Individual and Family Health Plan Rates - BCBSIL*rates subject to change 225436.1020 Individual and...

*rates subject to change

225436.1020

Individual and Family Health Plan Rates

New Business Rates Effective January 1, 2021*

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

NOT FOR DISTRIBUTION TO BENEFICIARIES, MEMBERS, OR PROSPECTS

Rating Area Rating Area Description1 Chicago - Central, IL2 Chicago - North, IL3 Chicago - West, IL4 Chicago - South, IL5 Rockford, IL6 Quad Cities, IL7 Peoria, IL8 Bloomington, IL9 Champaign, IL

10 Springfield, IL11 East St. Louis, IL12 St. Louis, IL13 Southern, IL

Illinois Rating Area Descriptions

Rates Effective January 1, 2021 Page 1 of 44

County Rating Area County Rating AreaAdams 10 Lee 5

Alexander 13 Livingston 8Bond 11 Logan 10

Boone 5 Macon 10Brown 10 Macoupin 11Bureau 6 Madison 12Calhoun 11 Marion 13Carroll 5 Marshall 7Cass 10 Mason 10

Champaign 9 Massac 13Christian 10 McDonough 7

Clark 9 McHenry 2Clay 13 McLean 8

Clinton 11 Menard 10Coles 9 Mercer 6Cook 1 Monroe 12

Crawford 13 Montgomery 11Cumberland 9 Morgan 10

DeKalb 5 Moultrie 10DeWitt 8 Ogle 5Douglas 9 Peoria 7Dupage 3 Perry 13Edgar 9 Piatt 9

Edwards 13 Pike 10Effingham 13 Pope 13

Fayette 13 Pulaski 13Ford 9 Putnam 7

Franklin 13 Randolph 11Fulton 7 Richland 13

Gallatin 13 Rock Island 6Greene 11 Saline 13Grundy 4 Sangamon 10

Hamilton 13 Schuyler 10Hancock 6 Scott 10Hardin 13 Shelby 10

Henderson 6 St. Clair 12Henry 6 Stark 7

Iroquois 9 Stephenson 5Jackson 13 Tazewell 7Jasper 13 Union 13

Jefferson 13 Vermilion 9Jersey 11 Wabash 13

Jo Daviess 5 Warren 6Johnson 13 Washington 11

Kane 3 Wayne 13Kankakee 4 White 13

Kendall 4 Whiteside 6Knox 7 Will 4Lake 2 Williamson 13

LaSalle 7 Winnebago 5Lawrence 13 Woodford 7

Illinois County Mapping

Individual Coverage

Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco

0-14 $338.03 $338.03 $378.79 $378.79 $246.54 $246.54 $296.61 $296.6115 $368.08 $368.08 $412.46 $412.46 $268.45 $268.45 $322.97 $322.9716 $379.57 $379.57 $425.33 $425.33 $276.83 $276.83 $333.05 $333.0517 $391.05 $391.05 $438.20 $438.20 $285.21 $285.21 $343.13 $343.1318 $403.43 $403.43 $452.07 $452.07 $294.23 $294.23 $353.99 $353.9919 $415.80 $415.80 $465.93 $465.93 $303.26 $303.26 $364.85 $364.8520 $428.61 $428.61 $480.29 $480.29 $312.60 $312.60 $376.09 $376.0921 $441.87 $441.87 $495.14 $495.14 $322.27 $322.27 $387.72 $387.7222 $441.87 $441.87 $495.14 $495.14 $322.27 $322.27 $387.72 $387.7223 $441.87 $441.87 $495.14 $495.14 $322.27 $322.27 $387.72 $387.7224 $441.87 $441.87 $495.14 $495.14 $322.27 $322.27 $387.72 $387.7225 $443.64 $443.64 $497.12 $497.12 $323.56 $323.56 $389.27 $389.2726 $452.47 $452.47 $507.03 $507.03 $330.01 $330.01 $397.03 $397.0327 $463.08 $463.08 $518.91 $518.91 $337.74 $337.74 $406.33 $406.3328 $480.31 $480.31 $538.22 $538.22 $350.31 $350.31 $421.45 $421.4529 $494.45 $494.45 $554.07 $554.07 $360.62 $360.62 $433.86 $433.8630 $501.52 $568.83 $561.99 $637.41 $365.78 $414.87 $440.06 $499.1231 $512.13 $580.86 $573.87 $650.89 $373.51 $423.64 $449.37 $509.6732 $522.73 $592.88 $585.76 $664.36 $381.25 $432.41 $458.67 $520.2333 $529.36 $600.40 $593.18 $672.79 $386.08 $437.89 $464.49 $526.8234 $536.43 $608.42 $601.11 $681.77 $391.24 $443.74 $470.69 $533.8635 $539.96 $662.97 $605.07 $742.90 $393.82 $483.53 $473.79 $581.7236 $543.50 $667.31 $609.03 $747.76 $396.39 $486.69 $476.90 $585.5337 $547.03 $671.65 $612.99 $752.63 $398.97 $489.86 $480.00 $589.3438 $550.57 $675.99 $616.95 $757.49 $401.55 $493.02 $483.10 $593.1539 $557.64 $684.67 $624.87 $767.22 $406.71 $499.35 $489.30 $600.7740 $564.71 $728.14 $632.79 $815.92 $411.86 $531.06 $495.51 $638.9141 $575.31 $741.81 $644.68 $831.25 $419.60 $541.03 $504.81 $650.9142 $585.48 $754.92 $656.07 $845.93 $427.01 $550.59 $513.73 $662.4143 $599.62 $773.15 $671.91 $866.36 $437.32 $563.89 $526.14 $678.4044 $617.29 $795.94 $691.72 $891.90 $450.21 $580.51 $541.65 $698.4045 $638.06 $841.35 $714.99 $942.78 $465.36 $613.63 $559.87 $738.2446 $662.80 $873.97 $742.72 $979.35 $483.41 $637.42 $581.58 $766.8747 $690.64 $910.68 $773.91 $1,020.48 $503.71 $664.19 $606.01 $799.0848 $722.46 $952.63 $809.56 $1,067.49 $526.91 $694.79 $633.92 $835.8949 $753.83 $994.00 $844.72 $1,113.84 $549.80 $724.96 $661.45 $872.1950 $789.18 $1,043.45 $884.33 $1,169.26 $575.58 $761.03 $692.47 $915.5851 $824.09 $1,089.61 $923.44 $1,220.98 $601.04 $794.69 $723.10 $956.0852 $862.53 $1,140.44 $966.52 $1,277.93 $629.07 $831.76 $756.83 $1,000.6853 $901.41 $1,191.85 $1,010.09 $1,335.55 $657.43 $869.26 $790.95 $1,045.8054 $943.39 $1,247.35 $1,057.13 $1,397.74 $688.05 $909.74 $827.78 $1,094.5055 $985.37 $1,289.06 $1,104.17 $1,444.48 $718.67 $940.16 $864.62 $1,131.0956 $1,030.88 $1,348.60 $1,155.17 $1,511.20 $751.86 $983.58 $904.55 $1,183.3457 $1,076.84 $1,408.72 $1,206.67 $1,578.56 $785.38 $1,027.43 $944.88 $1,236.0858 $1,125.88 $1,472.88 $1,261.63 $1,650.46 $821.15 $1,074.23 $987.91 $1,292.3959 $1,150.19 $1,504.67 $1,288.86 $1,686.09 $838.87 $1,097.41 $1,009.24 $1,320.2860 $1,199.23 $1,540.78 $1,343.82 $1,726.54 $874.65 $1,123.75 $1,052.27 $1,351.9661 $1,241.65 $1,595.28 $1,391.36 $1,787.61 $905.58 $1,163.50 $1,089.50 $1,399.7862 $1,269.49 $1,631.04 $1,422.55 $1,827.69 $925.89 $1,189.58 $1,113.92 $1,431.1763 $1,304.40 $1,675.89 $1,461.67 $1,877.95 $951.35 $1,222.29 $1,144.55 $1,470.52

64+ $1,325.61 $1,703.14 $1,485.42 $1,908.48 $966.81 $1,242.17 $1,163.16 $1,494.43

BlueCare Direct GoldSM with Advocate

Chicago - Central, IL

Illinois Off Exchange (Gold)

211204

Blue Choice Preferred Gold PPOSM Blue FocusCare GoldSM

Blue Precision Gold HMOSM

Individual Coverage

Age Non Tobacco Tobacco Non Tobacco Tobacco

0-14 $333.25 $333.25 $367.71 $367.7115 $362.87 $362.87 $400.40 $400.4016 $374.20 $374.20 $412.89 $412.8917 $385.52 $385.52 $425.39 $425.3918 $397.72 $397.72 $438.85 $438.8519 $409.92 $409.92 $452.31 $452.3120 $422.55 $422.55 $466.25 $466.2521 $435.62 $435.62 $480.67 $480.6722 $435.62 $435.62 $480.67 $480.6723 $435.62 $435.62 $480.67 $480.6724 $435.62 $435.62 $480.67 $480.6725 $437.36 $437.36 $482.59 $482.5926 $446.08 $446.08 $492.20 $492.2027 $456.53 $456.53 $503.74 $503.7428 $473.52 $473.52 $522.48 $522.4829 $487.46 $487.46 $537.87 $537.8730 $494.43 $560.78 $545.56 $618.7731 $504.88 $572.64 $557.09 $631.8632 $515.34 $584.50 $568.63 $644.9433 $521.87 $591.91 $575.84 $653.1234 $528.84 $599.82 $583.53 $661.8435 $532.33 $653.59 $587.37 $721.1836 $535.81 $657.87 $591.22 $725.9037 $539.30 $662.15 $595.07 $730.6238 $542.78 $666.43 $598.91 $735.3439 $549.75 $674.99 $606.60 $744.7840 $556.72 $717.84 $614.29 $792.0741 $567.18 $731.32 $625.83 $806.9442 $577.20 $744.24 $636.88 $821.2043 $591.14 $762.21 $652.26 $841.0344 $608.56 $784.68 $671.49 $865.8245 $629.04 $829.45 $694.08 $915.2246 $653.43 $861.61 $721.00 $950.7147 $680.88 $897.80 $751.28 $990.6448 $712.24 $939.16 $785.89 $1,036.2749 $743.17 $979.94 $820.02 $1,081.2750 $778.02 $1,028.70 $858.47 $1,135.0751 $812.43 $1,074.20 $896.44 $1,185.2852 $850.33 $1,124.31 $938.26 $1,240.5753 $888.67 $1,175.00 $980.56 $1,296.5054 $930.05 $1,229.71 $1,026.22 $1,356.8755 $971.43 $1,270.83 $1,071.89 $1,402.2456 $1,016.30 $1,329.53 $1,121.40 $1,467.0157 $1,061.61 $1,388.79 $1,171.38 $1,532.4058 $1,109.96 $1,452.05 $1,224.74 $1,602.2059 $1,133.92 $1,483.39 $1,251.18 $1,636.7960 $1,182.28 $1,518.99 $1,304.53 $1,676.0661 $1,224.09 $1,572.72 $1,350.67 $1,735.3562 $1,251.54 $1,607.98 $1,380.96 $1,774.2563 $1,285.95 $1,652.19 $1,418.93 $1,823.04

64+ $1,306.86 $1,679.06 $1,442.01 $1,852.68

Chicago - North, ILBlue Choice Preferred Gold PPOSM

207Blue Precision Gold HMOSM

Individual Coverage

Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco

0-14 $321.55 $321.55 $356.76 $356.76 $304.89 $304.8915 $350.14 $350.14 $388.47 $388.47 $331.99 $331.9916 $361.07 $361.07 $400.60 $400.60 $342.36 $342.3617 $371.99 $371.99 $412.72 $412.72 $352.72 $352.7218 $383.76 $383.76 $425.78 $425.78 $363.88 $363.8819 $395.53 $395.53 $438.84 $438.84 $375.04 $375.0420 $407.72 $407.72 $452.36 $452.36 $386.59 $386.5921 $420.33 $420.33 $466.35 $466.35 $398.55 $398.5522 $420.33 $420.33 $466.35 $466.35 $398.55 $398.5523 $420.33 $420.33 $466.35 $466.35 $398.55 $398.5524 $420.33 $420.33 $466.35 $466.35 $398.55 $398.5525 $422.01 $422.01 $468.22 $468.22 $400.15 $400.1526 $430.42 $430.42 $477.54 $477.54 $408.12 $408.1227 $440.51 $440.51 $488.74 $488.74 $417.68 $417.6828 $456.90 $456.90 $506.92 $506.92 $433.23 $433.2329 $470.35 $470.35 $521.85 $521.85 $445.98 $445.9830 $477.08 $541.10 $529.31 $600.34 $452.36 $513.0631 $487.17 $552.54 $540.50 $613.04 $461.92 $523.9132 $497.25 $563.99 $551.69 $625.73 $471.49 $534.7633 $503.56 $571.14 $558.69 $633.66 $477.46 $541.5434 $510.28 $578.77 $566.15 $642.13 $483.84 $548.7735 $513.65 $630.66 $569.88 $699.70 $487.03 $597.9736 $517.01 $634.78 $573.61 $704.28 $490.22 $601.8937 $520.37 $638.91 $577.34 $708.86 $493.41 $605.8138 $523.74 $643.04 $581.07 $713.44 $496.59 $609.7239 $530.46 $651.30 $588.54 $722.60 $502.97 $617.5540 $537.19 $692.65 $596.00 $768.48 $509.35 $656.7541 $547.27 $705.66 $607.19 $782.91 $518.91 $669.0942 $556.94 $718.12 $617.92 $796.74 $528.08 $680.9143 $570.39 $735.47 $632.84 $815.98 $540.83 $697.3544 $587.21 $757.14 $651.49 $840.03 $556.78 $717.9145 $606.96 $800.34 $673.41 $887.96 $575.51 $758.8746 $630.50 $831.38 $699.53 $922.40 $597.83 $788.2947 $656.98 $866.29 $728.91 $961.14 $622.94 $821.4048 $687.24 $906.20 $762.48 $1,005.41 $651.63 $859.2449 $717.09 $945.55 $795.60 $1,049.07 $679.93 $896.5550 $750.72 $992.60 $832.90 $1,101.27 $711.81 $941.1651 $783.92 $1,036.50 $869.75 $1,149.98 $743.30 $982.7952 $820.49 $1,084.85 $910.32 $1,203.62 $777.97 $1,028.6353 $857.48 $1,133.76 $951.36 $1,257.88 $813.04 $1,075.0154 $897.41 $1,186.56 $995.66 $1,316.46 $850.91 $1,125.0755 $937.34 $1,226.23 $1,039.96 $1,360.48 $888.77 $1,162.6956 $980.64 $1,282.87 $1,088.00 $1,423.32 $929.82 $1,216.3957 $1,024.35 $1,340.06 $1,136.50 $1,486.77 $971.27 $1,270.6158 $1,071.01 $1,401.09 $1,188.26 $1,554.48 $1,015.51 $1,328.4959 $1,094.13 $1,431.34 $1,213.91 $1,588.04 $1,037.43 $1,357.1660 $1,140.78 $1,465.68 $1,265.68 $1,626.14 $1,081.67 $1,389.7361 $1,181.14 $1,517.52 $1,310.45 $1,683.66 $1,119.93 $1,438.8962 $1,207.62 $1,551.55 $1,339.83 $1,721.41 $1,145.04 $1,471.1463 $1,240.82 $1,594.21 $1,376.67 $1,768.74 $1,176.52 $1,511.60

64+ $1,260.99 $1,620.13 $1,399.05 $1,797.50 $1,195.65 $1,536.18

Chicago - West, ILBlue Precision Gold HMOSM Blue Choice Preferred Gold PPOSM BlueCare Direct GoldSM with

Advocate204 409

Individual Coverage

0-14 $310.61 $310.61 $352.00 $352.0015 $338.22 $338.22 $383.28 $383.2816 $348.78 $348.78 $395.25 $395.2517 $359.33 $359.33 $407.21 $407.2118 $370.70 $370.70 $420.09 $420.0919 $382.07 $382.07 $432.98 $432.9820 $393.85 $393.85 $446.32 $446.3221 $406.03 $406.03 $460.13 $460.1322 $406.03 $406.03 $460.13 $460.1323 $406.03 $406.03 $460.13 $460.1324 $406.03 $406.03 $460.13 $460.1325 $407.65 $407.65 $461.97 $461.9726 $415.77 $415.77 $471.17 $471.1727 $425.52 $425.52 $482.21 $482.2128 $441.35 $441.35 $500.16 $500.1629 $454.34 $454.34 $514.88 $514.8830 $460.84 $522.69 $522.24 $592.3331 $470.59 $533.74 $533.29 $604.8532 $480.33 $544.79 $544.33 $617.3833 $486.42 $551.70 $551.23 $625.2034 $492.92 $559.07 $558.59 $633.5635 $496.17 $609.19 $562.27 $690.3636 $499.41 $613.18 $565.95 $694.8837 $502.66 $617.17 $569.64 $699.4038 $505.91 $621.16 $573.32 $703.9239 $512.41 $629.13 $580.68 $712.9640 $518.90 $669.07 $588.04 $758.2241 $528.65 $681.64 $599.08 $772.4642 $537.99 $693.68 $609.67 $786.1143 $550.98 $710.43 $624.39 $805.0944 $567.22 $731.37 $642.80 $828.8245 $586.30 $773.10 $664.42 $876.1146 $609.04 $803.08 $690.19 $910.0847 $634.62 $836.81 $719.18 $948.3148 $663.86 $875.36 $752.31 $991.9949 $692.68 $913.37 $784.97 $1,035.0750 $725.17 $958.81 $821.78 $1,086.5651 $757.24 $1,001.22 $858.13 $1,134.6252 $792.57 $1,047.93 $898.17 $1,187.5553 $828.30 $1,095.17 $938.66 $1,241.0954 $866.87 $1,146.18 $982.37 $1,298.8955 $905.44 $1,184.50 $1,026.08 $1,342.3256 $947.26 $1,239.21 $1,073.47 $1,404.3257 $989.49 $1,294.45 $1,121.33 $1,466.9258 $1,034.56 $1,353.41 $1,172.40 $1,533.7359 $1,056.89 $1,382.62 $1,197.71 $1,566.8460 $1,101.96 $1,415.80 $1,248.78 $1,604.4461 $1,140.94 $1,465.88 $1,292.95 $1,661.1962 $1,166.52 $1,498.74 $1,321.94 $1,698.4363 $1,198.59 $1,539.95 $1,358.29 $1,745.13

64+ $1,218.09 $1,564.99 $1,380.39 $1,773.51

Chicago - South, ILBlue Choice Preferred Gold PPOSM

Individual Coverage

0-14 $344.39 $344.39 $438.94 $438.9415 $375.01 $375.01 $477.96 $477.9616 $386.71 $386.71 $492.87 $492.8717 $398.42 $398.42 $507.79 $507.7918 $411.02 $411.02 $523.86 $523.8619 $423.63 $423.63 $539.92 $539.9220 $436.68 $436.68 $556.56 $556.5621 $450.19 $450.19 $573.78 $573.7822 $450.19 $450.19 $573.78 $573.7823 $450.19 $450.19 $573.78 $573.7824 $450.19 $450.19 $573.78 $573.7825 $451.99 $451.99 $576.07 $576.0726 $460.99 $460.99 $587.55 $587.5527 $471.80 $471.80 $601.32 $601.3228 $489.36 $489.36 $623.70 $623.7029 $503.76 $503.76 $642.06 $642.0630 $510.96 $579.54 $651.24 $738.6431 $521.77 $591.79 $665.01 $754.2532 $532.57 $604.05 $678.78 $769.8733 $539.33 $611.70 $687.39 $779.6334 $546.53 $619.87 $696.57 $790.0535 $550.13 $675.45 $701.16 $860.8836 $553.73 $679.87 $705.75 $866.5137 $557.33 $684.30 $710.34 $872.1538 $560.94 $688.72 $714.93 $877.7939 $568.14 $697.56 $724.11 $889.0640 $575.34 $741.84 $733.29 $945.5041 $586.15 $755.78 $747.06 $963.2642 $596.50 $769.13 $760.26 $980.2843 $610.91 $787.70 $778.62 $1,003.9544 $628.91 $810.92 $801.57 $1,033.5445 $650.07 $857.19 $828.53 $1,092.5146 $675.28 $890.43 $860.67 $1,134.8747 $703.65 $927.83 $896.81 $1,182.5448 $736.06 $970.57 $938.13 $1,237.0149 $768.02 $1,012.71 $978.86 $1,290.7350 $804.04 $1,063.10 $1,024.77 $1,354.9551 $839.60 $1,110.12 $1,070.09 $1,414.8852 $878.77 $1,161.91 $1,120.01 $1,480.8853 $918.39 $1,214.29 $1,170.51 $1,547.6454 $961.15 $1,270.84 $1,225.01 $1,619.7255 $1,003.92 $1,313.33 $1,279.52 $1,673.8856 $1,050.29 $1,373.99 $1,338.62 $1,751.1957 $1,097.11 $1,435.24 $1,398.30 $1,829.2558 $1,147.08 $1,500.61 $1,461.98 $1,912.5759 $1,171.84 $1,533.00 $1,493.54 $1,953.8560 $1,221.81 $1,569.79 $1,557.23 $2,000.7361 $1,265.03 $1,625.31 $1,612.31 $2,071.5062 $1,293.39 $1,661.75 $1,648.46 $2,117.9463 $1,328.96 $1,707.45 $1,693.79 $2,176.18

64+ $1,350.57 $1,735.21 $1,721.34 $2,211.57

Rockford, ILBlue Precision Gold HMOSM Blue Choice Preferred Gold PPOSM

Individual Coverage

Age Non Tobacco Tobacco

0-14 $381.73 $381.7315 $415.66 $415.6616 $428.64 $428.6417 $441.61 $441.6118 $455.58 $455.5819 $469.55 $469.5520 $484.03 $484.0321 $498.99 $498.9922 $498.99 $498.9923 $498.99 $498.9924 $498.99 $498.9925 $500.99 $500.9926 $510.97 $510.9727 $522.95 $522.9528 $542.41 $542.4129 $558.38 $558.3830 $566.36 $642.3731 $578.34 $655.9532 $590.31 $669.5333 $597.80 $678.0234 $605.78 $687.0835 $609.77 $748.6836 $613.76 $753.5837 $617.76 $758.4838 $621.75 $763.3839 $629.73 $773.1840 $637.72 $822.2741 $649.69 $837.7142 $661.17 $852.5143 $677.14 $873.1044 $697.10 $898.8345 $720.55 $950.1246 $748.49 $986.9647 $779.93 $1,028.4148 $815.86 $1,075.7949 $851.29 $1,122.5050 $891.20 $1,178.3551 $930.63 $1,230.4752 $974.04 $1,287.8753 $1,017.95 $1,345.9354 $1,065.35 $1,408.6155 $1,112.76 $1,455.7156 $1,164.16 $1,522.9557 $1,216.05 $1,590.8458 $1,271.44 $1,663.2959 $1,298.88 $1,699.2060 $1,354.27 $1,739.9761 $1,402.18 $1,801.5262 $1,433.61 $1,841.9163 $1,473.03 $1,892.55

