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EMERGENCY
MEDICAL |
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PLAN A | Coverage | 0-25 | 26-34 | 35-39 | 40-54 | 55-59 | 60-64 | 65-69 | 70-74 | 75-79 | 80-85 |
30-DAY
MULTI-TRIP
Annual Premium | $150,000 Annual Maximum | $205 | $211 | $218 | $248 | $317 | $398 | $454 | | |  |
SINGLE TRIP | $15,000 | $1.85 | $1.90 | $1.95 | $2.15 | $2.20 | $3.10 | $3.70 | $4.74 | $5.36 | $6.08 |
Premium per Day | $25,000 | $1.95 | $2.10 | $2.20 | $2.45 | $2.50 | $3.60 | $4.20 | $5.46 | $5.87 | $6.75 |
 | $50,000 | $2.25 | $2.40 | $2.45 | $2.75 | $2.80 | $4.20 | $4.90 | $6.49 | $7.36 | $8.55 |
| $100,000 | $2.95 | $3.25 | $3.40 | $4.30 | $4.35 | $5.30 | $6.60 | $8.14 | $9.58 | $10.82 |
| $150,000 | $4.15 | $4.20 | $4.25 | $5.55 | $5.60 | $6.90 | $8.85 | | |  |
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PLAN B | Coverage | 0-25 | 26-34 | 35-39 | 40-54 | 55-59 | 60-64 | 65-69 | 70-74 | 75-79 | 80-85 |
30-DAY
MULTI-TRIP
Annual Premium | $150,000 Annual Maximum | | | $229 | $269 | $343 | $442 | $490 | | |  |
SINGLE TRIP | $15,000 |  |  | $2.06 | $2.37 | $2.52 | $3.30 | $3.86 | $5.82 | $6.70 | $9.06 |
Premium per Day | $25,000 | | | $2.32 | $2.68 | $2.88 | $3.86 | $4.38 | $6.28 | $7.62 | $10.56 |
 | $50,000 | | | $2.58 | $3.04 | $3.24 | $4.53 | $5.15 | $7.47 | $9.58 | $12.41 |
| $100,000 | | | $3.55 | $4.53 | $4.69 | $5.61 | $6.95 | $9.37 | $11.59 | $15.71 |
| $150,000 | | | $4.48 | $5.92 | $6.03 | $7.78 | $10.30 | | |  |
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OPTIONAL INSURANCE
SINGLE TRIP ONLY |
Premium per Day | | 0-25 | 26-34 | 35-39 | 40-54 | 55-59 | 60-64 | 65-69 | 70-74 | 75-79 | 80-85 |
TRIP INTERRUPTION |  | $0.55 | $0.57 | $0.59 | $0.61 | $0.62 | $0.64 | $0.66 | $0.68 | $0.70 | $0.72 |
TRAVEL ACCIDENT | | $0.38 | $0.38 | $0.36 | $0.36 | $0.36 | $0.36 | $0.37 | $0.37 | $0.38 | $0.38 |
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