Areas & Rates (Copay)
Area 1 Area 2 Area 3 Area 4 Area 5
MONTHLY CO-PAY PLAN RATES FOR RATING AREA IV
Effective October 1st, 2018 the Administration Fee is included in the premiums listed below.
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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 | $201.63 | $188.44 | $181.95 | $173.74 | $155.54 | $140.28 | $126.17 | $104.39 | $87.76 | $75.71 | $66.80 | $56.15 |
| Age 66 | $218.28 | $203.89 | $196.80 | $187.86 | $167.98 | $151.30 | $135.92 | $112.15 | $93.99 | $80.83 | $71.10 | $59.47 |
| Age 67 | $225.23 | $210.34 | $203.00 | $193.74 | $173.16 | $155.91 | $139.97 | $115.39 | $96.59 | $82.96 | $72.88 | $60.85 |
| Age 68 | $232.04 | $216.64 | $209.06 | $199.49 | $178.25 | $160.41 | $143.96 | $118.54 | $99.11 | $85.05 | $74.63 | $62.19 |
| Age 69 | $238.66 | $222.80 | $214.98 | $205.11 | $183.19 | $164.80 | $147.83 | $121.62 | $101.60 | $87.08 | $76.35 | $63.51 |
| Age 70-74 | $277.45 | $262.05 | $254.24 | $244.65 | $222.45 | $203.08 | $184.81 | $155.79 | $132.90 | $115.66 | $102.41 | $85.31 |
| Age 75-79 | $323.80 | $307.91 | $299.64 | $289.63 | $265.81 | $244.55 | $224.11 | $191.22 | $164.71 | $144.22 | $128.19 | $106.63 |
| Age 80-84 | $391.96 | $375.08 | $366.01 | $354.85 | $328.13 | $303.85 | $280.34 | $241.68 | $209.80 | $184.61 | $164.59 | $136.60 |
| Age 85+ | $417.77 | $400.43 | $391.01 | $379.11 | $351.01 | $325.50 | $300.87 | $259.99 | $226.10 | $199.10 | $177.62 | $147.26 |
| OPTIONAL BENEFIT RATES | |
| Optional Benefit | Monthly Rate |
| Additional Skilled Nursing | $7.68 |
| Private Duty Nursing | $8.87 |
| At Home Recovery | $19.49 |
| Comprehensive Wellness | $14.18 |