BridgeSpan Health Company individual rate scheduleIndividual BridgeSpan Health Company

2017 Individual Nongrandfathered Health Plan 53732WA0780018

Plan Information

Plan Name: Bronze HDHP 6000 EPO EvergreenHealth Partners-Virginia Mason

HIOS Plan ID: 53732WA0780018

Effective Date: 1/1/2017

Market Type: Individual

Exchange Status: In the exchange

Metal Level: Bronze

Plan Geographic Availability

Area Number Available in area?

1 Yes

2 Yes

3 No

4 No

5 No

Plan Rates

Age

Band Area 1 Area 2 Area 3 Area 4 Area 5 Area 1 Area 2 Area 3 Area 4 Area 5

0-20 131.57 135.91 131.57 135.91

21 207.19 214.03 238.27 246.13

22 207.19 214.03 238.27 246.13

23 207.19 214.03 238.27 246.13

24 207.19 214.03 238.27 246.13

25 208.02 214.88 239.22 247.12

26 212.16 219.16 243.99 252.04

27 217.14 224.30 249.71 257.95

28 225.22 232.65 259.00 267.54

29 231.85 239.50 266.62 275.42

30 235.16 242.92 270.43 279.36

31 240.13 248.06 276.15 285.27

32 245.11 253.19 281.87 291.17

33 248.21 256.40 285.45 294.87

34 251.53 259.83 289.26 298.80

35 253.19 261.54 291.16 300.77

36 254.84 263.25 293.07 302.74

37 256.50 264.97 294.98 304.71

38 258.16 266.68 296.88 306.68

39 261.47 270.10 300.69 310.62

40 264.79 273.53 304.51 314.56

41 269.76 278.66 310.23 320.46

42 274.53 283.59 315.71 326.12

43 281.16 290.44 323.33 334.00

44 289.44 299.00 332.86 343.85

45 299.18 309.06 344.06 355.41

46 310.79 321.04 357.40 369.20

47 323.84 334.52 372.41 384.70

48 338.76 349.93 389.57 402.42

49 353.47 365.13 406.49 419.90

50 370.04 382.25 425.55 439.59

51 386.41 399.16 444.37 459.03

52 404.43 417.78 465.10 480.45

53 422.67 436.62 486.07 502.11

54 442.35 456.95 508.70 525.49

55 462.03 477.28 531.34 548.87

56 483.37 499.33 555.88 574.22

57 504.92 521.58 580.66 599.82

58 527.92 545.34 607.11 627.14

59 539.32 557.11 620.21 640.68

60 562.31 580.87 646.66 668.00

61 582.20 601.42 669.53 691.63

62 595.26 614.90 684.55 707.14

63 611.62 631.81 703.37 726.58

64 621.57 642.08 714.81 738.39

65 and over 621.57 642.08 714.81 738.39

N/A

N/A

BridgeSpan Health Company

RATE SCHEDULE

Non-Smoker Rates Smoker Rates

Counties where this plan is available

King

Snohomish

N/A

of 31


Plan Information

Plan Name: Silver HDHP 3000 EPO EvergreenHealth Partners-Virginia Mason





Metal Level: Silver



1 Yes

2 Yes

3 No

4 No

5 No

Plan Rates

Age


0-20 153.78 158.85 153.78 158.85

21 242.17 250.16 278.50 287.69

22 242.17 250.16 278.50 287.69

23 242.17 250.16 278.50 287.69

24 242.17 250.16 278.50 287.69

25 243.14 251.16 279.61 288.84

26 247.98 256.17 285.18 294.59

27 253.79 262.17 291.86 301.49

28 263.24 271.93 302.72 312.71

29 270.99 279.93 311.64 321.92

30 274.86 283.93 316.09 326.52

31 280.68 289.94 322.78 333.43

32 286.49 295.94 329.46 340.33

33 290.12 299.69 333.64 344.65

34 293.99 303.70 338.09 349.25

35 295.93 305.70 340.32 351.55

36 297.87 307.70 342.55 353.85

37 299.81 309.70 344.78 356.16

38 301.74 311.70 347.01 358.46

39 305.62 315.70 351.46 363.06

40 309.49 319.71 355.92 367.66

41 315.31 325.71 362.60 374.57

42 320.88 331.46 369.01 381.18

43 328.62 339.47 377.92 390.39

44 338.31 349.48 389.06 401.90

45 349.69 361.23 402.15 415.42

46 363.26 375.24 417.74 431.53

47 378.51 391.00 435.29 449.65

48 395.95 409.01 455.34 470.37

49 413.14 426.78 475.11 490.79

50 432.52 446.79 497.39 513.81

51 451.65 466.55 519.39 536.53

52 472.72 488.32 543.62 561.56

53 494.03 510.33 568.13 586.88

54 517.03 534.10 594.59 614.21

55 540.04 557.86 621.04 641.54

56 564.98 583.63 649.73 671.17

57 590.17 609.64 678.69 701.09

58 617.05 637.41 709.61 733.02

59 630.37 651.17 724.92 748.85

60 657.25 678.94 755.84 780.78

61 680.50 702.95 782.57 808.40

62 695.75 718.71 800.12 826.52

63 714.89 738.48 822.12 849.25

64 726.51 750.48 835.49 863.06

65 and over 726.51 750.48 835.49 863.06

N/A

N/A



RATE SCHEDULE


King

Snohomish

N/A

of 31


Plan Information

Plan Name: Silver Align 4000 EPO EvergreenHealth Partners-Virginia Mason





Metal Level: Silver



1 Yes

2 Yes

3 No

4 No

5 No

Plan Rates

Age


0-20 158.01 163.23 158.01 163.23

21 248.84 257.05 286.17 295.61

22 248.84 257.05 286.17 295.61

23 248.84 257.05 286.17 295.61

24 248.84 257.05 286.17 295.61

25 249.84 258.08 287.31 296.79

26 254.81 263.22 293.03 302.70

27 260.78 269.39 299.90 309.80

28 270.49 279.42 311.06 321.33

29 278.45 287.64 320.22 330.79

30 282.43 291.75 324.80 335.52

31 288.41 297.92 331.67 342.61

32 294.38 304.09 338.53 349.71

33 298.11 307.95 342.83 354.14

34 302.09 312.06 347.41 358.87

35 304.08 314.12 349.69 361.23

36 306.07 316.17 351.98 363.60

37 308.06 318.23 354.27 365.96

38 310.05 320.29 356.56 368.33

39 314.04 324.40 361.14 373.06

40 318.02 328.51 365.72 377.79

41 323.99 334.68 372.59 384.88

42 329.71 340.59 379.17 391.68

43 337.68 348.82 388.33 401.14

44 347.63 359.10 399.77 412.97

45 359.32 371.18 413.22 426.86

46 373.26 385.58 429.25 443.41

47 388.94 401.77 447.28 462.04

48 406.85 420.28 467.88 483.32

49 424.52 438.53 488.20 504.31

50 444.43 459.09 511.09 527.96

51 464.09 479.40 533.70 551.31

52 485.74 501.76 558.60 577.03

53 507.63 524.39 583.78 603.04

54 531.27 548.81 610.96 631.13

55 554.91 573.23 638.15 659.21

56 580.54 599.70 667.63 689.66

57 606.42 626.44 697.39 720.40

58 634.04 654.97 729.15 753.21

59 647.73 669.11 744.89 769.47

60 675.35 697.64 776.65 802.28

61 699.24 722.32 804.13 830.66

62 714.92 738.51 822.15 849.29

63 734.58 758.82 844.76 872.64

64 746.52 771.15 858.50 886.83

65 and over 746.52 771.15 858.50 886.83

N/A

N/A



RATE SCHEDULE


King

Snohomish

N/A

of 31


Plan Information

Plan Name: Gold Align 1500 EPO EvergreenHealth Partners-Virginia Mason





Metal Level: Gold



1 Yes

2 Yes

3 No

4 No

5 No

Plan Rates

Age


0-20 203.46 210.17 203.46 210.17

21 320.41 330.98 368.47 380.63

22 320.41 330.98 368.47 380.63

23 320.41 330.98 368.47 380.63

24 320.41 330.98 368.47 380.63

25 321.69 332.31 369.95 382.15

26 328.10 338.93 377.31 389.77

27 335.79 346.87 386.16 398.90

28 348.29 359.78 400.53 413.75

29 358.54 370.37 412.32 425.93

30 363.67 375.67 418.22 432.02

31 371.36 383.61 427.06 441.15

32 379.05 391.55 435.90 450.29

33 383.85 396.52 441.43 456.00

