individual and family health plan rates - bcbsil*rates subject to change 225436.1020 individual and...
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![Page 1: Individual and Family Health Plan Rates - BCBSIL*rates subject to change 225436.1020 Individual and Family Health Plan Rates New Business Rates Effective January 1, 2021* A Division](https://reader035.vdocument.in/reader035/viewer/2022071419/61171af0f00649441603111a/html5/thumbnails/1.jpg)
*rates subject to change
225436.1020
Individual and Family Health Plan Rates
New Business Rates Effective January 1, 2021*
A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
NOT FOR DISTRIBUTION TO BENEFICIARIES, MEMBERS, OR PROSPECTS
![Page 2: Individual and Family Health Plan Rates - BCBSIL*rates subject to change 225436.1020 Individual and Family Health Plan Rates New Business Rates Effective January 1, 2021* A Division](https://reader035.vdocument.in/reader035/viewer/2022071419/61171af0f00649441603111a/html5/thumbnails/2.jpg)
Rating Area Rating Area Description1 Chicago - Central, IL2 Chicago - North, IL3 Chicago - West, IL4 Chicago - South, IL5 Rockford, IL6 Quad Cities, IL7 Peoria, IL8 Bloomington, IL9 Champaign, IL
10 Springfield, IL11 East St. Louis, IL12 St. Louis, IL13 Southern, IL
Illinois Rating Area Descriptions
Rates Effective January 1, 2021 Page 1 of 44
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County Rating Area County Rating AreaAdams 10 Lee 5
Alexander 13 Livingston 8Bond 11 Logan 10
Boone 5 Macon 10Brown 10 Macoupin 11Bureau 6 Madison 12Calhoun 11 Marion 13Carroll 5 Marshall 7Cass 10 Mason 10
Champaign 9 Massac 13Christian 10 McDonough 7
Clark 9 McHenry 2Clay 13 McLean 8
Clinton 11 Menard 10Coles 9 Mercer 6Cook 1 Monroe 12
Crawford 13 Montgomery 11Cumberland 9 Morgan 10
DeKalb 5 Moultrie 10DeWitt 8 Ogle 5Douglas 9 Peoria 7Dupage 3 Perry 13Edgar 9 Piatt 9
Edwards 13 Pike 10Effingham 13 Pope 13
Fayette 13 Pulaski 13Ford 9 Putnam 7
Franklin 13 Randolph 11Fulton 7 Richland 13
Gallatin 13 Rock Island 6Greene 11 Saline 13Grundy 4 Sangamon 10
Hamilton 13 Schuyler 10Hancock 6 Scott 10Hardin 13 Shelby 10
Henderson 6 St. Clair 12Henry 6 Stark 7
Iroquois 9 Stephenson 5Jackson 13 Tazewell 7Jasper 13 Union 13
Jefferson 13 Vermilion 9Jersey 11 Wabash 13
Jo Daviess 5 Warren 6Johnson 13 Washington 11
Kane 3 Wayne 13Kankakee 4 White 13
Kendall 4 Whiteside 6Knox 7 Will 4Lake 2 Williamson 13
LaSalle 7 Winnebago 5Lawrence 13 Woodford 7
Illinois County Mapping
Rates Effective January 1, 2021 Page 2 of 44
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Individual Coverage
Plan
Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco
0-14 $338.03 $338.03 $378.79 $378.79 $246.54 $246.54 $296.61 $296.6115 $368.08 $368.08 $412.46 $412.46 $268.45 $268.45 $322.97 $322.9716 $379.57 $379.57 $425.33 $425.33 $276.83 $276.83 $333.05 $333.0517 $391.05 $391.05 $438.20 $438.20 $285.21 $285.21 $343.13 $343.1318 $403.43 $403.43 $452.07 $452.07 $294.23 $294.23 $353.99 $353.9919 $415.80 $415.80 $465.93 $465.93 $303.26 $303.26 $364.85 $364.8520 $428.61 $428.61 $480.29 $480.29 $312.60 $312.60 $376.09 $376.0921 $441.87 $441.87 $495.14 $495.14 $322.27 $322.27 $387.72 $387.7222 $441.87 $441.87 $495.14 $495.14 $322.27 $322.27 $387.72 $387.7223 $441.87 $441.87 $495.14 $495.14 $322.27 $322.27 $387.72 $387.7224 $441.87 $441.87 $495.14 $495.14 $322.27 $322.27 $387.72 $387.7225 $443.64 $443.64 $497.12 $497.12 $323.56 $323.56 $389.27 $389.2726 $452.47 $452.47 $507.03 $507.03 $330.01 $330.01 $397.03 $397.0327 $463.08 $463.08 $518.91 $518.91 $337.74 $337.74 $406.33 $406.3328 $480.31 $480.31 $538.22 $538.22 $350.31 $350.31 $421.45 $421.4529 $494.45 $494.45 $554.07 $554.07 $360.62 $360.62 $433.86 $433.8630 $501.52 $568.83 $561.99 $637.41 $365.78 $414.87 $440.06 $499.1231 $512.13 $580.86 $573.87 $650.89 $373.51 $423.64 $449.37 $509.6732 $522.73 $592.88 $585.76 $664.36 $381.25 $432.41 $458.67 $520.2333 $529.36 $600.40 $593.18 $672.79 $386.08 $437.89 $464.49 $526.8234 $536.43 $608.42 $601.11 $681.77 $391.24 $443.74 $470.69 $533.8635 $539.96 $662.97 $605.07 $742.90 $393.82 $483.53 $473.79 $581.7236 $543.50 $667.31 $609.03 $747.76 $396.39 $486.69 $476.90 $585.5337 $547.03 $671.65 $612.99 $752.63 $398.97 $489.86 $480.00 $589.3438 $550.57 $675.99 $616.95 $757.49 $401.55 $493.02 $483.10 $593.1539 $557.64 $684.67 $624.87 $767.22 $406.71 $499.35 $489.30 $600.7740 $564.71 $728.14 $632.79 $815.92 $411.86 $531.06 $495.51 $638.9141 $575.31 $741.81 $644.68 $831.25 $419.60 $541.03 $504.81 $650.9142 $585.48 $754.92 $656.07 $845.93 $427.01 $550.59 $513.73 $662.4143 $599.62 $773.15 $671.91 $866.36 $437.32 $563.89 $526.14 $678.4044 $617.29 $795.94 $691.72 $891.90 $450.21 $580.51 $541.65 $698.4045 $638.06 $841.35 $714.99 $942.78 $465.36 $613.63 $559.87 $738.2446 $662.80 $873.97 $742.72 $979.35 $483.41 $637.42 $581.58 $766.8747 $690.64 $910.68 $773.91 $1,020.48 $503.71 $664.19 $606.01 $799.0848 $722.46 $952.63 $809.56 $1,067.49 $526.91 $694.79 $633.92 $835.8949 $753.83 $994.00 $844.72 $1,113.84 $549.80 $724.96 $661.45 $872.1950 $789.18 $1,043.45 $884.33 $1,169.26 $575.58 $761.03 $692.47 $915.5851 $824.09 $1,089.61 $923.44 $1,220.98 $601.04 $794.69 $723.10 $956.0852 $862.53 $1,140.44 $966.52 $1,277.93 $629.07 $831.76 $756.83 $1,000.6853 $901.41 $1,191.85 $1,010.09 $1,335.55 $657.43 $869.26 $790.95 $1,045.8054 $943.39 $1,247.35 $1,057.13 $1,397.74 $688.05 $909.74 $827.78 $1,094.5055 $985.37 $1,289.06 $1,104.17 $1,444.48 $718.67 $940.16 $864.62 $1,131.0956 $1,030.88 $1,348.60 $1,155.17 $1,511.20 $751.86 $983.58 $904.55 $1,183.3457 $1,076.84 $1,408.72 $1,206.67 $1,578.56 $785.38 $1,027.43 $944.88 $1,236.0858 $1,125.88 $1,472.88 $1,261.63 $1,650.46 $821.15 $1,074.23 $987.91 $1,292.3959 $1,150.19 $1,504.67 $1,288.86 $1,686.09 $838.87 $1,097.41 $1,009.24 $1,320.2860 $1,199.23 $1,540.78 $1,343.82 $1,726.54 $874.65 $1,123.75 $1,052.27 $1,351.9661 $1,241.65 $1,595.28 $1,391.36 $1,787.61 $905.58 $1,163.50 $1,089.50 $1,399.7862 $1,269.49 $1,631.04 $1,422.55 $1,827.69 $925.89 $1,189.58 $1,113.92 $1,431.1763 $1,304.40 $1,675.89 $1,461.67 $1,877.95 $951.35 $1,222.29 $1,144.55 $1,470.52
64+ $1,325.61 $1,703.14 $1,485.42 $1,908.48 $966.81 $1,242.17 $1,163.16 $1,494.43
BlueCare Direct GoldSM with Advocate
409
Chicago - Central, IL
Illinois Off Exchange (Gold)
211204
Blue Choice Preferred Gold PPOSM Blue FocusCare GoldSM
207
Blue Precision Gold HMOSM
Rates Effective January 1, 2021 Page 3 of 44
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Individual Coverage
Plan
Age Non Tobacco Tobacco Non Tobacco Tobacco
0-14 $333.25 $333.25 $367.71 $367.7115 $362.87 $362.87 $400.40 $400.4016 $374.20 $374.20 $412.89 $412.8917 $385.52 $385.52 $425.39 $425.3918 $397.72 $397.72 $438.85 $438.8519 $409.92 $409.92 $452.31 $452.3120 $422.55 $422.55 $466.25 $466.2521 $435.62 $435.62 $480.67 $480.6722 $435.62 $435.62 $480.67 $480.6723 $435.62 $435.62 $480.67 $480.6724 $435.62 $435.62 $480.67 $480.6725 $437.36 $437.36 $482.59 $482.5926 $446.08 $446.08 $492.20 $492.2027 $456.53 $456.53 $503.74 $503.7428 $473.52 $473.52 $522.48 $522.4829 $487.46 $487.46 $537.87 $537.8730 $494.43 $560.78 $545.56 $618.7731 $504.88 $572.64 $557.09 $631.8632 $515.34 $584.50 $568.63 $644.9433 $521.87 $591.91 $575.84 $653.1234 $528.84 $599.82 $583.53 $661.8435 $532.33 $653.59 $587.37 $721.1836 $535.81 $657.87 $591.22 $725.9037 $539.30 $662.15 $595.07 $730.6238 $542.78 $666.43 $598.91 $735.3439 $549.75 $674.99 $606.60 $744.7840 $556.72 $717.84 $614.29 $792.0741 $567.18 $731.32 $625.83 $806.9442 $577.20 $744.24 $636.88 $821.2043 $591.14 $762.21 $652.26 $841.0344 $608.56 $784.68 $671.49 $865.8245 $629.04 $829.45 $694.08 $915.2246 $653.43 $861.61 $721.00 $950.7147 $680.88 $897.80 $751.28 $990.6448 $712.24 $939.16 $785.89 $1,036.2749 $743.17 $979.94 $820.02 $1,081.2750 $778.02 $1,028.70 $858.47 $1,135.0751 $812.43 $1,074.20 $896.44 $1,185.2852 $850.33 $1,124.31 $938.26 $1,240.5753 $888.67 $1,175.00 $980.56 $1,296.5054 $930.05 $1,229.71 $1,026.22 $1,356.8755 $971.43 $1,270.83 $1,071.89 $1,402.2456 $1,016.30 $1,329.53 $1,121.40 $1,467.0157 $1,061.61 $1,388.79 $1,171.38 $1,532.4058 $1,109.96 $1,452.05 $1,224.74 $1,602.2059 $1,133.92 $1,483.39 $1,251.18 $1,636.7960 $1,182.28 $1,518.99 $1,304.53 $1,676.0661 $1,224.09 $1,572.72 $1,350.67 $1,735.3562 $1,251.54 $1,607.98 $1,380.96 $1,774.2563 $1,285.95 $1,652.19 $1,418.93 $1,823.04
64+ $1,306.86 $1,679.06 $1,442.01 $1,852.68
Illinois Off Exchange (Gold)
204
Chicago - North, ILBlue Choice Preferred Gold PPOSM
207Blue Precision Gold HMOSM
Rates Effective January 1, 2021 Page 4 of 44
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Individual Coverage
Plan
Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco
0-14 $321.55 $321.55 $356.76 $356.76 $304.89 $304.8915 $350.14 $350.14 $388.47 $388.47 $331.99 $331.9916 $361.07 $361.07 $400.60 $400.60 $342.36 $342.3617 $371.99 $371.99 $412.72 $412.72 $352.72 $352.7218 $383.76 $383.76 $425.78 $425.78 $363.88 $363.8819 $395.53 $395.53 $438.84 $438.84 $375.04 $375.0420 $407.72 $407.72 $452.36 $452.36 $386.59 $386.5921 $420.33 $420.33 $466.35 $466.35 $398.55 $398.5522 $420.33 $420.33 $466.35 $466.35 $398.55 $398.5523 $420.33 $420.33 $466.35 $466.35 $398.55 $398.5524 $420.33 $420.33 $466.35 $466.35 $398.55 $398.5525 $422.01 $422.01 $468.22 $468.22 $400.15 $400.1526 $430.42 $430.42 $477.54 $477.54 $408.12 $408.1227 $440.51 $440.51 $488.74 $488.74 $417.68 $417.6828 $456.90 $456.90 $506.92 $506.92 $433.23 $433.2329 $470.35 $470.35 $521.85 $521.85 $445.98 $445.9830 $477.08 $541.10 $529.31 $600.34 $452.36 $513.0631 $487.17 $552.54 $540.50 $613.04 $461.92 $523.9132 $497.25 $563.99 $551.69 $625.73 $471.49 $534.7633 $503.56 $571.14 $558.69 $633.66 $477.46 $541.5434 $510.28 $578.77 $566.15 $642.13 $483.84 $548.7735 $513.65 $630.66 $569.88 $699.70 $487.03 $597.9736 $517.01 $634.78 $573.61 $704.28 $490.22 $601.8937 $520.37 $638.91 $577.34 $708.86 $493.41 $605.8138 $523.74 $643.04 $581.07 $713.44 $496.59 $609.7239 $530.46 $651.30 $588.54 $722.60 $502.97 $617.5540 $537.19 $692.65 $596.00 $768.48 $509.35 $656.7541 $547.27 $705.66 $607.19 $782.91 $518.91 $669.0942 $556.94 $718.12 $617.92 $796.74 $528.08 $680.9143 $570.39 $735.47 $632.84 $815.98 $540.83 $697.3544 $587.21 $757.14 $651.49 $840.03 $556.78 $717.9145 $606.96 $800.34 $673.41 $887.96 $575.51 $758.8746 $630.50 $831.38 $699.53 $922.40 $597.83 $788.2947 $656.98 $866.29 $728.91 $961.14 $622.94 $821.4048 $687.24 $906.20 $762.48 $1,005.41 $651.63 $859.2449 $717.09 $945.55 $795.60 $1,049.07 $679.93 $896.5550 $750.72 $992.60 $832.90 $1,101.27 $711.81 $941.1651 $783.92 $1,036.50 $869.75 $1,149.98 $743.30 $982.7952 $820.49 $1,084.85 $910.32 $1,203.62 $777.97 $1,028.6353 $857.48 $1,133.76 $951.36 $1,257.88 $813.04 $1,075.0154 $897.41 $1,186.56 $995.66 $1,316.46 $850.91 $1,125.0755 $937.34 $1,226.23 $1,039.96 $1,360.48 $888.77 $1,162.6956 $980.64 $1,282.87 $1,088.00 $1,423.32 $929.82 $1,216.3957 $1,024.35 $1,340.06 $1,136.50 $1,486.77 $971.27 $1,270.6158 $1,071.01 $1,401.09 $1,188.26 $1,554.48 $1,015.51 $1,328.4959 $1,094.13 $1,431.34 $1,213.91 $1,588.04 $1,037.43 $1,357.1660 $1,140.78 $1,465.68 $1,265.68 $1,626.14 $1,081.67 $1,389.7361 $1,181.14 $1,517.52 $1,310.45 $1,683.66 $1,119.93 $1,438.8962 $1,207.62 $1,551.55 $1,339.83 $1,721.41 $1,145.04 $1,471.1463 $1,240.82 $1,594.21 $1,376.67 $1,768.74 $1,176.52 $1,511.60
64+ $1,260.99 $1,620.13 $1,399.05 $1,797.50 $1,195.65 $1,536.18
207
Illinois Off Exchange (Gold)
Chicago - West, ILBlue Precision Gold HMOSM Blue Choice Preferred Gold PPOSM BlueCare Direct GoldSM with
Advocate204 409
Rates Effective January 1, 2021 Page 5 of 44
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Individual Coverage
Plan
Age Non Tobacco Tobacco Non Tobacco Tobacco
0-14 $310.61 $310.61 $352.00 $352.0015 $338.22 $338.22 $383.28 $383.2816 $348.78 $348.78 $395.25 $395.2517 $359.33 $359.33 $407.21 $407.2118 $370.70 $370.70 $420.09 $420.0919 $382.07 $382.07 $432.98 $432.9820 $393.85 $393.85 $446.32 $446.3221 $406.03 $406.03 $460.13 $460.1322 $406.03 $406.03 $460.13 $460.1323 $406.03 $406.03 $460.13 $460.1324 $406.03 $406.03 $460.13 $460.1325 $407.65 $407.65 $461.97 $461.9726 $415.77 $415.77 $471.17 $471.1727 $425.52 $425.52 $482.21 $482.2128 $441.35 $441.35 $500.16 $500.1629 $454.34 $454.34 $514.88 $514.8830 $460.84 $522.69 $522.24 $592.3331 $470.59 $533.74 $533.29 $604.8532 $480.33 $544.79 $544.33 $617.3833 $486.42 $551.70 $551.23 $625.2034 $492.92 $559.07 $558.59 $633.5635 $496.17 $609.19 $562.27 $690.3636 $499.41 $613.18 $565.95 $694.8837 $502.66 $617.17 $569.64 $699.4038 $505.91 $621.16 $573.32 $703.9239 $512.41 $629.13 $580.68 $712.9640 $518.90 $669.07 $588.04 $758.2241 $528.65 $681.64 $599.08 $772.4642 $537.99 $693.68 $609.67 $786.1143 $550.98 $710.43 $624.39 $805.0944 $567.22 $731.37 $642.80 $828.8245 $586.30 $773.10 $664.42 $876.1146 $609.04 $803.08 $690.19 $910.0847 $634.62 $836.81 $719.18 $948.3148 $663.86 $875.36 $752.31 $991.9949 $692.68 $913.37 $784.97 $1,035.0750 $725.17 $958.81 $821.78 $1,086.5651 $757.24 $1,001.22 $858.13 $1,134.6252 $792.57 $1,047.93 $898.17 $1,187.5553 $828.30 $1,095.17 $938.66 $1,241.0954 $866.87 $1,146.18 $982.37 $1,298.8955 $905.44 $1,184.50 $1,026.08 $1,342.3256 $947.26 $1,239.21 $1,073.47 $1,404.3257 $989.49 $1,294.45 $1,121.33 $1,466.9258 $1,034.56 $1,353.41 $1,172.40 $1,533.7359 $1,056.89 $1,382.62 $1,197.71 $1,566.8460 $1,101.96 $1,415.80 $1,248.78 $1,604.4461 $1,140.94 $1,465.88 $1,292.95 $1,661.1962 $1,166.52 $1,498.74 $1,321.94 $1,698.4363 $1,198.59 $1,539.95 $1,358.29 $1,745.13
64+ $1,218.09 $1,564.99 $1,380.39 $1,773.51
Illinois Off Exchange (Gold)
204
Chicago - South, ILBlue Choice Preferred Gold PPOSM
207Blue Precision Gold HMOSM
Rates Effective January 1, 2021 Page 6 of 44
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Individual Coverage
Plan
Age Non Tobacco Tobacco Non Tobacco Tobacco
0-14 $344.39 $344.39 $438.94 $438.9415 $375.01 $375.01 $477.96 $477.9616 $386.71 $386.71 $492.87 $492.8717 $398.42 $398.42 $507.79 $507.7918 $411.02 $411.02 $523.86 $523.8619 $423.63 $423.63 $539.92 $539.9220 $436.68 $436.68 $556.56 $556.5621 $450.19 $450.19 $573.78 $573.7822 $450.19 $450.19 $573.78 $573.7823 $450.19 $450.19 $573.78 $573.7824 $450.19 $450.19 $573.78 $573.7825 $451.99 $451.99 $576.07 $576.0726 $460.99 $460.99 $587.55 $587.5527 $471.80 $471.80 $601.32 $601.3228 $489.36 $489.36 $623.70 $623.7029 $503.76 $503.76 $642.06 $642.0630 $510.96 $579.54 $651.24 $738.6431 $521.77 $591.79 $665.01 $754.2532 $532.57 $604.05 $678.78 $769.8733 $539.33 $611.70 $687.39 $779.6334 $546.53 $619.87 $696.57 $790.0535 $550.13 $675.45 $701.16 $860.8836 $553.73 $679.87 $705.75 $866.5137 $557.33 $684.30 $710.34 $872.1538 $560.94 $688.72 $714.93 $877.7939 $568.14 $697.56 $724.11 $889.0640 $575.34 $741.84 $733.29 $945.5041 $586.15 $755.78 $747.06 $963.2642 $596.50 $769.13 $760.26 $980.2843 $610.91 $787.70 $778.62 $1,003.9544 $628.91 $810.92 $801.57 $1,033.5445 $650.07 $857.19 $828.53 $1,092.5146 $675.28 $890.43 $860.67 $1,134.8747 $703.65 $927.83 $896.81 $1,182.5448 $736.06 $970.57 $938.13 $1,237.0149 $768.02 $1,012.71 $978.86 $1,290.7350 $804.04 $1,063.10 $1,024.77 $1,354.9551 $839.60 $1,110.12 $1,070.09 $1,414.8852 $878.77 $1,161.91 $1,120.01 $1,480.8853 $918.39 $1,214.29 $1,170.51 $1,547.6454 $961.15 $1,270.84 $1,225.01 $1,619.7255 $1,003.92 $1,313.33 $1,279.52 $1,673.8856 $1,050.29 $1,373.99 $1,338.62 $1,751.1957 $1,097.11 $1,435.24 $1,398.30 $1,829.2558 $1,147.08 $1,500.61 $1,461.98 $1,912.5759 $1,171.84 $1,533.00 $1,493.54 $1,953.8560 $1,221.81 $1,569.79 $1,557.23 $2,000.7361 $1,265.03 $1,625.31 $1,612.31 $2,071.5062 $1,293.39 $1,661.75 $1,648.46 $2,117.9463 $1,328.96 $1,707.45 $1,693.79 $2,176.18
64+ $1,350.57 $1,735.21 $1,721.34 $2,211.57
207
Illinois Off Exchange (Gold)
Rockford, ILBlue Precision Gold HMOSM Blue Choice Preferred Gold PPOSM
204
Rates Effective January 1, 2021 Page 7 of 44
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Individual Coverage
Plan
Age Non Tobacco Tobacco
0-14 $381.73 $381.7315 $415.66 $415.6616 $428.64 $428.6417 $441.61 $441.6118 $455.58 $455.5819 $469.55 $469.5520 $484.03 $484.0321 $498.99 $498.9922 $498.99 $498.9923 $498.99 $498.9924 $498.99 $498.9925 $500.99 $500.9926 $510.97 $510.9727 $522.95 $522.9528 $542.41 $542.4129 $558.38 $558.3830 $566.36 $642.3731 $578.34 $655.9532 $590.31 $669.5333 $597.80 $678.0234 $605.78 $687.0835 $609.77 $748.6836 $613.76 $753.5837 $617.76 $758.4838 $621.75 $763.3839 $629.73 $773.1840 $637.72 $822.2741 $649.69 $837.7142 $661.17 $852.5143 $677.14 $873.1044 $697.10 $898.8345 $720.55 $950.1246 $748.49 $986.9647 $779.93 $1,028.4148 $815.86 $1,075.7949 $851.29 $1,122.5050 $891.20 $1,178.3551 $930.63 $1,230.4752 $974.04 $1,287.8753 $1,017.95 $1,345.9354 $1,065.35 $1,408.6155 $1,112.76 $1,455.7156 $1,164.16 $1,522.9557 $1,216.05 $1,590.8458 $1,271.44 $1,663.2959 $1,298.88 $1,699.2060 $1,354.27 $1,739.9761 $1,402.18 $1,801.5262 $1,433.61 $1,841.9163 $1,473.03 $1,892.55
64+ $1,496.97 $1,923.33
Illinois Off Exchange (Gold)
Quad Cities, ILBlue Choice Preferred Gold PPOSM
204
Rates Effective January 1, 2021 Page 8 of 44
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Illinois Off Exchange (Gold)Individual Coverage
Plan
Age Non Tobacco Tobacco Non Tobacco Tobacco
