Regence BlueShield RATE SCHEDULE Plan Information Plan ......Individual Nongrandfathered Health Plan 87718WA2190002 Plan Information Plan Name: Regence Cascade Silver Individual and

Individual Nongrandfathered Health Plan 87718WA2190001

Plan Information

Plan Name: Regence Cascade Gold Individual and Family Network

HIOS Plan ID: 87718WA2190001

Effective Date: 1/1/2021

Market Type: Individual

Exchange Status: Inside the Exchange

Metal Level: Gold

Plan Type: Standardized Non-Public Option Plan

Plan Geographic Availability

Area

Number

Available

in area?

1 Yes

2 Yes

3 Yes

4 N/A

5 Yes

6 Yes

7 N/A

8 Yes

9 N/A

Plan Rates

Age

Band Area 1 Area 2 Area 3 Area 4 Area 5 Area 6 Area 7 Area 8 Area 9 Area 1 Area 2 Area 3 Area 4 Area 5 Area 6 Area 7 Area 8 Area 9

0-14 334.11 373.87 362.18 345.47 351.82 346.81 334.11 373.87 362.18 345.47 351.82 346.81

15 363.81 407.11 394.37 376.18 383.09 377.64 363.81 407.11 394.37 376.18 383.09 377.64

16 375.17 419.81 406.68 387.92 395.05 389.42 375.17 419.81 406.68 387.92 395.05 389.42

17 386.52 432.52 418.99 399.67 407.01 401.21 386.52 432.52 418.99 399.67 407.01 401.21

18 398.75 446.20 432.25 412.31 419.89 413.91 398.75 446.20 432.25 412.31 419.89 413.91

19 410.98 459.89 445.50 424.96 432.76 426.60 410.98 459.89 445.50 424.96 432.76 426.60

20 423.65 474.06 459.23 438.05 446.10 439.75 423.65 474.06 459.23 438.05 446.10 439.75

21 436.75 488.72 473.44 451.60 459.90 453.35 502.26 562.03 544.45 519.34 528.88 521.35

22 436.75 488.72 473.44 451.60 459.90 453.35 502.26 562.03 544.45 519.34 528.88 521.35

23 436.75 488.72 473.44 451.60 459.90 453.35 502.26 562.03 544.45 519.34 528.88 521.35

24 436.75 488.72 473.44 451.60 459.90 453.35 502.26 562.03 544.45 519.34 528.88 521.35

25 438.50 490.68 475.33 453.41 461.74 455.16 504.27 564.28 546.63 521.42 531.00 523.43

26 447.23 500.45 484.80 462.44 470.94 464.23 514.32 575.52 557.52 531.80 541.58 533.86

27 457.71 512.18 496.16 473.28 481.97 475.11 526.37 589.01 570.59 544.27 554.27 546.37

28 474.75 531.24 514.63 490.89 499.91 492.79 545.96 610.93 591.82 564.52 574.90 566.71

29 488.72 546.88 529.78 505.34 514.63 507.29 562.03 628.91 609.24 581.14 591.82 583.39

30 495.71 554.70 537.35 512.57 521.98 514.55 570.07 637.91 617.95 589.45 600.28 591.73

31 506.19 566.43 548.71 523.40 533.02 525.43 582.12 651.39 631.02 601.91 612.97 604.24

32 516.68 578.16 560.08 534.24 544.06 536.31 594.18 664.88 644.09 614.38 625.67 616.76

33 523.23 585.49 567.18 541.02 550.96 543.11 601.71 673.31 652.25 622.17 633.60 624.58

34 530.21 593.31 574.75 548.24 558.32 550.36 609.75 682.31 660.97 630.48 642.06 632.92

35 533.71 597.22 578.54 551.85 562.00 553.99 613.76 686.80 665.32 634.63 646.29 637.09

36 537.20 601.13 582.33 555.47 565.67 557.62 617.78 691.30 669.68 638.79 650.53 641.26

37 540.70 605.04 586.12 559.08 569.35 561.24 621.80 695.80 674.03 642.94 654.76 645.43

38 544.19 608.95 589.90 562.69 573.03 564.87 625.82 700.29 678.39 647.10 658.99 649.60

39 551.18 616.77 597.48 569.92 580.39 572.12 633.86 709.28 687.10 655.41 667.45 657.94

40 558.17 624.59 605.05 577.14 587.75 579.38 641.89 718.28 695.81 663.72 675.91 666.28

41 568.65 636.32 616.41 587.98 598.79 590.26 653.95 731.77 708.88 676.18 688.60 678.80

42 578.69 647.56 627.30 598.37 609.36 600.68 665.50 744.69 721.40 688.12 700.77 690.79

43 592.67 663.20 642.45 612.82 624.08 615.19 681.57 762.68 738.82 704.74 717.69 707.47

44 610.14 682.75 661.39 630.88 642.48 633.33 701.66 785.16 760.60 725.52 738.85 728.32

45 630.67 705.72 683.64 652.11 664.09 654.63 725.27 811.57 786.19 749.93 763.71 752.83

46 655.13 733.08 710.16 677.40 689.85 680.02 753.39 843.05 816.68 779.01 793.32 782.02

47 682.64 763.87 739.98 705.85 718.82 708.58 785.04 878.46 850.98 811.73 826.64 814.87

48 714.09 799.06 774.07 738.37 751.93 741.22 821.20 918.92 890.18 849.12 864.72 852.40

49 745.10 833.76 807.68 770.43 784.59 773.41 856.86 958.83 928.84 885.99 902.27 889.42

50 780.04 872.86 845.56 806.56 821.38 809.68 897.04 1003.79 972.39 927.54 944.58 931.13

51 814.54 911.47 882.96 842.23 857.71 845.49 936.72 1048.19 1015.40 968.57 986.37 972.31

52 852.54 953.99 924.15 881.52 897.72 884.93 980.42 1097.09 1062.77 1013.75 1032.38 1017.67

53 890.97 997.00 965.81 921.26 938.19 924.83 1024.62 1146.54 1110.68 1059.45 1078.92 1063.55

54 932.46 1043.42 1010.79 964.16 981.88 967.89 1072.33 1199.94 1162.41 1108.79 1129.16 1113.08

55 973.95 1089.85 1055.76 1007.07 1025.57 1010.96 1120.05 1253.33 1214.13 1158.13 1179.41 1162.61

56 1018.94 1140.19 1104.53 1053.58 1072.94 1057.66 1171.78 1311.22 1270.21 1211.62 1233.88 1216.31

57 1064.36 1191.02 1153.77 1100.55 1120.77 1104.81 1224.01 1369.67 1326.83 1265.63 1288.89 1270.53

58 1112.84 1245.27 1206.32 1150.68 1171.82 1155.13 1279.76 1432.06 1387.27 1323.28 1347.59 1328.40

