| Zip Code | |
| Age |
| Dental PPO | 0.00 | Brochure | |
| Dental PPO 50/1250 | 0.00 | Brochure | |
| Enhanced Dental PPO 50/2000 | 0.00 | Brochure | |
| Enhanced Dental PPO 50/2000 | 0.00 | Brochure | |
| Dental HMO | 23.70 | Brochure | |
| Dental Standard HMO | 12.50 | Brochure | |
| Duo Dental & Vision | 43.50 | Brochure | |
| Ultimate Vision 15/25/120 | 6.90 | Brochure | |
| Ultimate Vision 15/25/150 | 12.90 | Brochure | |