Rate chart guide - Kaiser Permanente · PDF fileRate chart guide Denver/Boulder, Northern Colorado, Southern Colorado (Pueblo), Mountain Colorado Kaiser Permanente for Individuals

Rate chart guideDenver/Boulder, Northern Colorado, Southern Colorado (Pueblo), Mountain Colorado

Kaiser Permanente for Individuals and Families n January 2017

To use the Rate Chart Guide, first determine your rate area by finding your ZIP code and county in the chart beginning on page 2. Then locate the page listing your rate area. Your monthly rate will appear in the box where your age and plan intersect.

Rates are determined individually, whether you apply individually or as a family, and are based on the following:

n The plan you select

n Where you live, based on your ZIP code and county

n Your age on the plan’s effective or renewal date

n Whether you use tobacco

If you move and change your home ZIP code and county, your monthly rate may change. If you move to a ZIP code and county that aren’t covered by Kaiser Permanente, your coverage may not continue.

Tobacco use

Rates shown in this guide are for those individuals who do not use tobacco. Tobacco users 21 and older may pay higher rates than those shown here.

Although family members can enroll in different plans, there are some advantages to enrolling family members in the same plan:

n Children can be covered under your plan until they reach age 26, whether or not they’re in school or living at home.

n If you have more than 3 children under age 21 on the same plan, you will only be charged for the 3 oldest. Other children under 21 are covered at no additional cost.

n If you have a child-only account and everyone on the account is under 21, you’ll only be charged for the subscriber (the oldest child on the plan) and the next 3 oldest children under 21.

Health plans include pediatric dental benefits for children 18 and younger.

You may qualify for federal financial assistance

If you qualify for federal financial assistance, these rates will not apply to you. If you are eligible, the federal government will pay the financial assistance to Kaiser Permanente directly.

2017 Enrollment

60467809 January 2017 Colorado

Kaiser Permanente for Individuals and Families

60467809 January 2017 Colorado 2

Service area ZIP codes for Denver/Boulder, Northern Colorado, Southern Colorado (Pueblo), Mountain Colorado

ZIP Code County Rate Area

69128 Weld 6

69145 Weld 6

80001 Jefferson 3

80002 Jefferson 3

80002 Adams 3

80003 Adams 3

80003 Jefferson 3

80004 Jefferson 3

80005 Jefferson 3

80006 Jefferson 3

80007 Jefferson 3

80010 Adams 3

80010 Arapahoe 3

80011 Arapahoe 3

80011 Adams 3

80012 Arapahoe 3

80013 Arapahoe 3

80014 Arapahoe 3

80014 Denver 3

80015 Arapahoe 3

80016 Arapahoe 3

80017 Arapahoe 3

80018 Arapahoe 3

80019 Adams 3

80020 Jefferson 3

80020 Adams 3

80020 Broomfield 3

80020 Boulder 1

80021 Broomfield 3

80021 Jefferson 3

80022 Adams 3

80023 Adams 3

80023 Broomfield 3

80024 Adams 3

80025 Boulder 1

80026 Boulder 1

80027 Boulder 1

80030 Adams 3

80031 Adams 3

80031 Jefferson 3

80033 Jefferson 3

80034 Jefferson 3

80035 Adams 3

80036 Adams 3

80037 Adams 3

80038 Broomfield 3


80040 Adams 3

80041 Arapahoe 3

80042 Adams 3

80044 Arapahoe 3

80045 Adams 3

80046 Arapahoe 3

80047 Arapahoe 3

80102 Elbert 3

80102 Adams 3

80102 Arapahoe 3

80104 Douglas 3

80107 Elbert 3

80108 Douglas 3

80109 Douglas 3

80110 Arapahoe 3

80110 Denver 3

80111 Denver 3

80111 Arapahoe 3

80112 Arapahoe 3

80112 Denver 3

80112 Douglas 3

80113 Arapahoe 3

80116 Douglas 3

80117 Elbert 3

80120 Arapahoe 3

80121 Arapahoe 3

80122 Arapahoe 3

80123 Denver 3

80123 Arapahoe 3

80123 Jefferson 3

80124 Douglas 3

80125 Jefferson 3

80125 Douglas 3

80126 Douglas 3

80127 Jefferson 3

80128 Arapahoe 3

80128 Jefferson 3

80129 Arapahoe 3

80129 Douglas 3

80130 Douglas 3

80131 Douglas 3

80134 Elbert 3

80134 Douglas 3

80135 Teller 2

80135 Jefferson 3

80135 Douglas 3



Service area ZIP codes for Denver/Boulder, Northern Colorado, Southern Colorado (Pueblo), Mountain Colorado, con’t.