0-14 $397.14 $397.14 $422.88 $422.8815 $432.44 $432.44 $460.47 $460.4716 $445.94 $445.94 $474.84 $474.8417 $459.44 $459.44 $489.22 $489.2218 $473.98 $473.98 $504.69 $504.6919 $488.51 $488.51 $520.17 $520.1720 $503.57 $503.57 $536.20 $536.2021 $519.14 $519.14 $552.79 $552.7922 $519.14 $519.14 $552.79 $552.7923 $519.14 $519.14 $552.79 $552.7924 $519.14 $519.14 $552.79 $552.7925 $521.22 $521.22 $555.00 $555.0026 $531.60 $531.60 $566.05 $566.0527 $544.06 $544.06 $579.32 $579.3228 $564.31 $564.31 $600.88 $600.8829 $580.92 $580.92 $618.57 $618.5730 $589.23 $668.30 $627.41 $711.6131 $601.68 $682.43 $640.68 $726.6632 $614.14 $696.56 $653.95 $741.7133 $621.93 $705.39 $662.24 $751.1134 $630.24 $714.82 $671.08 $761.1435 $634.39 $778.90 $675.51 $829.3936 $638.54 $784.00 $679.93 $834.8137 $642.70 $789.11 $684.35 $840.2538 $646.85 $794.20 $688.77 $845.6839 $655.16 $804.40 $697.62 $856.5340 $663.46 $855.47 $706.46 $910.9141 $675.92 $871.53 $719.73 $928.0242 $687.86 $886.93 $732.44 $944.4143 $704.47 $908.35 $750.13 $967.2244 $725.24 $935.12 $772.24 $995.7345 $749.64 $988.48 $798.22 $1,052.5446 $778.71 $1,026.81 $829.18 $1,093.3647 $811.42 $1,069.93 $864.01 $1,139.2848 $848.80 $1,119.22 $903.81 $1,191.7649 $885.65 $1,167.82 $943.06 $1,243.5150 $927.19 $1,225.93 $987.28 $1,305.3851 $968.20 $1,280.15 $1,030.95 $1,363.1252 $1,013.36 $1,339.87 $1,079.04 $1,426.7153 $1,059.05 $1,400.27 $1,127.69 $1,491.0354 $1,108.37 $1,465.48 $1,180.20 $1,560.4655 $1,157.68 $1,514.49 $1,232.72 $1,612.6456 $1,211.16 $1,584.43 $1,289.65 $1,687.1257 $1,265.15 $1,655.06 $1,347.14 $1,762.3358 $1,322.77 $1,730.45 $1,408.50 $1,842.6059 $1,351.32 $1,767.80 $1,438.91 $1,882.3760 $1,408.95 $1,810.22 $1,500.26 $1,927.5461 $1,458.79 $1,874.25 $1,553.33 $1,995.7262 $1,491.49 $1,916.27 $1,588.16 $2,040.4763 $1,532.50 $1,968.96 $1,631.83 $2,096.57
64+ $1,557.42 $2,000.98 $1,658.37 $2,130.66
Blue Choice Preferred Gold PPOSM
204
Peoria, IL
207Blue Precision Gold HMOSM
Rates Effective January 1, 2021 Page 9 of 44
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Individual Coverage
Plan
Age Non Tobacco Tobacco
0-14 $404.24 $404.2415 $440.18 $440.1816 $453.92 $453.9217 $467.65 $467.6518 $482.45 $482.4519 $497.25 $497.2520 $512.57 $512.5721 $528.42 $528.4222 $528.42 $528.4223 $528.42 $528.4224 $528.42 $528.4225 $530.54 $530.5426 $541.11 $541.1127 $553.79 $553.7928 $574.40 $574.4029 $591.31 $591.3130 $599.76 $680.2531 $612.44 $694.6332 $625.12 $709.0233 $633.05 $718.0134 $641.51 $727.6035 $645.73 $792.8336 $649.96 $798.0237 $654.19 $803.2138 $658.42 $808.4039 $666.87 $818.7840 $675.32 $870.7641 $688.01 $887.1242 $700.16 $902.7943 $717.07 $924.5944 $738.21 $951.8445 $763.04 $1,006.1546 $792.63 $1,045.1747 $825.93 $1,089.0648 $863.97 $1,139.2349 $901.49 $1,188.7050 $943.76 $1,247.8551 $985.51 $1,303.0452 $1,031.48 $1,363.8253 $1,077.98 $1,425.3154 $1,128.18 $1,491.6955 $1,178.38 $1,541.5656 $1,232.81 $1,612.7657 $1,287.77 $1,684.6658 $1,346.42 $1,761.3959 $1,375.49 $1,799.4160 $1,434.14 $1,842.5961 $1,484.87 $1,907.7662 $1,518.16 $1,950.5363 $1,559.91 $2,004.17
64+ $1,585.26 $2,036.75
Blue Choice Preferred Gold PPOSM
204
Bloomington, IL
Illinois Off Exchange (Gold)
Rates Effective January 1, 2021 Page 10 of 44
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Individual Coverage
Plan
Age Non Tobacco Tobacco
0-14 $436.92 $436.9215 $475.75 $475.7516 $490.60 $490.6017 $505.45 $505.4518 $521.45 $521.4519 $537.44 $537.4420 $554.00 $554.0021 $571.13 $571.1322 $571.13 $571.1323 $571.13 $571.1324 $571.13 $571.1325 $573.42 $573.4226 $584.84 $584.8427 $598.55 $598.5528 $620.82 $620.8229 $639.10 $639.1030 $648.24 $735.2331 $661.94 $750.7832 $675.65 $766.3233 $684.22 $776.0434 $693.36 $786.4135 $697.93 $856.9136 $702.49 $862.5237 $707.06 $868.1438 $711.63 $873.7439 $720.77 $884.9640 $729.91 $941.1441 $743.62 $958.8242 $756.75 $975.7643 $775.03 $999.3244 $797.87 $1,028.7845 $824.72 $1,087.4746 $856.70 $1,129.6547 $892.68 $1,177.0948 $933.80 $1,231.3149 $974.35 $1,284.7850 $1,020.05 $1,348.7051 $1,065.16 $1,408.3652 $1,114.85 $1,474.0653 $1,165.11 $1,540.5154 $1,219.37 $1,612.2555 $1,273.63 $1,666.1656 $1,332.46 $1,743.1257 $1,391.85 $1,820.8258 $1,455.25 $1,903.7659 $1,486.66 $1,944.8560 $1,550.06 $1,991.5261 $1,604.89 $2,061.9662 $1,640.87 $2,108.1963 $1,685.99 $2,166.16
64+ $1,713.39 $2,201.38
Illinois Off Exchange (Gold)
Champaign, ILBlue Choice Preferred Gold PPOSM
204
Rates Effective January 1, 2021 Page 11 of 44
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Individual Coverage
Plan
Age Non Tobacco Tobacco
0-14 $399.71 $399.7115 $435.24 $435.2416 $448.83 $448.8317 $462.41 $462.4118 $477.04 $477.0419 $491.67 $491.6720 $506.82 $506.8221 $522.50 $522.5022 $522.50 $522.5023 $522.50 $522.5024 $522.50 $522.5025 $524.59 $524.5926 $535.04 $535.0427 $547.58 $547.5828 $567.96 $567.9629 $584.68 $584.6830 $593.04 $672.6231 $605.58 $686.8532 $618.12 $701.0733 $625.95 $709.9634 $634.31 $719.4435 $638.49 $783.9436 $642.67 $789.0737 $646.85 $794.2138 $651.03 $799.3439 $659.39 $809.6040 $667.75 $861.0041 $680.29 $877.1742 $692.31 $892.6743 $709.03 $914.2344 $729.93 $941.1745 $754.49 $994.8746 $783.75 $1,033.4547 $816.67 $1,076.8548 $854.29 $1,126.4649 $891.38 $1,175.3850 $933.18 $1,233.8551 $974.46 $1,288.4352 $1,019.92 $1,348.5353 $1,065.90 $1,409.3354 $1,115.53 $1,474.9655 $1,165.17 $1,524.2856 $1,218.99 $1,594.6857 $1,273.33 $1,665.7758 $1,331.33 $1,741.6459 $1,360.06 $1,779.2360 $1,418.06 $1,821.9361 $1,468.22 $1,886.3762 $1,501.14 $1,928.6663 $1,542.42 $1,981.70
64+ $1,567.50 $2,013.92
Illinois Off Exchange (Gold)
Springfield, ILBlue Choice Preferred Gold PPOSM
204
Rates Effective January 1, 2021 Page 12 of 44
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Individual Coverage
Plan
Age Non Tobacco Tobacco
0-14 $404.87 $404.8715 $440.85 $440.8516 $454.61 $454.6117 $468.37 $468.3718 $483.19 $483.1919 $498.01 $498.0120 $513.36 $513.3621 $529.24 $529.2422 $529.24 $529.2423 $529.24 $529.2424 $529.24 $529.2425 $531.35 $531.3526 $541.94 $541.9427 $554.64 $554.6428 $575.28 $575.2829 $592.22 $592.2230 $600.68 $681.3031 $613.39 $695.7032 $626.09 $710.1133 $634.03 $719.1134 $642.49 $728.7235 $646.73 $794.0536 $650.96 $799.2537 $655.20 $804.4538 $659.43 $809.6539 $667.90 $820.0440 $676.36 $872.1041 $689.07 $888.4842 $701.24 $904.1843 $718.17 $926.0244 $739.34 $953.3145 $764.22 $1,007.7046 $793.86 $1,046.7847 $827.20 $1,090.7448 $865.30 $1,140.9949 $902.88 $1,190.5350 $945.22 $1,249.7751 $987.03 $1,305.0552 $1,033.07 $1,365.9253 $1,079.64 $1,427.5154 $1,129.92 $1,493.9855 $1,180.20 $1,543.9456 $1,234.71 $1,615.2557 $1,289.75 $1,687.2558 $1,348.50 $1,764.1059 $1,377.60 $1,802.1860 $1,436.35 $1,845.4261 $1,487.16 $1,910.7062 $1,520.50 $1,953.5463 $1,562.31 $2,007.25
64+ $1,587.72 $2,039.89
Illinois Off Exchange (Gold)
East St. Louis, ILBlue Choice Preferred Gold PPOSM
204
Rates Effective January 1, 2021 Page 13 of 44
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Individual Coverage
Plan
Age Non Tobacco Tobacco
0-14 $366.61 $366.6115 $399.20 $399.2016 $411.66 $411.6617 $424.12 $424.1218 $437.54 $437.5419 $450.96 $450.9620 $464.86 $464.8621 $479.23 $479.2322 $479.23 $479.2323 $479.23 $479.2324 $479.23 $479.2325 $481.15 $481.1526 $490.74 $490.7427 $502.24 $502.2428 $520.93 $520.9329 $536.26 $536.2630 $543.93 $616.9331 $555.43 $629.9732 $566.93 $643.0233 $574.12 $651.1734 $581.79 $659.8735 $585.62 $719.0336 $589.46 $723.7337 $593.29 $728.4538 $597.13 $733.1539 $604.79 $742.5640 $612.46 $789.7141 $623.96 $804.5442 $634.99 $818.7543 $650.32 $838.5344 $669.49 $863.2445 $692.01 $912.4946 $718.85 $947.8847 $749.04 $987.6948 $783.55 $1,033.1949 $817.57 $1,078.0550 $855.91 $1,131.6951 $893.77 $1,181.7452 $935.47 $1,236.8753 $977.64 $1,292.6354 $1,023.17 $1,352.8355 $1,068.69 $1,398.0756 $1,118.05 $1,462.6457 $1,167.89 $1,527.8458 $1,221.09 $1,597.4359 $1,247.45 $1,631.9160 $1,300.64 $1,671.0761 $1,346.65 $1,730.1862 $1,376.84 $1,768.9663 $1,414.70 $1,817.61
64+ $1,437.69 $1,847.16
Illinois Off Exchange (Gold)
St. Louis, ILBlue Choice Preferred Gold PPOSM
204
Rates Effective January 1, 2021 Page 14 of 44
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Individual Coverage
Plan
Age Non Tobacco Tobacco
0-14 $485.30 $485.3015 $528.44 $528.4416 $544.93 $544.9317 $561.43 $561.4318 $579.19 $579.1919 $596.95 $596.9520 $615.35 $615.3521 $634.38 $634.3822 $634.38 $634.3823 $634.38 $634.3824 $634.38 $634.3825 $636.92 $636.9226 $649.61 $649.6127 $664.83 $664.8328 $689.57 $689.5729 $709.87 $709.8730 $720.02 $816.6531 $735.25 $833.9232 $750.47 $851.1933 $759.99 $861.9834 $770.14 $873.4935 $775.22 $951.8136 $780.29 $958.0437 $785.37 $964.2738 $790.44 $970.5039 $800.59 $982.9640 $810.74 $1,045.3741 $825.97 $1,065.0042 $840.56 $1,083.8243 $860.86 $1,109.9944 $886.23 $1,142.7145 $916.05 $1,207.9046 $951.57 $1,254.7547 $991.54 $1,307.4448 $1,037.22 $1,367.6749 $1,082.26 $1,427.0650 $1,133.01 $1,498.0651 $1,183.12 $1,564.3252 $1,238.31 $1,637.3053 $1,294.14 $1,711.1154 $1,354.41 $1,790.8055 $1,414.67 $1,850.6856 $1,480.01 $1,936.1557 $1,545.99 $2,022.4658 $1,616.41 $2,114.5859 $1,651.30 $2,160.2360 $1,721.71 $2,212.0661 $1,782.62 $2,290.3162 $1,822.58 $2,341.6563 $1,872.70 $2,406.04
64+ $1,903.14 $2,445.16
Illinois Off Exchange (Gold)
Southern, ILBlue Choice Preferred Gold PPOSM
204
Rates Effective January 1, 2021 Page 15 of 44
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Individual Coverage
Plan
Age Non Tobacco
TobaccoNon
TobaccoTobacco
Non Tobacco
TobaccoNon
TobaccoTobacco
Non Tobacco
TobaccoNon
TobaccoTobacco
0-14 $294.22 $294.22 $273.58 $273.58 $258.17 $258.17 $325.13 $325.13 $285.11 $285.11 $213.76 $213.7615 $320.38 $320.38 $297.89 $297.89 $281.12 $281.12 $354.03 $354.03 $310.45 $310.45 $232.76 $232.7616 $330.38 $330.38 $307.19 $307.19 $289.89 $289.89 $365.08 $365.08 $320.14 $320.14 $240.02 $240.0217 $340.38 $340.38 $316.49 $316.49 $298.67 $298.67 $376.13 $376.13 $329.83 $329.83 $247.29 $247.2918 $351.15 $351.15 $326.50 $326.50 $308.12 $308.12 $388.03 $388.03 $340.27 $340.27 $255.11 $255.1119 $361.92 $361.92 $336.52 $336.52 $317.57 $317.57 $399.93 $399.93 $350.70 $350.70 $262.93 $262.9320 $373.07 $373.07 $346.89 $346.89 $327.36 $327.36 $412.26 $412.26 $361.51 $361.51 $271.04 $271.0421 $384.61 $384.61 $357.61 $357.61 $337.48 $337.48 $425.01 $425.01 $372.69 $372.69 $279.42 $279.4222 $384.61 $384.61 $357.61 $357.61 $337.48 $337.48 $425.01 $425.01 $372.69 $372.69 $279.42 $279.4223 $384.61 $384.61 $357.61 $357.61 $337.48 $337.48 $425.01 $425.01 $372.69 $372.69 $279.42 $279.4224 $384.61 $384.61 $357.61 $357.61 $337.48 $337.48 $425.01 $425.01 $372.69 $372.69 $279.42 $279.4225 $386.15 $386.15 $359.05 $359.05 $338.83 $338.83 $426.71 $426.71 $374.18 $374.18 $280.54 $280.5426 $393.84 $393.84 $366.20 $366.20 $345.58 $345.58 $435.21 $435.21 $381.64 $381.64 $286.13 $286.1327 $403.07 $403.07 $374.78 $374.78 $353.68 $353.68 $445.41 $445.41 $390.58 $390.58 $292.83 $292.8328 $418.07 $418.07 $388.73 $388.73 $366.84 $366.84 $461.98 $461.98 $405.12 $405.12 $303.73 $303.7329 $430.38 $430.38 $400.17 $400.17 $377.64 $377.64 $475.58 $475.58 $417.04 $417.04 $312.67 $312.6730 $436.53 $495.11 $405.89 $460.36 $383.04 $434.44 $482.38 $547.12 $423.01 $479.78 $317.14 $359.7031 $445.76 $505.58 $414.48 $470.10 $391.14 $443.63 $492.58 $558.69 $431.95 $489.92 $323.85 $367.3132 $454.99 $516.05 $423.06 $479.83 $399.24 $452.82 $502.78 $570.26 $440.90 $500.07 $330.55 $374.9133 $460.76 $522.59 $428.42 $485.92 $404.30 $458.56 $509.16 $577.49 $446.49 $506.41 $334.74 $379.6734 $466.91 $529.57 $434.14 $492.41 $409.70 $464.68 $515.96 $585.20 $452.45 $513.17 $339.22 $384.7435 $469.99 $577.05 $437.01 $536.55 $412.40 $506.34 $519.36 $637.67 $455.43 $559.18 $341.45 $419.2336 $473.07 $580.83 $439.87 $540.07 $415.10 $509.66 $522.76 $641.84 $458.41 $562.84 $343.69 $421.9837 $476.14 $584.61 $442.73 $543.58 $417.80 $512.98 $526.16 $646.02 $461.39 $566.50 $345.92 $424.7238 $479.22 $588.39 $445.59 $547.09 $420.50 $516.29 $529.56 $650.19 $464.38 $570.16 $348.16 $427.4739 $485.37 $595.94 $451.31 $554.12 $425.90 $522.92 $536.36 $658.54 $470.34 $577.48 $352.63 $432.9540 $491.53 $633.77 $457.03 $589.30 $431.30 $556.12 $543.16 $700.35 $476.30 $614.14 $357.10 $460.4441 $500.76 $645.68 $465.61 $600.36 $439.40 $566.56 $553.36 $713.50 $485.25 $625.68 $363.80 $469.0942 $509.60 $657.09 $473.84 $610.97 $447.16 $576.57 $563.14 $726.11 $493.82 $636.73 $370.23 $477.3843 $521.91 $672.95 $485.28 $625.73 $457.96 $590.49 $576.74 $743.64 $505.75 $652.11 $379.17 $488.9144 $537.30 $692.79 $499.59 $644.17 $471.46 $607.90 $593.74 $765.56 $520.65 $671.33 $390.35 $503.3245 $555.37 $732.31 $516.40 $680.92 $487.32 $642.58 $613.71 $809.24 $538.17 $709.63 $403.48 $532.0346 $576.91 $760.71 $536.42 $707.33 $506.22 $667.50 $637.51 $840.62 $559.04 $737.15 $419.13 $552.6647 $601.14 $792.66 $558.95 $737.03 $527.48 $695.53 $664.29 $875.93 $582.52 $768.11 $436.73 $575.8748 $628.83 $829.18 $584.70 $770.99 $551.78 $727.58 $694.89 $916.28 $609.35 $803.49 $456.85 $602.4049 $656.14 $865.19 $610.09 $804.47 $575.74 $759.17 $725.06 $956.07 $635.82 $838.39 $476.69 $628.5650 $686.91 $908.23 $638.70 $844.49 $602.74 $796.94 $759.06 $1,003.63 $665.63 $880.10 $499.04 $659.8351 $717.29 $948.40 $666.95 $881.84 $629.40 $832.19 $792.64 $1,048.03 $695.07 $919.03 $521.12 $689.0252 $750.75 $992.64 $698.06 $922.98 $658.76 $871.01 $829.62 $1,096.92 $727.50 $961.90 $545.43 $721.1653 $784.60 $1,037.40 $729.53 $964.59 $688.46 $910.28 $867.02 $1,146.37 $760.30 $1,005.26 $570.02 $753.6754 $821.14 $1,085.71 $763.51 $1,009.51 $720.52 $952.67 $907.39 $1,199.75 $795.70 $1,052.08 $596.56 $788.7755 $857.67 $1,122.01 $797.48 $1,043.27 $752.58 $984.53 $947.77 $1,239.87 $831.11 $1,087.26 $623.11 $815.1556 $897.29 $1,173.83 $834.32 $1,091.45 $787.34 $1,030.00 $991.54 $1,297.14 $869.49 $1,137.47 $651.89 $852.8057 $937.29 $1,226.16 $871.51 $1,140.10 $822.44 $1,075.91 $1,035.74 $1,354.96 $908.25 $1,188.18 $680.94 $890.8158 $979.98 $1,282.01 $911.20 $1,192.03 $859.90 $1,124.92 $1,082.92 $1,416.67 $949.62 $1,242.30 $711.96 $931.3959 $1,001.13 $1,309.68 $930.87 $1,217.76 $878.46 $1,149.20 $1,106.30 $1,447.25 $970.12 $1,269.11 $727.33 $951.4960 $1,043.82 $1,341.11 $970.57 $1,246.99 $915.92 $1,176.77 $1,153.47 $1,481.98 $1,011.49 $1,299.56 $758.34 $974.3261 $1,080.75 $1,388.54 $1,004.90 $1,291.09 $948.32 $1,218.40 $1,194.27 $1,534.40 $1,047.27 $1,345.53 $785.17 $1,008.7862 $1,104.98 $1,419.67 $1,027.43 $1,320.04 $969.58 $1,245.71 $1,221.05 $1,568.80 $1,070.75 $1,375.70 $802.77 $1,031.4063 $1,135.36 $1,458.71 $1,055.68 $1,356.34 $996.24 $1,279.97 $1,254.62 $1,611.94 $1,100.19 $1,413.53 $824.85 $1,059.76
64+ $1,153.83 $1,482.43 $1,072.83 $1,378.39 $1,012.44 $1,300.78 $1,275.03 $1,638.15 $1,118.07 $1,436.51 $838.26 $1,076.99
210
Chicago - Central, IL
Illinois Off Exchange (Silver)
203 303212
BlueCare Direct SilverSM
306206with Advocate
Blue Precision Silver HMOSM Blue Choice Preferred Silver PPOSM Blue FocusCare SilverSM
Rates Effective January 1, 2021 Page 16 of 44
![Page 18: Individual and Family Health Plan Rates - BCBSIL*rates subject to change 225436.1020 Individual and Family Health Plan Rates New Business Rates Effective January 1, 2021* A Division](https://reader035.vdocument.in/reader035/viewer/2022071419/61171af0f00649441603111a/html5/thumbnails/18.jpg)
Individual Coverage
Plan
Age Non Tobacco
TobaccoNon
TobaccoTobacco
Non Tobacco
TobaccoNon
TobaccoTobacco
Non Tobacco
Tobacco
0-14 $290.22 $290.22 $269.64 $269.64 $268.30 $268.30 $316.17 $316.17 $277.26 $277.2615 $316.01 $316.01 $293.61 $293.61 $292.15 $292.15 $344.28 $344.28 $301.90 $301.9016 $325.88 $325.88 $302.77 $302.77 $301.27 $301.27 $355.02 $355.02 $311.32 $311.3217 $335.74 $335.74 $311.94 $311.94 $310.39 $310.39 $365.77 $365.77 $320.75 $320.7518 $346.36 $346.36 $321.81 $321.81 $320.21 $320.21 $377.34 $377.34 $330.90 $330.9019 $356.98 $356.98 $331.68 $331.68 $330.03 $330.03 $388.91 $388.91 $341.04 $341.0420 $367.99 $367.99 $341.90 $341.90 $340.20 $340.20 $400.90 $400.90 $351.55 $351.5521 $379.37 $379.37 $352.47 $352.47 $350.72 $350.72 $413.30 $413.30 $362.43 $362.4322 $379.37 $379.37 $352.47 $352.47 $350.72 $350.72 $413.30 $413.30 $362.43 $362.4323 $379.37 $379.37 $352.47 $352.47 $350.72 $350.72 $413.30 $413.30 $362.43 $362.4324 $379.37 $379.37 $352.47 $352.47 $350.72 $350.72 $413.30 $413.30 $362.43 $362.4325 $380.88 $380.88 $353.88 $353.88 $352.12 $352.12 $414.95 $414.95 $363.88 $363.8826 $388.47 $388.47 $360.93 $360.93 $359.14 $359.14 $423.22 $423.22 $371.12 $371.1227 $397.58 $397.58 $369.39 $369.39 $367.56 $367.56 $433.14 $433.14 $379.82 $379.8228 $412.37 $412.37 $383.14 $383.14 $381.23 $381.23 $449.26 $449.26 $393.96 $393.9629 $424.51 $424.51 $394.42 $394.42 $392.46 $392.46 $462.48 $462.48 $405.55 $405.5530 $430.58 $488.37 $400.06 $453.75 $398.07 $451.49 $469.09 $532.05 $411.35 $466.5631 $439.69 $498.69 $408.52 $463.34 $406.49 $461.04 $479.01 $543.30 $420.05 $476.4232 $448.79 $509.02 $416.98 $472.93 $414.90 $470.58 $488.93 $554.55 $428.75 $486.2933 $454.48 $515.47 $422.26 $478.93 $420.16 $476.55 $495.13 $561.58 $434.19 $492.4534 $460.55 $522.36 $427.90 $485.33 $425.78 $482.92 $501.74 $569.08 $439.99 $499.0335 $463.59 $569.19 $430.72 $528.84 $428.58 $526.21 $505.05 $620.10 $442.88 $543.7736 $466.62 $572.92 $433.54 $532.30 $431.39 $529.66 $508.36 $624.16 $445.78 $547.3337 $469.66 $576.64 $436.36 $535.77 $434.19 $533.10 $511.66 $628.22 $448.68 $550.9038 $472.69 $580.37 $439.18 $539.23 $437.00 $536.55 $514.97 $632.28 $451.58 $554.4539 $478.76 $587.82 $444.82 $546.15 $442.61 $543.44 $521.58 $640.40 $457.38 $561.5740 $484.83 $625.14 $450.46 $580.82 $448.22 $577.94 $528.20 $681.05 $463.18 $597.2241 $493.94 $636.88 $458.92 $591.73 $456.64 $588.79 $538.12 $693.85 $471.88 $608.4442 $502.66 $648.13 $467.03 $602.19 $464.71 $599.19 $547.62 $706.10 $480.21 $619.1943 $514.80 $663.79 $478.31 $616.73 $475.93 $613.66 $560.85 $723.16 $491.81 $634.1444 $529.97 $683.35 $492.40 $634.91 $489.96 $631.75 $577.38 $744.47 $506.31 $652.8345 $547.81 $722.34 $508.97 $671.13 $506.44 $667.79 $596.80 $786.95 $523.34 $690.0846 $569.05 $750.35 $528.71 $697.16 $526.08 $693.69 $619.95 $817.46 $543.64 $716.8447 $592.95 $781.86 $550.91 $726.44 $548.18 $722.83 $645.99 $851.80 $566.47 $746.9548 $620.26 $817.88 $576.29 $759.90 $573.43 $756.12 $675.74 $891.04 $592.57 $781.3649 $647.20 $853.40 $601.32 $792.90 $598.33 $788.96 $705.09 $929.73 $618.30 $815.2950 $677.55 $895.85 $629.52 $832.35 $626.39 $828.21 $738.15 $975.98 $647.29 $855.8551 $707.52 $935.48 $657.36 $869.16 $654.10 $864.84 $770.80 $1,019.15 $675.92 $893.7152 $740.52 $979.12 $688.03 $909.71 $684.61 $905.19 $806.76 $1,066.70 $707.46 $935.4053 $773.91 $1,023.26 $719.04 $950.72 $715.47 $946.00 $843.13 $1,114.79 $739.35 $977.5754 $809.95 $1,070.91 $752.53 $995.00 $748.79 $990.05 $882.39 $1,166.70 $773.78 $1,023.0955 $845.99 $1,106.72 $786.01 $1,028.27 $782.11 $1,023.16 $921.66 $1,205.71 $808.21 $1,057.3056 $885.06 $1,157.84 $822.32 $1,075.76 $818.23 $1,070.41 $964.23 $1,261.40 $845.54 $1,106.1457 $924.52 $1,209.45 $858.98 $1,123.71 $854.71 $1,118.13 $1,007.21 $1,317.63 $883.23 $1,155.4458 $966.63 $1,264.54 $898.10 $1,174.89 $893.64 $1,169.06 $1,053.09 $1,377.65 $923.46 $1,208.0759 $987.49 $1,291.83 $917.49 $1,200.25 $912.93 $1,194.29 $1,075.82 $1,407.38 $943.40 $1,234.1560 $1,029.60 $1,322.83 $956.61 $1,229.05 $951.86 $1,222.95 $1,121.69 $1,441.15 $983.62 $1,263.7661 $1,066.02 $1,369.62 $990.45 $1,272.53 $985.53 $1,266.21 $1,161.37 $1,492.13 $1,018.42 $1,308.4662 $1,089.92 $1,400.33 $1,012.65 $1,301.06 $1,007.62 $1,294.59 $1,187.41 $1,525.58 $1,041.25 $1,337.8063 $1,119.89 $1,438.83 $1,040.50 $1,336.83 $1,035.33 $1,330.19 $1,220.06 $1,567.53 $1,069.88 $1,374.58
