Premiums

Annual Premiums - For Insurance Effective Through 12/31/04

Platinum - Rate Table
	$250 Deductible		$500 Deductible		$1,000 Deductible		$2,500 Deductible
Age	Male	Female	Male	Female	Male	Female	Male	Female
14 days to 9*	$444	$444	$400	$400	$300	$300	$269	$269
10 to 18*	$464	$464	$420	$420	$323	$323	$289	$289
19-24	$1,091	$1,773	$972	$1,666	$773	$1,214	$687	$1,081
25-29	$1,203	$1,951	$1,089	$1,839	$855	$1,341	$757	$1,194
30-34	$1,289	$2,181	$1,147	$2,041	$902	$1,538	$806	$1,370
35-39	$1,497	$2,426	$1,270	$2,201	$994	$1,703	$886	$1,515
40-44	$1,662	$2,013	$1,412	$1,765	$1,106	$1,384	$989	$1,237
45-49	$1,821	$2,204	$1,561	$1,944	$1,224	$1,528	$1,092	$1,359
50-54	$2,184	$2,399	$1,912	$2,128	$1,504	$1,677	$1,377	$1,529
55-59	$2,744	$2,744	$2,452	$2,452	$1,865	$1,865	$1,776	$1,776
60-64	$3,673	$3,446	$3,392	$3,167	$2,824	$2,613	$2,619	$2,397
65-69	$7,605	$6,605	$7,324	$6,325	$6,747	$5,749	$5,339	$4,339
70	$9,022	$7,810	$8,740	$7,527	$8,175	$6,963	$6,446	$5,233
71	$9,445	$8,174	$9,163	$7,893	$8,599	$7,328	$6,789	$5,517
72	$9,807	$8,485	$9,528	$8,205	$8,969	$7,646	$7,084	$5,762
73	$10,180	$8,797	$9,903	$8,520	$9,349	$7,967	$7,390	$6,007
74	$10,675	$9,218	$10,398	$8,941	$9,845	$8,387	$7,784	$6,326
*First 2 children age 14 days to 9 years are free only when both parents are insured under the Platinum Plan. The Dependent Child rate is only available when parent (guardian) is insured under the Platinum Plan. Dependent children alone must pay the age 19 to 24 rate.
A one-time, non-refundable Policy Fee of $50 is required with each Application for the Platinum Plan.

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Premier - Rate Table
	$250 Deductible		$500 Deductible		$1,000 Deductible		$2,500 Deductible
Age	Male	Female	Male	Female	Male	Female	Male	Female
14 days to 9*	$306	$306	$274	$274	$209	$209	$188	$188
10 to 18*	$285	$285	$253	$253	$188	$188	$167	$167
19-24	$586	$811	$519	$748	$409	$553	$361	$488
25-29	$645	$892	$583	$829	$452	$611	$398	$540
30-34	$692	$986	$614	$907	$477	$684	$422	$605
35-39	$805	$1,110	$678	$985	$526	$755	$467	$669
40-44	$894	$1,091	$755	$952	$585	$739	$520	$657
45-49	$980	$1,193	$835	$1,048	$648	$815	$574	$722
50-54	$1,169	$1,292	$1,017	$1,142	$791	$890	$720	$808
55-59	$1,406	$1,406	$1,249	$1,249	$935	$935	$885	$885
60-64	$2,336	$2,223	$2,062	$1,949	$1,514	$1,401	$1,395	$1,282
65-69	$4,438	$3,903	$4,163	$3,629	$3,615	$3,081	$2,824	$2,289
70	$5,402	$4,724	$5,126	$4,446	$4,572	$3,893	$2,911	$2,342
71	$5,638	$4,928	$5,361	$4,650	$4,807	$4,097	$3,064	$2,353
72	$5,836	$5,097	$5,562	$4,822	$5,014	$4,274	$3,259	$2,520
73	$6,040	$5,268	$5,768	$4,996	$5,226	$4,453	$3,462	$2,689
74	$6,317	$5,503	$6,046	$5,231	$5,503	$4,688	$3,711	$2,897
*First child age 14 days to 9 years is free only when both parents are insured under the Premier Plan. The Dependent Child rate is only available when parent (guardian) is insured under the Premier Plan. Dependent children alone must pay the age 19 to 24 rate.
A one-time, non-refundable Policy Fee of $50 is required with each Application for the Premier Plan.

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Risk Share - Rate Table
	$1,000 Deductible		$2,500 Deductible		$5,000 Deductible
Age	Male	Female	Male	Female	Male	Female
14 days to 18*	$210	$210	$185	$185	$150	$150
19-39	$261	$413	$232	$365	$175	$274
40-49	$325	$405	$285	$360	$215	$270
50-59	$470	$470	$445	$445	$335	$335
60-69	$1,820	$1,550	$815	$800	$610	$600
70-74	$2,790	$2,400	$1,300	$1,125	$1,000	$850
*The Dependent Child rate is only available when parent (guardian) is insured under the Risk Share Plan. Dependent children alone must pay the age 19 to 24 rate.
A one-time, non-refundable Policy Fee of $100 is required with each Application for the Risk-Share Plan.

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Optional Term Life and AD&D Insurance - Rate Table
Age	Basic Premium	Supplemental Premium
19-29	$130	$100
30-39	$210	$160
40-44	$310	$235
45-49	$450	$340
50-54	$570	$430
55-59	$770	$580
60-64	$585	$440
65-69	$315	Not Available
Dependent Child	$85	Not Available

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THIS MEDICAL AND LIFE INSURANCE IS UNDERWRITTEN BY CERTAIN UNDERWRITERS AT LLOYD'S, LONDON, AND IS AVAILABLE TO MEMBERS OF THE ATLAS/INTERNATIONAL CITIZEN GROUP INSURANCE TRUST, HAMILTON, BERMUDA. LLOYD'S IS AN APPROVED NON-ADMITTED INSURER IN ALL STATES OF THE UNITED STATES, EXCEPT KENTUCKY AND ILLINOIS WHERE THEY ARE ADMITTED. CLAIMS UNDER THIS INSURANCE MAY NOT BE MADE AGAINST ANY STATE GUARANTY FUND.

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