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Basic Plan Rates
To determine your Visit USA-HealthCare™ rate,
choose Plan A or Plan B and a deductible ($250, $500, $1,000) from the chart below.
| Monthly Premiums | Plan
A | Plan B |
| Age | Deductible
Per Policy Period: | | $250 |
$500 |
$1000 |
$250 |
$500 |
$1000 | | Under
age 19 | $48 |
$43 | $38 |
$72 | $65 |
$58 | | 19
- 29 | $50 |
$45 | $40 |
$76 | $68 |
$60 | | 30
- 39 | $70 |
$63 | $56 |
$106 | $95 |
$85 | | 40
- 49 | $97 | $87 | $78 | $146 | $132 | $117 |
| 50 - 59 | $137 |
$123 | $110 |
$207 | $186 |
$165 | | 60
- 64 | $160 | $144 | $128 | $242 | $217 | $193 | | 65
- 69 | $210 | $189 | $168 | $317 | $285 | $254 |
| 70 - 79 | $350 |
$315 | $280 |
N/A | N/A |
N/A | | Age
80+ * | $450 |
$405 |
$360 |
N/A |
N/A |
N/A | | *
The Medical Expense Benefit Limit for ages 80+ is $10,000. |
| 15 Day Premiums | Plan
A | Plan B |
| Age | Deductible
Per Policy Period: | | $250 |
$500 |
$1000 |
$250 |
$500 |
$1000 | | Under
age 19 | $27 |
$24 | $21 |
$40 | $36 |
$32 | | 19
- 29 | $28 |
$25 | $22 |
$42 | $38 |
$33 | | 30
- 39 | $39 |
$35 | $31 |
$59 | $53 |
$47 | | 40
- 49 | $54 | $48 | $43 | $81 | $73 | $65 |
| 50 - 59 | $76 |
$68 | $61 |
$114 | $103 |
$91 | | 60
- 64 | $88 | $80 | $71 | $134 | $120 | $107 | | 65
- 69 | $116 | $104 | $93 | $175 | $157 | $140 |
| 70 - 79 | $193 |
$174 | $154 |
N/A | N/A |
N/A | | Age
80+ * | $248 |
$223 |
$198 |
N/A |
N/A |
N/A | | *
The Medical Expense Benefit Limit for ages 80+ is $10,000. |
Optional
Benefits Rates - Additional Accidental
Death & Dismemberment Coverage
- Hazardous Activity
Coverage
This will increase your Basic Plan Premium
as follows: Add ONE Optional Benefit
- Multiply Basic Plan Premium by 1.20
Add TWO Optional Benefits
- Multiply Basic Plan Premium by 1.30
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