64+ $1,496.97 $1,923.33

Quad Cities, ILBlue Choice Preferred Gold PPOSM

Illinois Off Exchange (Gold)Individual Coverage

0-14 $397.14 $397.14 $422.88 $422.8815 $432.44 $432.44 $460.47 $460.4716 $445.94 $445.94 $474.84 $474.8417 $459.44 $459.44 $489.22 $489.2218 $473.98 $473.98 $504.69 $504.6919 $488.51 $488.51 $520.17 $520.1720 $503.57 $503.57 $536.20 $536.2021 $519.14 $519.14 $552.79 $552.7922 $519.14 $519.14 $552.79 $552.7923 $519.14 $519.14 $552.79 $552.7924 $519.14 $519.14 $552.79 $552.7925 $521.22 $521.22 $555.00 $555.0026 $531.60 $531.60 $566.05 $566.0527 $544.06 $544.06 $579.32 $579.3228 $564.31 $564.31 $600.88 $600.8829 $580.92 $580.92 $618.57 $618.5730 $589.23 $668.30 $627.41 $711.6131 $601.68 $682.43 $640.68 $726.6632 $614.14 $696.56 $653.95 $741.7133 $621.93 $705.39 $662.24 $751.1134 $630.24 $714.82 $671.08 $761.1435 $634.39 $778.90 $675.51 $829.3936 $638.54 $784.00 $679.93 $834.8137 $642.70 $789.11 $684.35 $840.2538 $646.85 $794.20 $688.77 $845.6839 $655.16 $804.40 $697.62 $856.5340 $663.46 $855.47 $706.46 $910.9141 $675.92 $871.53 $719.73 $928.0242 $687.86 $886.93 $732.44 $944.4143 $704.47 $908.35 $750.13 $967.2244 $725.24 $935.12 $772.24 $995.7345 $749.64 $988.48 $798.22 $1,052.5446 $778.71 $1,026.81 $829.18 $1,093.3647 $811.42 $1,069.93 $864.01 $1,139.2848 $848.80 $1,119.22 $903.81 $1,191.7649 $885.65 $1,167.82 $943.06 $1,243.5150 $927.19 $1,225.93 $987.28 $1,305.3851 $968.20 $1,280.15 $1,030.95 $1,363.1252 $1,013.36 $1,339.87 $1,079.04 $1,426.7153 $1,059.05 $1,400.27 $1,127.69 $1,491.0354 $1,108.37 $1,465.48 $1,180.20 $1,560.4655 $1,157.68 $1,514.49 $1,232.72 $1,612.6456 $1,211.16 $1,584.43 $1,289.65 $1,687.1257 $1,265.15 $1,655.06 $1,347.14 $1,762.3358 $1,322.77 $1,730.45 $1,408.50 $1,842.6059 $1,351.32 $1,767.80 $1,438.91 $1,882.3760 $1,408.95 $1,810.22 $1,500.26 $1,927.5461 $1,458.79 $1,874.25 $1,553.33 $1,995.7262 $1,491.49 $1,916.27 $1,588.16 $2,040.4763 $1,532.50 $1,968.96 $1,631.83 $2,096.57

64+ $1,557.42 $2,000.98 $1,658.37 $2,130.66

Blue Choice Preferred Gold PPOSM

Peoria, IL

Individual Coverage

0-14 $404.24 $404.2415 $440.18 $440.1816 $453.92 $453.9217 $467.65 $467.6518 $482.45 $482.4519 $497.25 $497.2520 $512.57 $512.5721 $528.42 $528.4222 $528.42 $528.4223 $528.42 $528.4224 $528.42 $528.4225 $530.54 $530.5426 $541.11 $541.1127 $553.79 $553.7928 $574.40 $574.4029 $591.31 $591.3130 $599.76 $680.2531 $612.44 $694.6332 $625.12 $709.0233 $633.05 $718.0134 $641.51 $727.6035 $645.73 $792.8336 $649.96 $798.0237 $654.19 $803.2138 $658.42 $808.4039 $666.87 $818.7840 $675.32 $870.7641 $688.01 $887.1242 $700.16 $902.7943 $717.07 $924.5944 $738.21 $951.8445 $763.04 $1,006.1546 $792.63 $1,045.1747 $825.93 $1,089.0648 $863.97 $1,139.2349 $901.49 $1,188.7050 $943.76 $1,247.8551 $985.51 $1,303.0452 $1,031.48 $1,363.8253 $1,077.98 $1,425.3154 $1,128.18 $1,491.6955 $1,178.38 $1,541.5656 $1,232.81 $1,612.7657 $1,287.77 $1,684.6658 $1,346.42 $1,761.3959 $1,375.49 $1,799.4160 $1,434.14 $1,842.5961 $1,484.87 $1,907.7662 $1,518.16 $1,950.5363 $1,559.91 $2,004.17

64+ $1,585.26 $2,036.75

Blue Choice Preferred Gold PPOSM

Bloomington, IL

Individual Coverage

0-14 $436.92 $436.9215 $475.75 $475.7516 $490.60 $490.6017 $505.45 $505.4518 $521.45 $521.4519 $537.44 $537.4420 $554.00 $554.0021 $571.13 $571.1322 $571.13 $571.1323 $571.13 $571.1324 $571.13 $571.1325 $573.42 $573.4226 $584.84 $584.8427 $598.55 $598.5528 $620.82 $620.8229 $639.10 $639.1030 $648.24 $735.2331 $661.94 $750.7832 $675.65 $766.3233 $684.22 $776.0434 $693.36 $786.4135 $697.93 $856.9136 $702.49 $862.5237 $707.06 $868.1438 $711.63 $873.7439 $720.77 $884.9640 $729.91 $941.1441 $743.62 $958.8242 $756.75 $975.7643 $775.03 $999.3244 $797.87 $1,028.7845 $824.72 $1,087.4746 $856.70 $1,129.6547 $892.68 $1,177.0948 $933.80 $1,231.3149 $974.35 $1,284.7850 $1,020.05 $1,348.7051 $1,065.16 $1,408.3652 $1,114.85 $1,474.0653 $1,165.11 $1,540.5154 $1,219.37 $1,612.2555 $1,273.63 $1,666.1656 $1,332.46 $1,743.1257 $1,391.85 $1,820.8258 $1,455.25 $1,903.7659 $1,486.66 $1,944.8560 $1,550.06 $1,991.5261 $1,604.89 $2,061.9662 $1,640.87 $2,108.1963 $1,685.99 $2,166.16

64+ $1,713.39 $2,201.38

Champaign, ILBlue Choice Preferred Gold PPOSM

Individual Coverage

0-14 $399.71 $399.7115 $435.24 $435.2416 $448.83 $448.8317 $462.41 $462.4118 $477.04 $477.0419 $491.67 $491.6720 $506.82 $506.8221 $522.50 $522.5022 $522.50 $522.5023 $522.50 $522.5024 $522.50 $522.5025 $524.59 $524.5926 $535.04 $535.0427 $547.58 $547.5828 $567.96 $567.9629 $584.68 $584.6830 $593.04 $672.6231 $605.58 $686.8532 $618.12 $701.0733 $625.95 $709.9634 $634.31 $719.4435 $638.49 $783.9436 $642.67 $789.0737 $646.85 $794.2138 $651.03 $799.3439 $659.39 $809.6040 $667.75 $861.0041 $680.29 $877.1742 $692.31 $892.6743 $709.03 $914.2344 $729.93 $941.1745 $754.49 $994.8746 $783.75 $1,033.4547 $816.67 $1,076.8548 $854.29 $1,126.4649 $891.38 $1,175.3850 $933.18 $1,233.8551 $974.46 $1,288.4352 $1,019.92 $1,348.5353 $1,065.90 $1,409.3354 $1,115.53 $1,474.9655 $1,165.17 $1,524.2856 $1,218.99 $1,594.6857 $1,273.33 $1,665.7758 $1,331.33 $1,741.6459 $1,360.06 $1,779.2360 $1,418.06 $1,821.9361 $1,468.22 $1,886.3762 $1,501.14 $1,928.6663 $1,542.42 $1,981.70

64+ $1,567.50 $2,013.92

Springfield, ILBlue Choice Preferred Gold PPOSM

Individual Coverage

0-14 $404.87 $404.8715 $440.85 $440.8516 $454.61 $454.6117 $468.37 $468.3718 $483.19 $483.1919 $498.01 $498.0120 $513.36 $513.3621 $529.24 $529.2422 $529.24 $529.2423 $529.24 $529.2424 $529.24 $529.2425 $531.35 $531.3526 $541.94 $541.9427 $554.64 $554.6428 $575.28 $575.2829 $592.22 $592.2230 $600.68 $681.3031 $613.39 $695.7032 $626.09 $710.1133 $634.03 $719.1134 $642.49 $728.7235 $646.73 $794.0536 $650.96 $799.2537 $655.20 $804.4538 $659.43 $809.6539 $667.90 $820.0440 $676.36 $872.1041 $689.07 $888.4842 $701.24 $904.1843 $718.17 $926.0244 $739.34 $953.3145 $764.22 $1,007.7046 $793.86 $1,046.7847 $827.20 $1,090.7448 $865.30 $1,140.9949 $902.88 $1,190.5350 $945.22 $1,249.7751 $987.03 $1,305.0552 $1,033.07 $1,365.9253 $1,079.64 $1,427.5154 $1,129.92 $1,493.9855 $1,180.20 $1,543.9456 $1,234.71 $1,615.2557 $1,289.75 $1,687.2558 $1,348.50 $1,764.1059 $1,377.60 $1,802.1860 $1,436.35 $1,845.4261 $1,487.16 $1,910.7062 $1,520.50 $1,953.5463 $1,562.31 $2,007.25

64+ $1,587.72 $2,039.89

East St. Louis, ILBlue Choice Preferred Gold PPOSM

Individual Coverage

0-14 $366.61 $366.6115 $399.20 $399.2016 $411.66 $411.6617 $424.12 $424.1218 $437.54 $437.5419 $450.96 $450.9620 $464.86 $464.8621 $479.23 $479.2322 $479.23 $479.2323 $479.23 $479.2324 $479.23 $479.2325 $481.15 $481.1526 $490.74 $490.7427 $502.24 $502.2428 $520.93 $520.9329 $536.26 $536.2630 $543.93 $616.9331 $555.43 $629.9732 $566.93 $643.0233 $574.12 $651.1734 $581.79 $659.8735 $585.62 $719.0336 $589.46 $723.7337 $593.29 $728.4538 $597.13 $733.1539 $604.79 $742.5640 $612.46 $789.7141 $623.96 $804.5442 $634.99 $818.7543 $650.32 $838.5344 $669.49 $863.2445 $692.01 $912.4946 $718.85 $947.8847 $749.04 $987.6948 $783.55 $1,033.1949 $817.57 $1,078.0550 $855.91 $1,131.6951 $893.77 $1,181.7452 $935.47 $1,236.8753 $977.64 $1,292.6354 $1,023.17 $1,352.8355 $1,068.69 $1,398.0756 $1,118.05 $1,462.6457 $1,167.89 $1,527.8458 $1,221.09 $1,597.4359 $1,247.45 $1,631.9160 $1,300.64 $1,671.0761 $1,346.65 $1,730.1862 $1,376.84 $1,768.9663 $1,414.70 $1,817.61

64+ $1,437.69 $1,847.16

St. Louis, ILBlue Choice Preferred Gold PPOSM

Individual Coverage

0-14 $485.30 $485.3015 $528.44 $528.4416 $544.93 $544.9317 $561.43 $561.4318 $579.19 $579.1919 $596.95 $596.9520 $615.35 $615.3521 $634.38 $634.3822 $634.38 $634.3823 $634.38 $634.3824 $634.38 $634.3825 $636.92 $636.9226 $649.61 $649.6127 $664.83 $664.8328 $689.57 $689.5729 $709.87 $709.8730 $720.02 $816.6531 $735.25 $833.9232 $750.47 $851.1933 $759.99 $861.9834 $770.14 $873.4935 $775.22 $951.8136 $780.29 $958.0437 $785.37 $964.2738 $790.44 $970.5039 $800.59 $982.9640 $810.74 $1,045.3741 $825.97 $1,065.0042 $840.56 $1,083.8243 $860.86 $1,109.9944 $886.23 $1,142.7145 $916.05 $1,207.9046 $951.57 $1,254.7547 $991.54 $1,307.4448 $1,037.22 $1,367.6749 $1,082.26 $1,427.0650 $1,133.01 $1,498.0651 $1,183.12 $1,564.3252 $1,238.31 $1,637.3053 $1,294.14 $1,711.1154 $1,354.41 $1,790.8055 $1,414.67 $1,850.6856 $1,480.01 $1,936.1557 $1,545.99 $2,022.4658 $1,616.41 $2,114.5859 $1,651.30 $2,160.2360 $1,721.71 $2,212.0661 $1,782.62 $2,290.3162 $1,822.58 $2,341.6563 $1,872.70 $2,406.04

64+ $1,903.14 $2,445.16

Southern, ILBlue Choice Preferred Gold PPOSM

Individual Coverage

Age Non Tobacco

TobaccoNon

TobaccoTobacco

Non Tobacco

TobaccoNon

TobaccoTobacco

Non Tobacco

TobaccoNon

TobaccoTobacco

0-14 $294.22 $294.22 $273.58 $273.58 $258.17 $258.17 $325.13 $325.13 $285.11 $285.11 $213.76 $213.7615 $320.38 $320.38 $297.89 $297.89 $281.12 $281.12 $354.03 $354.03 $310.45 $310.45 $232.76 $232.7616 $330.38 $330.38 $307.19 $307.19 $289.89 $289.89 $365.08 $365.08 $320.14 $320.14 $240.02 $240.0217 $340.38 $340.38 $316.49 $316.49 $298.67 $298.67 $376.13 $376.13 $329.83 $329.83 $247.29 $247.2918 $351.15 $351.15 $326.50 $326.50 $308.12 $308.12 $388.03 $388.03 $340.27 $340.27 $255.11 $255.1119 $361.92 $361.92 $336.52 $336.52 $317.57 $317.57 $399.93 $399.93 $350.70 $350.70 $262.93 $262.9320 $373.07 $373.07 $346.89 $346.89 $327.36 $327.36 $412.26 $412.26 $361.51 $361.51 $271.04 $271.0421 $384.61 $384.61 $357.61 $357.61 $337.48 $337.48 $425.01 $425.01 $372.69 $372.69 $279.42 $279.4222 $384.61 $384.61 $357.61 $357.61 $337.48 $337.48 $425.01 $425.01 $372.69 $372.69 $279.42 $279.4223 $384.61 $384.61 $357.61 $357.61 $337.48 $337.48 $425.01 $425.01 $372.69 $372.69 $279.42 $279.4224 $384.61 $384.61 $357.61 $357.61 $337.48 $337.48 $425.01 $425.01 $372.69 $372.69 $279.42 $279.4225 $386.15 $386.15 $359.05 $359.05 $338.83 $338.83 $426.71 $426.71 $374.18 $374.18 $280.54 $280.5426 $393.84 $393.84 $366.20 $366.20 $345.58 $345.58 $435.21 $435.21 $381.64 $381.64 $286.13 $286.1327 $403.07 $403.07 $374.78 $374.78 $353.68 $353.68 $445.41 $445.41 $390.58 $390.58 $292.83 $292.8328 $418.07 $418.07 $388.73 $388.73 $366.84 $366.84 $461.98 $461.98 $405.12 $405.12 $303.73 $303.7329 $430.38 $430.38 $400.17 $400.17 $377.64 $377.64 $475.58 $475.58 $417.04 $417.04 $312.67 $312.6730 $436.53 $495.11 $405.89 $460.36 $383.04 $434.44 $482.38 $547.12 $423.01 $479.78 $317.14 $359.7031 $445.76 $505.58 $414.48 $470.10 $391.14 $443.63 $492.58 $558.69 $431.95 $489.92 $323.85 $367.3132 $454.99 $516.05 $423.06 $479.83 $399.24 $452.82 $502.78 $570.26 $440.90 $500.07 $330.55 $374.9133 $460.76 $522.59 $428.42 $485.92 $404.30 $458.56 $509.16 $577.49 $446.49 $506.41 $334.74 $379.6734 $466.91 $529.57 $434.14 $492.41 $409.70 $464.68 $515.96 $585.20 $452.45 $513.17 $339.22 $384.7435 $469.99 $577.05 $437.01 $536.55 $412.40 $506.34 $519.36 $637.67 $455.43 $559.18 $341.45 $419.2336 $473.07 $580.83 $439.87 $540.07 $415.10 $509.66 $522.76 $641.84 $458.41 $562.84 $343.69 $421.9837 $476.14 $584.61 $442.73 $543.58 $417.80 $512.98 $526.16 $646.02 $461.39 $566.50 $345.92 $424.7238 $479.22 $588.39 $445.59 $547.09 $420.50 $516.29 $529.56 $650.19 $464.38 $570.16 $348.16 $427.4739 $485.37 $595.94 $451.31 $554.12 $425.90 $522.92 $536.36 $658.54 $470.34 $577.48 $352.63 $432.9540 $491.53 $633.77 $457.03 $589.30 $431.30 $556.12 $543.16 $700.35 $476.30 $614.14 $357.10 $460.4441 $500.76 $645.68 $465.61 $600.36 $439.40 $566.56 $553.36 $713.50 $485.25 $625.68 $363.80 $469.0942 $509.60 $657.09 $473.84 $610.97 $447.16 $576.57 $563.14 $726.11 $493.82 $636.73 $370.23 $477.3843 $521.91 $672.95 $485.28 $625.73 $457.96 $590.49 $576.74 $743.64 $505.75 $652.11 $379.17 $488.9144 $537.30 $692.79 $499.59 $644.17 $471.46 $607.90 $593.74 $765.56 $520.65 $671.33 $390.35 $503.3245 $555.37 $732.31 $516.40 $680.92 $487.32 $642.58 $613.71 $809.24 $538.17 $709.63 $403.48 $532.0346 $576.91 $760.71 $536.42 $707.33 $506.22 $667.50 $637.51 $840.62 $559.04 $737.15 $419.13 $552.6647 $601.14 $792.66 $558.95 $737.03 $527.48 $695.53 $664.29 $875.93 $582.52 $768.11 $436.73 $575.8748 $628.83 $829.18 $584.70 $770.99 $551.78 $727.58 $694.89 $916.28 $609.35 $803.49 $456.85 $602.4049 $656.14 $865.19 $610.09 $804.47 $575.74 $759.17 $725.06 $956.07 $635.82 $838.39 $476.69 $628.5650 $686.91 $908.23 $638.70 $844.49 $602.74 $796.94 $759.06 $1,003.63 $665.63 $880.10 $499.04 $659.8351 $717.29 $948.40 $666.95 $881.84 $629.40 $832.19 $792.64 $1,048.03 $695.07 $919.03 $521.12 $689.0252 $750.75 $992.64 $698.06 $922.98 $658.76 $871.01 $829.62 $1,096.92 $727.50 $961.90 $545.43 $721.1653 $784.60 $1,037.40 $729.53 $964.59 $688.46 $910.28 $867.02 $1,146.37 $760.30 $1,005.26 $570.02 $753.6754 $821.14 $1,085.71 $763.51 $1,009.51 $720.52 $952.67 $907.39 $1,199.75 $795.70 $1,052.08 $596.56 $788.7755 $857.67 $1,122.01 $797.48 $1,043.27 $752.58 $984.53 $947.77 $1,239.87 $831.11 $1,087.26 $623.11 $815.1556 $897.29 $1,173.83 $834.32 $1,091.45 $787.34 $1,030.00 $991.54 $1,297.14 $869.49 $1,137.47 $651.89 $852.8057 $937.29 $1,226.16 $871.51 $1,140.10 $822.44 $1,075.91 $1,035.74 $1,354.96 $908.25 $1,188.18 $680.94 $890.8158 $979.98 $1,282.01 $911.20 $1,192.03 $859.90 $1,124.92 $1,082.92 $1,416.67 $949.62 $1,242.30 $711.96 $931.3959 $1,001.13 $1,309.68 $930.87 $1,217.76 $878.46 $1,149.20 $1,106.30 $1,447.25 $970.12 $1,269.11 $727.33 $951.4960 $1,043.82 $1,341.11 $970.57 $1,246.99 $915.92 $1,176.77 $1,153.47 $1,481.98 $1,011.49 $1,299.56 $758.34 $974.3261 $1,080.75 $1,388.54 $1,004.90 $1,291.09 $948.32 $1,218.40 $1,194.27 $1,534.40 $1,047.27 $1,345.53 $785.17 $1,008.7862 $1,104.98 $1,419.67 $1,027.43 $1,320.04 $969.58 $1,245.71 $1,221.05 $1,568.80 $1,070.75 $1,375.70 $802.77 $1,031.4063 $1,135.36 $1,458.71 $1,055.68 $1,356.34 $996.24 $1,279.97 $1,254.62 $1,611.94 $1,100.19 $1,413.53 $824.85 $1,059.76

64+ $1,153.83 $1,482.43 $1,072.83 $1,378.39 $1,012.44 $1,300.78 $1,275.03 $1,638.15 $1,118.07 $1,436.51 $838.26 $1,076.99

Illinois Off Exchange (Silver)

203 303212

BlueCare Direct SilverSM

306206with Advocate

Blue Precision Silver HMOSM Blue Choice Preferred Silver PPOSM Blue FocusCare SilverSM

Individual Coverage

Age Non Tobacco

TobaccoNon

TobaccoTobacco

Non Tobacco

TobaccoNon

TobaccoTobacco

Non Tobacco

Tobacco

0-14 $290.22 $290.22 $269.64 $269.64 $268.30 $268.30 $316.17 $316.17 $277.26 $277.2615 $316.01 $316.01 $293.61 $293.61 $292.15 $292.15 $344.28 $344.28 $301.90 $301.9016 $325.88 $325.88 $302.77 $302.77 $301.27 $301.27 $355.02 $355.02 $311.32 $311.3217 $335.74 $335.74 $311.94 $311.94 $310.39 $310.39 $365.77 $365.77 $320.75 $320.7518 $346.36 $346.36 $321.81 $321.81 $320.21 $320.21 $377.34 $377.34 $330.90 $330.9019 $356.98 $356.98 $331.68 $331.68 $330.03 $330.03 $388.91 $388.91 $341.04 $341.0420 $367.99 $367.99 $341.90 $341.90 $340.20 $340.20 $400.90 $400.90 $351.55 $351.5521 $379.37 $379.37 $352.47 $352.47 $350.72 $350.72 $413.30 $413.30 $362.43 $362.4322 $379.37 $379.37 $352.47 $352.47 $350.72 $350.72 $413.30 $413.30 $362.43 $362.4323 $379.37 $379.37 $352.47 $352.47 $350.72 $350.72 $413.30 $413.30 $362.43 $362.4324 $379.37 $379.37 $352.47 $352.47 $350.72 $350.72 $413.30 $413.30 $362.43 $362.4325 $380.88 $380.88 $353.88 $353.88 $352.12 $352.12 $414.95 $414.95 $363.88 $363.8826 $388.47 $388.47 $360.93 $360.93 $359.14 $359.14 $423.22 $423.22 $371.12 $371.1227 $397.58 $397.58 $369.39 $369.39 $367.56 $367.56 $433.14 $433.14 $379.82 $379.8228 $412.37 $412.37 $383.14 $383.14 $381.23 $381.23 $449.26 $449.26 $393.96 $393.9629 $424.51 $424.51 $394.42 $394.42 $392.46 $392.46 $462.48 $462.48 $405.55 $405.5530 $430.58 $488.37 $400.06 $453.75 $398.07 $451.49 $469.09 $532.05 $411.35 $466.5631 $439.69 $498.69 $408.52 $463.34 $406.49 $461.04 $479.01 $543.30 $420.05 $476.4232 $448.79 $509.02 $416.98 $472.93 $414.90 $470.58 $488.93 $554.55 $428.75 $486.2933 $454.48 $515.47 $422.26 $478.93 $420.16 $476.55 $495.13 $561.58 $434.19 $492.4534 $460.55 $522.36 $427.90 $485.33 $425.78 $482.92 $501.74 $569.08 $439.99 $499.0335 $463.59 $569.19 $430.72 $528.84 $428.58 $526.21 $505.05 $620.10 $442.88 $543.7736 $466.62 $572.92 $433.54 $532.30 $431.39 $529.66 $508.36 $624.16 $445.78 $547.3337 $469.66 $576.64 $436.36 $535.77 $434.19 $533.10 $511.66 $628.22 $448.68 $550.9038 $472.69 $580.37 $439.18 $539.23 $437.00 $536.55 $514.97 $632.28 $451.58 $554.4539 $478.76 $587.82 $444.82 $546.15 $442.61 $543.44 $521.58 $640.40 $457.38 $561.5740 $484.83 $625.14 $450.46 $580.82 $448.22 $577.94 $528.20 $681.05 $463.18 $597.2241 $493.94 $636.88 $458.92 $591.73 $456.64 $588.79 $538.12 $693.85 $471.88 $608.4442 $502.66 $648.13 $467.03 $602.19 $464.71 $599.19 $547.62 $706.10 $480.21 $619.1943 $514.80 $663.79 $478.31 $616.73 $475.93 $613.66 $560.85 $723.16 $491.81 $634.1444 $529.97 $683.35 $492.40 $634.91 $489.96 $631.75 $577.38 $744.47 $506.31 $652.8345 $547.81 $722.34 $508.97 $671.13 $506.44 $667.79 $596.80 $786.95 $523.34 $690.0846 $569.05 $750.35 $528.71 $697.16 $526.08 $693.69 $619.95 $817.46 $543.64 $716.8447 $592.95 $781.86 $550.91 $726.44 $548.18 $722.83 $645.99 $851.80 $566.47 $746.9548 $620.26 $817.88 $576.29 $759.90 $573.43 $756.12 $675.74 $891.04 $592.57 $781.3649 $647.20 $853.40 $601.32 $792.90 $598.33 $788.96 $705.09 $929.73 $618.30 $815.2950 $677.55 $895.85 $629.52 $832.35 $626.39 $828.21 $738.15 $975.98 $647.29 $855.8551 $707.52 $935.48 $657.36 $869.16 $654.10 $864.84 $770.80 $1,019.15 $675.92 $893.7152 $740.52 $979.12 $688.03 $909.71 $684.61 $905.19 $806.76 $1,066.70 $707.46 $935.4053 $773.91 $1,023.26 $719.04 $950.72 $715.47 $946.00 $843.13 $1,114.79 $739.35 $977.5754 $809.95 $1,070.91 $752.53 $995.00 $748.79 $990.05 $882.39 $1,166.70 $773.78 $1,023.0955 $845.99 $1,106.72 $786.01 $1,028.27 $782.11 $1,023.16 $921.66 $1,205.71 $808.21 $1,057.3056 $885.06 $1,157.84 $822.32 $1,075.76 $818.23 $1,070.41 $964.23 $1,261.40 $845.54 $1,106.1457 $924.52 $1,209.45 $858.98 $1,123.71 $854.71 $1,118.13 $1,007.21 $1,317.63 $883.23 $1,155.4458 $966.63 $1,264.54 $898.10 $1,174.89 $893.64 $1,169.06 $1,053.09 $1,377.65 $923.46 $1,208.0759 $987.49 $1,291.83 $917.49 $1,200.25 $912.93 $1,194.29 $1,075.82 $1,407.38 $943.40 $1,234.1560 $1,029.60 $1,322.83 $956.61 $1,229.05 $951.86 $1,222.95 $1,121.69 $1,441.15 $983.62 $1,263.7661 $1,066.02 $1,369.62 $990.45 $1,272.53 $985.53 $1,266.21 $1,161.37 $1,492.13 $1,018.42 $1,308.4662 $1,089.92 $1,400.33 $1,012.65 $1,301.06 $1,007.62 $1,294.59 $1,187.41 $1,525.58 $1,041.25 $1,337.8063 $1,119.89 $1,438.83 $1,040.50 $1,336.83 $1,035.33 $1,330.19 $1,220.06 $1,567.53 $1,069.88 $1,374.58

