323.38 27 $311.02 $311.02 $363.95 $363.95 $330.96 $330.96 28 $322.60 $322.60 $377.49 $377.49 $343.27 $343.27 29 $332.10 $332.10 $388.60 $388.60 $353.38 $353.38 30 $336.84 $382.05 $394.16 $447.06 $358.43 $406.54 31 $343.97 $390.13 $402.49 $456.51 $366.01 $415.13 32 $351.09 $398.21 $410.83 $465.96 $373.59 $423.73 33 $355.54 $403.25 $416.04 $471.87 $378.33 $429.10 34 $360.29 $408.64 $421.59 $478.17 $383.38 $434.83 35 $362.66 $445.28 $424.37 $521.04 $385.91 $473.82 36 $365.04 $448.19 $427.15 $524.45 $388.43 $476.92 37 $367.41 $451.11 $429.93 $527.87 $390.96 $480.02 38 $369.79 $454.02 $432.71 $531.28 $393.49 $483.12 39 $374.54 $459.85 $438.26 $538.10 $398.54 $489.33 40 $379.28 $489.05 $443.82 $572.26 $403.59 $520.39 41 $386.41 $498.23 $452.15 $583.01 $411.17 $530.17 42 $393.23 $507.04 $460.14 $593.31 $418.44 $539.53 43 $402.73 $519.28 $471.25 $607.64 $428.54 $552.56 44 $414.60 $534.59 $485.15 $625.55 $441.17 $568.85 45 $428.55 $565.09 $501.47 $661.24 $456.02 $601.30 46 $445.17 $587.00 $520.92 $686.88 $473.70 $624.62 47 $463.87 $611.65 $542.79 $715.73 $493.60 $650.85 48 $485.23 $639.83 $567.80 $748.70 $516.33 $680.84 49 $506.31 $667.61 $592.45 $781.21 $538.76 $710.40 50 $530.05 $700.83 $620.24 $820.08 $564.02 $745.75 51 $553.49 $731.83 $647.67 $856.35 $588.97 $778.73 52 $579.31 $765.97 $677.88 $896.30 $616.44 $815.06 53 $605.43 $800.50 $708.44 $936.71 $644.23 $851.80 54 $633.62 $837.78 $741.44 $980.33 $674.23 $891.47 55 $661.82 $865.79 $774.43 $1,013.11 $704.23 $921.28 56 $692.39 $905.78 $810.20 $1,059.90 $736.76 $963.83 57 $723.25 $946.16 $846.31 $1,107.15 $769.61 $1,006.80 58 $756.19 $989.25 $884.86 $1,157.57 $804.66 $1,052.65 59 $772.52 $1,010.60 $903.96 $1,182.56 $822.03 $1,075.38 60 $805.46 $1,034.85 $942.51 $1,210.94 $857.08 $1,101.18 61 $833.95 $1,071.46 $975.85 $1,253.77 $887.40 $1,140.13 62 $852.65 $1,095.48 $997.73 $1,281.88 $907.29 $1,165.69 63 $876.09 $1,125.60 $1,025.16 $1,317.13 $932.24 $1,197.74 64 $890.34 $1,143.91 $1,041.84 $1,338.54 $947.40 $1,217.22 65+ $890.34 $1,143.91 $1,041.84 $1,338.54 $947.40 $1,217.22 Rates Effective January 1, 2018 Page 32 of 44
Illinois Off Exchange (Bronze) Blue Precision Bronze HMO SM 205 Rockford, IL Blue Choice Preferred Bronze PPO SM 202 201 Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $232.93 $232.93 $306.61 $306.61 $278.82 $278.82 15 $253.63 $253.63 $333.87 $333.87 $303.60 $303.60 16 $261.55 $261.55 $344.29 $344.29 $313.08 $313.08 17 $269.46 $269.46 $354.71 $354.71 $322.56 $322.56 18 $277.99 $277.99 $365.93 $365.93 $332.76 $332.76 19 $286.52 $286.52 $377.15 $377.15 $342.97 $342.97 20 $295.34 $295.34 $388.77 $388.77 $353.54 $353.54 21 $304.48 $304.48 $400.80 $400.80 $364.47 $364.47 22 $304.48 $304.48 $400.80 $400.80 $364.47 $364.47 23 $304.48 $304.48 $400.80 $400.80 $364.47 $364.47 24 $304.48 $304.48 $400.80 $400.80 $364.47 $364.47 25 $305.70 $305.70 $402.40 $402.40 $365.93 $365.93 26 $311.79 $311.79 $410.42 $410.42 $373.22 $373.22 27 $319.09 $319.09 $420.04 $420.04 $381.97 $381.97 28 $330.97 $330.97 $435.67 $435.67 $396.18 $396.18 29 $340.71 $340.71 $448.49 $448.49 $407.84 $407.84 30 $345.58 $391.96 $454.91 $515.96 $413.67 $469.19 31 $352.89 $400.25 $464.53 $526.87 $422.42 $479.11 32 $360.20 $408.54 $474.14 $537.78 $431.17 $489.03 33 $364.77 $413.72 $480.16 $544.59 $436.64 $495.23 34 $369.64 $419.24 $486.57 $551.87 $442.47 $501.85 35 $372.07 $456.83 $489.78 $601.35 $445.38 $546.84 36 $374.51 $459.82 $492.98 $605.28 $448.30 $550.42 37 $376.95 $462.81 $496.19 $609.22 $451.21 $554.00 38 $379.38 $465.80 $499.40 $613.16 $454.13 $557.58 39 $384.25 $471.78 $505.81 $621.03 $459.96 $564.74 40 $389.12 $501.74 $512.22 $660.46 $465.79 $600.59 41 $396.43 $511.16 $521.84 $672.86 $474.54 $611.87 42 $403.44 $520.19 $531.06 $684.75 $482.92 $622.68 43 $413.18 $532.75 $543.88 $701.29 $494.59 $637.72 44 $425.36 $548.46 $559.92 $721.95 $509.17 $656.52 45 $439.67 $579.75 $578.75 $763.14 $526.30 $693.97 46 $456.72 $602.23 $601.20 $792.74 $546.71 $720.89 47 $475.90 $627.52 $626.45 $826.03 $569.67 $751.16 48 $497.82 $656.43 $655.31 $864.09 $595.91 $785.77 49 $519.44 $684.94 $683.76 $901.61 $621.79 $819.89 50 $543.80 $719.01 $715.83 $946.47 $650.95 $860.68 51 $567.85 $750.82 $747.49 $988.33 $679.74 $898.75 52 $594.34 $785.84 $782.36 $1,034.43 $711.45 $940.67 53 $621.14 $821.27 $817.63 $1,081.07 $743.52 $983.08 54 $650.06 $859.51 $855.71 $1,131.41 $778.15 $1,028.86 55 $678.99 $888.25 $893.78 $1,169.25 $812.77 $1,063.27 56 $710.35 $929.28 $935.06 $1,223.25 $850.31 $1,112.38 57 $742.02 $970.70 $976.75 $1,277.78 $888.22 $1,161.96 58 $775.81 $1,014.92 $1,021.23 $1,335.98 $928.67 $1,214.89 59 $792.56 $1,036.83 $1,043.28 $1,364.82 $948.72 $1,241.11 60 $826.36 $1,061.70 $1,087.77 $1,397.56 $989.17 $1,270.89 61 $855.59 $1,099.26 $1,126.24 $1,447.00 $1,024.16 $1,315.85 62 $874.77 $1,123.90 $1,151.49 $1,479.44 $1,047.12 $1,345.35 63 $898.82 $1,154.81 $1,183.16 $1,520.12 $1,075.92 $1,382.34 64 $913.44 $1,173.58 $1,202.40 $1,544.84 $1,093.41 $1,404.82 65+ $913.44 $1,173.58 $1,202.40 $1,544.84 $1,093.41 $1,404.82 Rates Effective January 1, 2018 Page 33 of 44
