Prism Continuum
C1
C2
C3
$500 per year
Paid at 80%
Brand name drugs covered if no generic
equivalent is available
$750 per year
Paid at 80%
Brand name drugs covered if no generic
equivalent is available
$1,200 per year
Paid at 80%
Brand name drugs covered if no generic
equivalent is available
DENTAL - Combined maximums per
person for Schedules A, B & C
(if applicable)
Not covered
$600 in the first 12 months
$800 in the next 12 months
$1,000 every 12 months thereafter
$750 in the first 12 months
$1,000 in the next 12 months
$1,250 every 12 months thereafter
Schedule A – Basic
Not covered
Paid at 80%
Paid at 80%
Schedule B – Basic Comprehensive
Not covered
Paid at 80%
Paid at 80%
Schedule C – Major Services
Not covered
Not covered
Paid at 50%, starting in the
3rd benefit year
Vision - maximum per person
$150 every 24 months
$200 every 24 months
$250 every 24 months
Accidental Dental - maximum per person
$2,500 per year
$5,000 per year
$10,000 per year
Ambulance Transportation
Includes land and air
Includes land and air
Includes land and air
Hearing Aids - maximum per person
$300 every 4 years
$400 every 4 years
$500 every 4 years
Home Support Services - maximum
per person
$1,500 per year
$2,500 per year
$5,000 per year
Medical Items - maximum per person
$1,500 per year
foot orthotics - $250 every 24 months
stockings - 2 pairs every 4 months
surgical brassieres - 2 every 12 months
$2,500 per year
foot orthotics - $250 every 24 months
stockings - 2 pairs every 4 months
surgical brassieres - 2 every 12 months
$5,000 per year
foot orthotics - $250 every 24 months
stockings - 2 pairs every 4 months
surgical brassieres - 2 every 12 months
Medical Services
Eye examinations - maximum per person
Covered
$50 every 24 months
Covered
$50 every 24 months
Covered
$65 every 24 months
Professional/Registered Therapists
- maximums per practitioner per person
• Chiropractor, Footcare Specialist
(Chiropodist/Podiatrist), Naturopath,
Osteopath, Physiotherapist
• Psychologist, Speech Therapist
• Massage Therapist, Acupuncturist
$20 per visit; 15 visits per year
$300 per year
$20 per visit; 15 visits per year
$300 per year
$300 per year
$20 per visit; 15 visits per year
$400 per year
$400 per year
$20 per visit; 20 visits per year
TRAVEL - maximum per person
[available up to age 65]
$1,000,000 per year
10 days per trip
$1,000,000 per year
10 days per trip
$1,000,000 per year
15 days per trip
$200 per day, 30 days per year
$200 per day, 30 days per year
$200 per day, 30 days per year
Please see “Benefit Descriptions”
for more details
PRESCRIPTION DRUGS - maximum
per person
EXTENDED HEALTH
SEMI-PRIVATE HOSPITAL ACCOMMODATION
- maximum per person
Benefit
Descriptions
Benefit
Descriptions
Benefit
Benefit
Benefit
Descriptions
Descriptions
Descriptions
PRESCRIPTION DRUGS
EXTENDED HEALTH
Medical Services
Prescription
drugs/medications
that have been approved for use in Canada that require a
PRESCRIPTION
PTION DRUGS
PRESCRIPTION
DRUGS
DRUGS
EXTENDED
EXTENDED
HEALTH Vision
HEALTH
EXTENDED HEALTH
prescription by law.
Prescription eye glasses, contact lenses, laser eye surgery or replacement parts to
prescription
Vision eye glasses.
rescription
rugs/medications
drugs/medications
that
Prescription
have been
that
drugs/medications
approved
have been
forapproved
usethat
in Canada
have
for use
been
that
inapproved
Canada
require that
afor use
require
in Canada
a
that requireVision
a
Vision
NOTE:
Excludes
patent or proprietary medicines, over-the-counter drugs, smoking
rescription
y law.
by law.
prescription
byvitamins,
law.