64+ $1,138.11 $1,462.23 $1,057.41 $1,358.57 $1,052.16 $1,351.82 $1,239.90 $1,593.02 $1,087.29 $1,396.94

203 303212

Chicago - North, ILBlueCare Direct

SilverSM

306206with Advocate

Blue Precision Silver HMOSM Blue Choice Preferred Silver PPOSM

Individual Coverage

Age Non Tobacco

TobaccoNon

TobaccoTobacco

Non Tobacco

TobaccoNon

TobaccoTobacco

Non Tobacco

Tobacco

0-14 $279.79 $279.79 $260.11 $260.11 $265.29 $265.29 $306.27 $306.27 $268.57 $268.5715 $304.66 $304.66 $283.23 $283.23 $288.87 $288.87 $333.49 $333.49 $292.44 $292.4416 $314.17 $314.17 $292.07 $292.07 $297.89 $297.89 $343.90 $343.90 $301.57 $301.5717 $323.68 $323.68 $300.91 $300.91 $306.91 $306.91 $354.31 $354.31 $310.70 $310.7018 $333.92 $333.92 $310.43 $310.43 $316.62 $316.62 $365.52 $365.52 $320.53 $320.5319 $344.16 $344.16 $319.95 $319.95 $326.33 $326.33 $376.73 $376.73 $330.36 $330.3620 $354.76 $354.76 $329.81 $329.81 $336.38 $336.38 $388.34 $388.34 $340.54 $340.5421 $365.74 $365.74 $340.01 $340.01 $346.79 $346.79 $400.35 $400.35 $351.07 $351.0722 $365.74 $365.74 $340.01 $340.01 $346.79 $346.79 $400.35 $400.35 $351.07 $351.0723 $365.74 $365.74 $340.01 $340.01 $346.79 $346.79 $400.35 $400.35 $351.07 $351.0724 $365.74 $365.74 $340.01 $340.01 $346.79 $346.79 $400.35 $400.35 $351.07 $351.0725 $367.20 $367.20 $341.37 $341.37 $348.17 $348.17 $401.95 $401.95 $352.48 $352.4826 $374.51 $374.51 $348.17 $348.17 $355.11 $355.11 $409.96 $409.96 $359.50 $359.5027 $383.29 $383.29 $356.33 $356.33 $363.43 $363.43 $419.57 $419.57 $367.92 $367.9228 $397.55 $397.55 $369.59 $369.59 $376.96 $376.96 $435.18 $435.18 $381.61 $381.6129 $409.26 $409.26 $380.47 $380.47 $388.05 $388.05 $447.99 $447.99 $392.85 $392.8530 $415.11 $470.82 $385.91 $437.70 $393.60 $446.43 $454.40 $515.38 $398.47 $451.9431 $423.89 $480.77 $394.07 $446.96 $401.93 $455.87 $464.01 $526.28 $406.89 $461.5032 $432.67 $490.73 $402.23 $456.21 $410.25 $465.31 $473.61 $537.17 $415.32 $471.0533 $438.15 $496.95 $407.33 $462.00 $415.45 $471.20 $479.62 $543.98 $420.58 $477.0334 $444.00 $503.59 $412.77 $468.17 $421.00 $477.50 $486.02 $551.25 $426.20 $483.4035 $446.93 $548.74 $415.49 $510.14 $423.77 $520.31 $489.23 $600.67 $429.01 $526.7436 $449.85 $552.33 $418.21 $513.48 $426.55 $523.71 $492.43 $604.60 $431.82 $530.1837 $452.78 $555.93 $420.93 $516.82 $429.32 $527.12 $495.63 $608.54 $434.63 $533.6438 $455.71 $559.52 $423.65 $520.16 $432.10 $530.53 $498.84 $612.47 $437.43 $537.0839 $461.56 $566.70 $429.09 $526.84 $437.65 $537.34 $505.24 $620.33 $443.05 $543.9840 $467.41 $602.68 $434.53 $560.29 $443.19 $571.45 $511.65 $659.72 $448.67 $578.5141 $476.19 $614.00 $442.69 $570.81 $451.52 $582.19 $521.26 $672.11 $457.09 $589.3842 $484.60 $624.84 $450.51 $580.89 $459.49 $592.47 $530.46 $683.98 $465.17 $599.7943 $496.30 $639.94 $461.39 $594.92 $470.59 $606.78 $543.27 $700.50 $476.40 $614.2844 $510.93 $658.80 $474.99 $612.46 $484.46 $624.66 $559.29 $721.15 $490.45 $632.3845 $528.12 $696.38 $490.97 $647.40 $500.76 $660.30 $578.11 $762.29 $506.95 $668.4646 $548.60 $723.39 $510.02 $672.51 $520.18 $685.91 $600.52 $791.85 $526.61 $694.3847 $571.64 $753.77 $531.44 $700.75 $542.03 $714.72 $625.75 $825.11 $548.72 $723.5548 $597.98 $788.49 $555.92 $733.03 $567.00 $747.64 $654.57 $863.12 $574.00 $756.8849 $623.95 $822.73 $580.06 $764.86 $591.62 $780.11 $683.00 $900.60 $598.93 $789.7550 $653.20 $863.67 $607.26 $802.92 $619.36 $818.92 $715.03 $945.41 $627.01 $829.0451 $682.10 $901.87 $634.12 $838.43 $646.76 $855.14 $746.65 $987.22 $654.75 $865.7152 $713.92 $943.94 $663.70 $877.54 $676.93 $895.03 $781.48 $1,033.28 $685.29 $906.0953 $746.10 $986.50 $693.62 $917.11 $707.45 $935.39 $816.71 $1,079.86 $716.19 $946.9454 $780.85 $1,032.44 $725.92 $959.82 $740.39 $978.95 $854.75 $1,130.15 $749.54 $991.0455 $815.59 $1,066.96 $758.22 $991.91 $773.34 $1,011.68 $892.78 $1,167.94 $782.89 $1,024.1856 $853.26 $1,116.24 $793.24 $1,037.72 $809.05 $1,058.40 $934.02 $1,221.88 $819.05 $1,071.4857 $891.30 $1,165.99 $828.61 $1,083.98 $845.12 $1,105.59 $975.65 $1,276.35 $855.56 $1,119.2458 $931.89 $1,219.10 $866.35 $1,133.35 $883.61 $1,155.94 $1,020.09 $1,334.48 $894.53 $1,170.2259 $952.01 $1,245.42 $885.05 $1,157.82 $902.69 $1,180.89 $1,042.11 $1,363.29 $913.84 $1,195.4860 $992.61 $1,275.30 $922.79 $1,185.60 $941.18 $1,209.23 $1,086.55 $1,396.00 $952.81 $1,224.1761 $1,027.72 $1,320.41 $955.43 $1,227.54 $974.47 $1,252.00 $1,124.98 $1,445.38 $986.51 $1,267.4762 $1,050.76 $1,350.01 $976.85 $1,255.06 $996.32 $1,280.07 $1,150.21 $1,477.78 $1,008.63 $1,295.8863 $1,079.65 $1,387.14 $1,003.71 $1,289.57 $1,023.72 $1,315.27 $1,181.83 $1,518.42 $1,036.36 $1,331.52

64+ $1,097.22 $1,409.69 $1,020.03 $1,310.54 $1,040.37 $1,336.66 $1,201.05 $1,543.11 $1,053.21 $1,353.17

203 303212

Chicago - West, ILBlueCare Direct

SilverSM

306206with Advocate

Blue Precision Silver HMOSM Blue Choice Preferred Silver PPOSM

Individual Coverage

0-14 $270.09 $270.09 $251.41 $251.41 $301.06 $301.06 $264.00 $264.0015 $294.09 $294.09 $273.76 $273.76 $327.82 $327.82 $287.47 $287.4716 $303.27 $303.27 $282.30 $282.30 $338.05 $338.05 $296.44 $296.4417 $312.45 $312.45 $290.85 $290.85 $348.28 $348.28 $305.41 $305.4118 $322.34 $322.34 $300.05 $300.05 $359.30 $359.30 $315.08 $315.0819 $332.22 $332.22 $309.25 $309.25 $370.32 $370.32 $324.74 $324.7420 $342.46 $342.46 $318.78 $318.78 $381.74 $381.74 $334.75 $334.7521 $353.05 $353.05 $328.64 $328.64 $393.54 $393.54 $345.10 $345.1022 $353.05 $353.05 $328.64 $328.64 $393.54 $393.54 $345.10 $345.1023 $353.05 $353.05 $328.64 $328.64 $393.54 $393.54 $345.10 $345.1024 $353.05 $353.05 $328.64 $328.64 $393.54 $393.54 $345.10 $345.1025 $354.47 $354.47 $329.95 $329.95 $395.12 $395.12 $346.48 $346.4826 $361.53 $361.53 $336.53 $336.53 $402.99 $402.99 $353.38 $353.3827 $370.00 $370.00 $344.41 $344.41 $412.43 $412.43 $361.67 $361.6728 $383.77 $383.77 $357.23 $357.23 $427.78 $427.78 $375.12 $375.1229 $395.07 $395.07 $367.75 $367.75 $440.37 $440.37 $386.17 $386.1730 $400.72 $454.49 $373.01 $423.06 $446.67 $506.61 $391.69 $444.2631 $409.19 $464.10 $380.89 $432.01 $456.11 $517.33 $399.97 $453.6532 $417.66 $473.71 $388.78 $440.95 $465.56 $528.04 $408.25 $463.0433 $422.96 $479.72 $393.71 $446.54 $471.46 $534.73 $413.43 $468.9134 $428.61 $486.13 $398.97 $452.51 $477.76 $541.88 $418.95 $475.1835 $431.43 $529.71 $401.60 $493.08 $480.91 $590.46 $421.71 $517.7836 $434.26 $533.18 $404.23 $496.31 $484.06 $594.32 $424.47 $521.1737 $437.08 $536.65 $406.85 $499.54 $487.20 $598.19 $427.23 $524.5638 $439.90 $540.12 $409.48 $502.76 $490.35 $602.06 $430.00 $527.9539 $445.55 $547.05 $414.74 $509.22 $496.65 $609.78 $435.52 $534.7340 $451.20 $581.78 $420.00 $541.55 $502.95 $648.50 $441.04 $568.6741 $459.68 $592.71 $427.89 $551.72 $512.39 $660.68 $449.32 $579.3642 $467.80 $603.18 $435.45 $561.47 $521.44 $672.35 $457.26 $589.5943 $479.09 $617.74 $445.96 $575.03 $534.04 $688.59 $468.30 $603.8344 $493.22 $635.95 $459.11 $591.97 $549.78 $708.88 $482.11 $621.6345 $509.81 $672.23 $474.55 $625.75 $568.27 $749.33 $498.33 $657.0946 $529.58 $698.30 $492.96 $650.01 $590.31 $778.39 $517.65 $682.5747 $551.82 $727.63 $513.66 $677.31 $615.11 $811.08 $539.39 $711.2448 $577.24 $761.15 $537.32 $708.52 $643.44 $848.44 $564.24 $744.0149 $602.31 $794.20 $560.66 $739.28 $671.38 $885.28 $588.74 $776.3150 $630.55 $833.72 $586.95 $776.06 $702.87 $929.33 $616.35 $814.9451 $658.44 $870.59 $612.91 $810.39 $733.95 $970.43 $643.61 $850.9852 $689.16 $911.21 $641.50 $848.19 $768.19 $1,015.70 $673.64 $890.6853 $720.23 $952.29 $670.42 $886.43 $802.82 $1,061.50 $704.01 $930.8454 $753.77 $996.63 $701.64 $927.71 $840.21 $1,110.93 $736.79 $974.1855 $787.31 $1,029.96 $732.86 $958.73 $877.60 $1,148.07 $769.57 $1,006.7656 $823.67 $1,077.53 $766.71 $1,003.02 $918.13 $1,201.10 $805.12 $1,053.2657 $860.39 $1,125.56 $800.89 $1,047.73 $959.06 $1,254.64 $841.01 $1,100.2158 $899.58 $1,176.83 $837.37 $1,095.45 $1,002.74 $1,311.79 $879.32 $1,150.3259 $919.00 $1,202.23 $855.45 $1,119.09 $1,024.39 $1,340.10 $898.30 $1,175.1560 $958.19 $1,231.08 $891.93 $1,145.95 $1,068.07 $1,372.26 $936.60 $1,203.3561 $992.08 $1,274.62 $923.48 $1,186.48 $1,105.85 $1,420.80 $969.73 $1,245.9162 $1,014.32 $1,303.20 $944.18 $1,213.08 $1,130.64 $1,452.65 $991.47 $1,273.8563 $1,042.21 $1,339.04 $970.14 $1,246.44 $1,161.73 $1,492.60 $1,018.74 $1,308.87

64+ $1,059.15 $1,360.81 $985.92 $1,266.71 $1,180.62 $1,516.87 $1,035.30 $1,330.16

203 303

Chicago - South, ILBlue Choice Preferred Silver PPOSM

306Blue Precision Silver HMOSM

Individual Coverage

0-14 $300.03 $300.03 $278.52 $278.52 $383.60 $383.60 $336.39 $336.3915 $326.70 $326.70 $303.27 $303.27 $417.70 $417.70 $366.29 $366.2916 $336.89 $336.89 $312.74 $312.74 $430.74 $430.74 $377.72 $377.7217 $347.09 $347.09 $322.20 $322.20 $443.78 $443.78 $389.15 $389.1518 $358.07 $358.07 $332.40 $332.40 $457.82 $457.82 $401.46 $401.4619 $369.05 $369.05 $342.59 $342.59 $471.86 $471.86 $413.78 $413.7820 $380.43 $380.43 $353.15 $353.15 $486.40 $486.40 $426.53 $426.5321 $392.19 $392.19 $364.07 $364.07 $501.44 $501.44 $439.72 $439.7222 $392.19 $392.19 $364.07 $364.07 $501.44 $501.44 $439.72 $439.7223 $392.19 $392.19 $364.07 $364.07 $501.44 $501.44 $439.72 $439.7224 $392.19 $392.19 $364.07 $364.07 $501.44 $501.44 $439.72 $439.7225 $393.76 $393.76 $365.53 $365.53 $503.45 $503.45 $441.48 $441.4826 $401.60 $401.60 $372.81 $372.81 $513.48 $513.48 $450.27 $450.2727 $411.02 $411.02 $381.55 $381.55 $525.51 $525.51 $460.83 $460.8328 $426.31 $426.31 $395.75 $395.75 $545.07 $545.07 $477.98 $477.9829 $438.86 $438.86 $407.40 $407.40 $561.11 $561.11 $492.05 $492.0530 $445.14 $504.88 $413.22 $468.68 $569.14 $645.52 $499.08 $566.0631 $454.55 $515.55 $421.96 $478.59 $581.17 $659.17 $509.64 $578.0332 $463.96 $526.23 $430.70 $488.50 $593.21 $672.82 $520.19 $590.0033 $469.85 $532.90 $436.16 $494.69 $600.73 $681.35 $526.79 $597.4834 $476.12 $540.02 $441.98 $501.30 $608.75 $690.45 $533.82 $605.4635 $479.26 $588.43 $444.90 $546.24 $612.76 $752.35 $537.34 $659.7436 $482.40 $592.28 $447.81 $549.82 $616.77 $757.27 $540.86 $664.0637 $485.53 $596.14 $450.72 $553.40 $620.79 $762.20 $544.37 $668.3838 $488.67 $599.99 $453.63 $556.97 $624.80 $767.13 $547.89 $672.7039 $494.95 $607.69 $459.46 $564.12 $632.82 $776.98 $554.93 $681.3440 $501.22 $646.27 $465.28 $599.94 $640.84 $826.30 $561.96 $724.5941 $510.63 $658.41 $474.02 $611.21 $652.88 $841.82 $572.52 $738.2042 $519.65 $670.04 $482.40 $622.00 $664.41 $856.69 $582.63 $751.2443 $532.20 $686.23 $494.05 $637.03 $680.46 $877.38 $596.70 $769.3944 $547.89 $706.45 $508.61 $655.80 $700.52 $903.24 $614.29 $792.0645 $566.32 $746.76 $525.72 $693.22 $724.08 $954.78 $634.96 $837.2546 $588.29 $775.72 $546.11 $720.10 $752.16 $991.80 $659.58 $869.7247 $613.00 $808.30 $569.05 $750.34 $783.75 $1,033.46 $687.28 $906.2548 $641.23 $845.53 $595.26 $784.91 $819.86 $1,081.07 $718.94 $948.0049 $669.08 $882.25 $621.11 $818.99 $855.46 $1,128.01 $750.16 $989.1650 $700.45 $926.14 $650.23 $859.74 $895.58 $1,184.13 $785.34 $1,038.3851 $731.44 $967.11 $679.00 $897.77 $935.19 $1,236.51 $820.08 $1,084.3152 $765.56 $1,012.22 $710.67 $939.65 $978.82 $1,294.19 $858.33 $1,134.8953 $800.07 $1,057.85 $742.71 $982.01 $1,022.94 $1,352.54 $897.03 $1,186.0554 $837.33 $1,107.12 $777.30 $1,027.74 $1,070.58 $1,415.52 $938.80 $1,241.2955 $874.59 $1,144.14 $811.88 $1,062.11 $1,118.22 $1,462.85 $980.58 $1,282.7956 $914.98 $1,196.98 $849.38 $1,111.16 $1,169.87 $1,530.42 $1,025.87 $1,342.0457 $955.77 $1,250.34 $887.25 $1,160.69 $1,222.02 $1,598.64 $1,071.60 $1,401.8658 $999.30 $1,307.29 $927.66 $1,213.56 $1,277.68 $1,671.45 $1,120.41 $1,465.7259 $1,020.88 $1,335.51 $947.68 $1,239.75 $1,305.26 $1,707.53 $1,144.59 $1,497.3560 $1,064.41 $1,367.55 $988.09 $1,269.50 $1,360.92 $1,748.51 $1,193.40 $1,533.2861 $1,102.06 $1,415.93 $1,023.04 $1,314.41 $1,409.05 $1,810.35 $1,235.61 $1,587.5262 $1,126.77 $1,447.67 $1,045.98 $1,343.88 $1,440.64 $1,850.94 $1,263.32 $1,623.1163 $1,157.75 $1,487.48 $1,074.74 $1,380.83 $1,480.26 $1,901.84 $1,298.05 $1,667.74

64+ $1,176.57 $1,511.66 $1,092.21 $1,403.28 $1,504.32 $1,932.76 $1,319.16 $1,694.86

203 303

Rockford, ILBlue Choice Preferred Silver PPOSM

Individual Coverage

0-14 $331.42 $331.42 $290.63 $290.6315 $360.88 $360.88 $316.46 $316.4616 $372.15 $372.15 $326.34 $326.3417 $383.41 $383.41 $336.22 $336.2218 $395.54 $395.54 $346.85 $346.8519 $407.67 $407.67 $357.49 $357.4920 $420.24 $420.24 $368.51 $368.5121 $433.23 $433.23 $379.91 $379.9122 $433.23 $433.23 $379.91 $379.9123 $433.23 $433.23 $379.91 $379.9124 $433.23 $433.23 $379.91 $379.9125 $434.97 $434.97 $381.43 $381.4326 $443.63 $443.63 $389.02 $389.0227 $454.03 $454.03 $398.14 $398.1428 $470.92 $470.92 $412.96 $412.9629 $484.79 $484.79 $425.11 $425.1130 $491.72 $557.71 $431.19 $489.0631 $502.12 $569.50 $440.31 $499.4032 $512.51 $581.29 $449.43 $509.7433 $519.01 $588.66 $455.13 $516.2134 $525.94 $596.53 $461.21 $523.1035 $529.41 $650.01 $464.25 $570.0036 $532.88 $654.26 $467.28 $573.7337 $536.34 $658.52 $470.32 $577.4638 $539.81 $662.78 $473.36 $581.2039 $546.74 $671.28 $479.44 $588.6640 $553.67 $713.90 $485.52 $626.0341 $564.07 $727.31 $494.64 $637.7942 $574.03 $740.16 $503.38 $649.0543 $587.90 $758.04 $515.53 $664.7344 $605.23 $780.38 $530.73 $684.3245 $625.59 $824.90 $548.58 $723.3646 $649.85 $856.89 $569.86 $751.4247 $677.14 $892.88 $593.79 $782.9848 $708.33 $934.01 $621.15 $819.0449 $739.09 $974.57 $648.12 $854.6150 $773.75 $1,023.06 $678.51 $897.1351 $807.98 $1,068.31 $708.52 $936.8152 $845.67 $1,118.14 $741.58 $980.5153 $883.79 $1,168.55 $775.01 $1,024.7254 $924.95 $1,222.97 $811.10 $1,072.4455 $966.11 $1,263.86 $847.19 $1,108.3056 $1,010.73 $1,322.24 $886.32 $1,159.4857 $1,055.79 $1,381.18 $925.83 $1,211.1758 $1,103.88 $1,444.09 $968.00 $1,266.3459 $1,127.70 $1,475.26 $988.90 $1,293.6760 $1,175.79 $1,510.66 $1,031.07 $1,324.7161 $1,217.38 $1,564.09 $1,067.54 $1,371.5762 $1,244.68 $1,599.16 $1,091.47 $1,402.3263 $1,278.90 $1,643.13 $1,121.48 $1,440.88

