P.O. Box 50540 Charleston, WV 25305-05401-866-445-8491www.accesswv.org

MONTHLY PREMIUMSEffective January 1, 2010

Premiums are based on region, age and gender.

AccessWV0004; 1109 Provided by the State of West Virginia

NORTH REGION

SOUTH REGION

$265 $400 $222 $335 $161 $243 $131 $195 Under 25 $724 $980 $607 $821 $453 $609 $361 $483 $265 $400 $222 $335 $161 $243 $131 $195 Under 25 $724 $980 $607 $821 $453 $609 $361 $483 $281 $496 $237 $417 $172 $303 $139 $251 25 to 29 $754 $1,162 $635 $977 $474 $723 $376 $589 $281 $496 $237 $417 $172 $303 $139 $251 25 to 29 $754 $1,162 $635 $977 $474 $723 $376 $589 $311 $523 $261 $440 $189 $319 $153 $291 30 to 34 $811 $1,214 $681 $1,021 $507 $754 $403 $665 $311 $523 $261 $440 $189 $319 $153 $291 30 to 34 $811 $1,214 $681 $1,021 $507 $754 $403 $665 $361 $561 $304 $472 $219 $342 $178 $318 35 to 39 $906 $1,286 $762 $1,082 $564 $797 $450 $716 $361 $561 $304 $472 $219 $342 $178 $318 35 to 39 $906 $1,286 $762 $1,082 $564 $797 $450 $716 $428 $593 $361 $498 $261 $360 $212 $318 40 to 44 $1,033 $1,347 $871 $1,131 $643 $831 $515 $716 $428 $593 $361 $498 $261 $360 $212 $318 40 to 44 $1,033 $1,347 $871 $1,131 $643 $831 $515 $716 $570 $684 $477 $573 $346 $416 $282 $334 45 to 49 $1,303 $1,520 $1,091 $1,274 $805 $938 $648 $747 $570 $684 $477 $573 $346 $416 $282 $334 45 to 49 $1,303 $1,520 $1,091 $1,274 $805 $938 $648 $747 $789 $816 $662 $686 $480 $497 $390 $404 50 to 54 $1,719 $1,770 $1,443 $1,488 $1,059 $1,092 $853 $880 $789 $816 $662 $686 $480 $497 $390 $404 50 to 54 $1,719 $1,770 $1,443 $1,488 $1,059 $1,092 $853 $880 $1,021 $964 $857 $809 $621 $588 $505 $477 55 to 59 $2,160 $2,052 $1,813 $1,722 $1,327 $1,265 $1,072 $1,019 $1,021 $964 $857 $809 $621 $588 $505 $477 55 to 59 $2,160 $2,052 $1,813 $1,722 $1,327 $1,265 $1,072 $1,019 $1,273 $1,059 $1,069 $890 $775 $645 $630 $524 60+ $2,639 $2,232 $2,216 $1,876 $1,620 $1,373 $1,309 $1,108$1,273 $1,059 $1,069 $890 $775 $645 $630 $524 60+ $2,639 $2,232 $2,216 $1,876 $1,620 $1,373 $1,309 $1,108

SINGLE FAMILY PLAN A PLAN B PLAN C PLAN D AGE PLAN A PLAN B PLAN C PLAN D PLAN A PLAN B PLAN C PLAN D AGE PLAN A PLAN B PLAN C PLAN D

$400 Deductible $800 Deductible $2,000D Deductible $4,000 Deductible BANDBAND $800 Deductible $1,600 Deductible $4,000 Deductible $8,000 Deductible

Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male FemaleMale Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female

