Medical Product and Options Rate$1655.84SmartSense Plus PPO Standard Rx, $750 Deductible

$1136.26SmartSense Plus PPO Standard Rx, $1500 Deductible

$920.18SmartSense Plus PPO Standard Rx, $2500 Deductible

$753.46SmartSense Plus PPO Standard Rx, $3500 Deductible

$687.10SmartSense Plus PPO Standard Rx, $5000 Deductible

$623.97SmartSense Plus PPO Standard Rx, $7500 Deductible

$572.18SmartSense Plus PPO Standard Rx, $10000 Deductible

RateBlue Choice DentalFamily Coverage for Blue Choice Dental $76.00

$76.00Total Dental Rate

The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.

IndividualRate Quote

AgeName Gender Rating TierValued Client 55 M Super Preferred

Spouse 51 F Super Preferredchild 1 16 M Super Preferredchild 2 14 F Super Preferred

Blue Cross and Blue Shield of Georgia (BCBSGA) and Greater Georgia Life Insurance Company(GGL) are independent licensees of the Blue Cross and Blue Shield Association

11207 McNeill Financial Services, LLCRate Area: Dekalb

03/17/2013

Monthly

3/17/2013Date Printed:

Billing Frequency:

Effective Date:

GAState:

Prepared For: Valued Client

Rates are for comparisonillustration only

Rates and products aresubject to change withoutnotice

Rates are subject tochange and will bedetermined based on BlueCross Blue Shield ofGeorgia's review of thesubmitted application.

Please Note:The rate you have received is a quote, which means it is an estimate. Review of your application by medical underwriting may

change your monthly premium or result in a denial of coverage.

v5.1.0 0828

To review your Summary of Benefit Coverage please visit HealthCare.gov