AMERICAN RETIREMENT LIFE INSURANCE COMPANYagentviewcigna.com/gasbagent/cache/forms/ar-hhds... ·...

AMERICAN RETIREMENT LIFE INSURANCE COMPANY P. O. BOX 26580 • AUSTIN, TX 78755-0580 • 866-459-4272

Outline of Medicare Supplement Coverage - Benefit Plans A, F, G, and N This chart shows the benefits included in each of the standard Medicare supplement plans. Every company must make Plan A available. Some plans may not be available in Your state. BASIC BENEFITS: • Hospitalization: Part A coinsurance plus coverage for 365 additional days after Medicare benefits end. • Medical Expenses: Part B coinsurance (generally 20% of Medicare-approved Expenses) or copayments for hospital outpatient services. Plans K, L, and N

require Insureds to pay a portion of Part B coinsurance or copayments. • Blood: First three pints of blood each year. • Hospice: Part A coinsurance.

A B C D F F* G K L M N Basic, including 100% Part B coinsurance

Basic, including 100% Part B coinsurance



Basic, including 100% Part B coinsurance*


Hospitalization and Preventive Care paid at 100%; other Basic Benefits paid at 50%

Hospitalization and Preventive Care paid at 100%; other Basic Benefits paid at 75%


Basic, including 100% Part B coinsurance, except up to $20 copayment for office visit and up to $50 copayment for ER visit

Skilled Nursing Facility coinsurance




50% Skilled Nursing Facility coinsurance

75% Skilled Nursing Facility coinsurance



Part A Deductible

Part A Deductible

Part A Deductible

Part A Deductible

Part A Deductible

50% Part A Deductible



Part A Deductible

Part B Deductible

Part B Deductible

Part B Excess (100%)

Part B Excess (100%)

Foreign Travel Emergency






Out-of-Pocket limit $5,120; paid at 100% after reached

Out-of-Pocket limit $2,560; paid at 100% after reached

*Plan F also has an option called a high-deductible Plan F. This high-deductible Plan pays the same benefits as Plan F after one has paid a calendar year $2,200 deductible. Benefits from high-deductible Plan F will not begin until out-of-pocket expenses exceed $2,200. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. These expenses include the Medicare Deductibles for Part A and Part B, but do not include the Plan’s separate Foreign Travel Emergency Deductible.

ARLIC-HHDS-OC-AA-VA PAGE 1 01/17

Annual Monthly Annual Monthly Annual Monthly Annual Monthly Annual Monthly Annual Monthly Annual Monthly Annual Monthly

1,049.64 87.44 1,302.06 108.46 978.41 81.50 775.73 64.62 65 1,207.09 100.55 1,497.36 124.73 1,125.17 93.73 892.09 74.311,049.64 87.44 1,302.06 108.46 978.41 81.50 775.73 64.62 66 1,207.09 100.55 1,497.36 124.73 1,125.17 93.73 892.09 74.311,096.89 91.37 1,358.80 113.19 1,026.02 85.47 812.14 67.65 67 1,261.43 105.08 1,562.61 130.17 1,179.93 98.29 933.95 77.801,143.59 95.26 1,412.97 117.70 1,071.48 89.25 847.42 70.59 68 1,315.12 109.55 1,624.92 135.36 1,232.21 102.64 974.52 81.181,189.46 99.08 1,468.40 122.32 1,118.00 93.13 882.70 73.53 69 1,367.88 113.94 1,688.66 140.67 1,285.70 107.10 1,015.11 84.561,233.87 102.78 1,519.93 126.61 1,161.23 96.73 915.93 76.30 70 1,418.95 118.20 1,747.91 145.60 1,335.41 111.24 1,053.32 87.741,270.75 105.85 1,569.69 130.76 1,202.99 100.21 949.31 79.08 71 1,461.35 121.73 1,805.14 150.37 1,383.44 115.24 1,091.71 90.941,307.63 108.93 1,619.45 134.90 1,244.75 103.69 982.69 81.86 72 1,503.77 125.26 1,862.37 155.14 1,431.46 119.24 1,130.10 94.141,344.51 112.00 1,669.21 139.05 1,286.51 107.17 1,016.07 84.64 73 1,546.18 128.80 1,919.60 159.90 1,479.48 123.24 1,168.48 97.331,381.39 115.07 1,718.98 143.19 1,328.26 110.64 1,049.45 87.42 74 1,588.60 132.33 1,976.82 164.67 1,527.50 127.24 1,206.86 100.531,419.69 118.26 1,770.51 147.48 1,371.39 114.24 1,083.91 90.29 75 1,632.64 136.00 2,036.09 169.61 1,577.10 131.37 1,246.49 103.831,452.73 121.01 1,823.77 151.92 1,414.95 117.87 1,120.21 93.31 76 1,670.65 139.16 2,097.34 174.71 1,627.19 135.54 1,288.24 107.311,486.31 123.81 1,877.93 156.43 1,459.24 121.55 1,157.12 96.39 77 1,709.25 142.38 2,159.62 179.90 1,678.12 139.79 1,330.70 110.851,521.91 126.77 1,934.90 161.18 1,505.76 125.43 1,195.85 99.61 78 1,750.19 145.79 2,225.13 185.35 1,731.62 144.24 1,375.23 114.561,558.11 129.79 1,992.89 166.01 1,553.12 129.38 1,235.29 102.90 79 1,791.82 149.26 2,291.82 190.91 1,786.09 148.78 1,420.58 118.331,594.93 132.86 2,051.92 170.93 1,601.35 133.39 1,275.45 106.24 80 1,834.17 152.79 2,359.71 196.56 1,841.55 153.40 1,466.77 122.181,636.28 136.30 2,124.56 176.98 1,660.24 138.30 1,325.95 110.45 81 1,881.72 156.75 2,443.24 203.52 1,909.28 159.04 1,524.84 127.021,678.40 139.81 2,198.64 183.15 1,720.32 143.30 1,377.47 114.74 82 1,930.16 160.78 2,528.44 210.62 1,978.37 164.80 1,584.09 131.961,723.00 143.53 2,276.43 189.63 1,783.36 148.55 1,431.46 119.24 83 1,981.46 165.06 2,617.90 218.07 2,050.87 170.84 1,646.18 137.131,768.47 147.31 2,355.89 196.25 1,847.75 153.92 1,486.62 123.84 84 2,033.75 169.41 2,709.28 225.68 2,124.91 177.01 1,709.61 142.411,814.84 151.18 2,437.03 203.00 1,913.51 159.40 1,542.97 128.53 85 2,087.06 173.85 2,802.58 233.45 2,200.54 183.30 1,774.41 147.811,864.38 155.30 2,522.61 210.13 1,982.31 165.13 1,601.63 133.42 86 2,144.03 178.60 2,901.01 241.65 2,279.65 189.90 1,841.88 153.431,915.11 159.53 2,610.49 217.45 2,052.97 171.01 1,661.90 138.44 87 2,202.37 183.46 3,002.06 250.07 2,360.91 196.66 1,911.19 159.201,967.06 163.86 2,700.72 224.97 2,125.53 177.06 1,723.82 143.59 88 2,262.12 188.43 3,105.83 258.72 2,444.35 203.61 1,982.39 165.132,018.28 168.12 2,790.60 232.46 2,197.87 183.08 1,785.68 148.75 89 2,321.03 193.34 3,209.19 267.33 2,527.55 210.54 2,053.53 171.062,068.64 172.32 2,879.92 239.90 2,269.83 189.08 1,847.32 153.88 90 2,378.94 198.17 3,311.91 275.88 2,610.30 217.44 2,124.42 176.962,117.61 176.40 2,971.55 247.53 2,343.39 195.20 1,910.91 159.18 91 2,435.26 202.86 3,417.29 284.66 2,694.90 224.48 2,197.55 183.062,167.52 180.55 3,065.08 255.32 2,418.48 201.46 1,975.84 164.59 92 2,492.64 207.64 3,524.84 293.62 2,781.25 231.68 2,272.22 189.282,213.97 184.42 3,154.28 262.75 2,490.20 207.43 2,038.11 169.77 93 2,546.07 212.09 3,627.43 302.16 2,863.73 238.55 2,343.82 195.242,261.19 188.36 3,245.09 270.32 2,563.21 213.52 2,101.50 175.05 94 2,600.36 216.61 3,731.85 310.86 2,947.69 245.54 2,416.72 201.312,309.17 192.35 3,337.51 278.01 2,637.52 219.71 2,166.04 180.43 95 2,655.55 221.21 3,838.13 319.72 3,033.14 252.66 2,490.95 207.502,355.36 196.20 3,404.26 283.57 2,690.27 224.10 2,209.37 184.04 96 2,708.66 225.63 3,914.90 326.11 3,093.80 257.71 2,540.76 211.652,402.47 200.13 3,472.34 289.25 2,744.07 228.58 2,253.55 187.72 97 2,762.83 230.14 3,993.20 332.63 3,155.69 262.87 2,591.58 215.882,450.52 204.13 3,541.79 295.03 2,798.95 233.15 2,298.62 191.48 98 2,818.09 234.75 4,073.06 339.29 3,218.80 268.13 2,643.41 220.202,499.53 208.21 3,612.63 300.93 2,854.94 237.82 2,344.59 195.30 99 2,874.45 239.44 4,154.52 346.07 3,283.18 273.49 2,696.28 224.60

Policies may be issued on an annual, semi-annual, quarterly or monthly mode. To obtain semi-annual premiums, multiply the above-quoted annual premium by 0.52. To obtain quarterly premiums, multiply the above quoted premium by 0.265.