64+ $1,299.69 $1,669.85 $1,139.73 $1,464.31

Quad Cities, IL

303Blue Choice Preferred Silver PPOSM

Illinois Off Exchange (Silver

Individual Coverage

0-14 $347.37 $347.37 $321.96 $321.96 $368.84 $368.84 $323.44 $323.4415 $378.24 $378.24 $350.57 $350.57 $401.63 $401.63 $352.19 $352.1916 $390.05 $390.05 $361.52 $361.52 $414.17 $414.17 $363.19 $363.1917 $401.85 $401.85 $372.46 $372.46 $426.70 $426.70 $374.18 $374.1818 $414.57 $414.57 $384.24 $384.24 $440.20 $440.20 $386.02 $386.0219 $427.28 $427.28 $396.03 $396.03 $453.70 $453.70 $397.86 $397.8620 $440.45 $440.45 $408.23 $408.23 $467.68 $467.68 $410.12 $410.1221 $454.07 $454.07 $420.86 $420.86 $482.15 $482.15 $422.80 $422.8022 $454.07 $454.07 $420.86 $420.86 $482.15 $482.15 $422.80 $422.8023 $454.07 $454.07 $420.86 $420.86 $482.15 $482.15 $422.80 $422.8024 $454.07 $454.07 $420.86 $420.86 $482.15 $482.15 $422.80 $422.8025 $455.89 $455.89 $422.54 $422.54 $484.08 $484.08 $424.49 $424.4926 $464.97 $464.97 $430.96 $430.96 $493.72 $493.72 $432.95 $432.9527 $475.87 $475.87 $441.06 $441.06 $505.29 $505.29 $443.10 $443.1028 $493.58 $493.58 $457.47 $457.47 $524.10 $524.10 $459.59 $459.5929 $508.11 $508.11 $470.94 $470.94 $539.53 $539.53 $473.12 $473.1230 $515.37 $584.54 $477.67 $541.78 $547.24 $620.68 $479.88 $544.2831 $526.27 $596.90 $487.77 $553.23 $558.81 $633.80 $490.03 $555.7932 $537.17 $609.26 $497.87 $564.69 $570.38 $646.93 $500.17 $567.3033 $543.98 $616.98 $504.19 $571.85 $577.61 $655.13 $506.52 $574.4934 $551.24 $625.22 $510.92 $579.49 $585.33 $663.88 $513.28 $582.1635 $554.88 $681.28 $514.29 $631.44 $589.19 $723.40 $516.66 $634.3636 $558.51 $685.74 $517.66 $635.58 $593.04 $728.14 $520.05 $638.5137 $562.14 $690.20 $521.02 $639.71 $596.90 $732.88 $523.43 $642.6738 $565.77 $694.66 $524.39 $643.85 $600.76 $737.61 $526.81 $646.8239 $573.04 $703.58 $531.12 $652.11 $608.47 $747.08 $533.58 $655.1240 $580.30 $748.24 $537.86 $693.51 $616.19 $794.51 $540.34 $696.7141 $591.20 $762.30 $547.96 $706.54 $627.76 $809.43 $550.49 $709.8042 $601.65 $775.76 $557.64 $719.02 $638.85 $823.73 $560.21 $722.3443 $616.18 $794.50 $571.10 $736.38 $654.28 $843.63 $573.74 $739.7844 $634.34 $817.92 $587.94 $758.09 $673.56 $868.49 $590.65 $761.5945 $655.68 $864.58 $607.72 $801.34 $696.22 $918.04 $610.53 $805.0446 $681.11 $898.11 $631.29 $832.41 $723.22 $953.64 $634.20 $836.2647 $709.72 $935.83 $657.80 $867.38 $753.60 $993.70 $660.84 $871.3848 $742.41 $978.94 $688.10 $907.33 $788.31 $1,039.47 $691.28 $911.5249 $774.65 $1,021.45 $717.98 $946.73 $822.55 $1,084.61 $721.30 $951.1150 $810.97 $1,072.27 $751.65 $993.83 $861.12 $1,138.57 $755.12 $998.4351 $846.84 $1,119.70 $784.90 $1,037.79 $899.21 $1,188.93 $788.53 $1,042.5952 $886.35 $1,171.93 $821.51 $1,086.20 $941.16 $1,244.39 $825.31 $1,091.2253 $926.31 $1,224.76 $858.55 $1,135.18 $983.58 $1,300.50 $862.52 $1,140.4254 $969.44 $1,281.80 $898.53 $1,188.04 $1,029.39 $1,361.06 $902.68 $1,193.5355 $1,012.58 $1,324.66 $938.51 $1,227.76 $1,075.19 $1,406.57 $942.85 $1,233.4456 $1,059.35 $1,385.84 $981.86 $1,284.47 $1,124.85 $1,471.53 $986.40 $1,290.4057 $1,106.57 $1,447.62 $1,025.63 $1,341.73 $1,175.00 $1,537.13 $1,030.37 $1,347.9358 $1,156.98 $1,513.55 $1,072.35 $1,402.84 $1,228.52 $1,607.14 $1,077.30 $1,409.3259 $1,181.95 $1,546.23 $1,095.49 $1,433.12 $1,255.03 $1,641.83 $1,100.55 $1,439.7460 $1,232.35 $1,583.33 $1,142.21 $1,467.51 $1,308.55 $1,681.23 $1,147.48 $1,474.2961 $1,275.94 $1,639.33 $1,182.61 $1,519.42 $1,354.84 $1,740.70 $1,188.07 $1,526.4462 $1,304.55 $1,676.09 $1,209.12 $1,553.48 $1,385.21 $1,779.72 $1,214.71 $1,560.6663 $1,340.42 $1,722.17 $1,242.37 $1,596.20 $1,423.30 $1,828.66 $1,248.11 $1,603.57

64+ $1,362.21 $1,750.18 $1,262.58 $1,622.15 $1,446.45 $1,858.40 $1,268.40 $1,629.65

203 303

Peoria, ILBlue Choice Preferred Silver PPOSM

Individual Coverage

0-14 $351.03 $351.03 $307.82 $307.8215 $382.23 $382.23 $335.18 $335.1816 $394.16 $394.16 $345.64 $345.6417 $406.09 $406.09 $356.11 $356.1118 $418.94 $418.94 $367.37 $367.3719 $431.79 $431.79 $378.64 $378.6420 $445.09 $445.09 $390.31 $390.3121 $458.86 $458.86 $402.38 $402.3822 $458.86 $458.86 $402.38 $402.3823 $458.86 $458.86 $402.38 $402.3824 $458.86 $458.86 $402.38 $402.3825 $460.70 $460.70 $403.99 $403.9926 $469.87 $469.87 $412.04 $412.0427 $480.89 $480.89 $421.69 $421.6928 $498.78 $498.78 $437.39 $437.3929 $513.47 $513.47 $450.26 $450.2630 $520.81 $590.70 $456.70 $517.9931 $531.82 $603.19 $466.36 $528.9432 $542.83 $615.68 $476.02 $539.9033 $549.72 $623.49 $482.05 $546.7434 $557.06 $631.81 $488.49 $554.0535 $560.73 $688.46 $491.71 $603.7236 $564.40 $692.97 $494.93 $607.6737 $568.07 $697.48 $498.15 $611.6338 $571.74 $701.98 $501.37 $615.5839 $579.08 $711.00 $507.80 $623.4840 $586.42 $756.13 $514.24 $663.0641 $597.44 $770.34 $523.90 $675.5242 $607.99 $783.95 $533.15 $687.4543 $622.67 $802.88 $546.03 $704.0544 $641.03 $826.54 $562.12 $724.8045 $662.59 $873.70 $581.04 $766.1646 $688.29 $907.58 $603.57 $795.8747 $717.20 $945.70 $628.92 $829.2948 $750.24 $989.26 $657.89 $867.4949 $782.82 $1,032.22 $686.46 $905.1750 $819.53 $1,083.58 $718.65 $950.2051 $855.78 $1,131.50 $750.44 $992.2352 $895.70 $1,184.29 $785.45 $1,038.5153 $936.08 $1,237.68 $820.86 $1,085.3454 $979.67 $1,295.32 $859.08 $1,135.8855 $1,023.26 $1,338.63 $897.31 $1,173.8656 $1,070.52 $1,400.46 $938.75 $1,228.0857 $1,118.24 $1,462.88 $980.60 $1,282.8258 $1,169.18 $1,529.52 $1,025.26 $1,341.2559 $1,194.41 $1,562.53 $1,047.40 $1,370.2060 $1,245.35 $1,600.02 $1,092.06 $1,403.0861 $1,289.40 $1,656.62 $1,130.69 $1,452.7162 $1,318.31 $1,693.76 $1,156.04 $1,485.2863 $1,354.56 $1,740.34 $1,187.83 $1,526.12

64+ $1,376.58 $1,768.63 $1,207.14 $1,550.93

Blue Choice Preferred Silver PPOSM

Bloomington, IL

Individual Coverage

0-14 $382.10 $382.10 $335.07 $335.0715 $416.06 $416.06 $364.85 $364.8516 $429.05 $429.05 $376.24 $376.2417 $442.03 $442.03 $387.62 $387.6218 $456.02 $456.02 $399.89 $399.8919 $470.00 $470.00 $412.15 $412.1520 $484.49 $484.49 $424.85 $424.8521 $499.47 $499.47 $437.99 $437.9922 $499.47 $499.47 $437.99 $437.9923 $499.47 $499.47 $437.99 $437.9924 $499.47 $499.47 $437.99 $437.9925 $501.47 $501.47 $439.75 $439.7526 $511.46 $511.46 $448.51 $448.5127 $523.45 $523.45 $459.02 $459.0228 $542.93 $542.93 $476.10 $476.1029 $558.91 $558.91 $490.11 $490.1130 $566.90 $642.98 $497.12 $563.8431 $578.89 $656.58 $507.63 $575.7632 $590.88 $670.17 $518.15 $587.6833 $598.37 $678.67 $524.72 $595.1334 $606.36 $687.74 $531.72 $603.0835 $610.36 $749.40 $535.23 $657.1536 $614.35 $754.30 $538.73 $661.4537 $618.35 $759.21 $542.24 $665.7638 $622.34 $764.11 $545.74 $670.0639 $630.34 $773.92 $552.75 $678.6640 $638.33 $823.06 $559.76 $721.7541 $650.31 $838.52 $570.27 $735.3042 $661.80 $853.33 $580.34 $748.2943 $677.79 $873.94 $594.36 $766.3744 $697.76 $899.70 $611.88 $788.9545 $721.24 $951.03 $632.46 $833.9746 $749.21 $987.91 $656.99 $866.3147 $780.68 $1,029.40 $684.58 $902.6948 $816.64 $1,076.82 $716.12 $944.2749 $852.10 $1,123.58 $747.22 $985.2850 $892.06 $1,179.48 $782.26 $1,034.3051 $931.52 $1,231.65 $816.86 $1,080.0552 $974.97 $1,289.11 $854.96 $1,130.4353 $1,018.93 $1,347.22 $893.51 $1,181.4054 $1,066.38 $1,409.96 $935.12 $1,236.4155 $1,113.83 $1,457.11 $976.73 $1,277.7556 $1,165.27 $1,524.41 $1,021.84 $1,336.7757 $1,217.22 $1,592.36 $1,067.39 $1,396.3658 $1,272.66 $1,664.89 $1,116.01 $1,459.9659 $1,300.13 $1,700.83 $1,140.10 $1,491.4760 $1,355.57 $1,741.64 $1,188.71 $1,527.2661 $1,403.52 $1,803.24 $1,230.76 $1,581.2862 $1,434.99 $1,843.67 $1,258.36 $1,616.7463 $1,474.45 $1,894.37 $1,292.96 $1,661.19

64+ $1,498.41 $1,925.17 $1,313.97 $1,688.20

Champaign, IL

Individual Coverage

0-14 $347.23 $347.23 $304.49 $304.4915 $378.10 $378.10 $331.56 $331.5616 $389.90 $389.90 $341.91 $341.9117 $401.70 $401.70 $352.26 $352.2618 $414.41 $414.41 $363.40 $363.4019 $427.12 $427.12 $374.55 $374.5520 $440.28 $440.28 $386.09 $386.0921 $453.90 $453.90 $398.03 $398.0322 $453.90 $453.90 $398.03 $398.0323 $453.90 $453.90 $398.03 $398.0324 $453.90 $453.90 $398.03 $398.0325 $455.72 $455.72 $399.62 $399.6226 $464.80 $464.80 $407.58 $407.5827 $475.69 $475.69 $417.14 $417.1428 $493.39 $493.39 $432.66 $432.6629 $507.92 $507.92 $445.40 $445.4030 $515.18 $584.32 $451.77 $512.3931 $526.07 $596.67 $461.32 $523.2332 $536.97 $609.03 $470.87 $534.0633 $543.77 $616.75 $476.84 $540.8334 $551.04 $624.99 $483.21 $548.0635 $554.67 $681.02 $486.39 $597.1936 $558.30 $685.48 $489.58 $601.1037 $561.93 $689.94 $492.76 $605.0238 $565.56 $694.40 $495.95 $608.9239 $572.82 $703.31 $502.32 $616.7440 $580.09 $747.96 $508.68 $655.9041 $590.98 $762.01 $518.24 $668.2142 $601.42 $775.47 $527.39 $680.0243 $615.94 $794.20 $540.13 $696.4444 $634.10 $817.61 $556.05 $716.9745 $655.43 $864.26 $574.76 $757.8846 $680.85 $897.77 $597.05 $787.2747 $709.45 $935.48 $622.12 $820.3348 $742.13 $978.57 $650.78 $858.1249 $774.36 $1,021.07 $679.04 $895.3850 $810.67 $1,071.87 $710.88 $939.9351 $846.53 $1,119.28 $742.33 $981.5152 $886.02 $1,171.49 $776.96 $1,027.2953 $925.96 $1,224.30 $811.98 $1,073.6154 $969.08 $1,281.32 $849.80 $1,123.6055 $1,012.20 $1,324.16 $887.61 $1,161.1756 $1,058.95 $1,385.32 $928.61 $1,214.8057 $1,106.16 $1,447.08 $970.00 $1,268.9658 $1,156.54 $1,512.99 $1,014.18 $1,326.7559 $1,181.51 $1,545.64 $1,036.08 $1,355.3960 $1,231.89 $1,582.73 $1,080.26 $1,387.9261 $1,275.46 $1,638.72 $1,118.47 $1,437.0162 $1,304.06 $1,675.46 $1,143.54 $1,469.2363 $1,339.92 $1,721.53 $1,174.99 $1,509.63

64+ $1,361.70 $1,749.52 $1,194.09 $1,534.17

Springfield, IL

Individual Coverage

0-14 $352.13 $352.13 $308.78 $308.7815 $383.43 $383.43 $336.23 $336.2316 $395.40 $395.40 $346.73 $346.7317 $407.36 $407.36 $357.22 $357.2218 $420.25 $420.25 $368.52 $368.5219 $433.14 $433.14 $379.83 $379.8320 $446.49 $446.49 $391.53 $391.5321 $460.30 $460.30 $403.64 $403.6422 $460.30 $460.30 $403.64 $403.6423 $460.30 $460.30 $403.64 $403.6424 $460.30 $460.30 $403.64 $403.6425 $462.14 $462.14 $405.25 $405.2526 $471.35 $471.35 $413.33 $413.3327 $482.39 $482.39 $423.02 $423.0228 $500.34 $500.34 $438.76 $438.7629 $515.07 $515.07 $451.67 $451.6730 $522.44 $592.55 $458.13 $519.6131 $533.49 $605.08 $467.82 $530.6032 $544.53 $617.61 $477.51 $541.5933 $551.44 $625.44 $483.56 $548.4534 $558.80 $633.79 $490.02 $555.7835 $562.48 $690.62 $493.25 $605.6136 $566.17 $695.14 $496.48 $609.5737 $569.85 $699.66 $499.71 $613.5438 $573.53 $704.18 $502.94 $617.5139 $580.90 $713.22 $509.39 $625.4340 $588.26 $758.50 $515.85 $665.1441 $599.31 $772.75 $525.54 $677.6342 $609.90 $786.40 $534.82 $689.6043 $624.62 $805.39 $547.74 $706.2644 $643.04 $829.13 $563.89 $727.0745 $664.67 $876.44 $582.86 $768.5646 $690.45 $910.42 $605.46 $798.3647 $719.45 $948.66 $630.89 $831.8948 $752.59 $992.36 $659.95 $870.2149 $785.27 $1,035.45 $688.61 $908.0050 $822.09 $1,086.97 $720.90 $953.1851 $858.46 $1,135.05 $752.79 $995.3452 $898.50 $1,188.00 $787.91 $1,041.7753 $939.01 $1,241.56 $823.43 $1,088.7454 $982.74 $1,299.38 $861.77 $1,139.4455 $1,026.46 $1,342.82 $900.12 $1,177.5456 $1,073.88 $1,404.84 $941.69 $1,231.9257 $1,121.75 $1,467.47 $983.67 $1,286.8458 $1,172.84 $1,534.31 $1,028.48 $1,345.4559 $1,198.16 $1,567.43 $1,050.68 $1,374.4960 $1,249.25 $1,605.04 $1,095.48 $1,407.4761 $1,293.44 $1,661.81 $1,134.23 $1,457.2662 $1,322.44 $1,699.07 $1,159.66 $1,489.9363 $1,358.80 $1,745.79 $1,191.55 $1,530.90

64+ $1,380.90 $1,774.17 $1,210.92 $1,555.79

East St. Louis, IL

Individual Coverage

0-14 $316.98 $316.98 $277.96 $277.9615 $345.15 $345.15 $302.67 $302.6716 $355.92 $355.92 $312.11 $312.1117 $366.70 $366.70 $321.56 $321.5618 $378.30 $378.30 $331.73 $331.7319 $389.90 $389.90 $341.91 $341.9120 $401.92 $401.92 $352.44 $352.4421 $414.35 $414.35 $363.35 $363.3522 $414.35 $414.35 $363.35 $363.3523 $414.35 $414.35 $363.35 $363.3524 $414.35 $414.35 $363.35 $363.3525 $416.00 $416.00 $364.80 $364.8026 $424.29 $424.29 $372.07 $372.0727 $434.24 $434.24 $380.79 $380.7928 $450.40 $450.40 $394.96 $394.9629 $463.65 $463.65 $406.58 $406.5830 $470.28 $533.40 $412.40 $467.7431 $480.23 $544.68 $421.12 $477.6332 $490.17 $555.95 $429.84 $487.5233 $496.39 $563.00 $435.29 $493.7034 $503.02 $570.52 $441.10 $500.3035 $506.33 $621.67 $444.01 $545.1536 $509.65 $625.74 $446.91 $548.7237 $512.96 $629.82 $449.82 $552.2938 $516.28 $633.88 $452.73 $555.8639 $522.91 $642.02 $458.54 $563.0040 $529.54 $682.78 $464.36 $598.7441 $539.48 $695.61 $473.08 $609.9842 $549.01 $707.90 $481.43 $620.7643 $562.27 $724.99 $493.06 $635.7544 $578.84 $746.36 $507.59 $654.4945 $598.32 $788.94 $524.67 $691.8346 $621.52 $819.54 $545.02 $718.6647 $647.62 $853.96 $567.91 $748.8448 $677.46 $893.29 $594.07 $783.3449 $706.88 $932.09 $619.87 $817.3650 $740.02 $978.46 $648.93 $858.0251 $772.76 $1,021.74 $677.64 $895.9752 $808.81 $1,069.40 $709.25 $937.7753 $845.27 $1,117.61 $741.22 $980.0554 $884.63 $1,169.66 $775.74 $1,025.6955 $923.99 $1,208.77 $810.26 $1,059.9856 $966.67 $1,264.60 $847.68 $1,108.9457 $1,009.76 $1,320.97 $885.47 $1,158.3758 $1,055.76 $1,381.14 $925.80 $1,211.1459 $1,078.54 $1,410.95 $945.79 $1,237.2860 $1,124.54 $1,444.81 $986.12 $1,266.9761 $1,164.31 $1,495.91 $1,021.00 $1,311.7862 $1,190.42 $1,529.45 $1,043.89 $1,341.1963 $1,223.15 $1,571.51 $1,072.60 $1,378.07

64+ $1,243.05 $1,597.06 $1,090.05 $1,400.48

St. Louis, IL

Individual Coverage

0-14 $427.71 $427.71 $375.07 $375.0715 $465.73 $465.73 $408.40 $408.4016 $480.27 $480.27 $421.15 $421.1517 $494.80 $494.80 $433.90 $433.9018 $510.46 $510.46 $447.63 $447.6319 $526.11 $526.11 $461.35 $461.3520 $542.33 $542.33 $475.57 $475.5721 $559.10 $559.10 $490.28 $490.2822 $559.10 $559.10 $490.28 $490.2823 $559.10 $559.10 $490.28 $490.2824 $559.10 $559.10 $490.28 $490.2825 $561.34 $561.34 $492.24 $492.2426 $572.52 $572.52 $502.05 $502.0527 $585.94 $585.94 $513.81 $513.8128 $607.74 $607.74 $532.94 $532.9429 $625.63 $625.63 $548.62 $548.6230 $634.58 $719.74 $556.47 $631.1531 $648.00 $734.96 $568.24 $644.4932 $661.42 $750.18 $580.00 $657.8433 $669.80 $759.69 $587.36 $666.1834 $678.75 $769.84 $595.20 $675.0835 $683.22 $838.86 $599.12 $735.6036 $687.69 $844.35 $603.05 $740.4237 $692.17 $849.84 $606.97 $745.2438 $696.64 $855.33 $610.89 $750.0539 $705.58 $866.31 $618.73 $759.6840 $714.53 $921.31 $626.58 $807.9141 $727.95 $938.62 $638.35 $823.0842 $740.81 $955.20 $649.62 $837.6343 $758.70 $978.27 $665.31 $857.8544 $781.06 $1,007.10 $684.92 $883.1445 $807.34 $1,064.56 $707.97 $933.5246 $838.65 $1,105.84 $735.42 $969.7347 $873.87 $1,152.29 $766.31 $1,010.4548 $914.13 $1,205.37 $801.61 $1,057.0049 $953.83 $1,257.71 $836.42 $1,102.9050 $998.55 $1,320.29 $875.64 $1,157.7751 $1,042.72 $1,378.69 $914.37 $1,208.9852 $1,091.36 $1,443.00 $957.03 $1,265.3853 $1,140.56 $1,508.06 $1,000.17 $1,322.4354 $1,193.68 $1,578.28 $1,046.75 $1,384.0155 $1,246.79 $1,631.06 $1,093.33 $1,430.2956 $1,304.38 $1,706.39 $1,143.83 $1,496.3557 $1,362.53 $1,782.46 $1,194.82 $1,563.0658 $1,424.59 $1,863.64 $1,249.24 $1,634.2559 $1,455.34 $1,903.87 $1,276.20 $1,669.5260 $1,517.40 $1,949.56 $1,330.62 $1,709.5961 $1,571.07 $2,018.51 $1,377.69 $1,770.0662 $1,606.30 $2,063.77 $1,408.58 $1,809.7463 $1,650.46 $2,120.52 $1,447.31 $1,859.50