34 388.98 401.81 447.32 462.09

35 391.54 404.46 450.27 465.13

36 394.10 407.11 453.22 468.18

37 396.67 409.76 456.17 471.22

38 399.23 412.41 459.12 474.27

39 404.36 417.70 465.01 480.36

40 409.48 423.00 470.91 486.45

41 417.17 430.94 479.75 495.58

42 424.54 438.55 488.22 504.34

43 434.80 449.14 500.02 516.52

44 447.61 462.38 514.75 531.74

45 462.67 477.94 532.07 549.63

46 480.62 496.48 552.71 570.95

47 500.80 517.33 575.92 594.93

48 523.87 541.16 602.45 622.33

49 546.62 564.66 628.61 649.36

50 572.25 591.14 658.09 679.81

51 597.56 617.28 687.20 709.88

52 625.44 646.08 719.26 742.99

53 653.64 675.21 751.68 776.49

54 684.08 706.65 786.69 812.65

55 714.51 738.09 821.69 848.81

56 747.52 772.18 859.64 888.01

57 780.84 806.61 897.97 927.60

58 816.40 843.35 938.87 969.85

59 834.03 861.55 959.13 990.78

60 869.59 898.29 1000.03 1033.03

61 900.35 930.06 1035.40 1069.57

62 920.54 950.92 1058.62 1093.55

63 945.85 977.06 1087.73 1123.62

64 961.23 992.94 1105.41 1141.89

65 and over 961.23 992.94 1105.41 1141.89

N/A

N/A



RATE SCHEDULE


King

Snohomish

N/A

of 31


Plan Information

Plan Name: Bronze HDHP 6000 EPO UW Medicine





Metal Level: Bronze



1 Yes

2 No

3 No

4 No

5 No

Plan Rates

Age


0-20 132.62 132.62

21 208.85 240.18

22 208.85 240.18

23 208.85 240.18

24 208.85 240.18

25 209.69 241.14

26 213.86 245.94

27 218.87 251.71

28 227.02 261.07

29 233.70 268.76

30 237.04 272.60

31 242.06 278.37

32 247.07 284.13

33 250.20 287.73

34 253.54 291.58

35 255.21 293.50

36 256.89 295.42

37 258.56 297.34

38 260.23 299.26

39 263.57 303.10

40 266.91 306.95

41 271.92 312.71

42 276.73 318.24

43 283.41 325.92

44 291.76 335.53

45 301.58 346.82

46 313.28 360.27

47 326.43 375.40

48 341.47 392.69

49 356.30 409.74

50 373.01 428.96

51 389.51 447.93

52 407.68 468.83

53 426.05 489.96

54 445.89 512.78

55 465.74 535.60

56 487.25 560.33

57 508.97 585.31

58 532.15 611.97

59 543.64 625.18

60 566.82 651.84

61 586.87 674.90

62 600.03 690.03

63 616.53 709.00

64 626.55 720.53

65 and over 626.55 720.53

N/A

N/A



RATE SCHEDULE


King

N/A

N/A

of 31


Plan Information

Plan Name: Silver HDHP 3000 EPO UW Medicine





Metal Level: Silver



1 Yes

2 No

3 No

4 No

5 No

Plan Rates

Age


0-20 155.04 155.04

21 244.15 280.77

22 244.15 280.77

23 244.15 280.77

24 244.15 280.77

25 245.13 281.90

26 250.01 287.51

27 255.87 294.25

28 265.39 305.20

29 273.20 314.18

30 277.11 318.68

31 282.97 325.42

32 288.83 332.15

33 292.49 336.37

34 296.40 340.86

35 298.35 343.10

36 300.30 345.35

37 302.26 347.60

38 304.21 349.84

39 308.12 354.33

40 312.02 358.83

41 317.88 365.57

42 323.50 372.02

43 331.31 381.01

44 341.08 392.24

45 352.55 405.44

46 366.23 421.16

47 381.61 438.85

48 399.19 459.06

49 416.52 479.00

50 436.05 501.46

51 455.34 523.64

52 476.58 548.07

53 498.07 572.78

54 521.26 599.45

55 544.45 626.12

56 569.60 655.04

57 594.99 684.24

58 622.09 715.41

59 635.52 730.85

60 662.62 762.02

61 686.06 788.97

62 701.44 806.66

63 720.73 828.84

64 732.45 842.31

65 and over 732.45 842.31

N/A

N/A



RATE SCHEDULE


King

N/A

N/A

of 31


Plan Information

Plan Name: Silver Align 4000 EPO UW Medicine





Metal Level: Silver



1 Yes

2 No

3 No

4 No

5 No

Plan Rates

Age


0-20 159.30 159.30

21 250.87 288.50

22 250.87 288.50

23 250.87 288.50

24 250.87 288.50

25 251.87 289.65

26 256.89 295.42

27 262.91 302.35

28 272.70 313.60

29 280.72 322.83

30 284.74 327.45

31 290.76 334.37

32 296.78 341.30

33 300.54 345.62

34 304.56 350.24

35 306.56 352.55

36 308.57 354.86

37 310.58 357.16

38 312.58 359.47

39 316.60 364.09

40 320.61 368.70

41 326.63 375.63

42 332.40 382.26

43 340.43 391.50

44 350.47 403.04

45 362.26 416.59

46 376.31 432.75

47 392.11 450.93

48 410.17 471.70

49 427.98 492.18

50 448.05 515.26

51 467.87 538.05

52 489.70 563.15

53 511.77 588.54

54 535.61 615.95

55 559.44 643.36

56 585.28 673.07

57 611.37 703.08

58 639.22 735.10

59 653.01 750.97

60 680.86 782.99

61 704.94 810.69

62 720.75 828.86

63 740.57 851.65

64 752.61 865.50

65 and over 752.61 865.50

N/A

N/A



RATE SCHEDULE


King

N/A

N/A

of 31


Plan Information

Plan Name: Gold Align 1500 EPO UW Medicine





Metal Level: Gold



1 Yes

2 No

3 No

4 No

5 No

Plan Rates

Age


0-20 205.12 205.12

21 323.03 371.48

22 323.03 371.48

23 323.03 371.48

24 323.03 371.48

25 324.32 372.97

26 330.78 380.40

27 338.54 389.32

28 351.13 403.80

29 361.47 415.69

30 366.64 421.63

31 374.39 430.55

32 382.14 439.47

33 386.99 445.04

34 392.16 450.98

35 394.74 453.95

36 397.33 456.93

37 399.91 459.90

38 402.50 462.87

39 407.66 468.81

40 412.83 474.76

41 420.59 483.67

42 428.01 492.22

43 438.35 504.10

44 451.27 518.96

45 466.46 536.42

46 484.55 557.23

47 504.90 580.63

48 528.15 607.38

49 551.09 633.75

50 576.93 663.47

51 602.45 692.82

52 630.55 725.14

53 658.98 757.83

54 689.67 793.12

55 720.36 828.41

56 753.63 866.67

57 787.22 905.31

58 823.08 946.54

59 840.85 966.97

60 876.70 1008.21

61 907.71 1043.87

62 928.07 1067.27

63 953.58 1096.62

64 969.09 1114.44

65 and over 969.09 1114.44

N/A

N/A



RATE SCHEDULE


King

N/A

N/A

of 31


Plan Information

Plan Name: Bronze HDHP 6000 EPO The Everett Clinic





Metal Level: Bronze



1 No

2 Yes

3 No

4 No

5 No

Plan Rates

Age


0-20 140.80 140.80

21 221.73 254.99

22 221.73 254.99

23 221.73 254.99

24 221.73 254.99

25 222.62 256.01

26 227.06 261.11

27 232.38 267.23

28 241.02 277.18

29 248.12 285.34

30 251.67 289.42

31 256.99 295.54

32 262.31 301.66

33 265.64 305.48

34 269.18 309.56

35 270.96 311.60

36 272.73 313.64

37 274.51 315.68

38 276.28 317.72

39 279.83 321.80

40 283.38 325.88

41 288.70 332.00

42 293.80 337.87

43 300.89 346.03

44 309.76 356.23

45 320.18 368.21

46 332.60 382.49

47 346.57 398.55

48 362.53 416.91

49 378.28 435.02

50 396.02 455.42

51 413.53 475.56

52 432.82 497.75

53 452.34 520.19

54 473.40 544.41

55 494.47 568.64

56 517.30 594.90

57 540.36 621.42

58 564.98 649.72

59 577.17 663.75

60 601.78 692.05

61 623.07 716.53

62 637.04 732.60

63 654.56 752.74

64 665.19 764.97

65 and over 665.19 764.97

N/A

N/A



RATE SCHEDULE


