Download - Aetna Health Plans for Texas
73.03.355.1-03 B (1/16)
Quality Health plans & benefits Healthier living Financial well-being Intelligent solutions Aetna Health Plans for Texas Rating Area 3 Counties – Monthly Rates (Effective 01/01/2016*) Bastrop, Caldwell, Hays, Travis, Williamson
Aetna Bronze HSA Eligible
PD
Age
Non Tobacco Tobacco
0-20 $124.73 $124.73
21 $196.42 $216.06 22 $196.42 $216.06 23 $196.42 $216.06 24 $196.42 $216.06 25 $197.21 $216.93 26 $201.14 $221.25 27 $205.85 $226.44 28 $213.51 $234.86 29 $219.80 $241.78 30 $222.94 $245.23 31 $227.65 $250.42 32 $232.37 $255.60 33 $235.31 $258.84 34 $238.46 $262.30 35 $240.03 $264.03 36 $241.60 $265.76 37 $243.17 $267.49 38 $244.74 $269.22 39 $247.88 $272.67 40 $251.03 $276.13 41 $255.74 $281.32 42 $260.26 $286.29 43 $266.54 $293.20 44 $274.40 $301.84 45 $283.63 $312.00 46 $294.63 $324.10 47 $307.01 $337.71 48 $321.15 $353.27 49 $335.10 $368.61 50 $350.81 $385.89 51 $366.33 $402.96 52 $383.42 $421.76 53 $400.70 $440.77 54 $419.36 $461.30 55 $438.02 $481.82 56 $458.25 $504.08 57 $478.68 $526.55 58 $500.48 $550.53 59 $511.29 $562.42 60 $533.09 $586.40 61 $551.95 $607.14 62 $564.32 $620.75 63 $579.84 $637.82 64 $589.07 $647.98 65+** $589.07 $647.98
Aetna Bronze $15 Copay PD
Age
Non Tobacco Tobacco
0-20 $133.44 $133.44
21 $210.14 $231.15 22 $210.14 $231.15 23 $210.14 $231.15 24 $210.14 $231.15 25 $210.98 $232.08 26 $215.18 $236.70 27 $220.23 $242.25 28 $228.42 $251.26 29 $235.15 $258.66 30 $238.51 $262.36 31 $243.55 $267.91 32 $248.60 $273.46 33 $251.75 $276.92 34 $255.11 $280.62 35 $256.79 $282.47 36 $258.47 $284.32 37 $260.15 $286.17 38 $261.83 $288.02 39 $265.20 $291.72 40 $268.56 $295.41 41 $273.60 $300.96 42 $278.44 $306.28 43 $285.16 $313.68 44 $293.57 $322.92 45 $303.44 $333.79 46 $315.21 $346.73 47 $328.45 $361.29 48 $343.58 $377.94 49 $358.50 $394.35 50 $375.31 $412.84 51 $391.91 $431.10 52 $410.19 $451.21 53 $428.69 $471.55 54 $448.65 $493.51 55 $468.61 $515.47 56 $490.26 $539.28 57 $512.11 $563.32 58 $535.44 $588.98 59 $546.99 $601.69 60 $570.32 $627.35 61 $590.49 $649.54 62 $603.73 $664.11 63 $620.33 $682.37 64 $630.21 $693.23 65+** $630.21 $693.23
Aetna Silver $10 Copay PD
Age
Non Tobacco Tobacco
0-20 $167.71 $167.71
21 $264.12 $290.53 22 $264.12 $290.53 23 $264.12 $290.53 24 $264.12 $290.53 25 $265.17 $291.69 26 $270.46 $297.50 27 $276.79 $304.47 28 $287.09 $315.80 29 $295.55 $325.10 30 $299.77 $329.75 31 $306.11 $336.72 32 $312.45 $343.70 33 $316.41 $348.05 34 $320.64 $352.70 35 $322.75 $355.03 36 $324.86 $357.35 37 $326.98 $359.67 38 $329.09 $362.00 39 $333.32 $366.65 40 $337.54 $371.30 41 $343.88 $378.27 42 $349.95 $384.95 43 $358.41 $394.25 44 $368.97 $405.87 45 $381.38 $419.52 46 $396.18 $435.79 47 $412.81 $454.10 48 $431.83 $475.01 49 $450.58 $495.64 50 $471.71 $518.88 51 $492.58 $541.84 52 $515.56 $567.11 53 $538.80 $592.68 54 $563.89 $620.28 55 $588.98 $647.88 56 $616.18 $677.80 57 $643.65 $708.02 58 $672.97 $740.27 59 $687.50 $756.25 60 $716.81 $788.49 61 $742.17 $816.38 62 $758.81 $834.69 63 $779.67 $857.64 64 $792.09 $871.29 65+** $792.09 $871.29
How to calculate your monthly payment
Look for the plan name(s) you're considering. Find your age and tobacco use status in the columns below each plan to see your monthly payment. Do the same for each person in your family. Your monthly payment will be the total of the rates for each person on the plan, based on their age and tobacco use. We will only charge you for your three oldest dependents under the age of 21.
*Networks may not be available in all zip codes and are subject to change. ** Age 65+ rates are not available to new applicants.
www.aetna.com
Aetna Health Plans for Texas Rating Area 3 Counties – Monthly Rates (Effective 01/01/2016*) Bastrop, Caldwell, Hays, Travis, Williamson
Aetna Gold $10 Copay PD
Age
Non Tobacco Tobacco
0-20 $194.28 $194.28
21 $305.95 $336.55 22 $305.95 $336.55 23 $305.95 $336.55 24 $305.95 $336.55 25 $307.18 $337.89 26 $313.29 $344.62 27 $320.64 $352.70 28 $332.57 $365.83 29 $342.36 $376.60 30 $347.25 $381.98 31 $354.60 $390.06 32 $361.94 $398.13 33 $366.53 $403.18 34 $371.42 $408.57 35 $373.87 $411.26 36 $376.32 $413.95 37 $378.77 $416.64 38 $381.22 $419.34 39 $386.11 $424.72 40 $391.01 $430.11 41 $398.35 $438.18 42 $405.39 $445.92 43 $415.18 $456.69 44 $427.41 $470.16 45 $441.79 $485.97 46 $458.93 $504.82 47 $478.20 $526.02 48 $500.23 $550.25 49 $521.95 $574.15 50 $546.43 $601.07 51 $570.60 $627.66 52 $597.22 $656.94 53 $624.14 $686.55 54 $653.21 $718.53 55 $682.27 $750.50 56 $713.78 $785.16 57 $745.60 $820.16 58 $779.56 $857.52 59 $796.39 $876.03 60 $830.35 $913.39 61 $859.72 $945.70 62 $879.00 $966.90 63 $903.17 $993.49 64 $917.55 $1,009.30 65+** $917.55 $1,009.30
*Networks may not be available in all zip codes and are subject to change. ** Age 65+ rates are not available to new applicants.
www.aetna.com
Aetna individual health insurance plans are underwritten by Aetna Life Insurance Company and/or by Aetna
Health Inc. (Aetna). Aetna does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations. If you need this material translated into another language, please call Member Services at 1-866-565-1236. Si usted necesita este material en otro lenguaje por favor llame a Servicios al Miembro al 1-866-565-1236. This material is for information only. Rates are subject to change on rate increases implemented to the whole book of business in accordance with state laws and regulations, and any optional benefits selected. Health/ Dental insurance plans contain exclusions and limitations. Information is believed to be accurate as of the production date; however, it is subject to change. Investment services are independently offered by the HSA Administrator.