64+ $1,677.30 $2,155.00 $1,470.84 $1,889.74

Southern, IL

Individual Coverage

Age Non Tobacco

TobaccoNon

TobaccoTobacco Non Tobacco Tobacco

Non Tobacco

Tobacco Non Tobacco TobaccoNon

TobaccoTobacco

Non Tobacco

Tobacco

0-14 $232.57 $232.57 $245.74 $245.74 $264.95 $264.95 $252.63 $252.63 $265.06 $265.06 $160.53 $160.53 $204.07 $204.0715 $253.25 $253.25 $267.58 $267.58 $288.50 $288.50 $275.09 $275.09 $288.62 $288.62 $174.80 $174.80 $222.21 $222.2116 $261.15 $261.15 $275.93 $275.93 $297.50 $297.50 $283.67 $283.67 $297.63 $297.63 $180.26 $180.26 $229.15 $229.1517 $269.05 $269.05 $284.29 $284.29 $306.51 $306.51 $292.26 $292.26 $306.63 $306.63 $185.72 $185.72 $236.08 $236.0818 $277.57 $277.57 $293.28 $293.28 $316.21 $316.21 $301.51 $301.51 $316.34 $316.34 $191.59 $191.59 $243.55 $243.5519 $286.08 $286.08 $302.28 $302.28 $325.90 $325.90 $310.75 $310.75 $326.04 $326.04 $197.47 $197.47 $251.02 $251.0220 $294.90 $294.90 $311.59 $311.59 $335.95 $335.95 $320.33 $320.33 $336.08 $336.08 $203.55 $203.55 $258.76 $258.7621 $304.02 $304.02 $321.23 $321.23 $346.34 $346.34 $330.24 $330.24 $346.48 $346.48 $209.85 $209.85 $266.76 $266.7622 $304.02 $304.02 $321.23 $321.23 $346.34 $346.34 $330.24 $330.24 $346.48 $346.48 $209.85 $209.85 $266.76 $266.7623 $304.02 $304.02 $321.23 $321.23 $346.34 $346.34 $330.24 $330.24 $346.48 $346.48 $209.85 $209.85 $266.76 $266.7624 $304.02 $304.02 $321.23 $321.23 $346.34 $346.34 $330.24 $330.24 $346.48 $346.48 $209.85 $209.85 $266.76 $266.7625 $305.23 $305.23 $322.51 $322.51 $347.72 $347.72 $331.56 $331.56 $347.86 $347.86 $210.69 $210.69 $267.83 $267.8326 $311.31 $311.31 $328.94 $328.94 $354.65 $354.65 $338.16 $338.16 $354.79 $354.79 $214.88 $214.88 $273.16 $273.1627 $318.61 $318.61 $336.65 $336.65 $362.96 $362.96 $346.09 $346.09 $363.11 $363.11 $219.92 $219.92 $279.57 $279.5728 $330.47 $330.47 $349.17 $349.17 $376.47 $376.47 $358.97 $358.97 $376.62 $376.62 $228.11 $228.11 $289.97 $289.9729 $340.19 $340.19 $359.45 $359.45 $387.55 $387.55 $369.53 $369.53 $387.71 $387.71 $234.82 $234.82 $298.51 $298.5130 $345.06 $391.37 $364.59 $413.52 $393.09 $445.85 $374.82 $425.12 $393.25 $446.03 $238.18 $270.14 $302.77 $343.4131 $352.36 $399.64 $372.30 $422.27 $401.40 $455.27 $382.74 $434.11 $401.57 $455.46 $243.21 $275.85 $309.18 $350.6732 $359.65 $407.92 $380.01 $431.01 $409.72 $464.70 $390.67 $443.10 $409.88 $464.89 $248.25 $281.57 $315.58 $357.9333 $364.21 $413.09 $384.83 $436.47 $414.91 $470.59 $395.62 $448.71 $415.08 $470.79 $251.40 $285.14 $319.58 $362.4734 $369.08 $418.61 $389.97 $442.30 $420.45 $476.88 $400.91 $454.71 $420.63 $477.07 $254.76 $288.94 $323.85 $367.3135 $371.51 $456.14 $392.54 $481.96 $423.22 $519.63 $403.55 $495.48 $423.40 $519.85 $256.43 $314.85 $325.98 $400.2436 $373.94 $459.12 $395.11 $485.11 $425.99 $523.03 $406.19 $498.72 $426.17 $523.25 $258.11 $316.91 $328.12 $402.8637 $376.37 $462.11 $397.68 $488.27 $428.76 $526.44 $408.83 $501.97 $428.94 $526.65 $259.79 $318.97 $330.25 $405.4838 $378.80 $465.10 $400.25 $491.43 $431.54 $529.84 $411.47 $505.21 $431.71 $530.06 $261.47 $321.03 $332.38 $408.1039 $383.67 $471.07 $405.39 $497.74 $437.08 $536.64 $416.76 $511.69 $437.26 $536.86 $264.83 $325.16 $336.65 $413.3440 $388.53 $500.97 $410.53 $529.33 $442.62 $570.71 $422.04 $544.18 $442.80 $570.95 $268.19 $345.80 $340.92 $439.5841 $395.83 $510.38 $418.24 $539.28 $450.93 $581.43 $429.97 $554.40 $451.12 $581.67 $273.22 $352.29 $347.32 $447.8442 $402.82 $519.40 $425.63 $548.80 $458.90 $591.70 $437.56 $564.20 $459.08 $591.95 $278.05 $358.52 $353.46 $455.7543 $412.55 $531.94 $435.91 $562.06 $469.98 $605.99 $448.13 $577.82 $470.17 $606.24 $284.76 $367.18 $361.99 $466.7644 $424.71 $547.62 $448.75 $578.62 $483.83 $623.85 $461.34 $594.85 $484.03 $624.11 $293.16 $378.00 $372.66 $480.5145 $439.00 $578.87 $463.85 $611.64 $500.11 $659.45 $476.86 $628.79 $500.32 $659.72 $303.02 $399.56 $385.20 $507.9346 $456.02 $601.31 $481.84 $635.36 $519.50 $685.02 $495.35 $653.17 $519.72 $685.30 $314.77 $415.06 $400.14 $527.6347 $475.18 $626.57 $502.08 $662.04 $541.32 $713.79 $516.16 $680.61 $541.55 $714.08 $327.99 $432.49 $416.95 $549.7948 $497.07 $655.43 $525.21 $692.54 $566.26 $746.67 $539.94 $711.96 $566.49 $746.98 $343.10 $452.41 $436.15 $575.1149 $518.65 $683.89 $548.01 $722.61 $590.85 $779.09 $563.38 $742.88 $591.09 $779.41 $358.00 $472.06 $455.09 $600.0950 $542.97 $717.92 $573.71 $758.56 $618.56 $817.86 $589.80 $779.84 $618.81 $818.19 $374.79 $495.55 $476.43 $629.9451 $566.99 $749.67 $599.09 $792.11 $645.92 $854.03 $615.89 $814.33 $646.18 $854.38 $391.37 $517.46 $497.51 $657.8152 $593.44 $784.65 $627.04 $829.07 $676.05 $893.87 $644.62 $852.32 $676.33 $894.24 $409.62 $541.60 $520.72 $688.4953 $620.19 $820.02 $655.30 $866.44 $706.53 $934.17 $673.68 $890.74 $706.82 $934.55 $428.09 $566.02 $544.19 $719.5354 $649.08 $858.21 $685.82 $906.79 $739.43 $977.67 $705.05 $932.22 $739.73 $978.08 $448.03 $592.38 $569.53 $753.0455 $677.96 $886.90 $716.34 $937.11 $772.33 $1,010.36 $736.43 $963.39 $772.65 $1,010.78 $467.96 $612.19 $594.88 $778.2256 $709.27 $927.87 $749.42 $980.40 $808.00 $1,057.03 $770.44 $1,007.89 $808.34 $1,057.46 $489.58 $640.46 $622.35 $814.1657 $740.89 $969.23 $782.83 $1,024.10 $844.02 $1,104.15 $804.79 $1,052.82 $844.37 $1,104.60 $511.40 $669.01 $650.10 $850.4558 $774.63 $1,013.38 $818.49 $1,070.74 $882.47 $1,154.44 $841.44 $1,100.77 $882.83 $1,154.91 $534.69 $699.49 $679.71 $889.1959 $791.36 $1,035.25 $836.16 $1,093.86 $901.51 $1,179.36 $859.60 $1,124.53 $901.88 $1,179.84 $546.23 $714.58 $694.38 $908.3860 $825.10 $1,060.09 $871.81 $1,120.10 $939.96 $1,207.66 $896.26 $1,151.52 $940.34 $1,208.15 $569.53 $731.73 $723.99 $930.1861 $854.29 $1,097.59 $902.65 $1,159.72 $973.21 $1,250.37 $927.96 $1,192.25 $973.61 $1,250.89 $589.67 $757.61 $749.60 $963.0862 $873.44 $1,122.19 $922.89 $1,185.72 $995.02 $1,278.41 $948.77 $1,218.98 $995.43 $1,278.93 $602.89 $774.60 $766.40 $984.6863 $897.46 $1,153.05 $948.26 $1,218.33 $1,022.38 $1,313.56 $974.86 $1,252.50 $1,022.81 $1,314.10 $619.47 $795.90 $787.48 $1,011.75

64+ $912.06 $1,171.80 $963.69 $1,238.14 $1,039.02 $1,334.92 $990.72 $1,272.86 $1,039.44 $1,335.47 $629.55 $808.84 $800.28 $1,028.20

Blue FocusCare BronzeSM

BlueCare Direct BronzeSM

Illinois Off Exchange (Bronze)

with Advocate

201 202205 502 209302

Blue Precision Bronze HMOSM Blue Choice Preferred Bronze PPOSM

Individual Coverage

Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco

0-14 $229.64 $229.64 $239.31 $239.31 $257.97 $257.97 $246.06 $246.06 $257.95 $257.9515 $250.05 $250.05 $260.58 $260.58 $280.90 $280.90 $267.93 $267.93 $280.88 $280.8816 $257.86 $257.86 $268.72 $268.72 $289.67 $289.67 $276.29 $276.29 $289.65 $289.6517 $265.66 $265.66 $276.85 $276.85 $298.44 $298.44 $284.66 $284.66 $298.42 $298.4218 $274.07 $274.07 $285.61 $285.61 $307.88 $307.88 $293.66 $293.66 $307.86 $307.8619 $282.47 $282.47 $294.37 $294.37 $317.32 $317.32 $302.67 $302.67 $317.30 $317.3020 $291.18 $291.18 $303.44 $303.44 $327.10 $327.10 $311.99 $311.99 $327.08 $327.0821 $300.18 $300.18 $312.82 $312.82 $337.21 $337.21 $321.64 $321.64 $337.20 $337.2022 $300.18 $300.18 $312.82 $312.82 $337.21 $337.21 $321.64 $321.64 $337.20 $337.2023 $300.18 $300.18 $312.82 $312.82 $337.21 $337.21 $321.64 $321.64 $337.20 $337.2024 $300.18 $300.18 $312.82 $312.82 $337.21 $337.21 $321.64 $321.64 $337.20 $337.2025 $301.38 $301.38 $314.08 $314.08 $338.56 $338.56 $322.93 $322.93 $338.54 $338.5426 $307.39 $307.39 $320.33 $320.33 $345.31 $345.31 $329.36 $329.36 $345.29 $345.2927 $314.59 $314.59 $327.84 $327.84 $353.40 $353.40 $337.08 $337.08 $353.38 $353.3828 $326.30 $326.30 $340.04 $340.04 $366.55 $366.55 $349.63 $349.63 $366.53 $366.5329 $335.90 $335.90 $350.05 $350.05 $377.34 $377.34 $359.92 $359.92 $377.32 $377.3230 $340.71 $386.43 $355.06 $402.70 $382.74 $434.10 $365.07 $414.06 $382.72 $434.0831 $347.91 $394.60 $362.56 $411.22 $390.83 $443.28 $372.79 $422.81 $390.81 $443.2632 $355.12 $402.77 $370.07 $419.73 $398.93 $452.46 $380.51 $431.57 $398.90 $452.4433 $359.62 $407.88 $374.76 $425.06 $403.98 $458.20 $385.33 $437.04 $403.96 $458.1734 $364.42 $413.33 $379.77 $430.73 $409.38 $464.32 $390.48 $442.88 $409.36 $464.2935 $366.82 $450.38 $382.27 $469.35 $412.08 $505.95 $393.05 $482.59 $412.05 $505.9236 $369.22 $453.33 $384.77 $472.42 $414.77 $509.26 $395.62 $485.74 $414.75 $509.2337 $371.63 $456.28 $387.28 $475.50 $417.47 $512.57 $398.20 $488.91 $417.45 $512.5438 $374.03 $459.23 $389.78 $478.57 $420.17 $515.88 $400.77 $492.06 $420.15 $515.8639 $378.83 $465.13 $394.78 $484.71 $425.57 $522.51 $405.92 $498.38 $425.54 $522.4840 $383.63 $494.65 $399.79 $515.49 $430.96 $555.68 $411.06 $530.02 $430.94 $555.6541 $390.84 $503.95 $407.30 $525.17 $439.05 $566.12 $418.78 $539.98 $439.03 $566.0842 $397.74 $512.85 $414.49 $534.45 $446.81 $576.12 $426.18 $549.52 $446.78 $576.0943 $407.35 $525.23 $424.50 $547.35 $457.60 $590.03 $436.47 $562.79 $457.57 $590.0044 $419.35 $540.71 $437.02 $563.49 $471.09 $607.42 $449.34 $579.37 $471.06 $607.3945 $433.46 $571.56 $451.72 $595.64 $486.94 $642.08 $464.45 $612.43 $486.91 $642.0446 $450.27 $593.73 $469.24 $618.73 $505.82 $666.98 $482.47 $636.18 $505.79 $666.9447 $469.18 $618.67 $488.94 $644.72 $527.07 $694.99 $502.73 $662.90 $527.04 $694.9548 $490.80 $647.17 $511.47 $674.42 $551.35 $727.00 $525.89 $693.44 $551.31 $726.9649 $512.11 $675.27 $533.68 $703.71 $575.29 $758.57 $548.73 $723.55 $575.26 $758.5350 $536.13 $708.86 $558.70 $738.72 $602.27 $796.32 $574.46 $759.55 $602.23 $796.2751 $559.84 $740.22 $583.42 $771.39 $628.91 $831.54 $599.87 $793.14 $628.87 $831.4952 $585.96 $774.75 $610.63 $807.38 $658.24 $870.33 $627.85 $830.14 $658.21 $870.2853 $612.37 $809.68 $638.16 $843.78 $687.92 $909.57 $656.15 $867.57 $687.88 $909.5154 $640.89 $847.38 $667.88 $883.07 $719.95 $951.92 $686.71 $907.97 $719.91 $951.8755 $669.41 $875.72 $697.60 $912.60 $751.99 $983.75 $717.27 $938.33 $751.95 $983.7056 $700.32 $916.16 $729.82 $954.75 $786.72 $1,029.19 $750.40 $981.67 $786.68 $1,029.1357 $731.54 $957.00 $762.35 $997.31 $821.79 $1,075.07 $783.85 $1,025.43 $821.75 $1,075.0158 $764.86 $1,000.59 $797.08 $1,042.73 $859.22 $1,124.03 $819.55 $1,072.13 $859.17 $1,123.9759 $781.37 $1,022.19 $814.28 $1,065.24 $877.77 $1,148.30 $837.24 $1,095.28 $877.72 $1,148.2360 $814.69 $1,046.72 $849.00 $1,090.80 $915.20 $1,175.85 $872.94 $1,121.56 $915.15 $1,175.7861 $843.51 $1,083.74 $879.04 $1,129.39 $947.57 $1,217.44 $903.82 $1,161.23 $947.52 $1,217.3762 $862.42 $1,108.04 $898.74 $1,154.71 $968.82 $1,244.74 $924.08 $1,187.26 $968.76 $1,244.6763 $886.14 $1,138.51 $923.46 $1,186.46 $995.46 $1,278.96 $949.49 $1,219.91 $995.40 $1,278.89

64+ $900.54 $1,157.02 $938.46 $1,205.75 $1,011.63 $1,299.76 $964.92 $1,239.75 $1,011.60 $1,299.69

502Blue Choice Preferred Bronze PPOSM

Chicago - North, IL

201 202Blue Precision Bronze HMOSM

Individual Coverage

Age Non Tobacco

TobaccoNon

TobaccoTobacco

Non Tobacco

TobaccoNon

TobaccoTobacco

Non Tobacco

Tobacco Non Tobacco Tobacco

0-14 $221.14 $221.14 $231.56 $231.56 $249.65 $249.65 $238.09 $238.09 $249.75 $249.75 $209.68 $209.6815 $240.79 $240.79 $252.14 $252.14 $271.84 $271.84 $259.25 $259.25 $271.95 $271.95 $228.32 $228.3216 $248.31 $248.31 $260.01 $260.01 $280.32 $280.32 $267.34 $267.34 $280.43 $280.43 $235.44 $235.4417 $255.83 $255.83 $267.88 $267.88 $288.81 $288.81 $275.44 $275.44 $288.92 $288.92 $242.57 $242.5718 $263.92 $263.92 $276.36 $276.36 $297.94 $297.94 $284.15 $284.15 $298.06 $298.06 $250.24 $250.2419 $272.01 $272.01 $284.83 $284.83 $307.08 $307.08 $292.86 $292.86 $307.20 $307.20 $257.92 $257.9220 $280.40 $280.40 $293.61 $293.61 $316.54 $316.54 $301.89 $301.89 $316.67 $316.67 $265.87 $265.8721 $289.07 $289.07 $302.69 $302.69 $326.33 $326.33 $311.23 $311.23 $326.47 $326.47 $274.09 $274.0922 $289.07 $289.07 $302.69 $302.69 $326.33 $326.33 $311.23 $311.23 $326.47 $326.47 $274.09 $274.0923 $289.07 $289.07 $302.69 $302.69 $326.33 $326.33 $311.23 $311.23 $326.47 $326.47 $274.09 $274.0924 $289.07 $289.07 $302.69 $302.69 $326.33 $326.33 $311.23 $311.23 $326.47 $326.47 $274.09 $274.0925 $290.23 $290.23 $303.90 $303.90 $327.64 $327.64 $312.47 $312.47 $327.77 $327.77 $275.19 $275.1926 $296.01 $296.01 $309.95 $309.95 $334.17 $334.17 $318.70 $318.70 $334.30 $334.30 $280.67 $280.6727 $302.94 $302.94 $317.22 $317.22 $342.00 $342.00 $326.17 $326.17 $342.14 $342.14 $287.25 $287.2528 $314.22 $314.22 $329.02 $329.02 $354.73 $354.73 $338.30 $338.30 $354.87 $354.87 $297.93 $297.9329 $323.47 $323.47 $338.71 $338.71 $365.17 $365.17 $348.26 $348.26 $365.32 $365.32 $306.71 $306.7130 $328.09 $372.12 $343.55 $389.66 $370.39 $420.10 $353.24 $400.65 $370.54 $420.27 $311.09 $352.8431 $335.03 $379.99 $350.82 $397.90 $378.22 $428.98 $360.71 $409.12 $378.37 $429.15 $317.67 $360.3032 $341.97 $387.86 $358.08 $406.14 $386.05 $437.86 $368.18 $417.59 $386.21 $438.04 $324.25 $367.7633 $346.30 $392.78 $362.62 $411.29 $390.95 $443.41 $372.85 $422.89 $391.11 $443.59 $328.36 $372.4234 $350.93 $398.02 $367.47 $416.78 $396.17 $449.34 $377.83 $428.53 $396.33 $449.52 $332.74 $377.4035 $353.24 $433.71 $369.89 $454.15 $398.78 $489.62 $380.32 $466.96 $398.94 $489.82 $334.94 $411.2336 $355.55 $436.55 $372.31 $457.12 $401.39 $492.83 $382.81 $470.01 $401.55 $493.03 $337.13 $413.9337 $357.87 $439.39 $374.73 $460.09 $404.00 $496.03 $385.30 $473.07 $404.17 $496.24 $339.32 $416.6238 $360.18 $442.23 $377.15 $463.07 $406.61 $499.24 $387.79 $476.13 $406.78 $499.44 $341.51 $419.3139 $364.80 $447.91 $381.99 $469.01 $411.83 $505.65 $392.77 $482.24 $412.00 $505.85 $345.90 $424.7040 $369.43 $476.34 $386.84 $498.79 $417.05 $537.75 $397.75 $512.86 $417.22 $537.97 $350.29 $451.6641 $376.37 $485.29 $394.10 $508.16 $424.89 $547.85 $405.22 $522.49 $425.06 $548.07 $356.86 $460.1442 $383.02 $493.86 $401.06 $517.13 $432.39 $557.53 $412.38 $531.72 $432.57 $557.75 $363.17 $468.2743 $392.27 $505.79 $410.75 $529.62 $442.84 $570.99 $422.33 $544.56 $443.01 $571.22 $371.94 $479.5844 $403.83 $520.70 $422.86 $545.23 $455.89 $587.82 $434.78 $560.61 $456.07 $588.06 $382.90 $493.7145 $417.42 $550.40 $437.08 $576.34 $471.23 $621.36 $449.41 $592.59 $471.42 $621.61 $395.78 $521.8846 $433.60 $571.75 $454.03 $598.69 $489.50 $645.46 $466.84 $615.58 $489.70 $645.72 $411.13 $542.1247 $451.81 $595.76 $473.10 $623.83 $510.06 $672.56 $486.45 $641.43 $510.27 $672.84 $428.40 $564.8948 $472.63 $623.21 $494.90 $652.57 $533.56 $703.55 $508.86 $670.98 $533.77 $703.83 $448.14 $590.9149 $493.15 $650.27 $516.39 $680.91 $556.73 $734.10 $530.95 $700.11 $556.95 $734.40 $467.60 $616.5750 $516.28 $682.62 $540.60 $714.79 $582.83 $770.62 $555.85 $734.95 $583.07 $770.93 $489.52 $647.2551 $539.11 $712.81 $564.52 $746.40 $608.61 $804.71 $580.44 $767.45 $608.86 $805.03 $511.18 $675.8852 $564.26 $746.07 $590.85 $781.22 $637.00 $842.25 $607.51 $803.25 $637.26 $842.59 $535.02 $707.4053 $589.70 $779.70 $617.49 $816.44 $665.72 $880.22 $634.90 $839.47 $665.99 $880.57 $559.14 $739.3054 $617.16 $816.01 $646.24 $854.46 $696.72 $921.21 $664.47 $878.56 $697.01 $921.58 $585.18 $773.7355 $644.62 $843.30 $675.00 $883.03 $727.72 $952.01 $694.04 $907.94 $728.02 $952.40 $611.22 $799.6056 $674.40 $882.25 $706.18 $923.82 $761.34 $995.98 $726.09 $949.87 $761.65 $996.38 $639.45 $836.5357 $704.46 $921.57 $737.66 $965.00 $795.28 $1,040.38 $758.46 $992.22 $795.60 $1,040.80 $667.95 $873.8258 $736.55 $963.55 $771.25 $1,008.95 $831.50 $1,087.77 $793.01 $1,037.41 $831.84 $1,088.21 $698.38 $913.6259 $752.45 $984.35 $787.90 $1,030.73 $849.45 $1,111.25 $810.12 $1,059.80 $849.79 $1,111.70 $713.45 $933.3460 $784.53 $1,007.97 $821.50 $1,055.46 $885.67 $1,137.91 $844.67 $1,085.23 $886.03 $1,138.37 $743.88 $955.7361 $812.28 $1,043.62 $850.56 $1,092.80 $917.00 $1,178.16 $874.55 $1,123.62 $917.37 $1,178.64 $770.19 $989.5462 $830.49 $1,067.02 $869.63 $1,117.30 $937.56 $1,204.57 $894.15 $1,148.81 $937.94 $1,205.06 $787.46 $1,011.7363 $853.33 $1,096.36 $893.54 $1,148.02 $963.34 $1,237.70 $918.74 $1,180.40 $963.73 $1,238.20 $809.11 $1,039.55

64+ $867.21 $1,114.19 $908.07 $1,166.69 $978.99 $1,257.82 $933.69 $1,199.59 $979.41 $1,258.33 $822.27 $1,056.45