N/A

Snohomish

N/A

of 31


Plan Information

Plan Name: Silver HDHP 3000 EPO The Everett Clinic





Metal Level: Silver



1 No

2 Yes

3 No

4 No

5 No

Plan Rates

Age


0-20 164.59 164.59

21 259.19 298.07

22 259.19 298.07

23 259.19 298.07

24 259.19 298.07

25 260.23 299.26

26 265.41 305.22

27 271.63 312.38

28 281.74 324.00

29 290.03 333.54

30 294.18 338.31

31 300.40 345.46

32 306.62 352.62

33 310.51 357.09

34 314.66 361.86

35 316.73 364.24

36 318.80 366.62

37 320.88 369.01

38 322.95 371.39

39 327.10 376.16

40 331.24 380.93

41 337.47 388.09

42 343.43 394.94

43 351.72 404.48

44 362.09 416.40

45 374.27 430.41

46 388.79 447.10

47 405.11 465.88

48 423.78 487.34

49 442.18 508.50

50 462.91 532.35

51 483.39 555.90

52 505.94 581.83

53 528.75 608.06

54 553.37 636.38

55 577.99 664.69

56 604.69 695.39

57 631.65 726.39

58 660.42 759.48

59 674.67 775.87

60 703.44 808.96

61 728.32 837.57

62 744.65 856.35

63 765.13 879.90

64 777.57 894.21

65 and over 777.57 894.21

N/A

N/A



RATE SCHEDULE


N/A

Snohomish

N/A

of 31


Plan Information

Plan Name: Silver Align 4000 EPO The Everett Clinic





Metal Level: Silver



1 No

2 Yes

3 No

4 No

5 No

Plan Rates

Age


0-20 169.12 169.12

21 266.33 306.28

22 266.33 306.28

23 266.33 306.28

24 266.33 306.28

25 267.39 307.50

26 272.72 313.63

27 279.11 320.98

28 289.50 332.92

29 298.02 342.72

30 302.28 347.62

31 308.67 354.98

32 315.07 362.33

33 319.06 366.92

34 323.32 371.82

35 325.45 374.27

36 327.58 376.72

37 329.71 379.17

38 331.84 381.62

39 336.11 386.52

40 340.37 391.42

41 346.76 398.77

42 352.88 405.82

43 361.41 415.62

44 372.06 427.87

45 384.58 442.26

46 399.49 459.42

47 416.27 478.71

48 435.45 500.76

49 454.36 522.51

50 475.66 547.01

51 496.70 571.21

52 519.87 597.85

53 543.31 624.81

54 568.61 653.90

55 593.91 683.00

56 621.34 714.54

57 649.04 746.40

58 678.60 780.39

59 693.25 797.24

60 722.81 831.24

61 748.38 860.64

62 765.16 879.93

63 786.20 904.13

64 798.98 918.83

65 and over 798.98 918.83

N/A

N/A



RATE SCHEDULE


N/A

Snohomish

N/A

of 31


Plan Information

Plan Name: Gold Align 1500 EPO The Everett Clinic





Metal Level: Gold



1 No

2 Yes

3 No

4 No

5 No

Plan Rates

Age


0-20 217.75 217.75

21 342.91 394.35

22 342.91 394.35

23 342.91 394.35

24 342.91 394.35

25 344.29 395.93

26 351.14 403.82

27 359.37 413.28

28 372.75 428.66

29 383.72 441.28

30 389.21 447.59

31 397.44 457.05

32 405.67 466.52

33 410.81 472.43

34 416.30 478.74

35 419.04 481.90

36 421.79 485.05

37 424.53 488.21

38 427.27 491.36

39 432.76 497.67

40 438.24 503.98

41 446.47 513.45

42 454.36 522.52

43 465.34 535.14

44 479.05 550.91

45 495.17 569.44

46 514.37 591.53

47 535.98 616.37

48 560.67 644.77

49 585.01 672.76

50 612.45 704.31

51 639.54 735.47

52 669.37 769.77

53 699.55 804.48

54 732.12 841.94

55 764.70 879.40

56 800.02 920.02

57 835.68 961.04

58 873.75 1004.81

59 892.61 1026.50

60 930.67 1070.27

61 963.59 1108.13

62 985.19 1132.97

63 1012.28 1164.13

64 1028.73 1183.05

65 and over 1028.73 1183.05

N/A

N/A



RATE SCHEDULE


N/A

Snohomish

N/A

of 31


Plan Information

Plan Name: Bronze HDHP 6000 EPO Providence-Swedish Health





Metal Level: Bronze



1 Yes

2 No

3 No

4 No

5 No

Plan Rates

Age


0-20 138.35 138.35

21 217.87 250.55

22 217.87 250.55

23 217.87 250.55

24 217.87 250.55

25 218.74 251.55

26 223.10 256.56

27 228.33 262.58

28 236.82 272.35

29 243.80 280.37

30 247.28 284.37

31 252.51 290.39

32 257.74 296.40

33 261.01 300.16

34 264.49 304.17

35 266.24 306.17

36 267.98 308.18

37 269.72 310.18

38 271.47 312.19

39 274.95 316.19

40 278.44 320.20

41 283.67 326.22

42 288.68 331.98

43 295.65 340.00

44 304.36 350.02

45 314.60 361.79

46 326.81 375.83

47 340.53 391.61

48 356.22 409.65

49 371.69 427.44

50 389.12 447.48

51 406.33 467.28

52 425.28 489.07

53 444.45 511.12

54 465.15 534.93

55 485.85 558.73

56 508.29 584.53

57 530.95 610.59

58 555.13 638.40

59 567.12 652.18

60 591.30 679.99

61 612.21 704.05

62 625.94 719.83

63 643.15 739.63

64 653.61 751.65

65 and over 653.61 751.65

N/A

N/A



RATE SCHEDULE


King

N/A

N/A

of 31


Plan Information

Plan Name: Silver HDHP 3000 EPO Providence-Swedish Health





Metal Level: Silver



1 Yes

2 No

3 No

4 No

5 No

Plan Rates

Age


0-20 161.70 161.70

21 254.64 292.84

22 254.64 292.84

23 254.64 292.84

24 254.64 292.84

25 255.66 294.01

26 260.75 299.86

27 266.86 306.89

28 276.79 318.31

29 284.94 327.68

30 289.02 332.37

31 295.13 339.40

32 301.24 346.42

33 305.06 350.82

34 309.13 355.50

35 311.17 357.85

36 313.21 360.19

37 315.24 362.53

38 317.28 364.87

39 321.36 369.56

40 325.43 374.24

41 331.54 381.27

42 337.40 388.01

43 345.55 397.38

44 355.73 409.09

45 367.70 422.86

46 381.96 439.25

47 398.00 457.70

48 416.34 478.79

49 434.42 499.58

50 454.79 523.01

51 474.90 546.14

52 497.06 571.62

53 519.47 597.39

54 543.66 625.20

55 567.85 653.02

56 594.08 683.19

57 620.56 713.64

58 648.82 746.15

59 662.83 762.25

60 691.09 794.76

61 715.54 822.87

62 731.58 841.32

63 751.70 864.45

64 763.92 878.51

65 and over 763.92 878.51

N/A

N/A



RATE SCHEDULE


King

N/A

N/A

of 31


Plan Information

Plan Name: Silver Align 4000 EPO Providence-Swedish Health





Metal Level: Silver



1 Yes

2 No

3 No

4 No

5 No

Plan Rates

Age


0-20 166.17 166.17

21 261.68 300.93

22 261.68 300.93

23 261.68 300.93

24 261.68 300.93

25 262.73 302.14

26 267.96 308.15

27 274.24 315.38

28 284.45 327.11

29 292.82 336.74

30 297.01 341.56

31 303.29 348.78

32 309.57 356.00

33 313.49 360.52

34 317.68 365.33

35 319.77 367.74

36 321.87 370.15

37 323.96 372.55

38 326.05 374.96

39 330.24 379.78

40 334.43 384.59

41 340.71 391.81

42 346.73 398.73

43 355.10 408.36

44 365.57 420.40

45 377.87 434.55

46 392.52 451.40

47 409.01 470.36

48 427.85 492.02

49 446.43 513.39

50 467.36 537.46

51 488.03 561.24

52 510.80 587.42

53 533.83 613.90

54 558.69 642.49

55 583.55 671.08

56 610.50 702.07

57 637.71 733.37

58 666.76 766.77

59 681.15 783.33

60 710.20 816.73

61 735.32 845.62

62 751.81 864.58

63 772.48 888.35

64 785.04 902.79