80137 Adams 3

80137 Arapahoe 3

80138 Elbert 3

80138 Douglas 3

80150 Arapahoe 3

80151 Arapahoe 3

80155 Arapahoe 3

80160 Arapahoe 3

80161 Arapahoe 3

80162 Jefferson 3

80163 Douglas 3

80165 Arapahoe 3

80166 Arapahoe 3

80201 Denver 3

80202 Denver 3

80203 Denver 3

80204 Denver 3

80205 Denver 3

80206 Denver 3

80207 Denver 3

80208 Denver 3

80209 Denver 3

80210 Denver 3

80211 Denver 3

80212 Jefferson 3

80212 Denver 3

80212 Adams 3

80214 Denver 3

80214 Jefferson 3

80215 Jefferson 3

80216 Denver 3

80216 Adams 3

80217 Denver 3

80218 Denver 3

80219 Denver 3

80220 Denver 3

80221 Adams 3

80221 Denver 3

80222 Arapahoe 3

80222 Denver 3

80223 Denver 3

80224 Denver 3

80225 Jefferson 3

80226 Jefferson 3

80226 Denver 3

80227 Jefferson 3


80227 Denver 3

80228 Jefferson 3

80229 Adams 3

80230 Denver 3

80231 Arapahoe 3

80231 Denver 3

80232 Jefferson 3

80232 Denver 3

80233 Adams 3

80234 Adams 3

80234 Broomfield 3

80235 Denver 3

80235 Jefferson 3

80236 Denver 3

80236 Arapahoe 3

80237 Denver 3

80238 Denver 3

80239 Denver 3

80241 Adams 3

80243 Denver 3

80244 Denver 3

80246 Arapahoe 3

80246 Denver 3

80247 Arapahoe 3

80247 Adams 3

80247 Denver 3

80248 Denver 3

80249 Adams 3

80249 Denver 3

80250 Denver 3

80251 Denver 3

80252 Denver 3

80256 Denver 3

80257 Denver 3

80259 Denver 3

80260 Adams 3

80261 Denver 3

80262 Denver 3

80263 Denver 3

80264 Denver 3

80265 Denver 3

80266 Denver 3

80271 Denver 3

80273 Denver 3

80274 Denver 3

80281 Denver 3





80290 Denver 3

80291 Denver 3

80293 Denver 3

80294 Denver 3

80299 Denver 3

80301 Boulder 1

80302 Boulder 1

80303 Boulder 1

80304 Boulder 1

80305 Boulder 1

80306 Boulder 1

80307 Boulder 1

80308 Boulder 1

80309 Boulder 1

80310 Boulder 1

80314 Boulder 1

80401 Jefferson 3

80402 Jefferson 3

80403 Jefferson 3

80403 Gilpin 3

80403 Boulder 1

80419 Jefferson 3

80421 Park 3

80422 Boulder 1

80422 Gilpin 3

80423 Eagle 9

80424 Summit 9

80425 Jefferson 3

80426 Eagle 9

80427 Gilpin 3

80433 Jefferson 3

80435 Summit 9

80437 Jefferson 3

80439 Clear Creek 3

80439 Jefferson 3

80443 Summit 9

80452 Clear Creek 3

80453 Jefferson 3

80454 Jefferson 3

80455 Boulder 1

80457 Jefferson 3

80463 Routt 9

80463 Eagle 9

80465 Jefferson 3

80466 Boulder 1

80470 Jefferson 3


80470 Park 3

80471 Boulder 1

80474 Gilpin 3

80481 Boulder 1

80497 Summit 9

80498 Summit 9

80498 Grand 9

80501 Boulder 1

80501 Weld 6

80502 Boulder 1

80503 Larimer 4

80503 Boulder 1

80504 Weld 6

80504 Larimer 4

80504 Boulder 1

80510 Larimer 4

80510 Boulder 1

80511 Larimer 4

80512 Larimer 4

80513 Boulder 1

80513 Weld 6

80513 Larimer 4

80514 Weld 6

80515 Larimer 4

80516 Weld 6

80516 Boulder 1

80517 Larimer 4

80520 Weld 6

80521 Larimer 4

80522 Larimer 4

80523 Larimer 4

80524 Larimer 4

80524 Weld 6

80525 Larimer 4

80526 Larimer 4

80527 Larimer 4

80528 Larimer 4

80530 Weld 6

80532 Larimer 4

80533 Boulder 1

80534 Weld 6

80534 Larimer 4

80535 Larimer 4

80536 Larimer 4

80537 Larimer 4

80537 Weld 6





80538 Larimer 4

80539 Larimer 4

80540 Larimer 4

80540 Boulder 1

80541 Larimer 4

80542 Weld 6

80543 Weld 6

80544 Boulder 1

80545 Larimer 4

80546 Weld 6

80547 Larimer 4

80549 Larimer 4

80549 Weld 6

80550 Larimer 4

80550 Weld 6

80551 Weld 6

80553 Larimer 4

80601 Adams 3

80602 Adams 3

80603 Adams 3

80603 Weld 6

80610 Weld 6

80611 Weld 6

80612 Weld 6

80612 Larimer 4

80614 Adams 3

80615 Weld 6

80620 Weld 6

80621 Weld 6

80622 Weld 6

80623 Weld 6

80624 Weld 6

80631 Weld 6

80632 Weld 6

80633 Weld 6

80634 Weld 6

80638 Weld 6

80639 Weld 6

80640 Adams 3

80642 Adams 3

80642 Weld 6

80643 Adams 3

80643 Weld 6

80644 Weld 6

80645 Weld 6

80646 Weld 6


80648 Weld 6

80649 Morgan 8

80649 Weld 6

80650 Weld 6

80651 Weld 6

80652 Weld 6

80654 Weld 6

80654 Morgan 8

80654 Adams 3

80729 Weld 6

80732 Weld 6

80742 Weld 6

80742 Morgan 8

80754 Weld 6

81001 Pueblo 7

81002 Pueblo 7

81003 Pueblo 7

81004 Pueblo 7

81005 Pueblo 7

81006 Pueblo 7

81007 Pueblo 7

81008 Pueblo 7

81008 El Paso 2

81009 Pueblo 7

81010 Pueblo 7

81011 Pueblo 7

81012 Pueblo 7

81019 Pueblo 7

81022 Pueblo 7

81023 Pueblo 7

81025 Pueblo 7

81039 Crowley 8

81039 Otero 8

81039 Pueblo 7

81039 Las Animas 8

81062 Crowley 8

81062 Pueblo 7

81069 Crowley 8

81069 Huerfano 8

81069 Custer 8

81069 Pueblo 7

81212 Fremont 8

81215 Fremont 8

81221 Fremont 8

81222 Fremont 8

81223 Fremont 8





81226 Fremont 8

81232 Fremont 8

81233 Fremont 8

81240 Fremont 8

81244 Fremont 8

81253 Pueblo 7

81253 Fremont 8

81253 Custer 8

81290 Fremont 8

81620 Eagle 9

81631 Eagle 9

81632 Eagle 9

81637 Eagle 9

81637 Garfield 9

81645 Eagle 9

81649 Eagle 9

81655 Eagle 9

81657 Eagle 9

81658 Eagle 9

82063 Larimer 4

82082 Weld 6



Rates are effective January 1, 2017 through December 31, 2017.

2017 Rate Area 1Please note: These rates do not include the federal financial assistance you may be eligible to receive through Connect for Health Colorado.

