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information and Enrollment Form
Benefits: OMIP Plan 500 | OMIP Plan
750 | OMIP Plan 1000
| OMIP Plan 1500 | FMIP Plan 500 | FMIP Plan 750
Rates: OMIP Plan 500 | OMIP Plan
750 | OMIP Plan 1000 | OMIP Plan
1500 | FMIP Plan 500 | FMIP Plan 750
OMIP Plan 750 - Medical Eligibility Rates
Effective date : 1/1/2010
Valid thru : 12/31/2010
Counties :
Available in all counties
| Family Status : |
Applicant |
Two |
Three+ |
| Age |
Deductible : 750 |
| 0-17 |
239.00 |
478.00 |
717.00 |
| 18-19 |
268.00 |
536.00 |
775.00 |
| 20-24 |
302.00 |
604.00 |
843.00 |
| 25-29 |
324.00 |
648.00 |
887.00 |
| 30-34 |
362.00 |
724.00 |
963.00 |
| 35-39 |
376.00 |
752.00 |
991.00 |
| 40-44 |
447.00 |
894.00 |
1133.00 |
| 45-49 |
515.00 |
1030.00 |
1269.00 |
| 50-54 |
590.00 |
1180.00 |
1419.00 |
| 55-59 |
677.00 |
1354.00 |
1593.00 |
| 60-64 |
677.00 |
1354.00 |
1593.00 |
| 65+ |
712.00 |
1424.00 |
1663.00 |
OMIP Plan 750 - Portability Eligibility Rates
Effective date : 1/1/2010
Valid thru : 12/31/2010
Counties :
Available in all counties
| Family Status : |
Applicant |
Two |
Three+ |
| Age |
Deductible : 750 |
| 0-17 |
250.00 |
500.00 |
750.00 |
| 18-19 |
250.00 |
500.00 |
750.00 |
| 20-24 |
250.00 |
500.00 |
750.00 |
| 25-29 |
307.00 |
614.00 |
864.00 |
| 30-34 |
376.00 |
752.00 |
1002.00 |
| 35-39 |
385.00 |
770.00 |
1020.00 |
| 40-44 |
463.00 |
926.00 |
1176.00 |
| 45-49 |
478.00 |
956.00 |
1206.00 |
| 50-54 |
588.00 |
1176.00 |
1426.00 |
| 55-59 |
603.00 |
1206.00 |
1456.00 |
| 60-64 |
615.00 |
1230.00 |
1480.00 |
| 65+ |
615.00 |
1230.00 |
1480.00 |
* - not all of the zip codes are eligible in this county
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