|
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 Value Plus 30 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 : 2500 |
| 0-24 |
205.00 |
238.00 |
| 25-29 |
245.00 |
284.00 |
| 30-34 |
253.00 |
295.00 |
| 35-39 |
284.00 |
330.00 |
| 40-44 |
376.00 |
437.00 |
| 45-49 |
437.00 |
507.00 |
| 50-54 |
502.00 |
582.00 |
| 55-59 |
605.00 |
705.00 |
| 60-64 |
707.00 |
824.00 |
| 65+ |
759.00 |
882.00 |
| Child |
155.00 |
155.00 |
| Age |
Deductible : 5000 |
| 0-24 |
172.00 |
197.00 |
| 25-29 |
203.00 |
235.00 |
| 30-34 |
209.00 |
245.00 |
| 35-39 |
235.00 |
273.00 |
| 40-44 |
314.00 |
363.00 |
| 45-49 |
363.00 |
420.00 |
| 50-54 |
416.00 |
484.00 |
| 55-59 |
504.00 |
585.00 |
| 60-64 |
587.00 |
684.00 |
| 65+ |
629.00 |
734.00 |
| Child |
131.00 |
131.00 |
| Age |
Deductible : 10000 |
| 0-24 |
112.00 |
132.00 |
| 25-29 |
135.00 |
157.00 |
| 30-34 |
139.00 |
162.00 |
| 35-39 |
157.00 |
183.00 |
| 40-44 |
207.00 |
240.00 |
| 45-49 |
240.00 |
280.00 |
| 50-54 |
278.00 |
320.00 |
| 55-59 |
334.00 |
389.00 |
| 60-64 |
390.00 |
454.00 |
| 65+ |
418.00 |
487.00 |
| Child |
86.00 |
86.00 |
* - not all of the zip codes are eligible in this county
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Assurant Health