Prescription Prescription
eye glasses, eye
contact
glasses,
Prescription
lenses,
contact
lasereye
lenses,
eyeglasses,
surgery
lasercontact
or
eyereplacement
surgery
lenses,orlaser
replacement
partseyetosurgery
parts
or to
replacement parts to
cessation products, erectile dysfunction (ED) agents, fertility and obesity drugs.
NOTE:
For information
regarding eye examinations please see description under
prescription prescription
eye glasses. eye glasses.
prescription
eye glasses.
Medical Services.
NOTE:
des vitamins,
Excludes
patent
vitamins,
NOTE:
or proprietary
patent
Excludes
ormedicines,
vitamins,
proprietary
patent
over-the-counter
medicines,
or proprietary
over-the-counter
drugs,
medicines,
smoking
drugs,
over-the-counter
smoking drugs, smoking
Includes diagnostic tests and x-rays, dialysis equipment, laboratory tests, radioactive t
eye examinations.
Medical Services
Medical Servicesand
Medical
Services
Includes diagnostic
Includestests
diagnostic
and x-rays,
Includes
testsdialysis
anddiagnostic
x-rays,
equipment,
dialysis
tests laboratory
and
equipment,
x-rays,tests,
dialysis
laboratory
radioactive
equipment,
tests,treatments
radioactive
laboratorytreatments
tests, radioactive
NOTE:
Eyeexaminations.
examinations are available only in those provinces where eye examination
and eye examinations.
and eye examinations.
and eye
covered by the provincial government health plan on an annual basis.
DENTAL
NOTE: Eye examinations
NOTE: Eye examinations
are available
NOTE:are
Eye
only
available
examinations
in thoseonly
provinces
inare
those
available
where
provinces
eye
onlyexaminations
where
in those
eyeprovinces
examinations
are notwhereare
eyenot
examinat
ion products,
cessation
erectile
products,
dysfunction
cessation
erectile (ED)
dysfunction
products,
agents,erectile
(ED)
fertility
agents,
dysfunction
and obesity
fertility(ED)
drugs.
andagents,
obesityfertility
drugs. and obesity drugs. NOTE: For information
NOTE: For information
NOTE:
regarding
eyeregarding
examinations
For information
eye examinations
please
regarding
see description
please
eye examinations
see under
description
please
under
see description under
Therapists
Accidental
DentalServices.
covered by the
covered
provincial
byProfessional/Registered
thegovernment
provincial
coveredgovernment
health
by theplan
provincial
on
health
an annual
government
plan onbasis.
an annual
health basis.
plan on an annual basis.
Medical Services.
Medical Services.
Medical
Chiropractor, Footcare Specialists (Chiropodist/Podiatrist), Naturopath, Osteopath,
A – Basic
The repair or replacement of natural teeth which were damaged as a result of an accident to the
DENTAL Schedule
DENTAL
Physiotherapist,
Psychologist,Therapists
Speech Therapist, Acupuncturist and Registered
• Preventative cleaning and polishing (every 9 months)
mouth
(blow toDental
the mouth).
Professional/Registered
Professional/Registered
Therapists
Professional/Registered
Therapists
Accidental Accidental
Dental
Dental
Accidental
Massage
Therapist
(RMT).Specialists
• Routine
examinations,
Chiropractor,
Footcare Specialists
Footcare
Chiropractor,
(Chiropodist/Podiatrist),
Specialists
Footcare
(Chiropodist/Podiatrist),
Naturopath,
(Chiropodist/Podiatrist),
Naturopath,
Osteopath, Osteopath,
Naturopath, Osteopath,
–chedule
Basic A – Basic
Schedule
A – Basic x-rays
The repair orThe
replacement
repair or replacement
of natural
The repair
teeth
of natural
or
which
replacement
teeth
were damaged
which
of natural
were
asdamaged
ateeth
resultwhich
ofasanawere
accident
resultdamaged
of to
an the
accident
as a result
to the
of an accident
to the Chiropractor,
• Fluoride
treatments
for children
NOTE:
Damage
teeth
as a result of eating something is not covered.
