Index | Exclusions & Limitations | Locate Providers | Brochure & Application
Plan Benefits:
Evolve Core | Evolve Plus | Evolve HSA 50 | Evolve HSA 80 | Evolve HSA 100
Plan Rates:
Evolve Core | Evolve Plus | Evolve HSA 50 | Evolve HSA 80 | Evolve HSA 100
Evolve HSA 50 Rates
Effective date : 7/1/2010
Valid thru : 9/30/2010
Counties : Available in all counties

Family Status :	Applicant	Applicant and Family
Age	Deductible : 1500
0-24	64.00	N/A
25	99.00	N/A
26	103.00	N/A
27	106.00	N/A
28	107.00	N/A
29	110.00	N/A
30	113.00	N/A
31	115.00	N/A
32	117.00	N/A
33	118.00	N/A
34	120.00	N/A
35	121.00	N/A
36	127.00	N/A
37	135.00	N/A
38	141.00	N/A
39	149.00	N/A
40	155.00	N/A
41	162.00	N/A
42	166.00	N/A
43	172.00	N/A
44	177.00	N/A
45	183.00	N/A
46	190.00	N/A
47	196.00	N/A
48	200.00	N/A
49	207.00	N/A
50	213.00	N/A
51	222.00	N/A
52	230.00	N/A
53	239.00	N/A
54	247.00	N/A
55	256.00	N/A
56	264.00	N/A
57	272.00	N/A
58	280.00	N/A
59	287.00	N/A
60	295.00	N/A
61	303.00	N/A
62	311.00	N/A
63	319.00	N/A
64	326.00	N/A
65+	334.00	N/A
Child	64.00	N/A
Age	Deductible : 3000
0-24	N/A	64.00
25	N/A	99.00
26	N/A	103.00
27	N/A	106.00
28	N/A	107.00
29	N/A	110.00
30	N/A	113.00
31	N/A	115.00
32	N/A	117.00
33	N/A	118.00
34	N/A	120.00
35	N/A	121.00
36	N/A	127.00
37	N/A	135.00
38	N/A	141.00
39	N/A	149.00
40	N/A	155.00
41	N/A	162.00
42	N/A	166.00
43	N/A	172.00
44	N/A	177.00
45	N/A	183.00
46	N/A	190.00
47	N/A	196.00
48	N/A	200.00
49	N/A	207.00
50	N/A	213.00
51	N/A	222.00
52	N/A	230.00
53	N/A	239.00
54	N/A	247.00
55	N/A	256.00
56	N/A	264.00
57	N/A	272.00
58	N/A	280.00
59	N/A	287.00
60	N/A	295.00
61	N/A	303.00
62	N/A	311.00
63	N/A	319.00
64	N/A	326.00
65+	N/A	334.00
Child	N/A	64.00
Age	Deductible : 3500
0-24	48.00	N/A
25	75.00	N/A
26	77.00	N/A
27	80.00	N/A
28	81.00	N/A
29	83.00	N/A
30	85.00	N/A
31	87.00	N/A
32	88.00	N/A
33	89.00	N/A
34	90.00	N/A
35	91.00	N/A
36	96.00	N/A
37	102.00	N/A
38	106.00	N/A
39	112.00	N/A
40	117.00	N/A
41	122.00	N/A
42	125.00	N/A
43	130.00	N/A
44	133.00	N/A
45	138.00	N/A
46	143.00	N/A
47	147.00	N/A
48	151.00	N/A
49	156.00	N/A
50	160.00	N/A
51	167.00	N/A
52	173.00	N/A
53	180.00	N/A
54	186.00	N/A
55	193.00	N/A
56	199.00	N/A
57	205.00	N/A
58	211.00	N/A
59	216.00	N/A
60	222.00	N/A
61	228.00	N/A
62	234.00	N/A
63	240.00	N/A
64	246.00	N/A
65+	252.00	N/A
Child	48.00	N/A
Age	Deductible : 7000
0-24	N/A	48.00
25	N/A	75.00
26	N/A	77.00
27	N/A	80.00
28	N/A	81.00
29	N/A	83.00
30	N/A	85.00
31	N/A	87.00
32	N/A	88.00
33	N/A	89.00
34	N/A	90.00
35	N/A	91.00
36	N/A	96.00
37	N/A	102.00
38	N/A	106.00
39	N/A	112.00
40	N/A	117.00
41	N/A	122.00
42	N/A	125.00
43	N/A	130.00
44	N/A	133.00
45	N/A	138.00
46	N/A	143.00
47	N/A	147.00
48	N/A	151.00
49	N/A	156.00
50	N/A	160.00
51	N/A	167.00
52	N/A	173.00
53	N/A	180.00
54	N/A	186.00
55	N/A	193.00
56	N/A	199.00
57	N/A	205.00
58	N/A	211.00
59	N/A	216.00
60	N/A	222.00
61	N/A	228.00
62	N/A	234.00
63	N/A	240.00
64	N/A	246.00
65+	N/A	252.00
Child	N/A	48.00

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