|
Premera Blue Cross - Online application
Index | Exclusions
& Limitations | Provider
List | Download Application
Benefit Schedules:
Protector Plus 20 | Value
Plus 30 | Preferred Plus
30 | Preferred Plus 20
Rate Schedules:
Protector Plus 20 | Value
Plus 30 | Preferred Plus 30 | Preferred
Plus 20
Heritage Protector Plus 20 Rates
Effective date : 10/1/2010
Valid thru : 9/30/2011
Counties :
Not available in
Clark
| Family Status : |
Applicant
Non-Smoker |
Applicant
Smoker |
| Age |
Deductible : 500 |
| 0-24 |
133.00 |
155.00 |
| 25-29 |
158.00 |
186.00 |
| 30-34 |
166.00 |
191.00 |
| 35-39 |
186.00 |
216.00 |
| 40-44 |
245.00 |
284.00 |
| 45-49 |
284.00 |
329.00 |
| 50-54 |
326.00 |
378.00 |
| 55-59 |
393.00 |
458.00 |
| 60-64 |
461.00 |
535.00 |
| 65+ |
494.00 |
573.00 |
| Child |
102.00 |
102.00 |
| Age |
Deductible : 1000 |
| 0-24 |
111.00 |
131.00 |
| 25-29 |
133.00 |
155.00 |
| 30-34 |
138.00 |
160.00 |
| 35-39 |
155.00 |
181.00 |
| 40-44 |
205.00 |
238.00 |
| 45-49 |
238.00 |
278.00 |
| 50-54 |
272.00 |
317.00 |
| 55-59 |
330.00 |
383.00 |
| 60-64 |
384.00 |
452.00 |
| 65+ |
414.00 |
481.00 |
| Child |
84.00 |
84.00 |
* - not all of the zip codes are eligible in this county
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Assurant Health