BlueCare Direct BronzeSM

Chicago - West, IL

201 202205 502with Advocate

Blue Precision Bronze HMOSM Blue Choice Preferred Bronze PPOSM

Individual Coverage

0-14 $212.96 $212.96 $227.17 $227.17 $244.90 $244.90 $233.51 $233.51 $245.22 $245.2215 $231.89 $231.89 $247.36 $247.36 $266.67 $266.67 $254.27 $254.27 $267.02 $267.0216 $239.13 $239.13 $255.08 $255.08 $275.00 $275.00 $262.21 $262.21 $275.35 $275.3517 $246.37 $246.37 $262.80 $262.80 $283.32 $283.32 $270.14 $270.14 $283.69 $283.6918 $254.16 $254.16 $271.11 $271.11 $292.29 $292.29 $278.69 $278.69 $292.66 $292.6619 $261.96 $261.96 $279.43 $279.43 $301.25 $301.25 $287.24 $287.24 $301.64 $301.6420 $270.03 $270.03 $288.04 $288.04 $310.53 $310.53 $296.09 $296.09 $310.94 $310.9421 $278.38 $278.38 $296.95 $296.95 $320.14 $320.14 $305.25 $305.25 $320.55 $320.5522 $278.38 $278.38 $296.95 $296.95 $320.14 $320.14 $305.25 $305.25 $320.55 $320.5523 $278.38 $278.38 $296.95 $296.95 $320.14 $320.14 $305.25 $305.25 $320.55 $320.5524 $278.38 $278.38 $296.95 $296.95 $320.14 $320.14 $305.25 $305.25 $320.55 $320.5525 $279.49 $279.49 $298.14 $298.14 $321.42 $321.42 $306.47 $306.47 $321.83 $321.8326 $285.06 $285.06 $304.07 $304.07 $327.82 $327.82 $312.57 $312.57 $328.24 $328.2427 $291.74 $291.74 $311.20 $311.20 $335.50 $335.50 $319.90 $319.90 $335.94 $335.9428 $302.60 $302.60 $322.78 $322.78 $347.99 $347.99 $331.80 $331.80 $348.44 $348.4429 $311.51 $311.51 $332.28 $332.28 $358.23 $358.23 $341.57 $341.57 $358.70 $358.7030 $315.96 $358.36 $337.04 $382.27 $363.36 $412.12 $346.46 $392.95 $363.83 $412.6531 $322.64 $365.94 $344.16 $390.35 $371.04 $420.83 $353.78 $401.26 $371.52 $421.3832 $329.32 $373.52 $351.29 $398.43 $378.72 $429.55 $361.11 $409.57 $379.21 $430.1033 $333.50 $378.25 $355.74 $403.48 $383.52 $434.99 $365.69 $414.76 $384.02 $435.5634 $337.95 $383.31 $360.49 $408.87 $388.65 $440.80 $370.57 $420.30 $389.15 $441.3735 $340.18 $417.67 $362.87 $445.53 $391.21 $480.32 $373.01 $457.98 $391.71 $480.9536 $342.41 $420.41 $365.25 $448.45 $393.77 $483.47 $375.45 $460.98 $394.28 $484.0937 $344.63 $423.14 $367.62 $451.37 $396.33 $486.61 $377.90 $463.98 $396.84 $487.2538 $346.86 $425.88 $370.00 $454.28 $398.89 $489.76 $380.34 $466.98 $399.41 $490.3939 $351.32 $431.34 $374.75 $460.12 $404.01 $496.05 $385.22 $472.97 $404.54 $496.6940 $355.77 $458.73 $379.50 $489.33 $409.14 $527.54 $390.11 $503.00 $409.67 $528.2241 $362.45 $467.34 $386.63 $498.52 $416.82 $537.45 $397.43 $512.45 $417.36 $538.1442 $368.85 $475.60 $393.46 $507.32 $424.18 $546.94 $404.45 $521.50 $424.73 $547.6543 $377.76 $487.09 $402.96 $519.58 $434.43 $560.15 $414.22 $534.10 $434.99 $560.8844 $388.90 $501.44 $414.84 $534.89 $447.23 $576.66 $426.43 $549.84 $447.81 $577.4145 $401.98 $530.05 $428.79 $565.41 $462.28 $609.56 $440.78 $581.21 $462.88 $610.3546 $417.57 $550.61 $445.42 $587.33 $480.21 $633.20 $457.87 $603.75 $480.83 $634.0247 $435.11 $573.73 $464.13 $612.00 $500.37 $659.79 $477.10 $629.10 $501.02 $660.6548 $455.15 $600.16 $485.51 $640.19 $523.42 $690.19 $499.08 $658.08 $524.10 $691.0849 $474.92 $626.22 $506.59 $667.99 $546.15 $720.16 $520.75 $686.66 $546.86 $721.0950 $497.19 $657.38 $530.35 $701.23 $571.77 $755.99 $545.17 $720.82 $572.51 $756.9751 $519.18 $686.46 $553.81 $732.24 $597.06 $789.43 $569.29 $752.71 $597.83 $790.4552 $543.40 $718.48 $579.64 $766.40 $624.91 $826.25 $595.84 $787.82 $625.72 $827.3253 $567.90 $750.87 $605.77 $800.96 $653.08 $863.50 $622.70 $823.34 $653.93 $864.6254 $594.34 $785.84 $633.98 $838.25 $683.49 $903.72 $651.70 $861.68 $684.38 $904.8955 $620.79 $812.12 $662.19 $866.28 $713.91 $933.93 $680.70 $890.49 $714.83 $935.1456 $649.46 $849.62 $692.78 $906.29 $746.88 $977.07 $712.14 $931.62 $747.85 $978.3357 $678.41 $887.50 $723.66 $946.69 $780.17 $1,020.62 $743.89 $973.15 $781.18 $1,021.9458 $709.31 $927.92 $756.62 $989.81 $815.71 $1,067.11 $777.77 $1,017.48 $816.77 $1,068.4959 $724.62 $947.95 $772.96 $1,011.18 $833.32 $1,090.14 $794.56 $1,039.44 $834.40 $1,091.5660 $755.52 $970.70 $805.92 $1,035.44 $868.85 $1,116.30 $828.44 $1,064.38 $869.98 $1,117.7561 $782.25 $1,005.03 $834.42 $1,072.07 $899.59 $1,155.79 $857.74 $1,102.03 $900.75 $1,157.2862 $799.79 $1,027.57 $853.13 $1,096.10 $919.75 $1,181.70 $876.97 $1,126.74 $920.95 $1,183.2363 $821.78 $1,055.82 $876.59 $1,126.24 $945.05 $1,214.19 $901.09 $1,157.72 $946.27 $1,215.77

64+ $835.14 $1,072.99 $890.85 $1,144.56 $960.42 $1,233.94 $915.75 $1,176.54 $961.65 $1,235.53

Chicago - South, ILBlue Choice Preferred Bronze PPOSM

Individual Coverage

0-14 $237.94 $237.94 $293.62 $293.62 $315.79 $315.79 $301.86 $301.86 $314.64 $314.6415 $259.09 $259.09 $319.72 $319.72 $343.86 $343.86 $328.70 $328.70 $342.60 $342.6016 $267.18 $267.18 $329.70 $329.70 $354.59 $354.59 $338.96 $338.96 $353.30 $353.3017 $275.26 $275.26 $339.68 $339.68 $365.33 $365.33 $349.22 $349.22 $363.99 $363.9918 $283.97 $283.97 $350.43 $350.43 $376.88 $376.88 $360.26 $360.26 $375.51 $375.5119 $292.68 $292.68 $361.18 $361.18 $388.44 $388.44 $371.31 $371.31 $387.02 $387.0220 $301.70 $301.70 $372.31 $372.31 $400.41 $400.41 $382.76 $382.76 $398.95 $398.9521 $311.03 $311.03 $383.82 $383.82 $412.80 $412.80 $394.59 $394.59 $411.29 $411.2922 $311.03 $311.03 $383.82 $383.82 $412.80 $412.80 $394.59 $394.59 $411.29 $411.2923 $311.03 $311.03 $383.82 $383.82 $412.80 $412.80 $394.59 $394.59 $411.29 $411.2924 $311.03 $311.03 $383.82 $383.82 $412.80 $412.80 $394.59 $394.59 $411.29 $411.2925 $312.28 $312.28 $385.36 $385.36 $414.45 $414.45 $396.17 $396.17 $412.93 $412.9326 $318.50 $318.50 $393.03 $393.03 $422.71 $422.71 $404.06 $404.06 $421.16 $421.1627 $325.96 $325.96 $402.25 $402.25 $432.61 $432.61 $413.53 $413.53 $431.03 $431.0328 $338.09 $338.09 $417.22 $417.22 $448.71 $448.71 $428.92 $428.92 $447.07 $447.0729 $348.05 $348.05 $429.50 $429.50 $461.92 $461.92 $441.55 $441.55 $460.23 $460.2330 $353.02 $400.40 $435.64 $494.10 $468.53 $531.40 $447.86 $507.97 $466.81 $529.4631 $360.49 $408.87 $444.85 $504.55 $478.43 $542.64 $457.33 $518.71 $476.68 $540.6532 $367.95 $417.33 $454.06 $515.00 $488.34 $553.88 $466.80 $529.45 $486.55 $551.8533 $372.62 $422.62 $459.82 $521.53 $494.53 $560.90 $472.72 $536.16 $492.72 $558.8534 $377.59 $428.27 $465.96 $528.49 $501.14 $568.39 $479.04 $543.32 $499.30 $566.3135 $380.08 $466.67 $469.03 $575.88 $504.44 $619.35 $482.19 $592.04 $502.59 $617.0836 $382.57 $469.72 $472.10 $579.65 $507.74 $623.40 $485.35 $595.91 $505.88 $621.1237 $385.06 $472.78 $475.17 $583.42 $511.04 $627.46 $488.51 $599.79 $509.17 $625.1738 $387.55 $475.83 $478.24 $587.19 $514.35 $631.51 $491.66 $603.67 $512.46 $629.2039 $392.52 $481.94 $484.38 $594.73 $520.95 $639.62 $497.98 $611.42 $519.05 $637.2840 $397.50 $512.54 $490.53 $632.48 $527.56 $680.23 $504.29 $650.23 $525.63 $677.7441 $404.97 $522.16 $499.74 $644.36 $537.46 $693.01 $513.76 $662.44 $535.50 $690.4742 $412.12 $531.39 $508.57 $655.75 $546.96 $705.25 $522.84 $674.15 $544.96 $702.6743 $422.07 $544.22 $520.85 $671.58 $560.17 $722.28 $535.46 $690.43 $558.12 $719.6444 $434.51 $560.26 $536.20 $691.38 $576.68 $743.57 $551.25 $710.78 $574.57 $740.8545 $449.13 $592.23 $554.24 $730.82 $596.08 $785.99 $569.79 $751.33 $593.90 $783.1246 $466.55 $615.19 $575.73 $759.16 $619.20 $816.47 $591.89 $780.47 $616.93 $813.4947 $486.15 $641.03 $599.92 $791.05 $645.20 $850.76 $616.75 $813.25 $642.84 $847.6548 $508.54 $670.56 $627.55 $827.49 $674.92 $889.96 $645.16 $850.71 $672.46 $886.7049 $530.62 $699.68 $654.80 $863.42 $704.23 $928.60 $673.18 $887.65 $701.66 $925.2050 $555.51 $734.49 $685.51 $906.38 $737.26 $974.80 $704.75 $931.81 $734.56 $971.2451 $580.08 $766.98 $715.83 $946.47 $769.87 $1,017.92 $735.92 $973.03 $767.05 $1,014.2052 $607.14 $802.76 $749.22 $990.62 $805.78 $1,065.40 $770.25 $1,018.42 $802.83 $1,061.5153 $634.51 $838.95 $783.00 $1,035.28 $842.11 $1,113.44 $804.97 $1,064.34 $839.03 $1,109.3654 $664.06 $878.02 $819.46 $1,083.49 $881.32 $1,165.29 $842.46 $1,113.90 $878.10 $1,161.0355 $693.60 $907.38 $855.93 $1,119.72 $920.54 $1,204.25 $879.95 $1,151.15 $917.17 $1,199.8556 $725.64 $949.28 $895.46 $1,171.44 $963.06 $1,259.87 $920.59 $1,204.31 $959.54 $1,255.2657 $757.99 $991.60 $935.38 $1,223.66 $1,005.99 $1,316.03 $961.63 $1,258.00 $1,002.31 $1,311.2258 $792.51 $1,036.77 $977.98 $1,279.39 $1,051.81 $1,375.98 $1,005.43 $1,315.30 $1,047.96 $1,370.9459 $809.62 $1,059.14 $999.09 $1,307.01 $1,074.51 $1,405.68 $1,027.13 $1,343.69 $1,070.58 $1,400.5360 $844.15 $1,084.56 $1,041.70 $1,338.37 $1,120.33 $1,439.41 $1,070.93 $1,375.93 $1,116.24 $1,434.1461 $874.00 $1,122.92 $1,078.54 $1,385.71 $1,159.96 $1,490.32 $1,108.81 $1,424.60 $1,155.72 $1,484.8762 $893.60 $1,148.10 $1,102.72 $1,416.78 $1,185.97 $1,523.73 $1,133.67 $1,456.54 $1,181.63 $1,518.1663 $918.17 $1,179.67 $1,133.05 $1,455.74 $1,218.58 $1,565.63 $1,164.84 $1,496.59 $1,214.12 $1,559.90

64+ $933.09 $1,198.85 $1,151.46 $1,479.41 $1,238.40 $1,591.09 $1,183.77 $1,520.92 $1,233.87 $1,585.27

Rockford, ILBlue Choice Preferred Bronze PPOSM

Individual Coverage

0-14 $252.89 $252.89 $272.00 $272.00 $259.80 $259.80 $271.21 $271.2115 $275.37 $275.37 $296.18 $296.18 $282.89 $282.89 $295.32 $295.3216 $283.97 $283.97 $305.42 $305.42 $291.72 $291.72 $304.54 $304.5417 $292.56 $292.56 $314.66 $314.66 $300.55 $300.55 $313.75 $313.7518 $301.82 $301.82 $324.62 $324.62 $310.06 $310.06 $323.68 $323.6819 $311.08 $311.08 $334.58 $334.58 $319.57 $319.57 $333.61 $333.6120 $320.66 $320.66 $344.89 $344.89 $329.42 $329.42 $343.89 $343.8921 $330.58 $330.58 $355.55 $355.55 $339.61 $339.61 $354.52 $354.5222 $330.58 $330.58 $355.55 $355.55 $339.61 $339.61 $354.52 $354.5223 $330.58 $330.58 $355.55 $355.55 $339.61 $339.61 $354.52 $354.5224 $330.58 $330.58 $355.55 $355.55 $339.61 $339.61 $354.52 $354.5225 $331.90 $331.90 $356.98 $356.98 $340.97 $340.97 $355.94 $355.9426 $338.51 $338.51 $364.09 $364.09 $347.76 $347.76 $363.03 $363.0327 $346.45 $346.45 $372.62 $372.62 $355.91 $355.91 $371.54 $371.5428 $359.34 $359.34 $386.49 $386.49 $369.15 $369.15 $385.37 $385.3729 $369.92 $369.92 $397.86 $397.86 $380.02 $380.02 $396.71 $396.7130 $375.21 $425.56 $403.55 $457.71 $385.45 $437.18 $402.38 $456.3831 $383.14 $434.56 $412.09 $467.39 $393.60 $446.43 $410.89 $466.0432 $391.08 $443.56 $420.62 $477.07 $401.76 $455.67 $419.40 $475.6933 $396.03 $449.18 $425.95 $483.11 $406.85 $461.45 $424.72 $481.7234 $401.32 $455.18 $431.64 $489.57 $412.28 $467.61 $430.39 $488.1535 $403.97 $495.99 $434.49 $533.46 $415.00 $509.54 $433.23 $531.9236 $406.61 $499.24 $437.33 $536.95 $417.72 $512.87 $436.06 $535.4037 $409.26 $502.49 $440.17 $540.45 $420.43 $516.21 $438.90 $538.8838 $411.90 $505.73 $443.02 $543.94 $423.15 $519.54 $441.74 $542.3639 $417.19 $512.23 $448.71 $550.92 $428.58 $526.21 $447.41 $549.3340 $422.48 $544.75 $454.40 $585.90 $434.02 $559.62 $453.08 $584.2041 $430.41 $554.98 $462.93 $596.90 $442.17 $570.13 $461.59 $595.1742 $438.02 $564.78 $471.11 $607.45 $449.98 $580.21 $469.74 $605.6943 $448.60 $578.42 $482.49 $622.12 $460.85 $594.22 $481.09 $620.3244 $461.82 $595.47 $496.71 $640.45 $474.43 $611.73 $495.27 $638.6045 $477.36 $629.44 $513.42 $676.99 $490.39 $646.63 $511.93 $675.0346 $495.87 $653.85 $533.33 $703.25 $509.41 $671.71 $531.78 $701.2147 $516.70 $681.31 $555.73 $732.78 $530.81 $699.92 $554.12 $730.6648 $540.50 $712.70 $581.33 $766.54 $555.26 $732.16 $579.65 $764.3249 $563.97 $743.65 $606.57 $799.83 $579.37 $763.96 $604.82 $797.5150 $590.41 $780.65 $635.02 $839.62 $606.54 $801.97 $633.18 $837.1951 $616.53 $815.18 $663.11 $876.76 $633.37 $837.44 $661.19 $874.2252 $645.29 $853.20 $694.04 $917.66 $662.91 $876.50 $692.03 $915.0053 $674.38 $891.67 $725.33 $959.03 $692.80 $916.02 $723.23 $956.2554 $705.79 $933.19 $759.11 $1,003.69 $725.06 $958.68 $756.91 $1,000.7855 $737.19 $964.40 $792.88 $1,037.25 $757.32 $990.73 $790.59 $1,034.2556 $771.24 $1,008.94 $829.50 $1,085.16 $792.30 $1,036.49 $827.10 $1,082.0257 $805.62 $1,053.91 $866.48 $1,133.53 $827.62 $1,082.70 $863.97 $1,130.2558 $842.32 $1,101.92 $905.95 $1,185.16 $865.32 $1,132.01 $903.33 $1,181.7359 $860.50 $1,125.70 $925.50 $1,210.74 $884.00 $1,156.44 $922.82 $1,207.2460 $897.19 $1,152.71 $964.97 $1,239.79 $921.69 $1,184.19 $962.18 $1,236.2061 $928.93 $1,193.49 $999.10 $1,283.65 $954.30 $1,226.08 $996.21 $1,279.9362 $949.75 $1,220.24 $1,021.50 $1,312.43 $975.69 $1,253.57 $1,018.55 $1,308.6363 $975.87 $1,253.80 $1,049.59 $1,348.52 $1,002.52 $1,288.04 $1,046.55 $1,344.61

64+ $991.74 $1,274.19 $1,066.65 $1,370.44 $1,018.83 $1,308.98 $1,063.56 $1,366.47

Quad Cities, ILBlue Choice Preferred Bronze PPOSM

202201 302

Individual Coverage

0-14 $275.86 $275.86 $281.84 $281.84 $303.27 $303.27 $289.83 $289.83 $302.31 $302.3115 $300.38 $300.38 $306.89 $306.89 $330.23 $330.23 $315.59 $315.59 $329.18 $329.1816 $309.76 $309.76 $316.47 $316.47 $340.54 $340.54 $325.44 $325.44 $339.46 $339.4617 $319.14 $319.14 $326.05 $326.05 $350.85 $350.85 $335.29 $335.29 $349.73 $349.7318 $329.23 $329.23 $336.37 $336.37 $361.95 $361.95 $345.90 $345.90 $360.79 $360.7919 $339.33 $339.33 $346.68 $346.68 $373.05 $373.05 $356.51 $356.51 $371.86 $371.8620 $349.79 $349.79 $357.37 $357.37 $384.54 $384.54 $367.50 $367.50 $383.32 $383.3221 $360.60 $360.60 $368.42 $368.42 $396.44 $396.44 $378.86 $378.86 $395.17 $395.1722 $360.60 $360.60 $368.42 $368.42 $396.44 $396.44 $378.86 $378.86 $395.17 $395.1723 $360.60 $360.60 $368.42 $368.42 $396.44 $396.44 $378.86 $378.86 $395.17 $395.1724 $360.60 $360.60 $368.42 $368.42 $396.44 $396.44 $378.86 $378.86 $395.17 $395.1725 $362.05 $362.05 $369.89 $369.89 $398.02 $398.02 $380.38 $380.38 $396.76 $396.7626 $369.26 $369.26 $377.26 $377.26 $405.95 $405.95 $387.96 $387.96 $404.66 $404.6627 $377.91 $377.91 $386.11 $386.11 $415.47 $415.47 $397.05 $397.05 $414.14 $414.1428 $391.98 $391.98 $400.47 $400.47 $430.93 $430.93 $411.82 $411.82 $429.56 $429.5629 $403.52 $403.52 $412.26 $412.26 $443.61 $443.61 $423.95 $423.95 $442.20 $442.2030 $409.29 $464.21 $418.16 $474.28 $449.95 $510.34 $430.01 $487.72 $448.52 $508.7231 $417.94 $474.03 $427.00 $484.30 $459.47 $521.13 $439.10 $498.03 $458.01 $519.4732 $426.60 $483.85 $435.84 $494.33 $468.98 $531.92 $448.20 $508.34 $467.49 $530.2333 $432.00 $489.98 $441.37 $500.60 $474.93 $538.67 $453.88 $514.79 $473.42 $536.9534 $437.77 $496.52 $447.26 $507.29 $481.27 $545.86 $459.94 $521.67 $479.74 $544.1235 $440.66 $541.04 $450.21 $552.77 $484.44 $594.80 $462.97 $568.44 $482.90 $592.9136 $443.54 $544.58 $453.16 $556.39 $487.62 $598.69 $466.00 $572.16 $486.07 $596.7937 $446.43 $548.13 $456.11 $560.01 $490.79 $602.59 $469.03 $575.88 $489.23 $600.6738 $449.31 $551.67 $459.05 $563.63 $493.96 $606.48 $472.06 $579.60 $492.39 $604.5539 $455.08 $558.75 $464.95 $570.86 $500.30 $614.27 $478.13 $587.04 $498.71 $612.3240 $460.85 $594.22 $470.84 $607.10 $506.65 $653.27 $484.19 $624.31 $505.03 $651.1941 $469.51 $605.38 $479.68 $618.51 $516.16 $665.54 $493.28 $636.04 $514.52 $663.4242 $477.80 $616.08 $488.16 $629.43 $525.28 $677.30 $501.99 $647.27 $523.61 $675.1443 $489.34 $630.96 $499.95 $644.63 $537.96 $693.65 $514.12 $662.91 $536.25 $691.4544 $503.77 $649.55 $514.68 $663.63 $553.82 $714.10 $529.27 $682.44 $552.06 $711.8245 $520.71 $686.61 $532.00 $701.50 $572.45 $754.84 $547.08 $721.38 $570.63 $752.4446 $540.91 $713.24 $552.63 $728.70 $594.65 $784.11 $568.30 $749.35 $592.76 $781.6247 $563.63 $743.20 $575.84 $759.30 $619.63 $817.04 $592.16 $780.83 $617.66 $814.4448 $589.59 $777.43 $602.37 $794.28 $648.17 $854.68 $619.44 $816.80 $646.11 $851.9649 $615.19 $811.19 $628.53 $828.77 $676.32 $891.79 $646.34 $852.27 $674.17 $888.9650 $644.04 $851.55 $658.00 $870.01 $708.03 $936.16 $676.65 $894.67 $705.78 $933.1951 $672.53 $889.22 $687.11 $908.49 $739.35 $977.57 $706.58 $934.24 $737.00 $974.4652 $703.90 $930.70 $719.16 $950.87 $773.84 $1,023.17 $739.54 $977.82 $771.38 $1,019.9253 $735.63 $972.66 $751.58 $993.74 $808.73 $1,069.30 $772.88 $1,021.91 $806.16 $1,065.9054 $769.89 $1,017.95 $786.58 $1,040.02 $846.39 $1,119.10 $808.87 $1,069.49 $843.70 $1,115.5455 $804.15 $1,051.99 $821.58 $1,074.79 $884.05 $1,156.52 $844.87 $1,105.26 $881.24 $1,152.8456 $841.29 $1,100.58 $859.53 $1,124.43 $924.89 $1,209.93 $883.89 $1,156.30 $921.94 $1,206.0957 $878.79 $1,149.64 $897.84 $1,174.56 $966.11 $1,263.87 $923.29 $1,207.85 $963.04 $1,259.8558 $918.82 $1,202.00 $938.74 $1,228.05 $1,010.12 $1,321.44 $965.34 $1,262.86 $1,006.91 $1,317.2359 $938.65 $1,227.95 $959.00 $1,254.56 $1,031.92 $1,349.96 $986.18 $1,290.12 $1,028.64 $1,345.6760 $978.68 $1,257.41 $999.89 $1,284.67 $1,075.93 $1,382.35 $1,028.24 $1,321.08 $1,072.50 $1,377.9561 $1,013.30 $1,301.89 $1,035.26 $1,330.11 $1,113.99 $1,431.25 $1,064.61 $1,367.81 $1,110.44 $1,426.7062 $1,036.02 $1,331.08 $1,058.47 $1,359.93 $1,138.96 $1,463.34 $1,088.48 $1,398.47 $1,135.34 $1,458.6863 $1,064.51 $1,367.68 $1,087.58 $1,397.32 $1,170.28 $1,503.58 $1,118.41 $1,436.93 $1,166.56 $1,498.79

64+ $1,081.80 $1,389.92 $1,105.26 $1,420.04 $1,189.32 $1,528.02 $1,136.58 $1,460.29 $1,185.51 $1,523.16

