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 Core Rates
Effective date : 7/1/2010
Valid thru : 9/30/2010
Counties : Available in all counties

Family Status :	Applicant
Age	Deductible : 1000
0-24	100.00
25	156.00
26	161.00
27	166.00
28	168.00
29	173.00
30	178.00
31	180.00
32	183.00
33	185.00
34	188.00
35	190.00
36	200.00
37	212.00
38	222.00
39	234.00
40	244.00
41	253.00
42	261.00
43	270.00
44	278.00
45	288.00
46	297.00
47	307.00
48	314.00
49	324.00
50	334.00
51	348.00
52	361.00
53	375.00
54	387.00
55	402.00
56	414.00
57	426.00
58	439.00
59	451.00
60	463.00
61	475.00
62	487.00
63	500.00
64	512.00
65+	524.00
Child	100.00
Age	Deductible : 2500
0-24	76.00
25	119.00
26	123.00
27	127.00
28	128.00
29	132.00
30	136.00
31	138.00
32	140.00
33	142.00
34	143.00
35	145.00
36	153.00
37	162.00
38	169.00
39	179.00
40	186.00
41	194.00
42	199.00
43	207.00
44	212.00
45	220.00
46	227.00
47	235.00
48	240.00
49	248.00
50	255.00
51	266.00
52	276.00
53	287.00
54	296.00
55	307.00
56	317.00
57	326.00
58	335.00
59	344.00
60	354.00
61	363.00
62	372.00
63	382.00
64	391.00
65+	400.00
Child	76.00
Age	Deductible : 5000
0-24	59.00
25	91.00
26	94.00
27	97.00
28	99.00
29	101.00
30	104.00
31	106.00
32	107.00
33	108.00
34	110.00
35	111.00
36	117.00
37	124.00
38	130.00
39	137.00
40	143.00
41	148.00
42	153.00
43	158.00
44	163.00
45	168.00
46	174.00
47	180.00
48	184.00
49	190.00
50	196.00
51	204.00
52	211.00
53	220.00
54	227.00
55	236.00
56	243.00
57	250.00
58	257.00
59	264.00
60	271.00
61	278.00
62	286.00
63	293.00
64	300.00
65+	307.00
Child	59.00
Age	Deductible : 7500
0-24	41.00
25	65.00
26	67.00
27	69.00
28	70.00
29	72.00
30	74.00
31	75.00
32	76.00
33	77.00
34	78.00
35	79.00
36	83.00
37	88.00
38	92.00
39	97.00
40	101.00
41	105.00
42	108.00
43	112.00
44	115.00
45	119.00
46	123.00
47	127.00
48	130.00
49	135.00
50	139.00
51	145.00
52	150.00
53	156.00
54	161.00
55	167.00
56	172.00
57	177.00
58	182.00
59	187.00
60	192.00
61	197.00
62	202.00
63	207.00
64	212.00
65+	217.00
Child	41.00
Age	Deductible : 10000
0-24	31.00
25	49.00
26	50.00
27	52.00
28	53.00
29	54.00
30	56.00
31	57.00
32	57.00
33	58.00
34	59.00
35	60.00
36	63.00
37	66.00
38	69.00
39	73.00
40	76.00
41	79.00
42	82.00
43	85.00
44	87.00
45	90.00
46	93.00
47	96.00
48	99.00
49	102.00
50	105.00
51	109.00
52	113.00
53	118.00
54	121.00
55	126.00
56	130.00
57	134.00
58	137.00
59	141.00
60	145.00
61	149.00
62	153.00
63	157.00
64	160.00
65+	164.00
Child	31.00

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