59 1136.86 1272.15 1232.36 1175.51 1197.11 1180.06 1307.39 1462.97 1417.21 1351.84 1376.68 1357.07

60 1185.34 1326.39 1284.91 1225.64 1248.16 1230.38 1363.14 1525.35 1477.64 1409.49 1435.39 1414.94

61 1227.27 1373.31 1330.36 1268.99 1292.31 1273.90 1411.36 1579.31 1529.91 1459.34 1486.16 1464.99

62 1254.78 1404.10 1360.18 1297.45 1321.29 1302.46 1443.00 1614.72 1564.21 1492.06 1519.48 1497.83

63 1289.29 1442.71 1397.59 1333.12 1357.62 1338.28 1482.68 1659.12 1607.22 1533.09 1561.26 1539.02

64 and over 1310.25 1466.16 1420.31 1354.80 1379.69 1360.04 1506.78 1686.09 1633.35 1558.02 1586.64 1564.05

Non-Smoker Rates Smoker Rates

Mason, Pierce, Thurston

Yakima

Island, San Juan, Skagit, Snohomish, Whatcom

Regence BlueShield

RATE SCHEDULE

Counties where this plan is available

King

Clallam, Cowlitz, Grays Harbor, Jefferson, Kitsap, Lewis, Pacific, Wahkiakum

Klickitat, Skamania

Page 1 of 12


Plan Information

Plan Name: Regence Cascade Silver Individual and Family Network





Metal Level: Silver



Area

Number

Available

in area?

1 Yes

2 Yes

3 Yes

4 N/A

5 Yes

6 Yes

7 N/A

8 Yes

9 N/A

Plan Rates

Age


0-14 284.53 318.39 308.43 294.20 299.61 295.34 284.53 318.39 308.43 294.20 299.61 295.34

15 309.82 346.69 335.84 320.35 326.24 321.59 309.82 346.69 335.84 320.35 326.24 321.59

16 319.49 357.51 346.32 330.35 336.42 331.63 319.49 357.51 346.32 330.35 336.42 331.63

17 329.16 368.33 356.81 340.35 346.60 341.67 329.16 368.33 356.81 340.35 346.60 341.67

18 339.57 379.98 368.10 351.12 357.57 352.48 339.57 379.98 368.10 351.12 357.57 352.48

19 349.99 391.63 379.38 361.89 368.54 363.29 349.99 391.63 379.38 361.89 368.54 363.29

20 360.77 403.70 391.08 373.04 379.89 374.48 360.77 403.70 391.08 373.04 379.89 374.48

21 371.93 416.19 403.17 384.58 391.64 386.06 427.72 478.62 463.65 442.26 450.39 443.97

22 371.93 416.19 403.17 384.58 391.64 386.06 427.72 478.62 463.65 442.26 450.39 443.97

23 371.93 416.19 403.17 384.58 391.64 386.06 427.72 478.62 463.65 442.26 450.39 443.97

24 371.93 416.19 403.17 384.58 391.64 386.06 427.72 478.62 463.65 442.26 450.39 443.97

25 373.42 417.85 404.78 386.11 393.21 387.61 429.43 480.53 465.50 444.03 452.19 445.75

26 380.86 426.18 412.85 393.81 401.04 395.33 437.98 490.10 474.78 452.88 461.20 454.63

27 389.78 436.17 422.52 403.04 410.44 404.59 448.25 501.59 485.90 463.49 472.01 465.28

28 404.29 452.40 438.25 418.03 425.72 419.65 464.93 520.26 503.99 480.74 489.57 482.60

29 416.19 465.72 451.15 430.34 438.25 432.00 478.62 535.57 518.82 494.89 503.98 496.81

30 422.14 472.38 457.60 436.49 444.51 438.18 485.46 543.23 526.24 501.97 511.19 503.91

31 431.07 482.36 467.28 445.72 453.91 447.45 495.73 554.72 537.37 512.58 522.00 514.56

32 439.99 492.35 476.95 454.95 463.31 456.71 505.99 566.21 548.50 523.20 532.81 525.22

33 445.57 498.60 483.00 460.72 469.19 462.50 512.41 573.38 555.45 529.83 539.57 531.88

34 451.52 505.25 489.45 466.87 475.45 468.68 519.25 581.04 562.87 536.91 546.77 538.98

35 454.50 508.58 492.68 469.95 478.59 471.77 522.67 584.87 566.58 540.44 550.37 542.53

36 457.47 511.91 495.90 473.03 481.72 474.86 526.09 588.70 570.29 543.98 553.98 546.09

37 460.45 515.24 499.13 476.10 484.85 477.95 529.52 592.53 574.00 547.52 557.58 549.64

38 463.42 518.57 502.35 479.18 487.99 481.03 532.94 596.36 577.71 551.06 561.18 553.19

39 469.38 525.23 508.80 485.33 494.25 487.21 539.78 604.02 585.12 558.13 568.39 560.29

40 475.33 531.89 515.25 491.49 500.52 493.39 546.63 611.67 592.54 565.21 575.60 567.40

41 484.25 541.88 524.93 500.72 509.92 502.65 556.89 623.16 603.67 575.83 586.41 578.05

42 492.81 551.45 534.20 509.56 518.93 511.53 566.73 634.17 614.33 586.00 596.76 588.26

43 504.71 564.77 547.10 521.87 531.46 523.89 580.42 649.48 629.17 600.15 611.18 602.47

44 519.59 581.42 563.23 537.25 547.12 539.33 597.52 668.63 647.72 617.84 629.19 620.23

45 537.07 600.98 582.18 555.33 565.53 557.48 617.63 691.12 669.51 638.63 650.36 641.10

46 557.90 624.28 604.76 576.86 587.46 579.10 641.58 717.93 695.47 663.39 675.58 665.96

47 581.33 650.50 630.16 601.09 612.14 603.42 668.53 748.08 724.68 691.26 703.96 693.93

48 608.11 680.47 659.19 628.78 640.34 631.21 699.32 782.54 758.06 723.10 736.39 725.90

49 634.51 710.02 687.81 656.09 668.14 658.62 729.69 816.52 790.98 754.50 768.36 757.42

50 664.27 743.31 720.07 686.85 699.47 689.51 763.91 854.81 828.08 789.88 804.39 792.94

51 693.65 776.19 751.92 717.23 730.41 720.01 797.70 892.62 864.70 824.82 839.97 828.01

52 726.01 812.40 786.99 750.69 764.49 753.60 834.91 934.26 905.04 863.30 879.16 866.63

53 758.74 849.03 822.47 784.53 798.95 787.57 872.55 976.38 945.84 902.21 918.79 905.70

54 794.07 888.56 860.77 821.07 836.16 824.25 913.18 1021.85 989.89 944.23 961.58 947.88