Illinois Off Exchange (Bronze) Quad Cities, IL Blue Choice Preferred Bronze PPO SM 202 201 Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $262.58 $262.58 $238.78 $238.78 15 $285.92 $285.92 $260.01 $260.01 16 $294.85 $294.85 $268.12 $268.12 17 $303.77 $303.77 $276.24 $276.24 18 $313.38 $313.38 $284.98 $284.98 19 $322.99 $322.99 $293.72 $293.72 20 $332.95 $332.95 $302.77 $302.77 21 $343.24 $343.24 $312.13 $312.13 22 $343.24 $343.24 $312.13 $312.13 23 $343.24 $343.24 $312.13 $312.13 24 $343.24 $343.24 $312.13 $312.13 25 $344.62 $344.62 $313.38 $313.38 26 $351.48 $351.48 $319.62 $319.62 27 $359.72 $359.72 $327.12 $327.12 28 $373.11 $373.11 $339.29 $339.29 29 $384.09 $384.09 $349.28 $349.28 30 $389.58 $441.86 $354.27 $401.81 31 $397.82 $451.21 $361.76 $410.31 32 $406.06 $460.55 $369.25 $418.81 33 $411.21 $466.39 $373.94 $424.12 34 $416.70 $472.62 $378.93 $429.78 35 $419.44 $514.99 $381.43 $468.31 36 $422.19 $518.36 $383.92 $471.38 37 $424.94 $521.74 $386.42 $474.45 38 $427.68 $525.11 $388.92 $477.51 39 $433.17 $531.85 $393.91 $483.64 40 $438.67 $565.61 $398.91 $514.35 41 $446.90 $576.24 $406.40 $524.01 42 $454.80 $586.42 $413.58 $533.27 43 $465.78 $600.58 $423.56 $546.15 44 $479.51 $618.28 $436.05 $562.24 45 $495.64 $653.56 $450.72 $594.32 46 $514.87 $678.90 $468.20 $617.37 47 $536.49 $707.42 $487.86 $643.30 48 $561.20 $740.00 $510.34 $672.93 49 $585.57 $772.14 $532.50 $702.15 50 $613.03 $810.55 $557.47 $737.09 51 $640.15 $846.41 $582.13 $769.69 52 $670.01 $885.89 $609.28 $805.59 53 $700.22 $925.83 $636.75 $841.91 54 $732.83 $968.94 $666.40 $881.12 55 $765.43 $1,001.34 $696.06 $910.58 56 $800.79 $1,047.59 $728.21 $952.64 57 $836.49 $1,094.29 $760.67 $995.10 58 $874.59 $1,144.13 $795.31 $1,040.43 59 $893.46 $1,168.83 $812.48 $1,062.89 60 $931.56 $1,196.87 $847.13 $1,088.39 61 $964.52 $1,239.21 $877.09 $1,126.89 62 $986.14 $1,266.99 $896.76 $1,152.15 63 $1,013.26 $1,301.83 $921.42 $1,183.84 64 $1,029.72 $1,323.00 $936.39 $1,203.08 65+ $1,029.72 $1,323.00 $936.39 $1,203.08 Rates Effective January 1, 2018 Page 34 of 44
Illinois Off Exchange (Bronze) Blue Precision Bronze HMO SM 205 Peoria, IL Blue Choice Preferred Bronze PPO SM 202 201 Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $242.16 $242.16 $304.78 $304.78 $277.15 $277.15 15 $263.68 $263.68 $331.87 $331.87 $301.79 $301.79 16 $271.91 $271.91 $342.23 $342.23 $311.21 $311.21 17 $280.14 $280.14 $352.59 $352.59 $320.63 $320.63 18 $289.01 $289.01 $363.74 $363.74 $330.77 $330.77 19 $297.87 $297.87 $374.90 $374.90 $340.92 $340.92 20 $307.05 $307.05 $386.45 $386.45 $351.42 $351.42 21 $316.55 $316.55 $398.40 $398.40 $362.29 $362.29 22 $316.55 $316.55 $398.40 $398.40 $362.29 $362.29 23 $316.55 $316.55 $398.40 $398.40 $362.29 $362.29 24 $316.55 $316.55 $398.40 $398.40 $362.29 $362.29 25 $317.81 $317.81 $400.00 $400.00 $363.74 $363.74 26 $324.14 $324.14 $407.96 $407.96 $370.99 $370.99 27 $331.74 $331.74 $417.53 $417.53 $379.68 $379.68 28 $344.09 $344.09 $433.06 $433.06 $393.81 $393.81 29 $354.22 $354.22 $445.81 $445.81 $405.40 $405.40 30 $359.28 $407.50 $452.19 $512.87 $411.20 $466.39 31 $366.88 $416.11 $461.75 $523.72 $419.90 $476.25 32 $374.48 $424.73 $471.31 $534.56 $428.59 $486.11 33 $379.22 $430.11 $477.29 $541.34 $434.03 $492.27 34 $384.29 $435.86 $483.66 $548.57 $439.82 $498.85 35 $386.82 $474.94 $486.85 $597.75 $442.72 $543.57 36 $389.35 $478.05 $490.03 $601.66 $445.62 $547.13 37 $391.89 $481.16 $493.22 $605.58 $448.52 $550.69 38 $394.42 $484.27 $496.41 $609.49 $451.42 $554.25 39 $399.48 $490.48 $502.78 $617.32 $457.21 $561.36 40 $404.55 $521.62 $509.16 $656.51 $463.01 $597.00 41 $412.14 $531.42 $518.72 $668.84 $471.70 $608.22 42 $419.43 $540.81 $527.88 $680.65 $480.04 $618.96 43 $429.55 $553.87 $540.63 $697.09 $491.63 $633.91 44 $442.22 $570.19 $556.57 $717.64 $506.12 $652.59 45 $457.09 $602.72 $575.29 $758.58 $523.15 $689.83 