64+ $1,138.11 $1,462.23 $1,057.41 $1,358.57 $1,052.16 $1,351.82 $1,239.90 $1,593.02 $1,087.29 $1,396.94
Illinois Off Exchange (Silver)
203 303212
Chicago - North, ILBlueCare Direct
SilverSM
306206with Advocate
Blue Precision Silver HMOSM Blue Choice Preferred Silver PPOSM
Rates Effective January 1, 2021 Page 17 of 44
![Page 19: Individual and Family Health Plan Rates - BCBSIL*rates subject to change 225436.1020 Individual and Family Health Plan Rates New Business Rates Effective January 1, 2021* A Division](https://reader035.vdocument.in/reader035/viewer/2022071419/61171af0f00649441603111a/html5/thumbnails/19.jpg)
Individual Coverage
Plan
Age Non Tobacco
TobaccoNon
TobaccoTobacco
Non Tobacco
TobaccoNon
TobaccoTobacco
Non Tobacco
Tobacco
0-14 $279.79 $279.79 $260.11 $260.11 $265.29 $265.29 $306.27 $306.27 $268.57 $268.5715 $304.66 $304.66 $283.23 $283.23 $288.87 $288.87 $333.49 $333.49 $292.44 $292.4416 $314.17 $314.17 $292.07 $292.07 $297.89 $297.89 $343.90 $343.90 $301.57 $301.5717 $323.68 $323.68 $300.91 $300.91 $306.91 $306.91 $354.31 $354.31 $310.70 $310.7018 $333.92 $333.92 $310.43 $310.43 $316.62 $316.62 $365.52 $365.52 $320.53 $320.5319 $344.16 $344.16 $319.95 $319.95 $326.33 $326.33 $376.73 $376.73 $330.36 $330.3620 $354.76 $354.76 $329.81 $329.81 $336.38 $336.38 $388.34 $388.34 $340.54 $340.5421 $365.74 $365.74 $340.01 $340.01 $346.79 $346.79 $400.35 $400.35 $351.07 $351.0722 $365.74 $365.74 $340.01 $340.01 $346.79 $346.79 $400.35 $400.35 $351.07 $351.0723 $365.74 $365.74 $340.01 $340.01 $346.79 $346.79 $400.35 $400.35 $351.07 $351.0724 $365.74 $365.74 $340.01 $340.01 $346.79 $346.79 $400.35 $400.35 $351.07 $351.0725 $367.20 $367.20 $341.37 $341.37 $348.17 $348.17 $401.95 $401.95 $352.48 $352.4826 $374.51 $374.51 $348.17 $348.17 $355.11 $355.11 $409.96 $409.96 $359.50 $359.5027 $383.29 $383.29 $356.33 $356.33 $363.43 $363.43 $419.57 $419.57 $367.92 $367.9228 $397.55 $397.55 $369.59 $369.59 $376.96 $376.96 $435.18 $435.18 $381.61 $381.6129 $409.26 $409.26 $380.47 $380.47 $388.05 $388.05 $447.99 $447.99 $392.85 $392.8530 $415.11 $470.82 $385.91 $437.70 $393.60 $446.43 $454.40 $515.38 $398.47 $451.9431 $423.89 $480.77 $394.07 $446.96 $401.93 $455.87 $464.01 $526.28 $406.89 $461.5032 $432.67 $490.73 $402.23 $456.21 $410.25 $465.31 $473.61 $537.17 $415.32 $471.0533 $438.15 $496.95 $407.33 $462.00 $415.45 $471.20 $479.62 $543.98 $420.58 $477.0334 $444.00 $503.59 $412.77 $468.17 $421.00 $477.50 $486.02 $551.25 $426.20 $483.4035 $446.93 $548.74 $415.49 $510.14 $423.77 $520.31 $489.23 $600.67 $429.01 $526.7436 $449.85 $552.33 $418.21 $513.48 $426.55 $523.71 $492.43 $604.60 $431.82 $530.1837 $452.78 $555.93 $420.93 $516.82 $429.32 $527.12 $495.63 $608.54 $434.63 $533.6438 $455.71 $559.52 $423.65 $520.16 $432.10 $530.53 $498.84 $612.47 $437.43 $537.0839 $461.56 $566.70 $429.09 $526.84 $437.65 $537.34 $505.24 $620.33 $443.05 $543.9840 $467.41 $602.68 $434.53 $560.29 $443.19 $571.45 $511.65 $659.72 $448.67 $578.5141 $476.19 $614.00 $442.69 $570.81 $451.52 $582.19 $521.26 $672.11 $457.09 $589.3842 $484.60 $624.84 $450.51 $580.89 $459.49 $592.47 $530.46 $683.98 $465.17 $599.7943 $496.30 $639.94 $461.39 $594.92 $470.59 $606.78 $543.27 $700.50 $476.40 $614.2844 $510.93 $658.80 $474.99 $612.46 $484.46 $624.66 $559.29 $721.15 $490.45 $632.3845 $528.12 $696.38 $490.97 $647.40 $500.76 $660.30 $578.11 $762.29 $506.95 $668.4646 $548.60 $723.39 $510.02 $672.51 $520.18 $685.91 $600.52 $791.85 $526.61 $694.3847 $571.64 $753.77 $531.44 $700.75 $542.03 $714.72 $625.75 $825.11 $548.72 $723.5548 $597.98 $788.49 $555.92 $733.03 $567.00 $747.64 $654.57 $863.12 $574.00 $756.8849 $623.95 $822.73 $580.06 $764.86 $591.62 $780.11 $683.00 $900.60 $598.93 $789.7550 $653.20 $863.67 $607.26 $802.92 $619.36 $818.92 $715.03 $945.41 $627.01 $829.0451 $682.10 $901.87 $634.12 $838.43 $646.76 $855.14 $746.65 $987.22 $654.75 $865.7152 $713.92 $943.94 $663.70 $877.54 $676.93 $895.03 $781.48 $1,033.28 $685.29 $906.0953 $746.10 $986.50 $693.62 $917.11 $707.45 $935.39 $816.71 $1,079.86 $716.19 $946.9454 $780.85 $1,032.44 $725.92 $959.82 $740.39 $978.95 $854.75 $1,130.15 $749.54 $991.0455 $815.59 $1,066.96 $758.22 $991.91 $773.34 $1,011.68 $892.78 $1,167.94 $782.89 $1,024.1856 $853.26 $1,116.24 $793.24 $1,037.72 $809.05 $1,058.40 $934.02 $1,221.88 $819.05 $1,071.4857 $891.30 $1,165.99 $828.61 $1,083.98 $845.12 $1,105.59 $975.65 $1,276.35 $855.56 $1,119.2458 $931.89 $1,219.10 $866.35 $1,133.35 $883.61 $1,155.94 $1,020.09 $1,334.48 $894.53 $1,170.2259 $952.01 $1,245.42 $885.05 $1,157.82 $902.69 $1,180.89 $1,042.11 $1,363.29 $913.84 $1,195.4860 $992.61 $1,275.30 $922.79 $1,185.60 $941.18 $1,209.23 $1,086.55 $1,396.00 $952.81 $1,224.1761 $1,027.72 $1,320.41 $955.43 $1,227.54 $974.47 $1,252.00 $1,124.98 $1,445.38 $986.51 $1,267.4762 $1,050.76 $1,350.01 $976.85 $1,255.06 $996.32 $1,280.07 $1,150.21 $1,477.78 $1,008.63 $1,295.8863 $1,079.65 $1,387.14 $1,003.71 $1,289.57 $1,023.72 $1,315.27 $1,181.83 $1,518.42 $1,036.36 $1,331.52
64+ $1,097.22 $1,409.69 $1,020.03 $1,310.54 $1,040.37 $1,336.66 $1,201.05 $1,543.11 $1,053.21 $1,353.17
Illinois Off Exchange (Silver)
203 303212
Chicago - West, ILBlueCare Direct
SilverSM
306206with Advocate
Blue Precision Silver HMOSM Blue Choice Preferred Silver PPOSM
Rates Effective January 1, 2021 Page 18 of 44
![Page 20: Individual and Family Health Plan Rates - BCBSIL*rates subject to change 225436.1020 Individual and Family Health Plan Rates New Business Rates Effective January 1, 2021* A Division](https://reader035.vdocument.in/reader035/viewer/2022071419/61171af0f00649441603111a/html5/thumbnails/20.jpg)
Individual Coverage
Plan
Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco
0-14 $270.09 $270.09 $251.41 $251.41 $301.06 $301.06 $264.00 $264.0015 $294.09 $294.09 $273.76 $273.76 $327.82 $327.82 $287.47 $287.4716 $303.27 $303.27 $282.30 $282.30 $338.05 $338.05 $296.44 $296.4417 $312.45 $312.45 $290.85 $290.85 $348.28 $348.28 $305.41 $305.4118 $322.34 $322.34 $300.05 $300.05 $359.30 $359.30 $315.08 $315.0819 $332.22 $332.22 $309.25 $309.25 $370.32 $370.32 $324.74 $324.7420 $342.46 $342.46 $318.78 $318.78 $381.74 $381.74 $334.75 $334.7521 $353.05 $353.05 $328.64 $328.64 $393.54 $393.54 $345.10 $345.1022 $353.05 $353.05 $328.64 $328.64 $393.54 $393.54 $345.10 $345.1023 $353.05 $353.05 $328.64 $328.64 $393.54 $393.54 $345.10 $345.1024 $353.05 $353.05 $328.64 $328.64 $393.54 $393.54 $345.10 $345.1025 $354.47 $354.47 $329.95 $329.95 $395.12 $395.12 $346.48 $346.4826 $361.53 $361.53 $336.53 $336.53 $402.99 $402.99 $353.38 $353.3827 $370.00 $370.00 $344.41 $344.41 $412.43 $412.43 $361.67 $361.6728 $383.77 $383.77 $357.23 $357.23 $427.78 $427.78 $375.12 $375.1229 $395.07 $395.07 $367.75 $367.75 $440.37 $440.37 $386.17 $386.1730 $400.72 $454.49 $373.01 $423.06 $446.67 $506.61 $391.69 $444.2631 $409.19 $464.10 $380.89 $432.01 $456.11 $517.33 $399.97 $453.6532 $417.66 $473.71 $388.78 $440.95 $465.56 $528.04 $408.25 $463.0433 $422.96 $479.72 $393.71 $446.54 $471.46 $534.73 $413.43 $468.9134 $428.61 $486.13 $398.97 $452.51 $477.76 $541.88 $418.95 $475.1835 $431.43 $529.71 $401.60 $493.08 $480.91 $590.46 $421.71 $517.7836 $434.26 $533.18 $404.23 $496.31 $484.06 $594.32 $424.47 $521.1737 $437.08 $536.65 $406.85 $499.54 $487.20 $598.19 $427.23 $524.5638 $439.90 $540.12 $409.48 $502.76 $490.35 $602.06 $430.00 $527.9539 $445.55 $547.05 $414.74 $509.22 $496.65 $609.78 $435.52 $534.7340 $451.20 $581.78 $420.00 $541.55 $502.95 $648.50 $441.04 $568.6741 $459.68 $592.71 $427.89 $551.72 $512.39 $660.68 $449.32 $579.3642 $467.80 $603.18 $435.45 $561.47 $521.44 $672.35 $457.26 $589.5943 $479.09 $617.74 $445.96 $575.03 $534.04 $688.59 $468.30 $603.8344 $493.22 $635.95 $459.11 $591.97 $549.78 $708.88 $482.11 $621.6345 $509.81 $672.23 $474.55 $625.75 $568.27 $749.33 $498.33 $657.0946 $529.58 $698.30 $492.96 $650.01 $590.31 $778.39 $517.65 $682.5747 $551.82 $727.63 $513.66 $677.31 $615.11 $811.08 $539.39 $711.2448 $577.24 $761.15 $537.32 $708.52 $643.44 $848.44 $564.24 $744.0149 $602.31 $794.20 $560.66 $739.28 $671.38 $885.28 $588.74 $776.3150 $630.55 $833.72 $586.95 $776.06 $702.87 $929.33 $616.35 $814.9451 $658.44 $870.59 $612.91 $810.39 $733.95 $970.43 $643.61 $850.9852 $689.16 $911.21 $641.50 $848.19 $768.19 $1,015.70 $673.64 $890.6853 $720.23 $952.29 $670.42 $886.43 $802.82 $1,061.50 $704.01 $930.8454 $753.77 $996.63 $701.64 $927.71 $840.21 $1,110.93 $736.79 $974.1855 $787.31 $1,029.96 $732.86 $958.73 $877.60 $1,148.07 $769.57 $1,006.7656 $823.67 $1,077.53 $766.71 $1,003.02 $918.13 $1,201.10 $805.12 $1,053.2657 $860.39 $1,125.56 $800.89 $1,047.73 $959.06 $1,254.64 $841.01 $1,100.2158 $899.58 $1,176.83 $837.37 $1,095.45 $1,002.74 $1,311.79 $879.32 $1,150.3259 $919.00 $1,202.23 $855.45 $1,119.09 $1,024.39 $1,340.10 $898.30 $1,175.1560 $958.19 $1,231.08 $891.93 $1,145.95 $1,068.07 $1,372.26 $936.60 $1,203.3561 $992.08 $1,274.62 $923.48 $1,186.48 $1,105.85 $1,420.80 $969.73 $1,245.9162 $1,014.32 $1,303.20 $944.18 $1,213.08 $1,130.64 $1,452.65 $991.47 $1,273.8563 $1,042.21 $1,339.04 $970.14 $1,246.44 $1,161.73 $1,492.60 $1,018.74 $1,308.87
64+ $1,059.15 $1,360.81 $985.92 $1,266.71 $1,180.62 $1,516.87 $1,035.30 $1,330.16
Illinois Off Exchange (Silver)
203 303
Chicago - South, ILBlue Choice Preferred Silver PPOSM
306Blue Precision Silver HMOSM
206
Rates Effective January 1, 2021 Page 19 of 44
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Individual Coverage
Plan
Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco
0-14 $300.03 $300.03 $278.52 $278.52 $383.60 $383.60 $336.39 $336.3915 $326.70 $326.70 $303.27 $303.27 $417.70 $417.70 $366.29 $366.2916 $336.89 $336.89 $312.74 $312.74 $430.74 $430.74 $377.72 $377.7217 $347.09 $347.09 $322.20 $322.20 $443.78 $443.78 $389.15 $389.1518 $358.07 $358.07 $332.40 $332.40 $457.82 $457.82 $401.46 $401.4619 $369.05 $369.05 $342.59 $342.59 $471.86 $471.86 $413.78 $413.7820 $380.43 $380.43 $353.15 $353.15 $486.40 $486.40 $426.53 $426.5321 $392.19 $392.19 $364.07 $364.07 $501.44 $501.44 $439.72 $439.7222 $392.19 $392.19 $364.07 $364.07 $501.44 $501.44 $439.72 $439.7223 $392.19 $392.19 $364.07 $364.07 $501.44 $501.44 $439.72 $439.7224 $392.19 $392.19 $364.07 $364.07 $501.44 $501.44 $439.72 $439.7225 $393.76 $393.76 $365.53 $365.53 $503.45 $503.45 $441.48 $441.4826 $401.60 $401.60 $372.81 $372.81 $513.48 $513.48 $450.27 $450.2727 $411.02 $411.02 $381.55 $381.55 $525.51 $525.51 $460.83 $460.8328 $426.31 $426.31 $395.75 $395.75 $545.07 $545.07 $477.98 $477.9829 $438.86 $438.86 $407.40 $407.40 $561.11 $561.11 $492.05 $492.0530 $445.14 $504.88 $413.22 $468.68 $569.14 $645.52 $499.08 $566.0631 $454.55 $515.55 $421.96 $478.59 $581.17 $659.17 $509.64 $578.0332 $463.96 $526.23 $430.70 $488.50 $593.21 $672.82 $520.19 $590.0033 $469.85 $532.90 $436.16 $494.69 $600.73 $681.35 $526.79 $597.4834 $476.12 $540.02 $441.98 $501.30 $608.75 $690.45 $533.82 $605.4635 $479.26 $588.43 $444.90 $546.24 $612.76 $752.35 $537.34 $659.7436 $482.40 $592.28 $447.81 $549.82 $616.77 $757.27 $540.86 $664.0637 $485.53 $596.14 $450.72 $553.40 $620.79 $762.20 $544.37 $668.3838 $488.67 $599.99 $453.63 $556.97 $624.80 $767.13 $547.89 $672.7039 $494.95 $607.69 $459.46 $564.12 $632.82 $776.98 $554.93 $681.3440 $501.22 $646.27 $465.28 $599.94 $640.84 $826.30 $561.96 $724.5941 $510.63 $658.41 $474.02 $611.21 $652.88 $841.82 $572.52 $738.2042 $519.65 $670.04 $482.40 $622.00 $664.41 $856.69 $582.63 $751.2443 $532.20 $686.23 $494.05 $637.03 $680.46 $877.38 $596.70 $769.3944 $547.89 $706.45 $508.61 $655.80 $700.52 $903.24 $614.29 $792.0645 $566.32 $746.76 $525.72 $693.22 $724.08 $954.78 $634.96 $837.2546 $588.29 $775.72 $546.11 $720.10 $752.16 $991.80 $659.58 $869.7247 $613.00 $808.30 $569.05 $750.34 $783.75 $1,033.46 $687.28 $906.2548 $641.23 $845.53 $595.26 $784.91 $819.86 $1,081.07 $718.94 $948.0049 $669.08 $882.25 $621.11 $818.99 $855.46 $1,128.01 $750.16 $989.1650 $700.45 $926.14 $650.23 $859.74 $895.58 $1,184.13 $785.34 $1,038.3851 $731.44 $967.11 $679.00 $897.77 $935.19 $1,236.51 $820.08 $1,084.3152 $765.56 $1,012.22 $710.67 $939.65 $978.82 $1,294.19 $858.33 $1,134.8953 $800.07 $1,057.85 $742.71 $982.01 $1,022.94 $1,352.54 $897.03 $1,186.0554 $837.33 $1,107.12 $777.30 $1,027.74 $1,070.58 $1,415.52 $938.80 $1,241.2955 $874.59 $1,144.14 $811.88 $1,062.11 $1,118.22 $1,462.85 $980.58 $1,282.7956 $914.98 $1,196.98 $849.38 $1,111.16 $1,169.87 $1,530.42 $1,025.87 $1,342.0457 $955.77 $1,250.34 $887.25 $1,160.69 $1,222.02 $1,598.64 $1,071.60 $1,401.8658 $999.30 $1,307.29 $927.66 $1,213.56 $1,277.68 $1,671.45 $1,120.41 $1,465.7259 $1,020.88 $1,335.51 $947.68 $1,239.75 $1,305.26 $1,707.53 $1,144.59 $1,497.3560 $1,064.41 $1,367.55 $988.09 $1,269.50 $1,360.92 $1,748.51 $1,193.40 $1,533.2861 $1,102.06 $1,415.93 $1,023.04 $1,314.41 $1,409.05 $1,810.35 $1,235.61 $1,587.5262 $1,126.77 $1,447.67 $1,045.98 $1,343.88 $1,440.64 $1,850.94 $1,263.32 $1,623.1163 $1,157.75 $1,487.48 $1,074.74 $1,380.83 $1,480.26 $1,901.84 $1,298.05 $1,667.74
64+ $1,176.57 $1,511.66 $1,092.21 $1,403.28 $1,504.32 $1,932.76 $1,319.16 $1,694.86
Illinois Off Exchange (Silver)
203 303
Rockford, ILBlue Choice Preferred Silver PPOSM
306Blue Precision Silver HMOSM
206
Rates Effective January 1, 2021 Page 20 of 44
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Individual Coverage
Plan
Age Non Tobacco Tobacco Non Tobacco Tobacco
0-14 $331.42 $331.42 $290.63 $290.6315 $360.88 $360.88 $316.46 $316.4616 $372.15 $372.15 $326.34 $326.3417 $383.41 $383.41 $336.22 $336.2218 $395.54 $395.54 $346.85 $346.8519 $407.67 $407.67 $357.49 $357.4920 $420.24 $420.24 $368.51 $368.5121 $433.23 $433.23 $379.91 $379.9122 $433.23 $433.23 $379.91 $379.9123 $433.23 $433.23 $379.91 $379.9124 $433.23 $433.23 $379.91 $379.9125 $434.97 $434.97 $381.43 $381.4326 $443.63 $443.63 $389.02 $389.0227 $454.03 $454.03 $398.14 $398.1428 $470.92 $470.92 $412.96 $412.9629 $484.79 $484.79 $425.11 $425.1130 $491.72 $557.71 $431.19 $489.0631 $502.12 $569.50 $440.31 $499.4032 $512.51 $581.29 $449.43 $509.7433 $519.01 $588.66 $455.13 $516.2134 $525.94 $596.53 $461.21 $523.1035 $529.41 $650.01 $464.25 $570.0036 $532.88 $654.26 $467.28 $573.7337 $536.34 $658.52 $470.32 $577.4638 $539.81 $662.78 $473.36 $581.2039 $546.74 $671.28 $479.44 $588.6640 $553.67 $713.90 $485.52 $626.0341 $564.07 $727.31 $494.64 $637.7942 $574.03 $740.16 $503.38 $649.0543 $587.90 $758.04 $515.53 $664.7344 $605.23 $780.38 $530.73 $684.3245 $625.59 $824.90 $548.58 $723.3646 $649.85 $856.89 $569.86 $751.4247 $677.14 $892.88 $593.79 $782.9848 $708.33 $934.01 $621.15 $819.0449 $739.09 $974.57 $648.12 $854.6150 $773.75 $1,023.06 $678.51 $897.1351 $807.98 $1,068.31 $708.52 $936.8152 $845.67 $1,118.14 $741.58 $980.5153 $883.79 $1,168.55 $775.01 $1,024.7254 $924.95 $1,222.97 $811.10 $1,072.4455 $966.11 $1,263.86 $847.19 $1,108.3056 $1,010.73 $1,322.24 $886.32 $1,159.4857 $1,055.79 $1,381.18 $925.83 $1,211.1758 $1,103.88 $1,444.09 $968.00 $1,266.3459 $1,127.70 $1,475.26 $988.90 $1,293.6760 $1,175.79 $1,510.66 $1,031.07 $1,324.7161 $1,217.38 $1,564.09 $1,067.54 $1,371.5762 $1,244.68 $1,599.16 $1,091.47 $1,402.3263 $1,278.90 $1,643.13 $1,121.48 $1,440.88
64+ $1,299.69 $1,669.85 $1,139.73 $1,464.31
Quad Cities, IL
303Blue Choice Preferred Silver PPOSM
203
Illinois Off Exchange (Silver
Rates Effective January 1, 2021 Page 21 of 44
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Individual Coverage
Plan
Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco
0-14 $347.37 $347.37 $321.96 $321.96 $368.84 $368.84 $323.44 $323.4415 $378.24 $378.24 $350.57 $350.57 $401.63 $401.63 $352.19 $352.1916 $390.05 $390.05 $361.52 $361.52 $414.17 $414.17 $363.19 $363.1917 $401.85 $401.85 $372.46 $372.46 $426.70 $426.70 $374.18 $374.1818 $414.57 $414.57 $384.24 $384.24 $440.20 $440.20 $386.02 $386.0219 $427.28 $427.28 $396.03 $396.03 $453.70 $453.70 $397.86 $397.8620 $440.45 $440.45 $408.23 $408.23 $467.68 $467.68 $410.12 $410.1221 $454.07 $454.07 $420.86 $420.86 $482.15 $482.15 $422.80 $422.8022 $454.07 $454.07 $420.86 $420.86 $482.15 $482.15 $422.80 $422.8023 $454.07 $454.07 $420.86 $420.86 $482.15 $482.15 $422.80 $422.8024 $454.07 $454.07 $420.86 $420.86 $482.15 $482.15 $422.80 $422.8025 $455.89 $455.89 $422.54 $422.54 $484.08 $484.08 $424.49 $424.4926 $464.97 $464.97 $430.96 $430.96 $493.72 $493.72 $432.95 $432.9527 $475.87 $475.87 $441.06 $441.06 $505.29 $505.29 $443.10 $443.1028 $493.58 $493.58 $457.47 $457.47 $524.10 $524.10 $459.59 $459.5929 $508.11 $508.11 $470.94 $470.94 $539.53 $539.53 $473.12 $473.1230 $515.37 $584.54 $477.67 $541.78 $547.24 $620.68 $479.88 $544.2831 $526.27 $596.90 $487.77 $553.23 $558.81 $633.80 $490.03 $555.7932 $537.17 $609.26 $497.87 $564.69 $570.38 $646.93 $500.17 $567.3033 $543.98 $616.98 $504.19 $571.85 $577.61 $655.13 $506.52 $574.4934 $551.24 $625.22 $510.92 $579.49 $585.33 $663.88 $513.28 $582.1635 $554.88 $681.28 $514.29 $631.44 $589.19 $723.40 $516.66 $634.3636 $558.51 $685.74 $517.66 $635.58 $593.04 $728.14 $520.05 $638.5137 $562.14 $690.20 $521.02 $639.71 $596.90 $732.88 $523.43 $642.6738 $565.77 $694.66 $524.39 $643.85 $600.76 $737.61 $526.81 $646.8239 $573.04 $703.58 $531.12 $652.11 $608.47 $747.08 $533.58 $655.1240 $580.30 $748.24 $537.86 $693.51 $616.19 $794.51 $540.34 $696.7141 $591.20 $762.30 $547.96 $706.54 $627.76 $809.43 $550.49 $709.8042 $601.65 $775.76 $557.64 $719.02 $638.85 $823.73 $560.21 $722.3443 $616.18 $794.50 $571.10 $736.38 $654.28 $843.63 $573.74 $739.7844 $634.34 $817.92 $587.94 $758.09 $673.56 $868.49 $590.65 $761.5945 $655.68 $864.58 $607.72 $801.34 $696.22 $918.04 $610.53 $805.0446 $681.11 $898.11 $631.29 $832.41 $723.22 $953.64 $634.20 $836.2647 $709.72 $935.83 $657.80 $867.38 $753.60 $993.70 $660.84 $871.3848 $742.41 $978.94 $688.10 $907.33 $788.31 $1,039.47 $691.28 $911.5249 $774.65 $1,021.45 $717.98 $946.73 $822.55 $1,084.61 $721.30 $951.1150 $810.97 $1,072.27 $751.65 $993.83 $861.12 $1,138.57 $755.12 $998.4351 $846.84 $1,119.70 $784.90 $1,037.79 $899.21 $1,188.93 $788.53 $1,042.5952 $886.35 $1,171.93 $821.51 $1,086.20 $941.16 $1,244.39 $825.31 $1,091.2253 $926.31 $1,224.76 $858.55 $1,135.18 $983.58 $1,300.50 $862.52 $1,140.4254 $969.44 $1,281.80 $898.53 $1,188.04 $1,029.39 $1,361.06 $902.68 $1,193.5355 $1,012.58 $1,324.66 $938.51 $1,227.76 $1,075.19 $1,406.57 $942.85 $1,233.4456 $1,059.35 $1,385.84 $981.86 $1,284.47 $1,124.85 $1,471.53 $986.40 $1,290.4057 $1,106.57 $1,447.62 $1,025.63 $1,341.73 $1,175.00 $1,537.13 $1,030.37 $1,347.9358 $1,156.98 $1,513.55 $1,072.35 $1,402.84 $1,228.52 $1,607.14 $1,077.30 $1,409.3259 $1,181.95 $1,546.23 $1,095.49 $1,433.12 $1,255.03 $1,641.83 $1,100.55 $1,439.7460 $1,232.35 $1,583.33 $1,142.21 $1,467.51 $1,308.55 $1,681.23 $1,147.48 $1,474.2961 $1,275.94 $1,639.33 $1,182.61 $1,519.42 $1,354.84 $1,740.70 $1,188.07 $1,526.4462 $1,304.55 $1,676.09 $1,209.12 $1,553.48 $1,385.21 $1,779.72 $1,214.71 $1,560.6663 $1,340.42 $1,722.17 $1,242.37 $1,596.20 $1,423.30 $1,828.66 $1,248.11 $1,603.57
64+ $1,362.21 $1,750.18 $1,262.58 $1,622.15 $1,446.45 $1,858.40 $1,268.40 $1,629.65
Illinois Off Exchange (Silver)
203 303
Peoria, ILBlue Choice Preferred Silver PPOSM
306Blue Precision Silver HMOSM
206
Rates Effective January 1, 2021 Page 22 of 44
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Individual Coverage
Plan
Age Non Tobacco Tobacco Non Tobacco Tobacco
0-14 $351.03 $351.03 $307.82 $307.8215 $382.23 $382.23 $335.18 $335.1816 $394.16 $394.16 $345.64 $345.6417 $406.09 $406.09 $356.11 $356.1118 $418.94 $418.94 $367.37 $367.3719 $431.79 $431.79 $378.64 $378.6420 $445.09 $445.09 $390.31 $390.3121 $458.86 $458.86 $402.38 $402.3822 $458.86 $458.86 $402.38 $402.3823 $458.86 $458.86 $402.38 $402.3824 $458.86 $458.86 $402.38 $402.3825 $460.70 $460.70 $403.99 $403.9926 $469.87 $469.87 $412.04 $412.0427 $480.89 $480.89 $421.69 $421.6928 $498.78 $498.78 $437.39 $437.3929 $513.47 $513.47 $450.26 $450.2630 $520.81 $590.70 $456.70 $517.9931 $531.82 $603.19 $466.36 $528.9432 $542.83 $615.68 $476.02 $539.9033 $549.72 $623.49 $482.05 $546.7434 $557.06 $631.81 $488.49 $554.0535 $560.73 $688.46 $491.71 $603.7236 $564.40 $692.97 $494.93 $607.6737 $568.07 $697.48 $498.15 $611.6338 $571.74 $701.98 $501.37 $615.5839 $579.08 $711.00 $507.80 $623.4840 $586.42 $756.13 $514.24 $663.0641 $597.44 $770.34 $523.90 $675.5242 $607.99 $783.95 $533.15 $687.4543 $622.67 $802.88 $546.03 $704.0544 $641.03 $826.54 $562.12 $724.8045 $662.59 $873.70 $581.04 $766.1646 $688.29 $907.58 $603.57 $795.8747 $717.20 $945.70 $628.92 $829.2948 $750.24 $989.26 $657.89 $867.4949 $782.82 $1,032.22 $686.46 $905.1750 $819.53 $1,083.58 $718.65 $950.2051 $855.78 $1,131.50 $750.44 $992.2352 $895.70 $1,184.29 $785.45 $1,038.5153 $936.08 $1,237.68 $820.86 $1,085.3454 $979.67 $1,295.32 $859.08 $1,135.8855 $1,023.26 $1,338.63 $897.31 $1,173.8656 $1,070.52 $1,400.46 $938.75 $1,228.0857 $1,118.24 $1,462.88 $980.60 $1,282.8258 $1,169.18 $1,529.52 $1,025.26 $1,341.2559 $1,194.41 $1,562.53 $1,047.40 $1,370.2060 $1,245.35 $1,600.02 $1,092.06 $1,403.0861 $1,289.40 $1,656.62 $1,130.69 $1,452.7162 $1,318.31 $1,693.76 $1,156.04 $1,485.2863 $1,354.56 $1,740.34 $1,187.83 $1,526.12
64+ $1,376.58 $1,768.63 $1,207.14 $1,550.93
Blue Choice Preferred Silver PPOSM
Illinois Off Exchange (Silver)
303
Bloomington, IL
203
Rates Effective January 1, 2021 Page 23 of 44
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Individual Coverage
Plan
Age Non Tobacco Tobacco Non Tobacco Tobacco
0-14 $382.10 $382.10 $335.07 $335.0715 $416.06 $416.06 $364.85 $364.8516 $429.05 $429.05 $376.24 $376.2417 $442.03 $442.03 $387.62 $387.6218 $456.02 $456.02 $399.89 $399.8919 $470.00 $470.00 $412.15 $412.1520 $484.49 $484.49 $424.85 $424.8521 $499.47 $499.47 $437.99 $437.9922 $499.47 $499.47 $437.99 $437.9923 $499.47 $499.47 $437.99 $437.9924 $499.47 $499.47 $437.99 $437.9925 $501.47 $501.47 $439.75 $439.7526 $511.46 $511.46 $448.51 $448.5127 $523.45 $523.45 $459.02 $459.0228 $542.93 $542.93 $476.10 $476.1029 $558.91 $558.91 $490.11 $490.1130 $566.90 $642.98 $497.12 $563.8431 $578.89 $656.58 $507.63 $575.7632 $590.88 $670.17 $518.15 $587.6833 $598.37 $678.67 $524.72 $595.1334 $606.36 $687.74 $531.72 $603.0835 $610.36 $749.40 $535.23 $657.1536 $614.35 $754.30 $538.73 $661.4537 $618.35 $759.21 $542.24 $665.7638 $622.34 $764.11 $545.74 $670.0639 $630.34 $773.92 $552.75 $678.6640 $638.33 $823.06 $559.76 $721.7541 $650.31 $838.52 $570.27 $735.3042 $661.80 $853.33 $580.34 $748.2943 $677.79 $873.94 $594.36 $766.3744 $697.76 $899.70 $611.88 $788.9545 $721.24 $951.03 $632.46 $833.9746 $749.21 $987.91 $656.99 $866.3147 $780.68 $1,029.40 $684.58 $902.6948 $816.64 $1,076.82 $716.12 $944.2749 $852.10 $1,123.58 $747.22 $985.2850 $892.06 $1,179.48 $782.26 $1,034.3051 $931.52 $1,231.65 $816.86 $1,080.0552 $974.97 $1,289.11 $854.96 $1,130.4353 $1,018.93 $1,347.22 $893.51 $1,181.4054 $1,066.38 $1,409.96 $935.12 $1,236.4155 $1,113.83 $1,457.11 $976.73 $1,277.7556 $1,165.27 $1,524.41 $1,021.84 $1,336.7757 $1,217.22 $1,592.36 $1,067.39 $1,396.3658 $1,272.66 $1,664.89 $1,116.01 $1,459.9659 $1,300.13 $1,700.83 $1,140.10 $1,491.4760 $1,355.57 $1,741.64 $1,188.71 $1,527.2661 $1,403.52 $1,803.24 $1,230.76 $1,581.2862 $1,434.99 $1,843.67 $1,258.36 $1,616.7463 $1,474.45 $1,894.37 $1,292.96 $1,661.19
64+ $1,498.41 $1,925.17 $1,313.97 $1,688.20
Illinois Off Exchange (Silver)
Champaign, IL
303Blue Choice Preferred Silver PPOSM
203
Rates Effective January 1, 2021 Page 24 of 44
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Individual Coverage
Plan
Age Non Tobacco Tobacco Non Tobacco Tobacco
0-14 $347.23 $347.23 $304.49 $304.4915 $378.10 $378.10 $331.56 $331.5616 $389.90 $389.90 $341.91 $341.9117 $401.70 $401.70 $352.26 $352.2618 $414.41 $414.41 $363.40 $363.4019 $427.12 $427.12 $374.55 $374.5520 $440.28 $440.28 $386.09 $386.0921 $453.90 $453.90 $398.03 $398.0322 $453.90 $453.90 $398.03 $398.0323 $453.90 $453.90 $398.03 $398.0324 $453.90 $453.90 $398.03 $398.0325 $455.72 $455.72 $399.62 $399.6226 $464.80 $464.80 $407.58 $407.5827 $475.69 $475.69 $417.14 $417.1428 $493.39 $493.39 $432.66 $432.6629 $507.92 $507.92 $445.40 $445.4030 $515.18 $584.32 $451.77 $512.3931 $526.07 $596.67 $461.32 $523.2332 $536.97 $609.03 $470.87 $534.0633 $543.77 $616.75 $476.84 $540.8334 $551.04 $624.99 $483.21 $548.0635 $554.67 $681.02 $486.39 $597.1936 $558.30 $685.48 $489.58 $601.1037 $561.93 $689.94 $492.76 $605.0238 $565.56 $694.40 $495.95 $608.9239 $572.82 $703.31 $502.32 $616.7440 $580.09 $747.96 $508.68 $655.9041 $590.98 $762.01 $518.24 $668.2142 $601.42 $775.47 $527.39 $680.0243 $615.94 $794.20 $540.13 $696.4444 $634.10 $817.61 $556.05 $716.9745 $655.43 $864.26 $574.76 $757.8846 $680.85 $897.77 $597.05 $787.2747 $709.45 $935.48 $622.12 $820.3348 $742.13 $978.57 $650.78 $858.1249 $774.36 $1,021.07 $679.04 $895.3850 $810.67 $1,071.87 $710.88 $939.9351 $846.53 $1,119.28 $742.33 $981.5152 $886.02 $1,171.49 $776.96 $1,027.2953 $925.96 $1,224.30 $811.98 $1,073.6154 $969.08 $1,281.32 $849.80 $1,123.6055 $1,012.20 $1,324.16 $887.61 $1,161.1756 $1,058.95 $1,385.32 $928.61 $1,214.8057 $1,106.16 $1,447.08 $970.00 $1,268.9658 $1,156.54 $1,512.99 $1,014.18 $1,326.7559 $1,181.51 $1,545.64 $1,036.08 $1,355.3960 $1,231.89 $1,582.73 $1,080.26 $1,387.9261 $1,275.46 $1,638.72 $1,118.47 $1,437.0162 $1,304.06 $1,675.46 $1,143.54 $1,469.2363 $1,339.92 $1,721.53 $1,174.99 $1,509.63
64+ $1,361.70 $1,749.52 $1,194.09 $1,534.17
Illinois Off Exchange (Silver)
Springfield, IL
303Blue Choice Preferred Silver PPOSM
203
Rates Effective January 1, 2021 Page 25 of 44
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Individual Coverage
Plan
Age Non Tobacco Tobacco Non Tobacco Tobacco
0-14 $352.13 $352.13 $308.78 $308.7815 $383.43 $383.43 $336.23 $336.2316 $395.40 $395.40 $346.73 $346.7317 $407.36 $407.36 $357.22 $357.2218 $420.25 $420.25 $368.52 $368.5219 $433.14 $433.14 $379.83 $379.8320 $446.49 $446.49 $391.53 $391.5321 $460.30 $460.30 $403.64 $403.6422 $460.30 $460.30 $403.64 $403.6423 $460.30 $460.30 $403.64 $403.6424 $460.30 $460.30 $403.64 $403.6425 $462.14 $462.14 $405.25 $405.2526 $471.35 $471.35 $413.33 $413.3327 $482.39 $482.39 $423.02 $423.0228 $500.34 $500.34 $438.76 $438.7629 $515.07 $515.07 $451.67 $451.6730 $522.44 $592.55 $458.13 $519.6131 $533.49 $605.08 $467.82 $530.6032 $544.53 $617.61 $477.51 $541.5933 $551.44 $625.44 $483.56 $548.4534 $558.80 $633.79 $490.02 $555.7835 $562.48 $690.62 $493.25 $605.6136 $566.17 $695.14 $496.48 $609.5737 $569.85 $699.66 $499.71 $613.5438 $573.53 $704.18 $502.94 $617.5139 $580.90 $713.22 $509.39 $625.4340 $588.26 $758.50 $515.85 $665.1441 $599.31 $772.75 $525.54 $677.6342 $609.90 $786.40 $534.82 $689.6043 $624.62 $805.39 $547.74 $706.2644 $643.04 $829.13 $563.89 $727.0745 $664.67 $876.44 $582.86 $768.5646 $690.45 $910.42 $605.46 $798.3647 $719.45 $948.66 $630.89 $831.8948 $752.59 $992.36 $659.95 $870.2149 $785.27 $1,035.45 $688.61 $908.0050 $822.09 $1,086.97 $720.90 $953.1851 $858.46 $1,135.05 $752.79 $995.3452 $898.50 $1,188.00 $787.91 $1,041.7753 $939.01 $1,241.56 $823.43 $1,088.7454 $982.74 $1,299.38 $861.77 $1,139.4455 $1,026.46 $1,342.82 $900.12 $1,177.5456 $1,073.88 $1,404.84 $941.69 $1,231.9257 $1,121.75 $1,467.47 $983.67 $1,286.8458 $1,172.84 $1,534.31 $1,028.48 $1,345.4559 $1,198.16 $1,567.43 $1,050.68 $1,374.4960 $1,249.25 $1,605.04 $1,095.48 $1,407.4761 $1,293.44 $1,661.81 $1,134.23 $1,457.2662 $1,322.44 $1,699.07 $1,159.66 $1,489.9363 $1,358.80 $1,745.79 $1,191.55 $1,530.90
64+ $1,380.90 $1,774.17 $1,210.92 $1,555.79
Illinois Off Exchange (Silver)
East St. Louis, IL
303Blue Choice Preferred Silver PPOSM
203
Rates Effective January 1, 2021 Page 26 of 44
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Individual Coverage
Plan
Age Non Tobacco Tobacco Non Tobacco Tobacco
0-14 $316.98 $316.98 $277.96 $277.9615 $345.15 $345.15 $302.67 $302.6716 $355.92 $355.92 $312.11 $312.1117 $366.70 $366.70 $321.56 $321.5618 $378.30 $378.30 $331.73 $331.7319 $389.90 $389.90 $341.91 $341.9120 $401.92 $401.92 $352.44 $352.4421 $414.35 $414.35 $363.35 $363.3522 $414.35 $414.35 $363.35 $363.3523 $414.35 $414.35 $363.35 $363.3524 $414.35 $414.35 $363.35 $363.3525 $416.00 $416.00 $364.80 $364.8026 $424.29 $424.29 $372.07 $372.0727 $434.24 $434.24 $380.79 $380.7928 $450.40 $450.40 $394.96 $394.9629 $463.65 $463.65 $406.58 $406.5830 $470.28 $533.40 $412.40 $467.7431 $480.23 $544.68 $421.12 $477.6332 $490.17 $555.95 $429.84 $487.5233 $496.39 $563.00 $435.29 $493.7034 $503.02 $570.52 $441.10 $500.3035 $506.33 $621.67 $444.01 $545.1536 $509.65 $625.74 $446.91 $548.7237 $512.96 $629.82 $449.82 $552.2938 $516.28 $633.88 $452.73 $555.8639 $522.91 $642.02 $458.54 $563.0040 $529.54 $682.78 $464.36 $598.7441 $539.48 $695.61 $473.08 $609.9842 $549.01 $707.90 $481.43 $620.7643 $562.27 $724.99 $493.06 $635.7544 $578.84 $746.36 $507.59 $654.4945 $598.32 $788.94 $524.67 $691.8346 $621.52 $819.54 $545.02 $718.6647 $647.62 $853.96 $567.91 $748.8448 $677.46 $893.29 $594.07 $783.3449 $706.88 $932.09 $619.87 $817.3650 $740.02 $978.46 $648.93 $858.0251 $772.76 $1,021.74 $677.64 $895.9752 $808.81 $1,069.40 $709.25 $937.7753 $845.27 $1,117.61 $741.22 $980.0554 $884.63 $1,169.66 $775.74 $1,025.6955 $923.99 $1,208.77 $810.26 $1,059.9856 $966.67 $1,264.60 $847.68 $1,108.9457 $1,009.76 $1,320.97 $885.47 $1,158.3758 $1,055.76 $1,381.14 $925.80 $1,211.1459 $1,078.54 $1,410.95 $945.79 $1,237.2860 $1,124.54 $1,444.81 $986.12 $1,266.9761 $1,164.31 $1,495.91 $1,021.00 $1,311.7862 $1,190.42 $1,529.45 $1,043.89 $1,341.1963 $1,223.15 $1,571.51 $1,072.60 $1,378.07
64+ $1,243.05 $1,597.06 $1,090.05 $1,400.48
Illinois Off Exchange (Silver)
St. Louis, IL
303Blue Choice Preferred Silver PPOSM
203
Rates Effective January 1, 2021 Page 27 of 44
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Individual Coverage
Plan
Age Non Tobacco Tobacco Non Tobacco Tobacco
0-14 $427.71 $427.71 $375.07 $375.0715 $465.73 $465.73 $408.40 $408.4016 $480.27 $480.27 $421.15 $421.1517 $494.80 $494.80 $433.90 $433.9018 $510.46 $510.46 $447.63 $447.6319 $526.11 $526.11 $461.35 $461.3520 $542.33 $542.33 $475.57 $475.5721 $559.10 $559.10 $490.28 $490.2822 $559.10 $559.10 $490.28 $490.2823 $559.10 $559.10 $490.28 $490.2824 $559.10 $559.10 $490.28 $490.2825 $561.34 $561.34 $492.24 $492.2426 $572.52 $572.52 $502.05 $502.0527 $585.94 $585.94 $513.81 $513.8128 $607.74 $607.74 $532.94 $532.9429 $625.63 $625.63 $548.62 $548.6230 $634.58 $719.74 $556.47 $631.1531 $648.00 $734.96 $568.24 $644.4932 $661.42 $750.18 $580.00 $657.8433 $669.80 $759.69 $587.36 $666.1834 $678.75 $769.84 $595.20 $675.0835 $683.22 $838.86 $599.12 $735.6036 $687.69 $844.35 $603.05 $740.4237 $692.17 $849.84 $606.97 $745.2438 $696.64 $855.33 $610.89 $750.0539 $705.58 $866.31 $618.73 $759.6840 $714.53 $921.31 $626.58 $807.9141 $727.95 $938.62 $638.35 $823.0842 $740.81 $955.20 $649.62 $837.6343 $758.70 $978.27 $665.31 $857.8544 $781.06 $1,007.10 $684.92 $883.1445 $807.34 $1,064.56 $707.97 $933.5246 $838.65 $1,105.84 $735.42 $969.7347 $873.87 $1,152.29 $766.31 $1,010.4548 $914.13 $1,205.37 $801.61 $1,057.0049 $953.83 $1,257.71 $836.42 $1,102.9050 $998.55 $1,320.29 $875.64 $1,157.7751 $1,042.72 $1,378.69 $914.37 $1,208.9852 $1,091.36 $1,443.00 $957.03 $1,265.3853 $1,140.56 $1,508.06 $1,000.17 $1,322.4354 $1,193.68 $1,578.28 $1,046.75 $1,384.0155 $1,246.79 $1,631.06 $1,093.33 $1,430.2956 $1,304.38 $1,706.39 $1,143.83 $1,496.3557 $1,362.53 $1,782.46 $1,194.82 $1,563.0658 $1,424.59 $1,863.64 $1,249.24 $1,634.2559 $1,455.34 $1,903.87 $1,276.20 $1,669.5260 $1,517.40 $1,949.56 $1,330.62 $1,709.5961 $1,571.07 $2,018.51 $1,377.69 $1,770.0662 $1,606.30 $2,063.77 $1,408.58 $1,809.7463 $1,650.46 $2,120.52 $1,447.31 $1,859.50
64+ $1,677.30 $2,155.00 $1,470.84 $1,889.74
Illinois Off Exchange (Silver)
Southern, IL
303Blue Choice Preferred Silver PPOSM
203
Rates Effective January 1, 2021 Page 28 of 44
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Individual Coverage
Plan
Age Non Tobacco
TobaccoNon
TobaccoTobacco Non Tobacco Tobacco
Non Tobacco
Tobacco Non Tobacco TobaccoNon
TobaccoTobacco
Non Tobacco
Tobacco
