Flexible Choice Dental, Vision & Hearing Rates for Florida

Monthly Premiums Rates may vary by state.*

Preventive at 60/70/80/90% coinsurance Loyal American Life Insurance Company

Individual Dental, Vision & Hearing Plan
in years 1/2/3/4+

Issue Age Maximum Deductible Individual Individual Individual Individual Issue Age Maximum Deductible Individual Individual Individual Individual
Only + Spouse + Child(ren) + Family Only + Spouse + Child(ren) + Family
18 to 49 $1,000 $100 $24.90 $48.64 $56.30 $87.02 50 to 89 $1,000 $100 $31.92 $61.69 $56.38 $90.18
$50 $28.94 $56.64 $66.23 $102.21 $50 $35.94 $69.62 $64.99 $103.45
$0 $33.23 $65.12 $77.04 $118.70 $0 $40.17 $77.95 $74.31 $117.72
$100 Disappearing $31.26 $61.21 $71.66 $110.57 $100 Disappearing $38.29 $74.24 $69.79 $110.91
$1,500 $100 $28.03 $54.89 $61.88 $96.28 $1,500 $100 $36.92 $71.68 $63.29 $102.40
$50 $32.24 $63.23 $72.15 $112.01 $50 $41.16 $80.06 $72.27 $116.28
$0 $36.75 $72.16 $83.41 $129.22 $0 $45.70 $89.01 $82.06 $131.36
$100 Disappearing $34.70 $68.09 $77.80 $120.76 $100 Disappearing $43.71 $85.09 $77.32 $124.23
$2,000 $100 $29.88 $58.60 $65.19 $101.77 $2,000 $100 $40.01 $77.84 $67.50 $109.88
$50 $34.19 $67.15 $75.66 $117.83 $50 $44.40 $86.52 $76.72 $124.16
$0 $38.82 $76.30 $87.15 $135.40 $0 $49.11 $95.85 $86.79 $139.73
$100 Disappearing $36.75 $72.19 $81.50 $126.87 $100 Disappearing $47.08 $91.82 $81.97 $132.46
$2,500 $100 $30.85 $60.53 $67.04 $104.77 $2,500 $100 $41.59 $81.02 $69.79 $113.87
$50 $35.20 $69.15 $77.63 $121.01 $50 $46.06 $89.85 $79.12 $128.35
$0 $39.87 $78.40 $89.19 $138.70 $0 $50.88 $99.38 $89.32 $144.14
$100 Disappearing $37.80 $74.29 $83.53 $130.16 $100 Disappearing $48.82 $95.29 $84.48 $136.83
$3,000 $100 $31.62 $62.07 $68.59 $107.28 $3,000 $100 $42.79 $83.41 $71.60 $116.97
$50 $36.00 $70.75 $79.24 $123.60 $50 $47.30 $92.34 $80.99 $131.58
$0 $40.70 $80.06 $90.87 $141.40 $0 $52.18 $101.98 $91.28 $147.51
$100 Disappearing $38.62 $75.94 $85.19 $132.83 $100 Disappearing $50.10 $97.86 $86.42 $140.15
$3,500 $100 $31.79 $62.41 $68.93 $107.81 $3,500 $100 $43.14 $84.11 $72.07 $117.82
$50 $36.16 $71.07 $79.53 $124.08 $50 $47.66 $93.06 $81.47 $132.42
$0 $40.86 $80.39 $91.16 $141.89 $0 $52.56 $102.74 $91.77 $148.40
$100 Disappearing $38.79 $76.27 $85.50 $133.34 $100 Disappearing $50.47 $98.61 $86.90 $141.03
$4,000 $100 $31.85 $62.52 $69.04 $107.98 $4,000 $100 $43.27 $84.36 $72.23 $118.12
$50 $36.24 $71.21 $79.68 $124.32 $50 $47.80 $93.34 $81.66 $132.77
$0 $40.94 $80.57 $91.35 $142.18 $0 $52.72 $103.06 $92.00 $148.80
$100 Disappearing $38.88 $76.43 $85.66 $133.59 $100 Disappearing $50.63 $98.93 $87.12 $141.42
$5,000 $100 $31.90 $62.63 $69.10 $108.10 $5,000 $100 $43.42 $84.65 $72.39 $118.42
$50 $36.30 $71.35 $79.76 $124.47 $50 $47.96 $93.67 $81.84 $133.10
$0 $41.01 $80.68 $91.41 $142.30 $0 $52.88 $103.38 $92.17 $149.13
$100 Disappearing $38.94 $76.55 $85.73 $133.72 $100 Disappearing $50.79 $99.25 $87.29 $141.75

Modal Factors * Please refer to CSB-9-0014 for product availability by state.