46 $474.82 $626.10 $597.60 $788.00 $543.44 $716.58 47 $494.76 $652.39 $622.70 $821.09 $566.26 $746.67 48 $517.55 $682.45 $651.39 $858.92 $592.35 $781.07 49 $540.03 $712.08 $679.67 $896.22 $618.07 $814.99 50 $565.35 $747.51 $711.55 $940.81 $647.05 $855.53 51 $590.36 $780.57 $743.02 $982.42 $675.67 $893.38 52 $617.90 $816.99 $777.68 $1,028.25 $707.19 $935.05 53 $645.76 $853.82 $812.74 $1,074.61 $739.08 $977.21 54 $675.83 $893.58 $850.59 $1,124.65 $773.49 $1,022.71 55 $705.90 $923.46 $888.44 $1,162.25 $807.91 $1,056.91 56 $738.50 $966.11 $929.47 $1,215.94 $845.23 $1,105.73 57 $771.43 $1,009.18 $970.91 $1,270.14 $882.90 $1,155.01 58 $806.56 $1,055.14 $1,015.13 $1,327.99 $923.12 $1,207.62 59 $823.97 $1,077.92 $1,037.04 $1,356.66 $943.05 $1,233.69 60 $859.11 $1,103.78 $1,081.26 $1,389.21 $983.26 $1,263.29 61 $889.50 $1,142.83 $1,119.51 $1,438.35 $1,018.04 $1,307.98 62 $909.44 $1,168.45 $1,144.61 $1,470.59 $1,040.86 $1,337.30 63 $934.45 $1,200.58 $1,176.08 $1,511.03 $1,069.49 $1,374.07 64 $949.65 $1,220.10 $1,195.20 $1,535.60 $1,086.87 $1,396.42 65+ $949.65 $1,220.10 $1,195.20 $1,535.60 $1,086.87 $1,396.42 Rates Effective January 1, 2018 Page 35 of 44
Illinois Off Exchange (Bronze) Bloomington, IL Blue Precision Bronze HMO SM Blue Choice Preferred Bronze PPO SM 205 202 201 Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $228.36 $228.36 $272.05 $272.05 $247.39 $247.39 15 $248.66 $248.66 $296.23 $296.23 $269.38 $269.38 16 $256.42 $256.42 $305.47 $305.47 $277.79 $277.79 17 $264.18 $264.18 $314.72 $314.72 $286.19 $286.19 18 $272.54 $272.54 $324.68 $324.68 $295.25 $295.25 19 $280.89 $280.89 $334.64 $334.64 $304.30 $304.30 20 $289.55 $289.55 $344.95 $344.95 $313.68 $313.68 21 $298.51 $298.51 $355.62 $355.62 $323.38 $323.38 22 $298.51 $298.51 $355.62 $355.62 $323.38 $323.38 23 $298.51 $298.51 $355.62 $355.62 $323.38 $323.38 24 $298.51 $298.51 $355.62 $355.62 $323.38 $323.38 25 $299.70 $299.70 $357.04 $357.04 $324.68 $324.68 26 $305.67 $305.67 $364.15 $364.15 $331.15 $331.15 27 $312.83 $312.83 $372.69 $372.69 $338.91 $338.91 28 $324.48 $324.48 $386.56 $386.56 $351.52 $351.52 29 $334.03 $334.03 $397.93 $397.93 $361.87 $361.87 30 $338.80 $384.27 $403.62 $457.79 $367.04 $416.30 31 $345.97 $392.40 $412.16 $467.47 $374.80 $425.10 32 $353.13 $400.52 $420.69 $477.15 $382.56 $433.90 33 $357.61 $405.60 $426.03 $483.20 $387.41 $439.40 34 $362.39 $411.02 $431.72 $489.66 $392.59 $445.27 35 $364.78 $447.87 $434.56 $533.56 $395.18 $485.20 36 $367.16 $450.80 $437.41 $537.05 $397.76 $488.37 37 $369.55 $453.74 $440.25 $540.54 $400.35 $491.55 38 $371.94 $456.67 $443.10 $544.04 $402.94 $494.73 39 $376.72 $462.53 $448.79 $551.02 $408.11 $501.08 40 $381.49 $491.89 $454.48 $586.00 $413.28 $532.89 41 $388.66 $501.13 $463.01 $597.01 $421.05 $542.90 42 $395.52 $509.99 $471.19 $607.56 $428.48 $552.49 43 $405.07 $522.30 $482.57 $622.23 $438.83 $565.83 44 $417.01 $537.70 $496.80 $640.57 $451.77 $582.51 45 $431.04 $568.37 $513.51 $677.12 $466.97 $615.74 46 $447.76 $590.42 $533.42 $703.37 $485.08 $639.62 47 $466.57 $615.21 $555.83 $732.91 $505.45 $666.48 48 $488.06 $643.55 $581.43 $766.68 $528.73 $697.19 49 $509.25 $671.50 $606.68 $799.97 $551.69 $727.46 50 $533.13 $704.91 $635.13 $839.77 $577.56 $763.66 51 $556.71 $736.09 $663.22 $876.91 $603.11 $797.43 52 $582.68 $770.42 $694.16 $917.82 $631.25 $834.63 53 $608.95 $805.16 $725.46 $959.20 $659.70 $872.26 54 $637.31 $842.65 $759.24 $1,003.87 $690.42 $912.88 55 $665.67 $870.83 $793.02 $1,037.44 $721.15 $943.40 56 $696.42 $911.05 $829.65 $1,085.35 $754.45 $986.98 57 $727.46 $951.66 $866.64 $1,133.73 $788.09 $1,030.97 58 $760.59 $995.01 $906.11 $1,185.37 $823.98 $1,077.93 59 $777.01 $1,016.49 $925.67 $1,210.96 $841.77 $1,101.20 60 $810.15 $1,040.88 $965.14 $1,240.02 $877.66 $1,127.62 61 $838.80 $1,077.70 $999.28 $1,283.88 $908.71 $1,167.51 62 $857.61 $1,101.86 $1,021.69 $1,312.66 $929.08 $1,193.68 63 $881.19 $1,132.15 $1,049.78 $1,348.76 $954.63 $1,226.51 64 $895.53 $1,150.56 $1,066.86 $1,370.69 $970.14 $1,246.45 65+ $895.53 $1,150.56 $1,066.86 $1,370.69 $970.14 $1,246.45 Rates Effective January 1, 2018 Page 36 of 44