Physiotherapist,
Physiotherapist,
Psychologist,Psychologist,
Speech
Physiotherapist,
Therapist,
Speech
Acupuncturist
Psychologist,
Therapist, Acupuncturist
Speech
and Registered
Therapist,
and Registered
Acupuncturist and Registered
ePreventative
cleaning andcleaning
polishing
• Preventative
and
(every
polishing
9 cleaning
months)
(every
and
9 months)
polishing (every 9 months)
mouth (blowmouth
to the(blow
mouth).
to the
mouth
mouth).
(blow totothe
mouth).
NOTE:
All
of
the
Extended
Health
benefits
are
not
payable
for
services and supplies p
•
Fillings
and
extractions
Massage Therapist
Massage
(RMT).
Therapist (RMT).
Massage Therapist (RMT).
aminations,
Routine examinations,
x-rays • Routine
x-raysexaminations, x-rays
a chronic care or psychiatric hospital or institution, chronic care unit of a gene
• Pit
andchildren
fissure
sealantsfor children
Ambulance
atments
Fluoridefor
treatments
children
• Fluoride
for
treatments
NOTE: Damage
NOTE:
NOTE:
to teeth
Damage
as ato
result
teethofasDamage
eating
a Transportation
result
something
to
of teeth
eatingas
issomething
not
a result
covered.
ofiseating
not covered.
something is not covered.
or All
when
abenefits
patient
isareconfined
to a and
nursing
home
or supplies
home
forprovided
the aged
and re
• Space
maintainers
and general anaesthetics
When required as the result of an accident or acute physical disability, professional landNOTE:
or air All ofNOTE:
the Extended
All of the
Health
Extended
NOTE:
benefits
Health
ofare
the
not
Extended
payable
Health
not
for services
payable
benefits
forare
services
supplies
not
payable
and
provided
for in
services
andinsupplie
extractions
Fillings and extractions
• Fillings
and extractions
provincial
assistance.
ambulance to the nearest hospital equipped to provide the required treatment.
a chronic care
a chronic
or psychiatric
care orhospital
psychiatric
a chronic
or government
institution,
hospital
care or psychiatric
orchronic
institution,
care
hospital
chronic
unit or
of institution,
acare
general
unit of
hospital,
chronic
a general
carehospital,
unit of a ge
ure
Pit sealants
and fissure sealants
• Pit and fissure sealants
Schedule
Bmaintainers
– Basic
Comprehensive
tainers
Space maintainers
and general
• and
Space
anaesthetics
general
anaesthetics
and general anaesthetics
• Periodontal treatment including: cleaning and scaling (8 units every 12 months) –
treatment
of
gums
and
tissues of the mouth
–chedule
Basic Comprehensive
B – Basic
Schedule
Comprehensive
B – Basic Comprehensive
• Endodontics
–treatment
root
canalincluding:
therapy
treatment
Periodontalincluding:
treatment
• Periodontal
cleaning
including:
and
cleaning
scaling
(8
and
units
scaling
every
cleaning
(812
units
months)
and
every
scaling
–12 months)
(8 units–every 12 months) –
• Denture
cleaning,
repairs,
rebasingofand
oftreatment
gums andoftissues
gums
of
treatment
and
thetissues
mouth
ofofgums
the
mouth
and tissues
the relining
mouth
s Endodontics
– root canal–therapy
root
• Endodontics
canal therapy– root canal therapy
Schedule
– Majorand
Services
aning,
Denture
repairs,
cleaning,
rebasing
•repairs,
Denture
andCrebasing
relining
cleaning,
repairs,
relining
rebasing and relining
• Dentures
•
Standard
crown
restorations
or onlays on natural teeth
–chedule
Major Services
C – Major
Schedule
Services
C – Major Services
• Standard
bridges, including pontics, abutment retainers/crowns on natural teeth
Dentures
• Dentures
Standard
repair
or restorations
recementing
crowns,ononlays
bridgework on natural teeth
own
Standard
restorations
crown• restorations
or
• Standard
onlays on
crown
ornatural
onlays
teeth
on naturalorofteeth
onlays
naturaland
teeth
AmbulanceAmbulance
Transportation
Transportation
Ambulance Transportation
or when
is confined
a patienttoisoraconfined
when
nursing
a patient
to
home
a nursing
oris home
confined
home
for or
to
thehome
a aged
nursing
for
andthe
home
receives
aged
or home
and receives
for the aged and
When required
When
as the
required
resultas
of the
an
When
accident
result
required
of or
an acute
accident
as thephysical
result
or acute
ofdisability,
anphysical
accident
professional
disability,
or acuteprofessional
land
physical
or air
disability,
land orprofessional
air
land or airor when a patient
Aids
provincial government
provincialTRAVEL
government
assistance.
