|
LifeWise Health Plan of WA - Online
Application
Index | Exclusions
& Limitations | Provider
List | Download Application
Benefit Schedules:
WiseEssentials Rx | WiseEssentials Copay | WiseSimplicity | WiseChoices
Prime | WiseSavings
Rate Schedules:
WiseEssentials Rx | WiseEssentials Copay | WiseSimplicity | WiseChoices
Prime | WiseSavings
WiseEssentials Rx Rates
Effective date : 1/1/2010
Valid thru : 12/31/2010
Counties :
Available in all counties
| Family Status : |
Applicant
Non-Smoker |
Applicant
Smoker |
| Age |
Deductible : 1850 |
| 0-24 |
109.00 |
128.00 |
| 25-29 |
124.00 |
143.00 |
| 30-34 |
142.00 |
165.00 |
| 35-39 |
170.00 |
198.00 |
| 40-44 |
199.00 |
234.00 |
| 45-49 |
251.00 |
290.00 |
| 50-54 |
307.00 |
357.00 |
| 55-59 |
357.00 |
414.00 |
| 60-64 |
407.00 |
476.00 |
| 65+ |
407.00 |
476.00 |
| Child |
92.00 |
92.00 |
| Age |
Deductible : 2500 |
| 0-24 |
93.00 |
109.00 |
| 25-29 |
105.00 |
122.00 |
| 30-34 |
121.00 |
140.00 |
| 35-39 |
145.00 |
169.00 |
| 40-44 |
170.00 |
199.00 |
| 45-49 |
214.00 |
247.00 |
| 50-54 |
262.00 |
305.00 |
| 55-59 |
305.00 |
353.00 |
| 60-64 |
347.00 |
405.00 |
| 65+ |
347.00 |
405.00 |
| Child |
78.00 |
78.00 |
| Age |
Deductible : 3500 |
| 0-24 |
83.00 |
98.00 |
| 25-29 |
95.00 |
110.00 |
| 30-34 |
109.00 |
126.00 |
| 35-39 |
130.00 |
152.00 |
| 40-44 |
153.00 |
179.00 |
| 45-49 |
192.00 |
222.00 |
| 50-54 |
235.00 |
274.00 |
| 55-59 |
274.00 |
317.00 |
| 60-64 |
311.00 |
364.00 |
| 65+ |
311.00 |
364.00 |
| Child |
70.00 |
70.00 |
* - not all of the zip codes are eligible in this county
|
Assurant Health