Peoria, ILBlue Choice Preferred Bronze PPOSM

Individual Coverage

0-14 $267.55 $267.55 $287.98 $287.98 $275.07 $275.07 $287.34 $287.3415 $291.33 $291.33 $313.58 $313.58 $299.52 $299.52 $312.88 $312.8816 $300.42 $300.42 $323.36 $323.36 $308.87 $308.87 $322.65 $322.6517 $309.51 $309.51 $333.15 $333.15 $318.22 $318.22 $332.41 $332.4118 $319.31 $319.31 $343.69 $343.69 $328.29 $328.29 $342.93 $342.9319 $329.10 $329.10 $354.23 $354.23 $338.35 $338.35 $353.45 $353.4520 $339.24 $339.24 $365.15 $365.15 $348.78 $348.78 $364.34 $364.3421 $349.73 $349.73 $376.44 $376.44 $359.57 $359.57 $375.61 $375.6122 $349.73 $349.73 $376.44 $376.44 $359.57 $359.57 $375.61 $375.6123 $349.73 $349.73 $376.44 $376.44 $359.57 $359.57 $375.61 $375.6124 $349.73 $349.73 $376.44 $376.44 $359.57 $359.57 $375.61 $375.6125 $351.13 $351.13 $377.95 $377.95 $361.01 $361.01 $377.11 $377.1126 $358.13 $358.13 $385.48 $385.48 $368.20 $368.20 $384.62 $384.6227 $366.52 $366.52 $394.51 $394.51 $376.83 $376.83 $393.64 $393.6428 $380.16 $380.16 $409.19 $409.19 $390.85 $390.85 $408.29 $408.2929 $391.35 $391.35 $421.24 $421.24 $402.36 $402.36 $420.30 $420.3030 $396.95 $450.22 $427.26 $484.60 $408.11 $462.88 $426.31 $483.5331 $405.34 $459.74 $436.29 $494.85 $416.74 $472.67 $435.33 $493.7532 $413.73 $469.26 $445.33 $505.09 $425.37 $482.46 $444.34 $503.9733 $418.98 $475.21 $450.98 $511.50 $430.76 $488.57 $449.98 $510.3634 $424.58 $481.55 $457.00 $518.33 $436.52 $495.10 $455.99 $517.1835 $427.37 $524.73 $460.01 $564.80 $439.39 $539.49 $458.99 $563.5536 $430.17 $528.16 $463.02 $568.50 $442.27 $543.02 $462.00 $567.2437 $432.97 $531.60 $466.03 $572.20 $445.15 $546.55 $465.00 $570.9338 $435.77 $535.03 $469.05 $575.89 $448.02 $550.08 $468.01 $574.6239 $441.36 $541.90 $475.07 $583.29 $453.78 $557.15 $474.02 $582.0040 $446.96 $576.31 $481.09 $620.32 $459.53 $592.52 $480.03 $618.9441 $455.35 $587.13 $490.13 $631.97 $468.16 $603.65 $489.04 $630.5742 $463.40 $597.50 $498.78 $643.13 $476.43 $614.31 $497.68 $641.7143 $474.59 $611.93 $510.83 $658.67 $487.94 $629.15 $509.70 $657.2144 $488.58 $629.97 $525.89 $678.08 $502.32 $647.69 $524.72 $676.5845 $505.01 $665.91 $543.58 $716.77 $519.22 $684.64 $542.38 $715.1846 $524.60 $691.74 $564.66 $744.56 $539.35 $711.19 $563.41 $742.9147 $546.63 $720.79 $588.38 $775.83 $562.01 $741.06 $587.07 $774.1248 $571.81 $753.99 $615.48 $811.57 $587.90 $775.20 $614.12 $809.7849 $596.64 $786.73 $642.21 $846.81 $613.43 $808.86 $640.79 $844.9450 $624.62 $825.88 $672.32 $888.95 $642.19 $849.11 $670.83 $886.9851 $652.25 $862.41 $702.06 $928.27 $670.60 $886.66 $700.51 $926.2152 $682.68 $902.63 $734.81 $971.57 $701.88 $928.02 $733.19 $969.4253 $713.45 $943.33 $767.94 $1,015.37 $733.52 $969.86 $766.24 $1,013.1254 $746.68 $987.26 $803.70 $1,062.65 $767.68 $1,015.03 $801.92 $1,060.3055 $779.90 $1,020.27 $839.46 $1,098.19 $801.84 $1,048.97 $837.60 $1,095.7656 $815.93 $1,067.39 $878.24 $1,148.91 $838.88 $1,097.42 $876.29 $1,146.3657 $852.30 $1,114.97 $917.39 $1,200.12 $876.27 $1,146.34 $915.35 $1,197.4758 $891.12 $1,165.76 $959.17 $1,254.79 $916.18 $1,198.55 $957.05 $1,252.0159 $910.35 $1,190.92 $979.88 $1,281.87 $935.96 $1,224.42 $977.71 $1,279.0360 $949.17 $1,219.50 $1,021.66 $1,312.63 $975.87 $1,253.80 $1,019.40 $1,309.7261 $982.75 $1,262.64 $1,057.80 $1,359.06 $1,010.39 $1,298.15 $1,055.46 $1,356.0562 $1,004.78 $1,290.94 $1,081.51 $1,389.53 $1,033.04 $1,327.25 $1,079.12 $1,386.4563 $1,032.41 $1,326.44 $1,111.25 $1,427.74 $1,061.45 $1,363.75 $1,108.79 $1,424.58

64+ $1,049.19 $1,348.01 $1,129.32 $1,450.95 $1,078.71 $1,385.92 $1,126.83 $1,447.74

Bloomington, ILBlue Choice Preferred Bronze PPOSM

202 302201

Individual Coverage

0-14 $292.44 $292.44 $314.55 $314.55 $300.71 $300.71 $313.40 $313.4015 $318.44 $318.44 $342.51 $342.51 $327.44 $327.44 $341.26 $341.2616 $328.38 $328.38 $353.20 $353.20 $337.66 $337.66 $351.91 $351.9117 $338.32 $338.32 $363.89 $363.89 $347.88 $347.88 $362.56 $362.5618 $349.02 $349.02 $375.40 $375.40 $358.89 $358.89 $374.03 $374.0319 $359.72 $359.72 $386.92 $386.92 $369.89 $369.89 $385.50 $385.5020 $370.81 $370.81 $398.84 $398.84 $381.29 $381.29 $397.38 $397.3821 $382.28 $382.28 $411.18 $411.18 $393.09 $393.09 $409.67 $409.6722 $382.28 $382.28 $411.18 $411.18 $393.09 $393.09 $409.67 $409.6723 $382.28 $382.28 $411.18 $411.18 $393.09 $393.09 $409.67 $409.6724 $382.28 $382.28 $411.18 $411.18 $393.09 $393.09 $409.67 $409.6725 $383.81 $383.81 $412.82 $412.82 $394.66 $394.66 $411.31 $411.3126 $391.45 $391.45 $421.05 $421.05 $402.52 $402.52 $419.51 $419.5127 $400.63 $400.63 $430.91 $430.91 $411.95 $411.95 $429.34 $429.3428 $415.54 $415.54 $446.95 $446.95 $427.28 $427.28 $445.32 $445.3229 $427.77 $427.77 $460.11 $460.11 $439.86 $439.86 $458.43 $458.4330 $433.88 $492.11 $466.69 $529.32 $446.15 $506.03 $464.98 $527.3831 $443.06 $502.52 $476.55 $540.51 $455.59 $516.73 $474.81 $538.5332 $452.23 $512.92 $486.42 $551.70 $465.02 $527.43 $484.65 $549.6933 $457.97 $519.43 $492.59 $558.70 $470.92 $534.11 $490.79 $556.6534 $464.08 $526.36 $499.17 $566.16 $477.21 $541.25 $497.35 $564.0935 $467.14 $573.56 $502.46 $616.92 $480.35 $589.77 $500.62 $614.6636 $470.20 $577.31 $505.75 $620.96 $483.49 $593.63 $503.90 $618.6937 $473.26 $581.07 $509.04 $625.00 $486.64 $597.50 $507.18 $622.7138 $476.32 $584.82 $512.33 $629.04 $489.78 $601.36 $510.45 $626.7439 $482.43 $592.33 $518.91 $637.11 $496.07 $609.08 $517.01 $634.7840 $488.55 $629.94 $525.48 $677.56 $502.36 $647.75 $523.56 $675.0841 $497.72 $641.77 $535.35 $690.28 $511.80 $659.91 $533.40 $687.7642 $506.52 $653.10 $544.81 $702.48 $520.84 $671.57 $542.82 $699.9143 $518.75 $668.88 $557.97 $719.45 $533.42 $687.79 $555.93 $716.8244 $534.04 $688.59 $574.41 $740.65 $549.14 $708.06 $572.32 $737.9445 $552.01 $727.88 $593.74 $782.91 $567.61 $748.46 $591.57 $780.0546 $573.42 $756.11 $616.77 $813.27 $589.63 $777.48 $614.51 $810.3047 $597.50 $787.86 $642.67 $847.42 $614.39 $810.14 $640.32 $844.3348 $625.02 $824.15 $672.28 $886.46 $642.69 $847.46 $669.82 $883.2249 $652.16 $859.94 $701.47 $924.96 $670.60 $884.26 $698.91 $921.5850 $682.75 $902.73 $734.36 $970.97 $702.05 $928.25 $731.68 $967.4351 $712.95 $942.66 $766.85 $1,013.92 $733.10 $969.31 $764.04 $1,010.2252 $746.20 $986.63 $802.62 $1,061.22 $767.30 $1,014.53 $799.69 $1,057.3453 $779.84 $1,031.11 $838.80 $1,109.06 $801.89 $1,060.26 $835.74 $1,105.0154 $816.16 $1,079.13 $877.86 $1,160.71 $839.24 $1,109.64 $874.66 $1,156.4755 $852.48 $1,115.21 $916.93 $1,199.52 $876.58 $1,146.74 $913.57 $1,195.1456 $891.85 $1,166.72 $959.28 $1,254.93 $917.07 $1,199.71 $955.77 $1,250.3457 $931.61 $1,218.73 $1,002.04 $1,310.87 $957.95 $1,253.19 $998.38 $1,306.0858 $974.04 $1,274.24 $1,047.68 $1,370.57 $1,001.58 $1,310.27 $1,043.85 $1,365.5659 $995.07 $1,301.74 $1,070.29 $1,400.16 $1,023.20 $1,338.55 $1,066.38 $1,395.0460 $1,037.50 $1,332.98 $1,115.94 $1,433.76 $1,066.83 $1,370.67 $1,111.86 $1,428.5261 $1,074.20 $1,380.13 $1,155.41 $1,484.47 $1,104.57 $1,419.15 $1,151.19 $1,479.0462 $1,098.28 $1,411.07 $1,181.31 $1,517.75 $1,129.33 $1,450.97 $1,177.00 $1,512.2063 $1,128.48 $1,449.87 $1,213.80 $1,559.48 $1,160.39 $1,490.87 $1,209.36 $1,553.79

64+ $1,146.84 $1,473.45 $1,233.54 $1,584.84 $1,179.27 $1,515.11 $1,229.01 $1,579.05

Champaign, ILBlue Choice Preferred Bronze PPOSM

202201 302

Individual Coverage

0-14 $265.40 $265.40 $285.11 $285.11 $272.48 $272.48 $284.31 $284.3115 $288.99 $288.99 $310.45 $310.45 $296.70 $296.70 $309.58 $309.5816 $298.01 $298.01 $320.14 $320.14 $305.96 $305.96 $319.25 $319.2517 $307.03 $307.03 $329.83 $329.83 $315.22 $315.22 $328.91 $328.9118 $316.74 $316.74 $340.27 $340.27 $325.19 $325.19 $339.32 $339.3219 $326.46 $326.46 $350.70 $350.70 $335.16 $335.16 $349.72 $349.7220 $336.52 $336.52 $361.51 $361.51 $345.49 $345.49 $360.50 $360.5021 $346.93 $346.93 $372.69 $372.69 $356.18 $356.18 $371.65 $371.6522 $346.93 $346.93 $372.69 $372.69 $356.18 $356.18 $371.65 $371.6523 $346.93 $346.93 $372.69 $372.69 $356.18 $356.18 $371.65 $371.6524 $346.93 $346.93 $372.69 $372.69 $356.18 $356.18 $371.65 $371.6525 $348.31 $348.31 $374.18 $374.18 $357.60 $357.60 $373.14 $373.1426 $355.25 $355.25 $381.64 $381.64 $364.73 $364.73 $380.57 $380.5727 $363.58 $363.58 $390.58 $390.58 $373.28 $373.28 $389.49 $389.4928 $377.11 $377.11 $405.12 $405.12 $387.17 $387.17 $403.98 $403.9829 $388.21 $388.21 $417.04 $417.04 $398.56 $398.56 $415.88 $415.8830 $393.76 $446.60 $423.01 $479.77 $404.26 $458.52 $421.82 $478.4331 $402.09 $456.05 $431.95 $489.92 $412.81 $468.21 $430.74 $488.5532 $410.41 $465.49 $440.90 $500.06 $421.36 $477.91 $439.66 $498.6633 $415.62 $471.39 $446.49 $506.40 $426.70 $483.97 $445.24 $504.9934 $421.17 $477.69 $452.45 $513.17 $432.40 $490.43 $451.18 $511.7335 $423.94 $520.52 $455.43 $559.18 $435.25 $534.40 $454.16 $557.6136 $426.72 $523.92 $458.41 $562.84 $438.10 $537.90 $457.13 $561.2637 $429.49 $527.33 $461.39 $566.50 $440.95 $541.40 $460.10 $564.9238 $432.27 $530.74 $464.37 $570.16 $443.80 $544.90 $463.08 $568.5639 $437.82 $537.55 $470.34 $577.48 $449.50 $551.89 $469.02 $575.8640 $443.37 $571.68 $476.30 $614.14 $455.20 $586.93 $474.97 $612.4241 $451.70 $582.42 $485.25 $625.68 $463.75 $597.95 $483.89 $623.9342 $459.68 $592.71 $493.82 $636.73 $471.94 $608.52 $492.44 $634.9543 $470.78 $607.02 $505.74 $652.11 $483.34 $623.21 $504.33 $650.2844 $484.65 $624.91 $520.65 $671.33 $497.58 $641.58 $519.19 $669.4545 $500.96 $660.57 $538.17 $709.63 $514.32 $678.19 $536.66 $707.6446 $520.39 $686.18 $559.04 $737.15 $534.27 $704.49 $557.47 $735.0947 $542.24 $715.00 $582.52 $768.11 $556.71 $734.07 $580.89 $765.9648 $567.22 $747.94 $609.35 $803.49 $582.35 $767.89 $607.65 $801.2449 $591.85 $780.42 $635.81 $838.38 $607.64 $801.24 $634.03 $836.0450 $619.61 $819.25 $665.63 $880.09 $636.14 $841.10 $663.77 $877.6351 $647.02 $855.48 $695.07 $919.02 $664.27 $878.30 $693.13 $916.4552 $677.20 $895.39 $727.50 $961.89 $695.26 $919.27 $725.46 $959.2053 $707.73 $935.76 $760.29 $1,005.26 $726.61 $960.72 $758.17 $1,002.4554 $740.69 $979.34 $795.70 $1,052.07 $760.44 $1,005.46 $793.47 $1,049.1355 $773.64 $1,012.08 $831.10 $1,087.25 $794.28 $1,039.08 $828.78 $1,084.2156 $809.38 $1,058.83 $869.49 $1,137.47 $830.97 $1,087.07 $867.06 $1,134.2957 $845.46 $1,106.03 $908.25 $1,188.17 $868.01 $1,135.53 $905.71 $1,184.8558 $883.97 $1,156.40 $949.62 $1,242.29 $907.54 $1,187.25 $946.96 $1,238.8259 $903.05 $1,181.36 $970.12 $1,269.11 $927.13 $1,212.88 $967.40 $1,265.5660 $941.56 $1,209.71 $1,011.49 $1,299.56 $966.67 $1,241.98 $1,008.66 $1,295.9261 $974.86 $1,252.50 $1,047.27 $1,345.53 $1,000.86 $1,285.91 $1,044.34 $1,341.7662 $996.72 $1,280.58 $1,070.75 $1,375.69 $1,023.30 $1,314.74 $1,067.75 $1,371.8463 $1,024.12 $1,315.79 $1,100.19 $1,413.52 $1,051.44 $1,350.89 $1,097.11 $1,409.57

64+ $1,040.79 $1,337.19 $1,118.07 $1,436.51 $1,068.54 $1,372.86 $1,114.95 $1,432.49

Springfield, ILBlue Choice Preferred Bronze PPOSM

202201 302

Individual Coverage

0-14 $268.69 $268.69 $289.12 $289.12 $276.21 $276.21 $288.34 $288.3415 $292.57 $292.57 $314.81 $314.81 $300.76 $300.76 $313.97 $313.9716 $301.70 $301.70 $324.64 $324.64 $310.15 $310.15 $323.77 $323.7717 $310.83 $310.83 $334.47 $334.47 $319.54 $319.54 $333.57 $333.5718 $320.67 $320.67 $345.05 $345.05 $329.65 $329.65 $344.13 $344.1319 $330.50 $330.50 $355.63 $355.63 $339.76 $339.76 $354.68 $354.6820 $340.69 $340.69 $366.59 $366.59 $350.23 $350.23 $365.61 $365.6121 $351.22 $351.22 $377.93 $377.93 $361.06 $361.06 $376.92 $376.9222 $351.22 $351.22 $377.93 $377.93 $361.06 $361.06 $376.92 $376.9223 $351.22 $351.22 $377.93 $377.93 $361.06 $361.06 $376.92 $376.9224 $351.22 $351.22 $377.93 $377.93 $361.06 $361.06 $376.92 $376.9225 $352.63 $352.63 $379.44 $379.44 $362.50 $362.50 $378.43 $378.4326 $359.65 $359.65 $387.00 $387.00 $369.72 $369.72 $385.96 $385.9627 $368.08 $368.08 $396.07 $396.07 $378.39 $378.39 $395.01 $395.0128 $381.78 $381.78 $410.81 $410.81 $392.47 $392.47 $409.71 $409.7129 $393.02 $393.02 $422.90 $422.90 $404.02 $404.02 $421.77 $421.7730 $398.64 $452.14 $428.95 $486.51 $409.80 $464.80 $427.80 $485.2131 $407.07 $461.70 $438.02 $496.80 $418.47 $474.63 $436.85 $495.4732 $415.50 $471.26 $447.09 $507.09 $427.13 $484.45 $445.89 $505.7333 $420.77 $477.23 $452.76 $513.52 $432.55 $490.60 $451.55 $512.1434 $426.39 $483.61 $458.81 $520.38 $438.33 $497.15 $457.58 $518.9935 $429.20 $526.97 $461.83 $567.03 $441.21 $541.72 $460.59 $565.5236 $432.01 $530.42 $464.85 $570.74 $444.10 $545.27 $463.61 $569.2237 $434.82 $533.87 $467.88 $574.46 $446.99 $548.82 $466.62 $572.9238 $437.63 $537.32 $470.90 $578.17 $449.88 $552.36 $469.64 $576.6239 $443.25 $544.22 $476.95 $585.59 $455.66 $559.45 $475.67 $584.0340 $448.87 $578.77 $482.99 $622.77 $461.43 $594.97 $481.70 $621.1041 $457.29 $589.64 $492.06 $634.47 $470.10 $606.15 $490.75 $632.7742 $465.37 $600.05 $500.76 $645.68 $478.40 $616.85 $499.42 $643.9543 $476.61 $614.55 $512.85 $661.27 $489.96 $631.75 $511.48 $659.5044 $490.66 $632.66 $527.97 $680.76 $504.40 $650.37 $526.55 $678.9445 $507.17 $668.75 $545.73 $719.60 $521.37 $687.48 $544.27 $717.6746 $526.84 $694.69 $566.89 $747.50 $541.59 $714.14 $565.38 $745.5147 $548.96 $723.86 $590.70 $778.90 $564.34 $744.13 $589.12 $776.8248 $574.25 $757.21 $617.91 $814.78 $590.33 $778.41 $616.26 $812.6049 $599.19 $790.09 $644.75 $850.16 $615.97 $812.21 $643.02 $847.8950 $627.29 $829.40 $674.98 $892.46 $644.85 $852.62 $673.17 $890.0751 $655.03 $866.09 $704.84 $931.93 $673.37 $890.34 $702.95 $929.4452 $685.59 $906.49 $737.72 $975.41 $704.79 $931.87 $735.74 $972.8053 $716.50 $947.36 $770.97 $1,019.38 $736.56 $973.88 $768.91 $1,016.6654 $749.87 $991.47 $806.88 $1,066.85 $770.86 $1,019.23 $804.72 $1,064.0055 $783.23 $1,024.63 $842.78 $1,102.53 $805.16 $1,053.31 $840.53 $1,099.5856 $819.41 $1,071.95 $881.71 $1,153.45 $842.35 $1,101.96 $879.35 $1,150.3657 $855.94 $1,119.73 $921.01 $1,204.87 $879.90 $1,151.08 $918.55 $1,201.6458 $894.92 $1,170.73 $962.96 $1,259.74 $919.98 $1,203.51 $960.39 $1,256.3859 $914.24 $1,196.01 $983.75 $1,286.94 $939.84 $1,229.49 $981.12 $1,283.5060 $953.22 $1,224.70 $1,025.70 $1,317.82 $979.91 $1,258.99 $1,022.95 $1,314.2961 $986.94 $1,268.02 $1,061.98 $1,364.43 $1,014.58 $1,303.53 $1,059.14 $1,360.7862 $1,009.07 $1,296.45 $1,085.79 $1,395.02 $1,037.32 $1,332.75 $1,082.88 $1,391.2963 $1,036.82 $1,332.10 $1,115.64 $1,433.38 $1,065.85 $1,369.40 $1,112.66 $1,429.55

64+ $1,053.66 $1,353.76 $1,133.79 $1,456.69 $1,083.18 $1,391.67 $1,130.76 $1,452.79

East St. Louis, ILBlue Choice Preferred Bronze PPOSM

202201 302

Individual Coverage

0-14 $241.08 $241.08 $259.36 $259.36 $247.72 $247.72 $259.04 $259.0415 $262.51 $262.51 $282.42 $282.42 $269.74 $269.74 $282.06 $282.0616 $270.70 $270.70 $291.23 $291.23 $278.16 $278.16 $290.87 $290.8717 $278.90 $278.90 $300.05 $300.05 $286.58 $286.58 $299.67 $299.6718 $287.72 $287.72 $309.54 $309.54 $295.65 $295.65 $309.15 $309.1519 $296.55 $296.55 $319.03 $319.03 $304.71 $304.71 $318.63 $318.6320 $305.69 $305.69 $328.87 $328.87 $314.10 $314.10 $328.45 $328.4521 $315.14 $315.14 $339.04 $339.04 $323.82 $323.82 $338.61 $338.6122 $315.14 $315.14 $339.04 $339.04 $323.82 $323.82 $338.61 $338.6123 $315.14 $315.14 $339.04 $339.04 $323.82 $323.82 $338.61 $338.6124 $315.14 $315.14 $339.04 $339.04 $323.82 $323.82 $338.61 $338.6125 $316.40 $316.40 $340.39 $340.39 $325.11 $325.11 $339.96 $339.9626 $322.70 $322.70 $347.17 $347.17 $331.59 $331.59 $346.74 $346.7427 $330.27 $330.27 $355.31 $355.31 $339.36 $339.36 $354.86 $354.8628 $342.56 $342.56 $368.53 $368.53 $351.99 $351.99 $368.07 $368.0729 $352.64 $352.64 $379.38 $379.38 $362.35 $362.35 $378.90 $378.9030 $357.68 $405.69 $384.81 $436.45 $367.53 $416.86 $384.32 $435.9031 $365.25 $414.26 $392.94 $445.68 $375.31 $425.67 $392.45 $445.1232 $372.81 $422.84 $401.08 $454.91 $383.08 $434.49 $400.57 $454.3333 $377.54 $428.20 $406.17 $460.67 $387.93 $439.99 $405.65 $460.0934 $382.58 $433.92 $411.59 $466.83 $393.12 $445.87 $411.07 $466.2435 $385.10 $472.83 $414.30 $508.68 $395.71 $485.85 $413.78 $508.0436 $387.62 $475.92 $417.02 $512.01 $398.30 $489.03 $416.49 $511.3637 $390.14 $479.02 $419.73 $515.34 $400.89 $492.21 $419.20 $514.6938 $392.66 $482.11 $422.44 $518.67 $403.48 $495.39 $421.91 $518.0239 $397.71 $488.30 $427.86 $525.33 $408.66 $501.75 $427.32 $524.6740 $402.75 $519.30 $433.29 $558.68 $413.84 $533.60 $432.74 $557.9841 $410.31 $529.06 $441.43 $569.18 $421.61 $543.63 $440.87 $568.4642 $417.56 $538.40 $449.22 $579.23 $429.06 $553.23 $448.66 $578.5043 $427.64 $551.41 $460.07 $593.22 $439.42 $566.59 $459.49 $592.4744 $440.25 $567.66 $473.63 $610.70 $452.37 $583.29 $473.04 $609.9345 $455.06 $600.04 $489.57 $645.55 $467.59 $616.57 $488.95 $644.7346 $472.71 $623.31 $508.56 $670.58 $485.73 $640.48 $507.91 $669.7347 $492.56 $649.49 $529.91 $698.75 $506.13 $667.38 $529.25 $697.8648 $515.25 $679.41 $554.33 $730.93 $529.44 $698.12 $553.63 $730.0149 $537.63 $708.92 $578.40 $762.67 $552.43 $728.44 $577.67 $761.7150 $562.84 $744.19 $605.52 $800.62 $578.34 $764.68 $604.76 $799.6151 $587.73 $777.10 $632.30 $836.03 $603.92 $798.50 $631.51 $834.9852 $615.15 $813.35 $661.80 $875.03 $632.09 $835.75 $660.97 $873.9353 $642.88 $850.02 $691.64 $914.48 $660.59 $873.43 $690.76 $913.3354 $672.82 $889.61 $723.84 $957.07 $691.35 $914.11 $722.93 $955.8655 $702.76 $919.35 $756.05 $989.07 $722.11 $944.67 $755.10 $987.8256 $735.22 $961.81 $790.97 $1,034.75 $755.47 $988.30 $789.98 $1,033.4557 $767.99 $1,004.69 $826.23 $1,080.88 $789.14 $1,032.36 $825.19 $1,079.5158 $802.97 $1,050.45 $863.87 $1,130.11 $825.09 $1,079.38 $862.78 $1,128.6859 $820.31 $1,073.12 $882.51 $1,154.50 $842.90 $1,102.68 $881.40 $1,153.0560 $855.29 $1,098.87 $920.15 $1,182.21 $878.84 $1,129.14 $918.99 $1,180.7161 $885.54 $1,137.74 $952.69 $1,224.02 $909.93 $1,169.08 $951.49 $1,222.4862 $905.40 $1,163.25 $974.05 $1,251.46 $930.33 $1,195.29 $972.82 $1,249.8863 $930.29 $1,195.24 $1,000.84 $1,285.88 $955.91 $1,228.16 $999.57 $1,284.25

