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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 Copay 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 : 5000 |
| 0-24 |
75.00 |
88.00 |
| 25-29 |
84.00 |
98.00 |
| 30-34 |
97.00 |
114.00 |
| 35-39 |
117.00 |
136.00 |
| 40-44 |
137.00 |
161.00 |
| 45-49 |
173.00 |
199.00 |
| 50-54 |
211.00 |
246.00 |
| 55-59 |
246.00 |
286.00 |
| 60-64 |
280.00 |
327.00 |
| 65+ |
280.00 |
327.00 |
| Child |
62.00 |
62.00 |
| Age |
Deductible : 7500 |
| 0-24 |
61.00 |
72.00 |
| 25-29 |
70.00 |
80.00 |
| 30-34 |
79.00 |
93.00 |
| 35-39 |
95.00 |
111.00 |
| 40-44 |
112.00 |
132.00 |
| 45-49 |
141.00 |
162.00 |
| 50-54 |
172.00 |
200.00 |
| 55-59 |
200.00 |
233.00 |
| 60-64 |
228.00 |
267.00 |
| 65+ |
228.00 |
267.00 |
| Child |
51.00 |
51.00 |
* - not all of the zip codes are eligible in this county
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Assurant Health