55 829.40 928.10 899.07 857.60 873.36 860.92 953.81 1067.32 1033.93 986.24 1004.37 990.06

56 867.71 970.97 940.60 897.21 913.70 900.69 997.87 1116.62 1081.69 1031.80 1050.76 1035.79

57 906.39 1014.25 982.53 937.21 954.43 940.84 1042.35 1166.39 1129.91 1077.79 1097.60 1081.96

58 947.68 1060.45 1027.28 979.90 997.90 983.69 1089.83 1219.52 1181.37 1126.88 1147.59 1131.24

59 968.13 1083.34 1049.46 1001.05 1019.44 1004.92 1113.35 1245.84 1206.88 1151.21 1172.36 1155.66

60 1009.42 1129.54 1094.21 1043.74 1062.92 1047.78 1160.83 1298.97 1258.34 1200.30 1222.35 1204.94

61 1045.12 1169.49 1132.91 1080.66 1100.51 1084.84 1201.89 1344.92 1302.85 1242.76 1265.59 1247.56

62 1068.55 1195.71 1158.31 1104.89 1125.19 1109.16 1228.84 1375.07 1332.06 1270.62 1293.97 1275.53

63 1097.94 1228.59 1190.16 1135.27 1156.13 1139.66 1262.63 1412.88 1368.69 1305.56 1329.55 1310.61

64 and over 1115.79 1248.57 1209.51 1153.73 1174.92 1158.18 1283.16 1435.85 1390.94 1326.78 1351.17 1331.91



Yakima


Regence BlueShield

RATE SCHEDULE


King


Klickitat, Skamania

Page 2 of 12


Plan Information

Plan Name: Silver 3000 Exchange EPO Individual and Family Network





Metal Level: Silver

Plan Type: Non-Standardized Plan


Area

Number

Available

in area?

1 Yes

2 Yes

3 Yes

4 N/A

5 Yes

6 Yes

7 N/A

8 Yes

9 N/A

Plan Rates

Age


0-14 274.35 307.00 297.40 283.68 288.89 284.78 274.35 307.00 297.40 283.68 288.89 284.78

15 298.74 334.29 323.83 308.90 314.57 310.09 298.74 334.29 323.83 308.90 314.57 310.09

16 308.06 344.72 333.94 318.54 324.39 319.77 308.06 344.72 333.94 318.54 324.39 319.77

17 317.39 355.16 344.05 328.18 334.21 329.45 317.39 355.16 344.05 328.18 334.21 329.45

18 327.43 366.39 354.93 338.56 344.78 339.87 327.43 366.39 354.93 338.56 344.78 339.87

19 337.47 377.63 365.82 348.94 355.36 350.29 337.47 377.63 365.82 348.94 355.36 350.29

20 347.87 389.27 377.09 359.70 366.31 361.09 347.87 389.27 377.09 359.70 366.31 361.09

21 358.63 401.31 388.75 370.82 377.64 372.26 412.42 461.50 447.07 426.45 434.28 428.10

22 358.63 401.31 388.75 370.82 377.64 372.26 412.42 461.50 447.07 426.45 434.28 428.10

23 358.63 401.31 388.75 370.82 377.64 372.26 412.42 461.50 447.07 426.45 434.28 428.10

24 358.63 401.31 388.75 370.82 377.64 372.26 412.42 461.50 447.07 426.45 434.28 428.10

25 360.06 402.91 390.31 372.31 379.15 373.75 414.07 463.35 448.86 428.15 436.02 429.81

26 367.24 410.94 398.09 379.72 386.70 381.19 422.32 472.58 457.80 436.68 444.71 438.37

27 375.84 420.57 407.42 388.62 395.76 390.13 432.22 483.66 468.53 446.92 455.13 448.65

28 389.83 436.22 422.58 403.09 410.49 404.64 448.31 501.65 485.96 463.55 472.07 465.34

29 401.31 449.06 435.02 414.95 422.58 416.56 461.50 516.42 500.27 477.19 485.96 479.04

30 407.05 455.48 441.24 420.88 428.62 422.51 468.10 523.81 507.42 484.02 492.91 485.89

31 415.65 465.11 450.57 429.78 437.68 431.45 478.00 534.88 518.15 494.25 503.33 496.16

32 424.26 474.75 459.90 438.68 446.75 440.38 487.90 545.96 528.88 504.49 513.76 506.44

33 429.64 480.77 465.73 444.25 452.41 445.97 494.08 552.88 535.59 510.88 520.27 512.86

34 435.38 487.19 471.95 450.18 458.45 451.92 500.68 560.26 542.74 517.71 527.22 519.71

35 438.25 490.40 475.06 453.15 461.47 454.90 503.98 563.96 546.32 521.12 530.69 523.13

36 441.11 493.61 478.17 456.11 464.49 457.88 507.28 567.65 549.89 524.53 534.17 526.56

37 443.98 496.82 481.28 459.08 467.52 460.86 510.58 571.34 553.47 527.94 537.64 529.98

38 446.85 500.03 484.39 462.05 470.54 463.83 513.88 575.03 557.05 531.35 541.12 533.41

39 452.59 506.45 490.61 467.98 476.58 469.79 520.48 582.42 564.20 538.18 548.07 540.26

40 458.33 512.87 496.83 473.91 482.62 475.75 527.08 589.80 571.35 545.00 555.01 547.11

41 466.94 522.50 506.16 482.81 491.68 484.68 536.98 600.88 582.08 555.23 565.44 557.38

42 475.18 531.73 515.10 491.34 500.37 493.24 546.46 611.49 592.37 565.04 575.42 567.23

43 486.66 544.57 527.54 503.21 512.45 505.15 559.66 626.26 606.67 578.69 589.32 580.93

44 501.01 560.63 543.09 518.04 527.56 520.04 576.16 644.72 624.55 595.75 606.69 598.05

45 517.86 579.49 561.36 535.47 545.31 537.54 595.54 666.41 645.57 615.79 627.10 618.17

46 537.95 601.96 583.13 556.24 566.46 558.39 618.64 692.25 670.60 639.67 651.42 642.14

47 560.54 627.24 607.62 579.60 590.25 581.84 644.62 721.33 698.77 666.54 678.78 669.12

48 586.36 656.14 635.61 606.30 617.44 608.64 674.31 754.56 730.96 697.24 710.05 699.94

49 611.82 684.63 663.22 632.62 644.25 635.07 703.60 787.32 762.70 727.52 740.89 730.33

50 640.51 716.73 694.32 662.29 674.46 664.85 736.59 824.24 798.46 761.63 775.63 764.58

51 668.84 748.44 725.03 691.59 704.29 694.26 769.17 860.70 833.78 795.32 809.94 798.40