64+ $945.42 $1,214.67 $1,017.12 $1,306.78 $971.46 $1,248.12 $1,015.83 $1,305.14

202201 302 502

St. Louis, ILBlue Choice Preferred Bronze PPOSM

Individual Coverage

0-14 $328.09 $328.09 $353.14 $353.14 $337.79 $337.79 $351.59 $351.5915 $357.26 $357.26 $384.53 $384.53 $367.82 $367.82 $382.84 $382.8416 $368.41 $368.41 $396.53 $396.53 $379.30 $379.30 $394.79 $394.7917 $379.56 $379.56 $408.53 $408.53 $390.78 $390.78 $406.74 $406.7418 $391.57 $391.57 $421.46 $421.46 $403.14 $403.14 $419.61 $419.6119 $403.58 $403.58 $434.38 $434.38 $415.50 $415.50 $432.48 $432.4820 $416.01 $416.01 $447.77 $447.77 $428.31 $428.31 $445.81 $445.8121 $428.88 $428.88 $461.62 $461.62 $441.55 $441.55 $459.60 $459.6022 $428.88 $428.88 $461.62 $461.62 $441.55 $441.55 $459.60 $459.6023 $428.88 $428.88 $461.62 $461.62 $441.55 $441.55 $459.60 $459.6024 $428.88 $428.88 $461.62 $461.62 $441.55 $441.55 $459.60 $459.6025 $430.60 $430.60 $463.47 $463.47 $443.32 $443.32 $461.43 $461.4326 $439.17 $439.17 $472.70 $472.70 $452.15 $452.15 $470.63 $470.6327 $449.47 $449.47 $483.78 $483.78 $462.75 $462.75 $481.66 $481.6628 $466.19 $466.19 $501.78 $501.78 $479.97 $479.97 $499.58 $499.5829 $479.92 $479.92 $516.55 $516.55 $494.10 $494.10 $514.29 $514.2930 $486.78 $552.11 $523.94 $594.25 $501.16 $568.42 $521.64 $591.6531 $497.07 $563.78 $535.02 $606.82 $511.76 $580.44 $532.67 $604.1632 $507.37 $575.45 $546.10 $619.38 $522.36 $592.46 $543.70 $616.6733 $513.80 $582.75 $553.02 $627.23 $528.98 $599.97 $550.60 $624.4834 $520.66 $590.53 $560.41 $635.61 $536.05 $607.99 $557.95 $632.8335 $524.09 $643.48 $564.10 $692.60 $539.58 $662.50 $561.63 $689.5636 $527.52 $647.69 $567.79 $697.13 $543.11 $666.83 $565.30 $694.0837 $530.95 $651.91 $571.48 $701.67 $546.64 $671.17 $568.98 $698.5938 $534.39 $656.12 $575.18 $706.20 $550.18 $675.51 $572.66 $703.1139 $541.25 $664.54 $582.56 $715.27 $557.24 $684.18 $580.01 $712.1340 $548.11 $706.73 $589.95 $760.68 $564.31 $727.62 $587.36 $757.3441 $558.40 $720.00 $601.03 $774.97 $574.90 $741.28 $598.39 $771.5742 $568.27 $732.73 $611.65 $788.66 $585.06 $754.38 $608.96 $785.2043 $581.99 $750.42 $626.42 $807.70 $599.19 $772.60 $623.67 $804.1644 $599.15 $772.54 $644.88 $831.51 $616.85 $795.37 $642.06 $827.8645 $619.30 $816.61 $666.58 $878.95 $637.61 $840.75 $663.66 $875.1046 $643.32 $848.28 $692.43 $913.04 $662.33 $873.35 $689.39 $909.0347 $670.34 $883.91 $721.51 $951.38 $690.15 $910.03 $718.35 $947.2148 $701.22 $924.63 $754.75 $995.21 $721.94 $951.95 $751.44 $990.8549 $731.67 $964.78 $787.52 $1,038.43 $753.29 $993.29 $784.07 $1,033.8750 $765.98 $1,012.78 $824.45 $1,090.09 $788.62 $1,042.71 $820.84 $1,085.3151 $799.86 $1,057.58 $860.92 $1,138.31 $823.50 $1,088.83 $857.15 $1,133.3252 $837.18 $1,106.91 $901.08 $1,191.41 $861.92 $1,139.62 $897.13 $1,186.1853 $874.92 $1,156.82 $941.70 $1,245.12 $900.77 $1,191.00 $937.57 $1,239.6654 $915.66 $1,210.69 $985.56 $1,303.10 $942.72 $1,246.47 $981.24 $1,297.3955 $956.40 $1,251.17 $1,029.41 $1,346.68 $984.67 $1,288.14 $1,024.90 $1,340.7756 $1,000.58 $1,308.96 $1,076.96 $1,408.88 $1,030.15 $1,347.64 $1,072.24 $1,402.7057 $1,045.18 $1,367.31 $1,124.97 $1,471.68 $1,076.07 $1,407.71 $1,120.03 $1,465.2358 $1,092.79 $1,429.58 $1,176.21 $1,538.71 $1,125.08 $1,471.83 $1,171.05 $1,531.9759 $1,116.38 $1,460.44 $1,201.59 $1,571.92 $1,149.37 $1,503.60 $1,196.33 $1,565.0360 $1,163.98 $1,495.49 $1,252.83 $1,609.64 $1,198.38 $1,539.68 $1,247.34 $1,602.5961 $1,205.15 $1,548.38 $1,297.15 $1,666.58 $1,240.77 $1,594.14 $1,291.46 $1,659.2762 $1,232.17 $1,583.10 $1,326.23 $1,703.94 $1,268.59 $1,629.88 $1,320.42 $1,696.4763 $1,266.06 $1,626.63 $1,362.70 $1,750.80 $1,303.47 $1,674.70 $1,356.73 $1,743.12

64+ $1,286.64 $1,653.08 $1,384.86 $1,779.26 $1,324.65 $1,701.93 $1,378.80 $1,771.47

202201 302 502

Southern, ILBlue Choice Preferred Bronze PPOSM

Individual Coverage

Rating Area

0-14 $222.82 $222.82 $217.24 $217.24 $209.98 $209.98 $205.54 $205.54 $268.27 $268.2715 $242.63 $242.63 $236.55 $236.55 $228.65 $228.65 $223.81 $223.81 $292.12 $292.1216 $250.20 $250.20 $243.93 $243.93 $235.78 $235.78 $230.80 $230.80 $301.23 $301.2317 $257.77 $257.77 $251.31 $251.31 $242.92 $242.92 $237.79 $237.79 $310.35 $310.3518 $265.93 $265.93 $259.26 $259.26 $250.61 $250.61 $245.31 $245.31 $320.17 $320.1719 $274.09 $274.09 $267.21 $267.21 $258.29 $258.29 $252.83 $252.83 $329.99 $329.9920 $282.53 $282.53 $275.45 $275.45 $266.25 $266.25 $260.62 $260.62 $340.16 $340.1621 $291.27 $291.27 $283.97 $283.97 $274.49 $274.49 $268.68 $268.68 $350.68 $350.6822 $291.27 $291.27 $283.97 $283.97 $274.49 $274.49 $268.68 $268.68 $350.68 $350.6823 $291.27 $291.27 $283.97 $283.97 $274.49 $274.49 $268.68 $268.68 $350.68 $350.6824 $291.27 $291.27 $283.97 $283.97 $274.49 $274.49 $268.68 $268.68 $350.68 $350.6825 $292.44 $292.44 $285.10 $285.10 $275.58 $275.58 $269.76 $269.76 $352.08 $352.0826 $298.26 $298.26 $290.78 $290.78 $281.07 $281.07 $275.13 $275.13 $359.10 $359.1027 $305.25 $305.25 $297.60 $297.60 $287.66 $287.66 $281.58 $281.58 $367.51 $367.5128 $316.61 $316.61 $308.67 $308.67 $298.37 $298.37 $292.06 $292.06 $381.19 $381.1929 $325.93 $325.93 $317.76 $317.76 $307.15 $307.15 $300.66 $300.66 $392.41 $392.4130 $330.59 $374.96 $322.30 $365.56 $311.54 $353.35 $304.96 $345.88 $398.02 $451.4431 $337.58 $382.89 $329.12 $373.29 $318.13 $360.82 $311.40 $353.20 $406.44 $460.9832 $344.57 $390.82 $335.93 $381.02 $324.72 $368.29 $317.85 $360.51 $414.85 $470.5333 $348.94 $395.77 $340.19 $385.85 $328.83 $372.96 $321.88 $365.08 $420.11 $476.4934 $353.60 $401.06 $344.74 $391.00 $333.23 $377.95 $326.18 $369.96 $425.72 $482.8635 $355.93 $437.01 $347.01 $426.06 $335.42 $411.83 $328.33 $403.13 $428.53 $526.1536 $358.26 $439.87 $349.28 $428.85 $337.62 $414.53 $330.48 $405.76 $431.34 $529.5937 $360.59 $442.74 $351.55 $431.64 $339.81 $417.22 $332.63 $408.41 $434.14 $533.0438 $362.92 $445.60 $353.82 $434.43 $342.01 $419.92 $334.78 $411.04 $436.95 $536.4839 $367.58 $451.32 $358.37 $440.00 $346.40 $425.31 $339.08 $416.32 $442.56 $543.3740 $372.24 $479.97 $362.91 $467.94 $350.79 $452.31 $343.38 $442.75 $448.17 $577.8741 $379.23 $488.99 $369.73 $476.73 $357.38 $460.81 $349.83 $451.07 $456.58 $588.7242 $385.93 $497.62 $376.26 $485.15 $363.69 $468.95 $356.01 $459.04 $464.65 $599.1243 $395.25 $509.64 $385.34 $496.86 $372.48 $480.27 $364.60 $470.12 $475.87 $613.5944 $406.91 $524.66 $396.70 $511.51 $383.46 $494.43 $375.35 $483.98 $489.90 $631.6745 $420.60 $554.60 $410.05 $540.69 $396.36 $522.64 $387.98 $511.59 $506.38 $667.7146 $436.91 $576.10 $425.95 $561.66 $411.73 $542.91 $403.03 $531.43 $526.02 $693.6147 $455.26 $600.30 $443.84 $585.25 $429.02 $565.71 $419.95 $553.75 $548.11 $722.7448 $476.23 $627.95 $464.29 $612.21 $448.78 $591.77 $439.30 $579.26 $573.36 $756.0349 $496.91 $655.22 $484.45 $638.79 $468.27 $617.46 $458.37 $604.41 $598.26 $788.8650 $520.21 $687.82 $507.17 $670.58 $490.23 $648.19 $479.87 $634.48 $626.31 $828.1151 $543.22 $718.25 $529.60 $700.24 $511.92 $676.86 $501.10 $662.55 $654.02 $864.7452 $568.56 $751.75 $554.31 $732.90 $535.80 $708.43 $524.47 $693.45 $684.53 $905.0853 $594.19 $785.64 $579.30 $765.94 $559.95 $740.37 $548.12 $724.72 $715.39 $945.8854 $621.86 $822.23 $606.27 $801.61 $586.03 $774.85 $573.64 $758.47 $748.70 $989.9355 $649.53 $849.72 $633.25 $828.42 $612.10 $800.76 $599.17 $783.83 $782.01 $1,023.0356 $679.54 $888.97 $662.50 $866.68 $640.38 $837.74 $626.84 $820.03 $818.13 $1,070.2857 $709.83 $928.60 $692.03 $905.31 $668.92 $875.08 $654.78 $856.59 $854.60 $1,117.9958 $742.16 $970.89 $723.55 $946.55 $699.39 $914.94 $684.61 $895.60 $893.53 $1,168.9159 $758.18 $991.85 $739.17 $966.98 $714.49 $934.69 $699.38 $914.93 $912.82 $1,194.1560 $790.51 $1,015.65 $770.69 $990.18 $744.96 $957.12 $729.21 $936.89 $951.74 $1,222.8061 $818.47 $1,051.57 $797.95 $1,025.21 $771.31 $990.97 $755.00 $970.03 $985.41 $1,266.0562 $836.82 $1,075.15 $815.84 $1,048.19 $788.60 $1,013.19 $771.93 $991.77 $1,007.50 $1,294.4463 $859.83 $1,104.71 $838.27 $1,077.01 $810.28 $1,041.05 $793.16 $1,019.05 $1,035.20 $1,330.03

64+ $873.81 $1,122.67 $851.91 $1,094.53 $823.47 $1,057.98 $806.04 $1,035.62 $1,052.04 $1,351.66

Illinois Off Exchange (Catastrophic)

Blue Choice Preferred Security PPOSM

Chicago - North, IL Chicago - West, IL Chicago - South, IL Rockford, ILChicago - Central, IL

Individual Coverage

Rating Area

0-14 $230.07 $230.07 $257.45 $257.45 $243.95 $243.95 $267.34 $267.34 $241.30 $241.3015 $250.52 $250.52 $280.34 $280.34 $265.63 $265.63 $291.10 $291.10 $262.75 $262.7516 $258.34 $258.34 $289.09 $289.09 $273.92 $273.92 $300.19 $300.19 $270.95 $270.9517 $266.16 $266.16 $297.84 $297.84 $282.21 $282.21 $309.27 $309.27 $279.15 $279.1518 $274.58 $274.58 $307.26 $307.26 $291.14 $291.14 $319.06 $319.06 $287.99 $287.9919 $283.00 $283.00 $316.69 $316.69 $300.07 $300.07 $328.84 $328.84 $296.82 $296.8220 $291.72 $291.72 $326.45 $326.45 $309.32 $309.32 $338.98 $338.98 $305.97 $305.9721 $300.75 $300.75 $336.54 $336.54 $318.88 $318.88 $349.46 $349.46 $315.43 $315.4322 $300.75 $300.75 $336.54 $336.54 $318.88 $318.88 $349.46 $349.46 $315.43 $315.4323 $300.75 $300.75 $336.54 $336.54 $318.88 $318.88 $349.46 $349.46 $315.43 $315.4324 $300.75 $300.75 $336.54 $336.54 $318.88 $318.88 $349.46 $349.46 $315.43 $315.4325 $301.95 $301.95 $337.89 $337.89 $320.16 $320.16 $350.86 $350.86 $316.69 $316.6926 $307.96 $307.96 $344.62 $344.62 $326.54 $326.54 $357.85 $357.85 $323.00 $323.0027 $315.18 $315.18 $352.70 $352.70 $334.19 $334.19 $366.23 $366.23 $330.57 $330.5728 $326.91 $326.91 $365.82 $365.82 $346.63 $346.63 $379.86 $379.86 $342.87 $342.8729 $336.53 $336.53 $376.59 $376.59 $356.83 $356.83 $391.05 $391.05 $352.97 $352.9730 $341.35 $387.16 $381.98 $433.24 $361.93 $410.51 $396.64 $449.87 $358.01 $406.0631 $348.56 $395.34 $390.05 $442.40 $369.59 $419.19 $405.02 $459.38 $365.58 $414.6432 $355.78 $403.53 $398.13 $451.56 $377.24 $427.87 $413.41 $468.89 $373.15 $423.2333 $360.29 $408.64 $403.18 $457.28 $382.02 $433.29 $418.65 $474.84 $377.88 $428.6034 $365.10 $414.10 $408.56 $463.39 $387.13 $439.08 $424.24 $481.18 $382.93 $434.3235 $367.51 $451.23 $411.25 $504.94 $389.68 $478.44 $427.04 $524.32 $385.45 $473.2636 $369.92 $454.18 $413.95 $508.24 $392.23 $481.58 $429.84 $527.75 $387.98 $476.3637 $372.32 $457.14 $416.64 $511.55 $394.78 $484.71 $432.63 $531.19 $390.50 $479.4638 $374.73 $460.09 $419.33 $514.86 $397.33 $487.84 $435.43 $534.62 $393.02 $482.5639 $379.54 $466.00 $424.72 $521.47 $402.43 $494.11 $441.02 $541.48 $398.07 $488.7540 $384.35 $495.58 $430.10 $554.57 $407.53 $525.47 $446.61 $575.86 $403.12 $519.7841 $391.57 $504.89 $438.18 $564.99 $415.19 $535.34 $455.00 $586.67 $410.69 $529.5442 $398.49 $513.81 $445.92 $574.97 $422.52 $544.80 $463.03 $597.04 $417.94 $538.9043 $408.11 $526.22 $456.69 $588.85 $432.73 $557.96 $474.22 $611.46 $428.04 $551.9144 $420.14 $541.73 $470.15 $606.21 $445.48 $574.40 $488.20 $629.48 $440.65 $568.1845 $434.28 $572.64 $485.97 $640.80 $460.47 $607.18 $504.62 $665.39 $455.48 $600.6046 $451.12 $594.84 $504.81 $665.65 $478.33 $630.72 $524.19 $691.20 $473.14 $623.8947 $470.06 $619.83 $526.02 $693.60 $498.42 $657.21 $546.21 $720.23 $493.02 $650.0948 $491.72 $648.38 $550.25 $725.55 $521.38 $687.49 $571.37 $753.41 $515.73 $680.0449 $513.07 $676.54 $574.14 $757.06 $544.02 $717.34 $596.18 $786.12 $538.12 $709.5750 $537.13 $710.19 $601.06 $794.73 $569.53 $753.03 $624.14 $825.23 $563.36 $744.8751 $560.89 $741.61 $627.65 $829.88 $594.72 $786.34 $651.74 $861.73 $588.28 $777.8252 $587.05 $776.20 $656.93 $868.59 $622.46 $823.02 $682.15 $901.93 $615.72 $814.1053 $613.52 $811.20 $686.55 $907.75 $650.52 $860.12 $712.90 $942.60 $643.48 $850.8054 $642.09 $848.97 $718.52 $950.03 $680.82 $900.18 $746.10 $986.49 $673.44 $890.4355 $670.66 $877.36 $750.49 $981.79 $711.11 $930.28 $779.30 $1,019.48 $703.41 $920.2056 $701.64 $917.88 $785.15 $1,027.14 $743.96 $973.25 $815.29 $1,066.56 $735.90 $962.7057 $732.92 $958.80 $820.15 $1,072.92 $777.12 $1,016.63 $851.63 $1,114.11 $768.70 $1,005.6158 $766.30 $1,002.47 $857.51 $1,121.79 $812.52 $1,062.93 $890.42 $1,164.85 $803.71 $1,051.4259 $782.84 $1,024.11 $876.02 $1,146.01 $830.06 $1,085.88 $909.65 $1,190.00 $821.06 $1,074.1160 $816.22 $1,048.68 $913.38 $1,173.51 $865.45 $1,111.93 $948.44 $1,218.55 $856.08 $1,099.8961 $845.09 $1,085.78 $945.68 $1,215.01 $896.07 $1,151.27 $981.98 $1,261.65 $886.36 $1,138.7962 $864.04 $1,110.12 $966.89 $1,242.25 $916.16 $1,177.08 $1,004.00 $1,289.94 $906.23 $1,164.3263 $887.80 $1,140.65 $993.47 $1,276.41 $941.35 $1,209.44 $1,031.61 $1,325.41 $931.15 $1,196.34

64+ $902.25 $1,159.19 $1,009.62 $1,297.17 $956.64 $1,229.11 $1,048.38 $1,346.96 $946.29 $1,215.79

Peoria, IL Bloomington, IL Champaign, IL Springfield, ILQuad Cities, IL

Individual Coverage

Rating Area

Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco

0-14 $245.07 $245.07 $219.02 $219.02 $301.56 $301.5615 $266.85 $266.85 $238.49 $238.49 $328.37 $328.3716 $275.18 $275.18 $245.93 $245.93 $338.62 $338.6217 $283.51 $283.51 $253.38 $253.38 $348.87 $348.8718 $292.48 $292.48 $261.39 $261.39 $359.91 $359.9119 $301.45 $301.45 $269.41 $269.41 $370.94 $370.9420 $310.74 $310.74 $277.71 $277.71 $382.37 $382.3721 $320.35 $320.35 $286.30 $286.30 $394.20 $394.2022 $320.35 $320.35 $286.30 $286.30 $394.20 $394.2023 $320.35 $320.35 $286.30 $286.30 $394.20 $394.2024 $320.35 $320.35 $286.30 $286.30 $394.20 $394.2025 $321.63 $321.63 $287.45 $287.45 $395.78 $395.7826 $328.04 $328.04 $293.17 $293.17 $403.66 $403.6627 $335.73 $335.73 $300.05 $300.05 $413.12 $413.1228 $348.22 $348.22 $311.21 $311.21 $428.50 $428.5029 $358.47 $358.47 $320.37 $320.37 $441.11 $441.1130 $363.60 $412.39 $324.95 $368.56 $447.42 $507.4631 $371.28 $421.11 $331.83 $376.36 $456.88 $518.1932 $378.97 $429.83 $338.70 $384.15 $466.34 $528.9233 $383.78 $435.28 $342.99 $389.02 $472.25 $535.6334 $388.90 $441.09 $347.57 $394.22 $478.56 $542.7835 $391.47 $480.64 $349.86 $429.56 $481.71 $591.4536 $394.03 $483.79 $352.15 $432.37 $484.87 $595.3237 $396.59 $486.94 $354.44 $435.19 $488.02 $599.1938 $399.15 $490.08 $356.73 $438.00 $491.17 $603.0639 $404.28 $496.37 $361.31 $443.62 $497.48 $610.8140 $409.41 $527.89 $365.90 $471.78 $503.79 $649.5841 $417.09 $537.80 $372.77 $480.65 $513.25 $661.7842 $424.46 $547.30 $379.35 $489.14 $522.32 $673.4843 $434.71 $560.52 $388.51 $500.95 $534.93 $689.7444 $447.53 $577.04 $399.97 $515.72 $550.70 $710.0745 $462.58 $609.96 $413.42 $545.14 $569.23 $750.5846 $480.52 $633.62 $429.45 $566.28 $591.30 $779.6947 $500.71 $660.23 $447.49 $590.06 $616.14 $812.4448 $523.77 $690.64 $468.11 $617.24 $644.52 $849.8649 $546.52 $720.63 $488.43 $644.05 $672.51 $886.7750 $572.14 $756.49 $511.34 $676.09 $704.04 $930.8951 $597.45 $789.95 $533.96 $706.00 $735.18 $972.0652 $625.32 $826.80 $558.86 $738.93 $769.48 $1,017.4153 $653.51 $864.07 $584.06 $772.24 $804.17 $1,063.2754 $683.94 $904.31 $611.26 $808.21 $841.62 $1,112.7955 $714.38 $934.55 $638.46 $835.23 $879.07 $1,150.0056 $747.37 $977.71 $667.95 $873.81 $919.67 $1,203.1157 $780.69 $1,021.30 $697.72 $912.76 $960.67 $1,256.7458 $816.25 $1,067.82 $729.50 $954.33 $1,004.42 $1,313.9959 $833.87 $1,090.86 $745.25 $974.93 $1,026.11 $1,342.3560 $869.43 $1,117.04 $777.03 $998.33 $1,069.86 $1,374.5661 $900.18 $1,156.55 $804.51 $1,033.64 $1,107.70 $1,423.1862 $920.36 $1,182.48 $822.55 $1,056.81 $1,132.54 $1,455.0963 $945.67 $1,215.00 $845.17 $1,085.87 $1,163.68 $1,495.10

64+ $961.05 $1,234.75 $858.90 $1,103.53 $1,182.60 $1,519.41

St. Louis, IL Southern ILEast St. Louis, IL

Blue Cross and Blue Shield of Illinois P.O.Box 3236 Naperville, IL 60566-7236

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