RESIDE Prime - Annual Premiums

RESIDE Prime Worldwide Medical Plan - Annual Premiums 2001

(formerly Signature Worldwide Medical Plan)
Annual Premiums Effective January 1, 2001
Underwritten by: The MEGA Life and Health Insurance Company

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	If you choose a $500 Annual Deductible		If you choose a $1000 Annual Deductible		If you choose a $2500 Annual Deductible		If you choose a $5000 Annual Deductible
Age	Male	Female	Male	Female	Male	Female	Male	Female
14 days through 18	$510	$510	$420	$420	$391	$391	$368	$368
19 through 29	$1,002	$1,746	$778	$1,351	$679	$1,179	$533	$920
30 through 39	$1,164	$2,086	$902	$1,612	$789	$1,407	$618	$1,098
40 through 44	$1,334	$1,675	$1,033	$1,296	$902	$1,131	$740	$941
45 through 49	$1,470	$1,838	$1,138	$1,421	$993	$1,240	$810	$978
50 through 54	$1,801	$2,011	$1,392	$1,560	$1,215	$1,389	$1,030	$1,152
55 through 59	$2,210	$2,210	$1,710	$1,708	$1,490	$1,490	$1,255	$1,267
60 through 64	$3,025	$2,830	$2,550	$2,251	$2,310	$2,072	$1,930	$1,715
65 through 69	$6,521	$5,653	$6,100	$5,149	$4,690	$3,827	$4,100	$3,672
70	$7,805	$6,674	$7,200	$6,158	$5,700	$4,660	$4,503	$3,738
71	$8,150	$6,988	$7,604	$6,473	$6,007	$4,869	$4,805	$3,895
72	$8,535	$7,327	$8,034	$6,853	$6,342	$5,147	$5,073	$4,119
73	$8,972	$7,681	$8,432	$7,186	$6,667	$5,438	$5,330	$4,365
74	$9,385	$8,081	$8,875	$7,559	$7,022	$5,724	$5,623	$4,575
Dependent Child*	$410	$410	$321	$321	$281	$281	$258	$258

* The Dependent Child Premium is only available when one parent (legal guardian), of a natural or legally adopted unmarried child over 14 days old and under 19 years of age (or under 24 years of age if attending a university full-time and must rely on parents for support), is also covered under the same program. No premium is charged for the first two (2) Dependent Children between the ages of 14 days and 9 years old if both parents are also covered under the same program.

If the Applicant desires to pay premiums on a Semi-Annual, Quarterly or Monthly basis, they must do so by Visa or Master Card payment only. SRI will automatically debit the credit card on the due date of the premium installment. The Premium Installment Factors to be applied to the Annual Premium are as follows:

Annual = 1.00 Semi-Annual = .55 Quarterly = .28 Monthly = .10

IMPORTANT NOTICE: The premiums referenced above are applicable for the initial 12 month coverage period, only after the Applicant has been accepted by SRI. SRI reserves the right to increase the stated premiums based upon the Applicant's medical condition at the time of application and underwriting. Applicants with chronic and/or severe medical conditions may be declined. At each renewal period, SRI will inform the Applicant of the renewal premium for each subsequent coverage period based upon the Applicant's age and deductible category.