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