65 and over 785.04 902.79

N/A

N/A



RATE SCHEDULE


King

N/A

N/A

of 31


Plan Information

Plan Name: Gold Align 1500 EPO Providence-Swedish Health





Metal Level: Gold



1 Yes

2 No

3 No

4 No

5 No

Plan Rates

Age


0-20 213.92 213.92

21 336.88 387.41

22 336.88 387.41

23 336.88 387.41

24 336.88 387.41

25 338.23 388.96

26 344.97 396.71

27 353.05 406.01

28 366.19 421.12

29 376.97 433.51

30 382.36 439.71

31 390.44 449.01

32 398.53 458.31

33 403.58 464.12

34 408.97 470.32

35 411.67 473.42

36 414.36 476.52

37 417.06 479.62

38 419.75 482.72

39 425.14 488.91

40 430.53 495.11

41 438.62 504.41

42 446.37 513.32

43 457.15 525.72

44 470.62 541.21

45 486.45 559.42

46 505.32 581.12

47 526.54 605.52

48 550.80 633.42

49 574.72 660.92

50 601.67 691.92

51 628.28 722.52

52 657.59 756.23

53 687.24 790.32

54 719.24 827.12

55 751.24 863.93

56 785.94 903.83

57 820.98 944.12

58 858.37 987.13

59 876.90 1008.43

60 914.29 1051.44

61 946.63 1088.63

62 967.86 1113.03

63 994.47 1143.64

64 1010.64 1162.23

65 and over 1010.64 1162.23

N/A

N/A



RATE SCHEDULE


King

N/A

N/A

of 31


Plan Information

Plan Name: Bronze HDHP 6000 EPO MultiCare Connected Care





Metal Level: Bronze



1 Yes

2 Yes

3 No

4 No

5 No

Plan Rates

Age


0-20 140.68 145.33 140.68 145.33

21 221.55 228.86 254.78 263.19

22 221.55 228.86 254.78 263.19

23 221.55 228.86 254.78 263.19

24 221.55 228.86 254.78 263.19

25 222.44 229.78 255.80 264.24

26 226.87 234.35 260.90 269.51

27 232.18 239.85 267.01 275.82

28 240.82 248.77 276.95 286.09

29 247.91 256.10 285.10 294.51

30 251.46 259.76 289.18 298.72

31 256.78 265.25 295.29 305.04

32 262.09 270.74 301.41 311.35

33 265.42 274.18 305.23 315.30

34 268.96 277.84 309.31 319.51

35 270.73 279.67 311.34 321.62

36 272.51 281.50 313.38 323.72

37 274.28 283.33 315.42 325.83

38 276.05 285.16 317.46 327.94

39 279.60 288.82 321.54 332.15

40 283.14 292.48 325.61 336.36

41 288.46 297.98 331.73 342.67

42 293.55 303.24 337.59 348.73

43 300.64 310.56 345.74 357.15

44 309.51 319.72 355.93 367.68

45 319.92 330.48 367.91 380.05

46 332.33 343.29 382.17 394.79

47 346.28 357.71 398.23 411.37

48 362.23 374.19 416.57 430.32

49 377.96 390.44 434.66 449.00

50 395.69 408.75 455.04 470.06

51 413.19 426.83 475.17 490.85

52 432.47 446.74 497.34 513.75

53 451.96 466.88 519.76 536.91

54 473.01 488.62 543.96 561.91

55 494.06 510.36 568.16 586.91

56 516.88 533.93 594.41 614.02

57 539.92 557.73 620.90 641.39

58 564.51 583.14 649.19 670.61

59 576.69 595.73 663.20 685.08

60 601.29 621.13 691.48 714.30

61 622.56 643.10 715.94 739.56

62 636.51 657.52 731.99 756.15

63 654.02 675.60 752.12 776.94

64 664.65 686.58 764.34 789.57

65 and over 664.65 686.58 764.34 789.57

N/A

N/A



RATE SCHEDULE


King

Pierce

N/A

of 31


Plan Information

Plan Name: Silver HDHP 3000 EPO MultiCare Connected Care





Metal Level: Silver



1 Yes

2 Yes

3 No

4 No

5 No

Plan Rates

Age


0-20 164.47 169.90 164.47 169.90

21 259.01 267.56 297.86 307.69

22 259.01 267.56 297.86 307.69

23 259.01 267.56 297.86 307.69

24 259.01 267.56 297.86 307.69

25 260.05 268.63 299.05 308.92

26 265.23 273.98 305.01 315.08

27 271.44 280.40 312.16 322.46

28 281.54 290.83 323.78 334.46

29 289.83 299.40 333.31 344.31

30 293.98 303.68 338.07 349.23

31 300.19 310.10 345.22 356.61

32 306.41 316.52 352.37 364.00

33 310.29 320.53 356.84 368.61

34 314.44 324.81 361.60 373.54

35 316.51 326.96 363.99 376.00

36 318.58 329.10 366.37 378.46

37 320.65 331.24 368.75 380.92

38 322.73 333.38 371.14 383.38

39 326.87 337.66 375.90 388.31

40 331.01 341.94 380.67 393.23

41 337.23 348.36 387.82 400.61

42 343.19 354.51 394.67 407.69

43 351.48 363.08 404.20 417.54

44 361.84 373.78 416.11 429.84

45 374.01 386.35 430.11 444.31

46 388.52 401.34 446.79 461.54

47 404.83 418.19 465.56 480.92

48 423.48 437.46 487.00 503.07

49 441.87 456.45 508.15 524.92

50 462.59 477.86 531.98 549.54

51 483.05 498.99 555.51 573.84

52 505.59 522.27 581.43 600.61

53 528.38 545.82 607.64 627.69

54 552.99 571.23 635.93 656.92

55 577.59 596.65 664.23 686.15

56 604.27 624.21 694.91 717.84

57 631.21 652.04 725.89 749.84

58 659.96 681.74 758.95 784.00

59 674.20 696.45 775.33 800.92

60 702.95 726.15 808.40 835.07

61 727.82 751.84 836.99 864.61

62 744.14 768.69 855.76 884.00

63 764.60 789.83 879.29 908.30

64 777.03 802.67 893.58 923.07

65 and over 777.03 802.67 893.58 923.07

N/A

N/A



RATE SCHEDULE


King

Pierce

N/A

of 31


Plan Information

Plan Name: Silver Align 4000 EPO MultiCare Connected Care





Metal Level: Silver



1 Yes

2 Yes

3 No

4 No

5 No

Plan Rates

Age


0-20 169.01 174.58 169.01 174.58

21 266.15 274.93 306.07 316.17

22 266.15 274.93 306.07 316.17

23 266.15 274.93 306.07 316.17

24 266.15 274.93 306.07 316.17

25 267.21 276.03 307.30 317.44

26 272.54 281.53 313.42 323.76

27 278.93 288.13 320.76 331.35

28 289.31 298.85 332.70 343.68

29 297.82 307.65 342.50 353.80

30 302.08 312.05 347.39 358.86

31 308.47 318.65 354.74 366.44

32 314.86 325.25 362.08 374.03

33 318.85 329.37 366.67 378.78

34 323.11 333.77 371.57 383.83

35 325.24 335.97 374.02 386.36

36 327.36 338.17 376.47 388.89

37 329.49 340.37 378.92 391.42

38 331.62 342.57 381.37 393.95

39 335.88 346.97 386.26 399.01

40 340.14 351.36 391.16 404.07

41 346.53 357.96 398.51 411.66

42 352.65 364.29 405.55 418.93

43 361.17 373.08 415.34 429.05

44 371.81 384.08 427.58 441.69

45 384.32 397.00 441.97 456.55

46 399.23 412.40 459.11 474.26

47 415.99 429.72 478.39 494.18

48 435.16 449.52 500.43 516.94

49 454.05 469.04 522.16 539.39

50 475.34 491.03 546.65 564.68

51 496.37 512.75 570.83 589.66

52 519.52 536.67 597.45 617.17

53 542.95 560.86 624.39 644.99

54 568.23 586.98 653.46 675.03

55 593.51 613.10 682.54 705.07

56 620.93 641.42 714.07 737.63

57 648.61 670.01 745.90 770.51

58 678.15 700.53 779.87 805.61

59 692.79 715.65 796.71 823.00

60 722.33 746.17 830.68 858.09

61 747.88 772.56 860.06 888.45

62 764.65 789.88 879.35 908.36

63 785.67 811.60 903.53 933.34

64 798.45 824.79 918.21 948.51

65 and over 798.45 824.79 918.21 948.51

N/A

N/A



RATE SCHEDULE


King

Pierce

N/A

of 31


Plan Information

