Areas & Rates (Copay – Washington)
Area 1 (WA) Area 2 (WA) Area 3 (WA)
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.
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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 | $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 66-69 | $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 |