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Application
Plan Benefits:
Optimum Plan | Value
Plan | Prime Plan | HSA Plan
Plan Rates:
Optimum Plan | Value
Plan | Prime Plan | HSA Plan
Value Plan Rates
Effective date : 11/1/2009
Valid thru : 10/31/2010
Counties :
Benton,
Clackamas,
Columbia,
Crook,
Deschutes,
Grant,
Harney,
Jefferson,
Klamath,
Lane,
Linn,
Marion,
Multnomah,
Polk,
Washington,
Wheeler,
Yamhill
| Family Status : |
Applicant |
Applicant and Spouse |
Applicant and Child(ren) |
Applicant and Family |
| Age |
Deductible : 1000 |
| 1-17 |
112.00 |
N/A |
N/A |
N/A |
| 18-20 |
145.00 |
290.00 |
218.00 |
408.00 |
| 21-24 |
174.00 |
349.00 |
261.00 |
488.00 |
| 25-29 |
188.00 |
376.00 |
282.00 |
556.00 |
| 30-34 |
214.00 |
428.00 |
321.00 |
642.00 |
| 35-39 |
229.00 |
458.00 |
344.00 |
676.00 |
| 40-44 |
292.00 |
584.00 |
438.00 |
848.00 |
| 45-49 |
344.00 |
689.00 |
517.00 |
862.00 |
| 50-54 |
400.00 |
800.00 |
600.00 |
921.00 |
| 55-59 |
481.00 |
964.00 |
723.00 |
1108.00 |
| 60-64 |
552.00 |
1105.00 |
829.00 |
1216.00 |
| Age |
Deductible : 2500 |
| 1-17 |
92.00 |
N/A |
N/A |
N/A |
| 18-20 |
120.00 |
240.00 |
180.00 |
336.00 |
| 21-24 |
144.00 |
287.00 |
216.00 |
402.00 |
| 25-29 |
155.00 |
311.00 |
233.00 |
458.00 |
| 30-34 |
176.00 |
353.00 |
265.00 |
530.00 |
| 35-39 |
188.00 |
378.00 |
283.00 |
558.00 |
| 40-44 |
241.00 |
482.00 |
361.00 |
699.00 |
| 45-49 |
284.00 |
569.00 |
427.00 |
712.00 |
| 50-54 |
330.00 |
661.00 |
495.00 |
760.00 |
| 55-59 |
397.00 |
795.00 |
596.00 |
915.00 |
| 60-64 |
456.00 |
912.00 |
683.00 |
1003.00 |
| Age |
Deductible : 5000 |
| 1-17 |
75.00 |
N/A |
N/A |
N/A |
| 18-20 |
98.00 |
196.00 |
147.00 |
275.00 |
| 21-24 |
118.00 |
236.00 |
177.00 |
331.00 |
| 25-29 |
127.00 |
255.00 |
190.00 |
376.00 |
| 30-34 |
145.00 |
289.00 |
217.00 |
435.00 |
| 35-39 |
155.00 |
310.00 |
232.00 |
457.00 |
| 40-44 |
197.00 |
395.00 |
296.00 |
573.00 |
| 45-49 |
233.00 |
466.00 |
350.00 |
583.00 |
| 50-54 |
271.00 |
542.00 |
407.00 |
623.00 |
| 55-59 |
326.00 |
652.00 |
488.00 |
750.00 |
| 60-64 |
373.00 |
748.00 |
561.00 |
823.00 |
| Age |
Deductible : 7500 |
| 1-17 |
63.00 |
N/A |
N/A |
N/A |
| 18-20 |
82.00 |
164.00 |
123.00 |
231.00 |
| 21-24 |
98.00 |
197.00 |
148.00 |
276.00 |
| 25-29 |
107.00 |
213.00 |
159.00 |
315.00 |
| 30-34 |
121.00 |
242.00 |
181.00 |
363.00 |
| 35-39 |
129.00 |
259.00 |
194.00 |
382.00 |
| 40-44 |
165.00 |
331.00 |
248.00 |
479.00 |
| 45-49 |
194.00 |
390.00 |
292.00 |
487.00 |
| 50-54 |
227.00 |
453.00 |
340.00 |
522.00 |
| 55-59 |
272.00 |
545.00 |
409.00 |
627.00 |
| 60-64 |
313.00 |
626.00 |
469.00 |
688.00 |
Value Plan 1000 Rates
Effective date : 11/1/2008
Valid thru : 10/31/2009
Counties :
Benton,
Clackamas,
Columbia,
Crook,
Deschutes,
Grant,
Harney,
Jefferson,
Klamath,
Lane,
Linn,
Marion,
Multnomah,
Polk,
Washington,
Wheeler,
Yamhill
| Family Status : |
Applicant |
Applicant and Spouse |
Applicant and Child(ren) |
Applicant and Family |
| Age |
Deductible : 1000 |
| 1-17 |
96.00 |
N/A |
N/A |
N/A |
| 18-20 |
125.00 |
250.00 |
187.00 |
350.00 |
| 21-24 |
149.00 |