Applicants who qualify for Household Discount multiply above rates by 0.93

VIRGINIAAttained Age Rates -- Effective 7/1/2016 -- Area I (226-231, 238-246)

American Retirement Life Insurance CompanyMEDICARE SUPPLEMENT

Attained Age

Plan A

PREFERRED ANNUAL & MONTHLY BANK DRAFT RATES

FEMALE RATES MALE RATES

Add one-time enrollment fee of $20.00 to the first premium.

Plan F Plan G Plan NPlan A Plan F Plan G Plan N



1,154.61 96.18 1,432.26 119.31 1,076.26 89.65 853.30 71.08 65 1,327.81 110.61 1,647.10 137.20 1,237.69 103.10 981.30 81.741,154.61 96.18 1,432.26 119.31 1,076.26 89.65 853.30 71.08 66 1,327.81 110.61 1,647.10 137.20 1,237.69 103.10 981.30 81.741,206.59 100.51 1,494.67 124.51 1,128.63 94.01 893.35 74.42 67 1,387.57 115.58 1,718.88 143.18 1,297.92 108.12 1,027.35 85.581,257.95 104.79 1,554.27 129.47 1,178.63 98.18 932.15 77.65 68 1,446.64 120.50 1,787.40 148.89 1,355.42 112.91 1,071.98 89.301,308.40 108.99 1,615.25 134.55 1,229.80 102.44 970.97 80.88 69 1,504.67 125.34 1,857.53 154.73 1,414.27 117.81 1,116.62 93.011,357.25 113.06 1,671.91 139.27 1,277.35 106.40 1,007.53 83.93 70 1,560.84 130.02 1,922.70 160.16 1,468.96 122.36 1,158.65 96.521,397.82 116.44 1,726.66 143.83 1,323.29 110.23 1,044.24 86.99 71 1,607.49 133.90 1,985.66 165.41 1,521.79 126.76 1,200.88 100.031,438.39 119.82 1,781.39 148.39 1,369.22 114.06 1,080.96 90.04 72 1,654.15 137.79 2,048.60 170.65 1,574.60 131.16 1,243.10 103.551,478.96 123.20 1,836.14 152.95 1,415.16 117.88 1,117.68 93.10 73 1,700.80 141.68 2,111.56 175.89 1,627.43 135.57 1,285.33 107.071,519.53 126.58 1,890.87 157.51 1,461.09 121.71 1,154.39 96.16 74 1,747.46 145.56 2,174.51 181.14 1,680.26 139.97 1,327.55 110.591,561.66 130.09 1,947.56 162.23 1,508.53 125.66 1,192.30 99.32 75 1,795.91 149.60 2,239.70 186.57 1,734.82 144.51 1,371.15 114.221,598.01 133.11 2,006.15 167.11 1,556.44 129.65 1,232.23 102.64 76 1,837.71 153.08 2,307.07 192.18 1,789.91 149.10 1,417.07 118.041,634.93 136.19 2,065.72 172.07 1,605.16 133.71 1,272.84 106.03 77 1,880.17 156.62 2,375.58 197.89 1,845.93 153.77 1,463.76 121.931,674.10 139.45 2,128.39 177.29 1,656.33 137.97 1,315.44 109.58 78 1,925.21 160.37 2,447.64 203.89 1,904.78 158.67 1,512.75 126.011,713.92 142.77 2,192.17 182.61 1,708.44 142.31 1,358.81 113.19 79 1,971.01 164.19 2,521.01 210.00 1,964.70 163.66 1,562.64 130.171,754.42 146.14 2,257.12 188.02 1,761.48 146.73 1,402.99 116.87 80 2,017.58 168.06 2,595.69 216.22 2,025.70 168.74 1,613.45 134.401,799.92 149.93 2,337.01 194.67 1,826.27 152.13 1,458.55 121.50 81 2,069.90 172.42 2,687.57 223.87 2,100.21 174.95 1,677.33 139.721,846.24 153.79 2,418.50 201.46 1,892.36 157.63 1,515.22 126.22 82 2,123.18 176.86 2,781.27 231.68 2,176.20 181.28 1,742.50 145.151,895.30 157.88 2,504.08 208.59 1,961.70 163.41 1,574.61 131.16 83 2,179.60 181.56 2,879.69 239.88 2,255.95 187.92 1,810.80 150.841,945.32 162.05 2,591.48 215.87 2,032.52 169.31 1,635.29 136.22 84 2,237.12 186.35 2,980.20 248.25 2,337.40 194.71 1,880.57 156.651,996.32 166.29 2,680.73 223.30 2,104.86 175.34 1,697.26 141.38 85 2,295.77 191.24 3,082.83 256.80 2,420.59 201.64 1,951.86 162.592,050.81 170.83 2,774.88 231.15 2,180.54 181.64 1,761.79 146.76 86 2,358.43 196.46 3,191.10 265.82 2,507.62 208.89 2,026.06 168.772,106.62 175.48 2,871.54 239.20 2,258.27 188.11 1,828.09 152.28 87 2,422.61 201.80 3,302.27 275.08 2,597.01 216.33 2,102.30 175.122,163.77 180.24 2,970.79 247.47 2,338.08 194.76 1,896.20 157.95 88 2,488.33 207.28 3,416.41 284.59 2,688.79 223.98 2,180.64 181.652,220.12 184.94 3,069.66 255.70 2,417.66 201.39 1,964.25 163.62 89 2,553.13 212.68 3,530.11 294.06 2,780.31 231.60 2,258.89 188.172,275.51 189.55 3,167.92 263.89 2,496.81 207.98 2,032.06 169.27 90 2,616.84 217.98 3,643.11 303.47 2,871.33 239.18 2,336.86 194.662,329.38 194.04 3,268.71 272.28 2,577.73 214.72 2,102.01 175.10 91 2,678.79 223.14 3,759.01 313.13 2,964.39 246.93 2,417.31 201.362,384.27 198.61 3,371.58 280.85 2,660.32 221.60 2,173.42 181.05 92 2,741.91 228.40 3,877.32 322.98 3,059.37 254.85 2,499.44 208.202,435.37 202.87 3,469.71 289.03 2,739.22 228.18 2,241.92 186.75 93 2,800.68 233.30 3,990.17 332.38 3,150.10 262.40 2,578.20 214.762,487.31 207.19 3,569.60 297.35 2,819.52 234.87 2,311.65 192.56 94 2,860.41 238.27 4,105.04 341.95 3,242.45 270.10 2,658.40 221.442,540.10 211.59 3,671.26 305.82 2,901.27 241.68 2,382.64 198.47 95 2,921.11 243.33 4,221.95 351.69 3,336.46 277.93 2,740.05 228.252,590.90 215.82 3,744.68 311.93 2,959.30 246.51 2,430.30 202.44 96 2,979.53 248.20 4,306.38 358.72 3,403.19 283.49 2,794.84 232.812,642.72 220.14 3,819.58 318.17 3,018.48 251.44 2,478.90 206.49 97 3,039.12 253.16 4,392.52 365.90 3,471.25 289.16 2,850.74 237.472,695.57 224.54 3,895.97 324.53 3,078.85 256.47 2,528.48 210.62 98 3,099.91 258.22 4,480.37 373.21 3,540.67 294.94 2,907.75 242.222,749.48 229.03 3,973.89 331.03 3,140.43 261.60 2,579.05 214.84 99 3,161.90 263.39 4,569.98 380.68 3,611.49 300.84 2,965.91 247.06



Attained Age Rates -- Effective 7/1/2016 -- Area I (226-231, 238-246)STANDARD ANNUAL & MONTHLY BANK DRAFT RATES

