|
Statewide
-Medical
Savings
Account
Plan, |
|||
|---|---|---|---|
| Costs incurred below the deductible may be tax deductible on your individual return. | |||
| SINGLE PERSON CONTRACT | |||
| MALE | Attained Age |
Deductible |
|
| $1650(SINGLE) | $2500(SINGLE) | ||
|
TO-24 |
68.12 | 56.42 | |
|
25-29 |
78.03 | 65.13 | |
|
30-34 |
93.64 | 77.38 | |
|
35-39 |
108.91 | 91.27 | |
|
40-44 |
130.55 | 109.22 | |
|
45-49 |
159.96 | 132.96 | |
|
50-54 |
194.82 | 162.21 | |
|
55-59 |
251.23 | 209.92 | |
|
60-64 |
316.48 | 263.98 | |
| FEMALE | Attained Age |
Deductible |
|
| $1650(SINGLE) | $2500(SINGLE) | ||
|
TO-24 |
92.84 | 76.85 | |
|
25-29 |
108.84 | 91.10 | |
|
30-34 |
130.78 | 109.03 | |
|
35-39 |
149.52 | 125.44 | |
|
40-44 |
169.92 | 142.17 | |
|
45-49 |
189.36 | 158.04 | |
|
50-54 |
216.87 | 181.68 | |
|
55-59 |
246.71 | 206.15 | |
|
60-64 |
276.27 | 231.05 | |
| MULTI-PERSON CONTRACT | |||
| MALE | Attained Age |
Deductible |
|
| $3300(FAMILY) | $4950(FAMILY) | ||
|
TO-24 |
53.21 | 43.42 | |
|
25-29 |
62.89 | 50.97 | |
|
30-34 |
75.68 | 61.12 | |
|
35-39 |
93.82 | 75.77 | |
|
40-44 |
113.31 | 92.65 | |
|
45-49 |
137.64 | 112.73 | |
|
50-54 |
170.33 | 139.29 | |
|
55-59 |
220.90 | 181.73 | |
|
60-64 |
281.21 | 229.87 | |
| FEMALE | Attained Age |
Deductible |
|
| $3300(FAMILY) | $4950(FAMILY) | ||
|
TO-24 |
79.41 | 64.66 | |
|
25-29 |
94.76 | 77.14 | |
|
30-34 |
115.57 | 94.50 | |
|
35-39 |
131.45 | 108.03 | |
|
40-44 |
149.81 | 122.33 | |
|
45-49 |
166.23 | 136.33 | |
|
50-54 |
193.49 | 158.97 | |
|
55-59 |
220.18 | 180.45 | |
|
60-64 |
245.82 | 201.50 | |
| $3300(FAMILY) | $4950(FAMILY) | ||
| CHILD(REN) | 97.74 | 78.63 | |
| MATERNITY | 75.75 | 55.08 | |
| SINGLE REHAB - $6.50 MULTI REHAB - $16.50 | |||
| Top G | |||