Plan Name: Gold Align 1500 EPO MultiCare Connected Care





Metal Level: Gold



1 Yes

2 Yes

3 No

4 No

5 No

Plan Rates

Age


0-20 217.60 224.78 217.60 224.78

21 342.68 353.99 394.08 407.09

22 342.68 353.99 394.08 407.09

23 342.68 353.99 394.08 407.09

24 342.68 353.99 394.08 407.09

25 344.05 355.40 395.66 408.72

26 350.90 362.48 403.54 416.86

27 359.13 370.98 413.00 426.63

28 372.49 384.79 428.37 442.50

29 383.46 396.11 440.98 455.53

30 388.94 401.78 447.28 462.04

31 397.17 410.27 456.74 471.81

32 405.39 418.77 466.20 481.58

33 410.53 424.08 472.11 487.69

34 416.01 429.74 478.42 494.20

35 418.75 432.57 481.57 497.46

36 421.50 435.41 484.72 500.72

37 424.24 438.24 487.87 503.97

38 426.98 441.07 491.03 507.23

39 432.46 446.73 497.33 513.74

40 437.95 452.40 503.64 520.26

41 446.17 460.89 513.09 530.03

42 454.05 469.03 522.16 539.39

43 465.02 480.36 534.77 552.42

44 478.72 494.52 550.53 568.70

45 494.83 511.16 569.05 587.83

46 514.02 530.98 591.12 610.63

47 535.61 553.28 615.95 636.28

48 560.28 578.77 644.32 665.59

49 584.61 603.90 672.30 694.49

50 612.03 632.22 703.83 727.06

51 639.10 660.19 734.96 759.22

52 668.91 690.99 769.25 794.63

53 699.07 722.14 803.93 830.46

54 731.62 755.77 841.37 869.13

55 764.18 789.39 878.80 907.80

56 799.47 825.86 919.39 949.73

57 835.11 862.67 960.38 992.07

58 873.15 901.96 1004.12 1037.26

59 892.00 921.43 1025.80 1059.65

60 930.03 960.72 1069.54 1104.83

61 962.93 994.71 1107.37 1143.91

62 984.52 1017.01 1132.20 1169.56

63 1011.59 1044.97 1163.33 1201.72

64 1028.04 1061.97 1182.24 1221.26

65 and over 1028.04 1061.97 1182.24 1221.26

N/A

N/A



RATE SCHEDULE


King

Pierce

N/A

of 31


Plan Information

Plan Name: Bronze HDHP 6000 EPO PeaceHealth





Metal Level: Bronze



1 No

2 No

3 Yes

4 No

5 No

Plan Rates

Age


0-20 138.78 138.78

21 218.55 251.34

22 218.55 251.34

23 218.55 251.34

24 218.55 251.34

25 219.43 252.34

26 223.80 257.37

27 229.04 263.40

28 237.57 273.20

29 244.56 281.25

30 248.06 285.27

31 253.30 291.30

32 258.55 297.33

33 261.83 301.10

34 265.32 305.12

35 267.07 307.13

36 268.82 309.14

37 270.57 311.16

38 272.32 313.17

39 275.82 317.19

40 279.31 321.21

41 284.56 327.24

42 289.58 333.02

43 296.58 341.06

44 305.32 351.12

45 315.59 362.93

46 327.83 377.01

47 341.60 392.84

48 357.34 410.94

49 372.85 428.78

50 390.34 448.89

51 407.60 468.74

52 426.62 490.61

53 445.85 512.73

54 466.61 536.60

55 487.38 560.48

56 509.89 586.37

57 532.62 612.51

58 556.88 640.41

59 568.90 654.23

60 593.16 682.13

61 614.14 706.26

62 627.91 722.09

63 645.17 741.95

64 655.65 754.01

65 and over 655.65 754.01

N/A

N/A



RATE SCHEDULE


N/A

N/A

Clark

of 31


Plan Information

Plan Name: Bronze Essential 7150 EPO PeaceHealth





Metal Level: Bronze



1 No

2 No

3 Yes

4 No

5 No

Plan Rates

Age


0-20 148.25 148.25

21 233.47 268.49

22 233.47 268.49

23 233.47 268.49

24 233.47 268.49

25 234.40 269.57

26 239.07 274.93

27 244.68 281.38

28 253.78 291.85

29 261.25 300.44

30 264.99 304.74

31 270.59 311.18

32 276.20 317.62

33 279.70 321.65

34 283.43 325.95

35 285.30 328.10

36 287.17 330.24

37 289.04 332.39

38 290.90 334.54

39 294.64 338.84

40 298.38 343.13

41 303.98 349.58

42 309.35 355.75

43 316.82 364.34

44 326.16 375.08

45 337.13 387.70

46 350.21 402.74

47 364.91 419.65

48 381.72 438.98

49 398.30 458.05

50 416.98 479.53

51 435.42 500.74

52 455.73 524.09

53 476.28 547.72

54 498.46 573.23

55 520.64 598.74

56 544.69 626.39

57 568.97 654.31

58 594.88 684.12

59 607.72 698.88

60 633.64 728.68

61 656.05 754.46

62 670.76 771.37

63 689.20 792.59

64 700.41 805.47

65 and over 700.41 805.47

N/A

N/A



RATE SCHEDULE


N/A

N/A

Clark

of 31


Plan Information

Plan Name: Silver HDHP 3000 EPO PeaceHealth





Metal Level: Silver



1 No

2 No

3 Yes

4 No

5 No

Plan Rates

Age


0-20 162.23 162.23

21 255.48 293.80

22 255.48 293.80

23 255.48 293.80

24 255.48 293.80

25 256.50 294.97

26 261.61 300.85

27 267.74 307.90

28 277.70 319.36

29 285.88 328.76

30 289.97 333.46

31 296.10 340.51

32 302.23 347.56

33 306.06 351.97

34 310.15 356.67

35 312.19 359.02

36 314.24 361.37

37 316.28 363.72

38 318.32 366.07

39 322.41 370.77

40 326.50 375.47

41 332.63 382.53

42 338.51 389.28

43 346.68 398.68

44 356.90 410.44

45 368.91 424.25

46 383.22 440.70

47 399.31 459.21

48 417.71 480.36

49 435.84 501.22

50 456.28 524.72

51 476.46 547.93

52 498.69 573.50

53 521.17 599.35

54 545.44 627.26

55 569.71 655.17

56 596.03 685.43

57 622.60 715.99

58 650.96 748.60

59 665.01 764.76

60 693.36 797.37

61 717.89 825.57

62 733.99 844.08

63 754.17 867.29

64 766.43 881.40

65 and over 766.43 881.40

N/A

N/A



RATE SCHEDULE


N/A

N/A

Clark

of 31


Plan Information

Plan Name: Silver Essential 3500 EPO PeaceHealth





Metal Level: Silver



1 No

2 No

3 Yes

4 No

5 No

Plan Rates

Age


0-20 170.64 170.64

21 268.72 309.03

22 268.72 309.03

23 268.72 309.03

24 268.72 309.03

25 269.80 310.27

26 275.17 316.45

27 281.62 323.87

28 292.10 335.92

29 300.70 345.81

30 305.00 350.75

31 311.45 358.17

32 317.90 365.59

33 321.93 370.22

34 326.23 375.17

35 328.38 377.64

36 330.53 380.11

37 332.68 382.58

38 334.83 385.06

39 339.13 390.00

40 343.43 394.94

41 349.88 402.36

42 356.06 409.47

43 364.66 419.36

44 375.41 431.72

45 388.04 446.24

46 403.09 463.55

47 420.02 483.02

48 439.36 505.27

49 458.44 527.21

50 479.94 551.93

51 501.17 576.35

52 524.55 603.23

53 548.20 630.43

54 573.73 659.79

55 599.26 689.14

56 626.93 720.97

57 654.88 753.11

58 684.71 787.42

59 699.49 804.41

60 729.32 838.72

61 755.12 868.38

62 772.04 887.85

63 793.27 912.27

64 806.16 927.09

65 and over 806.16 927.09

N/A

N/A



RATE SCHEDULE


N/A

N/A

Clark

of 31


Plan Information

Plan Name: Gold Essential 1200 EPO PeaceHealth





Metal Level: Gold



1 No

2 No

3 Yes

4 No

5 No

Plan Rates

Age


0-20 212.77 212.77

21 335.07 385.33

22 335.07 385.33

23 335.07 385.33

24 335.07 385.33

25 336.41 386.87

26 343.11 394.58

27 351.15 403.82

28 364.22 418.85

29 374.94 431.18

30 380.30 437.35

31 388.34 446.60

32 396.39 455.84

33 401.41 461.62

34 406.77 467.79

35 409.45 470.87