provincial
assistance.
government assistance.
ambulance to
ambulance
the nearest
to hospital
theHearing
nearest
ambulance
equipped
hospital
totothe
equipped
provide
nearestthe
to
hospital
required
provideequipped
the
treatment.
required
to provide
treatment.
the required treatment.
Standard hearing aids, repairs or replacement parts.
Services
that are required as a result of emergency illness or injuries which occurred w
TRAVEL TRAVEL
TRAVEL
Hearing Aids
Hearing Aids
Hearing Aids
you were vacationing or traveling for other than health reasons. Covers hospital servi
NOTE:
Does
not
include
the
replacement
cost
for
batteries.
Standard hearing
Standard
aids,hearing
repairs aids,
orStandard
replacement
repairshearing
or replacement
parts.
aids, repairs
parts.
or replacement parts.
accommodation,
services,
emergency
transportation,
repatriation
Services thatServices
are required
that are
as aand
required
result
Services
ofasemergency
that
a result
are required
ofmedical/surgical
illness
emergency
as
or ainjuries
result
illness
of
which
oremergency
injuries
occurred
which
illness
while
occurred
or injuries
while
which
occurred
airyou
ambulance.
Home
Support
Services
you were vacationing
you were or
vacationing
traveling
for
orwere
traveling
other
vacationing
than
forhealth
other
or reasons.
than
traveling
health
Covers
forreasons.
other
hospital
than
Covers
health
services
hospital
reasons.
services
Covers hospital ser
NOTE: DoesNOTE:
not include
Does the
not replacement
include
NOTE:the
Does
replacement
costnotforinclude
batteries.
cost
theforreplacement
batteries. cost for batteries.
Services of a Registered Nurse (RN), Registered Practical Nurse (RPN), or Licensed Practical
andNurse
accommodation,
and accommodation,
medical/surgical
andmedical/surgical
accommodation,
services, emergency
services,
medical/surgical
transportation,
emergencyservices,
transportation,
repatriation
emergency
repatriation
andtransportation,
and repatriati
Travel Benefits are not available after the age of 65.
(LPN)
in the
home when
certified medically necessary by the attending physician.
air ambulance.
air ambulance. NOTE:
air ambulance.
Home Support
Home
Services
Support Services
Home
Support
Services
Services of aServices
Registered
of aNurse
Registered
(RN),
Services
Registered
Nurse
of a(RN),
Registered
Practical
Registered
Nurse
Nurse
Practical
(RN),
(RPN),
Registered
Nurse
or Licensed
(RPN),
Practical
Practical
or Licensed
Nurse
Nurse
Practical
(RPN), orNurse
Licensed Practical Nurse
HOSPITAL
Medical
NOTE: TravelNOTE:
NOTE:
Benefits
Travel
are Benefits
notSEMI-PRIVATE
available
are Travel
not
after
available
Benefits
the age
after
of
are65.
the
not age
available
ofACCOMMODATION
65.after the age of 65.