MEDICARE SUPPLEMENTAmerican Retirement Life Insurance Company

VIRGINIA

Plan A Plan F Plan G Plan N Attained Age

Plan AFEMALE RATES MALE RATES


Plan F Plan G Plan N



2,125.38 177.04 2,603.64 216.88 2,352.89 196.00 1,869.04 155.69 65 2,444.19 203.60 2,994.19 249.42 2,705.82 225.39 2,149.39 179.042,125.38 177.04 2,603.64 216.88 2,352.89 196.00 1,869.04 155.69 66 2,444.19 203.60 2,994.19 249.42 2,705.82 225.39 2,149.39 179.042,125.38 177.04 2,603.64 216.88 2,352.89 196.00 1,869.04 155.69 67 2,444.19 203.60 2,994.19 249.42 2,705.82 225.39 2,149.39 179.042,125.38 177.04 2,603.64 216.88 2,352.89 196.00 1,869.04 155.69 68 2,444.19 203.60 2,994.19 249.42 2,705.82 225.39 2,149.39 179.042,125.38 177.04 2,603.64 216.88 2,352.89 196.00 1,869.04 155.69 69 2,444.19 203.60 2,994.19 249.42 2,705.82 225.39 2,149.39 179.042,125.38 177.04 2,603.64 216.88 2,352.89 196.00 1,869.04 155.69 70 2,444.19 203.60 2,994.19 249.42 2,705.82 225.39 2,149.39 179.042,125.38 177.04 2,603.64 216.88 2,352.89 196.00 1,869.04 155.69 71 2,444.19 203.60 2,994.19 249.42 2,705.82 225.39 2,149.39 179.042,125.38 177.04 2,609.45 217.37 2,390.18 199.10 1,895.28 157.88 72 2,444.19 203.60 3,000.86 249.97 2,748.70 228.97 2,179.56 181.562,157.01 179.68 2,655.11 221.17 2,438.65 203.14 1,934.50 161.14 73 2,480.56 206.63 3,053.38 254.35 2,804.45 233.61 2,224.68 185.322,189.69 182.40 2,701.58 225.04 2,487.71 207.23 1,974.16 164.45 74 2,518.14 209.76 3,106.82 258.80 2,860.86 238.31 2,270.28 189.112,223.13 185.19 2,748.85 228.98 2,537.36 211.36 2,014.29 167.79 75 2,556.60 212.96 3,161.18 263.33 2,917.97 243.07 2,316.43 192.962,247.09 187.18 2,796.96 232.99 2,585.97 215.41 2,056.31 171.29 76 2,584.16 215.26 3,216.50 267.93 2,973.86 247.72 2,364.76 196.982,266.21 188.78 2,838.92 236.48 2,628.85 218.98 2,093.77 174.41 77 2,606.14 217.09 3,264.75 271.95 3,023.18 251.83 2,407.83 200.572,285.95 190.42 2,881.50 240.03 2,672.29 222.60 2,131.63 177.56 78 2,628.85 218.98 3,313.72 276.03 3,073.13 255.99 2,451.38 204.202,306.31 192.12 2,924.72 243.63 2,716.28 226.27 2,169.92 180.75 79 2,652.27 220.93 3,363.43 280.17 3,123.72 260.21 2,495.41 207.872,327.28 193.86 2,968.59 247.28 2,760.85 229.98 2,208.65 183.98 80 2,676.38 222.94 3,413.88 284.38 3,174.98 264.48 2,539.95 211.582,340.59 194.97 3,013.12 250.99 2,806.00 233.74 2,250.86 187.50 81 2,691.68 224.22 3,465.09 288.64 3,226.90 268.80 2,588.49 215.622,348.95 195.67 3,050.78 254.13 2,844.69 236.96 2,287.79 190.57 82 2,701.29 225.02 3,508.40 292.25 3,271.39 272.51 2,630.96 219.162,358.06 196.43 3,088.92 257.31 2,883.75 240.22 2,324.90 193.66 83 2,711.77 225.89 3,552.26 295.90 3,316.31 276.25 2,673.64 222.712,367.91 197.25 3,127.53 260.52 2,923.19 243.50 2,362.22 196.77 84 2,723.09 226.83 3,596.66 299.60 3,361.67 280.03 2,716.55 226.292,378.45 198.12 3,166.63 263.78 2,963.03 246.82 2,399.76 199.90 85 2,735.22 227.84 3,641.62 303.35 3,407.48 283.84 2,759.73 229.892,389.97 199.08 3,206.21 267.08 3,002.49 250.11 2,436.56 202.97 86 2,748.48 228.95 3,687.14 307.14 3,452.86 287.62 2,802.05 233.412,400.84 199.99 3,244.68 270.28 3,040.88 253.31 2,472.46 205.96 87 2,760.96 229.99 3,731.39 310.82 3,497.01 291.30 2,843.33 236.852,412.19 200.94 3,283.62 273.53 3,079.69 256.54 2,508.65 208.97 88 2,774.02 231.08 3,776.16 314.55 3,541.64 295.02 2,884.95 240.322,424.02 201.92 3,323.03 276.81 3,118.92 259.81 2,545.15 212.01 89 2,787.63 232.21 3,821.48 318.33 3,586.76 298.78 2,926.92 243.812,436.33 202.95 3,362.90 280.13 3,158.59 263.11 2,581.96 215.08 90 2,801.78 233.39 3,867.33 322.15 3,632.37 302.58 2,969.25 247.342,446.12 203.76 3,403.26 283.49 3,198.32 266.42 2,619.54 218.21 91 2,813.03 234.33 3,913.74 326.01 3,678.07 306.38 3,012.48 250.942,455.28 204.52 3,442.39 286.75 3,236.90 269.63 2,656.10 221.25 92 2,823.56 235.20 3,958.75 329.76 3,722.43 310.08 3,054.52 254.442,465.00 205.33 3,481.98 290.05 3,275.87 272.88 2,692.93 224.32 93 2,834.74 236.13 4,004.28 333.56 3,767.25 313.81 3,096.87 257.972,475.26 206.19 3,522.02 293.38 3,315.25 276.16 2,730.04 227.41 94 2,846.55 237.12 4,050.32 337.39 3,812.54 317.58 3,139.54 261.522,486.06 207.09 3,562.53 296.76 3,355.05 279.48 2,767.42 230.53 95 2,858.97 238.15 4,096.90 341.27 3,858.30 321.40 3,182.54 265.112,510.92 209.16 3,598.15 299.73 3,388.59 282.27 2,795.10 232.83 96 2,887.55 240.53 4,137.88 344.69 3,896.88 324.61 3,214.36 267.762,536.03 211.25 3,634.13 302.72 3,422.48 285.09 2,823.05 235.16 97 2,916.43 242.94 4,179.25 348.13 3,935.85 327.86 3,246.51 270.432,561.39 213.36 3,670.47 305.75 3,456.70 287.94 2,851.28 237.51 98 2,945.60 245.37 4,221.04 351.61 3,975.21 331.13 3,278.97 273.142,587.00 215.50 3,707.18 308.81 3,491.27 290.82 2,879.80 239.89 99 2,975.05 247.82 4,263.25 355.13 4,014.96 334.45 3,311.76 275.87


Add one-time enrollment fee of $20.00 to the first premium.Applicants who qualify for Household Discount multiply above rates by 0.93

FEMALE RATES MALE RATESPlan A Plan F Plan G Plan N Attained

AgePlan A Plan F Plan G Plan N

VIRGINIAAttained Age Rates -- Effective 7/1/2016 -- Area I (226-231, 238-246)

