PREMIUM AMOUNT CHART

Age

Target Weight or Below

Above Target Weight•

Non-Tobacco User

Tobacco User

Non-Tobacco User

Tobacco User

< 30

$112.58

$134.58

$123.58

$145.58

30 – 39

$137.88

$159.88

$152.18

$174.18

40 – 49

$169.78

$191.78

$186.28

$208.28

50 – 59

$207.18

$229.18

$228.08

$250.08

60 – 64

$236.88

$258.88

$261.08

$283.08

65+

$277.58

$299.58

$305.08

$327.08

ONE-THIRD SHARE PREMIUM

Age

Target Weight or Below

Above Target Weight•

Non-Tobacco User

Tobacco User

Non-Tobacco User

Tobacco User

< 30

$37.53

$44.86

$41.19

$48.53

30 – 39

$45.96

$53.29

$50.73

$58.06

40 – 49

$56.59

$63.93

$62.09

$69.43

50 – 59

$69.06

$76.39

$76.03

$83.36

60 – 64

$78.96

$86.29

$87.03

$94.36

65+

$92.53

$99.86

$101.69

$109.03

TWO-THIRDS SHARE PREMIUM

Age

Target Weight or Below

Above Target Weight•

Non-Tobacco User

Tobacco User

Non-Tobacco User

Tobacco User

< 30

$75.05

$89.72

$82.39

$97.05

30 – 39

$91.92

$106.59

$101.45

$116.12

40 – 49

$113.19

$127.85

$124.19

$138.85

50 – 59

$138.12

$152.79

$152.05

$166.72

60 – 64

$157.92

$172.59

$174.05

$188.72

65+

$185.05

$199.72

$203.39

$218.05