Age on 2017

effective or renewal date

KP CO Bronze

6500/50

KP CO Bronze

6000/50

KP CO Bronze

5500/30% /HSA

KP CO Bronze

5250/40

KP CO Silver

3000/30

KP CO Silver

2750/20% /HSA

KP CO Silver

2000/30

KP CO Gold

1250/20

KP CO Gold 0/20

KP CO Catastrophic

<21 125.82 137.99 130.42 128.48 163.21 156.86 166.93 187.65 193.39 119.05

21 198.15 217.30 205.39 202.34 257.03 247.02 262.88 295.51 304.55 187.48

22 198.15 217.30 205.39 202.34 257.03 247.02 262.88 295.51 304.55 187.48

23 198.15 217.30 205.39 202.34 257.03 247.02 262.88 295.51 304.55 187.48

24 198.15 217.30 205.39 202.34 257.03 247.02 262.88 295.51 304.55 187.48

25 198.94 218.17 206.21 203.15 258.05 248.00 263.93 296.69 305.76 188.23

26 202.90 222.52 210.31 207.19 263.19 252.95 269.19 302.60 311.85 191.98

27 207.66 227.73 215.24 212.05 269.36 258.87 275.50 309.69 319.16 196.48

28 215.39 236.21 223.25 219.94 279.39 268.51 285.75 321.21 331.04 203.79

29 221.73 243.16 229.83 226.42 287.61 276.41 294.16 330.67 340.79 209.79

30 224.90 246.64 233.11 229.65 291.72 280.36 298.37 335.40 345.66 212.79

31 229.65 251.85 238.04 234.51 297.89 286.29 304.68 342.49 352.97 217.29

32 234.41 257.07 242.97 239.37 304.06 292.22 310.99 349.58 360.28 221.79

33 237.38 260.33 246.05 242.40 307.92 295.93 314.93 354.02 364.85 224.60

34 240.55 263.80 249.34 245.64 312.03 299.88 319.14 358.74 369.72 227.60

35 242.14 265.54 250.98 247.26 314.09 301.85 321.24 361.11 372.15 229.10

36 243.72 267.28 252.62 248.88 316.14 303.83 323.34 363.47 374.59 230.60

37 245.31 269.02 254.27 250.49 318.20 305.81 325.45 365.84 377.03 232.10

38 246.89 270.76 255.91 252.11 320.25 307.78 327.55 368.20 379.46 233.60

39 250.06 274.23 259.20 255.35 324.37 311.74 331.75 372.93 384.34 236.60

40 253.23 277.71 262.48 258.59 328.48 315.69 335.96 377.66 389.21 239.60

41 257.99 282.92 267.41 263.44 334.65 321.62 342.27 384.75 396.52 244.10

42 262.54 287.92 272.14 268.10 340.56 327.30 348.32 391.55 403.52 248.41

43 268.89 294.88 278.71 274.57 348.78 335.20 356.73 401.00 413.27 254.41

44 276.81 303.57 286.92 282.67 359.07 345.08 367.24 412.82 425.45 261.91

45 286.12 313.78 296.58 292.18 371.15 356.69 379.60 426.71 439.76 270.72

46 297.22 325.95 308.08 303.51 385.54 370.53 394.32 443.26 456.82 281.22

47 309.70 339.64 321.02 316.25 401.73 386.09 410.88 461.88 476.00 293.03

48 323.97 355.29 335.81 330.82 420.24 403.87 429.81 483.15 497.93 306.53

49 338.04 370.71 350.39 345.19 438.49 421.41 448.47 504.13 519.55 319.84

50 353.89 388.10 366.82 361.38 459.05 441.17 469.50 527.77 543.92 334.84

51 369.54 405.26 383.04 377.36 479.35 460.69 490.27 551.12 567.98 349.65

52 386.78 424.17 400.91 394.96 501.72 482.18 513.14 576.83 594.47 365.96

53 404.22 443.29 418.99 412.77 524.33 503.91 536.27 602.83 621.27 382.46

54 423.04 463.94 438.50 431.99 548.75 527.38 561.25 630.90 650.20 400.27

55 441.87 484.58 458.01 451.21 573.17 550.85 586.22 658.98 679.14 418.08

56 462.28 506.96 479.16 472.05 599.64 576.29 613.30 689.42 710.50 437.39

57 482.88 529.56 500.52 493.10 626.37 601.98 640.64 720.15 742.18 456.89

58 504.88 553.68 523.32 515.56 654.90 629.40 669.82 752.95 775.98 477.70

59 515.78 565.63 534.62 526.68 669.04 642.98 684.28 769.20 792.73 488.01

60 537.77 589.75 557.42 549.14 697.57 670.40 713.46 802.00 826.54 508.82

61 556.79 610.61 577.13 568.57 722.24 694.12 738.69 830.37 855.77 526.82

62 569.28 624.30 590.07 581.32 738.44 709.68 755.25 848.99 874.96 538.63

63 584.93 641.47 606.30 597.30 758.74 729.19 776.02 872.33 899.02 553.44

64+ 594.43 651.89 616.15 607.00 771.07 741.04 788.63 886.51 913.63 562.43





Age on 2017


KP CO Bronze

6500/50

KP CO Bronze

6000/50

KP CO Bronze

5500/30% /HSA

KP CO Bronze

5250/40

KP CO Silver

3000/30

KP CO Silver

2750/20% /HSA

KP CO Silver

2000/30

KP CO Gold

1250/20

KP CO Gold 0/20

KP CO Catastrophic

<21 134.63 147.64 139.55 137.48 174.64 167.84 178.61 200.78 206.92 127.38

21 212.02 232.51 219.76 216.50 275.02 264.31 281.28 316.19 325.86 200.60

22 212.02 232.51 219.76 216.50 275.02 264.31 281.28 316.19 325.86 200.60

23 212.02 232.51 219.76 216.50 275.02 264.31 281.28 316.19 325.86 200.60

24 212.02 232.51 219.76 216.50 275.02 264.31 281.28 316.19 325.86 200.60

25 212.87 233.44 220.64 217.37 276.12 265.37 282.41 317.46 327.17 201.41

26 217.11 238.09 225.04 221.70 281.62 270.65 288.03 323.78 333.68 205.42

27 222.19 243.67 230.31 226.89 288.22 276.99 294.78 331.37 341.51 210.23

28 230.46 252.74 238.88 235.34 298.94 287.30 305.75 343.70 354.21 218.06

29 237.25 260.18 245.91 242.26 307.75 295.76 314.75 353.82 364.64 224.47

30 240.64 263.90 249.43 245.73 312.15 299.99 319.25 358.88 369.86 227.68

31 245.73 269.48 254.70 250.93 318.75 306.33 326.00 366.47 377.68 232.50

32 250.82 275.06 259.98 256.12 325.35 312.68 332.76 374.05 385.50 237.31