73.03.355.1-04 B (1/16)
Quality Health plans & benefits Healthier living Financial well-being Intelligent solutions Aetna Health Plans for Texas Rating Area 4 Counties – Monthly Rates (Effective 01/01/2016*) Hardin, Jefferson, Orange
Aetna Bronze HSA Eligible
PD
Age
Non Tobacco Tobacco
0-20 $127.92 $127.92
21 $201.44 $221.59 22 $201.44 $221.59 23 $201.44 $221.59 24 $201.44 $221.59 25 $202.25 $222.47 26 $206.28 $226.91 27 $211.11 $232.22 28 $218.97 $240.87 29 $225.41 $247.96 30 $228.64 $251.50 31 $233.47 $256.82 32 $238.31 $262.14 33 $241.33 $265.46 34 $244.55 $269.01 35 $246.16 $270.78 36 $247.77 $272.55 37 $249.39 $274.33 38 $251.00 $276.10 39 $254.22 $279.64 40 $257.44 $283.19 41 $262.28 $288.51 42 $266.91 $293.60 43 $273.36 $300.69 44 $281.42 $309.56 45 $290.88 $319.97 46 $302.16 $332.38 47 $314.86 $346.34 48 $329.36 $362.30 49 $343.66 $378.03 50 $359.78 $395.76 51 $375.69 $413.26 52 $393.22 $432.54 53 $410.94 $452.04 54 $430.08 $473.09 55 $449.22 $494.14 56 $469.97 $516.96 57 $490.92 $540.01 58 $513.28 $564.60 59 $524.36 $576.79 60 $546.72 $601.39 61 $566.05 $622.66 62 $578.75 $636.62 63 $594.66 $654.13 64 $604.13 $664.54 65+** $604.13 $664.54
Aetna Bronze $15 Copay PD
Age
Non Tobacco Tobacco
0-20 $136.85 $136.85
21 $215.51 $237.06 22 $215.51 $237.06 23 $215.51 $237.06 24 $215.51 $237.06 25 $216.37 $238.01 26 $220.68 $242.75 27 $225.86 $248.44 28 $234.26 $257.69 29 $241.16 $265.27 30 $244.61 $269.07 31 $249.78 $274.76 32 $254.95 $280.45 33 $258.18 $284.00 34 $261.63 $287.79 35 $263.36 $289.69 36 $265.08 $291.59 37 $266.80 $293.48 38 $268.53 $295.38 39 $271.98 $299.17 40 $275.42 $302.97 41 $280.60 $308.66 42 $285.55 $314.11 43 $292.45 $321.69 44 $301.07 $331.18 45 $311.20 $342.32 46 $323.27 $355.59 47 $336.84 $370.53 48 $352.36 $387.60 49 $367.66 $404.43 50 $384.90 $423.39 51 $401.93 $442.12 52 $420.68 $462.75 53 $439.64 $483.61 54 $460.12 $506.13 55 $480.59 $528.65 56 $502.79 $553.07 57 $525.20 $577.72 58 $549.12 $604.04 59 $560.98 $617.07 60 $584.90 $643.39 61 $605.59 $666.15 62 $619.17 $681.08 63 $636.19 $699.81 64 $646.32 $710.95 65+** $646.32 $710.95
Aetna Silver $10 Copay PD
Age
Non Tobacco Tobacco
0-20 $172.00 $172.00
21 $270.87 $297.95 22 $270.87 $297.95 23 $270.87 $297.95 24 $270.87 $297.95 25 $271.95 $299.15 26 $277.37 $305.11 27 $283.87 $312.26 28 $294.43 $323.88 29 $303.10 $333.41 30 $307.44 $338.18 31 $313.94 $345.33 32 $320.44 $352.48 33 $324.50 $356.95 34 $328.83 $361.72 35 $331.00 $364.10 36 $333.17 $366.48 37 $335.33 $368.87 38 $337.50 $371.25 39 $341.84 $376.02 40 $346.17 $380.79 41 $352.67 $387.94 42 $358.90 $394.79 43 $367.57 $404.32 44 $378.40 $416.24 45 $391.13 $430.25 46 $406.30 $446.93 47 $423.37 $465.70 48 $442.87 $487.16 49 $462.10 $508.31 50 $483.77 $532.15 51 $505.17 $555.69 52 $528.73 $581.61 53 $552.57 $607.83 54 $578.30 $636.13 55 $604.04 $664.44 56 $631.94 $695.13 57 $660.11 $726.12 58 $690.17 $759.19 59 $705.07 $775.58 60 $735.14 $808.65 61 $761.14 $837.25 62 $778.20 $856.02 63 $799.60 $879.56 64 $812.33 $893.57 65+** $812.33 $893.57
How to calculate your monthly payment
Look for the plan name(s) you're considering. Find your age and tobacco use status in the columns below each plan to see your monthly payment. Do the same for each person in your family. Your monthly payment will be the total of the rates for each person on the plan, based on their age and tobacco use. We will only charge you for your three oldest dependents under the age of 21.
*Networks may not be available in all zip codes and are subject to change. ** Age 65+ rates are not available to new applicants.
www.aetna.com
Aetna Health Plans for Texas Rating Area 4 Counties – Monthly Rates (Effective 01/01/2016*) Hardin, Jefferson, Orange
Aetna Gold $10 Copay PD
Age
Non Tobacco Tobacco
0-20 $199.25 $199.25
21 $313.77 $345.15 22 $313.77 $345.15 23 $313.77 $345.15 24 $313.77 $345.15 25 $315.03 $346.53 26 $321.30 $353.43 27 $328.83 $361.72 28 $341.07 $375.18 29 $351.11 $386.22 30 $356.13 $391.74 31 $363.66 $400.03 32 $371.19 $408.31 33 $375.90 $413.49 34 $380.92 $419.01 35 $383.43 $421.77 36 $385.94 $424.53 37 $388.45 $427.29 38 $390.96 $430.06 39 $395.98 $435.58 40 $401.00 $441.10 41 $408.53 $449.38 42 $415.75 $457.32 43 $425.79 $468.37 44 $438.34 $482.17 45 $453.09 $498.40 46 $470.66 $517.72 47 $490.43 $539.47 48 $513.02 $564.32 49 $535.30 $588.82 50 $560.40 $616.44 51 $585.19 $643.70 52 $612.48 $673.73 53 $640.10 $704.10 54 $669.90 $736.89 55 $699.71 $769.68 56 $732.03 $805.23 57 $764.66 $841.13 58 $799.49 $879.44 59 $816.75 $898.42 60 $851.58 $936.74 61 $881.70 $969.87 62 $901.47 $991.61 63 $926.26 $1,018.88 64 $941.00 $1,035.10 65+** $941.00 $1,035.10
*Networks may not be available in all zip codes and are subject to change. ** Age 65+ rates are not available to new applicants.
www.aetna.com
Aetna individual health insurance plans are underwritten by Aetna Life Insurance Company and/or by Aetna
Health Inc. (Aetna). Aetna does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations. If you need this material translated into another language, please call Member Services at 1-866-565-1236. Si usted necesita este material en otro lenguaje por favor llame a Servicios al Miembro al 1-866-565-1236. This material is for information only. Rates are subject to change on rate increases implemented to the whole book of business in accordance with state laws and regulations, and any optional benefits selected. Health/ Dental insurance plans contain exclusions and limitations. Information is believed to be accurate as of the production date; however, it is subject to change. Investment services are independently offered by the HSA Administrator.
73.03.355.1-08 B (1/16)
Quality Health plans & benefits Healthier living Financial well-being Intelligent solutions Aetna Health Plans for Texas Rating Area 8 Counties – Monthly Rates (Effective 01/01/2016*) Collin, Dallas, Denton, Ellis, Parker, Rockwall, Tarrant
Aetna Bronze HSA Eligible
PD
Age
Non Tobacco Tobacco
0-20 $133.66 $133.66
21 $210.48 $231.53 22 $210.48 $231.53 23 $210.48 $231.53 24 $210.48 $231.53 25 $211.32 $232.46 26 $215.53 $237.09 27 $220.58 $242.64 28 $228.79 $251.67 29 $235.53 $259.08 30 $238.90 $262.79 31 $243.95 $268.34 32 $249.00 $273.90 33 $252.16 $277.37 34 $255.52 $281.08 35 $257.21 $282.93 36 $258.89 $284.78 37 $260.58 $286.63 38 $262.26 $288.49 39 $265.63 $292.19 40 $268.99 $295.89 41 $274.05 $301.45 42 $278.89 $306.78 43 $285.62 $314.18 44 $294.04 $323.45 45 $303.93 $334.33 46 $315.72 $347.29 47 $328.98 $361.88 48 $344.14 $378.55 49 $359.08 $394.99 50 $375.92 $413.51 51 $392.55 $431.80 52 $410.86 $451.94 53 $429.38 $472.32 54 $449.38 $494.31 55 $469.37 $516.31 56 $491.05 $540.16 57 $512.94 $564.24 58 $536.31 $589.94 59 $547.88 $602.67 60 $571.25 $628.37 61 $591.45 $650.60 62 $604.71 $665.18 63 $621.34 $683.47 64 $631.23 $694.36 65+** $631.23 $694.36
Aetna Bronze $15 Copay PD
Age
Non Tobacco Tobacco
0-20 $142.99 $142.99
21 $225.18 $247.70 22 $225.18 $247.70 23 $225.18 $247.70 24 $225.18 $247.70 25 $226.08 $248.69 26 $230.59 $253.64 27 $235.99 $259.59 28 $244.77 $269.25 29 $251.98 $277.18 30 $255.58 $281.14 31 $260.98 $287.08 32 $266.39 $293.03 33 $269.77 $296.74 34 $273.37 $300.71 35 $275.17 $302.69 36 $276.97 $304.67 37 $278.77 $306.65 38 $280.58 $308.63 39 $284.18 $312.60 40 $287.78 $316.56 41 $293.19 $322.50 42 $298.36 $328.20 43 $305.57 $336.13 44 $314.58 $346.04 45 $325.16 $357.68 46 $337.77 $371.55 47 $351.96 $387.15 48 $368.17 $404.99 49 $384.16 $422.57 50 $402.17 $442.39 51 $419.96 $461.96 52 $439.55 $483.51 53 $459.37 $505.31 54 $480.76 $528.84 55 $502.15 $552.37 56 $525.35 $577.88 57 $548.77 $603.64 58 $573.76 $631.14 59 $586.15 $644.76 60 $611.14 $672.25 61 $632.76 $696.03 62 $646.94 $711.64 63 $664.73 $731.21 64 $675.32 $742.85 65+** $675.32 $742.85
Aetna Silver $10 Copay PD
Age
Non Tobacco Tobacco
0-20 $179.72 $179.72
21 $283.02 $311.32 22 $283.02 $311.32 23 $283.02 $311.32 24 $283.02 $311.32 25 $284.15 $312.57 26 $289.81 $318.79 27 $296.61 $326.27 28 $307.64 $338.41 29 $316.70 $348.37 30 $321.23 $353.35 31 $328.02 $360.82 32 $334.81 $368.29 33 $339.06 $372.96 34 $343.59 $377.95 35 $345.85 $380.44 36 $348.12 $382.93 37 $350.38 $385.42 38 $352.64 $387.91 39 $357.17 $392.89 40 $361.70 $397.87 41 $368.49 $405.34 42 $375.00 $412.50 43 $384.06 $422.47 44 $395.38 $434.92 45 $408.68 $449.55 46 $424.53 $466.98 47 $442.36 $486.60 48 $462.74 $509.01 49 $482.83 $531.12 50 $505.48 $556.02 51 $527.83 $580.62 52 $552.46 $607.70 53 $577.36 $635.10 54 $604.25 $664.67 55 $631.14 $694.25 56 $660.29 $726.32 57 $689.72 $758.69 58 $721.14 $793.25 59 $736.70 $810.37 60 $768.12 $844.93 61 $795.29 $874.82 62 $813.12 $894.43 63 $835.48 $919.03 64 $848.78 $933.66 65+** $848.78 $933.66
How to calculate your monthly payment
Look for the plan name(s) you're considering. Find your age and tobacco use status in the columns below each plan to see your monthly payment. Do the same for each person in your family. Your monthly payment will be the total of the rates for each person on the plan, based on their age and tobacco use. We will only charge you for your three oldest dependents under the age of 21.