STANDARD II ANNUAL & MONTHLY BANK DRAFT RATES




2,337.93 194.75 2,864.01 238.57 2,588.17 215.59 2,055.94 171.26 65 2,688.61 223.96 3,293.61 274.36 2,976.40 247.93 2,364.33 196.952,337.93 194.75 2,864.01 238.57 2,588.17 215.59 2,055.94 171.26 66 2,688.61 223.96 3,293.61 274.36 2,976.40 247.93 2,364.33 196.952,337.93 194.75 2,864.01 238.57 2,588.17 215.59 2,055.94 171.26 67 2,688.61 223.96 3,293.61 274.36 2,976.40 247.93 2,364.33 196.952,337.93 194.75 2,864.01 238.57 2,588.17 215.59 2,055.94 171.26 68 2,688.61 223.96 3,293.61 274.36 2,976.40 247.93 2,364.33 196.952,337.93 194.75 2,864.01 238.57 2,588.17 215.59 2,055.94 171.26 69 2,688.61 223.96 3,293.61 274.36 2,976.40 247.93 2,364.33 196.952,337.93 194.75 2,864.01 238.57 2,588.17 215.59 2,055.94 171.26 70 2,688.61 223.96 3,293.61 274.36 2,976.40 247.93 2,364.33 196.952,337.93 194.75 2,864.01 238.57 2,588.17 215.59 2,055.94 171.26 71 2,688.61 223.96 3,293.61 274.36 2,976.40 247.93 2,364.33 196.952,337.93 194.75 2,870.39 239.10 2,629.19 219.01 2,084.80 173.66 72 2,688.61 223.96 3,300.95 274.97 3,023.58 251.86 2,397.53 199.712,372.71 197.65 2,920.62 243.29 2,682.52 223.45 2,127.95 177.26 73 2,728.62 227.29 3,358.72 279.78 3,084.90 256.97 2,447.14 203.852,408.66 200.64 2,971.74 247.55 2,736.48 227.95 2,171.57 180.89 74 2,769.95 230.74 3,417.50 284.68 3,146.95 262.14 2,497.32 208.032,445.44 203.71 3,023.74 251.88 2,791.11 232.50 2,215.71 184.57 75 2,812.26 234.26 3,477.30 289.66 3,209.77 267.37 2,548.07 212.252,471.80 205.90 3,076.66 256.29 2,844.56 236.95 2,261.94 188.42 76 2,842.57 236.79 3,538.16 294.73 3,271.25 272.50 2,601.23 216.682,492.83 207.65 3,122.81 260.13 2,891.73 240.88 2,303.15 191.85 77 2,866.76 238.80 3,591.23 299.15 3,325.50 277.01 2,648.61 220.632,514.55 209.46 3,169.65 264.03 2,939.52 244.86 2,344.80 195.32 78 2,891.73 240.88 3,645.10 303.64 3,380.44 281.59 2,696.51 224.622,536.94 211.33 3,217.20 267.99 2,987.91 248.89 2,386.91 198.83 79 2,917.49 243.03 3,699.77 308.19 3,436.10 286.23 2,744.95 228.652,560.01 213.25 3,265.45 272.01 3,036.94 252.98 2,429.51 202.38 80 2,944.01 245.24 3,755.27 312.81 3,492.47 290.92 2,793.94 232.732,574.66 214.47 3,314.43 276.09 3,086.60 257.11 2,475.95 206.25 81 2,960.85 246.64 3,811.60 317.51 3,549.59 295.68 2,847.34 237.182,583.84 215.23 3,355.86 279.54 3,129.16 260.66 2,516.57 209.63 82 2,971.42 247.52 3,859.25 321.48 3,598.53 299.76 2,894.05 241.072,593.87 216.07 3,397.81 283.04 3,172.12 264.24 2,557.39 213.03 83 2,982.95 248.48 3,907.49 325.49 3,647.94 303.87 2,941.00 244.992,604.69 216.97 3,440.28 286.58 3,215.51 267.85 2,598.45 216.45 84 2,995.40 249.52 3,956.33 329.56 3,697.83 308.03 2,988.21 248.922,616.29 217.94 3,483.29 290.16 3,259.32 271.50 2,639.74 219.89 85 3,008.74 250.63 4,005.78 333.68 3,748.23 312.23 3,035.70 252.872,628.97 218.99 3,526.83 293.79 3,302.73 275.12 2,680.22 223.26 86 3,023.32 251.84 4,055.85 337.85 3,798.14 316.39 3,082.25 256.752,640.92 219.99 3,569.16 297.31 3,344.97 278.64 2,719.70 226.55 87 3,037.05 252.99 4,104.52 341.91 3,846.72 320.43 3,127.66 260.532,653.40 221.03 3,611.99 300.88 3,387.66 282.19 2,759.52 229.87 88 3,051.41 254.18 4,153.78 346.01 3,895.81 324.52 3,173.45 264.352,666.43 222.11 3,655.32 304.49 3,430.81 285.79 2,799.66 233.21 89 3,066.39 255.43 4,203.62 350.16 3,945.44 328.66 3,219.61 268.192,679.97 223.24 3,699.19 308.14 3,474.44 289.42 2,840.15 236.58 90 3,081.96 256.73 4,254.07 354.36 3,995.60 332.83 3,266.18 272.072,690.73 224.14 3,743.58 311.84 3,518.16 293.06 2,881.50 240.03 91 3,094.34 257.76 4,305.12 358.62 4,045.88 337.02 3,313.72 276.032,700.80 224.98 3,786.63 315.43 3,560.58 296.60 2,921.72 243.38 92 3,105.92 258.72 4,354.62 362.74 4,094.67 341.09 3,359.97 279.892,711.49 225.87 3,830.17 319.05 3,603.45 300.17 2,962.23 246.75 93 3,118.21 259.75 4,404.71 366.91 4,143.98 345.19 3,406.56 283.772,722.79 226.81 3,874.22 322.72 3,646.77 303.78 3,003.04 250.15 94 3,131.20 260.83 4,455.36 371.13 4,193.79 349.34 3,453.50 287.682,734.66 227.80 3,918.77 326.43 3,690.55 307.42 3,044.17 253.58 95 3,144.87 261.97 4,506.59 375.40 4,244.13 353.54 3,500.80 291.622,762.01 230.08 3,957.96 329.70 3,727.45 310.50 3,074.61 256.12 96 3,176.31 264.59 4,551.66 379.15 4,286.57 357.07 3,535.80 294.532,789.63 232.38 3,997.55 333.00 3,764.72 313.60 3,105.36 258.68 97 3,208.08 267.23 4,597.18 382.95 4,329.44 360.64 3,571.16 297.482,817.52 234.70 4,037.52 336.33 3,802.38 316.74 3,136.41 261.26 98 3,240.16 269.91 4,643.15 386.77 4,372.73 364.25 3,606.88 300.452,845.71 237.05 4,077.89 339.69 3,840.40 319.91 3,167.78 263.88 99 3,272.56 272.60 4,689.58 390.64 4,416.45 367.89 3,642.94 303.46


Applicants who qualify for Household Discount multiply above rates by 0.93Add one-time enrollment fee of $20.00 to the first premium.

Plan G Plan NPlan A Plan F Plan G Plan N Attained Age

Plan A Plan F

Attained Age Rates -- Effective 7/1/2016 -- Area I (226-231, 238-246)STANDARD III ANNUAL & MONTHLY BANK DRAFT RATES



VIRGINIA



1,264.96 105.37 1,569.15 130.71 1,179.11 98.22 934.86 77.87 65 1,454.70 121.18 1,804.51 150.32 1,355.98 112.95 1,075.09 89.551,264.96 105.37 1,569.15 130.71 1,179.11 98.22 934.86 77.87 66 1,454.70 121.18 1,804.51 150.32 1,355.98 112.95 1,075.09 89.551,321.89 110.11 1,637.52 136.41 1,236.49 103.00 978.73 81.53 67 1,520.18 126.63 1,883.15 156.87 1,421.96 118.45 1,125.53 93.761,378.18 114.80 1,702.81 141.84 1,291.28 107.56 1,021.24 85.07 68 1,584.89 132.02 1,958.24 163.12 1,484.97 123.70 1,174.43 97.831,433.45 119.41 1,769.61 147.41 1,347.34 112.23 1,063.77 88.61 69 1,648.47 137.32 2,035.06 169.52 1,549.43 129.07 1,223.33 101.901,486.97 123.86 1,831.71 152.58 1,399.44 116.57 1,103.81 91.95 70 1,710.01 142.44 2,106.46 175.47 1,609.35 134.06 1,269.39 105.741,531.41 127.57 1,891.68 157.58 1,449.76 120.76 1,144.05 95.30 71 1,761.12 146.70 2,175.43 181.21 1,667.22 138.88 1,315.65 109.591,575.86 131.27 1,951.64 162.57 1,500.08 124.96 1,184.27 98.65 72 1,812.23 150.96 2,244.39 186.96 1,725.10 143.70 1,361.91 113.451,620.31 134.97 2,011.62 167.57 1,550.40 129.15 1,224.49 102.00 73 1,863.35 155.22 2,313.36 192.70 1,782.96 148.52 1,408.17 117.301,664.75 138.67 2,071.59 172.56 1,600.73 133.34 1,264.72 105.35 74 1,914.46 159.47 2,382.32 198.45 1,840.84 153.34 1,454.42 121.151,710.90 142.52 2,133.69 177.74 1,652.70 137.67 1,306.25 108.81 75 1,967.53 163.90 2,453.75 204.40 1,900.61 158.32 1,502.19 125.131,750.73 145.84 2,197.88 183.08 1,705.19 142.04 1,350.00 112.45 76 2,013.34 167.71 2,527.57 210.55 1,960.97 163.35 1,552.49 129.321,791.19 149.21 2,263.14 188.52 1,758.57 146.49 1,394.48 116.16 77 2,059.86 171.59 2,602.61 216.80 2,022.35 168.46 1,603.66 133.581,834.09 152.78 2,331.80 194.24 1,814.63 151.16 1,441.15 120.05 78 2,109.21 175.70 2,681.56 223.37 2,086.82 173.83 1,657.32 138.061,877.72 156.41 2,401.69 200.06 1,871.71 155.91 1,488.68 124.01 79 2,159.38 179.88 2,761.94 230.07 2,152.47 179.30 1,711.98 142.611,922.09 160.11 2,472.83 205.99 1,929.83 160.76 1,537.08 128.04 80 2,210.41 184.13 2,843.75 236.88 2,219.30 184.87 1,767.64 147.241,971.93 164.26 2,560.36 213.28 2,000.80 166.67 1,597.93 133.11 81 2,267.72 188.90 2,944.42 245.27 2,300.93 191.67 1,837.62 153.072,022.69 168.49 2,649.65 220.72 2,073.21 172.70 1,660.03 138.28 82 2,326.10 193.76 3,047.09 253.82 2,384.19 198.60 1,909.04 159.022,076.44 172.97 2,743.40 228.52 2,149.17 179.03 1,725.10 143.70 83 2,387.91 198.91 3,154.91 262.80 2,471.56 205.88 1,983.86 165.262,131.24 177.53 2,839.15 236.50 2,226.77 185.49 1,791.56 149.24 84 2,450.93 204.16 3,265.03 271.98 2,560.79 213.31 2,060.30 171.622,187.11 182.19 2,936.93 244.65 2,306.02 192.09 1,859.48 154.89 85 2,515.18 209.51 3,377.47 281.34 2,651.93 220.91 2,138.40 178.132,246.82 187.16 3,040.07 253.24 2,388.94 199.00 1,930.17 160.78 86 2,583.83 215.23 3,496.09 291.22 2,747.28 228.85 2,219.70 184.902,307.95 192.25 3,145.98 262.06 2,474.09 206.09 2,002.80 166.83 87 2,654.14 221.09 3,617.87 301.37 2,845.20 237.01 2,303.23 191.862,370.56 197.47 3,254.71 271.12 2,561.54 213.38 2,077.43 173.05 88 2,726.15 227.09 3,742.92 311.79 2,945.76 245.38 2,389.04 199.012,432.29 202.61 3,363.04 280.14 2,648.72 220.64 2,151.97 179.26 89 2,797.13 233.00 3,867.49 322.16 3,046.02 253.73 2,474.77 206.152,492.98 207.66 3,470.68 289.11 2,735.44 227.86 2,226.26 185.45 90 2,866.93 238.82 3,991.28 332.47 3,145.75 262.04 2,560.20 213.262,552.00 212.58 3,581.10 298.31 2,824.08 235.25 2,302.90 191.83 91 2,934.80 244.47 4,118.27 343.05 3,247.70 270.53 2,648.33 220.612,612.13 217.59 3,693.81 307.69 2,914.58 242.78 2,381.14 198.35 92 3,003.95 250.23 4,247.88 353.85 3,351.77 279.20 2,738.31 228.102,668.12 222.25 3,801.32 316.65 3,001.01 249.98 2,456.18 204.60 93 3,068.34 255.59 4,371.51 364.15 3,451.17 287.48 2,824.61 235.292,725.02 226.99 3,910.75 325.77 3,089.00 257.31 2,532.58 210.96 94 3,133.77 261.04 4,497.36 374.63 3,552.34 295.91 2,912.46 242.612,782.85 231.81 4,022.13 335.04 3,178.55 264.77 2,610.36 217.44 95 3,200.28 266.58 4,625.44 385.30 3,655.33 304.49 3,001.91 250.062,838.51 236.45 4,102.57 341.74 3,242.12 270.07 2,662.57 221.79 96 3,264.28 271.91 4,717.96 393.01 3,728.43 310.58 3,061.95 255.062,895.28 241.18 4,184.62 348.58 3,306.96 275.47 2,715.82 226.23 97 3,329.57 277.35 4,812.31 400.87 3,803.01 316.79 3,123.19 260.162,953.19 246.00 4,268.31 355.55 3,373.10 280.98 2,770.13 230.75 98 3,396.16 282.90 4,908.56 408.88 3,879.07 323.13 3,185.65 265.363,012.25 250.92 4,353.68 362.66 3,440.56 286.60 2,825.54 235.37 99 3,464.09 288.56 5,006.73 417.06 3,956.65 329.59 3,249.36 270.67



