IBU Rate Calculator
Participants
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First Name
DOB
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Smoker
Primary
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Spouse
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Child 1
M
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Child 2
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New Plan Info
Effective Date
Household Income
$
.00
Zip Code
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Group Conversion
Dental
Maternity
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Old Plan Name
Effective Date
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Quotes
PLANS
Effective Dates
Basic Rate
(tax portion)
with Maternity Rider
(tax portion)
with Dental Rider
(tax portion)
with Maternity &
Dental Rider
(tax portion)
Subsidy Estimates
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New Plan Estimates
Plan
MP
HSA
Total w/
Tax and Subsidy
SubTotal w/
Tax
Base
Tax
Old Plan Estimate
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PLANS
Effective
Dates
Basic Rate
(tax portion)
with Maternity
Rider
(tax portion)
with Dental Rider
(tax portion)
with Maternity
& Dental Rider
(tax portion)
Rate Quote Summary
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