33 254.00 278.55 263.28 259.37 329.47 316.64 336.97 378.80 390.38 240.32

34 257.39 282.27 266.79 262.83 333.87 320.87 341.48 383.86 395.60 243.53

35 259.08 284.13 268.55 264.56 336.07 322.98 343.73 386.39 398.21 245.14

36 260.78 285.99 270.31 266.30 338.27 325.10 345.98 388.92 400.81 246.74

37 262.48 287.85 272.07 268.03 340.47 327.21 348.23 391.44 403.42 248.35

38 264.17 289.71 273.82 269.76 342.67 329.33 350.48 393.97 406.03 249.95

39 267.57 293.43 277.34 273.22 347.07 333.56 354.98 399.03 411.24 253.16

40 270.96 297.15 280.86 276.69 351.47 337.79 359.48 404.09 416.45 256.37

41 276.05 302.73 286.13 281.88 358.07 344.13 366.23 411.68 424.27 261.18

42 280.92 308.08 291.19 286.86 364.40 350.21 372.70 418.95 431.77 265.80

43 287.71 315.52 298.22 293.79 373.20 358.67 381.70 429.07 442.20 272.22

44 296.19 324.82 307.01 302.45 384.20 369.24 392.95 441.72 455.23 280.24

45 306.15 335.75 317.34 312.63 397.13 381.66 406.17 456.58 470.55 289.67

46 318.03 348.77 329.64 324.75 412.53 396.46 421.92 474.29 488.80 300.90

47 331.38 363.41 343.49 338.39 429.85 413.11 439.64 494.21 509.33 313.54

48 346.65 380.16 359.31 353.98 449.65 432.14 459.89 516.97 532.79 327.99

49 361.70 396.66 374.91 369.35 469.18 450.91 479.87 539.42 555.92 342.23

50 378.66 415.26 392.50 386.67 491.18 472.05 502.37 564.72 581.99 358.28

51 395.41 433.63 409.86 403.77 512.91 492.93 524.59 589.70 607.74 374.12

52 413.86 453.86 428.98 422.61 536.84 515.93 549.06 617.21 636.09 391.58

53 432.51 474.32 448.32 441.66 561.04 539.19 573.81 645.03 664.76 409.23

54 452.66 496.41 469.19 462.23 587.16 564.30 600.54 675.07 695.72 428.29

55 472.80 518.50 490.07 482.80 613.29 589.41 627.26 705.11 726.68 447.34

56 494.64 542.45 512.71 505.10 641.62 616.63 656.23 737.67 760.24 468.01

57 516.69 566.63 535.56 527.61 670.22 644.12 685.48 770.56 794.13 488.87

58 540.22 592.44 559.95 551.65 700.75 673.46 716.70 805.66 830.30 511.14

59 551.88 605.23 572.04 563.55 715.87 687.99 732.18 823.05 848.22 522.17

60 575.41 631.03 596.44 587.58 746.40 717.33 763.40 858.14 884.39 544.44

61 595.77 653.36 617.53 608.37 772.80 742.71 790.40 888.50 915.68 563.69

62 609.13 668.00 631.38 622.01 790.13 759.36 808.12 908.42 936.21 576.33

63 625.87 686.37 648.74 639.11 811.85 780.24 830.34 933.40 961.95 592.18

64+ 636.04 697.52 659.28 649.49 825.04 792.91 843.83 948.56 977.58 601.80





Age on 2017


KP CO Bronze

6500/50

KP CO Bronze

6000/50

KP CO Bronze

5500/30% /HSA

KP CO Bronze

5250/40

KP CO Silver

3000/30

KP CO Silver

2750/20% /HSA

KP CO Silver

2000/30

KP CO Gold

1250/20

KP CO Gold 0/20

KP CO Catastrophic

<21 125.82 137.99 130.42 128.48 163.21 156.86 166.93 187.65 193.39 119.05

21 198.15 217.30 205.39 202.34 257.03 247.02 262.88 295.51 304.55 187.48

22 198.15 217.30 205.39 202.34 257.03 247.02 262.88 295.51 304.55 187.48

23 198.15 217.30 205.39 202.34 257.03 247.02 262.88 295.51 304.55 187.48

24 198.15 217.30 205.39 202.34 257.03 247.02 262.88 295.51 304.55 187.48

25 198.94 218.17 206.21 203.15 258.05 248.00 263.93 296.69 305.76 188.23

26 202.90 222.52 210.31 207.19 263.19 252.95 269.19 302.60 311.85 191.98

27 207.66 227.73 215.24 212.05 269.36 258.87 275.50 309.69 319.16 196.48

28 215.39 236.21 223.25 219.94 279.39 268.51 285.75 321.21 331.04 203.79

29 221.73 243.16 229.83 226.42 287.61 276.41 294.16 330.67 340.79 209.79

30 224.90 246.64 233.11 229.65 291.72 280.36 298.37 335.40 345.66 212.79

31 229.65 251.85 238.04 234.51 297.89 286.29 304.68 342.49 352.97 217.29

32 234.41 257.07 242.97 239.37 304.06 292.22 310.99 349.58 360.28 221.79

33 237.38 260.33 246.05 242.40 307.92 295.93 314.93 354.02 364.85 224.60

34 240.55 263.80 249.34 245.64 312.03 299.88 319.14 358.74 369.72 227.60

35 242.14 265.54 250.98 247.26 314.09 301.85 321.24 361.11 372.15 229.10

36 243.72 267.28 252.62 248.88 316.14 303.83 323.34 363.47 374.59 230.60

37 245.31 269.02 254.27 250.49 318.20 305.81 325.45 365.84 377.03 232.10

38 246.89 270.76 255.91 252.11 320.25 307.78 327.55 368.20 379.46 233.60

39 250.06 274.23 259.20 255.35 324.37 311.74 331.75 372.93 384.34 236.60

40 253.23 277.71 262.48 258.59 328.48 315.69 335.96 377.66 389.21 239.60

41 257.99 282.92 267.41 263.44 334.65 321.62 342.27 384.75 396.52 244.10

42 262.54 287.92 272.14 268.10 340.56 327.30 348.32 391.55 403.52 248.41

43 268.89 294.88 278.71 274.57 348.78 335.20 356.73 401.00 413.27 254.41

44 276.81 303.57 286.92 282.67 359.07 345.08 367.24 412.82 425.45 261.91

45 286.12 313.78 296.58 292.18 371.15 356.69 379.60 426.71 439.76 270.72

46 297.22 325.95 308.08 303.51 385.54 370.53 394.32 443.26 456.82 281.22

47 309.70 339.64 321.02 316.25 401.73 386.09 410.88 461.88 476.00 293.03

48 323.97 355.29 335.81 330.82 420.24 403.87 429.81 483.15 497.93 306.53

49 338.04 370.71 350.39 345.19 438.49 421.41 448.47 504.13 519.55 319.84

