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 |