DENTAL/VISION MONTHLY PREMIUMS**

Value Plan Monthly Rates
Single Only
$20.00
Insured & One (Spouse or Child)
$37.00
Insured & 2 or more
$55.00
Standard Plan Monthly Rates
Single Only
$28.60
Insured & One (Spouse or Child)
$52.50
Insured & 2 or more
$76.65
Royal Plan Monthly Rates
Single Only
$36.37
Insured & One (Spouse or Child)
$66.86
Insured & 2 or more
$98.15

100/70/50 Monthly Rates

Region One - NE, KS, SC, SD, TN, OH, ND, OK, KY, LA, MO, MS, WV, AL
Single Only
$34.76
Insured & One (Spouse or Child)
$73.94
Insured & 2 or more
$127.96
Region Two - WY, NM, FL, PA, IL, DE, NC, VA, GA, IN, TX, IA
Single Only
$38.03
Insured & One (Spouse or Child)
$80.73
Insured & 2 or more
$139.40
Region Three - MD, MT, VT, MI, UT, ID, MN, WI, ME
Single Only
$43.53
Insured & One (Spouse or Child)
$92.39
Insured & 2 or more
$159.71
Region Four - OR, MA, NV, NJ, RI, CO
Single Only
$49.45
Insured & One (Spouse or Child)
$104.90
Insured & 2 or more
$181.52
Region Five - AK, WA, HI, CA, DC, CT
Single Only
$54.14
Insured & One (Spouse or Child)
$114.90
Insured & 2 or more
$199.21

*Above rates include appropriate fees. The Group Policy is governed by the laws of the state of VA.
**As this is an association, plan coverage is not available in NY and NH due to state laws.