(LPN) in the (LPN)
home inwhen
the home
certified
when
(LPN)
medically
certified
inItems
the necessary
home
medically
when
bynecessary
certified
the attending
medically
by thephysician.
attending
necessaryphysician.
by the attending physician.
• Aids for daily living include: hospital style beds including rails and mattress, decubitus
ridges,
Standard
including
bridges,
pontics,
•including
Standard
abutment
pontics,
bridges,
retainers/crowns
abutment
including retainers/crowns
pontics,
on natural
abutment
teeth
onretainers/crowns
natural teeth on natural teeth
This
benefit
pays for the
difference in cost
between standard ward and semi-private
care)
supplies, trapeze
SEMI-PRIVATE
SEMI-PRIVATE
HOSPITAL
SEMI-PRIVATE
HOSPITAL
ACCOMMODATION
ACCOMMODATION
HOSPITAL
ACCOMMODATION
epair
Standard
or recementing
repair or• recementing
Standard
of crowns,repair
onlays
of crowns,
or and
recementing
bridgework
onlays and
of crowns,
on
bridgework
natural
onlays
teeth
on and
natural
bridgework
teeth on natural teeth Medical Items
Medical Items (ulcer
Medical
Items
accommodation in a public or general (acute care) hospital when you have occupied
NOTE: All of the dental benefits are based on the current Provincial Dental
•hospital
Braces,
casts,
diabetic
supplies
(blood
glucose
monitor,
lancets),
supplies,
• Aids for daily
• Aids
living
forinclude:
daily living
• Aids
include:
for
style
daily
hospital
beds
living
including
style
include:
beds
rails
hospital
including
and mattress,
style
railsbeds
and
decubitus
mattress,
including
decubitus
rails catheter
and mattress,
decubitus
active
treatment
bed.
Your
provincial
government
health
plan must
or agree to
Association fee guide for general practitioners.
ostomy
supplies,
customtrapeze
made foot orthotics
This benefit pays
This benefit
for the pays
difference
forThis
thein
benefit
difference
cost between
pays
infor
cost
standard
thebetween
difference
ward
standard
in
and
cost
semi-private
ward
between
and standard
semi-private
wardaccept
and semi-private
(ulcer care) supplies,
(ulcer care)
trapeze
supplies,
(ulcer
trapeze
care) supplies,
pay
the standard
ward
rate.
• Mobility
Aids
include:
cane,
crutch,
walker,
wheelchair,
traction
equipment
accommodation
in a public orin
general
accommodation
a public
(acute
or general
care)
in a(acute
hospital
publiccare)
or
when
general
hospital
you (acute
have
when
occupied
care)
you have
hospital
an occupied
when you
an have occupie
NOTE:
the dental
All ofbenefits
the dental
NOTE:
are benefits
based
All ofonthe
are
thedental
based
current
on
benefits
Provincial
the current
are based
Dental
Provincial
on theDental
current Provincial Dental
• Braces, casts,
• Braces,
diabetic
casts,
supplies
diabetic
• (blood
Braces,
supplies
glucose
casts,
(blood
diabetic
monitor,
glucose
supplies
lancets),
monitor,
(blood
catheter
lancets),
glucose
supplies,
catheter
monitor,
supplies,
lancets),
catheter supplies, accommodation
• Prosthetics
include:
artificialmade
limbs,foot
eyes,
prosthetic accessories, modifications and repairs,
active treatment
activebed.
treatment
Your provincial
bed.
active
Yourgovernment
treatment
provincialbed.
government
health
Yourplan
provincial
must
healthaccept
government
plan must
or agree
accept
health
to orplan
agree
must
to accept or agree
iation fee
Association
guide forfee
general
guide
Association
practitioners.
for general
feepractitioners.
guide for general practitioners.
ostomy supplies,
ostomy
custom
supplies,
made
custom
foot
ostomy
orthotics
made
supplies,
foot orthotics
custom
orthotics
• The
semi-private
benefit cannot be purchased on its own.
surgical
brassieres
after acane,
mastectomy
pay the standard
pay the
ward
standard
rate. NOTE:
ward
pay rate.
the
standard
ward rate.