*Networks may not be available in all zip codes and are subject to change. ** Age 65+ rates are not available to new applicants.
www.aetna.com
Aetna Health Plans for Texas Rating Area 8 Counties – Monthly Rates (Effective 01/01/2016*) Collin, Dallas, Denton, Ellis, Parker, Rockwall, Tarrant
Aetna Gold $10 Copay PD
Age
Non Tobacco Tobacco
0-20 $208.18 $208.18
21 $327.85 $360.63 22 $327.85 $360.63 23 $327.85 $360.63 24 $327.85 $360.63 25 $329.16 $362.08 26 $335.72 $369.29 27 $343.59 $377.95 28 $356.37 $392.01 29 $366.86 $403.55 30 $372.11 $409.32 31 $379.98 $417.98 32 $387.85 $426.63 33 $392.76 $432.04 34 $398.01 $437.81 35 $400.63 $440.70 36 $403.26 $443.58 37 $405.88 $446.47 38 $408.50 $449.35 39 $413.75 $455.12 40 $418.99 $460.89 41 $426.86 $469.55 42 $434.40 $477.84 43 $444.89 $489.38 44 $458.01 $503.81 45 $473.41 $520.76 46 $491.77 $540.95 47 $512.43 $563.67 48 $536.03 $589.64 49 $559.31 $615.24 50 $585.54 $644.09 51 $611.44 $672.58 52 $639.96 $703.96 53 $668.81 $735.69 54 $699.96 $769.95 55 $731.10 $804.22 56 $764.87 $841.36 57 $798.97 $878.87 58 $835.36 $918.90 59 $853.39 $938.73 60 $889.78 $978.76 61 $921.26 $1,013.38 62 $941.91 $1,036.10 63 $967.81 $1,064.59 64 $983.22 $1,081.54 65+** $983.22 $1,081.54
*Networks may not be available in all zip codes and are subject to change. ** Age 65+ rates are not available to new applicants.
www.aetna.com
Aetna individual health insurance plans are underwritten by Aetna Life Insurance Company and/or by Aetna
Health Inc. (Aetna). Aetna does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations. If you need this material translated into another language, please call Member Services at 1-866-565-1236. Si usted necesita este material en otro lenguaje por favor llame a Servicios al Miembro al 1-866-565-1236. This material is for information only. Rates are subject to change on rate increases implemented to the whole book of business in accordance with state laws and regulations, and any optional benefits selected. Health/ Dental insurance plans contain exclusions and limitations. Information is believed to be accurate as of the production date; however, it is subject to change. Investment services are independently offered by the HSA Administrator.
73.03.355.1-10 B (1/16)
Quality Health plans & benefits Healthier living Financial well-being Intelligent solutions Aetna Health Plans for Texas Rating Area 10 Counties – Monthly Rates (Effective 01/01/2016*) Austin, Brazoria, Chambers, Fort Bend, Galveston, Harris, Liberty, Montgomery, San Jacinto, Waller
Aetna Bronze HSA Eligible
PD
Age
Non Tobacco Tobacco
0-20 $127.53 $127.53
21 $200.84 $220.92 22 $200.84 $220.92 23 $200.84 $220.92 24 $200.84 $220.92 25 $201.64 $221.81 26 $205.66 $226.23 27 $210.48 $231.53 28 $218.31 $240.15 29 $224.74 $247.21 30 $227.95 $250.75 31 $232.77 $256.05 32 $237.59 $261.35 33 $240.61 $264.67 34 $243.82 $268.20 35 $245.43 $269.97 36 $247.03 $271.74 37 $248.64 $273.50 38 $250.25 $275.27 39 $253.46 $278.81 40 $256.67 $282.34 41 $261.49 $287.64 42 $266.11 $292.73 43 $272.54 $299.79 44 $280.57 $308.63 45 $290.01 $319.02 46 $301.26 $331.39 47 $313.91 $345.31 48 $328.37 $361.21 49 $342.63 $376.90 50 $358.70 $394.57 51 $374.57 $412.02 52 $392.04 $431.24 53 $409.71 $450.69 54 $428.79 $471.67 55 $447.87 $492.66 56 $468.56 $515.42 57 $489.45 $538.39 58 $511.74 $562.92 59 $522.79 $575.07 60 $545.08 $599.59 61 $564.36 $620.80 62 $577.01 $634.72 63 $592.88 $652.17 64 $602.32 $662.55 65+** $602.32 $662.55
Aetna Bronze $15 Copay PD
Age
Non Tobacco Tobacco
0-20 $136.44 $136.44
21 $214.87 $236.35 22 $214.87 $236.35 23 $214.87 $236.35 24 $214.87 $236.35 25 $215.73 $237.30 26 $220.02 $242.03 27 $225.18 $247.70 28 $233.56 $256.92 29 $240.44 $264.48 30 $243.87 $268.26 31 $249.03 $273.93 32 $254.19 $279.61 33 $257.41 $283.15 34 $260.85 $286.93 35 $262.57 $288.82 36 $264.29 $290.72 37 $266.01 $292.61 38 $267.72 $294.50 39 $271.16 $298.28 40 $274.60 $302.06 41 $279.76 $307.73 42 $284.70 $313.17 43 $291.57 $320.73 44 $300.17 $330.19 45 $310.27 $341.29 46 $322.30 $354.53 47 $335.84 $369.42 48 $351.31 $386.44 49 $366.56 $403.22 50 $383.75 $422.13 51 $400.73 $440.80 52 $419.42 $461.36 53 $438.33 $482.16 54 $458.74 $504.62 55 $479.15 $527.07 56 $501.29 $551.41 57 $523.63 $575.99 58 $547.48 $602.23 59 $559.30 $615.23 60 $583.15 $641.46 61 $603.78 $664.15 62 $617.31 $679.04 63 $634.29 $697.72 64 $644.39 $708.83 65+** $644.39 $708.83
Aetna Silver $10 Copay PD
Age
Non Tobacco Tobacco
0-20 $171.49 $171.49
21 $270.06 $297.06 22 $270.06 $297.06 23 $270.06 $297.06 24 $270.06 $297.06 25 $271.14 $298.25 26 $276.54 $304.19 27 $283.02 $311.32 28 $293.55 $322.91 29 $302.19 $332.41 30 $306.52 $337.17 31 $313.00 $344.30 32 $319.48 $351.43 33 $323.53 $355.88 34 $327.85 $360.64 35 $330.01 $363.01 36 $332.17 $365.39 37 $334.33 $367.76 38 $336.49 $370.14 39 $340.81 $374.89 40 $345.13 $379.65 41 $351.62 $386.78 42 $357.83 $393.61 43 $366.47 $403.12 44 $377.27 $415.00 45 $389.96 $428.96 46 $405.09 $445.60 47 $422.10 $464.31 48 $441.54 $485.70 49 $460.72 $506.79 50 $482.32 $530.56 51 $503.66 $554.02 52 $527.15 $579.87 53 $550.92 $606.01 54 $576.57 $634.23 55 $602.23 $662.45 56 $630.05 $693.05 57 $658.13 $723.94 58 $688.11 $756.92 59 $702.96 $773.26 60 $732.94 $806.23 61 $758.86 $834.75 62 $775.88 $853.46 63 $797.21 $876.93 64 $809.90 $890.89 65+** $809.90 $890.89
How to calculate your monthly payment
Look for the plan name(s) you're considering. Find your age and tobacco use status in the columns below each plan to see your monthly payment. Do the same for each person in your family. Your monthly payment will be the total of the rates for each person on the plan, based on their age and tobacco use. We will only charge you for your three oldest dependents under the age of 21.