52 700.05 783.35 758.85 723.85 737.15 726.65 805.05 900.85 872.68 832.42 847.72 835.64

53 731.61 818.67 793.06 756.48 770.38 759.41 841.35 941.47 912.02 869.95 885.94 873.32

54 765.68 856.79 829.99 791.71 806.26 794.77 880.53 985.31 954.49 910.46 927.19 913.99

55 799.74 894.91 866.92 826.94 842.13 830.14 919.71 1029.15 996.96 950.98 968.45 954.66

56 836.68 936.25 906.97 865.13 881.03 868.48 962.19 1076.69 1043.01 994.90 1013.18 998.75

57 873.98 977.99 947.40 903.70 920.30 907.19 1005.08 1124.68 1089.51 1039.25 1058.35 1043.27

58 913.79 1022.53 990.55 944.86 962.22 948.51 1050.86 1175.91 1139.13 1086.59 1106.55 1090.79

59 933.51 1044.60 1011.93 965.25 982.99 968.99 1073.54 1201.29 1163.72 1110.04 1130.44 1114.34

60 973.32 1089.15 1055.08 1006.41 1024.91 1010.31 1119.32 1252.52 1213.34 1157.38 1178.64 1161.85

61 1007.75 1127.67 1092.40 1042.01 1061.16 1046.04 1158.91 1296.82 1256.26 1198.32 1220.34 1202.95

62 1030.34 1152.95 1116.89 1065.38 1084.95 1069.50 1184.90 1325.90 1284.43 1225.18 1247.70 1229.92

63 1058.68 1184.66 1147.60 1094.67 1114.79 1098.91 1217.48 1362.36 1319.75 1258.87 1282.00 1263.74

64 and over 1075.89 1203.92 1166.25 1112.46 1132.91 1116.77 1237.26 1384.50 1341.20 1279.34 1302.84 1284.29



Yakima


Regence BlueShield

RATE SCHEDULE


King


Klickitat, Skamania

Page 3 of 12


Plan Information

Plan Name: Silver 3000 EPO Individual and Family Network




Exchange Status: Outside the Exchange

Metal Level: Silver



Area

Number

Available

in area?

1 Yes

2 Yes

3 Yes

4 N/A

5 Yes

6 Yes

7 N/A

8 Yes

9 N/A

Plan Rates

Age


0-14 242.89 271.79 263.29 251.15 255.76 252.12 242.89 271.79 263.29 251.15 255.76 252.12

15 264.48 295.95 286.69 273.47 278.49 274.53 264.48 295.95 286.69 273.47 278.49 274.53

16 272.73 305.19 295.64 282.01 287.19 283.10 272.73 305.19 295.64 282.01 287.19 283.10

17 280.99 314.43 304.59 290.54 295.88 291.67 280.99 314.43 304.59 290.54 295.88 291.67

18 289.88 324.37 314.23 299.73 305.24 300.89 289.88 324.37 314.23 299.73 305.24 300.89

19 298.77 334.32 323.86 308.93 314.60 310.12 298.77 334.32 323.86 308.93 314.60 310.12

20 307.98 344.62 333.84 318.45 324.30 319.68 307.98 344.62 333.84 318.45 324.30 319.68

21 317.50 355.28 344.17 328.30 334.33 329.57 365.13 408.57 395.80 377.54 384.48 379.00

22 317.50 355.28 344.17 328.30 334.33 329.57 365.13 408.57 395.80 377.54 384.48 379.00

23 317.50 355.28 344.17 328.30 334.33 329.57 365.13 408.57 395.80 377.54 384.48 379.00

24 317.50 355.28 344.17 328.30 334.33 329.57 365.13 408.57 395.80 377.54 384.48 379.00

25 318.77 356.70 345.55 329.61 335.66 330.88 366.59 410.21 397.38 379.05 386.01 380.52

26 325.12 363.81 352.43 336.17 342.35 337.47 373.89 418.38 405.29 386.60 393.70 388.10

27 332.74 372.34 360.69 344.05 350.38 345.38 382.65 428.19 414.79 395.66 402.93 397.19

28 345.12 386.19 374.11 356.86 363.41 358.24 396.89 444.12 430.23 410.39 417.93 411.97

29 355.28 397.56 385.13 367.36 374.11 368.78 408.57 457.20 442.90 422.47 430.23 424.10

30 360.36 403.25 390.63 372.61 379.46 374.06 414.42 463.73 449.23 428.51 436.38 430.16

31 367.98 411.77 398.89 380.49 387.49 381.97 423.18 473.54 458.73 437.57 445.61 439.26

32 375.60 420.30 407.15 388.37 395.51 389.88 431.94 483.34 468.23 446.63 454.84 448.36

33 380.37 425.63 412.32 393.30 400.52 394.82 437.42 489.47 474.16 452.29 460.60 454.04

34 385.45 431.31 417.82 398.55 405.87 400.09 443.26 496.01 480.50 458.33 466.75 460.11

35 387.99 434.16 420.58 401.18 408.55 402.73 446.18 499.28 483.66 461.35 469.83 463.14

36 390.53 437.00 423.33 403.80 411.22 405.36 449.10 502.55 486.83 464.37 472.91 466.17

37 393.07 439.84 426.08 406.43 413.90 408.00 452.02 505.82 489.99 467.39 475.98 469.20

38 395.61 442.68 428.84 409.06 416.57 410.64 454.95 509.08 493.16 470.41 479.06 472.23

39 400.69 448.37 434.34 414.31 421.92 415.91 460.79 515.62 499.49 476.45 485.21 478.30

40 405.77 454.05 439.85 419.56 427.27 421.18 466.63 522.16 505.83 482.50 491.36 484.36

41 413.39 462.58 448.11 427.44 435.29 429.09 475.39 531.96 515.33 491.56 500.59 493.46

42 420.69 470.75 456.03 434.99 442.98 436.67 483.79 541.36 524.43 500.24 509.43 502.17

43 430.85 482.12 467.04 445.50 453.68 447.22 495.47 554.44 537.09 512.32 521.73 514.30

44 443.55 496.33 480.81 458.63 467.06 460.40 510.08 570.78 552.93 527.42 537.11 529.46

45 458.47 513.03 496.98 474.06 482.77 475.89 527.24 589.98 571.53 545.17 555.18 547.28

46 476.25 532.92 516.26 492.44 501.49 494.35 547.69 612.86 593.69 566.31 576.71 568.50

47 496.25 555.31 537.94 513.13 522.55 515.11 570.69 638.60 618.63 590.09 600.94 592.38

48 519.11 580.89 562.72 536.76 546.63 538.84 596.98 668.02 647.13 617.28 628.62 619.66

49 541.66 606.11 587.15 560.07 570.36 562.24 622.90 697.03 675.23 644.08 655.92 646.57