300.00 |
225.00 |
419.00 |
| 25-29 |
162.00 |
323.00 |
242.00 |
447.00 |
| 30-34 |
184.00 |
367.00 |
276.00 |
550.00 |
| 35-39 |
197.00 |
393.00 |
295.00 |
579.00 |
| 40-44 |
251.00 |
501.00 |
376.00 |
727.00 |
| 45-49 |
296.00 |
591.00 |
443.00 |
739.00 |
| 50-54 |
343.00 |
686.00 |
515.00 |
789.00 |
| 55-59 |
413.00 |
826.00 |
620.00 |
950.00 |
| 60-64 |
473.00 |
947.00 |
710.00 |
1042.00 |
Value Plan 2500 Rates
Effective date : 11/1/2008
Valid thru : 10/31/2009
Counties :
Benton,
Clackamas,
Columbia,
Crook,
Deschutes,
Grant,
Harney,
Jefferson,
Klamath,
Lane,
Linn,
Marion,
Multnomah,
Polk,
Washington,
Wheeler,
Yamhill
| Family Status : |
Applicant |
Applicant and Spouse |
Applicant and Child(ren) |
Applicant and Family |
| Age |
Deductible : 2500 |
| 1-17 |
79.00 |
N/A |
N/A |
N/A |
| 18-20 |
103.00 |
206.00 |
154.00 |
288.00 |
| 21-24 |
123.00 |
247.00 |
185.00 |
346.00 |
| 25-29 |
133.00 |
267.00 |
199.00 |
393.00 |
| 30-34 |
151.00 |
303.00 |
227.00 |
455.00 |
| 35-39 |
162.00 |
324.00 |
243.00 |
478.00 |
| 40-44 |
207.00 |
413.00 |
310.00 |
599.00 |
| 45-49 |
244.00 |
488.00 |
366.00 |
610.00 |
| 50-54 |
283.00 |
567.00 |
425.00 |
652.00 |
| 55-59 |
341.00 |
681.00 |
512.00 |
785.00 |
| 60-64 |
391.00 |
782.00 |
586.00 |
860.00 |
Value Plan 5000 Rates
Effective date : 11/1/2008
Valid thru : 10/31/2009
Counties :
Benton,
Clackamas,
Columbia,
Crook,
Deschutes,
Grant,
Harney,
Jefferson,
Klamath,
Lane,
Linn,
Marion,
Multnomah,
Polk,
Washington,
Wheeler,
Yamhill
| Family Status : |
Applicant |
Applicant and Spouse |
Applicant and Child(ren) |
Applicant and Family |
| Age |
Deductible : 5000 |
| 1-17 |
66.00 |
N/A |
N/A |
N/A |
| 18-20 |
85.00 |
169.00 |
126.00 |
236.00 |
| 21-24 |
101.00 |
202.00 |
152.00 |
283.00 |
| 25-29 |
109.00 |
219.00 |
164.00 |
323.00 |
| 30-34 |
124.00 |
249.00 |
186.00 |
373.00 |
| 35-39 |
133.00 |
266.00 |
199.00 |
392.00 |
| 40-44 |
170.00 |
339.00 |
254.00 |
492.00 |
| 45-49 |
200.00 |
400.00 |
300.00 |
500.00 |
| 50-54 |
232.00 |
465.00 |
349.00 |
535.00 |
| 55-59 |
279.00 |
559.00 |
419.00 |
643.00 |
| 60-64 |
321.00 |
641.00 |
481.00 |
705.00 |
Value Plan 7500 Rates
Effective date : 11/1/2008
Valid thru : 10/31/2009
Counties :
Benton,
Clackamas,
Columbia,
Crook,
Deschutes,
Grant,
Harney,
Jefferson,
Klamath,
Lane,
Linn,
Marion,
Multnomah,
Polk,
Washington,
Wheeler,
Yamhill
| Family Status : |
Applicant |
Applicant and Spouse |
Applicant and Child(ren) |
Applicant and Family |
| Age |
Deductible : 7500 |
| 1-17 |
55.00 |
N/A |
N/A |
N/A |
| 18-20 |
70.00 |
142.00 |
106.00 |
198.00 |
| 21-24 |
85.00 |
170.00 |
127.00 |
237.00 |
| 25-29 |
92.00 |
183.00 |
137.00 |
270.00 |
| 30-34 |
104.00 |
208.00 |
156.00 |
312.00 |
| 35-39 |
111.00 |
223.00 |
167.00 |
328.00 |
| 40-44 |
142.00 |
283.00 |
213.00 |
412.00 |
| 45-49 |
168.00 |
334.00 |
251.00 |
418.00 |
| 50-54 |
195.00 |
388.00 |
291.00 |
447.00 |
| 55-59 |
234.00 |
467.00 |
351.00 |
538.00 |
| 60-64 |
268.00 |
537.00 |
402.00 |
590.00 |
* - not all of the zip codes are eligible in this county
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