*Networks may not be available in all zip codes and are subject to change. ** Age 65+ rates are not available to new applicants.
www.aetna.com
Aetna Health Plans for Texas Rating Area 10 Counties – Monthly Rates (Effective 01/01/2016*) Austin, Brazoria, Chambers, Fort Bend, Galveston, Harris, Liberty, Montgomery, San Jacinto, Waller
Aetna Gold $10 Copay PD
Age
Non Tobacco Tobacco
0-20 $198.65 $198.65
21 $312.83 $344.12 22 $312.83 $344.12 23 $312.83 $344.12 24 $312.83 $344.12 25 $314.09 $345.49 26 $320.34 $352.38 27 $327.85 $360.63 28 $340.05 $374.06 29 $350.06 $385.07 30 $355.07 $390.57 31 $362.57 $398.83 32 $370.08 $407.09 33 $374.77 $412.25 34 $379.78 $417.76 35 $382.28 $420.51 36 $384.79 $423.26 37 $387.29 $426.02 38 $389.79 $428.77 39 $394.80 $434.28 40 $399.80 $439.78 41 $407.31 $448.04 42 $414.50 $455.96 43 $424.52 $466.97 44 $437.03 $480.73 45 $451.73 $496.90 46 $469.25 $516.18 47 $488.96 $537.85 48 $511.48 $562.63 49 $533.69 $587.06 50 $558.72 $614.59 51 $583.43 $641.78 52 $610.65 $671.72 53 $638.18 $702.00 54 $667.90 $734.69 55 $697.62 $767.38 56 $729.84 $802.83 57 $762.38 $838.61 58 $797.10 $876.81 59 $814.31 $895.74 60 $849.03 $933.93 61 $879.06 $966.97 62 $898.77 $988.65 63 $923.48 $1,015.83 64 $938.19 $1,032.01 65+** $938.19 $1,032.01
*Networks may not be available in all zip codes and are subject to change. ** Age 65+ rates are not available to new applicants.
www.aetna.com
Aetna Health Plans for Texas Rating Area 10 Counties – Monthly Rates (Effective 01/01/2016*) Fort Bend, Harris, Montgomery
Aetna Memorial Hermann
Bronze HSA Eligible PD
Age
Non Tobacco Tobacco
0-20 $130.86 $130.86
21 $206.08 $226.69 22 $206.08 $226.69 23 $206.08 $226.69 24 $206.08 $226.69 25 $206.90 $227.59 26 $211.02 $232.13 27 $215.97 $237.57 28 $224.01 $246.41 29 $230.60 $253.66 30 $233.90 $257.29 31 $238.84 $262.73 32 $243.79 $268.17 33 $246.88 $271.57 34 $250.18 $275.20 35 $251.83 $277.01 36 $253.48 $278.82 37 $255.12 $280.64 38 $256.77 $282.45 39 $260.07 $286.08 40 $263.37 $289.70 41 $268.31 $295.14 42 $273.05 $300.36 43 $279.65 $307.61 44 $287.89 $316.68 45 $297.58 $327.33 46 $309.12 $340.03 47 $322.10 $354.31 48 $336.94 $370.63 49 $351.57 $386.73 50 $368.05 $404.86 51 $384.33 $422.77 52 $402.26 $442.49 53 $420.40 $462.44 54 $439.98 $483.97 55 $459.55 $505.51 56 $480.78 $528.86 57 $502.21 $552.43 58 $525.09 $577.59 59 $536.42 $590.06 60 $559.29 $615.22 61 $579.08 $636.99 62 $592.06 $651.27 63 $608.34 $669.18 64 $618.03 $679.83 65+** $618.03 $679.83
Aetna Bronze $15 Copay Memorial Hermann PD
Age
Non Tobacco Tobacco
0-20 $139.98 $139.98
21 $220.43 $242.48 22 $220.43 $242.48 23 $220.43 $242.48 24 $220.43 $242.48 25 $221.32 $243.45 26 $225.72 $248.30 27 $231.01 $254.12 28 $239.61 $263.57 29 $246.67 $271.33 30 $250.19 $275.21 31 $255.48 $281.03 32 $260.77 $286.85 33 $264.08 $290.49 34 $267.61 $294.37 35 $269.37 $296.31 36 $271.13 $298.25 37 $272.90 $300.19 38 $274.66 $302.13 39 $278.19 $306.01 40 $281.71 $309.89 41 $287.00 $315.71 42 $292.07 $321.28 43 $299.13 $329.04 44 $307.95 $338.74 45 $318.31 $350.14 46 $330.65 $363.72 47 $344.54 $378.99 48 $360.41 $396.45 49 $376.06 $413.67 50 $393.69 $433.06 51 $411.11 $452.22 52 $430.29 $473.32 53 $449.69 $494.65 54 $470.63 $517.69 55 $491.57 $540.72 56 $514.27 $565.70 57 $537.20 $590.92 58 $561.67 $617.83 59 $573.79 $631.17 60 $598.26 $658.08 61 $619.42 $681.36 62 $633.31 $696.64 63 $650.72 $715.79 64 $661.08 $727.19 65+** $661.08 $727.19
Aetna Silver $10 Copay Memorial Hermann PD
Age
Non Tobacco Tobacco
0-20 $175.95 $175.95
21 $277.09 $304.80 22 $277.09 $304.80 23 $277.09 $304.80 24 $277.09 $304.80 25 $278.20 $306.02 26 $283.74 $312.11 27 $290.39 $319.43 28 $301.20 $331.32 29 $310.06 $341.07 30 $314.50 $345.95 31 $321.15 $353.26 32 $327.80 $360.58 33 $331.95 $365.15 34 $336.39 $370.03 35 $338.60 $372.46 36 $340.82 $374.90 37 $343.04 $377.34 38 $345.25 $379.78 39 $349.69 $384.66 40 $354.12 $389.53 41 $360.77 $396.85 42 $367.14 $403.86 43 $376.01 $413.61 44 $387.09 $425.80 45 $400.12 $440.13 46 $415.63 $457.20 47 $433.09 $476.40 48 $453.04 $498.35 49 $472.71 $519.99 50 $494.88 $544.37 51 $516.77 $568.45 52 $540.88 $594.97 53 $565.26 $621.79 54 $591.59 $650.74 55 $617.91 $679.70 56 $646.45 $711.10 57 $675.27 $742.79 58 $706.02 $776.63 59 $721.26 $793.39 60 $752.02 $827.22 61 $778.62 $856.48 62 $796.08 $875.69 63 $817.97 $899.77 64 $830.99 $914.09 65+** $830.99 $914.09
Aetna Gold $10 Copay Memorial Hermann PD
Age
Non Tobacco Tobacco
0-20 $203.81 $203.81
21 $320.96 $353.06 22 $320.96 $353.06 23 $320.96 $353.06 24 $320.96 $353.06 25 $322.25 $354.47 26 $328.67 $361.53 27 $336.37 $370.01 28 $348.89 $383.78 29 $359.16 $395.07 30 $364.29 $400.72 31 $372.00 $409.20 32 $379.70 $417.67 33 $384.51 $422.97 34 $389.65 $428.62 35 $392.22 $431.44 36 $394.79 $434.26 37 $397.35 $437.09 38 $399.92 $439.91 39 $405.06 $445.56 40 $410.19 $451.21 41 $417.90 $459.68 42 $425.28 $467.80 43 $435.55 $479.10 44 $448.39 $493.23 45 $463.47 $509.82 46 $481.45 $529.59 47 $501.67 $551.83 48 $524.78 $577.25 49 $547.56 $602.32 50 $573.24 $630.57 51 $598.60 $658.46 52 $626.52 $689.17 53 $654.77 $720.24 54 $685.26 $753.78 55 $715.75 $787.32 56 $748.81 $823.69 57 $782.19 $860.41 58 $817.82 $899.60 59 $835.47 $919.02 60 $871.10 $958.21 61 $901.91 $992.10 62 $922.13 $1,014.34 63 $947.49 $1,042.23 64 $962.57 $1,058.83 65+** $962.57 $1,058.83
*Networks may not be available in all zip codes and are subject to change. ** Age 65+ rates are not available to new applicants.
www.aetna.com
Aetna individual health insurance plans are underwritten by Aetna Life Insurance Company and/or by Aetna
Health Inc. (Aetna). Aetna does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations. If you need this material translated into another language, please call Member Services at 1-866-565-1236. Si usted necesita este material en otro lenguaje por favor llame a Servicios al Miembro al 1-866-565-1236. This material is for information only. Rates are subject to change on rate increases implemented to the whole book of business in accordance with state laws and regulations, and any optional benefits selected. Health/ Dental insurance plans contain exclusions and limitations. Information is believed to be accurate as of the production date; however, it is subject to change. Investment services are independently offered by the HSA Administrator.