50 567.06 634.53 614.69 586.33 597.11 588.60 652.11 729.71 706.89 674.29 686.68 676.89

51 592.14 662.60 641.88 612.27 623.52 614.64 680.96 761.99 738.16 704.11 717.05 706.83

52 619.76 693.51 671.82 640.83 652.61 643.31 712.72 797.54 772.59 736.96 750.50 739.81

53 647.70 724.78 702.11 669.72 682.03 672.31 744.86 833.49 807.42 770.18 784.33 773.16

54 677.86 758.53 734.80 700.91 713.79 703.62 779.54 872.31 845.02 806.05 820.86 809.16

55 708.03 792.28 767.50 732.10 745.55 734.93 814.23 911.12 882.62 841.91 857.38 845.17

56 740.73 828.87 802.95 765.91 779.99 768.88 851.84 953.21 923.39 880.80 896.98 884.21

57 773.75 865.82 838.74 800.05 814.76 803.15 889.81 995.70 964.55 920.06 936.97 923.62

58 808.99 905.26 876.95 836.50 851.87 839.73 930.34 1041.05 1008.49 961.97 979.65 965.69

59 826.45 924.80 895.87 854.55 870.25 857.86 950.42 1063.52 1030.26 982.73 1000.79 986.54

60 861.70 964.24 934.08 890.99 907.36 894.44 990.95 1108.87 1074.19 1024.64 1043.47 1028.61

61 892.18 998.34 967.12 922.51 939.46 926.08 1026.00 1148.10 1112.19 1060.89 1080.38 1064.99

62 912.18 1020.73 988.80 943.19 960.52 946.84 1049.00 1173.84 1137.12 1084.67 1104.60 1088.87

63 937.26 1048.79 1015.99 969.13 986.93 972.88 1077.85 1206.11 1168.39 1114.50 1134.97 1118.81

64 and over 952.50 1065.84 1032.51 984.89 1002.98 988.70 1095.38 1225.71 1187.39 1132.62 1153.43 1137.00



Yakima


Regence BlueShield

RATE SCHEDULE


King


Klickitat, Skamania

Page 4 of 12


Plan Information

Plan Name: Silver HDHP 3000 EPO Individual and Family Network





Metal Level: Silver



Area

Number

Available

in area?

1 Yes

2 Yes

3 Yes

4 N/A

5 Yes

6 Yes

7 N/A

8 Yes

9 N/A

Plan Rates

Age


0-14 242.11 270.92 262.44 250.34 254.94 251.31 242.11 270.92 262.44 250.34 254.94 251.31

15 263.63 295.00 285.77 272.59 277.60 273.65 263.63 295.00 285.77 272.59 277.60 273.65

16 271.86 304.21 294.69 281.10 286.26 282.19 271.86 304.21 294.69 281.10 286.26 282.19

17 280.08 313.41 303.61 289.61 294.93 290.73 280.08 313.41 303.61 289.61 294.93 290.73

18 288.95 323.33 313.22 298.77 304.26 299.93 288.95 323.33 313.22 298.77 304.26 299.93

19 297.81 333.25 322.82 307.93 313.59 309.12 297.81 333.25 322.82 307.93 313.59 309.12

20 306.99 343.52 332.77 317.42 323.26 318.65 306.99 343.52 332.77 317.42 323.26 318.65

21 316.48 354.14 343.06 327.24 333.25 328.51 363.95 407.26 394.52 376.33 383.24 377.78

22 316.48 354.14 343.06 327.24 333.25 328.51 363.95 407.26 394.52 376.33 383.24 377.78

23 316.48 354.14 343.06 327.24 333.25 328.51 363.95 407.26 394.52 376.33 383.24 377.78

24 316.48 354.14 343.06 327.24 333.25 328.51 363.95 407.26 394.52 376.33 383.24 377.78

25 317.75 355.56 344.44 328.55 334.59 329.82 365.41 408.89 396.10 377.83 384.77 379.29

26 324.08 362.64 351.30 335.09 341.25 336.39 372.69 417.04 403.99 385.36 392.44 386.85

27 331.67 371.14 359.53 342.95 349.25 344.27 381.42 426.81 413.46 394.39 401.64 395.92

28 344.01 384.95 372.91 355.71 362.25 357.09 395.62 442.69 428.85 409.07 416.58 410.65

29 354.14 396.28 383.89 366.18 372.91 367.60 407.26 455.73 441.47 421.11 428.85 422.74

30 359.20 401.95 389.38 371.42 378.24 372.85 413.09 462.24 447.78 427.13 434.98 428.78

31 366.80 410.45 397.61 379.27 386.24 380.74 421.82 472.02 457.25 436.16 444.18 437.85

32 374.40 418.95 405.85 387.13 394.24 388.62 430.56 481.79 466.72 445.19 453.37 446.92

33 379.14 424.26 410.99 392.03 399.24 393.55 436.01 487.90 472.64 450.84 459.12 452.58

34 384.21 429.93 416.48 397.27 404.57 398.81 441.84 494.42 478.95 456.86 465.26 458.63

35 386.74 432.76 419.22 399.89 407.24 401.43 444.75 497.67 482.11 459.87 468.32 461.65

36 389.27 435.59 421.97 402.51 409.90 404.06 447.66 500.93 485.26 462.88 471.39 464.67

37 391.80 438.43 424.71 405.12 412.57 406.69 450.57 504.19 488.42 465.89 474.45 467.69

38 394.33 441.26 427.46 407.74 415.23 409.32 453.48 507.45 491.58 468.90 477.52 470.72

39 399.40 446.93 432.95 412.98 420.57 414.57 459.31 513.97 497.89 474.92 483.65 476.76

40 404.46 452.59 438.44 418.21 425.90 419.83 465.13 520.48 504.20 480.95 489.78 482.81

41 412.06 461.09 446.67 426.07 433.90 427.72 473.87 530.26 513.67 489.98 498.98 491.87

42 419.34 469.24 454.56 433.59 441.56 435.27 482.24 539.62 522.74 498.63 507.79 500.56

43 429.46 480.57 465.54 444.07 452.22 445.78 493.88 552.65 535.37 510.67 520.06 512.65

44 442.12 494.74 479.26 457.15 465.56 458.92 508.44 568.95 551.15 525.73 535.39 527.76

45 457.00 511.38 495.38 472.54 481.22 474.36 525.55 588.09 569.69 543.42 553.40 545.52

46 474.72 531.21 514.60 490.86 499.88 492.76 545.93 610.89 591.79 564.49 574.86 566.67

47 494.66 553.52 536.21 511.48 520.88 513.46 568.86 636.55 616.64 588.20 599.01 590.47

48 517.44 579.02 560.91 535.04 544.87 537.11 595.06 665.87 645.05 615.29 626.60 617.67

