Gateway Accident & Health Insurance Plans: Gateway International / Rates

Premium Rates Per Person

Medical Expense Maximum	Under Age 70	70 or older
Plan A: $25,000	$3.00/day	$7.50/day
Plan B: $100,000	$4.00/day	$10.00/day
Additional Optional AD&D Coverage
Option 1:
$100,000 Additional Principal Sum	$.55/day	$.55/day
Option 2:
$250,000 Additional Principal Sum	$1.35/day	$1.35/day

Note: If additional AD&D coverage is desired, all adults listed on this Application must purchase the same coverage (Option 1 or Option 2). Additional AD&D coverage is not available to persons under
age 18.