Blue Options HSASM Individual 2010 Rates
Step 1: Find the appropriate rate table for the county of residence using the provided color-coded map.
Step 2: Use the appropriate table to determine the plan, the deductible and its corresponding rates for the applicant.
Step 3: Add the Optional Maternity Benefit if applicable (use the deductible that corresponds to the deductible selected in Step Two above).
Step 4: Sum the rates.
Note: Actual rates may change based on medical underwriting review. Rates are effective from 1/1/10 through 12/31/10.
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U3707, 10/09