Regence BlueCross BlueShield of Oregon Health Insurance Plans for Washington

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Benefit Schedules:
Evolve Core | Evolve Plus | Evolve HSA 50 | Evolve HSA 80 | Evolve HSA 100
Rate Schedules:
Evolve Core | Evolve Plus | Evolve HSA 50 | Evolve HSA 80 | Evolve HSA 100

Evolve HSA 80 Rates
Effective date : 3/1/2010
Valid thru : 2/28/2011
Counties : Clark

Family Status :	Applicant Non-Smoker	Applicant Smoker	Family Non-Smoker	Family Smoker
Age	Deductible : 2000
0-24	154.00	177.00	N/A	N/A
25-29	177.00	203.00	N/A	N/A
30-34	205.00	236.00	N/A	N/A
35-39	242.00	278.00	N/A	N/A
40-44	285.00	328.00	N/A	N/A
45-49	345.00	396.00	N/A	N/A
50-54	410.00	472.00	N/A	N/A
55-59	481.00	554.00	N/A	N/A
60+	564.00	649.00	N/A	N/A
Child	154.00	177.00	N/A	N/A
Age	Deductible : 3500
0-24	123.00	141.00	N/A	N/A
25-29	141.00	162.00	N/A	N/A
30-34	164.00	188.00	N/A	N/A
35-39	193.00	222.00	N/A	N/A
40-44	227.00	261.00	N/A	N/A
45-49	275.00	316.00	N/A	N/A
50-54	327.00	376.00	N/A	N/A
55-59	384.00	441.00	N/A	N/A
60+	450.00	517.00	N/A	N/A
Child	123.00	141.00	N/A	N/A
Age	Deductible : 4000
0-24	N/A	N/A	154.00	177.00
25-29	N/A	N/A	177.00	203.00
30-34	N/A	N/A	205.00	236.00
35-39	N/A	N/A	242.00	278.00
40-44	N/A	N/A	285.00	328.00
45-49	N/A	N/A	345.00	396.00
50-54	N/A	N/A	410.00	472.00
55-59	N/A	N/A	481.00	554.00
60+	N/A	N/A	564.00	649.00
Child	N/A	N/A	154.00	177.00
Age	Deductible : 7000
0-24	N/A	N/A	123.00	141.00
25-29	N/A	N/A	141.00	162.00
30-34	N/A	N/A	164.00	188.00
35-39	N/A	N/A	193.00	222.00
40-44	N/A	N/A	227.00	261.00
45-49	N/A	N/A	275.00	316.00
50-54	N/A	N/A	327.00	376.00
55-59	N/A	N/A	384.00	441.00
60+	N/A	N/A	450.00	517.00
Child	N/A	N/A	123.00	141.00

* - not all of the zip codes are eligible in this county

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