AARP Medicare Supplement Application - Colorado Health Agents

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COLORADO Area 1 ZIP Codes, Effective August 1, 2012 Th e ZIP Codes Below Apply to Rates Included on the Page Headed “Cover Page – Rates” 80011 80216 80249 80601 80019 80217 80250 80602 80022 80218 80251 80603 80024 80219 80252 80614 80030 80220 80256 80640 80035 80221 80257 80036 80222 80259 80037 80223 80260 80040 80224 80261 80042 80227 80262 80045 80229 80263 80102 80230 80264 80136 80231 80265 80137 80233 80266 80201 80234 80271 80202 80235 80273 80203 80236 80274 80204 80237 80279 80205 80238 80280 80206 80239 80281 80207 80241 80290 80208 80243 80291 80209 80244 80293 80210 80246 80294 80211 80247 80295 80212 80248 80299 SA5110 OA (08-12) Page 1 of 1 0000001 0000006 0012 0074 UMS1129 01 L
Cover Page - Rates for Colorado - Area 2 Non-Tobacco Monthly Plan Rates AARP ® Medicare Supplement Insurance Plans insured by UnitedHealthcare Insurance Company Group 1 Applies to individuals whose plan effective date will be within three years following their 65th birthday or Medicare Part B effective date, if later. Age 1 Plan A Plan B Plan C Plan F Plan K Plan L Plan N Standard Rates with Enrollment Discount 2 for individuals ages 65-74 65 $61.42 $116.72 $139.65 $140.17 $49.17 $75.77 $100.45 66 $64.05 $121.72 $145.63 $146.18 $51.28 $79.02 $104.75 67 $66.69 $126.73 $151.62 $152.19 $53.39 $82.27 $109.06 68 $69.32 $131.73 $157.60 $158.19 $55.49 $85.51 $113.36 69 $71.95 $136.73 $163.59 $164.20 $57.60 $88.76 $117.67 70 $74.58 $141.73 $169.57 $170.21 $59.71 $92.01 $121.97 71 $77.22 $146.74 $175.56 $176.22 $61.82 $95.26 $126.28 72 $79.85 $151.74 $181.54 $182.22 $63.92 $98.50 $130.58 73 $82.48 $156.74 $187.53 $188.23 $66.03 $101.75 $134.89 74 $85.11 $161.74 $193.51 $194.24 $68.14 $105.00 $139.19 Standard Rates for ages 75 and older 75+ $87.75 $166.75 $199.50 $200.25 $70.25 $108.25 $143.50 Group 2 Applies to individuals whose plan effective date will be between 3 years and less than 6 years following their 65th birthday or Medicare Part B effective date, if later. Age 1 Plan A Plan B Plan C Plan F Plan K Plan L Plan N Standard Rates with Enrollment Discount 2 for individuals ages 68-74 who do not have any of the medical conditions on the application. 3 68 $69.32 $131.73 $157.60 $158.19 $55.49 $85.51 $113.36 69 $71.95 $136.73 $163.59 $164.20 $57.60 $88.76 $117.67 70 $74.58 $141.73 $169.57 $170.21 $59.71 $92.01 $121.97 71 $77.22 $146.74 $175.56 $176.22 $61.82 $95.26 $126.28 72 $79.85 $151.74 $181.54 $182.22 $63.92 $98.50 $130.58 73 $82.48 $156.74 $187.53 $188.23 $66.03 $101.75 $134.89 74 $85.11 $161.74 $193.51 $194.24 $68.14 $105.00 $139.19 Standard Rates for individuals ages 75 and older who do not have any of the medical conditions on the application. 3 75+ $87.75 $166.75 $199.50 $200.25 $70.25 $108.25 $143.50 Level 2 Rates for individuals ages 68 and older who have one or more of the medical conditions on the application. 3 68+ $131.62 $250.12 $299.25 $300.37 $105.37 $162.37 $215.25 Group 3 Applies to individuals whose plan effective date will be 6 or more years following their 65th birthday or Medicare Part B effective date, if later. Age 1 Plan A Plan B Plan C Plan F Plan K Plan L Plan N Level 1 Rates for individuals ages 71 and older who do not have any of the medical conditions on the application. 3 71+ $96.52 $183.42 $219.45 $220.27 $77.27 $119.07 $157.85 Level 2 Rates for individuals ages 71 and older who have one or more of the medical conditions on the application. 3 71+ $131.62 $250.12 $299.25 $300.37 $105.37 $162.37 $215.25 The rates above are for plan effective dates from January - December 2013 and may change. MRP0003 COB 1-13 0000001 0000007 0013 0074 UMS1129 01 L
Page 1 and 2: Colorado AARP Medicare Supplement I
Page 3 and 4: Instructions Page Please Read Befor
Page 5 and 6: Hello, Thank you for your interest
Page 7 and 8: Your Plans and Rates AARP ® Medica
Page 9 and 10: Cover Page - Rates for Colorado - A
Page 11: Cover Page - Rates for Colorado - A
Page 25 and 26: Outline of Coverage | UnitedHealthc
Page 27 and 28: Your Guide to AARP Medicare Supplem
Page 51 and 52: Your Exclusive Member Services. Get
Page 53 and 54: Enrollment Checklist In the followi
Page 55 and 56: Application Form AARP ® Medicare S
Page 57 and 58: 5 Answer these health questions to
Page 59 and 60: 7 Tell us about your past and curre
Page 61 and 62: 8 Authorization and Verification of
Page 63 and 64:
AARP membership offers so much for
Page 65 and 66:
Save $24 a year with the Electronic
Page 67 and 68:
Save $24 a year with the Electronic
Page 69 and 70:
NOTICE TO APPLICANT REGARDING REPLA
Page 71 and 72:
0000001 0000036 0071 0074 UMS1129 0
Page 73 and 74:
Thank You for Applying for an AARP
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AARP Medicare Supplement Application - Colorado Health Agents

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