36 412.13 473.95

37 414.81 477.04

38 417.50 480.12

39 422.86 486.28

40 428.22 492.45

41 436.26 501.70

42 443.97 510.56

43 454.69 522.89

44 468.09 538.30

45 483.84 556.41

46 502.60 577.99

47 523.71 602.27

48 547.84 630.01

49 571.63 657.37

50 598.43 688.20

51 624.90 718.64

52 654.05 752.16

53 683.54 786.07

54 715.37 822.68

55 747.20 859.28

56 781.71 898.97

57 816.56 939.05

58 853.75 981.82

59 872.18 1003.01

60 909.38 1045.78

61 941.54 1082.77

62 962.65 1107.05

63 989.12 1137.49

64 1005.20 1155.99

65 and over 1005.20 1155.99

N/A

N/A



RATE SCHEDULE


N/A

N/A

Clark

of 31


Plan Information

Plan Name: Bronze HDHP 6000 EPO RealValue





Metal Level: Bronze



1 Yes

2 Yes

3 No

4 Yes

5 Yes

Plan Rates

Age


0-20 142.06 146.74 138.93 150.44 142.06 146.74 138.93 150.44

21 223.71 231.09 218.79 236.91 257.27 265.76 251.61 272.45

22 223.71 231.09 218.79 236.91 257.27 265.76 251.61 272.45

23 223.71 231.09 218.79 236.91 257.27 265.76 251.61 272.45

24 223.71 231.09 218.79 236.91 257.27 265.76 251.61 272.45

25 224.60 232.02 219.66 237.86 258.30 266.82 252.61 273.54

26 229.08 236.64 224.04 242.59 263.44 272.13 257.65 278.98

27 234.45 242.18 229.29 248.28 269.62 278.51 263.68 285.52

28 243.17 251.20 237.82 257.52 279.65 288.88 273.50 296.15

29 250.33 258.59 244.82 265.10 287.88 297.38 281.55 304.87

30 253.91 262.29 248.32 268.89 292.00 301.63 285.57 309.23

31 259.28 267.84 253.58 274.58 298.17 308.01 291.61 315.76

32 264.65 273.38 258.83 280.26 304.35 314.39 297.65 322.30

33 268.00 276.85 262.11 283.82 308.21 318.38 301.42 326.39

34 271.58 280.55 265.61 287.61 312.32 322.63 305.45 330.75

35 273.37 282.39 267.36 289.50 314.38 324.75 307.46 332.93

36 275.16 284.24 269.11 291.40 316.44 326.88 309.48 335.11

37 276.95 286.09 270.86 293.29 318.50 329.01 311.49 337.29

38 278.74 287.94 272.61 295.19 320.55 331.13 313.50 339.47

39 282.32 291.64 276.11 298.98 324.67 335.38 317.53 343.83

40 285.90 295.34 279.61 302.77 328.79 339.64 321.55 348.18

41 291.27 300.88 284.86 308.46 334.96 346.01 327.59 354.72

42 296.42 306.20 289.89 313.90 340.88 352.13 333.38 360.99

43 303.57 313.59 296.90 321.49 349.11 360.63 341.43 369.71

44 312.52 322.84 305.65 330.96 359.40 371.26 351.49 380.61

45 323.04 333.70 315.93 342.10 371.49 383.75 363.32 393.41

46 335.57 346.64 328.18 355.36 385.90 398.63 377.41 408.67

47 349.66 361.20 341.97 370.29 402.11 415.38 393.26 425.83

48 365.77 377.84 357.72 387.35 420.63 434.51 411.38 445.45

49 381.65 394.24 373.25 404.17 438.90 453.38 429.24 464.79

50 399.55 412.73 390.76 423.12 459.48 474.64 449.37 486.59

51 417.22 430.99 408.04 441.84 479.80 495.64 469.25 508.11

52 436.68 451.09 427.07 462.45 502.18 518.76 491.14 531.81

53 456.37 471.43 446.33 483.29 524.82 542.14 513.28 555.79

54 477.62 493.38 467.11 505.80 549.26 567.39 537.18 581.67

55 498.87 515.34 487.90 528.31 573.70 592.64 561.08 607.55

56 521.92 539.14 510.43 552.71 600.20 620.01 587.00 635.61

57 545.18 563.17 533.19 577.35 626.96 647.65 613.17 663.95

58 570.01 588.82 557.47 603.64 655.52 677.15 641.09 694.19

59 582.32 601.53 569.51 616.67 669.66 691.76 654.93 709.17

60 607.15 627.18 593.79 642.97 698.22 721.26 682.86 739.42

61 628.63 649.37 614.80 665.71 722.92 746.78 707.01 765.57

62 642.72 663.93 628.58 680.64 739.13 763.52 722.87 782.74

63 660.39 682.18 645.86 699.36 759.45 784.51 742.74 804.26

64 671.13 693.27 656.37 710.73 771.80 797.27 754.82 817.34

65 and over 671.13 693.27 656.37 710.73 771.80 797.27 754.82 817.34

Spokane

Benton, Franklin, Walla Walla, Yakima



RATE SCHEDULE


King

Kitsap, Pierce, Skagit, Snohomish, Thurston

N/A

of 31


Plan Information

Plan Name: Bronze Essential 7150 EPO RealValue





Metal Level: Bronze



1 Yes

2 Yes

3 No

4 Yes

5 Yes

Plan Rates

Age


0-20 151.76 156.77 148.42 160.71 151.76 156.77 148.42 160.71

21 238.99 246.88 233.73 253.09 274.84 283.91 268.79 291.05

22 238.99 246.88 233.73 253.09 274.84 283.91 268.79 291.05

23 238.99 246.88 233.73 253.09 274.84 283.91 268.79 291.05

24 238.99 246.88 233.73 253.09 274.84 283.91 268.79 291.05

25 239.95 247.86 234.67 254.10 275.94 285.04 269.87 292.22

26 244.73 252.80 239.34 259.16 281.43 290.72 275.24 298.04

27 250.46 258.73 244.95 265.24 288.03 297.54 281.69 305.02

28 259.78 268.35 254.07 275.11 298.75 308.61 292.18 316.38

29 267.43 276.25 261.55 283.21 307.54 317.69 300.78 325.69

30 271.25 280.21 265.29 287.26 311.94 322.24 305.08 330.35

31 276.99 286.13 270.90 293.33 318.54 329.05 311.53 337.33

32 282.73 292.06 276.51 299.41 325.13 335.86 317.98 344.32

33 286.31 295.76 280.01 303.20 329.26 340.12 322.01 348.68

34 290.13 299.71 283.75 307.25 333.65 344.66 326.31 353.34

35 292.05 301.68 285.62 309.28 335.85 346.94 328.46 355.67

36 293.96 303.66 287.49 311.30 338.05 349.21 330.61 358.00

37 295.87 305.63 289.36 313.33 340.25 351.48 332.76 360.32

38 297.78 307.61 291.23 315.35 342.45 353.75 334.91 362.65

39 301.61 311.56 294.97 319.40 346.85 358.29 339.22 367.31

40 305.43 315.51 298.71 323.45 351.24 362.83 343.52 371.97

41 311.16 321.43 304.32 329.52 357.84 369.65 349.97 378.95

42 316.66 327.11 309.70 335.34 364.16 376.18 356.15 385.65

43 324.31 335.01 317.17 343.44 372.96 385.26 364.75 394.96

44 333.87 344.89 326.52 353.57 383.95 396.62 375.50 406.60

45 345.10 356.49 337.51 365.46 396.87 409.96 388.14 420.28

46 358.49 370.32 350.60 379.64 412.26 425.86 403.19 436.58

47 373.54 385.87 365.32 395.58 429.57 443.75 420.12 454.92

48 390.75 403.64 382.15 413.80 449.36 464.19 439.48 475.87

49 407.72 421.17 398.75 431.77 468.87 484.35 458.56 496.54

50 426.84 440.92 417.45 452.02 490.86 507.06 480.06 519.82

51 445.72 460.42 435.91 472.01 512.57 529.49 501.30 542.82

52 466.51 481.90 456.25 494.03 536.48 554.19 524.68 568.14

53 487.54 503.63 476.81 516.30 560.67 579.17 548.34 593.75

54 510.24 527.08 499.02 540.35 586.78 606.14 573.87 621.40

55 532.95 550.53 521.22 564.39 612.89 633.12 599.41 649.05

56 557.56 575.96 545.30 590.46 641.20 662.36 627.09 679.03

57 582.42 601.64 569.61 616.78 669.78 691.88 655.05 709.30

58 608.95 629.04 595.55 644.87 700.29 723.40 684.88 741.61

59 622.09 642.62 608.40 658.79 715.40 739.01 699.67 757.61

60 648.62 670.02 634.35 686.89 745.91 770.53 729.50 789.92