Illinois Off Exchange (Bronze) Champaign, IL Blue Choice Preferred Bronze PPO SM 202 201 Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $285.63 $285.63 $259.74 $259.74 15 $311.02 $311.02 $282.83 $282.83 16 $320.72 $320.72 $291.65 $291.65 17 $330.43 $330.43 $300.48 $300.48 18 $340.89 $340.89 $309.99 $309.99 19 $351.34 $351.34 $319.50 $319.50 20 $362.17 $362.17 $329.34 $329.34 21 $373.37 $373.37 $339.53 $339.53 22 $373.37 $373.37 $339.53 $339.53 23 $373.37 $373.37 $339.53 $339.53 24 $373.37 $373.37 $339.53 $339.53 25 $374.86 $374.86 $340.89 $340.89 26 $382.33 $382.33 $347.68 $347.68 27 $391.29 $391.29 $355.83 $355.83 28 $405.85 $405.85 $369.07 $369.07 29 $417.80 $417.80 $379.93 $379.93 30 $423.77 $480.65 $385.36 $437.08 31 $432.74 $490.81 $393.51 $446.32 32 $441.70 $500.97 $401.66 $455.56 33 $447.30 $507.32 $406.75 $461.34 34 $453.27 $514.10 $412.19 $467.50 35 $456.26 $560.19 $414.90 $509.42 36 $459.24 $563.86 $417.62 $512.75 37 $462.23 $567.53 $420.34 $516.09 38 $465.22 $571.20 $423.05 $519.42 39 $471.19 $578.53 $428.48 $526.09 40 $477.17 $615.26 $433.92 $559.49 41 $486.13 $626.81 $442.07 $570.00 42 $494.71 $637.89 $449.87 $580.07 43 $506.66 $653.29 $460.74 $594.08 44 $521.60 $672.55 $474.32 $611.59 45 $539.15 $710.92 $490.28 $646.48 46 $560.05 $738.49 $509.29 $671.55 47 $583.58 $769.50 $530.68 $699.76 48 $610.46 $804.95 $555.13 $731.99 49 $636.97 $839.91 $579.23 $763.78 50 $666.84 $881.69 $606.40 $801.78 51 $696.33 $920.69 $633.22 $837.24 52 $728.82 $963.64 $662.76 $876.30 53 $761.67 $1,007.09 $692.64 $915.81 54 $797.14 $1,053.98 $724.89 $958.45 55 $832.61 $1,089.23 $757.15 $990.50 56 $871.07 $1,139.53 $792.12 $1,036.25 57 $909.90 $1,190.33 $827.43 $1,082.44 58 $951.35 $1,244.55 $865.12 $1,131.74 59 $971.88 $1,271.41 $883.79 $1,156.17 60 $1,013.32 $1,301.92 $921.48 $1,183.92 61 $1,049.17 $1,347.97 $954.07 $1,225.79 62 $1,072.69 $1,378.19 $975.46 $1,253.28 63 $1,102.19 $1,416.09 $1,002.29 $1,287.74 64 $1,120.11 $1,439.12 $1,018.59 $1,308.68 65+ $1,120.11 $1,439.12 $1,018.59 $1,308.68 Rates Effective January 1, 2018 Page 37 of 44
Illinois Off Exchange (Bronze) Springfield, IL Blue Choice Preferred Bronze PPO SM 202 201 Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $293.41 $293.41 $266.81 $266.81 15 $319.49 $319.49 $290.53 $290.53 16 $329.46 $329.46 $299.60 $299.60 17 $339.43 $339.43 $308.67 $308.67 18 $350.17 $350.17 $318.43 $318.43 19 $360.91 $360.91 $328.20 $328.20 20 $372.03 $372.03 $338.31 $338.31 21 $383.54 $383.54 $348.78 $348.78 22 $383.54 $383.54 $348.78 $348.78 23 $383.54 $383.54 $348.78 $348.78 24 $383.54 $383.54 $348.78 $348.78 25 $385.07 $385.07 $350.17 $350.17 26 $392.75 $392.75 $357.15 $357.15 27 $401.95 $401.95 $365.52 $365.52 28 $416.91 $416.91 $379.12 $379.12 29 $429.18 $429.18 $390.28 $390.28 30 $435.32 $493.74 $395.86 $448.99 31 $444.52 $504.18 $404.23 $458.48 32 $453.73 $514.62 $412.60 $467.98 33 $459.48 $521.14 $417.83 $473.91 34 $465.62 $528.10 $423.42 $480.24 35 $468.69 $575.45 $426.21 $523.29 36 $471.75 $579.22 $429.00 $526.72 37 $474.82 $582.99 $431.79 $530.15 38 $477.89 $586.76 $434.58 $533.57 39 $484.03 $594.29 $440.16 $540.42 40 $490.16 $632.02 $445.74 $574.73 41 $499.37 $643.89 $454.11 $585.53 42 $508.19 $655.26 $462.13 $595.87 43 $520.46 $671.09 $473.29 $610.26 44 $535.81 $690.87 $487.24 $628.25 45 $553.83 $730.28 $503.63 $664.09 46 $575.31 $758.60 $523.17 $689.85 47 $599.47 $790.47 $545.14 $718.82 48 $627.09 $826.88 $570.25 $751.93 49 $654.32 $862.79 $595.01 $784.58 50 $685.00 $905.71 $622.92 $823.62 51 $715.30 $945.77 $650.47 $860.05 52 $748.67 $989.89 $680.81 $900.17 53 $782.42 $1,034.52 $711.51 $940.75 54 $818.86 $1,082.70 $744.64 $984.56 55 $855.30 $1,118.90 $777.77 $1,017.48 56 $894.80 $1,170.58 $813.70 $1,064.48 57 $934.69 $1,222.76 $849.97 $1,111.93 58 $977.26 $1,278.45 $888.68 $1,162.57 59 $998.36 $1,306.05 $907.87 $1,187.67 60 $1,040.93 $1,337.39 $946.58 $1,216.17 61 $1,077.75 $1,384.69 $980.06 $1,259.19 62 $1,101.91 $1,415.74 $1,002.04 $1,287.42 63 $1,132.21 $1,454.67 $1,029.59 $1,322.82 64 $1,150.62 $1,478.32 $1,046.34 $1,344.33 65+ $1,150.62 $1,478.32 $1,046.34 $1,344.33 Rates Effective January 1, 2018 Page 38 of 44
Illinois Off Exchange (Bronze) East St. Louis, IL Blue Choice Preferred Bronze PPO SM 202 201 Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $272.50 $272.50 $247.81 $247.81 15 $296.73 $296.73 $269.83 $269.83 16 $305.99 $305.99 $278.25 $278.25 17 $315.25 $315.25 $286.68 $286.68 18 $325.22 $325.22 $295.75 $295.75 19 $335.20 $335.20 $304.82 $304.82 20 $345.53 $345.53 $314.21 $314.21 21 $356.22 $356.22 $323.93 $323.93 22 $356.22 $356.22 $323.93 $323.93 23 $356.22 $356.22 $323.93 $323.93 24 $356.22 $356.22 $323.93 $323.93 25 $357.64 $357.64 $325.22 $325.22 26 $364.76 $364.76 $331.70 $331.70 27 $373.31 $373.31 $339.48 $339.48 28 $387.21 $387.21 $352.11 $352.11 29 $398.60 $398.60 $362.48 $362.48 30 $404.30 $458.56 $367.66 $417.00 31 $412.85 $468.26 $375.43 $425.82 32 $421.40 $477.96 $383.21 $434.63 33 $426.75 $484.01 $388.07 $440.14 34 $432.45 $490.48 $393.25 $446.02 35 $435.29 $534.45 $395.84 $486.01 36 $438.14 $537.95 $398.43 $489.19 37 $440.99 $541.45 $401.02 $492.38 38 $443.84 $544.95 $403.61 $495.56 39 $449.54 $551.95 $408.80 $501.92 40 $455.24 $586.99 $413.98 $533.79 41 $463.79 $598.01 $421.75 $543.81 42 $471.99 $608.58 $429.21 $553.42 43 $483.38 $623.28 $439.57 $566.78 44 $497.63 $641.65 $452.53 $583.49 45 $514.37 $678.26 $467.75 $616.78 46 $534.32 $704.56 $485.89 $640.70 47 $556.76 $734.15 $506.30 $667.61 48 $582.41 $767.97 $529.62 $698.36 49 $607.70 $801.32 $552.62 $728.69 50 $636.20 $841.18 $578.54 $764.94 51 $664.34 $878.39 $604.13 $798.78 52 $695.33 $919.37 $632.31 $836.04 53 $726.68 $960.82 $660.81 $873.73 54 $760.52 $1,005.56 $691.59 $914.42 55 $794.36 $1,039.18 $722.36 $944.99 56 $831.05 $1,087.18 $755.73 $988.64 57 $868.10 $1,135.64 $789.41 $1,032.71 58 $907.64 $1,187.37 $825.37 $1,079.75 59 $927.23 $1,213.00 $843.19 $1,103.05 60 $966.77 $1,242.10 $879.14 $1,129.52 61 $1,000.96 $1,286.04 $910.24 $1,169.48 62 $1,023.41 $1,314.87 $930.65 $1,195.69 63 $1,051.55 $1,351.03 $956.24 $1,228.57 64 $1,068.66 $1,373.00 $971.79 $1,248.55 65+ $1,068.66 $1,373.00 $971.79 $1,248.55 Rates Effective January 1, 2018 Page 39 of 44
Illinois Off Exchange (Bronze) St. Louis, IL Blue Choice Preferred Bronze PPO SM 202 201 Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $264.64 $264.64 $240.66 $240.66 15 $288.17 $288.17 $262.05 $262.05 16 $297.16 $297.16 $270.23 $270.23 17 $306.16 $306.16 $278.41 $278.41 18 $315.84 $315.84 $287.21 $287.21 19 $325.53 $325.53 $296.02 $296.02 20 $335.56 $335.56 $305.15 $305.15 21 $345.94 $345.94 $314.58 $314.58 22 $345.94 $345.94 $314.58 $314.58 23 $345.94 $345.94 $314.58 $314.58 24 $345.94 $345.94 $314.58 $314.58 25 $347.32 $347.32 $315.84 $315.84 26 $354.24 $354.24 $322.13 $322.13 27 $362.54 $362.54 $329.68 $329.68 28 $376.04 $376.04 $341.95 $341.95 29 $387.11 $387.11 $352.02 $352.02 30 $392.64 $445.33 $357.05 $404.97 31 $400.94 $454.75 $364.60 $413.53 32 $409.25 $464.17 $372.15 $422.10 33 $414.44 $470.05 $376.87 $427.45 34 $419.97 $476.33 $381.90 $433.16 35 $422.74 $519.04 $384.42 $471.99 36 $425.51 $522.43 $386.94 $475.08 37 $428.27 $525.83 $389.45 $478.17 38 $431.04 $529.23 $391.97 $481.26 39 $436.58 $536.03 $397.00 $487.44 40 $442.11 $570.06 $402.04 $518.39 41 $450.41 $580.76 $409.59 $528.12 42 $458.37 $591.02 $416.82 $537.45 43 $469.44 $605.30 $426.89 $550.43 44 $483.28 $623.14 $439.47 $566.66 45 $499.54 $658.69 $454.26 $598.99 46 $518.91 $684.23 $471.88 $622.22 47 $540.70 $712.97 $491.69 $648.35 48 $565.61 $745.81 $514.34 $678.21 49 $590.17 $778.20 $536.68 $707.67 50 $617.85 $816.92 $561.85 $742.87 51 $645.18 $853.05 $586.70 $775.73 52 $675.27 $892.84 $614.07 $811.92 53 $705.72 $933.10 $641.75 $848.52 54 $738.58 $976.55 $671.64 $888.04 55 $771.44 $1,009.20 $701.52 $917.73 56 $807.08 $1,055.82 $733.92 $960.12 57 $843.05 $1,102.88 $766.64 $1,002.92 58 $881.45 $1,153.12 $801.56 $1,048.60 59 $900.48 $1,178.01 $818.86 $1,071.23 60 $938.88 $1,206.27 $853.78 $1,096.94 61 $972.09 $1,248.94 $883.98 $1,135.74 62 $993.88 $1,276.94 $903.80 $1,161.20 63 $1,021.21 $1,312.05 $928.65 $1,193.13 64 $1,037.82 $1,333.39 $943.74 $1,212.53 65+ $1,037.82 $1,333.39 $943.74 $1,212.53 Rates Effective January 1, 2018 Page 40 of 44
Illinois Off Exchange (Bronze) Southern, IL Blue Choice Preferred Bronze PPO SM 202 201 Age Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $325.29 $325.29 $295.81 $295.81 15 $354.21 $354.21 $322.10 $322.10 16 $365.26 $365.26 $332.16 $332.16 17 $376.32 $376.32 $342.21 $342.21 18 $388.23 $388.23 $353.04 $353.04 19 $400.13 $400.13 $363.87 $363.87 20 $412.46 $412.46 $375.08 $375.08 21 $425.22 $425.22 $386.68 $386.68 22 $425.22 $425.22 $386.68 $386.68 23 $425.22 $425.22 $386.68 $386.68 24 $425.22 $425.22 $386.68 $386.68 25 $426.92 $426.92 $388.23 $388.23 26 $435.43 $435.43 $395.96 $395.96 27 $445.63 $445.63 $405.24 $405.24 28 $462.21 $462.21 $420.32 $420.32 29 $475.82 $475.82 $432.69 $432.69 30 $482.63 $547.39 $438.88 $497.78 31 $492.83 $558.97 $448.16 $508.31 32 $503.04 $570.54 $457.44 $518.83 33 $509.41 $577.78 $463.24 $525.41 34 $516.22 $585.49 $469.43 $532.43 35 $519.62 $637.99 $472.52 $580.16 36 $523.02 $642.16 $475.62 $583.96 37 $526.42 $646.34 $478.71 $587.76 38 $529.82 $650.52 $481.80 $591.56 39 $536.63 $658.87 $487.99 $599.15 40 $543.43 $700.70 $494.18 $637.19 41 $553.64 $713.86 $503.46 $649.16 42 $563.42 $726.47 $512.35 $660.63 43 $577.02 $744.02 $524.72 $676.58 44 $594.03 $765.95 $540.19 $696.52 45 $614.02 $809.65 $558.36 $736.26 46 $637.83 $841.04 $580.02 $764.81 47 $664.62 $876.37 $604.38 $796.93 48 $695.24 $916.74 $632.22 $833.65 49 $725.43 $956.55 $659.67 $869.85 50 $759.44 $1,004.14 $690.61 $913.12 51 $793.04 $1,048.55 $721.16 $953.51 52 $830.03 $1,097.46 $754.80 $997.99 53 $867.45 $1,146.94 $788.83 $1,042.99 54 $907.85 $1,200.36 $825.56 $1,091.56 55 $948.24 $1,240.49 $862.29 $1,128.06 56 $992.04 $1,297.79 $902.12 $1,180.16 57 $1,036.26 $1,355.64 $942.34 $1,232.76 58 $1,083.46 $1,417.38 $985.26 $1,288.91 59 $1,106.85 $1,447.98 $1,006.53 $1,316.74 60 $1,154.05 $1,482.72 $1,049.45 $1,348.33 61 $1,194.87 $1,535.17 $1,086.57 $1,396.02 62 $1,221.66 $1,569.59 $1,110.93 $1,427.32 63 $1,255.25 $1,612.75 $1,141.48 $1,466.57 64 $1,275.66 $1,638.97 $1,160.04 $1,490.42 65+ $1,275.66 $1,638.97 $1,160.04 $1,490.42 Rates Effective January 1, 2018 Page 41 of 44
Illinois Off Exchange (Catastrophic) Rating Area Blue Choice Preferred Security PPO SM 200 Chicago - Central, IL Chicago - North, IL Chicago - West, IL Chicago - South, IL Rockford, IL Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $228.89 $228.89 $230.19 $230.19 $225.25 $225.25 $225.21 $225.21 $259.92 $259.92 15 $249.23 $249.23 $250.65 $250.65 $245.27 $245.27 $245.23 $245.23 $283.02 $283.02 16 $257.01 $257.01 $258.47 $258.47 $252.93 $252.93 $252.88 $252.88 $291.86 $291.86 17 $264.79 $264.79 $266.30 $266.30 $260.58 $260.58 $260.54 $260.54 $300.69 $300.69 18 $273.17 $273.17 $274.72 $274.72 $268.83 $268.83 $268.78 $268.78 $310.20 $310.20 19 $281.54 $281.54 $283.15 $283.15 $277.07 $277.07 $277.02 $277.02 $319.72 $319.72 20 $290.22 $290.22 $291.87 $291.87 $285.61 $285.61 $285.56 $285.56 $329.57 $329.57 21 $299.20 $299.20 $300.90 $300.90 $294.44 $294.44 $294.39 $294.39 $339.76 $339.76 22 $299.20 $299.20 $300.90 $300.90 $294.44 $294.44 $294.39 $294.39 $339.76 $339.76 23 $299.20 $299.20 $300.90 $300.90 $294.44 $294.44 $294.39 $294.39 $339.76 $339.76 24 $299.20 $299.20 $300.90 $300.90 $294.44 $294.44 $294.39 $294.39 $339.76 $339.76 25 $300.39 $300.39 $302.10 $302.10 $295.62 $295.62 $295.57 $295.57 $341.12 $341.12 26 $306.38 $306.38 $308.12 $308.12 $301.51 $301.51 $301.46 $301.46 $347.92 $347.92 27 $313.56 $313.56 $315.34 $315.34 $308.58 $308.58 $308.52 $308.52 $356.07 $356.07 28 $325.23 $325.23 $327.08 $327.08 $320.06 $320.06 $320.01 $320.01 $369.32 $369.32 29 $334.80 $334.80 $336.71 $336.71 $329.48 $329.48 $329.43 $329.43 $380.20 $380.20 30 $339.59 $385.16 $341.52 $387.36 $334.19 $379.04 $334.14 $378.98 $385.63 $437.39 31 $346.77 $393.31 $348.74 $395.55 $341.26 $387.06 $341.20 $386.99 $393.79 $446.63 32 $353.95 $401.45 $355.97 $403.74 $348.32 $395.07 $348.27 $395.00 $401.94 $455.88 33 $358.44 $406.54 $360.48 $408.86 $352.74 $400.08 $352.68 $400.01 $407.04 $461.66 34 $363.22 $411.97 $365.29 $414.32 $357.45 $405.42 $357.39 $405.36 $412.47 $467.83 35 $365.62 $448.91 $367.70 $451.46 $359.81 $441.77 $359.75 $441.70 $415.19 $509.77 36 $368.01 $451.84 $370.11 $454.42 $362.16 $444.66 $362.10 $444.59 $417.91 $513.11 37 $370.41 $454.79 $372.52 $457.38 $364.52 $447.56 $364.46 $447.48 $420.63 $516.45 38 $372.80 $457.72 $374.92 $460.33 $366.87 $450.45 $366.81 $450.37 $423.35 $519.79 39 $377.59 $463.60 $379.74 $466.24 $371.59 $456.23 $371.52 $456.16 $428.78 $526.46 40 $382.37 $493.03 $384.55 $495.84 $376.30 $485.20 $376.23 $485.12 $434.22 $559.88 41 $389.55 $502.29 $391.77 $505.15 $383.36 $494.31 $383.30 $494.23 $442.37 $570.40 42 $396.44 $511.17 $398.69 $514.08 $390.14 $503.04 $390.07 $502.96 $450.19 $580.47 43 $406.01 $523.51 $408.32 $526.49 $399.56 $515.19 $399.49 $515.11 $461.06 $594.49 44 $417.98 $538.94 $420.36 $542.01 $411.34 $530.38 $411.27 $530.29 $474.65 $612.01 45 $432.04 $569.69 $434.50 $572.93 $425.17 $560.64 $425.10 $560.54 $490.62 $646.93 46 $448.80 $591.78 $451.35 $595.15 $441.66 $582.38 $441.59 $582.28 $509.65 $672.02 47 $467.64 $616.64 $470.31 $620.15 $460.21 $606.84 $460.14 $606.74 $531.05 $700.24 48 $489.19 $645.04 $491.97 $648.72 $481.41 $634.79 $481.33 $634.68 $555.51 $732.50 49 $510.43 $673.05 $513.34 $676.89 $502.32 $662.36 $502.23 $662.25 $579.64 $764.31 50 $534.37 $706.54 $537.41 $710.56 $525.87 $695.31 $525.79 $695.19 $606.82 $802.34 51 $558.00 $737.79 $561.18 $741.99 $549.13 $726.06 $549.04 $725.94 $633.66 $837.83 52 $584.03 $772.21 $587.36 $776.61 $574.75 $759.93 $574.66 $759.81 $663.22 $876.91 53 $610.36 $807.02 $613.84 $811.62 $600.66 $794.20 $600.56 $794.06 $693.12 $916.44 54 $638.79 $844.60 $642.42 $849.41 $628.63 $831.18 $628.53 $831.04 $725.40 $959.12 55 $667.21 $872.84 $671.01 $877.82 $656.61 $858.97 $656.50 $858.83 $757.67 $991.19 56 $698.03 $913.16 $702.00 $918.36 $686.93 $898.65 $686.82 $898.50 $792.67 $1,036.97 57 $729.14 $953.86 $733.30 $959.30 $717.56 $938.70 $717.44 $938.55 $828.01 $1,083.20 58 $762.35 $997.31 $766.70 $1,002.99 $750.24 $981.46 $750.11 $981.30 $865.72 $1,132.53 59 $778.81 $1,018.84 $783.25 $1,024.64 $766.43 $1,002.65 $766.31 $1,002.48 $884.41 $1,156.98 60 $812.02 $1,043.28 $816.65 $1,049.23 $799.12 $1,026.70 $798.98 $1,026.53 $922.12 $1,184.74 61 $840.74 $1,080.19 $845.53 $1,086.34 $827.38 $1,063.02 $827.24 $1,062.84 $954.74 $1,226.65 62 $859.59 $1,104.40 $864.49 $1,110.70 $845.93 $1,086.85 $845.79 $1,086.67 $976.14 $1,254.15 63 $883.23 $1,134.77 $888.26 $1,141.24 $869.19 $1,116.74 $869.05 $1,116.55 $1,002.98 $1,288.63 64 $897.60 $1,153.22 $902.70 $1,159.79 $883.32 $1,134.90 $883.17 $1,134.71 $1,019.28 $1,309.59 65+ $897.60 $1,153.22 $902.70 $1,159.79 $883.32 $1,134.90 $883.17 $1,134.71 $1,019.28 $1,309.59 Rates Effective January 1, 2018 Page 42 of 44
Illinois Off Exchange (Catastrophic) Rating Area Blue Choice Preferred Security PPO SM 200 Quad Cities, IL Peoria, IL Bloomington, IL Champaign, IL Springfield, IL Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $222.60 $222.60 $258.37 $258.37 $230.62 $230.62 $242.13 $242.13 $248.73 $248.73 15 $242.38 $242.38 $281.33 $281.33 $251.12 $251.12 $263.65 $263.65 $270.84 $270.84 16 $249.95 $249.95 $290.11 $290.11 $258.96 $258.96 $271.88 $271.88 $279.29 $279.29 17 $257.51 $257.51 $298.89 $298.89 $266.79 $266.79 $280.11 $280.11 $287.74 $287.74 18 $265.66 $265.66 $308.35 $308.35 $275.24 $275.24 $288.98 $288.98 $296.85 $296.85 19 $273.81 $273.81 $317.81 $317.81 $283.68 $283.68 $297.84 $297.84 $305.95 $305.95 20 $282.25 $282.25 $327.60 $327.60 $292.42 $292.42 $307.02 $307.02 $315.38 $315.38 21 $290.97 $290.97 $337.73 $337.73 $301.46 $301.46 $316.51 $316.51 $325.13 $325.13 22 $290.97 $290.97 $337.73 $337.73 $301.46 $301.46 $316.51 $316.51 $325.13 $325.13 23 $290.97 $290.97 $337.73 $337.73 $301.46 $301.46 $316.51 $316.51 $325.13 $325.13 24 $290.97 $290.97 $337.73 $337.73 $301.46 $301.46 $316.51 $316.51 $325.13 $325.13 25 $292.14 $292.14 $339.08 $339.08 $302.67 $302.67 $317.78 $317.78 $326.43 $326.43 26 $297.96 $297.96 $345.84 $345.84 $308.70 $308.70 $324.11 $324.11 $332.94 $332.94 27 $304.94 $304.94 $353.94 $353.94 $315.93 $315.93 $331.70 $331.70 $340.74 $340.74 28 $316.29 $316.29 $367.12 $367.12 $327.69 $327.69 $344.05 $344.05 $353.42 $353.42 29 $325.60 $325.60 $377.92 $377.92 $337.34 $337.34 $354.18 $354.18 $363.83 $363.83 30 $330.26 $374.58 $383.33 $434.77 $342.16 $388.08 $359.24 $407.45 $369.03 $418.55 31 $337.24 $382.50 $391.43 $443.96 $349.40 $396.28 $366.84 $416.07 $376.83 $427.40 32 $344.22 $390.42 $399.54 $453.16 $356.63 $404.49 $374.43 $424.68 $384.63 $436.25 33 $348.59 $395.37 $404.60 $458.90 $361.15 $409.62 $379.18 $430.07 $389.51 $441.78 34 $353.24 $400.65 $410.01 $465.03 $365.98 $415.09 $384.25 $435.81 $394.71 $447.68 35 $355.57 $436.57 $412.71 $506.72 $368.39 $452.31 $386.78 $474.89 $397.31 $487.82 36 $357.90 $439.43 $415.41 $510.04 $370.80 $455.27 $389.31 $477.99 $399.92 $491.01 37 $360.23 $442.29 $418.11 $513.36 $373.21 $458.23 $391.84 $481.10 $402.52 $494.21 38 $362.55 $445.14 $420.82 $516.68 $375.62 $461.19 $394.37 $484.21 $405.12 $497.40 39 $367.21 $450.86 $426.22 $523.31 $380.45 $467.11 $399.44 $490.43 $410.32 $503.79 40 $371.87 $479.48 $431.62 $556.53 $385.27 $496.77 $404.50 $521.56 $415.52 $535.77 41 $378.85 $488.49 $439.73 $566.99 $392.50 $506.10 $412.10 $531.36 $423.32 $545.84 42 $385.54 $497.12 $447.50 $577.00 $399.44 $515.04 $419.38 $540.75 $430.80 $555.48 43 $394.85 $509.12 $458.30 $590.94 $409.08 $527.48 $429.51 $553.81 $441.21 $568.89 44 $406.49 $524.13 $471.81 $608.36 $421.14 $543.02 $442.17 $570.13 $454.21 $585.66 45 $420.17 $554.03 $487.69 $643.06 $435.31 $574.00 $457.04 $602.66 $469.49 $619.08 46 $436.46 $575.52 $506.60 $668.00 $452.19 $596.26 $474.77 $626.03 $487.70 $643.08 47 $454.79 $599.69 $527.88 $696.06 $471.19 $621.31 $494.71 $652.32 $508.19 $670.09 48 $475.74 $627.31 $552.19 $728.12 $492.89 $649.93 $517.50 $682.37 $531.59 $700.96 49 $496.40 $654.56 $576.17 $759.74 $514.30 $678.15 $539.97 $712.00 $554.68 $731.40 50 $519.68 $687.12 $603.19 $797.54 $538.41 $711.89 $565.29 $747.43 $580.69 $767.79 51 $542.67 $717.51 $629.87 $832.82 $562.23 $743.38 $590.30 $780.49 $606.38 $801.75 52 $567.98 $750.98 $659.25 $871.67 $588.46 $778.05 $617.83 $816.90 $634.66 $839.15 53 $593.59 $784.84 $688.98 $910.96 $614.98 $813.13 $645.69 $853.73 $663.27 $876.98 54 $621.23 $821.39 $721.06 $953.39 $643.62 $851.00 $675.75 $893.48 $694.16 $917.82 55 $648.87 $848.86 $753.14 $985.27 $672.26 $879.45 $705.82 $923.36 $725.05 $948.51 56 $678.84 $888.06 $787.93 $1,030.77 $703.31 $920.07 $738.42 $966.00 $758.54 $992.32 57 $709.10 $927.65 $823.06 $1,076.72 $734.66 $961.09 $771.34 $1,009.07 $792.35 $1,036.55 58 $741.40 $969.90 $860.54 $1,125.76 $768.13 $1,004.86 $806.47 $1,055.03 $828.44 $1,083.77 59 $757.41 $990.84 $879.12 $1,150.06 $784.71 $1,026.55 $823.88 $1,077.80 $846.32 $1,107.16 60 $789.70 $1,014.61 $916.61 $1,177.66 $818.17 $1,051.19 $859.01 $1,103.66 $882.41 $1,133.73 61 $817.64 $1,050.50 $949.03 $1,219.31 $847.11 $1,088.37 $889.40 $1,142.70 $913.63 $1,173.83 62 $835.97 $1,074.05 $970.31 $1,246.65 $866.10 $1,112.77 $909.34 $1,168.32 $934.11 $1,200.15 63 $858.96 $1,103.59 $996.99 $1,280.93 $889.92 $1,143.37 $934.34 $1,200.45 $959.80 $1,233.15 64 $872.91 $1,121.53 $1,013.19 $1,301.76 $904.38 $1,161.96 $949.53 $1,219.96 $975.39 $1,253.20 65+ $872.91 $1,121.53 $1,013.19 $1,301.76 $904.38 $1,161.96 $949.53 $1,219.96 $975.39 $1,253.20 Rates Effective January 1, 2018 Page 43 of 44
Illinois Off Exchange (Catastrophic) Rating Area Blue Choice Preferred Security PPO SM 200 East St. Louis, IL St. Louis, IL Southern, IL Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco 0-14 $231.01 $231.01 $224.34 $224.34 $275.76 $275.76 15 $251.54 $251.54 $244.28 $244.28 $300.27 $300.27 16 $259.39 $259.39 $251.91 $251.91 $309.64 $309.64 17 $267.24 $267.24 $259.53 $259.53 $319.01 $319.01 18 $275.70 $275.70 $267.75 $267.75 $329.11 $329.11 19 $284.15 $284.15 $275.96 $275.96 $339.20 $339.20 20 $292.91 $292.91 $284.46 $284.46 $349.65 $349.65 21 $301.97 $301.97 $293.26 $293.26 $360.47 $360.47 22 $301.97 $301.97 $293.26 $293.26 $360.47 $360.47 23 $301.97 $301.97 $293.26 $293.26 $360.47 $360.47 24 $301.97 $301.97 $293.26 $293.26 $360.47 $360.47 25 $303.18 $303.18 $294.43 $294.43 $361.91 $361.91 26 $309.22 $309.22 $300.30 $300.30 $369.12 $369.12 27 $316.46 $316.46 $307.34 $307.34 $377.77 $377.77 28 $328.24 $328.24 $318.77 $318.77 $391.83 $391.83 29 $337.90 $337.90 $328.16 $328.16 $403.36 $403.36 30 $342.74 $388.73 $332.85 $377.52 $409.13 $464.04 31 $349.98 $396.95 $339.89 $385.50 $417.78 $473.85 32 $357.23 $405.17 $346.93 $393.48 $426.43 $483.66 33 $361.76 $410.31 $351.32 $398.47 $431.84 $489.79 34 $366.59 $415.79 $356.02 $403.79 $437.61 $496.33 35 $369.01 $453.07 $358.36 $440.00 $440.49 $540.83 36 $371.42 $456.03 $360.71 $442.88 $443.37 $544.37 37 $373.84 $459.00 $363.05 $445.76 $446.26 $547.92 38 $376.25 $461.97 $365.40 $448.64 $449.14 $551.46 39 $381.09 $467.90 $370.09 $454.40 $454.91 $558.54 40 $385.92 $497.60 $374.79 $483.25 $460.68 $594.00 41 $393.17 $506.95 $381.82 $492.32 $469.33 $605.15 42 $400.11 $515.90 $388.57 $501.02 $477.62 $615.84 43 $409.77 $528.36 $397.95 $513.12 $489.15 $630.72 44 $421.85 $543.94 $409.68 $528.24 $503.57 $649.31 45 $436.05 $574.97 $423.47 $558.38 $520.51 $686.35 46 $452.96 $597.27 $439.89 $580.04 $540.70 $712.97 47 $471.98 $622.35 $458.36 $604.40 $563.41 $742.91 48 $493.72 $651.02 $479.48 $632.24 $589.36 $777.14 49 $515.16 $679.29 $500.30 $659.70 $614.96 $810.88 50 $539.32 $713.09 $523.76 $692.52 $643.79 $851.23 51 $563.17 $744.63 $546.93 $723.15 $672.27 $888.88 52 $589.45 $779.36 $572.44 $756.88 $703.63 $930.34 53 $616.02 $814.50 $598.25 $791.00 $735.35 $972.29 54 $644.71 $852.43 $626.11 $827.84 $769.60 $1,017.56 55 $673.39 $880.93 $653.97 $855.52 $803.84 $1,051.59 56 $704.50 $921.62 $684.17 $895.04 $840.97 $1,100.16 57 $735.90 $962.71 $714.67 $934.93 $878.46 $1,149.20 58 $769.42 $1,006.55 $747.22 $977.52 $918.47 $1,201.54 59 $786.03 $1,028.28 $763.35 $998.62 $938.30 $1,227.48 60 $819.55 $1,052.96 $795.91 $1,022.58 $978.31 $1,256.93 61 $848.54 $1,090.20 $824.06 $1,058.75 $1,012.91 $1,301.39 62 $867.56 $1,114.64 $842.53 $1,082.49 $1,035.62 $1,330.57 63 $891.42 $1,145.29 $865.70 $1,112.25 $1,064.10 $1,367.16 64 $905.91 $1,163.91 $879.78 $1,130.34 $1,081.41 $1,389.39 65+ $905.91 $1,163.91 $879.78 $1,130.34 $1,081.41 $1,389.39 Rates Effective January 1, 2018 Page 44 of 44