Plan A - US$25,000 maximum benefit per life of plan

Deductible per period of coverage Option 1
US$0.00
Option 2
US$50.00
Option 3
US$100.00
AGE
Monthly Rates
2 weeks-29 $23.00 $19.00 $17.00
30-39 $26.00 $22.00 $19.00
40-49 $27.00 $23.00 $20.00
50-59 $38.00 $31.00 $29.00
60-69 $47.00 $39.00 $36.00
70-79 N/A $61.00 $58.00
80+* N/A $122.00 $116.00
DEP. CHILD $21.00 $17.00 $16.00
*$10,000 policy maximum...
AGE
Daily Rates
2 weeks-29 $0.77 $0.64 $0.57
30-39 $0.87 $0.74 $0.64
40-49 $0.90 $0.77 $0.67
50-59 $1.27 $1.04 $0.97
60-69 $1.57 $1.30 $1.20
70-79 N/A $2.04 $1.94
80+* N/A $4.07 $3.87
DEP. CHILD $0.70 $0.57 $0.54
*$10,000 policy maximum...

Plan B - US$50,000 maximum benefit per life of plan

Deductible per period of coverage Option 4
US$0.00
Option 5
US$50.00
Option 6
US$100.00
AGE
Monthly Rates
2 weeks-29 $34.00 $29.00 $26.00
30-39 $40.00 $34.00 $31.00
40-49 $41.00 $35.00 $32.00
50-59 $57.00 $49.00 $44.00
60-69 $71.00 $59.00 $55.00
70-79 N/A $91.00 $86.00
80+* N/A N/A N/A
DEP. CHILD $31.00 $26.00 $23.00
*$10,000 policy maximum...
AGE
Daily Rates
2 weeks-29 $1.14 $0.97 $0.87
30-39 $1.34 $1.14 $1.04
40-49 $1.37 $1.17 $1.07
50-59 $1.90 $1.64 $1.47
60-69 $2.37 $1.97 $1.84
70-79 N/A $3.04 $2.87
80+* N/A N/A N/A
DEP. CHILD $1.04 $0.87 $0.77
*$10,000 policy maximum...

Plan C - US$100,000 maximum benefit per life of plan

Deductible per period of coverage Option 7
US$0.00
Option 8
US$50.00
Option 9
US$100.00
AGE
Monthly Rates
2 weeks-29 $50.00 $41.00 $38.00
30-39 $55.00 $46.00 $43.00
40-49 $56.00 $47.00 $44.00
50-59 $79.00 $65.00 $60.00
60-69 $104.00 $87.00 $85.00
70-79 N/A $136.00 $132.00
DEP. CHILD $44.00 $37.00 $34.00
AGE
Daily Rates
2 weeks-29 $1.67 $1.37 $1.27
30-39 $1.84 $1.54 $1.44
40-49 $1.87 $1.57 $1.47
50-59 $2.64 $2.17 $2.00
60-69 $3.47 $2.90 $2.84
70-79 N/A $4.54 $4.40
DEP. CHILD $1.47 $1.24 $1.14

Rates include 2.5% surplus lines tax where applicable. A dependent child is your child shown on the Application Form over 14 days and under 18 years of age, traveling with you, and for whom premium has been paid.