** Direct bill is not available on a monthly basis. To calculate the premium for any mode, multiply the monthly premium by
Mode Bank draft/Direct bill** the factor.
Monthly 1 Note: Rates will be based upon the age of the primary applicant.
Quarterly 3 Quarterly, semi-annual, and annual rates calculated from the monthly rates using modal factors may differ from the actual annual,
Semi-annually 6 semi-annual, and quarterly premium rates due to rounding.
Annual 12 All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Loyal
American Life Insurance Company. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc.
© 2021 Cigna. Insured by Loyal American Life Insurance Company

LOYAL-15-0002-FL  For Agent Use Only Page 1 of 2 4/21

Flexible Choice Dental, Vision & Hearing Rates for Florida
Monthly Premiums Rates may vary by state.*

Preventive at 100% coinsurance all years Loyal American Life Insurance Company
Individual Dental, Vision & Hearing Plan

Issue Age Maximum Deductible Individual Individual Individual Individual Issue Age Maximum Deductible Individual Individual Individual Individual
Only + Spouse + Child(ren) + Family Only + Spouse + Child(ren) + Family
18 to 49 $1,000 $100 $25.96 $50.76 $60.00 $92.39 50 to 89 $1,000 $100 $33.08 $64.00 $59.58 $94.89
$50 $30.43 $59.60 $71.09 $109.33 $50 $37.49 $72.74 $69.18 $109.62
$0 $35.24 $69.15 $83.31 $127.96 $0 $42.17 $81.96 $79.63 $125.57
$100 Disappearing $32.78 $64.26 $76.64 $117.85 $100 Disappearing $39.81 $77.28 $73.99 $117.09
$1,500 $100 $29.40 $57.64 $66.54 $103.06 $1,500 $100 $38.46 $74.76 $67.38 $108.45
$50 $34.14 $67.03 $78.24 $120.97 $50 $43.19 $84.11 $77.55 $124.13
$0 $39.22 $77.12 $91.17 $140.66 $0 $48.26 $94.15 $88.74 $141.27
$100 Disappearing $36.69 $72.08 $84.22 $130.16 $100 Disappearing $45.74 $89.14 $82.79 $132.29
$2,000 $100 $31.49 $61.81 $70.50 $109.51 $2,000 $100 $41.87 $81.58 $72.24 $116.96
$50 $36.33 $71.41 $82.41 $127.76 $50 $46.78 $91.30 $82.68 $133.10
$0 $41.52 $81.71 $95.49 $147.72 $0 $52.06 $101.73 $94.10 $150.69
$100 Disappearing $38.96 $76.61 $88.48 $137.14 $100 Disappearing $49.45 $96.56 $88.06 $141.52
$2,500 $100 $32.58 $63.98 $72.71 $113.06 $2,500 $100 $43.70 $85.24 $74.96 $121.65
$50 $37.46 $73.67 $84.73 $131.47 $50 $48.71 $95.15 $85.53 $138.03
$0 $42.74 $84.14 $97.99 $151.73 $0 $54.13 $105.87 $97.18 $156.01
$100 Disappearing $40.15 $79.00 $90.94 $141.07 $100 Disappearing $51.47 $100.61 $91.08 $146.73
$3,000 $100 $33.42 $65.67 $74.46 $115.86 $3,000 $100 $45.06 $87.94 $77.02 $125.18
$50 $38.35 $75.44 $86.56 $134.40 $50 $50.11 $97.98 $87.69 $141.71
$0 $43.64 $85.94 $99.83 $154.68 $0 $55.59 $108.79 $99.37 $159.78
$100 Disappearing $41.06 $80.80 $92.80 $144.03 $100 Disappearing $52.92 $103.48 $93.25 $150.46
$3,500 $100 $33.58 $65.98 $74.75 $116.33 $3,500 $100 $45.45 $88.74 $77.52 $126.09
$50 $38.52 $75.80 $86.89 $134.94 $50 $50.53 $98.80 $88.22 $142.69
$0 $43.84 $86.34 $100.21 $155.29 $0 $56.03 $109.68 $99.96 $160.83
$100 Disappearing $41.24 $81.17 $93.13 $144.59 $100 Disappearing $53.35 $104.35 $93.80 $151.46
$4,000 $100 $33.66 $66.16 $74.91 $116.60 $4,000 $100 $45.64 $89.11 $77.76 $126.53
$50 $38.61 $75.96 $87.04 $135.19 $50 $50.74 $99.22 $88.48 $143.16
$0 $43.92 $86.51 $100.36 $155.55 $0 $56.26 $110.14 $100.24 $161.34
$100 Disappearing $41.34 $81.35 $93.31 $144.88 $100 Disappearing $53.58 $104.80 $94.09 $151.99
$5,000 $100 $33.74 $66.32 $75.05 $116.84 $5,000 $100 $45.83 $89.49 $78.00 $126.98
$50 $38.68 $76.12 $87.17 $135.41 $50 $50.94 $99.61 $88.72 $143.61
$0 $44.00 $86.67 $100.49 $155.76 $0 $56.47 $110.56 $100.49 $161.81
$100 Disappearing $41.41 $81.51 $93.44 $145.09 $100 Disappearing $53.78 $105.21 $94.33 $152.45

Modal Factors * Please refer to CSB-9-0014 for product availability by state.

** Direct bill is not available on a monthly basis. To calculate the premium for any mode, multiply the monthly premium by
Mode Bank draft/Direct bill* the factor.
Monthly 1 Note: Rates will be based upon the age of the primary applicant.
Quarterly 3 Quarterly, semi-annual, and annual rates calculated from the monthly rates using modal factors may differ from the actual annual,
Semi-annually 6 semi-annual, and quarterly premium rates due to rounding.
Annual 12 All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Loyal
American Life Insurance Company. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc.
© 2021 Cigna. Insured by Loyal American Life Insurance Company

LOYAL-15-0002-FL  For Agent Use Only Page 2 of 2 4/21