49 539.91 604.16 585.27 558.27 568.53 560.43 620.90 694.79 673.06 642.01 653.81 644.50

50 565.23 632.50 612.71 584.45 595.19 586.71 650.02 727.37 704.62 672.12 684.47 674.72

51 590.24 660.47 639.81 610.30 621.52 612.66 678.77 759.54 735.79 701.85 714.75 704.56

52 617.77 691.28 669.66 638.77 650.51 641.24 710.43 794.98 770.11 734.59 748.09 737.43

53 645.62 722.45 699.85 667.57 679.84 670.15 742.46 830.82 804.83 767.71 781.81 770.68

54 675.68 756.09 732.44 698.66 711.50 701.36 777.04 869.50 842.31 803.46 818.22 806.56

55 705.75 789.73 765.03 729.75 743.16 732.57 811.61 908.19 879.79 839.21 854.63 842.45

56 738.35 826.21 800.37 763.45 777.48 766.41 849.10 950.14 920.42 877.97 894.10 881.37

57 771.26 863.04 836.05 797.48 812.14 800.57 886.95 992.50 961.45 917.11 933.96 920.66

58 806.39 902.35 874.13 833.81 849.13 837.03 927.35 1037.70 1005.25 958.88 976.50 962.59

59 823.80 921.83 893.00 851.81 867.46 855.10 947.37 1060.10 1026.95 979.58 997.58 983.37

60 858.93 961.14 931.08 888.13 904.45 891.57 987.77 1105.31 1070.74 1021.35 1040.12 1025.30

61 889.31 995.14 964.01 919.55 936.44 923.10 1022.71 1144.41 1108.61 1057.48 1076.91 1061.57

62 909.25 1017.45 985.62 940.16 957.44 943.80 1045.63 1170.06 1133.47 1081.19 1101.05 1085.37

63 934.25 1045.42 1012.73 966.01 983.76 969.75 1074.39 1202.24 1164.63 1110.92 1131.33 1115.21

64 and over 949.44 1062.42 1029.18 981.72 999.75 985.52 1091.85 1221.78 1183.56 1128.98 1149.72 1133.34



Yakima


Regence BlueShield

RATE SCHEDULE


King


Klickitat, Skamania

Page 5 of 12


Plan Information

Plan Name: Regence Cascade Bronze Individual and Family Network





Metal Level: Bronze



Area

Number

Available

in area?

1 Yes

2 Yes

3 Yes

4 N/A

5 Yes

6 Yes

7 N/A

8 Yes

9 N/A

Plan Rates

Age


0-14 194.94 218.13 211.31 201.57 205.27 202.34 194.94 218.13 211.31 201.57 205.27 202.34

15 212.27 237.52 230.10 219.48 223.52 220.33 212.27 237.52 230.10 219.48 223.52 220.33

16 218.89 244.94 237.28 226.33 230.49 227.21 218.89 244.94 237.28 226.33 230.49 227.21

17 225.52 252.35 244.46 233.18 237.47 234.09 225.52 252.35 244.46 233.18 237.47 234.09

18 232.65 260.34 252.19 240.56 244.98 241.49 232.65 260.34 252.19 240.56 244.98 241.49

19 239.79 268.32 259.93 247.94 252.49 248.90 239.79 268.32 259.93 247.94 252.49 248.90

20 247.18 276.59 267.94 255.58 260.28 256.57 247.18 276.59 267.94 255.58 260.28 256.57

21 254.82 285.14 276.22 263.48 268.33 264.50 293.04 327.92 317.66 303.01 308.57 304.18

22 254.82 285.14 276.22 263.48 268.33 264.50 293.04 327.92 317.66 303.01 308.57 304.18

23 254.82 285.14 276.22 263.48 268.33 264.50 293.04 327.92 317.66 303.01 308.57 304.18

24 254.82 285.14 276.22 263.48 268.33 264.50 293.04 327.92 317.66 303.01 308.57 304.18

25 255.84 286.28 277.33 264.54 269.40 265.56 294.22 329.23 318.93 304.22 309.81 305.40

26 260.94 291.99 282.85 269.81 274.77 270.85 300.08 335.79 325.28 310.28 315.98 311.48

27 267.05 298.83 289.48 276.13 281.21 277.20 307.11 343.66 332.91 317.55 323.39 318.78

28 276.99 309.95 300.26 286.41 291.67 287.51 318.54 356.44 345.29 329.37 335.42 330.64

29 285.14 319.08 309.10 294.84 300.26 295.98 327.92 366.94 355.46 339.06 345.29 340.38

30 289.22 323.64 313.52 299.05 304.55 300.21 332.60 372.18 360.54 343.91 350.23 345.24

31 295.34 330.48 320.14 305.38 310.99 306.56 339.64 380.05 368.17 351.18 357.64 352.54

32 301.45 337.32 326.77 311.70 317.43 312.91 346.67 387.92 375.79 358.46 365.04 359.84

33 305.27 341.60 330.92 315.65 321.45 316.87 351.07 392.84 380.56 363.00 369.67 364.41

34 309.35 346.16 335.34 319.87 325.75 321.11 355.75 398.09 385.64 367.85 374.61 369.27

35 311.39 348.45 337.55 321.98 327.89 323.22 358.10 400.71 388.18 370.27 377.08 371.71

36 313.43 350.73 339.76 324.09 330.04 325.34 360.44 403.34 390.72 372.70 379.55 374.14

37 315.47 353.01 341.97 326.19 332.19 327.45 362.79 405.96 393.26 375.12 382.01 376.57

38 317.51 355.29 344.18 328.30 334.33 329.57 365.13 408.58 395.80 377.55 384.48 379.01

39 321.58 359.85 348.60 332.52 338.63 333.80 369.82 413.83 400.89 382.39 389.42 383.87

40 325.66 364.41 353.02 336.73 342.92 338.04 374.51 419.08 405.97 387.24 394.36 388.74

41 331.78 371.26 359.64 343.06 349.36 344.38 381.54 426.95 413.59 394.51 401.76 396.04

42 337.64 377.82 366.00 349.12 355.53 350.47 388.28 434.49 420.90 401.48 408.86 403.04

43 345.79 386.94 374.84 357.55 364.12 358.93 397.66 444.98 431.06 411.18 418.74 412.77

44 355.98 398.35 385.89 368.09 374.85 369.51 409.38 458.10 443.77 423.30 431.08 424.94

45 367.96 411.75 398.87 380.47 387.46 381.94 423.15 473.51 458.70 437.54 445.58 439.23

46 382.23 427.72 414.34 395.23 402.49 396.75 439.56 491.87 476.49 454.51 462.86 456.27

47 398.28 445.68 431.74 411.83 419.39 413.42 458.03 512.53 496.50 473.60 482.30 475.43

