|
Asuris Northwest Health - Online
Application
Index | Optional Dental | Exclusions
& Limitations | Provider
Directory | Download Application
Benefit Schedules:
Emerge Core | Emerge Plus | Emerge HSA 50 | Emerge
HSA 80 | Emerge HSA 100
Rate Schedules:
Emerge Core | Emerge Plus | Emerge HSA 50 | Emerge HSA 80 | Emerge HSA 100
Emerge HSA 50 Rates
Effective date : 10/1/2010
Valid thru : 6/30/2011
Counties :
Adams,
Benton,
Chelan,
Douglas,
Ferry,
Franklin,
Grant,
Kittitas,
Lincoln,
Okanogan,
Pend Oreille,
Spokane,
Stevens,
Whitman
| Family Status : |
Applicant
Non-Smoker |
Applicant
Smoker |
Family
Non-Smoker |
Family
Smoker |
| Age |
Deductible : 2000 |
| 0-24 |
91.00 |
104.00 |
N/A |
N/A |
| 25-29 |
104.00 |
120.00 |
N/A |
N/A |
| 30-34 |
121.00 |
139.00 |
N/A |
N/A |
| 35-39 |
143.00 |
164.00 |
N/A |
N/A |
| 40-44 |
168.00 |
193.00 |
N/A |
N/A |
| 45-49 |
203.00 |
233.00 |
N/A |
N/A |
| 50-54 |
242.00 |
278.00 |
N/A |
N/A |
| 55-59 |
283.00 |
326.00 |
N/A |
N/A |
| 60+ |
332.00 |
382.00 |
N/A |
N/A |
| Child |
91.00 |
91.00 |
N/A |
N/A |
| Age |
Deductible : 3500 |
| 0-24 |
72.00 |
83.00 |
N/A |
N/A |
| 25-29 |
83.00 |
95.00 |
N/A |
N/A |
| 30-34 |
96.00 |
111.00 |
N/A |
N/A |
| 35-39 |
114.00 |
131.00 |
N/A |
N/A |
| 40-44 |
134.00 |
154.00 |
N/A |
N/A |
| 45-49 |
162.00 |
186.00 |
N/A |
N/A |
| 50-54 |
193.00 |
222.00 |
N/A |
N/A |
| 55-59 |
226.00 |
260.00 |
N/A |
N/A |
| 60+ |
265.00 |
305.00 |
N/A |
N/A |
| Child |
72.00 |
72.00 |
N/A |
N/A |
| Age |
Deductible : 4000 |
| 0-24 |
N/A |
N/A |
91.00 |
104.00 |
| 25-29 |
N/A |
N/A |
104.00 |
120.00 |
| 30-34 |
N/A |
N/A |
121.00 |
139.00 |
| 35-39 |
N/A |
N/A |
143.00 |
164.00 |
| 40-44 |
N/A |
N/A |
168.00 |
193.00 |
| 45-49 |
N/A |
N/A |
203.00 |
233.00 |
| 50-54 |
N/A |
N/A |
242.00 |
278.00 |
| 55-59 |
N/A |
N/A |
283.00 |
326.00 |
| 60+ |
N/A |
N/A |
332.00 |
382.00 |
| Child |
N/A |
N/A |
91.00 |
91.00 |
| Age |
Deductible : 7000 |
| 0-24 |
N/A |
N/A |
72.00 |
83.00 |
| 25-29 |
N/A |
N/A |
83.00 |
95.00 |
| 30-34 |
N/A |
N/A |
96.00 |
111.00 |
| 35-39 |
N/A |
N/A |
114.00 |
131.00 |
| 40-44 |
N/A |
N/A |
134.00 |
154.00 |
| 45-49 |
N/A |
N/A |
162.00 |
186.00 |
| 50-54 |
N/A |
N/A |
193.00 |
222.00 |
| 55-59 |
N/A |
N/A |
226.00 |
260.00 |
| 60+ |
N/A |
N/A |
265.00 |
305.00 |
| Child |
N/A |
N/A |
72.00 |
72.00 |
* - not all of the zip codes are eligible in this county
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Assurant Health