50 353.89 388.10 366.82 361.38 459.05 441.17 469.50 527.77 543.92 334.84

51 369.54 405.26 383.04 377.36 479.35 460.69 490.27 551.12 567.98 349.65

52 386.78 424.17 400.91 394.96 501.72 482.18 513.14 576.83 594.47 365.96

53 404.22 443.29 418.99 412.77 524.33 503.91 536.27 602.83 621.27 382.46

54 423.04 463.94 438.50 431.99 548.75 527.38 561.25 630.90 650.20 400.27

55 441.87 484.58 458.01 451.21 573.17 550.85 586.22 658.98 679.14 418.08

56 462.28 506.96 479.16 472.05 599.64 576.29 613.30 689.42 710.50 437.39

57 482.88 529.56 500.52 493.10 626.37 601.98 640.64 720.15 742.18 456.89

58 504.88 553.68 523.32 515.56 654.90 629.40 669.82 752.95 775.98 477.70

59 515.78 565.63 534.62 526.68 669.04 642.98 684.28 769.20 792.73 488.01

60 537.77 589.75 557.42 549.14 697.57 670.40 713.46 802.00 826.54 508.82

61 556.79 610.61 577.13 568.57 722.24 694.12 738.69 830.37 855.77 526.82

62 569.28 624.30 590.07 581.32 738.44 709.68 755.25 848.99 874.96 538.63

63 584.93 641.47 606.30 597.30 758.74 729.19 776.02 872.33 899.02 553.44

64+ 594.43 651.89 616.15 607.00 771.07 741.04 788.63 886.51 913.63 562.43





Age on 2017


KP CO Bronze

6500/50

KP CO Bronze

6000/50

KP CO Bronze

5500/30% /HSA

KP CO Bronze

5250/40

KP CO Silver

3000/30

KP CO Silver

2750/20% /HSA

KP CO Silver

2000/30

KP CO Gold

1250/20

KP CO Gold 0/20

KP CO Catastrophic

<21 138.41 151.78 143.46 141.33 179.53 172.54 183.62 206.41 212.73 130.95

21 217.96 239.03 225.92 222.57 282.73 271.72 289.17 325.06 335.00 206.23

22 217.96 239.03 225.92 222.57 282.73 271.72 289.17 325.06 335.00 206.23

23 217.96 239.03 225.92 222.57 282.73 271.72 289.17 325.06 335.00 206.23

24 217.96 239.03 225.92 222.57 282.73 271.72 289.17 325.06 335.00 206.23

25 218.83 239.99 226.83 223.46 283.86 272.81 290.32 326.36 336.34 207.05

26 223.19 244.77 231.35 227.91 289.51 278.24 296.11 332.86 343.04 211.18

27 228.42 250.50 236.77 233.25 296.30 284.76 303.05 340.66 351.08 216.13

28 236.92 259.83 245.58 241.94 307.33 295.36 314.33 353.34 364.15 224.17

29 243.90 267.47 252.81 249.06 316.37 304.05 323.58 363.74 374.87 230.77

30 247.39 271.30 256.42 252.62 320.90 308.40 328.21 368.94 380.23 234.07

31 252.62 277.04 261.85 257.96 327.68 314.92 335.15 376.74 388.27 239.02

32 257.85 282.77 267.27 263.30 334.47 321.44 342.09 384.54 396.31 243.97

33 261.12 286.36 270.66 266.64 338.71 325.52 346.42 389.42 401.33 247.06

34 264.61 290.18 274.27 270.20 343.23 329.87 351.05 394.62 406.69 250.36

35 266.35 292.09 276.08 271.98 345.49 332.04 353.36 397.22 409.37 252.01

36 268.09 294.01 277.89 273.76 347.76 334.21 355.68 399.82 412.05 253.66

37 269.84 295.92 279.69 275.54 350.02 336.39 357.99 402.42 414.73 255.31

38 271.58 297.83 281.50 277.32 352.28 338.56 360.30 405.02 417.41 256.96

39 275.07 301.66 285.12 280.89 356.80 342.91 364.93 410.22 422.77 260.26

40 278.55 305.48 288.73 284.45 361.33 347.26 369.56 415.42 428.13 263.56

41 283.79 311.22 294.15 289.79 368.11 353.78 376.50 423.22 436.17 268.51

42 288.80 316.71 299.35 294.91 374.62 360.03 383.15 430.70 443.88 273.25

43 295.77 324.36 306.58 302.03 383.66 368.72 392.40 441.10 454.60 279.85

44 304.49 333.92 315.62 310.93 394.97 379.59 403.97 454.10 468.00 288.10

45 314.74 345.16 326.23 321.39 408.26 392.36 417.56 469.38 483.74 297.79

46 326.94 358.54 338.89 333.86 424.09 407.58 433.75 487.58 502.50 309.34

47 340.67 373.60 353.12 347.88 441.91 424.70 451.97 508.06 523.61 322.33

48 356.37 390.81 369.39 363.90 462.26 444.26 472.79 531.47 547.73 337.18

49 371.84 407.79 385.43 379.71 482.34 463.55 493.32 554.55 571.51 351.82

50 389.28 426.91 403.50 397.51 504.95 485.29 516.45 580.55 598.31 368.32

51 406.50 445.79 421.35 415.10 527.29 506.76 539.30 606.23 624.78 384.61

52 425.46 466.59 441.00 434.46 551.89 530.39 564.46 634.51 653.92 402.56

53 444.64 487.62 460.89 454.05 576.77 554.31 589.90 663.12 683.40 420.70

54 465.35 510.33 482.35 475.19 603.63 580.12 617.37 694.00 715.23 440.30

55 486.05 533.04 503.81 496.33 630.49 605.93 644.84 724.88 747.05 459.89

56 508.50 557.66 527.08 519.26 659.61 633.92 674.63 758.36 781.56 481.13

57 531.17 582.52 550.58 542.41 689.01 662.18 704.70 792.16 816.40 502.58

58 555.37 609.05 575.65 567.11 720.39 692.34 736.80 828.24 853.58 525.47

59 567.35 622.20 588.08 579.35 735.94 707.28 752.70 846.12 872.01 536.81

60 591.55 648.73 613.16 604.06 767.33 737.44 784.80 882.20 909.19 559.70

61 612.47 671.67 634.85 625.43 794.47 763.53 812.56 913.41 941.35 579.50

62 626.20 686.73 649.08 639.45 812.28 780.65 830.78 933.89 962.46 592.49

63 643.42 705.62 666.93 657.03 834.62 802.11 853.62 959.57 988.92 608.78

64+ 653.87 717.08 677.76 667.70 848.18 815.15 867.49 975.16 1004.99 618.67





Age on 2017


KP CO Bronze

6500/50

KP CO Bronze

6000/50

KP CO Bronze

5500/30% /HSA

KP CO Bronze

5250/40

