Areas & Rates (Copay – Washington)

Area 1 (WA) Area 2 (WA) Area 3 (WA)

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.
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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

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