48 416.63 466.21 451.63 430.80 438.71 432.46 479.13 536.14 519.37 495.42 504.52 497.33

49 434.72 486.45 471.24 449.50 457.76 451.24 499.93 559.42 541.93 516.93 526.43 518.93

50 455.11 509.27 493.34 470.58 479.23 472.40 523.37 585.66 567.34 541.17 551.11 543.26

51 475.24 531.79 515.16 491.40 500.43 493.30 546.53 611.56 592.43 565.11 575.49 567.29

52 497.41 556.60 539.19 514.32 523.77 516.31 572.02 640.09 620.07 591.47 602.34 593.76

53 519.83 581.69 563.50 537.51 547.38 539.59 597.81 668.95 648.02 618.13 629.49 620.52

54 544.04 608.78 589.74 562.54 572.87 564.71 625.65 700.10 678.20 646.92 658.81 649.42

55 568.25 635.87 615.98 587.57 598.37 589.84 653.49 731.25 708.38 675.70 688.12 678.32

56 594.50 665.24 644.43 614.71 626.00 617.09 683.67 765.03 741.10 706.91 719.90 709.65

57 621.00 694.89 673.16 642.11 653.91 644.59 714.15 799.13 774.13 738.43 752.00 741.28

58 649.28 726.55 703.82 671.36 683.69 673.95 746.67 835.53 809.39 772.06 786.25 775.05

59 663.30 742.23 719.01 685.85 698.45 688.50 762.79 853.56 826.87 788.73 803.22 791.78

60 691.58 773.88 749.67 715.10 728.24 717.86 795.32 889.96 862.13 822.36 837.47 825.54

61 716.04 801.25 776.19 740.39 753.99 743.25 823.45 921.44 892.62 851.45 867.09 854.74

62 732.10 819.22 793.59 756.99 770.90 759.92 841.91 942.10 912.63 870.54 886.53 873.91

63 752.23 841.74 815.42 777.80 792.10 780.81 865.06 968.01 937.73 894.48 910.91 897.94

64 and over 764.46 855.42 828.66 790.44 804.98 793.50 879.12 983.75 952.98 909.02 925.71 912.54



Yakima


Regence BlueShield

RATE SCHEDULE


King


Klickitat, Skamania

Page 6 of 12


Plan Information

Plan Name: Bronze HDHP 5700 EPO Individual and Family Network





Metal Level: Bronze



Area

Number

Available

in area?

1 Yes

2 Yes

3 Yes

4 N/A

5 Yes

6 Yes

7 N/A

8 Yes

9 N/A

Plan Rates

Age


0-14 192.99 215.95 209.20 199.55 203.21 200.32 192.99 215.95 209.20 199.55 203.21 200.32

15 210.14 235.15 227.79 217.29 221.28 218.13 210.14 235.15 227.79 217.29 221.28 218.13

16 216.70 242.49 234.90 224.07 228.19 224.93 216.70 242.49 234.90 224.07 228.19 224.93

17 223.26 249.83 242.01 230.85 235.09 231.74 223.26 249.83 242.01 230.85 235.09 231.74

18 230.32 257.73 249.67 238.15 242.53 239.07 230.32 257.73 249.67 238.15 242.53 239.07

19 237.39 265.64 257.33 245.46 249.97 246.41 237.39 265.64 257.33 245.46 249.97 246.41

20 244.70 273.82 265.26 253.02 257.67 254.00 244.70 273.82 265.26 253.02 257.67 254.00

21 252.27 282.29 273.46 260.85 265.64 261.86 290.11 324.63 314.48 299.97 305.49 301.13

22 252.27 282.29 273.46 260.85 265.64 261.86 290.11 324.63 314.48 299.97 305.49 301.13

23 252.27 282.29 273.46 260.85 265.64 261.86 290.11 324.63 314.48 299.97 305.49 301.13

24 252.27 282.29 273.46 260.85 265.64 261.86 290.11 324.63 314.48 299.97 305.49 301.13

25 253.28 283.42 274.55 261.89 266.70 262.90 291.27 325.93 315.74 301.17 306.71 302.34

26 258.32 289.07 280.02 267.11 272.02 268.14 297.07 332.42 322.03 307.17 312.82 308.36

27 264.38 295.84 286.59 273.37 278.39 274.43 304.04 340.22 329.57 314.37 320.15 315.59

28 274.22 306.85 297.25 283.54 288.75 284.64 315.35 352.88 341.84 326.07 332.06 327.33

29 282.29 315.88 306.00 291.89 297.25 293.02 324.63 363.27 351.90 335.67 341.84 336.97

30 286.33 320.40 310.38 296.06 301.50 297.21 329.28 368.46 356.93 340.47 346.73 341.79

31 292.38 327.17 316.94 302.32 307.88 303.49 336.24 376.25 364.48 347.67 354.06 349.02

32 298.44 333.95 323.50 308.58 314.25 309.78 343.20 384.04 372.03 354.87 361.39 356.24

33 302.22 338.18 327.61 312.49 318.24 313.70 347.55 388.91 376.75 359.37 365.97 360.76

34 306.26 342.70 331.98 316.67 322.49 317.89 352.19 394.11 381.78 364.17 370.86 365.58

35 308.27 344.96 334.17 318.76 324.61 319.99 354.52 396.70 384.29 366.57 373.30 367.99

36 310.29 347.22 336.36 320.84 326.74 322.08 356.84 399.30 386.81 368.97 375.75 370.40

37 312.31 349.48 338.54 322.93 328.86 324.18 359.16 401.90 389.33 371.37 378.19 372.80

38 314.33 351.73 340.73 325.02 330.99 326.27 361.48 404.49 391.84 373.77 380.64 375.21

39 318.36 356.25 345.11 329.19 335.24 330.46 366.12 409.69 396.87 378.57 385.52 380.03

40 322.40 360.77 349.48 333.36 339.49 334.65 370.76 414.88 401.91 383.37 390.41 384.85

41 328.46 367.54 356.05 339.62 345.86 340.94 377.72 422.67 409.45 390.57 397.74 392.08

42 334.26 374.03 362.34 345.62 351.97 346.96 384.40 430.14 416.69 397.47 404.77 399.00

43 342.33 383.07 371.09 353.97 360.47 355.34 393.68 440.53 426.75 407.07 414.54 408.64

44 352.42 394.36 382.02 364.40 371.10 365.81 405.28 453.51 439.33 419.06 426.76 420.69

45 364.28 407.63 394.88 376.66 383.58 378.12 418.92 468.77 454.11 433.16 441.12 434.84

46 378.41 423.44 410.19 391.27 398.46 392.78 435.17 486.95 471.72 449.96 458.23 451.70

47 394.30 441.22 427.42 407.70 415.20 409.28 453.44 507.40 491.53 468.86 477.48 470.67