VIRGINIAAttained Age Rates -- Effective 7/1/2016 -- Area II (201, 220-225, 232-237)


PREFERRED ANNUAL & MONTHLY BANK DRAFT RATES



Plan A Plan F Plan G Plan NPlan A Plan FPlan G Plan N Attained Age



1,391.45 115.91 1,726.06 143.78 1,297.03 108.04 1,028.34 85.66 65 1,600.18 133.29 1,984.96 165.35 1,491.57 124.25 1,182.60 98.511,391.45 115.91 1,726.06 143.78 1,297.03 108.04 1,028.34 85.66 66 1,600.18 133.29 1,984.96 165.35 1,491.57 124.25 1,182.60 98.511,454.09 121.13 1,801.27 150.05 1,360.14 113.30 1,076.60 89.68 67 1,672.21 139.29 2,071.47 172.55 1,564.16 130.29 1,238.08 103.131,515.99 126.28 1,873.09 156.03 1,420.41 118.32 1,123.37 93.58 68 1,743.38 145.22 2,154.05 179.43 1,633.46 136.07 1,291.87 107.611,576.79 131.35 1,946.58 162.15 1,482.07 123.46 1,170.14 97.47 69 1,813.32 151.05 2,238.57 186.47 1,704.38 141.98 1,345.67 112.091,635.67 136.25 2,014.87 167.84 1,539.38 128.23 1,214.20 101.14 70 1,881.01 156.69 2,317.10 193.01 1,770.28 147.46 1,396.32 116.311,684.55 140.32 2,080.84 173.33 1,594.73 132.84 1,258.44 104.83 71 1,937.24 161.37 2,392.97 199.33 1,833.95 152.77 1,447.21 120.551,733.44 144.40 2,146.81 178.83 1,650.09 137.45 1,302.70 108.51 72 1,993.46 166.06 2,468.83 205.65 1,897.60 158.07 1,498.10 124.791,782.33 148.47 2,212.78 184.32 1,705.45 142.06 1,346.94 112.20 73 2,049.68 170.74 2,544.69 211.97 1,961.26 163.37 1,548.99 129.031,831.22 152.54 2,278.74 189.82 1,760.80 146.67 1,391.19 115.89 74 2,105.91 175.42 2,620.56 218.29 2,024.93 168.68 1,599.87 133.271,882.00 156.77 2,347.06 195.51 1,817.97 151.44 1,436.87 119.69 75 2,164.30 180.29 2,699.12 224.84 2,090.68 174.15 1,652.41 137.651,925.81 160.42 2,417.67 201.39 1,875.71 156.25 1,484.99 123.70 76 2,214.68 184.48 2,780.32 231.60 2,157.07 179.68 1,707.75 142.261,970.31 164.13 2,489.46 207.37 1,934.42 161.14 1,533.93 127.78 77 2,265.85 188.75 2,862.88 238.48 2,224.58 185.31 1,764.02 146.942,017.50 168.06 2,564.98 213.66 1,996.09 166.27 1,585.27 132.05 78 2,320.12 193.27 2,949.72 245.71 2,295.51 191.22 1,823.05 151.862,065.49 172.06 2,641.85 220.07 2,058.89 171.51 1,637.55 136.41 79 2,375.32 197.86 3,038.14 253.08 2,367.71 197.23 1,883.18 156.872,114.30 176.12 2,720.12 226.59 2,122.81 176.83 1,690.79 140.84 80 2,431.44 202.54 3,128.14 260.57 2,441.23 203.35 1,944.41 161.972,169.13 180.69 2,816.40 234.61 2,200.88 183.33 1,757.73 146.42 81 2,494.49 207.79 3,238.86 269.80 2,531.02 210.83 2,021.39 168.382,224.96 185.34 2,914.60 242.79 2,280.53 189.97 1,826.03 152.11 82 2,558.71 213.14 3,351.79 279.20 2,622.60 218.46 2,099.94 174.932,284.08 190.26 3,017.74 251.38 2,364.10 196.93 1,897.61 158.07 83 2,626.70 218.80 3,470.40 289.08 2,718.71 226.47 2,182.25 181.782,344.37 195.29 3,123.07 260.15 2,449.45 204.04 1,970.73 164.16 84 2,696.02 224.58 3,591.52 299.17 2,816.87 234.65 2,266.33 188.792,405.82 200.41 3,230.62 269.11 2,536.63 211.30 2,045.42 170.38 85 2,766.69 230.47 3,715.21 309.48 2,917.13 243.00 2,352.24 195.942,471.49 205.88 3,344.08 278.56 2,627.83 218.90 2,123.19 176.86 86 2,842.21 236.76 3,845.69 320.35 3,022.01 251.73 2,441.66 203.392,538.75 211.48 3,460.57 288.27 2,721.50 226.70 2,203.09 183.52 87 2,919.56 243.20 3,979.66 331.51 3,129.73 260.71 2,533.54 211.042,607.62 217.22 3,580.18 298.23 2,817.69 234.71 2,285.17 190.35 88 2,998.76 249.80 4,117.21 342.96 3,240.34 269.92 2,627.95 218.912,675.53 222.87 3,699.34 308.15 2,913.58 242.70 2,367.17 197.19 89 3,076.85 256.30 4,254.24 354.38 3,350.63 279.11 2,722.25 226.762,742.28 228.43 3,817.75 318.02 3,008.97 250.65 2,448.89 203.99 90 3,153.62 262.70 4,390.41 365.72 3,460.32 288.25 2,816.22 234.592,807.20 233.84 3,939.21 328.14 3,106.49 258.77 2,533.19 211.01 91 3,228.28 268.92 4,530.09 377.36 3,572.47 297.59 2,913.16 242.672,873.35 239.35 4,063.19 338.46 3,206.03 267.06 2,619.25 218.18 92 3,304.35 275.25 4,672.67 389.23 3,686.94 307.12 3,012.15 250.912,934.93 244.48 4,181.45 348.31 3,301.11 274.98 2,701.80 225.06 93 3,375.17 281.15 4,808.67 400.56 3,796.28 316.23 3,107.07 258.822,997.53 249.69 4,301.82 358.34 3,397.89 283.04 2,785.83 232.06 94 3,447.16 287.15 4,947.09 412.09 3,907.57 325.50 3,203.71 266.873,061.14 254.99 4,424.34 368.55 3,496.40 291.25 2,871.39 239.19 95 3,520.31 293.24 5,088.00 423.83 4,020.86 334.94 3,302.11 275.073,122.37 260.09 4,512.82 375.92 3,566.33 297.08 2,928.82 243.97 96 3,590.72 299.11 5,189.75 432.31 4,101.28 341.64 3,368.14 280.573,184.81 265.29 4,603.08 383.44 3,637.65 303.02 2,987.40 248.85 97 3,662.53 305.09 5,293.55 440.95 4,183.31 348.47 3,435.51 286.183,248.51 270.60 4,695.15 391.11 3,710.41 309.08 3,047.14 253.83 98 3,735.78 311.19 5,399.42 449.77 4,266.97 355.44 3,504.22 291.903,313.48 276.01 4,789.05 398.93 3,784.62 315.26 3,108.09 258.90 99 3,810.50 317.41 5,507.41 458.77 4,352.31 362.55 3,574.30 297.74