$257 $383 $216 $321 $157 $233 $130 $190 Under 25 $708 $948 $595 $795 $446 $590 $359 $473 $257 $383 $216 $321 $157 $233 $130 $190 Under 25 $708 $948 $595 $795 $446 $590 $359 $473 $272 $476 $229 $401 $166 $289 $138 $245 25 to 29 $737 $1,124 $620 $947 $463 $697 $374 $578 $272 $476 $229 $401 $166 $289 $138 $245 25 to 29 $737 $1,124 $620 $947 $463 $697 $374 $578 $301 $503 $252 $423 $182 $306 $152 $281 30 to 34 $792 $1,176 $664 $989 $493 $729 $401 $646 $301 $503 $252 $423 $182 $306 $152 $281 30 to 34 $792 $1,176 $664 $989 $493 $729 $401 $646 $350 $542 $294 $455 $213 $329 $177 $310 35 to 39 $885 $1,250 $743 $1,049 $552 $773 $449 $701 $350 $542 $294 $455 $213 $329 $177 $310 35 to 39 $885 $1,250 $743 $1,049 $552 $773 $449 $701 $417 $575 $349 $482 $253 $350 $210 $312 40 to 44 $1,012 $1,313 $848 $1,101 $628 $812 $511 $705 $417 $575 $349 $482 $253 $350 $210 $312 40 to 44 $1,012 $1,313 $848 $1,101 $628 $812 $511 $705 $553 $661 $464 $557 $336 $404 $279 $332 45 to 49 $1,271 $1,476 $1,066 $1,243 $786 $915 $642 $743 $553 $661 $464 $557 $336 $404 $279 $332 45 to 49 $1,271 $1,476 $1,066 $1,243 $786 $915 $642 $743 $765 $792 $644 $667 $466 $483 $387 $401 50 to 54 $1,674 $1,725 $1,408 $1,452 $1,033 $1,065 $848 $874 $765 $792 $644 $667 $466 $483 $387 $401 50 to 54 $1,674 $1,725 $1,408 $1,452 $1,033 $1,065 $848 $874 $990 $935 $832 $785 $603 $569 $500 $473 55 to 59 $2,101 $1,997 $1,766 $1,676 $1,293 $1,229 $1,062 $1,011 $990 $935 $832 $785 $603 $569 $500 $473 55 to 59 $2,101 $1,997 $1,766 $1,676 $1,293 $1,229 $1,062 $1,011 $1,235 $1,026 $1,038 $864 $751 $627 $625 $519 60+ $2,567 $2,169 $2,157 $1,826 $1,574 $1,339 $1,300 $1,098 $1,235 $1,026 $1,038 $864 $751 $627 $625 $519 60+ $2,567 $2,169 $2,157 $1,826 $1,574 $1,339 $1,300 $1,098

SINGLE FAMILY PLAN A PLAN B PLAN C PLAN D AGE PLAN A PLAN B PLAN C PLAN D PLAN A PLAN B PLAN C PLAN D AGE PLAN A PLAN B PLAN C PLAN D

$400 Deductible $800 Deductible $2,000D Deductible $4,000 Deductible BANDBAND $800 Deductible $1,600 Deductible $4,000 Deductible $8,000 Deductible

Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male FemaleMale Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female

Counties: Brooke, Hancock, Marion, Marshall, Monongalia, Ohio, Taylor, Tyler, Wetzel

Counties: Boone, Clay, Fayette, Greenbrier, Kanawha, Lincoln, Logan, McDowell, Mercer, Mingo, Monroe, Nicholas, Raleigh, Summers, Wyoming

MONTHLY PREMIUMSEffective January 1, 2010

EAST REGION

CENTRAL REGION

P.O. Box 50540 Charleston, WV 25305-05401-866-445-8491www.accesswv.org

AccessWV0004; 1109 Provided by the State of West Virginia

Premiums are based on region, age and gender.

$239 $376 $201 $316 $145 $229 $106 $156 Under 25 $674 $934 $567 $785 $423 $583 $314 $409 $239 $376 $201 $316 $145 $229 $106 $156 Under 25 $674 $934 $567 $785 $423 $583 $314 $409 $255 $466 $215 $394 $155 $284 $114 $201 25 to 29 $705 $1,105 $593 $933 $442 $687 $329 $494 $255 $466 $215 $394 $155 $284 $114 $201 25 to 29 $705 $1,105 $593 $933 $442 $687 $329 $494 $282 $489 $237 $409 $172 $296 $125 $230 30 to 34 $756 $1,149 $635 $962 $474 $710 $350 $549 $282 $489 $237 $409 $172 $296 $125 $230 30 to 34 $756 $1,149 $635 $962 $474 $710 $350 $549 $327 $520 $274 $436 $198 $317 $145 $253 35 to 39 $841 $1,208 $705 $1,013 $524 $750 $388 $593 $327 $520 $274 $436 $198 $317 $145 $253 35 to 39 $841 $1,208 $705 $1,013 $524 $750 $388 $593 $388 $540 $327 $455 $236 $329 $173 $256 40 to 44 $957 $1,246 $806 $1,049 $596 $773 $441 $599 $388 $540 $327 $455 $236 $329 $173 $256 40 to 44 $957 $1,246 $806 $1,049 $596 $773 $441 $599 $515 $620 $433 $520 $315 $377 $228 $272 45 to 49 $1,199 $1,398 $1,008 $1,173 $746 $864 $545 $629 $515 $620 $433 $520 $315 $377 $228 $272 45 to 49 $1,199 $1,398 $1,008 $1,173 $746 $864 $545 $629 $716 $740 $601 $623 $435 $451 $317 $329 50 to 54 $1,580 $1,626 $1,327 $1,369 $974 $1,004 $715 $737 $716 $740 $601 $623 $435 $451 $317 $329 50 to 54 $1,580 $1,626 $1,327 $1,369 $974 $1,004 $715 $737 $925 $873 $777 $734 $562 $532 $410 $388 55 to 59 $1,978 $1,879 $1,661 $1,579 $1,215 $1,158 $891 $849 $925 $873 $777 $734 $562 $532 $410 $388 55 to 59 $1,978 $1,879 $1,661 $1,579 $1,215 $1,158 $891 $849 $1,153 $959 $969 $807 $702 $585 $513 $426 60+ $2,411 $2,042 $2,026 $1,718 $1,481 $1,259 $1,087 $922$1,153 $959 $969 $807 $702 $585 $513 $426 60+ $2,411 $2,042 $2,026 $1,718 $1,481 $1,259 $1,087 $922

