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HIP MONTHLY FEE SCHEDULE 2011

HIP HMO/ Sole Proprietors


HIP PRIME – HIP PRIME –
PHSTD6963 PHSTD7001
SINGLE $ 617.29 $ 567.86
COUPLE $ 1,185.34 $ 1,090.43
PARENT/ CHILD $ 1,455.69 $ 1,337.06
FAMILY $ 1,922.22 $ 1,768.29

HIP HMO/ Small Group


HIP PRIME – HIP PRIME –
PHSTD6963 PHSTD7001
SINGLE $ 536.77 $ 493.79
COUPLE $ 1,030.73 $ 948.20
PARENT/ CHILD $ 1,265.82 $ 1,162.66
FAMILY $ 1,671.49 $ 1,537.64

HIP Select PPO- PFSLTB-016


Sole Proprietors Small Group
SINGLE $ 562.93 $ 489.51
COUPLE $ 1,081.29 $ 940.25
PARENT/ CHILD $ 1,339.22 $ 1,164.54
FAMILY $ 1,754.84 $ 1,525.95

Please note that you must send a one-time non refundable $25.00 Health Insurance
enrollment fee.

HIP HMO AND PPO RATES 2011

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