• Mobility Aids
• Mobility
include:Aids
cane,
include:
crutch,
• Mobility
cane,
walker,
Aids
crutch,
wheelchair,
include:
walker,
traction
wheelchair,
crutch,
equipment
walker,
tractionwheelchair,
equipment traction equipment
• This benefit does not apply to accommodation in a long-term care facility
Prism
•limbs,
Respiratory
Cardiology
includes:
continuous
positive
pressure
pump (CPAP),
• Prosthetics•include:
Prosthetics
artificial
include:
• Prosthetics
artificial
eyes, prosthetic
limbs,
include:
eyes,accessories,
artificial
prosthetic
limbs,
accessories,
modifications
eyes, prosthetic
modifications
and airway
repairs,
accessories,
and repairs,
modifications
and apnea
repairs,
(i.e.
carebefacility/hospital),
hospitalonoritsprogram
This brochure outlines benefits available. This is not a contract. Actual details,
monitor
respiratory
disrhythmias
(for infants), compressor, inhalant devices, tracheotomy
NOTE: • TheNOTE:
• The semi-private
NOTE:
•benefit
semi-private
benefit
cannot
The
bechronic
purchased
semi-private
cannot
onpurchased
benefit
its own.
cannot
on itsprivate
beown.
purchased
own. treatment fac
surgical brassieres
surgicalafter
brassieres
a mastectomy
after
surgical
afor
mastectomy
brassieres
after
a mastectomy
•toBenefits
aretonot
payable
for hospitalization
pregnancy
or care
pregnancy
terms,
conditions, limitations and exclusions are detailed in the policy issued by
supplies,
oxygen
• This
doesbenefit
not apply
does
•not
accommodation
Thisapply
benefit
accommodation
does
innot
a long-term
apply
to
in accommodation
acare
long-term
facilitydue
caretoinfacility
a long-term
facility
Prism
Prism
• Respiratory• Cardiology
Respiratoryincludes:
Cardiology
• Respiratory
continuous
includes:
Cardiology
positive
continuous
airway
includes:
positive
pressure
continuous
airway
pump
pressure
(CPAP),
positive
pump
apnea
airway
(CPAP),
pressure
apnea
pump (CPAP), apnea • This benefit
which
commence
during
firstfacility.
ten
(10) or
month
period
followinf
Green
Shield
Canada
application
approval.
• Vascular
compression
includes:
intermittent
compression
pumptracheotomy
and
sleeve,
pressure
gradient (i.e. chronic (i.e.
care chronic
facility/hospital),
care conditions
facility/hospital),
(i.e.private
chronic
hospital
careprivate
facility/hospital),
or program
hospital
treatment
or the
program
private
hospital
treatment
program
facility.
treatment
ureThis
outlines
brochure
benefits
outlines
available.
Thisbenefits
brochure
This
available.
outlines
is notupon
a This
contract.
benefits
is notavailable.
Actual
a contract.
details,
ThisActual
is notdetails,
a contract. Actual details,
monitor for respiratory
monitor fordisrhythmias
respiratory
monitor
disrhythmias
(for
for
infants),
respiratory
(for
compressor,
infants),
disrhythmias
compressor,
inhalant
(fordevices,
infants),
inhalant
tracheotomy
compressor,
devices,
inhalant
devices,
tracheotomy
effective
date
of
the
coverage.