0-14 $232.57 $232.57 $245.74 $245.74 $264.95 $264.95 $252.63 $252.63 $265.06 $265.06 $160.53 $160.53 $204.07 $204.0715 $253.25 $253.25 $267.58 $267.58 $288.50 $288.50 $275.09 $275.09 $288.62 $288.62 $174.80 $174.80 $222.21 $222.2116 $261.15 $261.15 $275.93 $275.93 $297.50 $297.50 $283.67 $283.67 $297.63 $297.63 $180.26 $180.26 $229.15 $229.1517 $269.05 $269.05 $284.29 $284.29 $306.51 $306.51 $292.26 $292.26 $306.63 $306.63 $185.72 $185.72 $236.08 $236.0818 $277.57 $277.57 $293.28 $293.28 $316.21 $316.21 $301.51 $301.51 $316.34 $316.34 $191.59 $191.59 $243.55 $243.5519 $286.08 $286.08 $302.28 $302.28 $325.90 $325.90 $310.75 $310.75 $326.04 $326.04 $197.47 $197.47 $251.02 $251.0220 $294.90 $294.90 $311.59 $311.59 $335.95 $335.95 $320.33 $320.33 $336.08 $336.08 $203.55 $203.55 $258.76 $258.7621 $304.02 $304.02 $321.23 $321.23 $346.34 $346.34 $330.24 $330.24 $346.48 $346.48 $209.85 $209.85 $266.76 $266.7622 $304.02 $304.02 $321.23 $321.23 $346.34 $346.34 $330.24 $330.24 $346.48 $346.48 $209.85 $209.85 $266.76 $266.7623 $304.02 $304.02 $321.23 $321.23 $346.34 $346.34 $330.24 $330.24 $346.48 $346.48 $209.85 $209.85 $266.76 $266.7624 $304.02 $304.02 $321.23 $321.23 $346.34 $346.34 $330.24 $330.24 $346.48 $346.48 $209.85 $209.85 $266.76 $266.7625 $305.23 $305.23 $322.51 $322.51 $347.72 $347.72 $331.56 $331.56 $347.86 $347.86 $210.69 $210.69 $267.83 $267.8326 $311.31 $311.31 $328.94 $328.94 $354.65 $354.65 $338.16 $338.16 $354.79 $354.79 $214.88 $214.88 $273.16 $273.1627 $318.61 $318.61 $336.65 $336.65 $362.96 $362.96 $346.09 $346.09 $363.11 $363.11 $219.92 $219.92 $279.57 $279.5728 $330.47 $330.47 $349.17 $349.17 $376.47 $376.47 $358.97 $358.97 $376.62 $376.62 $228.11 $228.11 $289.97 $289.9729 $340.19 $340.19 $359.45 $359.45 $387.55 $387.55 $369.53 $369.53 $387.71 $387.71 $234.82 $234.82 $298.51 $298.5130 $345.06 $391.37 $364.59 $413.52 $393.09 $445.85 $374.82 $425.12 $393.25 $446.03 $238.18 $270.14 $302.77 $343.4131 $352.36 $399.64 $372.30 $422.27 $401.40 $455.27 $382.74 $434.11 $401.57 $455.46 $243.21 $275.85 $309.18 $350.6732 $359.65 $407.92 $380.01 $431.01 $409.72 $464.70 $390.67 $443.10 $409.88 $464.89 $248.25 $281.57 $315.58 $357.9333 $364.21 $413.09 $384.83 $436.47 $414.91 $470.59 $395.62 $448.71 $415.08 $470.79 $251.40 $285.14 $319.58 $362.4734 $369.08 $418.61 $389.97 $442.30 $420.45 $476.88 $400.91 $454.71 $420.63 $477.07 $254.76 $288.94 $323.85 $367.3135 $371.51 $456.14 $392.54 $481.96 $423.22 $519.63 $403.55 $495.48 $423.40 $519.85 $256.43 $314.85 $325.98 $400.2436 $373.94 $459.12 $395.11 $485.11 $425.99 $523.03 $406.19 $498.72 $426.17 $523.25 $258.11 $316.91 $328.12 $402.8637 $376.37 $462.11 $397.68 $488.27 $428.76 $526.44 $408.83 $501.97 $428.94 $526.65 $259.79 $318.97 $330.25 $405.4838 $378.80 $465.10 $400.25 $491.43 $431.54 $529.84 $411.47 $505.21 $431.71 $530.06 $261.47 $321.03 $332.38 $408.1039 $383.67 $471.07 $405.39 $497.74 $437.08 $536.64 $416.76 $511.69 $437.26 $536.86 $264.83 $325.16 $336.65 $413.3440 $388.53 $500.97 $410.53 $529.33 $442.62 $570.71 $422.04 $544.18 $442.80 $570.95 $268.19 $345.80 $340.92 $439.5841 $395.83 $510.38 $418.24 $539.28 $450.93 $581.43 $429.97 $554.40 $451.12 $581.67 $273.22 $352.29 $347.32 $447.8442 $402.82 $519.40 $425.63 $548.80 $458.90 $591.70 $437.56 $564.20 $459.08 $591.95 $278.05 $358.52 $353.46 $455.7543 $412.55 $531.94 $435.91 $562.06 $469.98 $605.99 $448.13 $577.82 $470.17 $606.24 $284.76 $367.18 $361.99 $466.7644 $424.71 $547.62 $448.75 $578.62 $483.83 $623.85 $461.34 $594.85 $484.03 $624.11 $293.16 $378.00 $372.66 $480.5145 $439.00 $578.87 $463.85 $611.64 $500.11 $659.45 $476.86 $628.79 $500.32 $659.72 $303.02 $399.56 $385.20 $507.9346 $456.02 $601.31 $481.84 $635.36 $519.50 $685.02 $495.35 $653.17 $519.72 $685.30 $314.77 $415.06 $400.14 $527.6347 $475.18 $626.57 $502.08 $662.04 $541.32 $713.79 $516.16 $680.61 $541.55 $714.08 $327.99 $432.49 $416.95 $549.7948 $497.07 $655.43 $525.21 $692.54 $566.26 $746.67 $539.94 $711.96 $566.49 $746.98 $343.10 $452.41 $436.15 $575.1149 $518.65 $683.89 $548.01 $722.61 $590.85 $779.09 $563.38 $742.88 $591.09 $779.41 $358.00 $472.06 $455.09 $600.0950 $542.97 $717.92 $573.71 $758.56 $618.56 $817.86 $589.80 $779.84 $618.81 $818.19 $374.79 $495.55 $476.43 $629.9451 $566.99 $749.67 $599.09 $792.11 $645.92 $854.03 $615.89 $814.33 $646.18 $854.38 $391.37 $517.46 $497.51 $657.8152 $593.44 $784.65 $627.04 $829.07 $676.05 $893.87 $644.62 $852.32 $676.33 $894.24 $409.62 $541.60 $520.72 $688.4953 $620.19 $820.02 $655.30 $866.44 $706.53 $934.17 $673.68 $890.74 $706.82 $934.55 $428.09 $566.02 $544.19 $719.5354 $649.08 $858.21 $685.82 $906.79 $739.43 $977.67 $705.05 $932.22 $739.73 $978.08 $448.03 $592.38 $569.53 $753.0455 $677.96 $886.90 $716.34 $937.11 $772.33 $1,010.36 $736.43 $963.39 $772.65 $1,010.78 $467.96 $612.19 $594.88 $778.2256 $709.27 $927.87 $749.42 $980.40 $808.00 $1,057.03 $770.44 $1,007.89 $808.34 $1,057.46 $489.58 $640.46 $622.35 $814.1657 $740.89 $969.23 $782.83 $1,024.10 $844.02 $1,104.15 $804.79 $1,052.82 $844.37 $1,104.60 $511.40 $669.01 $650.10 $850.4558 $774.63 $1,013.38 $818.49 $1,070.74 $882.47 $1,154.44 $841.44 $1,100.77 $882.83 $1,154.91 $534.69 $699.49 $679.71 $889.1959 $791.36 $1,035.25 $836.16 $1,093.86 $901.51 $1,179.36 $859.60 $1,124.53 $901.88 $1,179.84 $546.23 $714.58 $694.38 $908.3860 $825.10 $1,060.09 $871.81 $1,120.10 $939.96 $1,207.66 $896.26 $1,151.52 $940.34 $1,208.15 $569.53 $731.73 $723.99 $930.1861 $854.29 $1,097.59 $902.65 $1,159.72 $973.21 $1,250.37 $927.96 $1,192.25 $973.61 $1,250.89 $589.67 $757.61 $749.60 $963.0862 $873.44 $1,122.19 $922.89 $1,185.72 $995.02 $1,278.41 $948.77 $1,218.98 $995.43 $1,278.93 $602.89 $774.60 $766.40 $984.6863 $897.46 $1,153.05 $948.26 $1,218.33 $1,022.38 $1,313.56 $974.86 $1,252.50 $1,022.81 $1,314.10 $619.47 $795.90 $787.48 $1,011.75
64+ $912.06 $1,171.80 $963.69 $1,238.14 $1,039.02 $1,334.92 $990.72 $1,272.86 $1,039.44 $1,335.47 $629.55 $808.84 $800.28 $1,028.20
Blue FocusCare BronzeSM
BlueCare Direct BronzeSM
401
Chicago - Central, IL
Illinois Off Exchange (Bronze)
with Advocate
201 202205 502 209302
Blue Precision Bronze HMOSM Blue Choice Preferred Bronze PPOSM
Rates Effective January 1, 2021 Page 29 of 44
![Page 31: Individual and Family Health Plan Rates - BCBSIL*rates subject to change 225436.1020 Individual and Family Health Plan Rates New Business Rates Effective January 1, 2021* A Division](https://reader035.vdocument.in/reader035/viewer/2022071419/61171af0f00649441603111a/html5/thumbnails/31.jpg)
Individual Coverage
Plan
Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco
0-14 $229.64 $229.64 $239.31 $239.31 $257.97 $257.97 $246.06 $246.06 $257.95 $257.9515 $250.05 $250.05 $260.58 $260.58 $280.90 $280.90 $267.93 $267.93 $280.88 $280.8816 $257.86 $257.86 $268.72 $268.72 $289.67 $289.67 $276.29 $276.29 $289.65 $289.6517 $265.66 $265.66 $276.85 $276.85 $298.44 $298.44 $284.66 $284.66 $298.42 $298.4218 $274.07 $274.07 $285.61 $285.61 $307.88 $307.88 $293.66 $293.66 $307.86 $307.8619 $282.47 $282.47 $294.37 $294.37 $317.32 $317.32 $302.67 $302.67 $317.30 $317.3020 $291.18 $291.18 $303.44 $303.44 $327.10 $327.10 $311.99 $311.99 $327.08 $327.0821 $300.18 $300.18 $312.82 $312.82 $337.21 $337.21 $321.64 $321.64 $337.20 $337.2022 $300.18 $300.18 $312.82 $312.82 $337.21 $337.21 $321.64 $321.64 $337.20 $337.2023 $300.18 $300.18 $312.82 $312.82 $337.21 $337.21 $321.64 $321.64 $337.20 $337.2024 $300.18 $300.18 $312.82 $312.82 $337.21 $337.21 $321.64 $321.64 $337.20 $337.2025 $301.38 $301.38 $314.08 $314.08 $338.56 $338.56 $322.93 $322.93 $338.54 $338.5426 $307.39 $307.39 $320.33 $320.33 $345.31 $345.31 $329.36 $329.36 $345.29 $345.2927 $314.59 $314.59 $327.84 $327.84 $353.40 $353.40 $337.08 $337.08 $353.38 $353.3828 $326.30 $326.30 $340.04 $340.04 $366.55 $366.55 $349.63 $349.63 $366.53 $366.5329 $335.90 $335.90 $350.05 $350.05 $377.34 $377.34 $359.92 $359.92 $377.32 $377.3230 $340.71 $386.43 $355.06 $402.70 $382.74 $434.10 $365.07 $414.06 $382.72 $434.0831 $347.91 $394.60 $362.56 $411.22 $390.83 $443.28 $372.79 $422.81 $390.81 $443.2632 $355.12 $402.77 $370.07 $419.73 $398.93 $452.46 $380.51 $431.57 $398.90 $452.4433 $359.62 $407.88 $374.76 $425.06 $403.98 $458.20 $385.33 $437.04 $403.96 $458.1734 $364.42 $413.33 $379.77 $430.73 $409.38 $464.32 $390.48 $442.88 $409.36 $464.2935 $366.82 $450.38 $382.27 $469.35 $412.08 $505.95 $393.05 $482.59 $412.05 $505.9236 $369.22 $453.33 $384.77 $472.42 $414.77 $509.26 $395.62 $485.74 $414.75 $509.2337 $371.63 $456.28 $387.28 $475.50 $417.47 $512.57 $398.20 $488.91 $417.45 $512.5438 $374.03 $459.23 $389.78 $478.57 $420.17 $515.88 $400.77 $492.06 $420.15 $515.8639 $378.83 $465.13 $394.78 $484.71 $425.57 $522.51 $405.92 $498.38 $425.54 $522.4840 $383.63 $494.65 $399.79 $515.49 $430.96 $555.68 $411.06 $530.02 $430.94 $555.6541 $390.84 $503.95 $407.30 $525.17 $439.05 $566.12 $418.78 $539.98 $439.03 $566.0842 $397.74 $512.85 $414.49 $534.45 $446.81 $576.12 $426.18 $549.52 $446.78 $576.0943 $407.35 $525.23 $424.50 $547.35 $457.60 $590.03 $436.47 $562.79 $457.57 $590.0044 $419.35 $540.71 $437.02 $563.49 $471.09 $607.42 $449.34 $579.37 $471.06 $607.3945 $433.46 $571.56 $451.72 $595.64 $486.94 $642.08 $464.45 $612.43 $486.91 $642.0446 $450.27 $593.73 $469.24 $618.73 $505.82 $666.98 $482.47 $636.18 $505.79 $666.9447 $469.18 $618.67 $488.94 $644.72 $527.07 $694.99 $502.73 $662.90 $527.04 $694.9548 $490.80 $647.17 $511.47 $674.42 $551.35 $727.00 $525.89 $693.44 $551.31 $726.9649 $512.11 $675.27 $533.68 $703.71 $575.29 $758.57 $548.73 $723.55 $575.26 $758.5350 $536.13 $708.86 $558.70 $738.72 $602.27 $796.32 $574.46 $759.55 $602.23 $796.2751 $559.84 $740.22 $583.42 $771.39 $628.91 $831.54 $599.87 $793.14 $628.87 $831.4952 $585.96 $774.75 $610.63 $807.38 $658.24 $870.33 $627.85 $830.14 $658.21 $870.2853 $612.37 $809.68 $638.16 $843.78 $687.92 $909.57 $656.15 $867.57 $687.88 $909.5154 $640.89 $847.38 $667.88 $883.07 $719.95 $951.92 $686.71 $907.97 $719.91 $951.8755 $669.41 $875.72 $697.60 $912.60 $751.99 $983.75 $717.27 $938.33 $751.95 $983.7056 $700.32 $916.16 $729.82 $954.75 $786.72 $1,029.19 $750.40 $981.67 $786.68 $1,029.1357 $731.54 $957.00 $762.35 $997.31 $821.79 $1,075.07 $783.85 $1,025.43 $821.75 $1,075.0158 $764.86 $1,000.59 $797.08 $1,042.73 $859.22 $1,124.03 $819.55 $1,072.13 $859.17 $1,123.9759 $781.37 $1,022.19 $814.28 $1,065.24 $877.77 $1,148.30 $837.24 $1,095.28 $877.72 $1,148.2360 $814.69 $1,046.72 $849.00 $1,090.80 $915.20 $1,175.85 $872.94 $1,121.56 $915.15 $1,175.7861 $843.51 $1,083.74 $879.04 $1,129.39 $947.57 $1,217.44 $903.82 $1,161.23 $947.52 $1,217.3762 $862.42 $1,108.04 $898.74 $1,154.71 $968.82 $1,244.74 $924.08 $1,187.26 $968.76 $1,244.6763 $886.14 $1,138.51 $923.46 $1,186.46 $995.46 $1,278.96 $949.49 $1,219.91 $995.40 $1,278.89
64+ $900.54 $1,157.02 $938.46 $1,205.75 $1,011.63 $1,299.76 $964.92 $1,239.75 $1,011.60 $1,299.69
502Blue Choice Preferred Bronze PPOSM
Chicago - North, IL
302
Illinois Off Exchange (Bronze)
201 202Blue Precision Bronze HMOSM
205
Rates Effective January 1, 2021 Page 30 of 44
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Individual Coverage
Plan
Age Non Tobacco
TobaccoNon
TobaccoTobacco
Non Tobacco
TobaccoNon
TobaccoTobacco
Non Tobacco
Tobacco Non Tobacco Tobacco
0-14 $221.14 $221.14 $231.56 $231.56 $249.65 $249.65 $238.09 $238.09 $249.75 $249.75 $209.68 $209.6815 $240.79 $240.79 $252.14 $252.14 $271.84 $271.84 $259.25 $259.25 $271.95 $271.95 $228.32 $228.3216 $248.31 $248.31 $260.01 $260.01 $280.32 $280.32 $267.34 $267.34 $280.43 $280.43 $235.44 $235.4417 $255.83 $255.83 $267.88 $267.88 $288.81 $288.81 $275.44 $275.44 $288.92 $288.92 $242.57 $242.5718 $263.92 $263.92 $276.36 $276.36 $297.94 $297.94 $284.15 $284.15 $298.06 $298.06 $250.24 $250.2419 $272.01 $272.01 $284.83 $284.83 $307.08 $307.08 $292.86 $292.86 $307.20 $307.20 $257.92 $257.9220 $280.40 $280.40 $293.61 $293.61 $316.54 $316.54 $301.89 $301.89 $316.67 $316.67 $265.87 $265.8721 $289.07 $289.07 $302.69 $302.69 $326.33 $326.33 $311.23 $311.23 $326.47 $326.47 $274.09 $274.0922 $289.07 $289.07 $302.69 $302.69 $326.33 $326.33 $311.23 $311.23 $326.47 $326.47 $274.09 $274.0923 $289.07 $289.07 $302.69 $302.69 $326.33 $326.33 $311.23 $311.23 $326.47 $326.47 $274.09 $274.0924 $289.07 $289.07 $302.69 $302.69 $326.33 $326.33 $311.23 $311.23 $326.47 $326.47 $274.09 $274.0925 $290.23 $290.23 $303.90 $303.90 $327.64 $327.64 $312.47 $312.47 $327.77 $327.77 $275.19 $275.1926 $296.01 $296.01 $309.95 $309.95 $334.17 $334.17 $318.70 $318.70 $334.30 $334.30 $280.67 $280.6727 $302.94 $302.94 $317.22 $317.22 $342.00 $342.00 $326.17 $326.17 $342.14 $342.14 $287.25 $287.2528 $314.22 $314.22 $329.02 $329.02 $354.73 $354.73 $338.30 $338.30 $354.87 $354.87 $297.93 $297.9329 $323.47 $323.47 $338.71 $338.71 $365.17 $365.17 $348.26 $348.26 $365.32 $365.32 $306.71 $306.7130 $328.09 $372.12 $343.55 $389.66 $370.39 $420.10 $353.24 $400.65 $370.54 $420.27 $311.09 $352.8431 $335.03 $379.99 $350.82 $397.90 $378.22 $428.98 $360.71 $409.12 $378.37 $429.15 $317.67 $360.3032 $341.97 $387.86 $358.08 $406.14 $386.05 $437.86 $368.18 $417.59 $386.21 $438.04 $324.25 $367.7633 $346.30 $392.78 $362.62 $411.29 $390.95 $443.41 $372.85 $422.89 $391.11 $443.59 $328.36 $372.4234 $350.93 $398.02 $367.47 $416.78 $396.17 $449.34 $377.83 $428.53 $396.33 $449.52 $332.74 $377.4035 $353.24 $433.71 $369.89 $454.15 $398.78 $489.62 $380.32 $466.96 $398.94 $489.82 $334.94 $411.2336 $355.55 $436.55 $372.31 $457.12 $401.39 $492.83 $382.81 $470.01 $401.55 $493.03 $337.13 $413.9337 $357.87 $439.39 $374.73 $460.09 $404.00 $496.03 $385.30 $473.07 $404.17 $496.24 $339.32 $416.6238 $360.18 $442.23 $377.15 $463.07 $406.61 $499.24 $387.79 $476.13 $406.78 $499.44 $341.51 $419.3139 $364.80 $447.91 $381.99 $469.01 $411.83 $505.65 $392.77 $482.24 $412.00 $505.85 $345.90 $424.7040 $369.43 $476.34 $386.84 $498.79 $417.05 $537.75 $397.75 $512.86 $417.22 $537.97 $350.29 $451.6641 $376.37 $485.29 $394.10 $508.16 $424.89 $547.85 $405.22 $522.49 $425.06 $548.07 $356.86 $460.1442 $383.02 $493.86 $401.06 $517.13 $432.39 $557.53 $412.38 $531.72 $432.57 $557.75 $363.17 $468.2743 $392.27 $505.79 $410.75 $529.62 $442.84 $570.99 $422.33 $544.56 $443.01 $571.22 $371.94 $479.5844 $403.83 $520.70 $422.86 $545.23 $455.89 $587.82 $434.78 $560.61 $456.07 $588.06 $382.90 $493.7145 $417.42 $550.40 $437.08 $576.34 $471.23 $621.36 $449.41 $592.59 $471.42 $621.61 $395.78 $521.8846 $433.60 $571.75 $454.03 $598.69 $489.50 $645.46 $466.84 $615.58 $489.70 $645.72 $411.13 $542.1247 $451.81 $595.76 $473.10 $623.83 $510.06 $672.56 $486.45 $641.43 $510.27 $672.84 $428.40 $564.8948 $472.63 $623.21 $494.90 $652.57 $533.56 $703.55 $508.86 $670.98 $533.77 $703.83 $448.14 $590.9149 $493.15 $650.27 $516.39 $680.91 $556.73 $734.10 $530.95 $700.11 $556.95 $734.40 $467.60 $616.5750 $516.28 $682.62 $540.60 $714.79 $582.83 $770.62 $555.85 $734.95 $583.07 $770.93 $489.52 $647.2551 $539.11 $712.81 $564.52 $746.40 $608.61 $804.71 $580.44 $767.45 $608.86 $805.03 $511.18 $675.8852 $564.26 $746.07 $590.85 $781.22 $637.00 $842.25 $607.51 $803.25 $637.26 $842.59 $535.02 $707.4053 $589.70 $779.70 $617.49 $816.44 $665.72 $880.22 $634.90 $839.47 $665.99 $880.57 $559.14 $739.3054 $617.16 $816.01 $646.24 $854.46 $696.72 $921.21 $664.47 $878.56 $697.01 $921.58 $585.18 $773.7355 $644.62 $843.30 $675.00 $883.03 $727.72 $952.01 $694.04 $907.94 $728.02 $952.40 $611.22 $799.6056 $674.40 $882.25 $706.18 $923.82 $761.34 $995.98 $726.09 $949.87 $761.65 $996.38 $639.45 $836.5357 $704.46 $921.57 $737.66 $965.00 $795.28 $1,040.38 $758.46 $992.22 $795.60 $1,040.80 $667.95 $873.8258 $736.55 $963.55 $771.25 $1,008.95 $831.50 $1,087.77 $793.01 $1,037.41 $831.84 $1,088.21 $698.38 $913.6259 $752.45 $984.35 $787.90 $1,030.73 $849.45 $1,111.25 $810.12 $1,059.80 $849.79 $1,111.70 $713.45 $933.3460 $784.53 $1,007.97 $821.50 $1,055.46 $885.67 $1,137.91 $844.67 $1,085.23 $886.03 $1,138.37 $743.88 $955.7361 $812.28 $1,043.62 $850.56 $1,092.80 $917.00 $1,178.16 $874.55 $1,123.62 $917.37 $1,178.64 $770.19 $989.5462 $830.49 $1,067.02 $869.63 $1,117.30 $937.56 $1,204.57 $894.15 $1,148.81 $937.94 $1,205.06 $787.46 $1,011.7363 $853.33 $1,096.36 $893.54 $1,148.02 $963.34 $1,237.70 $918.74 $1,180.40 $963.73 $1,238.20 $809.11 $1,039.55
64+ $867.21 $1,114.19 $908.07 $1,166.69 $978.99 $1,257.82 $933.69 $1,199.59 $979.41 $1,258.33 $822.27 $1,056.45
BlueCare Direct BronzeSM
401
Chicago - West, IL
302
Illinois Off Exchange (Bronze)
201 202205 502with Advocate
Blue Precision Bronze HMOSM Blue Choice Preferred Bronze PPOSM
Rates Effective January 1, 2021 Page 31 of 44
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Individual Coverage
Plan
Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco
0-14 $212.96 $212.96 $227.17 $227.17 $244.90 $244.90 $233.51 $233.51 $245.22 $245.2215 $231.89 $231.89 $247.36 $247.36 $266.67 $266.67 $254.27 $254.27 $267.02 $267.0216 $239.13 $239.13 $255.08 $255.08 $275.00 $275.00 $262.21 $262.21 $275.35 $275.3517 $246.37 $246.37 $262.80 $262.80 $283.32 $283.32 $270.14 $270.14 $283.69 $283.6918 $254.16 $254.16 $271.11 $271.11 $292.29 $292.29 $278.69 $278.69 $292.66 $292.6619 $261.96 $261.96 $279.43 $279.43 $301.25 $301.25 $287.24 $287.24 $301.64 $301.6420 $270.03 $270.03 $288.04 $288.04 $310.53 $310.53 $296.09 $296.09 $310.94 $310.9421 $278.38 $278.38 $296.95 $296.95 $320.14 $320.14 $305.25 $305.25 $320.55 $320.5522 $278.38 $278.38 $296.95 $296.95 $320.14 $320.14 $305.25 $305.25 $320.55 $320.5523 $278.38 $278.38 $296.95 $296.95 $320.14 $320.14 $305.25 $305.25 $320.55 $320.5524 $278.38 $278.38 $296.95 $296.95 $320.14 $320.14 $305.25 $305.25 $320.55 $320.5525 $279.49 $279.49 $298.14 $298.14 $321.42 $321.42 $306.47 $306.47 $321.83 $321.8326 $285.06 $285.06 $304.07 $304.07 $327.82 $327.82 $312.57 $312.57 $328.24 $328.2427 $291.74 $291.74 $311.20 $311.20 $335.50 $335.50 $319.90 $319.90 $335.94 $335.9428 $302.60 $302.60 $322.78 $322.78 $347.99 $347.99 $331.80 $331.80 $348.44 $348.4429 $311.51 $311.51 $332.28 $332.28 $358.23 $358.23 $341.57 $341.57 $358.70 $358.7030 $315.96 $358.36 $337.04 $382.27 $363.36 $412.12 $346.46 $392.95 $363.83 $412.6531 $322.64 $365.94 $344.16 $390.35 $371.04 $420.83 $353.78 $401.26 $371.52 $421.3832 $329.32 $373.52 $351.29 $398.43 $378.72 $429.55 $361.11 $409.57 $379.21 $430.1033 $333.50 $378.25 $355.74 $403.48 $383.52 $434.99 $365.69 $414.76 $384.02 $435.5634 $337.95 $383.31 $360.49 $408.87 $388.65 $440.80 $370.57 $420.30 $389.15 $441.3735 $340.18 $417.67 $362.87 $445.53 $391.21 $480.32 $373.01 $457.98 $391.71 $480.9536 $342.41 $420.41 $365.25 $448.45 $393.77 $483.47 $375.45 $460.98 $394.28 $484.0937 $344.63 $423.14 $367.62 $451.37 $396.33 $486.61 $377.90 $463.98 $396.84 $487.2538 $346.86 $425.88 $370.00 $454.28 $398.89 $489.76 $380.34 $466.98 $399.41 $490.3939 $351.32 $431.34 $374.75 $460.12 $404.01 $496.05 $385.22 $472.97 $404.54 $496.6940 $355.77 $458.73 $379.50 $489.33 $409.14 $527.54 $390.11 $503.00 $409.67 $528.2241 $362.45 $467.34 $386.63 $498.52 $416.82 $537.45 $397.43 $512.45 $417.36 $538.1442 $368.85 $475.60 $393.46 $507.32 $424.18 $546.94 $404.45 $521.50 $424.73 $547.6543 $377.76 $487.09 $402.96 $519.58 $434.43 $560.15 $414.22 $534.10 $434.99 $560.8844 $388.90 $501.44 $414.84 $534.89 $447.23 $576.66 $426.43 $549.84 $447.81 $577.4145 $401.98 $530.05 $428.79 $565.41 $462.28 $609.56 $440.78 $581.21 $462.88 $610.3546 $417.57 $550.61 $445.42 $587.33 $480.21 $633.20 $457.87 $603.75 $480.83 $634.0247 $435.11 $573.73 $464.13 $612.00 $500.37 $659.79 $477.10 $629.10 $501.02 $660.6548 $455.15 $600.16 $485.51 $640.19 $523.42 $690.19 $499.08 $658.08 $524.10 $691.0849 $474.92 $626.22 $506.59 $667.99 $546.15 $720.16 $520.75 $686.66 $546.86 $721.0950 $497.19 $657.38 $530.35 $701.23 $571.77 $755.99 $545.17 $720.82 $572.51 $756.9751 $519.18 $686.46 $553.81 $732.24 $597.06 $789.43 $569.29 $752.71 $597.83 $790.4552 $543.40 $718.48 $579.64 $766.40 $624.91 $826.25 $595.84 $787.82 $625.72 $827.3253 $567.90 $750.87 $605.77 $800.96 $653.08 $863.50 $622.70 $823.34 $653.93 $864.6254 $594.34 $785.84 $633.98 $838.25 $683.49 $903.72 $651.70 $861.68 $684.38 $904.8955 $620.79 $812.12 $662.19 $866.28 $713.91 $933.93 $680.70 $890.49 $714.83 $935.1456 $649.46 $849.62 $692.78 $906.29 $746.88 $977.07 $712.14 $931.62 $747.85 $978.3357 $678.41 $887.50 $723.66 $946.69 $780.17 $1,020.62 $743.89 $973.15 $781.18 $1,021.9458 $709.31 $927.92 $756.62 $989.81 $815.71 $1,067.11 $777.77 $1,017.48 $816.77 $1,068.4959 $724.62 $947.95 $772.96 $1,011.18 $833.32 $1,090.14 $794.56 $1,039.44 $834.40 $1,091.5660 $755.52 $970.70 $805.92 $1,035.44 $868.85 $1,116.30 $828.44 $1,064.38 $869.98 $1,117.7561 $782.25 $1,005.03 $834.42 $1,072.07 $899.59 $1,155.79 $857.74 $1,102.03 $900.75 $1,157.2862 $799.79 $1,027.57 $853.13 $1,096.10 $919.75 $1,181.70 $876.97 $1,126.74 $920.95 $1,183.2363 $821.78 $1,055.82 $876.59 $1,126.24 $945.05 $1,214.19 $901.09 $1,157.72 $946.27 $1,215.77