73.03.355.1-11 B (1/16)
Quality Health plans & benefits Healthier living Financial well-being Intelligent solutions Aetna Health Plans for Texas Rating Area 11 Counties – Monthly Rates (Effective 01/01/2016*) Bell, Coryell, Lampasas
Aetna Bronze HSA Eligible
PD
Age
Non Tobacco Tobacco
0-20 $135.06 $135.06
21 $212.69 $233.96 22 $212.69 $233.96 23 $212.69 $233.96 24 $212.69 $233.96 25 $213.54 $234.89 26 $217.79 $239.57 27 $222.90 $245.19 28 $231.19 $254.31 29 $238.00 $261.80 30 $241.40 $265.54 31 $246.51 $271.16 32 $251.61 $276.77 33 $254.80 $280.28 34 $258.21 $284.03 35 $259.91 $285.90 36 $261.61 $287.77 37 $263.31 $289.64 38 $265.01 $291.51 39 $268.41 $295.26 40 $271.82 $299.00 41 $276.92 $304.61 42 $281.81 $310.00 43 $288.62 $317.48 44 $297.13 $326.84 45 $307.12 $337.84 46 $319.04 $350.94 47 $332.43 $365.68 48 $347.75 $382.52 49 $362.85 $399.13 50 $379.86 $417.85 51 $396.67 $436.33 52 $415.17 $456.69 53 $433.89 $477.28 54 $454.09 $499.50 55 $474.30 $521.73 56 $496.21 $545.83 57 $518.33 $570.16 58 $541.93 $596.13 59 $553.63 $609.00 60 $577.24 $634.97 61 $597.66 $657.43 62 $611.06 $672.16 63 $627.86 $690.65 64 $637.86 $701.64 65+** $637.86 $701.64
Aetna Bronze $15 Copay PD
Age
Non Tobacco Tobacco
0-20 $144.49 $144.49
21 $227.54 $250.30 22 $227.54 $250.30 23 $227.54 $250.30 24 $227.54 $250.30 25 $228.45 $251.30 26 $233.01 $256.31 27 $238.47 $262.31 28 $247.34 $272.07 29 $254.62 $280.08 30 $258.26 $284.09 31 $263.72 $290.10 32 $269.18 $296.10 33 $272.60 $299.86 34 $276.24 $303.86 35 $278.06 $305.87 36 $279.88 $307.87 37 $281.70 $309.87 38 $283.52 $311.87 39 $287.16 $315.88 40 $290.80 $319.88 41 $296.26 $325.89 42 $301.50 $331.65 43 $308.78 $339.66 44 $317.88 $349.67 45 $328.57 $361.43 46 $341.32 $375.45 47 $355.65 $391.22 48 $372.03 $409.24 49 $388.19 $427.01 50 $406.39 $447.03 51 $424.37 $466.81 52 $444.17 $488.58 53 $464.19 $510.61 54 $485.81 $534.39 55 $507.42 $558.17 56 $530.86 $583.95 57 $554.53 $609.98 58 $579.78 $637.76 59 $592.30 $651.53 60 $617.56 $679.31 61 $639.40 $703.34 62 $653.73 $719.11 63 $671.71 $738.88 64 $682.41 $750.65 65+** $682.41 $750.65
Aetna Silver $10 Copay PD
Age
Non Tobacco Tobacco
0-20 $181.60 $181.60
21 $285.99 $314.59 22 $285.99 $314.59 23 $285.99 $314.59 24 $285.99 $314.59 25 $287.14 $315.85 26 $292.86 $322.14 27 $299.72 $329.69 28 $310.87 $341.96 29 $320.02 $352.03 30 $324.60 $357.06 31 $331.46 $364.61 32 $338.33 $372.16 33 $342.62 $376.88 34 $347.19 $381.91 35 $349.48 $384.43 36 $351.77 $386.95 37 $354.06 $389.46 38 $356.35 $391.98 39 $360.92 $397.01 40 $365.50 $402.05 41 $372.36 $409.60 42 $378.94 $416.83 43 $388.09 $426.90 44 $399.53 $439.48 45 $412.97 $454.27 46 $428.99 $471.89 47 $447.00 $491.71 48 $467.60 $514.36 49 $487.90 $536.69 50 $510.78 $561.86 51 $533.37 $586.71 52 $558.26 $614.08 53 $583.42 $641.76 54 $610.59 $671.65 55 $637.76 $701.54 56 $667.22 $733.94 57 $696.96 $766.66 58 $728.71 $801.58 59 $744.44 $818.88 60 $776.18 $853.80 61 $803.64 $884.00 62 $821.65 $903.82 63 $844.25 $928.67 64 $857.69 $943.46 65+** $857.69 $943.46
How to calculate your monthly payment
Look for the plan name(s) you're considering. Find your age and tobacco use status in the columns below each plan to see your monthly payment. Do the same for each person in your family. Your monthly payment will be the total of the rates for each person on the plan, based on their age and tobacco use. We will only charge you for your three oldest dependents under the age of 21.
*Networks may not be available in all zip codes and are subject to change. ** Age 65+ rates are not available to new applicants.
www.aetna.com
Aetna Health Plans for Texas Rating Area 11 Counties – Monthly Rates (Effective 01/01/2016*) Bell, Coryell, Lampasas
Aetna Gold $10 Copay PD
Age
Non Tobacco Tobacco
0-20 $210.37 $210.37
21 $331.29 $364.42 22 $331.29 $364.42 23 $331.29 $364.42 24 $331.29 $364.42 25 $332.62 $365.88 26 $339.24 $373.17 27 $347.19 $381.91 28 $360.11 $396.12 29 $370.71 $407.79 30 $376.02 $413.62 31 $383.97 $422.36 32 $391.92 $431.11 33 $396.89 $436.58 34 $402.19 $442.41 35 $404.84 $445.32 36 $407.49 $448.24 37 $410.14 $451.15 38 $412.79 $454.07 39 $418.09 $459.90 40 $423.39 $465.73 41 $431.34 $474.47 42 $438.96 $482.86 43 $449.56 $494.52 44 $462.81 $509.09 45 $478.38 $526.22 46 $496.94 $546.63 47 $517.81 $569.59 48 $541.66 $595.83 49 $565.18 $621.70 50 $591.69 $650.85 51 $617.86 $679.64 52 $646.68 $711.35 53 $675.83 $743.42 54 $707.31 $778.04 55 $738.78 $812.66 56 $772.90 $850.19 57 $807.36 $888.09 58 $844.13 $928.54 59 $862.35 $948.59 60 $899.12 $989.04 61 $930.93 $1,024.02 62 $951.80 $1,046.98 63 $977.97 $1,075.77 64 $993.54 $1,092.90 65+** $993.54 $1,092.90
*Networks may not be available in all zip codes and are subject to change. ** Age 65+ rates are not available to new applicants.
www.aetna.com
Aetna individual health insurance plans are underwritten by Aetna Life Insurance Company and/or by Aetna
Health Inc. (Aetna). Aetna does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations. If you need this material translated into another language, please call Member Services at 1-866-565-1236. Si usted necesita este material en otro lenguaje por favor llame a Servicios al Miembro al 1-866-565-1236. This material is for information only. Rates are subject to change on rate increases implemented to the whole book of business in accordance with state laws and regulations, and any optional benefits selected. Health/ Dental insurance plans contain exclusions and limitations. Information is believed to be accurate as of the production date; however, it is subject to change. Investment services are independently offered by the HSA Administrator.
