INSURANCE COMPANY NAME ADDRESS & PHONE NUMBER
AGE
Premium Method
PLAN A
PLAN B
PLAN C
PLAN D
PLAN F
PLAN G
PLAN K
PLAN L
PLAN M
PLAN N
Annual Premium
Annual Premium
Annual Premium
Annual Premium
Annual Premium
Annual Premium
Annual Premium
Annual Premium
Annual Premium
Annual Premium
Blue Cross Blue Shield of Montana 560 N. Park Avenue Helena, MT 59601 1-800-447-7828
65 Attained 66 Age 67 68 69 70 71 72 73 74 75 76 77 78 79 80 & up
1101 1136 1173 1210 1249 1299 1345 1393 1440 1489 1559 1615 1673 1732 1794 1859
1524 1575 1625 1677 1730 1800 1865 1930 1996 2065 2163 2240 2320 2405 2491 2582
1545 1596 1647 1699 1753 1825 1890 1956 2024 2092 2191 2270 2351 2436 2523 2616
1296 1339 1381 1425 1471 1530 1585 1640 1696 1756 1839 1904 1972 2043 2116 2193
1117 1152 1190 1228 1267 1319 1366 1412 1461 1511 1582 1639 1696 1757 1819 1886
Blue Cross Blue Shield of Montana 560 N. Park Avenue Helena, MT 59601 1-800-447-7828
65 Issue 66 Age 67 68 69 70 71 72 73 74 75 76 77 78 79 80 & up
1495 1495 1662 1662 1662 1886 1886 1886 1886 1886 2153 2153 2153 2153 2153 2508
2070 2070 2302 2302 2302 2612 2612 2612 2612 2612 2981 2981 2981 2981 2981 3474
2079 2079 2311 2311 2311 2622 2622 2622 2622 2622 2993 2993 2993 2993 2993 3488
1760 1760 1959 1959 1959 2221 2221 2221 2221 2221 2535 2535 2535 2535 2535 2952
1517 1517 1687 1687 1687 1914 1914 1914 1914 1914 2184 2184 2184 2184 2184 2545
Central States Indemnity Company of Omaha 1212 N. 96th Street Omaha, NE 68114-2274 1-866-644-3988
65 Attained 66 Age 67 68 69 70 71 72 73 74 75 76 77 78 79 80 & up
920 920 920 980 1021 1058 1095 1129 1162 1197 1224 1260 1302 1342 1374 1410
1288 1288 1288 1368 1426 1479 1534 1587 1643 1693 1734 1786 1845 1901 1946 1997
1337 1337 1337 1410 1467 1517 1572 1627 1683 1731 1770 1821 1878 1931 1976 2026
1075 1075 1075 1143 1192 1235 1277 1317 1358 1397 1428 1471 1519 1566 1602 1645
1150 1150 1150 1199 1247 1290 1337 1383 1430 1471 1505 1548 1596 1642 1680 1722
928 928 928 978 1017 1054 1091 1128 1167 1200 1227 1263 1301 1339 1370 1404