SINGLE FAMILY PLAN A PLAN B PLAN C PLAN D AGE PLAN A PLAN B PLAN C PLAN D PLAN A PLAN B PLAN C PLAN D AGE PLAN A PLAN B PLAN C PLAN D

$400 Deductible $800 Deductible $2,000D Deductible $4,000 Deductible BANDBAND $800 Deductible $1,600 Deductible $4,000 Deductible $8,000 Deductible

Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male FemaleMale Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female

$234 $360 $197 $302 $143 $219 $112 $164 Under 25 $665 $904 $559 $759 $419 $564 $325 $424 $234 $360 $197 $302 $143 $219 $112 $164 Under 25 $665 $904 $559 $759 $419 $564 $325 $424 $250 $446 $210 $375 $153 $272 $119 $211 25 to 29 $695 $1,067 $584 $897 $438 $664 $338 $513 $250 $446 $210 $375 $153 $272 $119 $211 25 to 29 $695 $1,067 $584 $897 $438 $664 $338 $513 $275 $470 $232 $395 $169 $286 $131 $243 30 to 34 $743 $1,113 $626 $935 $469 $691 $361 $547 $275 $470 $232 $395 $169 $286 $131 $243 30 to 34 $743 $1,113 $626 $935 $469 $691 $361 $547 $320 $503 $269 $422 $195 $306 $152 $266 35 to 39 $828 $1,176 $696 $987 $518 $729 $401 $618 $320 $503 $269 $422 $195 $306 $152 $266 35 to 39 $828 $1,176 $696 $987 $518 $729 $401 $618 $381 $528 $319 $444 $230 $321 $180 $269 40 to 44 $944 $1,223 $791 $1,028 $584 $757 $454 $623 $381 $528 $319 $444 $230 $321 $180 $269 40 to 44 $944 $1,223 $791 $1,028 $584 $757 $454 $623 $506 $608 $425 $510 $308 $369 $241 $285 45 to 49 $1,181 $1,375 $992 $1,154 $733 $849 $570 $654 $506 $608 $425 $510 $308 $369 $241 $285 45 to 49 $1,181 $1,375 $992 $1,154 $733 $849 $570 $654 $700 $725 $590 $609 $426 $442 $333 $344 50 to 54 $1,550 $1,598 $1,306 $1,342 $957 $987 $745 $766 $700 $725 $590 $609 $426 $442 $333 $344 50 to 54 $1,550 $1,598 $1,306 $1,342 $957 $987 $745 $766 $906 $856 $761 $718 $552 $521 $431 $407 55 to 59 $1,941 $1,846 $1,631 $1,549 $1,196 $1,137 $931 $886 $906 $856 $761 $718 $552 $521 $431 $407 55 to 59 $1,941 $1,846 $1,631 $1,549 $1,196 $1,137 $931 $886 $1,130 $941 $950 $791 $688 $572 $538 $447 60+ $2,367 $2,008 $1,990 $1,688 $1,455 $1,234 $1,134 $962 $1,130 $941 $950 $791 $688 $572 $538 $447 60+ $2,367 $2,008 $1,990 $1,688 $1,455 $1,234 $1,134 $962

SINGLE FAMILY PLAN A PLAN B PLAN C PLAN D AGE PLAN A PLAN B PLAN C PLAN D PLAN A PLAN B PLAN C PLAN D AGE PLAN A PLAN B PLAN C PLAN D

$400 Deductible $800 Deductible $2,000D Deductible $4,000 Deductible BANDBAND $800 Deductible $1,600 Deductible $4,000 Deductible $8,000 Deductible

Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male FemaleMale Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female

Counties: Barbour, Berkeley, Grant, Hampshire, Hardy, Jefferson, Lewis, Mineral, Morgan, Pendleton, Pocahontas, Preston, Randolph, Tucker, Upshur, Webster

Counties: Braxton, Cabell, Calhoun, Doddridge, Gilmer, Harrison, Jackson, Mason, Pleasants, Putnam, Ritchie, Roane, Wayne, Wirt, Wood