73.03.355.1-19 B (1/16)
Quality Health plans & benefits Healthier living Financial well-being Intelligent solutions Aetna Health Plans for Texas Rating Area 19 Counties – Monthly Rates (Effective 01/01/2016*) Atascosa, Bandera, Bexar, Comal, Guadalupe, Kendall, Medina, Wilson
Aetna Bronze HSA Eligible
PD
Age
Non Tobacco Tobacco
0-20 $117.08 $117.08
21 $184.37 $202.81 22 $184.37 $202.81 23 $184.37 $202.81 24 $184.37 $202.81 25 $185.11 $203.62 26 $188.80 $207.68 27 $193.22 $212.54 28 $200.41 $220.45 29 $206.31 $226.94 30 $209.26 $230.19 31 $213.69 $235.06 32 $218.11 $239.92 33 $220.88 $242.96 34 $223.83 $246.21 35 $225.30 $247.83 36 $226.78 $249.45 37 $228.25 $251.08 38 $229.73 $252.70 39 $232.68 $255.94 40 $235.63 $259.19 41 $240.05 $264.06 42 $244.29 $268.72 43 $250.19 $275.21 44 $257.57 $283.32 45 $266.23 $292.86 46 $276.56 $304.21 47 $288.17 $316.99 48 $301.45 $331.59 49 $314.54 $345.99 50 $329.29 $362.22 51 $343.85 $378.24 52 $359.89 $395.88 53 $376.12 $413.73 54 $393.63 $433.00 55 $411.15 $452.26 56 $430.14 $473.15 57 $449.31 $494.24 58 $469.78 $516.76 59 $479.92 $527.91 60 $500.38 $550.42 61 $518.08 $569.89 62 $529.70 $582.67 63 $544.26 $598.69 64 $552.93 $608.22 65+** $552.93 $608.22
Aetna Bronze $15 Copay PD
Age
Non Tobacco Tobacco
0-20 $125.25 $125.25
21 $197.25 $216.97 22 $197.25 $216.97 23 $197.25 $216.97 24 $197.25 $216.97 25 $198.04 $217.84 26 $201.98 $222.18 27 $206.72 $227.39 28 $214.41 $235.85 29 $220.72 $242.79 30 $223.88 $246.26 31 $228.61 $251.47 32 $233.34 $256.68 33 $236.30 $259.93 34 $239.46 $263.41 35 $241.04 $265.14 36 $242.62 $266.88 37 $244.19 $268.61 38 $245.77 $270.35 39 $248.93 $273.82 40 $252.08 $277.29 41 $256.82 $282.50 42 $261.35 $287.49 43 $267.67 $294.43 44 $275.56 $303.11 45 $284.83 $313.31 46 $295.87 $325.46 47 $308.30 $339.13 48 $322.50 $354.75 49 $336.51 $370.16 50 $352.28 $387.51 51 $367.87 $404.65 52 $385.03 $423.53 53 $402.39 $442.62 54 $421.12 $463.24 55 $439.86 $483.85 56 $460.18 $506.20 57 $480.69 $528.76 58 $502.59 $552.85 59 $513.44 $564.78 60 $535.33 $588.86 61 $554.27 $609.69 62 $566.69 $623.36 63 $582.28 $640.50 64 $591.55 $650.70 65+** $591.55 $650.70
Aetna Silver $10 Copay PD
Age
Non Tobacco Tobacco
0-20 $157.42 $157.42
21 $247.91 $272.70 22 $247.91 $272.70 23 $247.91 $272.70 24 $247.91 $272.70 25 $248.90 $273.80 26 $253.86 $279.25 27 $259.81 $285.79 28 $269.48 $296.43 29 $277.41 $305.16 30 $281.38 $309.52 31 $287.33 $316.06 32 $293.28 $322.61 33 $297.00 $326.70 34 $300.97 $331.06 35 $302.95 $333.24 36 $304.93 $335.43 37 $306.92 $337.61 38 $308.90 $339.79 39 $312.87 $344.15 40 $316.83 $348.52 41 $322.78 $355.06 42 $328.49 $361.33 43 $336.42 $370.06 44 $346.33 $380.97 45 $357.99 $393.79 46 $371.87 $409.06 47 $387.49 $426.24 48 $405.34 $445.87 49 $422.94 $465.23 50 $442.77 $487.05 51 $462.36 $508.59 52 $483.93 $532.32 53 $505.74 $556.32 54 $529.29 $582.22 55 $552.85 $608.13 56 $578.38 $636.22 57 $604.16 $664.58 58 $631.68 $694.85 59 $645.32 $709.85 60 $672.84 $740.12 61 $696.64 $766.30 62 $712.25 $783.48 63 $731.84 $805.02 64 $743.49 $817.84 65+** $743.49 $817.84
How to calculate your monthly payment
Look for the plan name(s) you're considering. Find your age and tobacco use status in the columns below each plan to see your monthly payment. Do the same for each person in your family. Your monthly payment will be the total of the rates for each person on the plan, based on their age and tobacco use. We will only charge you for your three oldest dependents under the age of 21.
*Networks may not be available in all zip codes and are subject to change. ** Age 65+ rates are not available to new applicants.
www.aetna.com
Aetna Health Plans for Texas Rating Area 19 Counties – Monthly Rates (Effective 01/01/2016*) Atascosa, Bandera, Bexar, Comal, Guadalupe, Kendall, Medina, Wilson
Aetna Gold $10 Copay PD
Age
Non Tobacco Tobacco
0-20 $182.36 $182.36
21 $287.18 $315.90 22 $287.18 $315.90 23 $287.18 $315.90 24 $287.18 $315.90 25 $288.33 $317.16 26 $294.07 $323.48 27 $300.97 $331.06 28 $312.17 $343.38 29 $321.36 $353.49 30 $325.95 $358.55 31 $332.84 $366.13 32 $339.74 $373.71 33 $344.04 $378.45 34 $348.64 $383.50 35 $350.94 $386.03 36 $353.23 $388.56 37 $355.53 $391.08 38 $357.83 $393.61 39 $362.42 $398.67 40 $367.02 $403.72 41 $373.91 $411.30 42 $380.52 $418.57 43 $389.71 $428.68 44 $401.19 $441.31 45 $414.69 $456.16 46 $430.77 $473.85 47 $448.86 $493.75 48 $469.54 $516.50 49 $489.93 $538.92 50 $512.91 $564.20 51 $535.59 $589.15 52 $560.58 $616.64 53 $585.85 $644.43 54 $613.13 $674.45 55 $640.41 $704.46 56 $669.99 $736.99 57 $699.86 $769.85 58 $731.74 $804.91 59 $747.53 $822.29 60 $779.41 $857.35 61 $806.98 $887.68 62 $825.07 $907.58 63 $847.76 $932.54 64 $861.26 $947.38 65+** $861.26 $947.38
*Networks may not be available in all zip codes and are subject to change. ** Age 65+ rates are not available to new applicants.
www.aetna.com
Aetna Health Plans for Texas Rating Area 19 Counties – Monthly Rates (Effective 01/01/2016*) Atascosa, Bandera, Bexar, Comal, Guadalupe, Kendall, Medina, Wilson
Aetna Bronze HSA Eligible San Antonio Community
Plan PD
Age
Non Tobacco Tobacco
0-20 $116.82 $116.82
21 $183.97 $202.36 22 $183.97 $202.36 23 $183.97 $202.36 24 $183.97 $202.36 25 $184.70 $203.17 26 $188.38 $207.22 27 $192.80 $212.08 28 $199.97 $219.97 29 $205.86 $226.45 30 $208.80 $229.68 31 $213.22 $234.54 32 $217.63 $239.40 33 $220.39 $242.43 34 $223.34 $245.67 35 $224.81 $247.29 36 $226.28 $248.91 37 $227.75 $250.53 38 $229.22 $252.15 39 $232.17 $255.38 40 $235.11 $258.62 41 $239.53 $263.48 42 $243.76 $268.13 43 $249.64 $274.61 44 $257.00 $282.70 45 $265.65 $292.22 46 $275.95 $303.55 47 $287.54 $316.30 48 $300.79 $330.87 49 $313.85 $345.23 50 $328.57 $361.42 51 $343.10 $377.41 52 $359.11 $395.02 53 $375.30 $412.82 54 $392.77 $432.05 55 $410.25 $451.27 56 $429.20 $472.12 57 $448.33 $493.16 58 $468.75 $515.63 59 $478.87 $526.76 60 $499.29 $549.22 61 $516.95 $568.65 62 $528.54 $581.39 63 $543.07 $597.38 64 $551.72 $606.89 65+** $551.72 $606.89
Aetna Bronze $15 Copay San Antonio Community
Plan PD
Age
Non Tobacco Tobacco
0-20 $125.00 $125.00
21 $196.84 $216.53 22 $196.84 $216.53 23 $196.84 $216.53 24 $196.84 $216.53 25 $197.63 $217.40 26 $201.57 $221.73 27 $206.29 $226.92 28 $213.97 $235.37 29 $220.27 $242.30 30 $223.42 $245.76 31 $228.14 $250.96 32 $232.87 $256.15 33 $235.82 $259.40 34 $238.97 $262.87 35 $240.54 $264.60 36 $242.12 $266.33 37 $243.69 $268.06 38 $245.27 $269.80 39 $248.42 $273.26 40 $251.57 $276.72 41 $256.29 $281.92 42 $260.82 $286.90 43 $267.12 $293.83 44 $274.99 $302.49 45 $284.24 $312.67 46 $295.27 $324.79 47 $307.67 $338.43 48 $321.84 $354.03 49 $335.82 $369.40 50 $351.56 $386.72 51 $367.12 $403.83 52 $384.24 $422.66 53 $401.56 $441.72 54 $420.26 $462.29 55 $438.96 $482.86 56 $459.24 $505.16 57 $479.71 $527.68 58 $501.56 $551.72 59 $512.39 $563.63 60 $534.24 $587.66 61 $553.13 $608.45 62 $565.53 $622.09 63 $581.09 $639.19 64 $590.34 $649.37 65+** $590.34 $649.37
Aetna Silver $10 Copay San Antonio Community Plan
PD
Age
Non Tobacco Tobacco
0-20 $157.08 $157.08
21 $247.38 $272.11 22 $247.38 $272.11 23 $247.38 $272.11 24 $247.38 $272.11 25 $248.36 $273.20 26 $253.31 $278.64 27 $259.25 $285.17 28 $268.90 $295.79 29 $276.81 $304.49 30 $280.77 $308.85 31 $286.71 $315.38 32 $292.65 $321.91 33 $296.36 $325.99 34 $300.31 $330.35 35 $302.29 $332.52 36 $304.27 $334.70 37 $306.25 $336.88 38 $308.23 $339.05 39 $312.19 $343.41 40 $316.15 $347.76 41 $322.08 $354.29 42 $327.77 $360.55 43 $335.69 $369.26 44 $345.58 $380.14 45 $357.21 $392.93 46 $371.06 $408.17 47 $386.65 $425.31 48 $404.46 $444.90 49 $422.02 $464.22 50 $441.81 $485.99 51 $461.35 $507.49 52 $482.88 $531.16 53 $504.65 $555.11 54 $528.15 $580.96 55 $551.65 $606.81 56 $577.13 $634.84 57 $602.85 $663.14 58 $630.31 $693.34 59 $643.92 $708.31 60 $671.38 $738.51 61 $695.12 $764.64 62 $710.71 $781.78 63 $730.25 $803.28 64 $741.88 $816.07 65+** $741.88 $816.07
Aetna Gold $10 Copay San Antonio Community Plan
PD
Age
Non Tobacco Tobacco
0-20 $181.98 $181.98
21 $286.58 $315.23 22 $286.58 $315.23 23 $286.58 $315.23 24 $286.58 $315.23 25 $287.72 $316.49 26 $293.45 $322.80 27 $300.33 $330.36 28 $311.51 $342.66 29 $320.68 $352.75 30 $325.26 $357.79 31 $332.14 $365.36 32 $339.02 $372.92 33 $343.32 $377.65 34 $347.90 $382.69 35 $350.20 $385.22 36 $352.49 $387.74 37 $354.78 $390.26 38 $357.07 $392.78 39 $361.66 $397.83 40 $366.24 $402.87 41 $373.12 $410.43 42 $379.71 $417.68 43 $388.88 $427.77 44 $400.35 $440.38 45 $413.82 $455.20 46 $429.86 $472.85 47 $447.92 $492.71 48 $468.55 $515.41 49 $488.90 $537.79 50 $511.82 $563.01 51 $534.46 $587.91 52 $559.40 $615.34 53 $584.62 $643.08 54 $611.84 $673.02 55 $639.06 $702.97 56 $668.58 $735.44 57 $698.39 $768.22 58 $730.20 $803.22 59 $745.96 $820.55 60 $777.77 $855.54 61 $805.28 $885.81 62 $823.33 $905.67 63 $845.97 $930.57 64 $859.44 $945.39 65+** $859.44 $945.39
*Networks may not be available in all zip codes and are subject to change. ** Age 65+ rates are not available to new applicants.