61 671.56 693.72 656.79 711.18 772.30 797.78 755.31 817.86

62 686.62 709.28 671.51 727.13 789.61 815.67 772.24 836.20

63 705.50 728.78 689.98 747.12 811.32 838.10 793.47 859.19

64 716.97 740.63 701.19 759.27 824.52 851.72 806.37 873.15

65 and over 716.97 740.63 701.19 759.27 824.52 851.72 806.37 873.15

Spokane




RATE SCHEDULE


King


N/A

of 31


Plan Information

Plan Name: Silver HDHP 3000 EPO RealValue





Metal Level: Silver



1 Yes

2 Yes

3 No

4 Yes

5 Yes

Plan Rates

Age


0-20 166.05 171.53 162.40 175.85 166.05 171.53 162.40 175.85

21 261.50 270.13 255.75 276.93 300.73 310.65 294.11 318.47

22 261.50 270.13 255.75 276.93 300.73 310.65 294.11 318.47

23 261.50 270.13 255.75 276.93 300.73 310.65 294.11 318.47

24 261.50 270.13 255.75 276.93 300.73 310.65 294.11 318.47

25 262.55 271.21 256.77 278.04 301.93 311.89 295.29 319.74

26 267.78 276.61 261.88 283.57 307.94 318.10 301.17 326.11

27 274.05 283.10 268.02 290.22 315.16 325.56 308.23 333.75

28 284.25 293.63 278.00 301.02 326.89 337.68 319.70 346.17

29 292.62 302.27 286.18 309.88 336.51 347.62 329.11 356.37

30 296.80 306.60 290.27 314.31 341.32 352.59 333.81 361.46

31 303.08 313.08 296.41 320.96 348.54 360.04 340.87 369.10

32 309.35 319.56 302.55 327.61 355.76 367.50 347.93 376.75

33 313.28 323.62 306.38 331.76 360.27 372.16 352.34 381.52

34 317.46 327.94 310.48 336.19 365.08 377.13 357.05 386.62

35 319.55 330.10 312.52 338.41 367.49 379.61 359.40 389.17

36 321.65 332.26 314.57 340.62 369.89 382.10 361.75 391.72

37 323.74 334.42 316.61 342.84 372.30 384.58 364.11 394.26

38 325.83 336.58 318.66 345.05 374.70 387.07 366.46 396.81

39 330.01 340.90 322.75 349.48 379.51 392.04 371.17 401.91

40 334.20 345.23 326.84 353.91 384.33 397.01 375.87 407.00

41 340.47 351.71 332.98 360.56 391.54 404.46 382.93 414.65

42 346.49 357.92 338.86 366.93 398.46 411.61 389.69 421.97

43 354.86 366.57 347.05 375.79 408.08 421.55 399.11 432.16

44 365.32 377.37 357.28 386.87 420.11 433.98 410.87 444.90

45 377.61 390.07 369.30 399.88 434.25 448.58 424.69 459.87

46 392.25 405.19 383.62 415.39 451.09 465.97 441.16 477.70

47 408.72 422.21 399.73 432.84 470.03 485.54 459.69 497.77

48 427.55 441.66 418.15 452.78 491.69 507.91 480.87 520.69

49 446.12 460.84 436.30 472.44 513.04 529.97 501.75 543.31

50 467.04 482.45 456.76 494.59 537.09 554.82 525.28 568.78

51 487.70 503.79 476.97 516.47 560.85 579.36 548.51 593.94

52 510.45 527.29 499.22 540.56 587.02 606.39 574.10 621.65

53 533.46 551.06 521.72 564.93 613.48 633.72 599.98 649.67

54 558.30 576.73 546.02 591.24 642.05 663.24 627.92 679.93

55 583.15 602.39 570.32 617.55 670.62 692.75 655.86 710.18

56 610.08 630.21 596.66 646.07 701.59 724.74 686.16 742.99

57 637.28 658.31 623.26 674.87 732.87 757.05 716.74 776.11

58 666.30 688.29 651.64 705.61 766.25 791.53 749.39 811.46

59 680.68 703.15 665.71 720.84 782.79 808.62 765.57 828.97

60 709.71 733.13 694.10 751.58 816.17 843.10 798.21 864.32

61 734.82 759.06 718.65 778.17 845.04 872.92 826.45 894.89

62 751.29 776.08 734.76 795.62 863.98 892.49 844.98 914.96

63 771.95 797.42 754.97 817.49 887.74 917.04 868.21 940.12

64 784.50 810.39 767.24 830.79 902.18 931.95 882.33 955.40

65 and over 784.50 810.39 767.24 830.79 902.18 931.95 882.33 955.40

Spokane




RATE SCHEDULE


King


N/A

of 31


Plan Information

Plan Name: Silver Essential 3500 EPO RealValue





Metal Level: Silver



1 Yes

2 Yes

3 No

4 Yes

5 Yes

Plan Rates

Age


0-20 174.67 180.43 170.83 184.97 174.67 180.43 170.83 184.97

21 275.07 284.15 269.02 291.30 316.33 326.77 309.37 334.99

22 275.07 284.15 269.02 291.30 316.33 326.77 309.37 334.99

23 275.07 284.15 269.02 291.30 316.33 326.77 309.37 334.99

24 275.07 284.15 269.02 291.30 316.33 326.77 309.37 334.99

25 276.17 285.28 270.09 292.46 317.60 328.08 310.61 336.33

26 281.67 290.97 275.47 298.29 323.92 334.61 316.80 343.03

27 288.27 297.79 281.93 305.28 331.51 342.45 324.22 351.07

28 299.00 308.87 292.42 316.64 343.85 355.20 336.29 364.14

29 307.80 317.96 301.03 325.96 353.97 365.65 346.19 374.86

30 312.20 322.51 305.34 330.62 359.04 370.88 351.14 380.22

31 318.81 329.33 311.79 337.62 366.63 378.73 358.56 388.26

32 325.41 336.15 318.25 344.61 374.22 386.57 365.99 396.30

33 329.53 340.41 322.28 348.98 378.96 391.47 370.63 401.32

34 333.93 344.95 326.59 353.64 384.03 396.70 375.58 406.68

35 336.14 347.23 328.74 355.97 386.56 399.31 378.05 409.36

36 338.34 349.50 330.89 358.30 389.09 401.93 380.53 412.04

37 340.54 351.77 333.04 360.63 391.62 404.54 383.00 414.72

38 342.74 354.05 335.20 362.96 394.15 407.15 385.48 417.40

39 347.14 358.59 339.50 367.62 399.21 412.38 390.43 422.76

40 351.54 363.14 343.81 372.28 404.27 417.61 395.38 428.12

41 358.14 369.96 350.26 379.27 411.86 425.45 402.80 436.16

42 364.47 376.50 356.45 385.97 419.14 432.97 409.92 443.87

43 373.27 385.59 365.06 395.29 429.26 443.43 419.82 454.59

44 384.27 396.95 375.82 406.94 441.91 456.50 432.19 467.99

45 397.20 410.31 388.46 420.64 456.78 471.86 446.73 483.73

46 412.61 426.22 403.53 436.95 474.50 490.15 464.06 502.49

47 429.93 444.12 420.48 455.30 494.42 510.74 483.55 523.60

48 449.74 464.58 439.85 476.27 517.20 534.27 505.82 547.72

49 469.27 484.76 458.95 496.96 539.66 557.47 527.79 571.50

50 491.28 507.49 480.47 520.26 564.97 583.61 552.54 598.30

51 513.01 529.93 501.72 543.27 589.96 609.42 576.98 624.76

52 536.94 554.66 525.12 568.62 617.48 637.85 603.89 653.91

53 561.14 579.66 548.80 594.25 645.31 666.61 631.12 683.39

54 587.27 606.65 574.35 621.92 675.37 697.65 660.51 715.21

55 613.41 633.65 599.91 649.60 705.42 728.70 689.90 747.04

56 641.74 662.92 627.62 679.60 738.00 762.35 721.76 781.54

57 670.35 692.47 655.60 709.90 770.90 796.34 753.94 816.38

58 700.88 724.01 685.46 742.23 806.01 832.61 788.28 853.56

59 716.01 739.64 700.26 758.25 823.41 850.58 805.29 871.99

60 746.54 771.18 730.12 790.59 858.52 886.85 839.63 909.17

61 772.95 798.45 755.94 818.55 888.89 918.22 869.33 941.33

62 790.28 816.36 772.89 836.90 908.82 938.81 888.82 962.44

63 812.01 838.80 794.14 859.92 933.81 964.62 913.26 988.90

64 825.21 852.44 807.06 873.90 948.99 980.31 928.11 1004.97

65 and over 825.21 852.44 807.06 873.90 948.99 980.31 928.11 1004.97