KP CO Silver

3000/30

KP CO Silver

2750/20% /HSA

KP CO Silver

2000/30

KP CO Gold

1250/20

KP CO Gold 0/20

KP CO Catastrophic

<21 138.41 151.78 143.46 141.33 179.53 172.54 183.62 206.41 212.73 130.95

21 217.96 239.03 225.92 222.57 282.73 271.72 289.17 325.06 335.00 206.23

22 217.96 239.03 225.92 222.57 282.73 271.72 289.17 325.06 335.00 206.23

23 217.96 239.03 225.92 222.57 282.73 271.72 289.17 325.06 335.00 206.23

24 217.96 239.03 225.92 222.57 282.73 271.72 289.17 325.06 335.00 206.23

25 218.83 239.99 226.83 223.46 283.86 272.81 290.32 326.36 336.34 207.05

26 223.19 244.77 231.35 227.91 289.51 278.24 296.11 332.86 343.04 211.18

27 228.42 250.50 236.77 233.25 296.30 284.76 303.05 340.66 351.08 216.13

28 236.92 259.83 245.58 241.94 307.33 295.36 314.33 353.34 364.15 224.17

29 243.90 267.47 252.81 249.06 316.37 304.05 323.58 363.74 374.87 230.77

30 247.39 271.30 256.42 252.62 320.90 308.40 328.21 368.94 380.23 234.07

31 252.62 277.04 261.85 257.96 327.68 314.92 335.15 376.74 388.27 239.02

32 257.85 282.77 267.27 263.30 334.47 321.44 342.09 384.54 396.31 243.97

33 261.12 286.36 270.66 266.64 338.71 325.52 346.42 389.42 401.33 247.06

34 264.61 290.18 274.27 270.20 343.23 329.87 351.05 394.62 406.69 250.36

35 266.35 292.09 276.08 271.98 345.49 332.04 353.36 397.22 409.37 252.01

36 268.09 294.01 277.89 273.76 347.76 334.21 355.68 399.82 412.05 253.66

37 269.84 295.92 279.69 275.54 350.02 336.39 357.99 402.42 414.73 255.31

38 271.58 297.83 281.50 277.32 352.28 338.56 360.30 405.02 417.41 256.96

39 275.07 301.66 285.12 280.89 356.80 342.91 364.93 410.22 422.77 260.26

40 278.55 305.48 288.73 284.45 361.33 347.26 369.56 415.42 428.13 263.56

41 283.79 311.22 294.15 289.79 368.11 353.78 376.50 423.22 436.17 268.51

42 288.80 316.71 299.35 294.91 374.62 360.03 383.15 430.70 443.88 273.25

43 295.77 324.36 306.58 302.03 383.66 368.72 392.40 441.10 454.60 279.85

44 304.49 333.92 315.62 310.93 394.97 379.59 403.97 454.10 468.00 288.10

45 314.74 345.16 326.23 321.39 408.26 392.36 417.56 469.38 483.74 297.79

46 326.94 358.54 338.89 333.86 424.09 407.58 433.75 487.58 502.50 309.34

47 340.67 373.60 353.12 347.88 441.91 424.70 451.97 508.06 523.61 322.33

48 356.37 390.81 369.39 363.90 462.26 444.26 472.79 531.47 547.73 337.18

49 371.84 407.79 385.43 379.71 482.34 463.55 493.32 554.55 571.51 351.82

50 389.28 426.91 403.50 397.51 504.95 485.29 516.45 580.55 598.31 368.32

51 406.50 445.79 421.35 415.10 527.29 506.76 539.30 606.23 624.78 384.61

52 425.46 466.59 441.00 434.46 551.89 530.39 564.46 634.51 653.92 402.56

53 444.64 487.62 460.89 454.05 576.77 554.31 589.90 663.12 683.40 420.70

54 465.35 510.33 482.35 475.19 603.63 580.12 617.37 694.00 715.23 440.30

55 486.05 533.04 503.81 496.33 630.49 605.93 644.84 724.88 747.05 459.89

56 508.50 557.66 527.08 519.26 659.61 633.92 674.63 758.36 781.56 481.13

57 531.17 582.52 550.58 542.41 689.01 662.18 704.70 792.16 816.40 502.58

58 555.37 609.05 575.65 567.11 720.39 692.34 736.80 828.24 853.58 525.47

59 567.35 622.20 588.08 579.35 735.94 707.28 752.70 846.12 872.01 536.81

60 591.55 648.73 613.16 604.06 767.33 737.44 784.80 882.20 909.19 559.70

61 612.47 671.67 634.85 625.43 794.47 763.53 812.56 913.41 941.35 579.50

62 626.20 686.73 649.08 639.45 812.28 780.65 830.78 933.89 962.46 592.49

63 643.42 705.62 666.93 657.03 834.62 802.11 853.62 959.57 988.92 608.78

64+ 653.87 717.08 677.76 667.70 848.18 815.15 867.49 975.16 1004.99 618.67





Age on 2017


KP CO Bronze

6500/50

KP CO Bronze

6000/50

KP CO Bronze

5500/30% /HSA

KP CO Bronze

5250/40

KP CO Silver

3000/30

KP CO Silver

2750/20% /HSA

KP CO Silver

2000/30

KP CO Gold

1250/20

KP CO Gold 0/20

KP CO Catastrophic

<21 147.21 161.44 152.59 150.33 190.96 183.52 195.31 219.55 226.26 139.29

21 231.83 254.24 240.30 236.74 300.72 289.01 307.57 345.74 356.32 219.35

22 231.83 254.24 240.30 236.74 300.72 289.01 307.57 345.74 356.32 219.35

23 231.83 254.24 240.30 236.74 300.72 289.01 307.57 345.74 356.32 219.35

24 231.83 254.24 240.30 236.74 300.72 289.01 307.57 345.74 356.32 219.35

25 232.76 255.26 241.26 237.68 301.92 290.17 308.80 347.12 357.74 220.23

26 237.40 260.34 246.07 242.42 307.94 295.95 314.95 354.04 364.87 224.62

27 242.96 266.44 251.84 248.10 315.16 302.88 322.33 362.34 373.42 229.88

28 252.00 276.36 261.21 257.33 326.88 314.15 334.33 375.82 387.32 238.43

29 259.42 284.50 268.90 264.91 336.51 323.40 344.17 386.89 398.72 245.45

30 263.13 288.56 272.74 268.69 341.32 328.03 349.09 392.42 404.42 248.96

31 268.69 294.67 278.51 274.38 348.54 334.96 356.47 400.71 412.97 254.23

32 274.26 300.77 284.28 280.06 355.75 341.90 363.85 409.01 421.52 259.49

33 277.73 304.58 287.88 283.61 360.26 346.23 368.47 414.20 426.87 262.78

34 281.44 308.65 291.73 287.40 365.08 350.86 373.39 419.73 432.57 266.29

