Areas & Rates (Copay – Washington)

MONTHLY CO-PAY PLAN RATES FOR RATING AREA I (Washington)

 

Effective October 1st, 2017
Monthly Administration Fee is an additional $15.00 per member per month.
← Back to Areas & Rates (Copay)
Plan Deductible $0 $100 $150 $250 $500 $750 $1,000 $1,500 $2,000 $2,500 $3,000 $4,000
Age 65 $138.92 $128.84 $123.87 $117.59 $103.67 $92.00 $81.21 $64.56 $51.83 $42.61 $35.80 $27.63
Age 66-69 $151.54 $140.55 $135.12 $128.29 $113.10 $100.35 $88.59 $70.42 $56.54 $46.49 $39.04 $30.15
Age 70-74 $187.06 $175.88 $170.21 $163.24 $147.11 $133.05 $119.75 $98.66 $82.05 $69.51 $59.88 $47.46
Age 75-79 $220.75 $209.21 $203.18 $195.93 $178.61 $163.17 $148.30 $124.39 $105.13 $90.26 $78.61 $62.95
Age 80-84 $270.29 $258.02 $251.42 $243.31 $223.89 $206.25 $189.19 $161.08 $137.91 $119.61 $105.06 $84.73
Age 85+ $289.03 $276.43 $269.59 $260.96 $240.53 $222.00 $204.10 $174.39 $149.74 $130.16 $114.52 $92.47
OPTIONAL BENEFIT RATES
Optional Benefit Monthly Rate
Additional Skilled Nursing $7.24
Private Duty Nursing $8.36
At Home Recovery $18.39
Comprehensive Wellness $13.37

← Back to Areas & Rates (Copay)

MONTHLY CO-PAY PLAN RATES FOR RATING AREA II (Washington)

 

Effective October 1st, 2017
Monthly Administration Fee is an additional $15.00 per member per month.
← Back to Areas & Rates (Copay)
Plan Deductible $0 $100 $150 $250 $500 $750 $1,000 $1,500 $2,000 $2,500 $3,000 $4,000
Age 65 $159.75 $148.16 $142.45 $135.24 $119.23 $105.80 $93.40 $74.24 $59.60 $49.00 $41.16 $31.78
Age 66 $174.27 $161.63 $155.41 $147.53 $130.06 $115.41 $101.88 $81.00 $65.03 $53.47 $44.91 $34.68
Age 67 $174.27 $161.63 $155.41 $147.53 $130.06 $115.41 $101.88 $81.00 $65.03 $53.47 $44.91 $34.68
Age 68 $174.27 $161.63 $155.41 $147.53 $130.06 $115.41 $101.88 $81.00 $65.03 $53.47 $44.91 $34.68
Age 69 $174.27 $161.63 $155.41 $147.53 $130.06 $115.41 $101.88 $81.00 $65.03 $53.47 $44.91 $34.68
Age 70-74 $215.11 $202.26 $195.73 $187.72 $169.17 $152.99 $137.70 $113.47 $94.35 $79.93 $68.86 $54.57
Age 75-79 $253.86 $240.58 $233.67 $225.31 $205.38 $187.65 $170.57 $143.06 $120.91 $103.80 $90.40 $72.39
Age 80-84 $310.80 $296.72 $289.14 $279.82 $257.46 $237.19 $217.56 $185.26 $158.61 $137.56 $120.82 $97.45
Age 85+ $332.39 $317.89 $310.01 $300.09 $276.61 $255.29 $234.70 $200.55 $172.19 $149.67 $131.71 $106.35
OPTIONAL BENEFIT RATES
Optional Benefit Monthly Rate
Additional Skilled Nursing $7.24
Private Duty Nursing $8.36
At Home Recovery $18.39
Comprehensive Wellness $13.37

← Back to Areas & Rates (Copay)

MONTHLY CO-PAY PLAN RATES FOR RATING AREA III (Washington)

 

Effective October 1st, 2017
Monthly Administration Fee is an additional $15.00 per member per month.
← Back to Areas & Rates (Copay)
Plan Deductible $0 $100 $150 $250 $500 $750 $1,000 $1,500 $2,000 $2,500 $3,000 $4,000
Age 65 $173.64 $161.04 $154.84 $146.99 $129.58 $114.99 $101.51 $80.68 $64.78 $53.27 $44.74 $34.56
Age 66 $189.44 $175.68 $168.91 $160.36 $141.37 $125.43 $110.74 $88.04 $70.68 $58.12 $48.42 $37.71
Age 67 $189.44 $175.68 $168.91 $160.36 $141.37 $125.43 $110.74 $88.04 $70.68 $58.12 $48.42 $37.71
Age 68 $189.44 $175.68 $168.91 $160.36 $141.37 $125.43 $110.74 $88.04 $70.68 $58.12 $48.42 $37.71
Age 69 $189.44 $175.68 $168.91 $160.36 $141.37 $125.43 $110.74 $88.04 $70.68 $58.12 $48.42 $37.71
Age 70-74 $233.83 $219.86 $212.74 $204.05 $183.88 $166.31 $149.68 $123.32 $102.55 $86.88 $74.86 $59.31
Age 75-79 $275.94 $261.51 $253.99 $244.90 $223.26 $203.95 $185.39 $155.51 $131.41 $112.83 $98.26 $78.69
Age 80-84 $337.84 $322.51 $314.28 $304.15 $279.86 $257.82 $236.48 $201.34 $172.40 $149.52 $131.33 $105.91
Age 85+ $361.29 $345.54 $336.97 $326.20 $300.66 $277.49 $255.11 $217.99 $187.18 $162.68 $143.17 $115.60
OPTIONAL BENEFIT RATES
Optional Benefit Monthly Rate
Additional Skilled Nursing $7.24
Private Duty Nursing $8.36
At Home Recovery $18.39
Comprehensive Wellness $13.37

← Back to Areas & Rates (Copay)