GoBlue SM  Rates - (effective April 1, 2012 through March 31, 2013)

Area 1 Preferred Rates Standard Rates without substance abuse coverage without substance abuse coverage including substance abuse coverage including substance abuse coverage Area 2 Preferred Rates Standard Rates without substance abuse coverage without substance abuse coverage including substance abuse coverage including substance abuse coverage Area 3 Preferred Rates Standard Rates without substance abuse coverage without substance abuse coverage including substance abuse coverage including substance abuse coverage

Rates apply to plans with the following group numbers: YA025, YA026, YA027, YA028 Effective April 1, 2011 Health plans are as unique and individual as you are. With Blue Cross and Blue Shield of Minnesota, your monthly rate is based on where you live, your age, the deductible amount you select, whether you are tobacco free and whether you choose substance abuse coverage. The information below will help you determine your monthly rate based on these factors. Follow these steps to determine your rate: Select Area 1 or Area 2 Area 1 rates include ZIP codes in the following Minnesota counties: Anoka, Carver, Dakota, Hennepin, Ramsey, Scott, Washington Area 2 rates include ZIP codes in all counties outside Area 1 plus all out-of-state ZIP codes Note: If you live on a county line, call Blue Cross customer service to determine your area as our system is based on ZIP codes Select the rate table based on tobacco usage Decide whether you want coverage for substance abuse Select your deductible Find your age group on the left side of the table These rates are effective April 1, 2011 through March 31, 2012. Rates are subject to benefit changes mandated by law and annual adjustments. Applicants must be age 19 to 64 to be eligible for coverage. Note: Your rate will change when you age into a new age category or move into a different rate area.