64+ $835.14 $1,072.99 $890.85 $1,144.56 $960.42 $1,233.94 $915.75 $1,176.54 $961.65 $1,235.53
502
Chicago - South, ILBlue Choice Preferred Bronze PPOSM
302
Illinois Off Exchange (Bronze)
201 202Blue Precision Bronze HMOSM
205
Rates Effective January 1, 2021 Page 32 of 44
![Page 34: Individual and Family Health Plan Rates - BCBSIL*rates subject to change 225436.1020 Individual and Family Health Plan Rates New Business Rates Effective January 1, 2021* A Division](https://reader035.vdocument.in/reader035/viewer/2022071419/61171af0f00649441603111a/html5/thumbnails/34.jpg)
Individual Coverage
Plan
Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco
0-14 $237.94 $237.94 $293.62 $293.62 $315.79 $315.79 $301.86 $301.86 $314.64 $314.6415 $259.09 $259.09 $319.72 $319.72 $343.86 $343.86 $328.70 $328.70 $342.60 $342.6016 $267.18 $267.18 $329.70 $329.70 $354.59 $354.59 $338.96 $338.96 $353.30 $353.3017 $275.26 $275.26 $339.68 $339.68 $365.33 $365.33 $349.22 $349.22 $363.99 $363.9918 $283.97 $283.97 $350.43 $350.43 $376.88 $376.88 $360.26 $360.26 $375.51 $375.5119 $292.68 $292.68 $361.18 $361.18 $388.44 $388.44 $371.31 $371.31 $387.02 $387.0220 $301.70 $301.70 $372.31 $372.31 $400.41 $400.41 $382.76 $382.76 $398.95 $398.9521 $311.03 $311.03 $383.82 $383.82 $412.80 $412.80 $394.59 $394.59 $411.29 $411.2922 $311.03 $311.03 $383.82 $383.82 $412.80 $412.80 $394.59 $394.59 $411.29 $411.2923 $311.03 $311.03 $383.82 $383.82 $412.80 $412.80 $394.59 $394.59 $411.29 $411.2924 $311.03 $311.03 $383.82 $383.82 $412.80 $412.80 $394.59 $394.59 $411.29 $411.2925 $312.28 $312.28 $385.36 $385.36 $414.45 $414.45 $396.17 $396.17 $412.93 $412.9326 $318.50 $318.50 $393.03 $393.03 $422.71 $422.71 $404.06 $404.06 $421.16 $421.1627 $325.96 $325.96 $402.25 $402.25 $432.61 $432.61 $413.53 $413.53 $431.03 $431.0328 $338.09 $338.09 $417.22 $417.22 $448.71 $448.71 $428.92 $428.92 $447.07 $447.0729 $348.05 $348.05 $429.50 $429.50 $461.92 $461.92 $441.55 $441.55 $460.23 $460.2330 $353.02 $400.40 $435.64 $494.10 $468.53 $531.40 $447.86 $507.97 $466.81 $529.4631 $360.49 $408.87 $444.85 $504.55 $478.43 $542.64 $457.33 $518.71 $476.68 $540.6532 $367.95 $417.33 $454.06 $515.00 $488.34 $553.88 $466.80 $529.45 $486.55 $551.8533 $372.62 $422.62 $459.82 $521.53 $494.53 $560.90 $472.72 $536.16 $492.72 $558.8534 $377.59 $428.27 $465.96 $528.49 $501.14 $568.39 $479.04 $543.32 $499.30 $566.3135 $380.08 $466.67 $469.03 $575.88 $504.44 $619.35 $482.19 $592.04 $502.59 $617.0836 $382.57 $469.72 $472.10 $579.65 $507.74 $623.40 $485.35 $595.91 $505.88 $621.1237 $385.06 $472.78 $475.17 $583.42 $511.04 $627.46 $488.51 $599.79 $509.17 $625.1738 $387.55 $475.83 $478.24 $587.19 $514.35 $631.51 $491.66 $603.67 $512.46 $629.2039 $392.52 $481.94 $484.38 $594.73 $520.95 $639.62 $497.98 $611.42 $519.05 $637.2840 $397.50 $512.54 $490.53 $632.48 $527.56 $680.23 $504.29 $650.23 $525.63 $677.7441 $404.97 $522.16 $499.74 $644.36 $537.46 $693.01 $513.76 $662.44 $535.50 $690.4742 $412.12 $531.39 $508.57 $655.75 $546.96 $705.25 $522.84 $674.15 $544.96 $702.6743 $422.07 $544.22 $520.85 $671.58 $560.17 $722.28 $535.46 $690.43 $558.12 $719.6444 $434.51 $560.26 $536.20 $691.38 $576.68 $743.57 $551.25 $710.78 $574.57 $740.8545 $449.13 $592.23 $554.24 $730.82 $596.08 $785.99 $569.79 $751.33 $593.90 $783.1246 $466.55 $615.19 $575.73 $759.16 $619.20 $816.47 $591.89 $780.47 $616.93 $813.4947 $486.15 $641.03 $599.92 $791.05 $645.20 $850.76 $616.75 $813.25 $642.84 $847.6548 $508.54 $670.56 $627.55 $827.49 $674.92 $889.96 $645.16 $850.71 $672.46 $886.7049 $530.62 $699.68 $654.80 $863.42 $704.23 $928.60 $673.18 $887.65 $701.66 $925.2050 $555.51 $734.49 $685.51 $906.38 $737.26 $974.80 $704.75 $931.81 $734.56 $971.2451 $580.08 $766.98 $715.83 $946.47 $769.87 $1,017.92 $735.92 $973.03 $767.05 $1,014.2052 $607.14 $802.76 $749.22 $990.62 $805.78 $1,065.40 $770.25 $1,018.42 $802.83 $1,061.5153 $634.51 $838.95 $783.00 $1,035.28 $842.11 $1,113.44 $804.97 $1,064.34 $839.03 $1,109.3654 $664.06 $878.02 $819.46 $1,083.49 $881.32 $1,165.29 $842.46 $1,113.90 $878.10 $1,161.0355 $693.60 $907.38 $855.93 $1,119.72 $920.54 $1,204.25 $879.95 $1,151.15 $917.17 $1,199.8556 $725.64 $949.28 $895.46 $1,171.44 $963.06 $1,259.87 $920.59 $1,204.31 $959.54 $1,255.2657 $757.99 $991.60 $935.38 $1,223.66 $1,005.99 $1,316.03 $961.63 $1,258.00 $1,002.31 $1,311.2258 $792.51 $1,036.77 $977.98 $1,279.39 $1,051.81 $1,375.98 $1,005.43 $1,315.30 $1,047.96 $1,370.9459 $809.62 $1,059.14 $999.09 $1,307.01 $1,074.51 $1,405.68 $1,027.13 $1,343.69 $1,070.58 $1,400.5360 $844.15 $1,084.56 $1,041.70 $1,338.37 $1,120.33 $1,439.41 $1,070.93 $1,375.93 $1,116.24 $1,434.1461 $874.00 $1,122.92 $1,078.54 $1,385.71 $1,159.96 $1,490.32 $1,108.81 $1,424.60 $1,155.72 $1,484.8762 $893.60 $1,148.10 $1,102.72 $1,416.78 $1,185.97 $1,523.73 $1,133.67 $1,456.54 $1,181.63 $1,518.1663 $918.17 $1,179.67 $1,133.05 $1,455.74 $1,218.58 $1,565.63 $1,164.84 $1,496.59 $1,214.12 $1,559.90
64+ $933.09 $1,198.85 $1,151.46 $1,479.41 $1,238.40 $1,591.09 $1,183.77 $1,520.92 $1,233.87 $1,585.27
502
Rockford, ILBlue Choice Preferred Bronze PPOSM
302
Illinois Off Exchange (Bronze)
201 202Blue Precision Bronze HMOSM
205
Rates Effective January 1, 2021 Page 33 of 44
![Page 35: Individual and Family Health Plan Rates - BCBSIL*rates subject to change 225436.1020 Individual and Family Health Plan Rates New Business Rates Effective January 1, 2021* A Division](https://reader035.vdocument.in/reader035/viewer/2022071419/61171af0f00649441603111a/html5/thumbnails/35.jpg)
Individual Coverage
Plan
Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco
0-14 $252.89 $252.89 $272.00 $272.00 $259.80 $259.80 $271.21 $271.2115 $275.37 $275.37 $296.18 $296.18 $282.89 $282.89 $295.32 $295.3216 $283.97 $283.97 $305.42 $305.42 $291.72 $291.72 $304.54 $304.5417 $292.56 $292.56 $314.66 $314.66 $300.55 $300.55 $313.75 $313.7518 $301.82 $301.82 $324.62 $324.62 $310.06 $310.06 $323.68 $323.6819 $311.08 $311.08 $334.58 $334.58 $319.57 $319.57 $333.61 $333.6120 $320.66 $320.66 $344.89 $344.89 $329.42 $329.42 $343.89 $343.8921 $330.58 $330.58 $355.55 $355.55 $339.61 $339.61 $354.52 $354.5222 $330.58 $330.58 $355.55 $355.55 $339.61 $339.61 $354.52 $354.5223 $330.58 $330.58 $355.55 $355.55 $339.61 $339.61 $354.52 $354.5224 $330.58 $330.58 $355.55 $355.55 $339.61 $339.61 $354.52 $354.5225 $331.90 $331.90 $356.98 $356.98 $340.97 $340.97 $355.94 $355.9426 $338.51 $338.51 $364.09 $364.09 $347.76 $347.76 $363.03 $363.0327 $346.45 $346.45 $372.62 $372.62 $355.91 $355.91 $371.54 $371.5428 $359.34 $359.34 $386.49 $386.49 $369.15 $369.15 $385.37 $385.3729 $369.92 $369.92 $397.86 $397.86 $380.02 $380.02 $396.71 $396.7130 $375.21 $425.56 $403.55 $457.71 $385.45 $437.18 $402.38 $456.3831 $383.14 $434.56 $412.09 $467.39 $393.60 $446.43 $410.89 $466.0432 $391.08 $443.56 $420.62 $477.07 $401.76 $455.67 $419.40 $475.6933 $396.03 $449.18 $425.95 $483.11 $406.85 $461.45 $424.72 $481.7234 $401.32 $455.18 $431.64 $489.57 $412.28 $467.61 $430.39 $488.1535 $403.97 $495.99 $434.49 $533.46 $415.00 $509.54 $433.23 $531.9236 $406.61 $499.24 $437.33 $536.95 $417.72 $512.87 $436.06 $535.4037 $409.26 $502.49 $440.17 $540.45 $420.43 $516.21 $438.90 $538.8838 $411.90 $505.73 $443.02 $543.94 $423.15 $519.54 $441.74 $542.3639 $417.19 $512.23 $448.71 $550.92 $428.58 $526.21 $447.41 $549.3340 $422.48 $544.75 $454.40 $585.90 $434.02 $559.62 $453.08 $584.2041 $430.41 $554.98 $462.93 $596.90 $442.17 $570.13 $461.59 $595.1742 $438.02 $564.78 $471.11 $607.45 $449.98 $580.21 $469.74 $605.6943 $448.60 $578.42 $482.49 $622.12 $460.85 $594.22 $481.09 $620.3244 $461.82 $595.47 $496.71 $640.45 $474.43 $611.73 $495.27 $638.6045 $477.36 $629.44 $513.42 $676.99 $490.39 $646.63 $511.93 $675.0346 $495.87 $653.85 $533.33 $703.25 $509.41 $671.71 $531.78 $701.2147 $516.70 $681.31 $555.73 $732.78 $530.81 $699.92 $554.12 $730.6648 $540.50 $712.70 $581.33 $766.54 $555.26 $732.16 $579.65 $764.3249 $563.97 $743.65 $606.57 $799.83 $579.37 $763.96 $604.82 $797.5150 $590.41 $780.65 $635.02 $839.62 $606.54 $801.97 $633.18 $837.1951 $616.53 $815.18 $663.11 $876.76 $633.37 $837.44 $661.19 $874.2252 $645.29 $853.20 $694.04 $917.66 $662.91 $876.50 $692.03 $915.0053 $674.38 $891.67 $725.33 $959.03 $692.80 $916.02 $723.23 $956.2554 $705.79 $933.19 $759.11 $1,003.69 $725.06 $958.68 $756.91 $1,000.7855 $737.19 $964.40 $792.88 $1,037.25 $757.32 $990.73 $790.59 $1,034.2556 $771.24 $1,008.94 $829.50 $1,085.16 $792.30 $1,036.49 $827.10 $1,082.0257 $805.62 $1,053.91 $866.48 $1,133.53 $827.62 $1,082.70 $863.97 $1,130.2558 $842.32 $1,101.92 $905.95 $1,185.16 $865.32 $1,132.01 $903.33 $1,181.7359 $860.50 $1,125.70 $925.50 $1,210.74 $884.00 $1,156.44 $922.82 $1,207.2460 $897.19 $1,152.71 $964.97 $1,239.79 $921.69 $1,184.19 $962.18 $1,236.2061 $928.93 $1,193.49 $999.10 $1,283.65 $954.30 $1,226.08 $996.21 $1,279.9362 $949.75 $1,220.24 $1,021.50 $1,312.43 $975.69 $1,253.57 $1,018.55 $1,308.6363 $975.87 $1,253.80 $1,049.59 $1,348.52 $1,002.52 $1,288.04 $1,046.55 $1,344.61
64+ $991.74 $1,274.19 $1,066.65 $1,370.44 $1,018.83 $1,308.98 $1,063.56 $1,366.47
502
Quad Cities, ILBlue Choice Preferred Bronze PPOSM
Illinois Off Exchange (Bronze)
202201 302
Rates Effective January 1, 2021 Page 34 of 44
![Page 36: Individual and Family Health Plan Rates - BCBSIL*rates subject to change 225436.1020 Individual and Family Health Plan Rates New Business Rates Effective January 1, 2021* A Division](https://reader035.vdocument.in/reader035/viewer/2022071419/61171af0f00649441603111a/html5/thumbnails/36.jpg)
Individual Coverage
Plan
Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco
0-14 $275.86 $275.86 $281.84 $281.84 $303.27 $303.27 $289.83 $289.83 $302.31 $302.3115 $300.38 $300.38 $306.89 $306.89 $330.23 $330.23 $315.59 $315.59 $329.18 $329.1816 $309.76 $309.76 $316.47 $316.47 $340.54 $340.54 $325.44 $325.44 $339.46 $339.4617 $319.14 $319.14 $326.05 $326.05 $350.85 $350.85 $335.29 $335.29 $349.73 $349.7318 $329.23 $329.23 $336.37 $336.37 $361.95 $361.95 $345.90 $345.90 $360.79 $360.7919 $339.33 $339.33 $346.68 $346.68 $373.05 $373.05 $356.51 $356.51 $371.86 $371.8620 $349.79 $349.79 $357.37 $357.37 $384.54 $384.54 $367.50 $367.50 $383.32 $383.3221 $360.60 $360.60 $368.42 $368.42 $396.44 $396.44 $378.86 $378.86 $395.17 $395.1722 $360.60 $360.60 $368.42 $368.42 $396.44 $396.44 $378.86 $378.86 $395.17 $395.1723 $360.60 $360.60 $368.42 $368.42 $396.44 $396.44 $378.86 $378.86 $395.17 $395.1724 $360.60 $360.60 $368.42 $368.42 $396.44 $396.44 $378.86 $378.86 $395.17 $395.1725 $362.05 $362.05 $369.89 $369.89 $398.02 $398.02 $380.38 $380.38 $396.76 $396.7626 $369.26 $369.26 $377.26 $377.26 $405.95 $405.95 $387.96 $387.96 $404.66 $404.6627 $377.91 $377.91 $386.11 $386.11 $415.47 $415.47 $397.05 $397.05 $414.14 $414.1428 $391.98 $391.98 $400.47 $400.47 $430.93 $430.93 $411.82 $411.82 $429.56 $429.5629 $403.52 $403.52 $412.26 $412.26 $443.61 $443.61 $423.95 $423.95 $442.20 $442.2030 $409.29 $464.21 $418.16 $474.28 $449.95 $510.34 $430.01 $487.72 $448.52 $508.7231 $417.94 $474.03 $427.00 $484.30 $459.47 $521.13 $439.10 $498.03 $458.01 $519.4732 $426.60 $483.85 $435.84 $494.33 $468.98 $531.92 $448.20 $508.34 $467.49 $530.2333 $432.00 $489.98 $441.37 $500.60 $474.93 $538.67 $453.88 $514.79 $473.42 $536.9534 $437.77 $496.52 $447.26 $507.29 $481.27 $545.86 $459.94 $521.67 $479.74 $544.1235 $440.66 $541.04 $450.21 $552.77 $484.44 $594.80 $462.97 $568.44 $482.90 $592.9136 $443.54 $544.58 $453.16 $556.39 $487.62 $598.69 $466.00 $572.16 $486.07 $596.7937 $446.43 $548.13 $456.11 $560.01 $490.79 $602.59 $469.03 $575.88 $489.23 $600.6738 $449.31 $551.67 $459.05 $563.63 $493.96 $606.48 $472.06 $579.60 $492.39 $604.5539 $455.08 $558.75 $464.95 $570.86 $500.30 $614.27 $478.13 $587.04 $498.71 $612.3240 $460.85 $594.22 $470.84 $607.10 $506.65 $653.27 $484.19 $624.31 $505.03 $651.1941 $469.51 $605.38 $479.68 $618.51 $516.16 $665.54 $493.28 $636.04 $514.52 $663.4242 $477.80 $616.08 $488.16 $629.43 $525.28 $677.30 $501.99 $647.27 $523.61 $675.1443 $489.34 $630.96 $499.95 $644.63 $537.96 $693.65 $514.12 $662.91 $536.25 $691.4544 $503.77 $649.55 $514.68 $663.63 $553.82 $714.10 $529.27 $682.44 $552.06 $711.8245 $520.71 $686.61 $532.00 $701.50 $572.45 $754.84 $547.08 $721.38 $570.63 $752.4446 $540.91 $713.24 $552.63 $728.70 $594.65 $784.11 $568.30 $749.35 $592.76 $781.6247 $563.63 $743.20 $575.84 $759.30 $619.63 $817.04 $592.16 $780.83 $617.66 $814.4448 $589.59 $777.43 $602.37 $794.28 $648.17 $854.68 $619.44 $816.80 $646.11 $851.9649 $615.19 $811.19 $628.53 $828.77 $676.32 $891.79 $646.34 $852.27 $674.17 $888.9650 $644.04 $851.55 $658.00 $870.01 $708.03 $936.16 $676.65 $894.67 $705.78 $933.1951 $672.53 $889.22 $687.11 $908.49 $739.35 $977.57 $706.58 $934.24 $737.00 $974.4652 $703.90 $930.70 $719.16 $950.87 $773.84 $1,023.17 $739.54 $977.82 $771.38 $1,019.9253 $735.63 $972.66 $751.58 $993.74 $808.73 $1,069.30 $772.88 $1,021.91 $806.16 $1,065.9054 $769.89 $1,017.95 $786.58 $1,040.02 $846.39 $1,119.10 $808.87 $1,069.49 $843.70 $1,115.5455 $804.15 $1,051.99 $821.58 $1,074.79 $884.05 $1,156.52 $844.87 $1,105.26 $881.24 $1,152.8456 $841.29 $1,100.58 $859.53 $1,124.43 $924.89 $1,209.93 $883.89 $1,156.30 $921.94 $1,206.0957 $878.79 $1,149.64 $897.84 $1,174.56 $966.11 $1,263.87 $923.29 $1,207.85 $963.04 $1,259.8558 $918.82 $1,202.00 $938.74 $1,228.05 $1,010.12 $1,321.44 $965.34 $1,262.86 $1,006.91 $1,317.2359 $938.65 $1,227.95 $959.00 $1,254.56 $1,031.92 $1,349.96 $986.18 $1,290.12 $1,028.64 $1,345.6760 $978.68 $1,257.41 $999.89 $1,284.67 $1,075.93 $1,382.35 $1,028.24 $1,321.08 $1,072.50 $1,377.9561 $1,013.30 $1,301.89 $1,035.26 $1,330.11 $1,113.99 $1,431.25 $1,064.61 $1,367.81 $1,110.44 $1,426.7062 $1,036.02 $1,331.08 $1,058.47 $1,359.93 $1,138.96 $1,463.34 $1,088.48 $1,398.47 $1,135.34 $1,458.6863 $1,064.51 $1,367.68 $1,087.58 $1,397.32 $1,170.28 $1,503.58 $1,118.41 $1,436.93 $1,166.56 $1,498.79
64+ $1,081.80 $1,389.92 $1,105.26 $1,420.04 $1,189.32 $1,528.02 $1,136.58 $1,460.29 $1,185.51 $1,523.16
502
Peoria, ILBlue Choice Preferred Bronze PPOSM
302
Illinois Off Exchange (Bronze)
201 202Blue Precision Bronze HMOSM
205
Rates Effective January 1, 2021 Page 35 of 44
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Individual Coverage
Plan
Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco
0-14 $267.55 $267.55 $287.98 $287.98 $275.07 $275.07 $287.34 $287.3415 $291.33 $291.33 $313.58 $313.58 $299.52 $299.52 $312.88 $312.8816 $300.42 $300.42 $323.36 $323.36 $308.87 $308.87 $322.65 $322.6517 $309.51 $309.51 $333.15 $333.15 $318.22 $318.22 $332.41 $332.4118 $319.31 $319.31 $343.69 $343.69 $328.29 $328.29 $342.93 $342.9319 $329.10 $329.10 $354.23 $354.23 $338.35 $338.35 $353.45 $353.4520 $339.24 $339.24 $365.15 $365.15 $348.78 $348.78 $364.34 $364.3421 $349.73 $349.73 $376.44 $376.44 $359.57 $359.57 $375.61 $375.6122 $349.73 $349.73 $376.44 $376.44 $359.57 $359.57 $375.61 $375.6123 $349.73 $349.73 $376.44 $376.44 $359.57 $359.57 $375.61 $375.6124 $349.73 $349.73 $376.44 $376.44 $359.57 $359.57 $375.61 $375.6125 $351.13 $351.13 $377.95 $377.95 $361.01 $361.01 $377.11 $377.1126 $358.13 $358.13 $385.48 $385.48 $368.20 $368.20 $384.62 $384.6227 $366.52 $366.52 $394.51 $394.51 $376.83 $376.83 $393.64 $393.6428 $380.16 $380.16 $409.19 $409.19 $390.85 $390.85 $408.29 $408.2929 $391.35 $391.35 $421.24 $421.24 $402.36 $402.36 $420.30 $420.3030 $396.95 $450.22 $427.26 $484.60 $408.11 $462.88 $426.31 $483.5331 $405.34 $459.74 $436.29 $494.85 $416.74 $472.67 $435.33 $493.7532 $413.73 $469.26 $445.33 $505.09 $425.37 $482.46 $444.34 $503.9733 $418.98 $475.21 $450.98 $511.50 $430.76 $488.57 $449.98 $510.3634 $424.58 $481.55 $457.00 $518.33 $436.52 $495.10 $455.99 $517.1835 $427.37 $524.73 $460.01 $564.80 $439.39 $539.49 $458.99 $563.5536 $430.17 $528.16 $463.02 $568.50 $442.27 $543.02 $462.00 $567.2437 $432.97 $531.60 $466.03 $572.20 $445.15 $546.55 $465.00 $570.9338 $435.77 $535.03 $469.05 $575.89 $448.02 $550.08 $468.01 $574.6239 $441.36 $541.90 $475.07 $583.29 $453.78 $557.15 $474.02 $582.0040 $446.96 $576.31 $481.09 $620.32 $459.53 $592.52 $480.03 $618.9441 $455.35 $587.13 $490.13 $631.97 $468.16 $603.65 $489.04 $630.5742 $463.40 $597.50 $498.78 $643.13 $476.43 $614.31 $497.68 $641.7143 $474.59 $611.93 $510.83 $658.67 $487.94 $629.15 $509.70 $657.2144 $488.58 $629.97 $525.89 $678.08 $502.32 $647.69 $524.72 $676.5845 $505.01 $665.91 $543.58 $716.77 $519.22 $684.64 $542.38 $715.1846 $524.60 $691.74 $564.66 $744.56 $539.35 $711.19 $563.41 $742.9147 $546.63 $720.79 $588.38 $775.83 $562.01 $741.06 $587.07 $774.1248 $571.81 $753.99 $615.48 $811.57 $587.90 $775.20 $614.12 $809.7849 $596.64 $786.73 $642.21 $846.81 $613.43 $808.86 $640.79 $844.9450 $624.62 $825.88 $672.32 $888.95 $642.19 $849.11 $670.83 $886.9851 $652.25 $862.41 $702.06 $928.27 $670.60 $886.66 $700.51 $926.2152 $682.68 $902.63 $734.81 $971.57 $701.88 $928.02 $733.19 $969.4253 $713.45 $943.33 $767.94 $1,015.37 $733.52 $969.86 $766.24 $1,013.1254 $746.68 $987.26 $803.70 $1,062.65 $767.68 $1,015.03 $801.92 $1,060.3055 $779.90 $1,020.27 $839.46 $1,098.19 $801.84 $1,048.97 $837.60 $1,095.7656 $815.93 $1,067.39 $878.24 $1,148.91 $838.88 $1,097.42 $876.29 $1,146.3657 $852.30 $1,114.97 $917.39 $1,200.12 $876.27 $1,146.34 $915.35 $1,197.4758 $891.12 $1,165.76 $959.17 $1,254.79 $916.18 $1,198.55 $957.05 $1,252.0159 $910.35 $1,190.92 $979.88 $1,281.87 $935.96 $1,224.42 $977.71 $1,279.0360 $949.17 $1,219.50 $1,021.66 $1,312.63 $975.87 $1,253.80 $1,019.40 $1,309.7261 $982.75 $1,262.64 $1,057.80 $1,359.06 $1,010.39 $1,298.15 $1,055.46 $1,356.0562 $1,004.78 $1,290.94 $1,081.51 $1,389.53 $1,033.04 $1,327.25 $1,079.12 $1,386.4563 $1,032.41 $1,326.44 $1,111.25 $1,427.74 $1,061.45 $1,363.75 $1,108.79 $1,424.58
64+ $1,049.19 $1,348.01 $1,129.32 $1,450.95 $1,078.71 $1,385.92 $1,126.83 $1,447.74
Illinois Off Exchange (Bronze)
302
Bloomington, ILBlue Choice Preferred Bronze PPOSM
202 302201
Rates Effective January 1, 2021 Page 36 of 44
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Individual Coverage
Plan
Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco
0-14 $292.44 $292.44 $314.55 $314.55 $300.71 $300.71 $313.40 $313.4015 $318.44 $318.44 $342.51 $342.51 $327.44 $327.44 $341.26 $341.2616 $328.38 $328.38 $353.20 $353.20 $337.66 $337.66 $351.91 $351.9117 $338.32 $338.32 $363.89 $363.89 $347.88 $347.88 $362.56 $362.5618 $349.02 $349.02 $375.40 $375.40 $358.89 $358.89 $374.03 $374.0319 $359.72 $359.72 $386.92 $386.92 $369.89 $369.89 $385.50 $385.5020 $370.81 $370.81 $398.84 $398.84 $381.29 $381.29 $397.38 $397.3821 $382.28 $382.28 $411.18 $411.18 $393.09 $393.09 $409.67 $409.6722 $382.28 $382.28 $411.18 $411.18 $393.09 $393.09 $409.67 $409.6723 $382.28 $382.28 $411.18 $411.18 $393.09 $393.09 $409.67 $409.6724 $382.28 $382.28 $411.18 $411.18 $393.09 $393.09 $409.67 $409.6725 $383.81 $383.81 $412.82 $412.82 $394.66 $394.66 $411.31 $411.3126 $391.45 $391.45 $421.05 $421.05 $402.52 $402.52 $419.51 $419.5127 $400.63 $400.63 $430.91 $430.91 $411.95 $411.95 $429.34 $429.3428 $415.54 $415.54 $446.95 $446.95 $427.28 $427.28 $445.32 $445.3229 $427.77 $427.77 $460.11 $460.11 $439.86 $439.86 $458.43 $458.4330 $433.88 $492.11 $466.69 $529.32 $446.15 $506.03 $464.98 $527.3831 $443.06 $502.52 $476.55 $540.51 $455.59 $516.73 $474.81 $538.5332 $452.23 $512.92 $486.42 $551.70 $465.02 $527.43 $484.65 $549.6933 $457.97 $519.43 $492.59 $558.70 $470.92 $534.11 $490.79 $556.6534 $464.08 $526.36 $499.17 $566.16 $477.21 $541.25 $497.35 $564.0935 $467.14 $573.56 $502.46 $616.92 $480.35 $589.77 $500.62 $614.6636 $470.20 $577.31 $505.75 $620.96 $483.49 $593.63 $503.90 $618.6937 $473.26 $581.07 $509.04 $625.00 $486.64 $597.50 $507.18 $622.7138 $476.32 $584.82 $512.33 $629.04 $489.78 $601.36 $510.45 $626.7439 $482.43 $592.33 $518.91 $637.11 $496.07 $609.08 $517.01 $634.7840 $488.55 $629.94 $525.48 $677.56 $502.36 $647.75 $523.56 $675.0841 $497.72 $641.77 $535.35 $690.28 $511.80 $659.91 $533.40 $687.7642 $506.52 $653.10 $544.81 $702.48 $520.84 $671.57 $542.82 $699.9143 $518.75 $668.88 $557.97 $719.45 $533.42 $687.79 $555.93 $716.8244 $534.04 $688.59 $574.41 $740.65 $549.14 $708.06 $572.32 $737.9445 $552.01 $727.88 $593.74 $782.91 $567.61 $748.46 $591.57 $780.0546 $573.42 $756.11 $616.77 $813.27 $589.63 $777.48 $614.51 $810.3047 $597.50 $787.86 $642.67 $847.42 $614.39 $810.14 $640.32 $844.3348 $625.02 $824.15 $672.28 $886.46 $642.69 $847.46 $669.82 $883.2249 $652.16 $859.94 $701.47 $924.96 $670.60 $884.26 $698.91 $921.5850 $682.75 $902.73 $734.36 $970.97 $702.05 $928.25 $731.68 $967.4351 $712.95 $942.66 $766.85 $1,013.92 $733.10 $969.31 $764.04 $1,010.2252 $746.20 $986.63 $802.62 $1,061.22 $767.30 $1,014.53 $799.69 $1,057.3453 $779.84 $1,031.11 $838.80 $1,109.06 $801.89 $1,060.26 $835.74 $1,105.0154 $816.16 $1,079.13 $877.86 $1,160.71 $839.24 $1,109.64 $874.66 $1,156.4755 $852.48 $1,115.21 $916.93 $1,199.52 $876.58 $1,146.74 $913.57 $1,195.1456 $891.85 $1,166.72 $959.28 $1,254.93 $917.07 $1,199.71 $955.77 $1,250.3457 $931.61 $1,218.73 $1,002.04 $1,310.87 $957.95 $1,253.19 $998.38 $1,306.0858 $974.04 $1,274.24 $1,047.68 $1,370.57 $1,001.58 $1,310.27 $1,043.85 $1,365.5659 $995.07 $1,301.74 $1,070.29 $1,400.16 $1,023.20 $1,338.55 $1,066.38 $1,395.0460 $1,037.50 $1,332.98 $1,115.94 $1,433.76 $1,066.83 $1,370.67 $1,111.86 $1,428.5261 $1,074.20 $1,380.13 $1,155.41 $1,484.47 $1,104.57 $1,419.15 $1,151.19 $1,479.0462 $1,098.28 $1,411.07 $1,181.31 $1,517.75 $1,129.33 $1,450.97 $1,177.00 $1,512.2063 $1,128.48 $1,449.87 $1,213.80 $1,559.48 $1,160.39 $1,490.87 $1,209.36 $1,553.79
64+ $1,146.84 $1,473.45 $1,233.54 $1,584.84 $1,179.27 $1,515.11 $1,229.01 $1,579.05
502
Champaign, ILBlue Choice Preferred Bronze PPOSM
Illinois Off Exchange (Bronze)
202201 302
Rates Effective January 1, 2021 Page 37 of 44
![Page 39: Individual and Family Health Plan Rates - BCBSIL*rates subject to change 225436.1020 Individual and Family Health Plan Rates New Business Rates Effective January 1, 2021* A Division](https://reader035.vdocument.in/reader035/viewer/2022071419/61171af0f00649441603111a/html5/thumbnails/39.jpg)
Individual Coverage
Plan
Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco
0-14 $265.40 $265.40 $285.11 $285.11 $272.48 $272.48 $284.31 $284.3115 $288.99 $288.99 $310.45 $310.45 $296.70 $296.70 $309.58 $309.5816 $298.01 $298.01 $320.14 $320.14 $305.96 $305.96 $319.25 $319.2517 $307.03 $307.03 $329.83 $329.83 $315.22 $315.22 $328.91 $328.9118 $316.74 $316.74 $340.27 $340.27 $325.19 $325.19 $339.32 $339.3219 $326.46 $326.46 $350.70 $350.70 $335.16 $335.16 $349.72 $349.7220 $336.52 $336.52 $361.51 $361.51 $345.49 $345.49 $360.50 $360.5021 $346.93 $346.93 $372.69 $372.69 $356.18 $356.18 $371.65 $371.6522 $346.93 $346.93 $372.69 $372.69 $356.18 $356.18 $371.65 $371.6523 $346.93 $346.93 $372.69 $372.69 $356.18 $356.18 $371.65 $371.6524 $346.93 $346.93 $372.69 $372.69 $356.18 $356.18 $371.65 $371.6525 $348.31 $348.31 $374.18 $374.18 $357.60 $357.60 $373.14 $373.1426 $355.25 $355.25 $381.64 $381.64 $364.73 $364.73 $380.57 $380.5727 $363.58 $363.58 $390.58 $390.58 $373.28 $373.28 $389.49 $389.4928 $377.11 $377.11 $405.12 $405.12 $387.17 $387.17 $403.98 $403.9829 $388.21 $388.21 $417.04 $417.04 $398.56 $398.56 $415.88 $415.8830 $393.76 $446.60 $423.01 $479.77 $404.26 $458.52 $421.82 $478.4331 $402.09 $456.05 $431.95 $489.92 $412.81 $468.21 $430.74 $488.5532 $410.41 $465.49 $440.90 $500.06 $421.36 $477.91 $439.66 $498.6633 $415.62 $471.39 $446.49 $506.40 $426.70 $483.97 $445.24 $504.9934 $421.17 $477.69 $452.45 $513.17 $432.40 $490.43 $451.18 $511.7335 $423.94 $520.52 $455.43 $559.18 $435.25 $534.40 $454.16 $557.6136 $426.72 $523.92 $458.41 $562.84 $438.10 $537.90 $457.13 $561.2637 $429.49 $527.33 $461.39 $566.50 $440.95 $541.40 $460.10 $564.9238 $432.27 $530.74 $464.37 $570.16 $443.80 $544.90 $463.08 $568.5639 $437.82 $537.55 $470.34 $577.48 $449.50 $551.89 $469.02 $575.8640 $443.37 $571.68 $476.30 $614.14 $455.20 $586.93 $474.97 $612.4241 $451.70 $582.42 $485.25 $625.68 $463.75 $597.95 $483.89 $623.9342 $459.68 $592.71 $493.82 $636.73 $471.94 $608.52 $492.44 $634.9543 $470.78 $607.02 $505.74 $652.11 $483.34 $623.21 $504.33 $650.2844 $484.65 $624.91 $520.65 $671.33 $497.58 $641.58 $519.19 $669.4545 $500.96 $660.57 $538.17 $709.63 $514.32 $678.19 $536.66 $707.6446 $520.39 $686.18 $559.04 $737.15 $534.27 $704.49 $557.47 $735.0947 $542.24 $715.00 $582.52 $768.11 $556.71 $734.07 $580.89 $765.9648 $567.22 $747.94 $609.35 $803.49 $582.35 $767.89 $607.65 $801.2449 $591.85 $780.42 $635.81 $838.38 $607.64 $801.24 $634.03 $836.0450 $619.61 $819.25 $665.63 $880.09 $636.14 $841.10 $663.77 $877.6351 $647.02 $855.48 $695.07 $919.02 $664.27 $878.30 $693.13 $916.4552 $677.20 $895.39 $727.50 $961.89 $695.26 $919.27 $725.46 $959.2053 $707.73 $935.76 $760.29 $1,005.26 $726.61 $960.72 $758.17 $1,002.4554 $740.69 $979.34 $795.70 $1,052.07 $760.44 $1,005.46 $793.47 $1,049.1355 $773.64 $1,012.08 $831.10 $1,087.25 $794.28 $1,039.08 $828.78 $1,084.2156 $809.38 $1,058.83 $869.49 $1,137.47 $830.97 $1,087.07 $867.06 $1,134.2957 $845.46 $1,106.03 $908.25 $1,188.17 $868.01 $1,135.53 $905.71 $1,184.8558 $883.97 $1,156.40 $949.62 $1,242.29 $907.54 $1,187.25 $946.96 $1,238.8259 $903.05 $1,181.36 $970.12 $1,269.11 $927.13 $1,212.88 $967.40 $1,265.5660 $941.56 $1,209.71 $1,011.49 $1,299.56 $966.67 $1,241.98 $1,008.66 $1,295.9261 $974.86 $1,252.50 $1,047.27 $1,345.53 $1,000.86 $1,285.91 $1,044.34 $1,341.7662 $996.72 $1,280.58 $1,070.75 $1,375.69 $1,023.30 $1,314.74 $1,067.75 $1,371.8463 $1,024.12 $1,315.79 $1,100.19 $1,413.52 $1,051.44 $1,350.89 $1,097.11 $1,409.57
64+ $1,040.79 $1,337.19 $1,118.07 $1,436.51 $1,068.54 $1,372.86 $1,114.95 $1,432.49
502
Springfield, ILBlue Choice Preferred Bronze PPOSM
Illinois Off Exchange (Bronze)
202201 302
Rates Effective January 1, 2021 Page 38 of 44
![Page 40: Individual and Family Health Plan Rates - BCBSIL*rates subject to change 225436.1020 Individual and Family Health Plan Rates New Business Rates Effective January 1, 2021* A Division](https://reader035.vdocument.in/reader035/viewer/2022071419/61171af0f00649441603111a/html5/thumbnails/40.jpg)
Individual Coverage
Plan
Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco
0-14 $268.69 $268.69 $289.12 $289.12 $276.21 $276.21 $288.34 $288.3415 $292.57 $292.57 $314.81 $314.81 $300.76 $300.76 $313.97 $313.9716 $301.70 $301.70 $324.64 $324.64 $310.15 $310.15 $323.77 $323.7717 $310.83 $310.83 $334.47 $334.47 $319.54 $319.54 $333.57 $333.5718 $320.67 $320.67 $345.05 $345.05 $329.65 $329.65 $344.13 $344.1319 $330.50 $330.50 $355.63 $355.63 $339.76 $339.76 $354.68 $354.6820 $340.69 $340.69 $366.59 $366.59 $350.23 $350.23 $365.61 $365.6121 $351.22 $351.22 $377.93 $377.93 $361.06 $361.06 $376.92 $376.9222 $351.22 $351.22 $377.93 $377.93 $361.06 $361.06 $376.92 $376.9223 $351.22 $351.22 $377.93 $377.93 $361.06 $361.06 $376.92 $376.9224 $351.22 $351.22 $377.93 $377.93 $361.06 $361.06 $376.92 $376.9225 $352.63 $352.63 $379.44 $379.44 $362.50 $362.50 $378.43 $378.4326 $359.65 $359.65 $387.00 $387.00 $369.72 $369.72 $385.96 $385.9627 $368.08 $368.08 $396.07 $396.07 $378.39 $378.39 $395.01 $395.0128 $381.78 $381.78 $410.81 $410.81 $392.47 $392.47 $409.71 $409.7129 $393.02 $393.02 $422.90 $422.90 $404.02 $404.02 $421.77 $421.7730 $398.64 $452.14 $428.95 $486.51 $409.80 $464.80 $427.80 $485.2131 $407.07 $461.70 $438.02 $496.80 $418.47 $474.63 $436.85 $495.4732 $415.50 $471.26 $447.09 $507.09 $427.13 $484.45 $445.89 $505.7333 $420.77 $477.23 $452.76 $513.52 $432.55 $490.60 $451.55 $512.1434 $426.39 $483.61 $458.81 $520.38 $438.33 $497.15 $457.58 $518.9935 $429.20 $526.97 $461.83 $567.03 $441.21 $541.72 $460.59 $565.5236 $432.01 $530.42 $464.85 $570.74 $444.10 $545.27 $463.61 $569.2237 $434.82 $533.87 $467.88 $574.46 $446.99 $548.82 $466.62 $572.9238 $437.63 $537.32 $470.90 $578.17 $449.88 $552.36 $469.64 $576.6239 $443.25 $544.22 $476.95 $585.59 $455.66 $559.45 $475.67 $584.0340 $448.87 $578.77 $482.99 $622.77 $461.43 $594.97 $481.70 $621.1041 $457.29 $589.64 $492.06 $634.47 $470.10 $606.15 $490.75 $632.7742 $465.37 $600.05 $500.76 $645.68 $478.40 $616.85 $499.42 $643.9543 $476.61 $614.55 $512.85 $661.27 $489.96 $631.75 $511.48 $659.5044 $490.66 $632.66 $527.97 $680.76 $504.40 $650.37 $526.55 $678.9445 $507.17 $668.75 $545.73 $719.60 $521.37 $687.48 $544.27 $717.6746 $526.84 $694.69 $566.89 $747.50 $541.59 $714.14 $565.38 $745.5147 $548.96 $723.86 $590.70 $778.90 $564.34 $744.13 $589.12 $776.8248 $574.25 $757.21 $617.91 $814.78 $590.33 $778.41 $616.26 $812.6049 $599.19 $790.09 $644.75 $850.16 $615.97 $812.21 $643.02 $847.8950 $627.29 $829.40 $674.98 $892.46 $644.85 $852.62 $673.17 $890.0751 $655.03 $866.09 $704.84 $931.93 $673.37 $890.34 $702.95 $929.4452 $685.59 $906.49 $737.72 $975.41 $704.79 $931.87 $735.74 $972.8053 $716.50 $947.36 $770.97 $1,019.38 $736.56 $973.88 $768.91 $1,016.6654 $749.87 $991.47 $806.88 $1,066.85 $770.86 $1,019.23 $804.72 $1,064.0055 $783.23 $1,024.63 $842.78 $1,102.53 $805.16 $1,053.31 $840.53 $1,099.5856 $819.41 $1,071.95 $881.71 $1,153.45 $842.35 $1,101.96 $879.35 $1,150.3657 $855.94 $1,119.73 $921.01 $1,204.87 $879.90 $1,151.08 $918.55 $1,201.6458 $894.92 $1,170.73 $962.96 $1,259.74 $919.98 $1,203.51 $960.39 $1,256.3859 $914.24 $1,196.01 $983.75 $1,286.94 $939.84 $1,229.49 $981.12 $1,283.5060 $953.22 $1,224.70 $1,025.70 $1,317.82 $979.91 $1,258.99 $1,022.95 $1,314.2961 $986.94 $1,268.02 $1,061.98 $1,364.43 $1,014.58 $1,303.53 $1,059.14 $1,360.7862 $1,009.07 $1,296.45 $1,085.79 $1,395.02 $1,037.32 $1,332.75 $1,082.88 $1,391.2963 $1,036.82 $1,332.10 $1,115.64 $1,433.38 $1,065.85 $1,369.40 $1,112.66 $1,429.55
64+ $1,053.66 $1,353.76 $1,133.79 $1,456.69 $1,083.18 $1,391.67 $1,130.76 $1,452.79
502
East St. Louis, ILBlue Choice Preferred Bronze PPOSM
Illinois Off Exchange (Bronze)
202201 302
Rates Effective January 1, 2021 Page 39 of 44
![Page 41: Individual and Family Health Plan Rates - BCBSIL*rates subject to change 225436.1020 Individual and Family Health Plan Rates New Business Rates Effective January 1, 2021* A Division](https://reader035.vdocument.in/reader035/viewer/2022071419/61171af0f00649441603111a/html5/thumbnails/41.jpg)
Individual Coverage
Plan
Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco
0-14 $241.08 $241.08 $259.36 $259.36 $247.72 $247.72 $259.04 $259.0415 $262.51 $262.51 $282.42 $282.42 $269.74 $269.74 $282.06 $282.0616 $270.70 $270.70 $291.23 $291.23 $278.16 $278.16 $290.87 $290.8717 $278.90 $278.90 $300.05 $300.05 $286.58 $286.58 $299.67 $299.6718 $287.72 $287.72 $309.54 $309.54 $295.65 $295.65 $309.15 $309.1519 $296.55 $296.55 $319.03 $319.03 $304.71 $304.71 $318.63 $318.6320 $305.69 $305.69 $328.87 $328.87 $314.10 $314.10 $328.45 $328.4521 $315.14 $315.14 $339.04 $339.04 $323.82 $323.82 $338.61 $338.6122 $315.14 $315.14 $339.04 $339.04 $323.82 $323.82 $338.61 $338.6123 $315.14 $315.14 $339.04 $339.04 $323.82 $323.82 $338.61 $338.6124 $315.14 $315.14 $339.04 $339.04 $323.82 $323.82 $338.61 $338.6125 $316.40 $316.40 $340.39 $340.39 $325.11 $325.11 $339.96 $339.9626 $322.70 $322.70 $347.17 $347.17 $331.59 $331.59 $346.74 $346.7427 $330.27 $330.27 $355.31 $355.31 $339.36 $339.36 $354.86 $354.8628 $342.56 $342.56 $368.53 $368.53 $351.99 $351.99 $368.07 $368.0729 $352.64 $352.64 $379.38 $379.38 $362.35 $362.35 $378.90 $378.9030 $357.68 $405.69 $384.81 $436.45 $367.53 $416.86 $384.32 $435.9031 $365.25 $414.26 $392.94 $445.68 $375.31 $425.67 $392.45 $445.1232 $372.81 $422.84 $401.08 $454.91 $383.08 $434.49 $400.57 $454.3333 $377.54 $428.20 $406.17 $460.67 $387.93 $439.99 $405.65 $460.0934 $382.58 $433.92 $411.59 $466.83 $393.12 $445.87 $411.07 $466.2435 $385.10 $472.83 $414.30 $508.68 $395.71 $485.85 $413.78 $508.0436 $387.62 $475.92 $417.02 $512.01 $398.30 $489.03 $416.49 $511.3637 $390.14 $479.02 $419.73 $515.34 $400.89 $492.21 $419.20 $514.6938 $392.66 $482.11 $422.44 $518.67 $403.48 $495.39 $421.91 $518.0239 $397.71 $488.30 $427.86 $525.33 $408.66 $501.75 $427.32 $524.6740 $402.75 $519.30 $433.29 $558.68 $413.84 $533.60 $432.74 $557.9841 $410.31 $529.06 $441.43 $569.18 $421.61 $543.63 $440.87 $568.4642 $417.56 $538.40 $449.22 $579.23 $429.06 $553.23 $448.66 $578.5043 $427.64 $551.41 $460.07 $593.22 $439.42 $566.59 $459.49 $592.4744 $440.25 $567.66 $473.63 $610.70 $452.37 $583.29 $473.04 $609.9345 $455.06 $600.04 $489.57 $645.55 $467.59 $616.57 $488.95 $644.7346 $472.71 $623.31 $508.56 $670.58 $485.73 $640.48 $507.91 $669.7347 $492.56 $649.49 $529.91 $698.75 $506.13 $667.38 $529.25 $697.8648 $515.25 $679.41 $554.33 $730.93 $529.44 $698.12 $553.63 $730.0149 $537.63 $708.92 $578.40 $762.67 $552.43 $728.44 $577.67 $761.7150 $562.84 $744.19 $605.52 $800.62 $578.34 $764.68 $604.76 $799.6151 $587.73 $777.10 $632.30 $836.03 $603.92 $798.50 $631.51 $834.9852 $615.15 $813.35 $661.80 $875.03 $632.09 $835.75 $660.97 $873.9353 $642.88 $850.02 $691.64 $914.48 $660.59 $873.43 $690.76 $913.3354 $672.82 $889.61 $723.84 $957.07 $691.35 $914.11 $722.93 $955.8655 $702.76 $919.35 $756.05 $989.07 $722.11 $944.67 $755.10 $987.8256 $735.22 $961.81 $790.97 $1,034.75 $755.47 $988.30 $789.98 $1,033.4557 $767.99 $1,004.69 $826.23 $1,080.88 $789.14 $1,032.36 $825.19 $1,079.5158 $802.97 $1,050.45 $863.87 $1,130.11 $825.09 $1,079.38 $862.78 $1,128.6859 $820.31 $1,073.12 $882.51 $1,154.50 $842.90 $1,102.68 $881.40 $1,153.0560 $855.29 $1,098.87 $920.15 $1,182.21 $878.84 $1,129.14 $918.99 $1,180.7161 $885.54 $1,137.74 $952.69 $1,224.02 $909.93 $1,169.08 $951.49 $1,222.4862 $905.40 $1,163.25 $974.05 $1,251.46 $930.33 $1,195.29 $972.82 $1,249.8863 $930.29 $1,195.24 $1,000.84 $1,285.88 $955.91 $1,228.16 $999.57 $1,284.25