www.aetna.com
Aetna individual health insurance plans are underwritten by Aetna Life Insurance Company and/or by Aetna
Health Inc. (Aetna). Aetna does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations. If you need this material translated into another language, please call Member Services at 1-866-565-1236. Si usted necesita este material en otro lenguaje por favor llame a Servicios al Miembro al 1-866-565-1236. This material is for information only. Rates are subject to change on rate increases implemented to the whole book of business in accordance with state laws and regulations, and any optional benefits selected. Health/ Dental insurance plans contain exclusions and limitations. Information is believed to be accurate as of the production date; however, it is subject to change. Investment services are independently offered by the HSA Administrator.
73.03.355.1-24 B (1/16)
Quality Health plans & benefits Healthier living Financial well-being Intelligent solutions Aetna Health Plans for Texas Rating Area 24 Counties – Monthly Rates (Effective 01/01/2016*) Mclennan
Aetna Bronze HSA Eligible
PD
Age
Non Tobacco Tobacco
0-20 $137.86 $137.86
21 $217.11 $238.82 22 $217.11 $238.82 23 $217.11 $238.82 24 $217.11 $238.82 25 $217.98 $239.77 26 $222.32 $244.55 27 $227.53 $250.28 28 $236.00 $259.60 29 $242.94 $267.24 30 $246.42 $271.06 31 $251.63 $276.79 32 $256.84 $282.52 33 $260.10 $286.11 34 $263.57 $289.93 35 $265.31 $291.84 36 $267.04 $293.75 37 $268.78 $295.66 38 $270.52 $297.57 39 $273.99 $301.39 40 $277.46 $305.21 41 $282.68 $310.94 42 $287.67 $316.44 43 $294.62 $324.08 44 $303.30 $333.63 45 $313.50 $344.86 46 $325.66 $358.23 47 $339.34 $373.27 48 $354.97 $390.47 49 $370.39 $407.43 50 $387.76 $426.53 51 $404.91 $445.40 52 $423.80 $466.18 53 $442.90 $487.19 54 $463.53 $509.88 55 $484.15 $532.57 56 $506.51 $557.17 57 $529.09 $582.00 58 $553.19 $608.51 59 $565.13 $621.65 60 $589.23 $648.16 61 $610.08 $671.08 62 $623.75 $686.13 63 $640.90 $705.00 64 $651.11 $716.22 65+** $651.11 $716.22
Aetna Bronze $15 Copay PD
Age
Non Tobacco Tobacco
0-20 $147.49 $147.49
21 $232.27 $255.50 22 $232.27 $255.50 23 $232.27 $255.50 24 $232.27 $255.50 25 $233.20 $256.52 26 $237.85 $261.63 27 $243.42 $267.76 28 $252.48 $277.73 29 $259.91 $285.90 30 $263.63 $289.99 31 $269.20 $296.12 32 $274.78 $302.25 33 $278.26 $306.09 34 $281.98 $310.18 35 $283.84 $312.22 36 $285.69 $314.26 37 $287.55 $316.31 38 $289.41 $318.35 39 $293.13 $322.44 40 $296.84 $326.53 41 $302.42 $332.66 42 $307.76 $338.54 43 $315.19 $346.71 44 $324.48 $356.93 45 $335.40 $368.94 46 $348.41 $383.25 47 $363.04 $399.34 48 $379.76 $417.74 49 $396.25 $435.88 50 $414.84 $456.32 51 $433.19 $476.50 52 $453.39 $498.73 53 $473.83 $521.22 54 $495.90 $545.49 55 $517.97 $569.76 56 $541.89 $596.08 57 $566.05 $622.65 58 $591.83 $651.01 59 $604.60 $665.06 60 $630.38 $693.42 61 $652.68 $717.95 62 $667.32 $734.05 63 $685.67 $754.23 64 $696.58 $766.24 65+** $696.58 $766.24
Aetna Silver $10 Copay PD
Age
Non Tobacco Tobacco
0-20 $185.38 $185.38
21 $291.93 $321.13 22 $291.93 $321.13 23 $291.93 $321.13 24 $291.93 $321.13 25 $293.10 $322.41 26 $298.94 $328.83 27 $305.95 $336.54 28 $317.33 $349.06 29 $326.67 $359.34 30 $331.34 $364.48 31 $338.35 $372.18 32 $345.36 $379.89 33 $349.74 $384.71 34 $354.41 $389.85 35 $356.74 $392.42 36 $359.08 $394.98 37 $361.41 $397.55 38 $363.75 $400.12 39 $368.42 $405.26 40 $373.09 $410.40 41 $380.10 $418.11 42 $386.81 $425.49 43 $396.15 $435.77 44 $407.83 $448.61 45 $421.55 $463.71 46 $437.90 $481.69 47 $456.29 $501.92 48 $477.31 $525.04 49 $498.04 $547.84 50 $521.39 $573.53 51 $544.45 $598.90 52 $569.85 $626.84 53 $595.54 $655.10 54 $623.28 $685.60 55 $651.01 $716.11 56 $681.08 $749.19 57 $711.44 $782.58 58 $743.84 $818.23 59 $759.90 $835.89 60 $792.31 $871.54 61 $820.33 $902.36 62 $838.72 $922.59 63 $861.79 $947.96 64 $875.51 $963.06 65+** $875.51 $963.06
How to calculate your monthly payment
Look for the plan name(s) you're considering. Find your age and tobacco use status in the columns below each plan to see your monthly payment. Do the same for each person in your family. Your monthly payment will be the total of the rates for each person on the plan, based on their age and tobacco use. We will only charge you for your three oldest dependents under the age of 21.