Attained Age Rates -- Effective 7/1/2016 -- Area II (201, 220-225, 232-237)STANDARD ANNUAL & MONTHLY BANK DRAFT RATES

MEDICARE SUPPLEMENTAmerican Retirement Life Insurance Company

VIRGINIA

FEMALE RATES MALE RATESPlan G Plan N Attained

AgePlan A Plan F


Plan G Plan NPlan A Plan F



2,561.36 213.36 3,137.72 261.37 2,835.53 236.20 2,252.43 187.63 65 2,945.57 245.37 3,608.39 300.58 3,260.86 271.63 2,590.29 215.772,561.36 213.36 3,137.72 261.37 2,835.53 236.20 2,252.43 187.63 66 2,945.57 245.37 3,608.39 300.58 3,260.86 271.63 2,590.29 215.772,561.36 213.36 3,137.72 261.37 2,835.53 236.20 2,252.43 187.63 67 2,945.57 245.37 3,608.39 300.58 3,260.86 271.63 2,590.29 215.772,561.36 213.36 3,137.72 261.37 2,835.53 236.20 2,252.43 187.63 68 2,945.57 245.37 3,608.39 300.58 3,260.86 271.63 2,590.29 215.772,561.36 213.36 3,137.72 261.37 2,835.53 236.20 2,252.43 187.63 69 2,945.57 245.37 3,608.39 300.58 3,260.86 271.63 2,590.29 215.772,561.36 213.36 3,137.72 261.37 2,835.53 236.20 2,252.43 187.63 70 2,945.57 245.37 3,608.39 300.58 3,260.86 271.63 2,590.29 215.772,561.36 213.36 3,137.72 261.37 2,835.53 236.20 2,252.43 187.63 71 2,945.57 245.37 3,608.39 300.58 3,260.86 271.63 2,590.29 215.772,561.36 213.36 3,144.72 261.96 2,880.47 239.94 2,284.05 190.26 72 2,945.57 245.37 3,616.42 301.25 3,312.54 275.93 2,626.65 218.802,599.48 216.54 3,199.75 266.54 2,938.89 244.81 2,331.32 194.20 73 2,989.40 249.02 3,679.71 306.52 3,379.72 281.53 2,681.02 223.332,638.85 219.82 3,255.75 271.20 2,998.01 249.73 2,379.12 198.18 74 3,034.68 252.79 3,744.11 311.88 3,447.70 287.19 2,735.98 227.912,679.16 223.17 3,312.72 275.95 3,057.85 254.72 2,427.47 202.21 75 3,081.03 256.65 3,809.63 317.34 3,516.53 292.93 2,791.59 232.542,708.04 225.58 3,370.70 280.78 3,116.42 259.60 2,478.11 206.43 76 3,114.24 259.42 3,876.30 322.90 3,583.88 298.54 2,849.84 237.392,731.08 227.50 3,421.26 284.99 3,168.10 263.90 2,523.26 210.19 77 3,140.74 261.62 3,934.45 327.74 3,643.32 303.49 2,901.74 241.722,754.87 229.48 3,472.58 289.27 3,220.45 268.26 2,568.89 213.99 78 3,168.10 263.90 3,993.46 332.66 3,703.52 308.50 2,954.22 246.092,779.40 231.52 3,524.66 293.60 3,273.47 272.68 2,615.03 217.83 79 3,196.32 266.25 4,053.36 337.65 3,764.48 313.58 3,007.29 250.512,804.67 233.63 3,577.54 298.01 3,327.18 277.15 2,661.70 221.72 80 3,225.38 268.67 4,114.16 342.71 3,826.26 318.73 3,060.96 254.982,820.71 234.97 3,631.20 302.48 3,381.58 281.69 2,712.58 225.96 81 3,243.82 270.21 4,175.87 347.85 3,888.83 323.94 3,119.47 259.852,830.78 235.80 3,676.58 306.26 3,428.22 285.57 2,757.08 229.66 82 3,255.40 271.17 4,228.07 352.20 3,942.44 328.41 3,170.64 264.112,841.77 236.72 3,722.54 310.09 3,475.28 289.49 2,801.80 233.39 83 3,268.03 272.23 4,280.93 356.60 3,996.58 332.92 3,222.08 268.402,853.63 237.71 3,769.08 313.96 3,522.82 293.45 2,846.78 237.14 84 3,281.67 273.36 4,334.43 361.06 4,051.24 337.47 3,273.79 272.712,866.33 238.77 3,816.19 317.89 3,570.83 297.45 2,892.02 240.91 85 3,296.29 274.58 4,388.62 365.57 4,106.45 342.07 3,325.82 277.042,880.23 239.92 3,863.89 321.86 3,618.38 301.41 2,936.37 244.60 86 3,312.27 275.91 4,443.47 370.14 4,161.14 346.62 3,376.83 281.292,893.32 241.01 3,910.26 325.72 3,664.66 305.27 2,979.63 248.20 87 3,327.31 277.16 4,496.80 374.58 4,214.35 351.06 3,426.57 285.432,907.00 242.15 3,957.18 329.63 3,711.42 309.16 3,023.25 251.84 88 3,343.04 278.48 4,550.76 379.08 4,268.14 355.54 3,476.73 289.612,921.26 243.34 4,004.67 333.59 3,758.70 313.10 3,067.23 255.50 89 3,359.45 279.84 4,605.37 383.63 4,322.51 360.06 3,527.31 293.832,936.09 244.58 4,052.73 337.59 3,806.50 317.08 3,111.59 259.20 90 3,376.51 281.26 4,660.63 388.23 4,377.48 364.64 3,578.33 298.072,947.89 245.56 4,101.36 341.64 3,854.39 321.07 3,156.89 262.97 91 3,390.06 282.39 4,716.56 392.89 4,432.55 369.23 3,630.42 302.412,958.92 246.48 4,148.52 345.57 3,900.88 324.94 3,200.94 266.64 92 3,402.75 283.45 4,770.80 397.41 4,486.01 373.68 3,681.09 306.632,970.64 247.45 4,196.24 349.55 3,947.84 328.86 3,245.33 270.34 93 3,416.22 284.57 4,825.67 401.98 4,540.02 378.18 3,732.13 310.892,983.01 248.48 4,244.49 353.57 3,995.30 332.81 3,290.05 274.06 94 3,430.45 285.76 4,881.16 406.60 4,594.60 382.73 3,783.55 315.172,996.02 249.57 4,293.30 357.63 4,043.26 336.80 3,335.10 277.81 95 3,445.42 287.00 4,937.29 411.28 4,649.75 387.32 3,835.37 319.493,025.98 252.06 4,336.23 361.21 4,083.69 340.17 3,368.45 280.59 96 3,479.87 289.87 4,986.67 415.39 4,696.24 391.20 3,873.72 322.683,056.24 254.58 4,379.59 364.82 4,124.52 343.57 3,402.14 283.40 97 3,514.67 292.77 5,036.53 419.54 4,743.20 395.11 3,912.46 325.913,086.80 257.13 4,423.39 368.47 4,165.77 347.01 3,436.16 286.23 98 3,549.83 295.70 5,086.89 423.74 4,790.63 399.06 3,951.58 329.173,117.67 259.70 4,467.62 372.15 4,207.43 350.48 3,470.53 289.09 99 3,585.32 298.66 5,137.77 427.98 4,838.55 403.05 3,991.10 332.46


Add one-time enrollment fee of $20.00 to the first premium.Applicants who qualify for Household Discount multiply above rates by 0.93

Attained Age

Plan A Plan F Plan G Plan NFEMALE RATES MALE RATES

Plan A Plan F Plan G Plan N

VIRGINIAAttained Age Rates -- Effective 7/1/2016 -- Area II (201, 220-225, 232-237)