35 283.30 310.68 293.65 289.29 367.48 353.17 375.85 422.50 435.42 268.05

36 285.15 312.72 295.57 291.18 369.89 355.48 378.31 425.26 438.27 269.80

37 287.01 314.75 297.49 293.08 372.29 357.79 380.77 428.03 441.12 271.56

38 288.86 316.78 299.42 294.97 374.70 360.11 383.23 430.79 443.97 273.31

39 292.57 320.85 303.26 298.76 379.51 364.73 388.15 436.33 449.67 276.82

40 296.28 324.92 307.10 302.55 384.32 369.35 393.07 441.86 455.37 280.33

41 301.84 331.02 312.87 308.23 391.54 376.29 400.46 450.16 463.93 285.59

42 307.18 336.87 318.40 313.67 398.46 382.94 407.53 458.11 472.12 290.64

43 314.60 345.01 326.09 321.25 408.08 392.19 417.37 469.17 483.52 297.66

44 323.87 355.17 335.70 330.72 420.11 403.75 429.67 483.00 497.78 306.43

45 334.77 367.12 346.99 341.85 434.24 417.33 444.13 499.25 514.52 316.74

46 347.75 381.36 360.45 355.10 451.08 433.51 461.35 518.61 534.48 329.03

47 362.35 397.38 375.59 370.02 470.03 451.72 480.73 540.39 556.93 342.85

48 379.04 415.68 392.89 387.06 491.68 472.53 502.88 565.29 582.58 358.64

49 395.51 433.74 409.95 403.87 513.03 493.05 524.71 589.84 607.88 374.21

50 414.05 454.07 429.18 422.81 537.09 516.17 549.32 617.49 636.38 391.76

51 432.37 474.16 448.16 441.51 560.84 539.00 573.62 644.81 664.53 409.09

52 452.54 496.28 469.07 462.11 587.01 564.15 600.38 674.89 695.53 428.17

53 472.94 518.65 490.21 482.94 613.47 589.58 627.44 705.31 726.89 447.48

54 494.96 542.80 513.04 505.43 642.04 617.04 656.66 738.16 760.74 468.31

55 516.98 566.96 535.87 527.92 670.61 644.49 685.88 771.00 794.59 489.15

56 540.86 593.14 560.62 552.30 701.58 674.26 717.56 806.62 831.29 511.75

57 564.97 619.59 585.61 576.92 732.86 704.32 749.55 842.57 868.35 534.56

58 590.71 647.81 612.29 603.20 766.24 736.40 783.69 880.95 907.90 558.91

59 603.46 661.79 625.50 616.22 782.78 752.29 800.60 899.97 927.50 570.97

60 629.19 690.01 652.18 642.50 816.16 784.37 834.74 938.34 967.05 595.32

61 651.45 714.42 675.25 665.23 845.03 812.12 864.27 971.53 1001.25 616.38

62 666.05 730.43 690.39 680.14 863.97 830.32 883.65 993.32 1023.70 630.19

63 684.37 750.52 709.37 698.84 887.73 853.16 907.94 1020.63 1051.85 647.52

64+ 695.49 762.71 720.89 710.20 902.15 867.02 922.70 1037.22 1068.94 658.04





Age on 2017


KP CO Bronze

6500/50

KP CO Bronze

6000/50

KP CO Bronze

5500/30% /HSA

KP CO Bronze

5250/40

KP CO Silver

3000/30

KP CO Silver

2750/20% /HSA

KP CO Silver

2000/30

KP CO Gold

1250/20

KP CO Gold 0/20

KP CO Catastrophic

<21 147.21 161.44 152.59 150.33 190.96 183.52 195.31 219.55 226.26 139.29

21 231.83 254.24 240.30 236.74 300.72 289.01 307.57 345.74 356.32 219.35

22 231.83 254.24 240.30 236.74 300.72 289.01 307.57 345.74 356.32 219.35

23 231.83 254.24 240.30 236.74 300.72 289.01 307.57 345.74 356.32 219.35

24 231.83 254.24 240.30 236.74 300.72 289.01 307.57 345.74 356.32 219.35

25 232.76 255.26 241.26 237.68 301.92 290.17 308.80 347.12 357.74 220.23

26 237.40 260.34 246.07 242.42 307.94 295.95 314.95 354.04 364.87 224.62

27 242.96 266.44 251.84 248.10 315.16 302.88 322.33 362.34 373.42 229.88

28 252.00 276.36 261.21 257.33 326.88 314.15 334.33 375.82 387.32 238.43

29 259.42 284.50 268.90 264.91 336.51 323.40 344.17 386.89 398.72 245.45

30 263.13 288.56 272.74 268.69 341.32 328.03 349.09 392.42 404.42 248.96

31 268.69 294.67 278.51 274.38 348.54 334.96 356.47 400.71 412.97 254.23

32 274.26 300.77 284.28 280.06 355.75 341.90 363.85 409.01 421.52 259.49

33 277.73 304.58 287.88 283.61 360.26 346.23 368.47 414.20 426.87 262.78

34 281.44 308.65 291.73 287.40 365.08 350.86 373.39 419.73 432.57 266.29

35 283.30 310.68 293.65 289.29 367.48 353.17 375.85 422.50 435.42 268.05

36 285.15 312.72 295.57 291.18 369.89 355.48 378.31 425.26 438.27 269.80

37 287.01 314.75 297.49 293.08 372.29 357.79 380.77 428.03 441.12 271.56

38 288.86 316.78 299.42 294.97 374.70 360.11 383.23 430.79 443.97 273.31

39 292.57 320.85 303.26 298.76 379.51 364.73 388.15 436.33 449.67 276.82

40 296.28 324.92 307.10 302.55 384.32 369.35 393.07 441.86 455.37 280.33

41 301.84 331.02 312.87 308.23 391.54 376.29 400.46 450.16 463.93 285.59

42 307.18 336.87 318.40 313.67 398.46 382.94 407.53 458.11 472.12 290.64

43 314.60 345.01 326.09 321.25 408.08 392.19 417.37 469.17 483.52 297.66

44 323.87 355.17 335.70 330.72 420.11 403.75 429.67 483.00 497.78 306.43

45 334.77 367.12 346.99 341.85 434.24 417.33 444.13 499.25 514.52 316.74

46 347.75 381.36 360.45 355.10 451.08 433.51 461.35 518.61 534.48 329.03

47 362.35 397.38 375.59 370.02 470.03 451.72 480.73 540.39 556.93 342.85

48 379.04 415.68 392.89 387.06 491.68 472.53 502.88 565.29 582.58 358.64

49 395.51 433.74 409.95 403.87 513.03 493.05 524.71 589.84 607.88 374.21

50 414.05 454.07 429.18 422.81 537.09 516.17 549.32 617.49 636.38 391.76

51 432.37 474.16 448.16 441.51 560.84 539.00 573.62 644.81 664.53 409.09

