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Page 2 <br /> HEALTH PLAN <br /> FHP,INC. FOUNDATION HEALTH NET OF AMERICA <br /> (FHP) (FDN) (HN) (HPA) <br /> Plan Monthly Plan Monthly Plan Monthly Plan Monthly <br /> Code Rate Code Rate Code Rate Code Rate <br /> Basic(B) <br /> Emp.only 591 $151.29 841 $164.10 861 $161.62 2091 $156.98 <br /> Emp. & 1 dep. 592 302.58 842 328.20 862 300.24 2092 300.12 <br /> Emp. &2+deps. 593 408.48 843 429.94 863 421.43 2093 406.95 <br /> Supplement To Medicare(SM) <br /> Emp.only 611 10.24 851 143.99 871 128.77 2101 108.26 <br /> Emp. & 1 dep. 612 20.48 852 287.98 872 257.54 2102 216.52 <br /> Emp. & 2+deps. 613 33.47 853 431.97 873 385.95 2103 305.56 <br /> Combination (B&SM) <br /> Emp. (SM), 1 dep.(B) 614 161.53 854 308.09 874 267.39 2104 251.40 <br /> Emp. (SM), 2+deps. (B) 615 267.43 855 409.83 875 388.58 2105 358.23 <br /> Emp. & 1 dep. (SM), 1+deps. (B) 616 126.38 856 389.72 876 378.73 2106 323.35 <br /> Emp. (B), 1 dep. (SM) 617 161.53 857 308.09 877 290.39 2107 265.24 <br /> Emp. (B), 2+deps.(SM) 618 174.52 858 452.08 878 418.80 2108 354.28 <br /> Emp. & 1+dep.(B), 1 dep. (SM) 619 267.43 859 409.83 879 411.58 2109 372.07 <br /> HEALTH PLAN <br /> OF THE REDWOODS KAISER NORTH KAISER SOUTH LIFEGUARD <br /> (HPR) (KN) (KS) (LI) <br /> Plan Monthly Plan Monthly Plan Monthly Plan Monthly <br /> Code Rate Code Rate Code Rate Code Rate <br /> Basic(B) <br /> Emp. only 341 $157.00 561 $162.82 571 $165.85 2281 $156.00 <br /> Emp. & 1 dep. 342 322.00 562 325.64 572 331.70 2282 312.00 <br /> Emp. & 2+deps. 343 436.00 563 433.11 573 469.68 2283 427.25 <br /> Supplement To Medicare (SM) <br /> Emp.only 371 118.00 661 102.48 671 74.50 2291 143.35 <br /> Emp. & 1 dep. 372 236.00 662 204.96 672 149.00 2292 286.70 <br /> Emp. & 2+deps. 373 354.00 663 307.44 673 223.50 2293 430.05 <br /> Combination(B&SM) <br /> Emp. (SM), 1 dep. (B) 374 283.00 664 265.30 674 240.35 2294 299.35 <br /> Emp. (SM), 2+deps. (B) 375 397.00 665 372.77 675 378.33 2295 414.60 <br /> Emp. & 1 dep. (SM), 1+ deps. (B) 376 350.00 666 312.43 676 286.98 2296 401.95 <br /> Emp. (B), 1 dep.(SM) 377 275.00 667 265.30 677 240.35 2297 299.35 <br /> Emp. (B), 2 deps.(SM) 378 393.00 668 367.78 678 314.85 2298 442.70 <br /> Emp. & 1+dep. (B), 1 dep. (SM) 379 389.00 669 372.77 679 378.33 2299 414.60 <br /> 29 <br />