STANDARD II ANNUAL & MONTHLY BANK DRAFT RATES




2,817.50 234.70 3,451.50 287.51 3,119.08 259.82 2,477.67 206.39 65 3,240.12 269.90 3,969.23 330.64 3,586.95 298.79 2,849.32 237.352,817.50 234.70 3,451.50 287.51 3,119.08 259.82 2,477.67 206.39 66 3,240.12 269.90 3,969.23 330.64 3,586.95 298.79 2,849.32 237.352,817.50 234.70 3,451.50 287.51 3,119.08 259.82 2,477.67 206.39 67 3,240.12 269.90 3,969.23 330.64 3,586.95 298.79 2,849.32 237.352,817.50 234.70 3,451.50 287.51 3,119.08 259.82 2,477.67 206.39 68 3,240.12 269.90 3,969.23 330.64 3,586.95 298.79 2,849.32 237.352,817.50 234.70 3,451.50 287.51 3,119.08 259.82 2,477.67 206.39 69 3,240.12 269.90 3,969.23 330.64 3,586.95 298.79 2,849.32 237.352,817.50 234.70 3,451.50 287.51 3,119.08 259.82 2,477.67 206.39 70 3,240.12 269.90 3,969.23 330.64 3,586.95 298.79 2,849.32 237.352,817.50 234.70 3,451.50 287.51 3,119.08 259.82 2,477.67 206.39 71 3,240.12 269.90 3,969.23 330.64 3,586.95 298.79 2,849.32 237.352,817.50 234.70 3,459.19 288.15 3,168.51 263.94 2,512.45 209.29 72 3,240.12 269.90 3,978.07 331.37 3,643.80 303.53 2,889.33 240.682,859.42 238.19 3,519.73 293.19 3,232.78 269.29 2,564.45 213.62 73 3,288.34 273.92 4,047.69 337.17 3,717.70 309.68 2,949.12 245.662,902.74 241.80 3,581.32 298.32 3,297.81 274.71 2,617.03 218.00 74 3,338.15 278.07 4,118.53 343.07 3,792.48 315.91 3,009.59 250.702,947.07 245.49 3,643.99 303.54 3,363.64 280.19 2,670.22 222.43 75 3,389.13 282.31 4,190.60 349.08 3,868.18 322.22 3,070.75 255.792,978.84 248.14 3,707.76 308.86 3,428.06 285.56 2,725.92 227.07 76 3,425.66 285.36 4,263.93 355.19 3,942.28 328.39 3,134.82 261.133,004.18 250.25 3,763.38 313.49 3,484.91 290.29 2,775.59 231.21 77 3,454.81 287.79 4,327.89 360.51 4,007.65 333.84 3,191.92 265.893,030.35 252.43 3,819.83 318.19 3,542.49 295.09 2,825.78 235.39 78 3,484.91 290.29 4,392.81 365.92 4,073.87 339.35 3,249.65 270.703,057.34 254.68 3,877.13 322.97 3,600.81 299.95 2,876.53 239.62 79 3,515.95 292.88 4,458.70 371.41 4,140.94 344.94 3,308.02 275.563,085.14 256.99 3,935.29 327.81 3,659.90 304.87 2,927.87 243.89 80 3,547.91 295.54 4,525.58 376.98 4,208.88 350.60 3,367.05 280.483,102.79 258.46 3,994.31 332.73 3,719.75 309.86 2,983.83 248.55 81 3,568.20 297.23 4,593.47 382.64 4,277.71 356.33 3,431.40 285.843,113.86 259.38 4,044.25 336.89 3,771.04 314.13 3,032.79 252.63 82 3,580.94 298.29 4,650.89 387.42 4,336.69 361.25 3,487.70 290.533,125.94 260.39 4,094.80 341.10 3,822.81 318.44 3,081.99 256.73 83 3,594.83 299.45 4,709.02 392.26 4,396.24 366.21 3,544.28 295.243,138.99 261.48 4,145.98 345.36 3,875.10 322.80 3,131.46 260.85 84 3,609.84 300.70 4,767.89 397.16 4,456.36 371.21 3,601.18 299.983,152.97 262.64 4,197.81 349.68 3,927.90 327.19 3,181.22 265.00 85 3,625.92 302.04 4,827.48 402.13 4,517.09 376.27 3,658.40 304.753,168.25 263.92 4,250.29 354.05 3,980.21 331.55 3,230.01 269.06 86 3,643.49 303.50 4,887.82 407.16 4,577.25 381.28 3,714.50 309.423,182.64 265.11 4,301.29 358.30 4,031.11 335.79 3,277.59 273.02 87 3,660.04 304.88 4,946.48 412.04 4,635.79 386.16 3,769.23 313.983,197.69 266.37 4,352.90 362.60 4,082.57 340.08 3,325.57 277.02 88 3,677.35 306.32 5,005.84 416.99 4,694.95 391.09 3,824.41 318.573,213.39 267.68 4,405.13 366.95 4,134.57 344.41 3,373.95 281.05 89 3,695.39 307.83 5,065.90 421.99 4,754.76 396.07 3,880.05 323.213,229.71 269.03 4,458.00 371.35 4,187.15 348.79 3,422.75 285.11 90 3,714.16 309.39 5,126.69 427.05 4,815.22 401.11 3,936.17 327.883,242.67 270.11 4,511.49 375.81 4,239.83 353.18 3,472.58 289.27 91 3,729.07 310.63 5,188.22 432.18 4,875.80 406.15 3,993.46 332.663,254.81 271.13 4,563.37 380.13 4,290.96 357.44 3,521.04 293.30 92 3,743.03 311.79 5,247.88 437.15 4,934.61 411.05 4,049.20 337.303,267.69 272.20 4,615.85 384.50 4,342.62 361.74 3,569.87 297.37 93 3,757.85 313.03 5,308.24 442.18 4,994.02 416.00 4,105.34 341.973,281.31 273.33 4,668.93 388.92 4,394.83 366.09 3,619.05 301.47 94 3,773.50 314.33 5,369.28 447.26 5,054.05 421.00 4,161.91 346.693,295.62 274.53 4,722.63 393.39 4,447.58 370.48 3,668.61 305.60 95 3,789.97 315.70 5,431.02 452.40 5,114.72 426.06 4,218.91 351.443,328.58 277.27 4,769.85 397.33 4,492.05 374.19 3,705.30 308.65 96 3,827.86 318.86 5,485.33 456.93 5,165.86 430.32 4,261.10 354.953,361.86 280.04 4,817.56 401.30 4,536.98 377.93 3,742.36 311.74 97 3,866.14 322.05 5,540.19 461.50 5,217.53 434.62 4,303.71 358.503,395.48 282.84 4,865.73 405.32 4,582.35 381.71 3,779.78 314.86 98 3,904.81 325.27 5,595.59 466.11 5,269.70 438.97 4,346.75 362.083,429.44 285.67 4,914.39 409.37 4,628.17 385.53 3,817.58 318.00 99 3,943.85 328.52 5,651.54 470.77 5,322.39 443.36 4,390.21 365.70


Applicants who qualify for Household Discount multiply above rates by 0.93Add one-time enrollment fee of $20.00 to the first premium.

Plan F Plan G Plan NPlan A Plan F Plan G Plan N Attained Age

Plan A

Attained Age Rates -- Effective 7/1/2016 -- Area II (201, 220-225, 232-237)STANDARD III ANNUAL & MONTHLY BANK DRAFT RATES



VIRGINIA


THIS PAGE INTENTIONALLY LEFT BLANK


Locate appropriate Area according to the Applicant's ZIP Code in the ZIP Code chart below. VIRGINIA ZIP CODES: Area 3-digit ZIP Codes Area I 226-231, 238-246 Area II 201, 220-225, 232-237


THIS PAGE INTENTIONALLY LEFT BLANK


PREMIUM INFORMATION We, American Retirement Life Insurance Company, can only raise Your premium if we raise rates for all policies like Yours in this Commonwealth. The premiums for this policy are based on Your attained age. Your premium will increase on each policy anniversary because of an increase in Your attained age. The current premiums for all ages are shown in this outline of coverage. Premiums for other Medicare Supplement policies that are issue age or community rated do not increase due to changes in Your age. While the cost of this policy at Your present age may be lower than the cost of a Medicare Supplement policy that is based on issue age or community rates, it is important to compare the potential cost of these policies over the life of the policy.

There will be a one-time enrollment fee of $20 added to the first premium.

DISCLOSURES Use this Outline to compare benefits and premiums among policies.

READ YOUR POLICY VERY CAREFULLY This is only an Outline describing Your policy’s most important features. The policy is Your insurance contract. You must read the policy itself to understand all of the rights and duties of both You and American Retirement Life Insurance Company.

30-DAY RIGHT TO RETURN POLICY If You find that You are not satisfied with Your policy, You may return it to American Retirement Life Insurance Company, P. O. Box 26580, Austin, TX 78755-0580. If You send the policy back to Us within thirty (30) days after You receive it, We will treat the policy as if it had never been issued and return all of Your premiums.

POLICY REPLACEMENT If You are replacing another health insurance policy, do NOT cancel it until You have actually received Your new policy and are sure You want to keep it.

NOTICE This policy may not fully cover all of Your medical costs. Neither American Retirement Life Insurance Company nor its agents are connected with Medicare. This Outline of Coverage does not give all the details of Medicare coverage. Contact Your local Social Security Office or consult the Medicare and You for more details.

COMPLETE ANSWERS ARE VERY IMPORTANT When You fill out the application for the new policy, be sure to answer truthfully and completely all questions about Your medical and health history. We may cancel Your policy and refuse to pay any claims if You leave out or falsify important medical information.

