SOMA College Health Insurance Plan

08/01/08-07/31-09
MONTHLY PREMIUM
	Medical Plan		Vision	Dental
Plan Types	Plan 1 Co-Pay Plan	Plan 2 High Deductible (HDHP)	Vision Plan	Dental Plan
Student Under Age 30 Age 30 & Over	148 176	89 105	13	38
Spouse Under Age 30 Age 30 & Over	320 385	179 214	7	32
Child(ren) Under Age 30 Age 30 & Over	237 237	144 144	13	43

PAYMENT OPTIONS

Applicants Who Wish To Have Their Monthly Premiums Charged To Their Credit Card

Complete the Enrollment Form

Do not send any payment - premium will be charged to your Master Card or VISA Credit Card

Applicants Who Wish To Have Their Monthly Premiums Debited From a Checking Account

1) Complete the Enrollment Form and Monthly Automatic Enrollment Form

2) Send 2 checks; 1st check equal to the monthly payment payable to Mass Marketing Insurance Consultants, Inc. and the 2nd check marked "void" and unsigned.

Applicants Who Wish To Have Direct Billing

Call 1-800-349-1039

Home Page / Important Information / Plan 1 / Plan 2 /
Exclusions & Limitations / Vision Option / Dental Option / How to Apply / Schedule of Premiums / Enrollment Form / Online Enrollment Form / Monthly Automatic Pay Plan Form / RX Information / PPO Information / PPO Networks / FAQ
©2008 SOMA College Health Insurance Plan. All Rights Reserved.

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