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)
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 |
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)
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 |
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)
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 |