Spokane




RATE SCHEDULE


King


N/A

of 31


Plan Information

Plan Name: Gold Essential 1200 EPO RealValue





Metal Level: Gold



1 Yes

2 Yes

3 No

4 Yes

5 Yes

Plan Rates

Age


0-20 217.81 224.99 213.01 230.66 217.81 224.99 213.01 230.66

21 343.00 354.32 335.45 363.24 394.45 407.47 385.77 417.72

22 343.00 354.32 335.45 363.24 394.45 407.47 385.77 417.72

23 343.00 354.32 335.45 363.24 394.45 407.47 385.77 417.72

24 343.00 354.32 335.45 363.24 394.45 407.47 385.77 417.72

25 344.37 355.74 336.80 364.69 396.03 409.10 387.32 419.39

26 351.23 362.82 343.50 371.95 403.92 417.25 395.03 427.75

27 359.46 371.33 351.56 380.67 413.38 427.03 404.29 437.77

28 372.84 385.14 364.64 394.84 428.77 442.92 419.33 454.06

29 383.82 396.48 375.37 406.46 441.39 455.96 431.68 467.43

30 389.31 402.15 380.74 412.27 447.70 462.47 437.85 474.12

31 397.54 410.66 388.79 420.99 457.17 472.25 447.11 484.14

32 405.77 419.16 396.84 429.71 466.63 482.03 456.37 494.17

33 410.91 424.47 401.87 435.16 472.55 488.15 462.15 500.43

34 416.40 430.14 407.24 440.97 478.86 494.66 468.33 507.12

35 419.15 432.98 409.92 443.88 482.02 497.92 471.41 510.46

36 421.89 435.81 412.61 446.78 485.17 501.18 474.50 513.80

37 424.63 438.65 415.29 449.69 488.33 504.44 477.59 517.14

38 427.38 441.48 417.98 452.59 491.48 507.70 480.67 520.48

39 432.87 447.15 423.34 458.41 497.80 514.22 486.84 527.17

40 438.35 452.82 428.71 464.22 504.11 520.74 493.02 533.85

41 446.59 461.32 436.76 472.93 513.57 530.52 502.28 543.87

42 454.48 469.47 444.48 481.29 522.65 539.89 511.15 553.48

43 465.45 480.81 455.21 492.91 535.27 552.93 523.49 566.85

44 479.17 494.98 468.63 507.44 551.05 569.23 538.92 583.56

45 495.29 511.64 484.40 524.51 569.59 588.38 557.05 603.19

46 514.50 531.48 503.18 544.86 591.68 611.20 578.66 626.58

47 536.11 553.80 524.31 567.74 616.53 636.87 602.96 652.90

48 560.81 579.31 548.47 593.89 644.93 666.21 630.74 682.98

49 585.16 604.47 572.28 619.68 672.93 695.14 658.13 712.63

50 612.60 632.81 599.12 648.74 704.49 727.74 688.99 746.05

51 639.70 660.80 625.62 677.44 735.65 759.93 719.46 779.05

52 669.54 691.63 654.81 709.04 769.97 795.38 753.03 815.39

53 699.72 722.81 684.33 741.00 804.68 831.23 786.98 852.15

54 732.31 756.47 716.19 775.51 842.15 869.94 823.62 891.84

55 764.89 790.13 748.06 810.02 879.62 908.65 860.27 931.52

56 800.22 826.63 782.61 847.43 920.25 950.62 900.01 974.55

57 835.89 863.48 817.50 885.21 961.27 993.00 940.13 1017.99

58 873.96 902.80 854.74 925.53 1005.06 1038.23 982.95 1064.36

59 892.83 922.29 873.19 945.51 1026.75 1060.64 1004.16 1087.33

60 930.90 961.62 910.42 985.83 1070.54 1105.87 1046.99 1133.70

61 963.83 995.64 942.63 1020.70 1108.40 1144.98 1084.02 1173.80

62 985.44 1017.96 963.76 1043.58 1133.25 1170.65 1108.32 1200.12

63 1012.54 1045.95 990.26 1072.28 1164.42 1202.84 1138.80 1233.12

64 1029.00 1062.96 1006.35 1089.71 1183.35 1222.40 1157.31 1253.16

65 and over 1029.00 1062.96 1006.35 1089.71 1183.35 1222.40 1157.31 1253.16

Spokane




RATE SCHEDULE


King


N/A

of 31


Plan Information

Plan Name: Silver HDHP 2500 RealValue





Metal Level: Silver



1 Yes

2 Yes

3 No

4 Yes

5 Yes

Plan Rates

Age


0-20 169.59 175.19 165.86 179.60 169.59 175.19 165.86 179.60

21 267.07 275.88 261.19 282.83 307.13 317.27 300.37 325.25

22 267.07 275.88 261.19 282.83 307.13 317.27 300.37 325.25

23 267.07 275.88 261.19 282.83 307.13 317.27 300.37 325.25

24 267.07 275.88 261.19 282.83 307.13 317.27 300.37 325.25

25 268.14 276.99 262.24 283.96 308.36 318.53 301.58 326.55

26 273.48 282.50 267.46 289.61 314.50 324.88 307.58 333.06

27 279.89 289.13 273.73 296.40 321.87 332.49 314.79 340.86

28 290.31 299.89 283.92 307.43 333.85 344.87 326.51 353.55

29 298.85 308.71 292.28 316.48 343.68 355.02 336.12 363.96

30 303.12 313.13 296.46 321.01 348.59 360.10 340.92 369.16

31 309.53 319.75 302.72 327.80 355.96 367.71 348.13 376.97

32 315.94 326.37 308.99 334.58 363.34 375.33 355.34 384.77

33 319.95 330.51 312.91 338.83 367.94 380.08 359.85 389.65

34 324.22 334.92 317.09 343.35 372.86 385.16 364.65 394.85

35 326.36 337.13 319.18 345.61 375.31 387.70 367.06 397.46

36 328.50 339.34 321.27 347.88 377.77 390.24 369.46 400.06

37 330.63 341.54 323.36 350.14 380.23 392.78 371.86 402.66

38 332.77 343.75 325.45 352.40 382.68 395.31 374.27 405.26

39 337.04 348.16 329.63 356.93 387.60 400.39 379.07 410.47

40 341.32 352.58 333.81 361.45 392.51 405.47 383.88 415.67

41 347.73 359.20 340.08 368.24 399.88 413.08 391.09 423.48

42 353.87 365.55 346.08 374.75 406.95 420.38 398.00 430.96

43 362.41 374.37 354.44 383.80 416.78 430.53 407.61 441.37

44 373.10 385.41 364.89 395.11 429.06 443.22 419.62 454.38

45 385.65 398.38 377.16 408.40 443.50 458.13 433.74 469.66

46 400.61 413.82 391.79 424.24 460.70 475.90 450.56 487.88

47 417.43 431.21 408.25 442.06 480.04 495.89 469.48 508.37

48 436.66 451.07 427.05 462.42 502.16 518.73 491.11 531.79

49 455.62 470.66 445.60 482.50 523.96 541.26 512.44 554.88

50 476.99 492.73 466.49 505.13 548.54 566.64 536.47 580.90

51 498.09 514.52 487.13 527.47 572.80 591.70 560.20 606.59

52 521.32 538.52 509.85 552.08 599.52 619.30 586.33 634.89

53 544.82 562.80 532.84 576.97 626.55 647.22 612.76 663.51

54 570.19 589.01 557.65 603.84 655.72 677.36 641.30 694.41

55 595.57 615.22 582.46 630.70 684.90 707.50 669.83 725.31

56 623.07 643.64 609.37 659.84 716.54 740.18 700.77 758.81

57 650.85 672.33 636.53 689.25 748.48 773.18 732.01 792.64

58 680.49 702.95 665.52 720.64 782.57 808.39 765.35 828.74

59 695.18 718.12 679.89 736.20 799.46 825.84 781.87 846.63

60 724.83 748.75 708.88 767.59 833.55 861.06 815.21 882.73

61 750.47 775.23 733.96 794.74 863.04 891.52 844.05 913.96

62 767.29 792.61 750.41 812.56 882.39 911.50 862.97 934.45

63 788.39 814.41 771.05 834.91 906.65 936.57 886.70 960.14

64 801.21 827.64 783.57 848.48 921.39 951.80 901.11 975.75

65 and over 801.21 827.64 783.57 848.48 921.39 951.80 901.11 975.75

Spokane




RATE SCHEDULE


King


N/A

of 31

BridgeSpan Health Company individual rate scheduleIndividual BridgeSpan Health Company

Documents

Transcript of BridgeSpan Health Company individual rate scheduleIndividual BridgeSpan Health Company