| KS | Classic | $1,500.00 | | | KS | Classic | $3,000.00 | | | KS | Classic | $3,000.00 | | | KS | First | $1,500.00 | | | KS | First | $1,500.00 | | | KS | First | $1,500.00 | | | KS | First | $1,500.00 | | | KS | First | $2,000.00 | | | KS | First | $2,000.00 | | | KS | First | $2,000.00 | | | KS | First | $2,000.00 | | | KS | First | $5,000.00 | | | KS | First | $5,000.00 | | | KS | Basic | $2,750.00 | | | KS | Basic | $6,000.00 | | | KS | Classic | $1,500.00 | | | KS | Classic | $2,000.00 | | | KS | Classic | $3,000.00 | | | KS | Classic | $3,000.00 | | | KS | Classic | $5,000.00 | | | KS | Classic | $5,000.00 | | | KS | First | $1,500.00 | | | KS | First | $1,500.00 | | | KS | First | $2,200.00 | | | KS | First | $2,200.00 | | | KS | First | $2,200.00 | | | KS | First | $2,200.00 | | | KS | First | $2,700.00 | | | KS | First | $2,700.00 | | | KS | First | $5,100.00 | | | KS | First | $5,100.00 | | | KS | First | $6,000.00 | | | KS | First | $6,000.00 | | | KS | First | $6,000.00 | | | KS | First | $6,800.00 | | | KS | First | $6,800.00 | | | KS | HRA | $2,500.00 | | | KS | HRA | $2,750.00 | | | KS | HRA | $3,000.00 | | | KS | HRA | $3,500.00 | | | KS | Saver | $1,500.00 | | | KS | Saver | $3,000.00 | | | KS | Saver | $3,000.00 | | | KS | Saver | $4,000.00 | | | KS | Saver | $4,000.00 | | | KS | Saver | $5,000.00 | | | KS | Saver | $5,000.00 | | | KS | Traditional | $2,500.00 | | | KS | Traditional | $3,500.00 | | | KS | Traditional | $3,500.00 | | | MO | Basic | $2,750.00 | | | MO | Basic | $3,500.00 | | | MO | Basic | $6,000.00 | | | MO | Classic | $1,500.00 | | | MO | Classic | $2,000.00 | | | MO | Classic | $3,000.00 | | | MO | Classic | $5,000.00 | | | MO | Classic | $5,000.00 | | | MO | First | $1,500.00 | | | MO | First | $1,500.00 | | | MO | First | $1,500.00 | | | MO | First | $2,200.00 | | | MO | First | $2,200.00 | | | MO | First | $2,200.00 | | | MO | First | $2,200.00 | | | MO | First | $2,200.00 | | | MO | First | $2,700.00 | | | MO | First | $2,700.00 | | | MO | First | $5,100.00 | | | MO | First | $5,100.00 | | | MO | First | $6,000.00 | | | MO | First | $6,000.00 | | | MO | First | $6,800.00 | | | MO | First | $6,800.00 | | | MO | HRA | $2,750.00 | | | MO | HRA | $2,500.00 | | | MO | HRA | $3,000.00 | | | MO | HRA | $3,500.00 | | | MO | Saver | $1,500.00 | | | MO | Saver | $1,500.00 | | | MO | Saver | $3,000.00 | | | MO | Saver | $3,000.00 | | | MO | Saver | $4,000.00 | | | MO | Saver | $4,000.00 | | | MO | Saver | $5,000.00 | | | MO | Saver | $5,000.00 | | | MO | Traditional | $2,500.00 | | | MO | Traditional | $2,500.00 | | | MO | Traditional | $3,500.00 | | | MO | Traditional | $3,500.00 | | | KS | Basic | $2,750.00 | | | KS | Basic | $6,000.00 | | | KS | Classic | $3,000.00 | | | KS | Classic | $4,750.00 | | | KS | Preferred-Care Blue | $750.00 | | | KS | First | $1,000.00 | | | KS | First | $1,000.00 | | | KS | First | $2,500.00 | | | KS | First | $2,500.00 | | | KS | First | $2,500.00 | | | KS | First | $2,500.00 | | | KS | First | $5,000.00 | | | KS | First | $5,000.00 | | | KS | First | $6,500.00 | | | KS | First Value | $5,000.00 | | | KS | HRA | $3,000.00 | | | KS | Saver | $1,500.00 | | | KS | Saver | $3,000.00 | | | KS | Saver | $5,500.00 | | | KS | Saver Value | $1,750.00 | | | KS | Saver Value | $3,250.00 | | | KS | Traditional | $2,500.00 | | | KS | Traditional | $3,500.00 | | | KS | Value | $6,000.00 | | | MO | Preferred-Care Blue | $2,750.00 | | | MO | Basic | $6,000.00 | | | MO | Classic | $3,000.00 | | | MO | Preferred-Care Blue | $4,750.00 | | | MO | Preferred-Care Blue | $750.00 | | | MO | First | $1,000.00 | | | MO | First | $1,000.00 | | | MO | Preferred-Care Blue | $2,500.00 | | | MO | First | $2,500.00 | | | MO | First | $2,500.00 | | | MO | Preferred-Care Blue | $2,500.00 | | | MO | First | $2,500.00 | | | MO | First | $5,000.00 | | | MO | First | $6,500.00 | | | MO | First Value | $5,000.00 | | | MO | HRA | $3,000.00 | | | MO | Saver | $1,500.00 | | | MO | Saver | $3,000.00 | | | MO | Saver | $5,500.00 | | | MO | Saver Value | $1,750.00 | | | MO | Saver Value | $3,250.00 | | | MO | Traditional | $2,500.00 | | | MO | Traditional | $3,500.00 | | | MO | Value | $6,000.00 | | | KS | Classic | $3,500.00 | | | KS | Basic | $2,750.00 | | | KS | Basic | $6,000.00 | | | KS | Classic | $5,000.00 | | | KS | Classic | $750.00 | | | KS | First | $1,000.00 | | | KS | First | $2,500.00 | | | KS | First | $3,000.00 | | | KS | First | $5,000.00 | | | KS | First | $6,500.00 | | | KS | First Value | $5,000.00 | | | KS | HRA | $3,000.00 | | | KS | Saver | $1,500.00 | | | KS | Saver | $1,500.00 | | | KS | Saver | $3,000.00 | | | KS | Saver | $4,000.00 | | | KS | Saver Value | $1,750.00 | | | KS | Saver Value | $1,750.00 | | | KS | Saver Value | $3,250.00 | | | KS | Traditional | $2,500.00 | | | KS | Traditional | $3,500.00 | | | KS | Saver Value | $6,000.00 | | | MO | Basic | $2,750.00 | | | MO | Basic | $6,000.00 | | | MO | Classic | $3,500.00 | | | MO | Classic | $5,000.00 | | | MO | Classic | $750.00 | | | MO | First | $1,000.00 | | | MO | First | $2,500.00 | | | MO | First | $3,000.00 | | | MO | First | $5,000.00 | | | MO | First | $6,500.00 | | | MO | First Value | $5,000.00 | | | MO | HRA | $3,000.00 | | | MO | Saver | $1,500.00 | | | MO | Saver | $1,500.00 | | | MO | Saver | $3,000.00 | | | MO | Saver | $4,000.00 | | | MO | Saver Value | $1,750.00 | | | MO | Saver Value | $1,750.00 | | | MO | Saver Value | $3,250.00 | | | MO | Saver Value | $6,000.00 | | | MO | Traditional | $2,500.00 | | | MO | Traditional | $3,500.00 | |
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