Medicare Supplement Rates Tobacco User

FLORIDA MEDICARE SUPPLEMENT Issue Age Monthly (PAC) and Annual Premiums- 2004 Individual Statewide Level Tobacco User For Rates Other Than Florida Please Call: 1-800-654-7355
Issue Age	Plan A		Plan B		Plan C		Plan F
Issue Age	Monthly	Annual	Monthly	Annual	Monthly	Annual	Monthly	Annual

69 & Under	94.58	1087.12	147.03	1690.05	170.01	1954.09	191.72	2203.72
70-74	103.49	1189.54	168.53	1937.09	195.57	2247.94	218.14	2507.35
75 & Older	113.62	1305.93	196.65	2260.34	231.55	3145.34	254.46	2924.88

Zip Code	Factor
323 324-328 33755-33767 33770-33782 33785-33786 338, 342-348 320-322, 329 335-336 33700-33754 33768-33784 33787-33799 339, 341, 349 334 333 330-332, 340	1.00 1.10 1.20 1.30 1.50 1.60

Issue Age	Plan D Male		Plan D Female
Issue Age	Monthly	Annual	Monthly	Annual

65 & Under	149.61	1719.65	136.02	1563.43
66	149.61	1719.65	136.02	1563.43
67	154.56	1776.56	140.55	1615.50
68	159.93	1838.33	145.40	1671.21
69	164.99	1896.46	150.03	1724.50
70	170.15	1955.80	154.67	1777.78
71	175.21	2013.93	159.30	1831.06
72	180.16	2070.84	163.83	1883.14
73	185.22	2128.98	168.36	1935.22
74	190.07	2184.68	172.79	1986.07
75	194.91	2240.39	177.21	2036.93
76	199.55	2293.67	181.43	2085.37
77	204.19	2346.96	185.64	2133.81
78	208.51	2396.61	189.54	2178.63
79	212.82	2446.26	193.54	2224.64
80	216.93	2493.49	197.23	2267.03
81	220.83	2538.30	200.81	2308.20
82	224.31	2578.26	203.87	2344.53
83	227.57	2615.80	206.82	2377.24
84	230.42	2648.50	209.45	2407.51
85+	235.27	2704.21	213.88	2458.37


1. Monthly (PAC) or Annual Tobacco User Premium (shown above): 2. Multiply by applicable zip code factor: X Total Monthly (PAC) or Annual Premium: =	________________ ________________ ________________

3. If paying quarterly or semi-annually, please check o which one and multiply the Annual Premium
    by the applicable premium modal factor:
                                     Annual                         Zip Code
                                     Premium                         Factor
o Quarterly      ___________        X     ____________     X .265 =______________ (Quarterly Premium)
o      Semi- Annual     ___________        X     ____________     X .52     =______________ (Semi-Annual Premium)

IMPORTANT NOTES:
Rates may vary by a few cents from the rate shown at the tme if issue due to computer rounding.