|
HDHP 2600 with Rx Rates
Effective date : 10/1/2008
Valid thru : 9/30/2009
Counties :
Columbia,
Multnomah,
Polk,
Washington,
Yamhill,
Benton*,
Clackamas*,
Hood River*,
Linn*,
Marion*
| Family Status : |
Applicant |
Applicant and Spouse |
Applicant and Child(ren) |
Applicant and Family |
| Age |
Deductible : 2600 |
| 0-19 |
98.00 |
N/A |
N/A |
N/A |
| 20-25 |
117.00 |
N/A |
N/A |
N/A |
| 26-29 |
142.00 |
N/A |
N/A |
N/A |
| 30-34 |
181.00 |
N/A |
N/A |
N/A |
| 35-39 |
198.00 |
N/A |
N/A |
N/A |
| 40-44 |
246.00 |
N/A |
N/A |
N/A |
| 45-49 |
264.00 |
N/A |
N/A |
N/A |
| 50-54 |
343.00 |
N/A |
N/A |
N/A |
| 55-59 |
426.00 |
N/A |
N/A |
N/A |
| 60-64 |
466.00 |
N/A |
N/A |
N/A |
| 65 |
556.00 |
N/A |
N/A |
N/A |
| Age |
Deductible : 5200 |
| 0-19 |
N/A |
N/A |
N/A |
N/A |
| 20-25 |
N/A |
234.00 |
211.00 |
351.00 |
| 26-29 |
N/A |
284.00 |
256.00 |
426.00 |
| 30-34 |
N/A |
362.00 |
326.00 |
543.00 |
| 35-39 |
N/A |
396.00 |
356.00 |
594.00 |
| 40-44 |
N/A |
492.00 |
443.00 |
738.00 |
| 45-49 |
N/A |
528.00 |
475.00 |
792.00 |
| 50-54 |
N/A |
686.00 |
617.00 |
1029.00 |
| 55-59 |
N/A |
852.00 |
767.00 |
1278.00 |
| 60-64 |
N/A |
932.00 |
839.00 |
1398.00 |
| 65 |
N/A |
N/A |
N/A |
N/A |
|
|
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