stockings
• Benefits are
• Benefits
not payable
are not
for hospitalization
payable
• Benefits
forare
hospitalization
due
not payable
to pregnancy
due
for hospitalization
toorpregnancy
pregnancyordue
related
pregnancy
to pregnancy
related
or pregnan
ditions,
terms,limitations
conditions,and
limitations
terms,
exclusions
conditions,
andare
exclusions
detailed
limitations
are
in the
and
detailed
policy
exclusions
inissued
the policy
are
by detailed
issuedinbythe policy issued by
supplies, oxygen
supplies, oxygen surgical
supplies,
oxygen
conditions
commence
whichduring
commence
conditions
the first
during
which
ten the
(10)
commence
first
month
ten during
period
(10) month
following
the first
period
ten
thefollowing
(10) month
theperiod follow
eldGreen
Canada
Shield
uponCanada
application
Green
uponShield
approval.
application
Canadaapproval.
upon application approval.
• Vascular compression
• Vascular compression
includes:
• Vascular
intermittent
includes:
compression
intermittent
compression
includes:
compression
pump intermittent
and sleeve,
pump pressure
compression
and sleeve,
gradient
pressure
pump and
gradient
sleeve, pressure gradient conditions which
effective dateeffective
of the coverage.
date of theeffective
coverage.
date of the coverage.
surgical stockings
surgical stockings surgical stockings
3
3
3
4
3
4
4
5
4
5
5
5
Prism Continuum® - Monthly Rates Effective January 1, 2008
Rates and/or benefits are subject to change with thirty (30) days notice to the applicant/policy holder.
Saskatchewan,
Manitoba,
Northwest Territories,
Yukon Territory and
Nunavut
Alberta
British Columbia
C1
Ontario
New Brunswick,
Nova Scotia,
Prince Edward Island
and Newfoundland
Quebec
Age
Single
Couple
Family
Single
Couple
Family
Single
Couple
Family
Single
Couple
Family
Single
Couple
Family
Single
Couple
Family
0-44
$61
$115
$162
$61
$115
$162
$51
$95
$133
$74
$139
$196
$74
$139
$196
$72
$134
$189
45-54
$75
$141
$199
$75
$141
$199
$61
$115
$162
$91
$169
$240
$91
$169
$240
$88
$163
$232
55-64
$83
$154
$219
$83
$154
$219
$67
$123
$174
$100
$185
$264
$100
$185
$264
$96
$178
$252
65+
$64
$118
$163
$64
$118
$163
$51
$94
$129
$77
$142
$197
$77
$142
$197
$74
$137
$189
Age
Single
Couple
Family
Single
Couple
Family
Single
Couple
Family
Single
Couple
Family
Single
Couple
Family
Single
Couple
Family
0-44
$99
$186
$269
$101
$190
$278
$76
$142
$207
$118
$221
$320
$110
$207
$296
$102
$191
$280
45-54
$110
$207
$296
$112
$211
$300
$83
$158
$224
$130
$245
$347
$122
$228
$324
$115
$214
$299
55-64
$119
$220
$311
$121
$225
$321
$89
$167
$236
$141
$261
$369
$131
$242
$343
$122
$228
$324
65+
$86
$160
$230
$88
$165
$233
$66
$123
$175
$103
$190
$270
$97
$180
$255
$90
$168
$238
Age
Single
Couple
Family
Single
Couple
Family
Single
Couple
Family
Single
Couple
Family
Single
Couple
Family
Single
Couple
Family
0-44
$122
$232
$342
$125
$237
$350
$95
$177
$260
$144
$273
$403
$135
$253
$375
$126
$238
$348
45-54
$143
$268
$397
$146
$273
$407
$111
$205
$301
$170
$318
$468
$159
$297
$439
$148
$279
$408
55-64
$157
$297
$436
$160
$301
$446
$121
$227
$332
$187
$351
$511
$176
$328
$482
$162
$306
$448
65+
$110
$204
$297
$110
$204
$297
$82
$153
$221
$130
$240
$351
$121
$225
$326
$112
$210
$301
C2
C3