$2,500 Deductible + 50% ($5,000 Max)
| Age | Single | Two | Family 3+ |
|---|---|---|---|
| Under 19 | $91 | — | — |
| 20–24 | $101 | $193 | $295 |
| 25–29 | $112 | $213 | $327 |
| 30–34 | $132 | $253 | $406 |
| 35–39 | $148 | $279 | $452 |
| 40–44 | $170 | $316 | $489 |
| 45–49 | $215 | $421 | $612 |
| 50–54 | $284 | $558 | $730 |
| 55–59 | $356 | $716 | $896 |
| 60–64 | $524 | $1,027 | $1,209 |