Review the application carefully before You sign it. Be certain that all information has been properly recorded.

RENEWABILITY This policy is guaranteed renewable for life.

HOUSEHOLD DISCOUNT Affiliate means an insurance company that is under common ownership or control with American Retirement Life Insurance Company and that is a member of the same insurance holding company system.

Household Discount is a discount that is available when more than one member of Your household enrolls or is enrolled in a Medicare Supplement policy provided by or through an Affiliate of American Retirement Life Insurance Company. Household is defined as a condominium unit, a single family home, or an apartment unit within an apartment complex.

The household premium discount will be removed if the other Medicare Supplement policyholder whose policy status entitles You to the discount no longer resides with You or no longer has a Medicare Supplement policy through an Affiliate of American Retirement Life Insurance Company. However, if that person becomes deceased, Your discount will still apply. The addition or removal of the discount will occur on the billing cycle following the date We learn Your eligibility has changed.


PLAN A MEDICARE (PART A) – HOSPITAL SERVICES – PER BENEFIT PERIOD

*A benefit period begins on the first day You receive service as an inpatient in a hospital and ends after You have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.

SERVICES MEDICARE PAYS PLAN A PAYS YOU PAY HOSPITALIZATION* Semi-private room and board, general nursing, and miscellaneous services and supplies First 60 days 61st thru 90th day 91st day and after:

– while using 60 lifetime reserve days – once lifetime reserve days are used, additional

365 days

– beyond the additional 365 days

All but $1,316 All but $329 per day All but $658 per day $0 $0

$0 $329 per day $658 per day 100% of Medicare Eligible Expenses $0

$1,316 (Part A Deductible) $0 $0 $0** All costs

SKILLED NURSING FACILITY CARE * You must meet Medicare’s requirements, including having been in a hospital for at least 3 days and entering a Medicare-approved facility within 30 days after leaving the hospital First 20 days 21st thru 100th day 101st day and after

All approved amounts All but $164.50 per day $0

$0 $0 $0

$0 Up to $164.50 per day All costs

BLOOD First 3 pints Additional amounts

$0 100%

3 pints $0

$0 $0

HOSPICE CARE You must meet Medicare’s requirements, including a doctor’s certification of terminal illness

All but very limited copayment/coinsurance for outpatient drugs and inpatient respite care

Medicare copayment/coinsurance

$0

**NOTICE: When Your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy’s “Core Benefits.” During this time, the hospital is prohibited from billing You for the balance based on any difference between its billed charges and the amount Medicare would have paid.


PLAN A MEDICARE (PART B) – MEDICAL SERVICES – PER CALENDAR YEAR

*Once You have been billed $183 of Medicare-approved amounts for covered services (which are noted with an asterisk), Your Part B Deductible will have been met for the calendar year.

SERVICES MEDICARE PAYS PLAN A PAYS YOU PAY MEDICAL EXPENSES – IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT such as physician’s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment First $183 of Medicare-approved amounts* Remainder of Medicare-approved amounts

$0 Generally 80%

$0 Generally 20%

$183 (Part B Deductible) $0

PART B EXCESS CHARGES (above Medicare-approved amounts)

$0

$0

All costs

BLOOD First 3 pints Next $183 of Medicare-approved amounts* Remainder of Medicare-approved amounts

$0 $0 80%

All costs $0 20%

$0 $183 (Part B Deductible) $0

CLINICAL LABORATORY SERVICES Tests for diagnostic services

100%

$0

$0

PARTS A & B

SERVICES MEDICARE PAYS PLAN A PAYS YOU PAY

HOME HEALTH CARE MEDICARE- APPROVED SERVICES Medically-necessary skilled care services and medical supplies – Durable medical equipment First $183 of Medicare-approved amounts* Remainder of Medicare-approved amounts

100% $0 80%

$0 $0 20%



PLAN F MEDICARE (PART A) – HOSPITAL SERVICES – PER BENEFIT PERIOD


SERVICES MEDICARE PAYS PLAN F PAYS YOU PAY HOSPITALIZATION* Semi-private room and board, general nursing, and miscellaneous services and supplies First 60 days 61st thru 90th day 91st day and after:


365 days



$1,316 (Part A Deductible) $329 per day $658 per day 100% of Medicare Eligible Expenses $0

$0 $0 $0 $0** All costs



$0 Up to $164.50 per day $0

$0 $0 All costs


$0 100%

3 pints $0

$0 $0




$0



PLAN F MEDICARE (PART B) – MEDICAL SERVICES – PER CALENDAR YEAR


SERVICES MEDICARE PAYS PLAN F PAYS YOU PAY MEDICAL EXPENSES – IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT such as physician’s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment First $183 of Medicare-approved amounts* Remainder of Medicare-approved amounts

$0 Generally 80%

$183 (Part B Deductible) Generally 20%

$0 $0


$0

100%

$0


$0 $0 80%

All costs $183 (Part B Deductible) 20%

$0 $0 $0


100%

$0

$0

PARTS A & B

SERVICES MEDICARE PAYS PLAN F PAYS YOU PAY


100% $0 80%

$0 $183 (Part B Deductible) 20%

$0 $0 $0


PLAN F MEDICARE (PART B) – MEDICAL SERVICES – PER CALENDAR YEAR (CONT’D.)

OTHER BENEFITS – NOT COVERED BY MEDICARE

SERVICES MEDICARE PAYS PLAN F PAYS YOU PAY

FOREIGN TRAVEL – NOT COVERED BY MEDICARE Medically-necessary emergency care services beginning during the first 60 days of each trip outside the USA First $250 each calendar year Remainder of charges

$0 $0

$0 80% to a lifetime maximum benefit of $50,000

$250 20% and amounts over the $50,000 lifetime maximum


PLAN G MEDICARE (PART A) – HOSPITAL SERVICES – PER BENEFIT PERIOD


SERVICES MEDICARE PAYS PLAN G PAYS YOU PAY HOSPITALIZATION* Semi-private room and board, general nursing, and miscellaneous services and supplies First 60 days 61st thru 90th day 91st day and after:


365 days




$0 $0 $0 $0** All costs



$0 Up to $164.50 per day $0

$0 $0 All costs


$0 100%

3 pints $0

$0 $0




$0



PLAN G MEDICARE (PART B) – MEDICAL SERVICES – PER CALENDAR YEAR


SERVICES MEDICARE PAYS PLAN G PAYS YOU PAY MEDICAL EXPENSES – IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT such as physician’s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment First $183 of Medicare-approved amounts* Remainder of Medicare-approved amounts

$0 Generally 80%

$0 Generally 20%

$183 (Part B Deductible) $0


$0

100%

$0


$0 $0 80%

All costs $0 20%



100%

$0

$0

PARTS A & B

SERVICES MEDICARE PAYS PLAN G PAYS YOU PAY


100% $0 80%

$0 $0 20%



PLAN G MEDICARE (PART B) – MEDICAL SERVICES – PER CALENDAR YEAR (CONT’D.)


SERVICES MEDICARE PAYS PLAN G PAYS YOU PAY


$0 $0




PLAN N MEDICARE (PART A) – HOSPITAL SERVICES – PER BENEFIT PERIOD


SERVICES MEDICARE PAYS PLAN N PAYS YOU PAY HOSPITALIZATION* Semi-private room and board, general nursing, and miscellaneous services and supplies First 60 days 61st thru 90th day 91st day and after:


365 days




$0 $0 $0 $0** All costs



$0 Up to $164.50 per day $0

$0 $0 All costs


$0 100%

3 pints $0

$0 $0




$0



PLAN N MEDICARE (PART B) – MEDICAL SERVICES – PER CALENDAR YEAR


SERVICES MEDICARE PAYS PLAN N PAYS YOU PAY MEDICAL EXPENSES – IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT such as physician’s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment First $183 of Medicare-approved amounts* Remainder of Medicare-approved amounts

$0 Generally 80%

$0 Balance, other than up to $20 per office visit and up to $50 per emergency room visit. The copayment of up to $50 is waived if the Insured is admitted to any hospital and the emergency visit is covered as a Medicare Part A expense

$183 (Part B Deductible) Up to $20 per office visit and up to $50 per emergency room visit. The copayment of up to $50 is waived if the Insured is admitted to any hospital and the emergency visit is covered as a Medicare Part A expense


$0

$0

All costs


$0 $0 80%

All costs $0 20%



100%

$0

$0


PLAN N MEDICARE (PART B) – MEDICAL SERVICES – PER CALENDAR YEAR (CONT’D.)

PARTS A & B

SERVICES MEDICARE PAYS PLAN N PAYS YOU PAY


100% $0 80%

$0 $0 20%



SERVICES MEDICARE PAYS PLAN N PAYS YOU PAY


$0 $0




AMERICAN RETIREMENT LIFE INSURANCE COMPANYagentviewcigna.com/gasbagent/cache/forms/ar-hhds... ·...

Documents

Transcript of AMERICAN RETIREMENT LIFE INSURANCE COMPANYagentviewcigna.com/gasbagent/cache/forms/ar-hhds... ·...