*Networks may not be available in all zip codes and are subject to change. ** Age 65+ rates are not available to new applicants.
www.aetna.com
Aetna Health Plans for Texas Rating Area 24 Counties – Monthly Rates (Effective 01/01/2016*) Mclennan
Aetna Gold $10 Copay PD
Age
Non Tobacco Tobacco
0-20 $214.74 $214.74
21 $338.17 $371.99 22 $338.17 $371.99 23 $338.17 $371.99 24 $338.17 $371.99 25 $339.53 $373.48 26 $346.29 $380.92 27 $354.41 $389.85 28 $367.59 $404.35 29 $378.42 $416.26 30 $383.83 $422.21 31 $391.94 $431.14 32 $400.06 $440.06 33 $405.13 $445.64 34 $410.54 $451.60 35 $413.25 $454.57 36 $415.95 $457.55 37 $418.66 $460.52 38 $421.36 $463.50 39 $426.77 $469.45 40 $432.19 $475.40 41 $440.30 $484.33 42 $448.08 $492.89 43 $458.90 $504.79 44 $472.43 $519.67 45 $488.32 $537.15 46 $507.26 $557.99 47 $528.56 $581.42 48 $552.91 $608.20 49 $576.92 $634.62 50 $603.98 $664.38 51 $630.69 $693.76 52 $660.11 $726.13 53 $689.87 $758.86 54 $722.00 $794.20 55 $754.13 $829.54 56 $788.96 $867.85 57 $824.13 $906.54 58 $861.67 $947.83 59 $880.26 $968.29 60 $917.80 $1,009.58 61 $950.27 $1,045.29 62 $971.57 $1,068.73 63 $998.29 $1,098.12 64 $1,014.18 $1,115.60 65+** $1,014.18 $1,115.60
*Networks may not be available in all zip codes and are subject to change. ** Age 65+ rates are not available to new applicants.
www.aetna.com
Aetna individual health insurance plans are underwritten by Aetna Life Insurance Company and/or by Aetna
Health Inc. (Aetna). Aetna does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations. If you need this material translated into another language, please call Member Services at 1-866-565-1236. Si usted necesita este material en otro lenguaje por favor llame a Servicios al Miembro al 1-866-565-1236. This material is for information only. Rates are subject to change on rate increases implemented to the whole book of business in accordance with state laws and regulations, and any optional benefits selected. Health/ Dental insurance plans contain exclusions and limitations. Information is believed to be accurate as of the production date; however, it is subject to change. Investment services are independently offered by the HSA Administrator.
73.03.355.1-26 B (1/16)
Quality Health plans & benefits Healthier living Financial well-being Intelligent solutions Aetna Health Plans for Texas Rating Area 26 Counties – Monthly Rates (Effective 01/01/2016*) Burnet, Colorado, Falls, Fayette, Jasper, Lee, Limestone, Llano, Matagorda, Palo Pinto, Tyler, Wharton
Aetna Bronze HSA Eligible
PD
Age
Non Tobacco Tobacco
0-20 $119.88 $119.88
21 $188.79 $207.67 22 $188.79 $207.67 23 $188.79 $207.67 24 $188.79 $207.67 25 $189.55 $208.50 26 $193.32 $212.65 27 $197.85 $217.64 28 $205.21 $225.74 29 $211.26 $232.38 30 $214.28 $235.70 31 $218.81 $240.69 32 $223.34 $245.67 33 $226.17 $248.79 34 $229.19 $252.11 35 $230.70 $253.77 36 $232.21 $255.43 37 $233.72 $257.09 38 $235.23 $258.76 39 $238.25 $262.08 40 $241.27 $265.40 41 $245.80 $270.39 42 $250.15 $275.16 43 $256.19 $281.81 44 $263.74 $290.11 45 $272.61 $299.87 46 $283.19 $311.50 47 $295.08 $324.59 48 $308.67 $339.54 49 $322.08 $354.28 50 $337.18 $370.90 51 $352.09 $387.30 52 $368.52 $405.37 53 $385.13 $423.64 54 $403.07 $443.37 55 $421.00 $463.10 56 $440.45 $484.49 57 $460.08 $506.09 58 $481.04 $529.14 59 $491.42 $540.56 60 $512.38 $563.61 61 $530.50 $583.55 62 $542.39 $596.63 63 $557.31 $613.04 64 $566.18 $622.80 65+** $566.18 $622.80
Aetna Bronze $15 Copay PD
Age
Non Tobacco Tobacco
0-20 $128.25 $128.25
21 $201.98 $222.17 22 $201.98 $222.17 23 $201.98 $222.17 24 $201.98 $222.17 25 $202.78 $223.06 26 $206.82 $227.50 27 $211.67 $232.84 28 $219.55 $241.50 29 $226.01 $248.61 30 $229.24 $252.17 31 $234.09 $257.50 32 $238.94 $262.83 33 $241.97 $266.16 34 $245.20 $269.72 35 $246.81 $271.49 36 $248.43 $273.27 37 $250.05 $275.05 38 $251.66 $276.83 39 $254.89 $280.38 40 $258.12 $283.94 41 $262.97 $289.27 42 $267.62 $294.38 43 $274.08 $301.49 44 $282.16 $310.38 45 $291.65 $320.82 46 $302.96 $333.26 47 $315.69 $347.26 48 $330.23 $363.25 49 $344.57 $379.03 50 $360.73 $396.80 51 $376.68 $414.35 52 $394.26 $433.68 53 $412.03 $453.23 54 $431.22 $474.34 55 $450.40 $495.44 56 $471.21 $518.33 57 $492.21 $541.43 58 $514.63 $566.10 59 $525.74 $578.32 60 $548.16 $602.98 61 $567.55 $624.31 62 $580.27 $638.30 63 $596.23 $655.85 64 $605.72 $666.30 65+** $605.72 $666.30
Aetna Silver $10 Copay PD
Age
Non Tobacco Tobacco
0-20 $161.20 $161.20
21 $253.85 $279.24 22 $253.85 $279.24 23 $253.85 $279.24 24 $253.85 $279.24 25 $254.87 $280.36 26 $259.95 $285.94 27 $266.04 $292.64 28 $275.94 $303.53 29 $284.06 $312.47 30 $288.12 $316.94 31 $294.22 $323.64 32 $300.31 $330.34 33 $304.12 $334.53 34 $308.18 $339.00 35 $310.21 $341.23 36 $312.24 $343.47 37 $314.27 $345.70 38 $316.30 $347.93 39 $320.36 $352.40 40 $324.43 $356.87 41 $330.52 $363.57 42 $336.36 $369.99 43 $344.48 $378.93 44 $354.63 $390.10 45 $366.57 $403.22 46 $380.78 $418.86 47 $396.77 $436.45 48 $415.05 $456.56 49 $433.08 $476.38 50 $453.38 $498.72 51 $473.44 $520.78 52 $495.52 $545.08 53 $517.86 $569.65 54 $541.98 $596.18 55 $566.10 $622.71 56 $592.24 $651.47 57 $618.64 $680.51 58 $646.82 $711.50 59 $660.78 $726.86 60 $688.96 $757.86 61 $713.33 $784.66 62 $729.32 $802.26 63 $749.38 $824.32 64 $761.31 $837.44 65+** $761.31 $837.44
How to calculate your monthly payment
Look for the plan name(s) you're considering. Find your age and tobacco use status in the columns below each plan to see your monthly payment. Do the same for each person in your family. Your monthly payment will be the total of the rates for each person on the plan, based on their age and tobacco use. We will only charge you for your three oldest dependents under the age of 21.
*Networks may not be available in all zip codes and are subject to change. ** Age 65+ rates are not available to new applicants.
www.aetna.com
Aetna Health Plans for Texas Rating Area 26 Counties – Monthly Rates (Effective 01/01/2016*) Burnet, Colorado, Falls, Fayette, Jasper, Lee, Limestone, Llano, Matagorda, Palo Pinto, Tyler, Wharton
Aetna Gold $10 Copay PD
Age
Non Tobacco Tobacco
0-20 $186.73 $186.73
21 $294.06 $323.47 22 $294.06 $323.47 23 $294.06 $323.47 24 $294.06 $323.47 25 $295.24 $324.76 26 $301.12 $331.23 27 $308.18 $339.00 28 $319.65 $351.61 29 $329.06 $361.96 30 $333.76 $367.14 31 $340.82 $374.90 32 $347.88 $382.67 33 $352.29 $387.52 34 $356.99 $392.69 35 $359.35 $395.28 36 $361.70 $397.87 37 $364.05 $400.46 38 $366.40 $403.04 39 $371.11 $408.22 40 $375.81 $413.39 41 $382.87 $421.16 42 $389.63 $428.60 43 $399.04 $438.95 44 $410.81 $451.89 45 $424.63 $467.09 46 $441.10 $485.21 47 $459.62 $505.58 48 $480.79 $528.87 49 $501.67 $551.84 50 $525.20 $577.72 51 $548.43 $603.27 52 $574.01 $631.41 53 $599.89 $659.88 54 $627.83 $690.61 55 $655.76 $721.34 56 $686.05 $754.66 57 $716.63 $788.30 58 $749.27 $824.20 59 $765.45 $841.99 60 $798.09 $877.90 61 $826.32 $908.95 62 $844.84 $929.33 63 $868.08 $954.88 64 $881.90 $970.09 65+** $881.90 $970.09
*Networks may not be available in all zip codes and are subject to change. ** Age 65+ rates are not available to new applicants.
www.aetna.com
Aetna individual health insurance plans are underwritten by Aetna Life Insurance Company and/or by Aetna
Health Inc. (Aetna). Aetna does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations. If you need this material translated into another language, please call Member Services at 1-866-565-1236. Si usted necesita este material en otro lenguaje por favor llame a Servicios al Miembro al 1-866-565-1236. This material is for information only. Rates are subject to change on rate increases implemented to the whole book of business in accordance with state laws and regulations, and any optional benefits selected. Health/ Dental insurance plans contain exclusions and limitations. Information is believed to be accurate as of the production date; however, it is subject to change. Investment services are independently offered by the HSA Administrator.