52 452.54 496.28 469.07 462.11 587.01 564.15 600.38 674.89 695.53 428.17

53 472.94 518.65 490.21 482.94 613.47 589.58 627.44 705.31 726.89 447.48

54 494.96 542.80 513.04 505.43 642.04 617.04 656.66 738.16 760.74 468.31

55 516.98 566.96 535.87 527.92 670.61 644.49 685.88 771.00 794.59 489.15

56 540.86 593.14 560.62 552.30 701.58 674.26 717.56 806.62 831.29 511.75

57 564.97 619.59 585.61 576.92 732.86 704.32 749.55 842.57 868.35 534.56

58 590.71 647.81 612.29 603.20 766.24 736.40 783.69 880.95 907.90 558.91

59 603.46 661.79 625.50 616.22 782.78 752.29 800.60 899.97 927.50 570.97

60 629.19 690.01 652.18 642.50 816.16 784.37 834.74 938.34 967.05 595.32

61 651.45 714.42 675.25 665.23 845.03 812.12 864.27 971.53 1001.25 616.38

62 666.05 730.43 690.39 680.14 863.97 830.32 883.65 993.32 1023.70 630.19

63 684.37 750.52 709.37 698.84 887.73 853.16 907.94 1020.63 1051.85 647.52

64+ 695.49 762.71 720.89 710.20 902.15 867.02 922.70 1037.22 1068.94 658.04





Age on 2017


KP CO Bronze

6500/50

KP CO Bronze

6000/50

KP CO Bronze

5500/30% /HSA

KP CO Bronze

5250/40

KP CO Silver

3000/30

KP CO Silver

2750/20% /HSA

KP CO Silver

2000/30

KP CO Gold

1250/20

KP CO Gold 0/20

KP CO Catastrophic

<21 163.57 179.38 169.55 167.03 212.18 203.91 217.01 243.94 251.40 154.76

21 257.59 282.49 267.00 263.04 334.13 321.12 341.74 384.16 395.91 243.72

22 257.59 282.49 267.00 263.04 334.13 321.12 341.74 384.16 395.91 243.72

23 257.59 282.49 267.00 263.04 334.13 321.12 341.74 384.16 395.91 243.72

24 257.59 282.49 267.00 263.04 334.13 321.12 341.74 384.16 395.91 243.72

25 258.62 283.62 268.07 264.09 335.47 322.41 343.11 385.69 397.49 244.70

26 263.77 289.27 273.41 269.35 342.15 328.83 349.95 393.38 405.41 249.57

27 269.96 296.05 279.82 275.66 350.17 336.54 358.15 402.60 414.91 255.42

28 280.00 307.07 290.23 285.92 363.20 349.06 371.48 417.58 430.35 264.93

29 288.24 316.11 298.77 294.34 373.90 359.34 382.41 429.87 443.02 272.73

30 292.37 320.63 303.05 298.55 379.24 364.47 387.88 436.02 449.36 276.63

31 298.55 327.41 309.45 304.86 387.26 372.18 396.08 445.24 458.86 282.47

32 304.73 334.19 315.86 311.18 395.28 379.89 404.28 454.46 468.36 288.32

33 308.59 338.42 319.87 315.12 400.29 384.70 409.41 460.22 474.30 291.98

34 312.72 342.94 324.14 319.33 405.64 389.84 414.88 466.37 480.63 295.88

35 314.78 345.20 326.28 321.43 408.31 392.41 417.61 469.44 483.80 297.83

36 316.84 347.46 328.41 323.54 410.99 394.98 420.34 472.51 486.97 299.78

37 318.90 349.72 330.55 325.64 413.66 397.55 423.08 475.59 490.14 301.73

38 320.96 351.98 332.68 327.75 416.33 400.12 425.81 478.66 493.30 303.68

39 325.08 356.50 336.96 331.96 421.68 405.26 431.28 484.81 499.64 307.58

40 329.20 361.02 341.23 336.16 427.02 410.39 436.75 490.95 505.97 311.48

41 335.38 367.80 347.64 342.48 435.04 418.10 444.95 500.17 515.47 317.33

42 341.31 374.30 353.78 348.53 442.73 425.49 452.81 509.01 524.58 322.93

43 349.55 383.34 362.32 356.94 453.42 435.76 463.75 521.30 537.25 330.73

44 359.85 394.64 373.00 367.47 466.79 448.61 477.42 536.67 553.09 340.48

45 371.96 407.92 385.55 379.83 482.49 463.70 493.48 554.72 571.69 351.94

46 386.39 423.73 400.50 394.56 501.20 481.68 512.62 576.24 593.86 365.58

47 402.61 441.53 417.32 411.13 522.25 501.91 534.15 600.44 618.81 380.94

48 421.16 461.87 436.55 430.07 546.31 525.03 558.75 628.10 647.31 398.49

49 439.45 481.93 455.50 448.74 570.03 547.83 583.01 655.37 675.42 415.79

50 460.06 504.53 476.86 469.79 596.76 573.52 610.35 686.11 707.09 435.29

51 480.41 526.84 497.96 490.57 623.16 598.89 637.35 716.45 738.37 454.54

52 502.82 551.42 521.19 513.45 652.23 626.83 667.08 749.88 772.81 475.75

53 525.49 576.28 544.68 536.60 681.63 655.09 697.16 783.68 807.65 497.19

54 549.96 603.12 570.05 561.59 713.38 685.60 729.62 820.18 845.27 520.35

55 574.43 629.95 595.41 586.58 745.12 716.10 762.09 856.67 882.88 543.50

56 600.96 659.05 622.91 613.67 779.54 749.18 797.29 896.24 923.66 568.61

57 627.75 688.43 650.68 641.03 814.29 782.57 832.83 936.19 964.83 593.95

58 656.34 719.78 680.32 670.22 851.37 818.22 870.76 978.83 1008.78 621.01

59 670.51 735.32 695.00 684.69 869.75 835.88 889.56 999.96 1030.55 634.41

60 699.10 766.68 724.64 713.89 906.84 871.52 927.49 1042.60 1074.50 661.46

61 723.83 793.80 750.27 739.14 938.92 902.35 960.30 1079.48 1112.50 684.86

62 740.06 811.59 767.09 755.71 959.97 922.58 981.83 1103.68 1137.45 700.22

63 760.41 833.91 788.19 776.49 986.36 947.95 1008.83 1134.03 1168.72 719.47

64+ 772.76 847.46 800.99 789.11 1002.39 963.36 1025.22 1152.46 1187.72 731.16



60467809 January 2017 Colorado

Documents

Rate chart guide - Kaiser Permanente · PDF fileRate chart guide Denver/Boulder, Northern Colorado, Southern Colorado (Pueblo), Mountain Colorado Kaiser Permanente for Individuals