Medicare Supplement Washington

Use the online e-Enrollment Application

Rates effective January 1, 2006

Plan	Monthly	Quarterly	Semiannually	Annually
Plan A	$86.00	$258.00	$516.00	$1,032.00
Plan C	$138.00	$414.00	$828.00	$1,656.00
Plan F	$148.00	$444.00	$888.00	$1,776.00
Plan J	$155.00	$465.00	$930.00	$1,860.00

Payment Mode Options

• Include a check or money order for 2 months payment.
• If you prefer to use Automatic Bank Charge, fill out the Asuris EFT form.

Rates and a summary of benefits (PDF) are available in a single document.