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Regence BlueCross BlueShield - Online Application

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Benefit Schedule
Evolve HSA 50 | Evolve HSA 80 | Evolve HSA 100 | Optional Dental Coverage
Rate Schedule
Evolve HSA 50 | Evolve HSA 80 | Evolve HSA 100


Evolve HSA 100 Rates
Effective date : 3/1/2010
Valid thru : 2/28/2011
Counties : Clark
Family Status : Applicant
Non-Smoker		 Applicant
Smoker		 Family
Non-Smoker		 Family
Smoker
Age Deductible : 5000
0-24 153.00 176.00 N/A N/A
25-29 175.00 202.00 N/A N/A
30-34 204.00 234.00 N/A N/A
35-39 240.00 276.00 N/A N/A
40-44 283.00 325.00 N/A N/A
45-49 342.00 393.00 N/A N/A
50-54 407.00 468.00 N/A N/A
55-59 478.00 549.00 N/A N/A
60+ 560.00 644.00 N/A N/A
Child 153.00 176.00 N/A N/A
Age Deductible : 10000
0-24 N/A N/A 153.00 176.00
25-29 N/A N/A 175.00 202.00
30-34 N/A N/A 204.00 234.00
35-39 N/A N/A 240.00 276.00
40-44 N/A N/A 283.00 325.00
45-49 N/A N/A 342.00 393.00
50-54 N/A N/A 407.00 468.00
55-59 N/A N/A 478.00 549.00
60+ N/A N/A 560.00 644.00
Child N/A N/A 153.00 176.00



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