64+ $945.42 $1,214.67 $1,017.12 $1,306.78 $971.46 $1,248.12 $1,015.83 $1,305.14
Illinois Off Exchange (Bronze)
202201 302 502
St. Louis, ILBlue Choice Preferred Bronze PPOSM
Rates Effective January 1, 2021 Page 40 of 44
![Page 42: Individual and Family Health Plan Rates - BCBSIL*rates subject to change 225436.1020 Individual and Family Health Plan Rates New Business Rates Effective January 1, 2021* A Division](https://reader035.vdocument.in/reader035/viewer/2022071419/61171af0f00649441603111a/html5/thumbnails/42.jpg)
Individual Coverage
Plan
Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco
0-14 $328.09 $328.09 $353.14 $353.14 $337.79 $337.79 $351.59 $351.5915 $357.26 $357.26 $384.53 $384.53 $367.82 $367.82 $382.84 $382.8416 $368.41 $368.41 $396.53 $396.53 $379.30 $379.30 $394.79 $394.7917 $379.56 $379.56 $408.53 $408.53 $390.78 $390.78 $406.74 $406.7418 $391.57 $391.57 $421.46 $421.46 $403.14 $403.14 $419.61 $419.6119 $403.58 $403.58 $434.38 $434.38 $415.50 $415.50 $432.48 $432.4820 $416.01 $416.01 $447.77 $447.77 $428.31 $428.31 $445.81 $445.8121 $428.88 $428.88 $461.62 $461.62 $441.55 $441.55 $459.60 $459.6022 $428.88 $428.88 $461.62 $461.62 $441.55 $441.55 $459.60 $459.6023 $428.88 $428.88 $461.62 $461.62 $441.55 $441.55 $459.60 $459.6024 $428.88 $428.88 $461.62 $461.62 $441.55 $441.55 $459.60 $459.6025 $430.60 $430.60 $463.47 $463.47 $443.32 $443.32 $461.43 $461.4326 $439.17 $439.17 $472.70 $472.70 $452.15 $452.15 $470.63 $470.6327 $449.47 $449.47 $483.78 $483.78 $462.75 $462.75 $481.66 $481.6628 $466.19 $466.19 $501.78 $501.78 $479.97 $479.97 $499.58 $499.5829 $479.92 $479.92 $516.55 $516.55 $494.10 $494.10 $514.29 $514.2930 $486.78 $552.11 $523.94 $594.25 $501.16 $568.42 $521.64 $591.6531 $497.07 $563.78 $535.02 $606.82 $511.76 $580.44 $532.67 $604.1632 $507.37 $575.45 $546.10 $619.38 $522.36 $592.46 $543.70 $616.6733 $513.80 $582.75 $553.02 $627.23 $528.98 $599.97 $550.60 $624.4834 $520.66 $590.53 $560.41 $635.61 $536.05 $607.99 $557.95 $632.8335 $524.09 $643.48 $564.10 $692.60 $539.58 $662.50 $561.63 $689.5636 $527.52 $647.69 $567.79 $697.13 $543.11 $666.83 $565.30 $694.0837 $530.95 $651.91 $571.48 $701.67 $546.64 $671.17 $568.98 $698.5938 $534.39 $656.12 $575.18 $706.20 $550.18 $675.51 $572.66 $703.1139 $541.25 $664.54 $582.56 $715.27 $557.24 $684.18 $580.01 $712.1340 $548.11 $706.73 $589.95 $760.68 $564.31 $727.62 $587.36 $757.3441 $558.40 $720.00 $601.03 $774.97 $574.90 $741.28 $598.39 $771.5742 $568.27 $732.73 $611.65 $788.66 $585.06 $754.38 $608.96 $785.2043 $581.99 $750.42 $626.42 $807.70 $599.19 $772.60 $623.67 $804.1644 $599.15 $772.54 $644.88 $831.51 $616.85 $795.37 $642.06 $827.8645 $619.30 $816.61 $666.58 $878.95 $637.61 $840.75 $663.66 $875.1046 $643.32 $848.28 $692.43 $913.04 $662.33 $873.35 $689.39 $909.0347 $670.34 $883.91 $721.51 $951.38 $690.15 $910.03 $718.35 $947.2148 $701.22 $924.63 $754.75 $995.21 $721.94 $951.95 $751.44 $990.8549 $731.67 $964.78 $787.52 $1,038.43 $753.29 $993.29 $784.07 $1,033.8750 $765.98 $1,012.78 $824.45 $1,090.09 $788.62 $1,042.71 $820.84 $1,085.3151 $799.86 $1,057.58 $860.92 $1,138.31 $823.50 $1,088.83 $857.15 $1,133.3252 $837.18 $1,106.91 $901.08 $1,191.41 $861.92 $1,139.62 $897.13 $1,186.1853 $874.92 $1,156.82 $941.70 $1,245.12 $900.77 $1,191.00 $937.57 $1,239.6654 $915.66 $1,210.69 $985.56 $1,303.10 $942.72 $1,246.47 $981.24 $1,297.3955 $956.40 $1,251.17 $1,029.41 $1,346.68 $984.67 $1,288.14 $1,024.90 $1,340.7756 $1,000.58 $1,308.96 $1,076.96 $1,408.88 $1,030.15 $1,347.64 $1,072.24 $1,402.7057 $1,045.18 $1,367.31 $1,124.97 $1,471.68 $1,076.07 $1,407.71 $1,120.03 $1,465.2358 $1,092.79 $1,429.58 $1,176.21 $1,538.71 $1,125.08 $1,471.83 $1,171.05 $1,531.9759 $1,116.38 $1,460.44 $1,201.59 $1,571.92 $1,149.37 $1,503.60 $1,196.33 $1,565.0360 $1,163.98 $1,495.49 $1,252.83 $1,609.64 $1,198.38 $1,539.68 $1,247.34 $1,602.5961 $1,205.15 $1,548.38 $1,297.15 $1,666.58 $1,240.77 $1,594.14 $1,291.46 $1,659.2762 $1,232.17 $1,583.10 $1,326.23 $1,703.94 $1,268.59 $1,629.88 $1,320.42 $1,696.4763 $1,266.06 $1,626.63 $1,362.70 $1,750.80 $1,303.47 $1,674.70 $1,356.73 $1,743.12
64+ $1,286.64 $1,653.08 $1,384.86 $1,779.26 $1,324.65 $1,701.93 $1,378.80 $1,771.47
Illinois Off Exchange (Bronze)
202201 302 502
Southern, ILBlue Choice Preferred Bronze PPOSM
Rates Effective January 1, 2021 Page 41 of 44
![Page 43: Individual and Family Health Plan Rates - BCBSIL*rates subject to change 225436.1020 Individual and Family Health Plan Rates New Business Rates Effective January 1, 2021* A Division](https://reader035.vdocument.in/reader035/viewer/2022071419/61171af0f00649441603111a/html5/thumbnails/43.jpg)
Individual Coverage
Rating Area
Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco
0-14 $222.82 $222.82 $217.24 $217.24 $209.98 $209.98 $205.54 $205.54 $268.27 $268.2715 $242.63 $242.63 $236.55 $236.55 $228.65 $228.65 $223.81 $223.81 $292.12 $292.1216 $250.20 $250.20 $243.93 $243.93 $235.78 $235.78 $230.80 $230.80 $301.23 $301.2317 $257.77 $257.77 $251.31 $251.31 $242.92 $242.92 $237.79 $237.79 $310.35 $310.3518 $265.93 $265.93 $259.26 $259.26 $250.61 $250.61 $245.31 $245.31 $320.17 $320.1719 $274.09 $274.09 $267.21 $267.21 $258.29 $258.29 $252.83 $252.83 $329.99 $329.9920 $282.53 $282.53 $275.45 $275.45 $266.25 $266.25 $260.62 $260.62 $340.16 $340.1621 $291.27 $291.27 $283.97 $283.97 $274.49 $274.49 $268.68 $268.68 $350.68 $350.6822 $291.27 $291.27 $283.97 $283.97 $274.49 $274.49 $268.68 $268.68 $350.68 $350.6823 $291.27 $291.27 $283.97 $283.97 $274.49 $274.49 $268.68 $268.68 $350.68 $350.6824 $291.27 $291.27 $283.97 $283.97 $274.49 $274.49 $268.68 $268.68 $350.68 $350.6825 $292.44 $292.44 $285.10 $285.10 $275.58 $275.58 $269.76 $269.76 $352.08 $352.0826 $298.26 $298.26 $290.78 $290.78 $281.07 $281.07 $275.13 $275.13 $359.10 $359.1027 $305.25 $305.25 $297.60 $297.60 $287.66 $287.66 $281.58 $281.58 $367.51 $367.5128 $316.61 $316.61 $308.67 $308.67 $298.37 $298.37 $292.06 $292.06 $381.19 $381.1929 $325.93 $325.93 $317.76 $317.76 $307.15 $307.15 $300.66 $300.66 $392.41 $392.4130 $330.59 $374.96 $322.30 $365.56 $311.54 $353.35 $304.96 $345.88 $398.02 $451.4431 $337.58 $382.89 $329.12 $373.29 $318.13 $360.82 $311.40 $353.20 $406.44 $460.9832 $344.57 $390.82 $335.93 $381.02 $324.72 $368.29 $317.85 $360.51 $414.85 $470.5333 $348.94 $395.77 $340.19 $385.85 $328.83 $372.96 $321.88 $365.08 $420.11 $476.4934 $353.60 $401.06 $344.74 $391.00 $333.23 $377.95 $326.18 $369.96 $425.72 $482.8635 $355.93 $437.01 $347.01 $426.06 $335.42 $411.83 $328.33 $403.13 $428.53 $526.1536 $358.26 $439.87 $349.28 $428.85 $337.62 $414.53 $330.48 $405.76 $431.34 $529.5937 $360.59 $442.74 $351.55 $431.64 $339.81 $417.22 $332.63 $408.41 $434.14 $533.0438 $362.92 $445.60 $353.82 $434.43 $342.01 $419.92 $334.78 $411.04 $436.95 $536.4839 $367.58 $451.32 $358.37 $440.00 $346.40 $425.31 $339.08 $416.32 $442.56 $543.3740 $372.24 $479.97 $362.91 $467.94 $350.79 $452.31 $343.38 $442.75 $448.17 $577.8741 $379.23 $488.99 $369.73 $476.73 $357.38 $460.81 $349.83 $451.07 $456.58 $588.7242 $385.93 $497.62 $376.26 $485.15 $363.69 $468.95 $356.01 $459.04 $464.65 $599.1243 $395.25 $509.64 $385.34 $496.86 $372.48 $480.27 $364.60 $470.12 $475.87 $613.5944 $406.91 $524.66 $396.70 $511.51 $383.46 $494.43 $375.35 $483.98 $489.90 $631.6745 $420.60 $554.60 $410.05 $540.69 $396.36 $522.64 $387.98 $511.59 $506.38 $667.7146 $436.91 $576.10 $425.95 $561.66 $411.73 $542.91 $403.03 $531.43 $526.02 $693.6147 $455.26 $600.30 $443.84 $585.25 $429.02 $565.71 $419.95 $553.75 $548.11 $722.7448 $476.23 $627.95 $464.29 $612.21 $448.78 $591.77 $439.30 $579.26 $573.36 $756.0349 $496.91 $655.22 $484.45 $638.79 $468.27 $617.46 $458.37 $604.41 $598.26 $788.8650 $520.21 $687.82 $507.17 $670.58 $490.23 $648.19 $479.87 $634.48 $626.31 $828.1151 $543.22 $718.25 $529.60 $700.24 $511.92 $676.86 $501.10 $662.55 $654.02 $864.7452 $568.56 $751.75 $554.31 $732.90 $535.80 $708.43 $524.47 $693.45 $684.53 $905.0853 $594.19 $785.64 $579.30 $765.94 $559.95 $740.37 $548.12 $724.72 $715.39 $945.8854 $621.86 $822.23 $606.27 $801.61 $586.03 $774.85 $573.64 $758.47 $748.70 $989.9355 $649.53 $849.72 $633.25 $828.42 $612.10 $800.76 $599.17 $783.83 $782.01 $1,023.0356 $679.54 $888.97 $662.50 $866.68 $640.38 $837.74 $626.84 $820.03 $818.13 $1,070.2857 $709.83 $928.60 $692.03 $905.31 $668.92 $875.08 $654.78 $856.59 $854.60 $1,117.9958 $742.16 $970.89 $723.55 $946.55 $699.39 $914.94 $684.61 $895.60 $893.53 $1,168.9159 $758.18 $991.85 $739.17 $966.98 $714.49 $934.69 $699.38 $914.93 $912.82 $1,194.1560 $790.51 $1,015.65 $770.69 $990.18 $744.96 $957.12 $729.21 $936.89 $951.74 $1,222.8061 $818.47 $1,051.57 $797.95 $1,025.21 $771.31 $990.97 $755.00 $970.03 $985.41 $1,266.0562 $836.82 $1,075.15 $815.84 $1,048.19 $788.60 $1,013.19 $771.93 $991.77 $1,007.50 $1,294.4463 $859.83 $1,104.71 $838.27 $1,077.01 $810.28 $1,041.05 $793.16 $1,019.05 $1,035.20 $1,330.03
64+ $873.81 $1,122.67 $851.91 $1,094.53 $823.47 $1,057.98 $806.04 $1,035.62 $1,052.04 $1,351.66
Illinois Off Exchange (Catastrophic)
Blue Choice Preferred Security PPOSM
200
Chicago - North, IL Chicago - West, IL Chicago - South, IL Rockford, ILChicago - Central, IL
Rates Effective January 1, 2021 Page 42 of 44
![Page 44: Individual and Family Health Plan Rates - BCBSIL*rates subject to change 225436.1020 Individual and Family Health Plan Rates New Business Rates Effective January 1, 2021* A Division](https://reader035.vdocument.in/reader035/viewer/2022071419/61171af0f00649441603111a/html5/thumbnails/44.jpg)
Individual Coverage
Rating Area
Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco
0-14 $230.07 $230.07 $257.45 $257.45 $243.95 $243.95 $267.34 $267.34 $241.30 $241.3015 $250.52 $250.52 $280.34 $280.34 $265.63 $265.63 $291.10 $291.10 $262.75 $262.7516 $258.34 $258.34 $289.09 $289.09 $273.92 $273.92 $300.19 $300.19 $270.95 $270.9517 $266.16 $266.16 $297.84 $297.84 $282.21 $282.21 $309.27 $309.27 $279.15 $279.1518 $274.58 $274.58 $307.26 $307.26 $291.14 $291.14 $319.06 $319.06 $287.99 $287.9919 $283.00 $283.00 $316.69 $316.69 $300.07 $300.07 $328.84 $328.84 $296.82 $296.8220 $291.72 $291.72 $326.45 $326.45 $309.32 $309.32 $338.98 $338.98 $305.97 $305.9721 $300.75 $300.75 $336.54 $336.54 $318.88 $318.88 $349.46 $349.46 $315.43 $315.4322 $300.75 $300.75 $336.54 $336.54 $318.88 $318.88 $349.46 $349.46 $315.43 $315.4323 $300.75 $300.75 $336.54 $336.54 $318.88 $318.88 $349.46 $349.46 $315.43 $315.4324 $300.75 $300.75 $336.54 $336.54 $318.88 $318.88 $349.46 $349.46 $315.43 $315.4325 $301.95 $301.95 $337.89 $337.89 $320.16 $320.16 $350.86 $350.86 $316.69 $316.6926 $307.96 $307.96 $344.62 $344.62 $326.54 $326.54 $357.85 $357.85 $323.00 $323.0027 $315.18 $315.18 $352.70 $352.70 $334.19 $334.19 $366.23 $366.23 $330.57 $330.5728 $326.91 $326.91 $365.82 $365.82 $346.63 $346.63 $379.86 $379.86 $342.87 $342.8729 $336.53 $336.53 $376.59 $376.59 $356.83 $356.83 $391.05 $391.05 $352.97 $352.9730 $341.35 $387.16 $381.98 $433.24 $361.93 $410.51 $396.64 $449.87 $358.01 $406.0631 $348.56 $395.34 $390.05 $442.40 $369.59 $419.19 $405.02 $459.38 $365.58 $414.6432 $355.78 $403.53 $398.13 $451.56 $377.24 $427.87 $413.41 $468.89 $373.15 $423.2333 $360.29 $408.64 $403.18 $457.28 $382.02 $433.29 $418.65 $474.84 $377.88 $428.6034 $365.10 $414.10 $408.56 $463.39 $387.13 $439.08 $424.24 $481.18 $382.93 $434.3235 $367.51 $451.23 $411.25 $504.94 $389.68 $478.44 $427.04 $524.32 $385.45 $473.2636 $369.92 $454.18 $413.95 $508.24 $392.23 $481.58 $429.84 $527.75 $387.98 $476.3637 $372.32 $457.14 $416.64 $511.55 $394.78 $484.71 $432.63 $531.19 $390.50 $479.4638 $374.73 $460.09 $419.33 $514.86 $397.33 $487.84 $435.43 $534.62 $393.02 $482.5639 $379.54 $466.00 $424.72 $521.47 $402.43 $494.11 $441.02 $541.48 $398.07 $488.7540 $384.35 $495.58 $430.10 $554.57 $407.53 $525.47 $446.61 $575.86 $403.12 $519.7841 $391.57 $504.89 $438.18 $564.99 $415.19 $535.34 $455.00 $586.67 $410.69 $529.5442 $398.49 $513.81 $445.92 $574.97 $422.52 $544.80 $463.03 $597.04 $417.94 $538.9043 $408.11 $526.22 $456.69 $588.85 $432.73 $557.96 $474.22 $611.46 $428.04 $551.9144 $420.14 $541.73 $470.15 $606.21 $445.48 $574.40 $488.20 $629.48 $440.65 $568.1845 $434.28 $572.64 $485.97 $640.80 $460.47 $607.18 $504.62 $665.39 $455.48 $600.6046 $451.12 $594.84 $504.81 $665.65 $478.33 $630.72 $524.19 $691.20 $473.14 $623.8947 $470.06 $619.83 $526.02 $693.60 $498.42 $657.21 $546.21 $720.23 $493.02 $650.0948 $491.72 $648.38 $550.25 $725.55 $521.38 $687.49 $571.37 $753.41 $515.73 $680.0449 $513.07 $676.54 $574.14 $757.06 $544.02 $717.34 $596.18 $786.12 $538.12 $709.5750 $537.13 $710.19 $601.06 $794.73 $569.53 $753.03 $624.14 $825.23 $563.36 $744.8751 $560.89 $741.61 $627.65 $829.88 $594.72 $786.34 $651.74 $861.73 $588.28 $777.8252 $587.05 $776.20 $656.93 $868.59 $622.46 $823.02 $682.15 $901.93 $615.72 $814.1053 $613.52 $811.20 $686.55 $907.75 $650.52 $860.12 $712.90 $942.60 $643.48 $850.8054 $642.09 $848.97 $718.52 $950.03 $680.82 $900.18 $746.10 $986.49 $673.44 $890.4355 $670.66 $877.36 $750.49 $981.79 $711.11 $930.28 $779.30 $1,019.48 $703.41 $920.2056 $701.64 $917.88 $785.15 $1,027.14 $743.96 $973.25 $815.29 $1,066.56 $735.90 $962.7057 $732.92 $958.80 $820.15 $1,072.92 $777.12 $1,016.63 $851.63 $1,114.11 $768.70 $1,005.6158 $766.30 $1,002.47 $857.51 $1,121.79 $812.52 $1,062.93 $890.42 $1,164.85 $803.71 $1,051.4259 $782.84 $1,024.11 $876.02 $1,146.01 $830.06 $1,085.88 $909.65 $1,190.00 $821.06 $1,074.1160 $816.22 $1,048.68 $913.38 $1,173.51 $865.45 $1,111.93 $948.44 $1,218.55 $856.08 $1,099.8961 $845.09 $1,085.78 $945.68 $1,215.01 $896.07 $1,151.27 $981.98 $1,261.65 $886.36 $1,138.7962 $864.04 $1,110.12 $966.89 $1,242.25 $916.16 $1,177.08 $1,004.00 $1,289.94 $906.23 $1,164.3263 $887.80 $1,140.65 $993.47 $1,276.41 $941.35 $1,209.44 $1,031.61 $1,325.41 $931.15 $1,196.34
64+ $902.25 $1,159.19 $1,009.62 $1,297.17 $956.64 $1,229.11 $1,048.38 $1,346.96 $946.29 $1,215.79
Illinois Off Exchange (Catastrophic)
Blue Choice Preferred Security PPOSM
200
Peoria, IL Bloomington, IL Champaign, IL Springfield, ILQuad Cities, IL
Rates Effective January 1, 2021 Page 43 of 44
![Page 45: Individual and Family Health Plan Rates - BCBSIL*rates subject to change 225436.1020 Individual and Family Health Plan Rates New Business Rates Effective January 1, 2021* A Division](https://reader035.vdocument.in/reader035/viewer/2022071419/61171af0f00649441603111a/html5/thumbnails/45.jpg)
Individual Coverage
Rating Area
Age Non Tobacco Tobacco Non Tobacco Tobacco Non Tobacco Tobacco
0-14 $245.07 $245.07 $219.02 $219.02 $301.56 $301.5615 $266.85 $266.85 $238.49 $238.49 $328.37 $328.3716 $275.18 $275.18 $245.93 $245.93 $338.62 $338.6217 $283.51 $283.51 $253.38 $253.38 $348.87 $348.8718 $292.48 $292.48 $261.39 $261.39 $359.91 $359.9119 $301.45 $301.45 $269.41 $269.41 $370.94 $370.9420 $310.74 $310.74 $277.71 $277.71 $382.37 $382.3721 $320.35 $320.35 $286.30 $286.30 $394.20 $394.2022 $320.35 $320.35 $286.30 $286.30 $394.20 $394.2023 $320.35 $320.35 $286.30 $286.30 $394.20 $394.2024 $320.35 $320.35 $286.30 $286.30 $394.20 $394.2025 $321.63 $321.63 $287.45 $287.45 $395.78 $395.7826 $328.04 $328.04 $293.17 $293.17 $403.66 $403.6627 $335.73 $335.73 $300.05 $300.05 $413.12 $413.1228 $348.22 $348.22 $311.21 $311.21 $428.50 $428.5029 $358.47 $358.47 $320.37 $320.37 $441.11 $441.1130 $363.60 $412.39 $324.95 $368.56 $447.42 $507.4631 $371.28 $421.11 $331.83 $376.36 $456.88 $518.1932 $378.97 $429.83 $338.70 $384.15 $466.34 $528.9233 $383.78 $435.28 $342.99 $389.02 $472.25 $535.6334 $388.90 $441.09 $347.57 $394.22 $478.56 $542.7835 $391.47 $480.64 $349.86 $429.56 $481.71 $591.4536 $394.03 $483.79 $352.15 $432.37 $484.87 $595.3237 $396.59 $486.94 $354.44 $435.19 $488.02 $599.1938 $399.15 $490.08 $356.73 $438.00 $491.17 $603.0639 $404.28 $496.37 $361.31 $443.62 $497.48 $610.8140 $409.41 $527.89 $365.90 $471.78 $503.79 $649.5841 $417.09 $537.80 $372.77 $480.65 $513.25 $661.7842 $424.46 $547.30 $379.35 $489.14 $522.32 $673.4843 $434.71 $560.52 $388.51 $500.95 $534.93 $689.7444 $447.53 $577.04 $399.97 $515.72 $550.70 $710.0745 $462.58 $609.96 $413.42 $545.14 $569.23 $750.5846 $480.52 $633.62 $429.45 $566.28 $591.30 $779.6947 $500.71 $660.23 $447.49 $590.06 $616.14 $812.4448 $523.77 $690.64 $468.11 $617.24 $644.52 $849.8649 $546.52 $720.63 $488.43 $644.05 $672.51 $886.7750 $572.14 $756.49 $511.34 $676.09 $704.04 $930.8951 $597.45 $789.95 $533.96 $706.00 $735.18 $972.0652 $625.32 $826.80 $558.86 $738.93 $769.48 $1,017.4153 $653.51 $864.07 $584.06 $772.24 $804.17 $1,063.2754 $683.94 $904.31 $611.26 $808.21 $841.62 $1,112.7955 $714.38 $934.55 $638.46 $835.23 $879.07 $1,150.0056 $747.37 $977.71 $667.95 $873.81 $919.67 $1,203.1157 $780.69 $1,021.30 $697.72 $912.76 $960.67 $1,256.7458 $816.25 $1,067.82 $729.50 $954.33 $1,004.42 $1,313.9959 $833.87 $1,090.86 $745.25 $974.93 $1,026.11 $1,342.3560 $869.43 $1,117.04 $777.03 $998.33 $1,069.86 $1,374.5661 $900.18 $1,156.55 $804.51 $1,033.64 $1,107.70 $1,423.1862 $920.36 $1,182.48 $822.55 $1,056.81 $1,132.54 $1,455.0963 $945.67 $1,215.00 $845.17 $1,085.87 $1,163.68 $1,495.10
64+ $961.05 $1,234.75 $858.90 $1,103.53 $1,182.60 $1,519.41
Illinois Off Exchange (Catastrophic)
Blue Choice Preferred Security PPOSM
200
St. Louis, IL Southern ILEast St. Louis, IL
Rates Effective January 1, 2021 Page 44 of 44
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Blue Cross and Blue Shield of Illinois P.O.Box 3236 Naperville, IL 60566-7236
bcbsil.com
A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association