48 412.46 461.54 447.11 426.49 434.32 428.13 474.33 530.78 514.17 490.46 499.47 492.36

49 430.37 481.59 466.52 445.01 453.18 446.73 494.93 553.83 536.50 511.76 521.16 513.74

50 450.55 504.17 488.40 465.87 474.43 467.68 518.14 579.80 561.66 535.75 545.60 537.83

51 470.48 526.47 510.00 486.48 495.42 488.36 541.06 605.44 586.50 559.45 569.73 561.62

52 492.43 551.03 533.80 509.17 518.53 511.14 566.30 633.68 613.86 585.55 596.31 587.81

53 514.63 575.87 557.86 532.13 541.91 534.19 591.83 662.25 641.54 611.95 623.19 614.31

54 538.60 602.69 583.84 556.91 567.14 559.06 619.39 693.09 671.41 640.45 652.21 642.92

55 562.56 629.51 609.82 581.69 592.38 583.94 646.95 723.93 701.29 668.94 681.23 671.53

56 588.55 658.58 637.98 608.56 619.74 610.91 676.83 757.37 733.68 699.84 712.70 702.55

57 614.78 687.94 666.42 635.68 647.37 638.14 707.00 791.13 766.39 731.04 744.47 733.87

58 642.78 719.28 696.78 664.64 676.85 667.21 739.20 827.17 801.29 764.33 778.38 767.29

59 656.66 734.80 711.82 678.99 691.46 681.61 755.16 845.02 818.59 780.83 795.18 783.85

60 684.66 766.14 742.17 707.94 720.95 710.68 787.36 881.06 853.50 814.13 829.09 817.28

61 708.88 793.24 768.42 732.98 746.45 735.82 815.21 912.22 883.69 842.93 858.42 846.19

62 724.77 811.02 785.65 749.41 763.18 752.31 833.49 932.67 903.50 861.83 877.66 865.16

63 744.70 833.32 807.26 770.02 784.17 773.00 856.41 958.32 928.34 885.52 901.80 888.95

64 and over 756.81 846.87 820.38 782.54 796.92 785.57 870.33 973.89 943.44 899.91 916.46 903.39



Yakima


Regence BlueShield

RATE SCHEDULE


King


Klickitat, Skamania

Page 7 of 12


Plan Information

Plan Name: Bronze HDHP 5700 Exchange EPO Individual and Family Network





Metal Level: Bronze



Area

Number

Available

in area?

1 Yes

2 Yes

3 Yes

4 N/A

5 Yes

6 Yes

7 N/A

8 Yes

9 N/A

Plan Rates

Age


0-14 192.21 215.08 208.35 198.74 202.39 199.51 192.21 215.08 208.35 198.74 202.39 199.51

15 209.29 234.20 226.87 216.41 220.38 217.24 209.29 234.20 226.87 216.41 220.38 217.24

16 215.82 241.51 233.95 223.16 227.26 224.03 215.82 241.51 233.95 223.16 227.26 224.03

17 222.36 248.82 241.03 229.92 234.14 230.81 222.36 248.82 241.03 229.92 234.14 230.81

18 229.39 256.69 248.66 237.19 241.55 238.11 229.39 256.69 248.66 237.19 241.55 238.11

19 236.43 264.56 256.29 244.46 248.96 245.41 236.43 264.56 256.29 244.46 248.96 245.41

20 243.71 272.71 264.18 252.00 256.63 252.97 243.71 272.71 264.18 252.00 256.63 252.97

21 251.25 281.15 272.36 259.79 264.57 260.80 288.94 323.32 313.21 298.76 304.25 299.92

22 251.25 281.15 272.36 259.79 264.57 260.80 288.94 323.32 313.21 298.76 304.25 299.92

23 251.25 281.15 272.36 259.79 264.57 260.80 288.94 323.32 313.21 298.76 304.25 299.92

24 251.25 281.15 272.36 259.79 264.57 260.80 288.94 323.32 313.21 298.76 304.25 299.92

25 252.26 282.27 273.44 260.83 265.62 261.84 290.09 324.61 314.46 299.96 305.47 301.12

26 257.28 287.90 278.89 266.03 270.92 267.06 295.87 331.08 320.73 305.93 311.55 307.12

27 263.31 294.64 285.43 272.26 277.27 273.32 302.81 338.84 328.24 313.10 318.86 314.31

28 273.11 305.61 296.05 282.39 287.58 283.49 314.08 351.45 340.46 324.75 330.72 326.01

29 281.15 314.61 304.77 290.71 296.05 291.83 323.32 361.80 350.48 334.31 340.46 335.61

30 285.17 319.10 309.12 294.86 300.28 296.01 327.94 366.97 355.49 339.09 345.33 340.41

31 291.20 325.85 315.66 301.10 306.63 302.26 334.88 374.73 363.01 346.26 352.63 347.60

32 297.23 332.60 322.20 307.33 312.98 308.52 341.81 382.49 370.53 353.43 359.93 354.80

33 301.00 336.82 326.28 311.23 316.95 312.44 346.15 387.34 375.22 357.92 364.49 359.30

34 305.02 341.31 330.64 315.39 321.18 316.61 350.77 392.51 380.23 362.70 369.36 364.10

35 307.03 343.56 332.82 317.47 323.30 318.69 353.08 395.10 382.74 365.09 371.79 366.50

36 309.04 345.81 335.00 319.54 325.42 320.78 355.39 397.68 385.25 367.48 374.23 368.90

37 311.05 348.06 337.18 321.62 327.53 322.87 357.70 400.27 387.75 369.87 376.66 371.30

38 313.06 350.31 339.35 323.70 329.65 324.95 360.02 402.86 390.26 372.26 379.10 373.70

39 317.08 354.81 343.71 327.86 333.88 329.13 364.64 408.03 395.27 377.04 383.96 378.50

40 321.10 359.31 348.07 332.01 338.12 333.30 369.26 413.20 400.28 381.82 388.83 383.29

41 327.13 366.06 354.61 338.25 344.47 339.56 376.20 420.96 407.80 388.99 396.14 390.49

42 332.91 372.52 360.87 344.23 350.55 345.56 382.84 428.40 415.00 395.86 403.13 397.39

43 340.95 381.52 369.59 352.54 359.02 353.90 392.09 438.75 425.02 405.42 412.87 406.99

44 351.00 392.76 380.48 362.93 369.60 364.33 403.65 451.68 437.55 417.37 425.04 418.98

45 362.81 405.98 393.28 375.14 382.03 376.59 417.23 466.88 452.27 431.41 439.34 433.08

46 376.88 421.72 408.53 389.69 396.85 391.20 433.41 484.98 469.81 448.14 456.38 449.88

47 392.70 439.44 425.69 406.06 413.52 407.63 451.61 505.35 489.54 466.96 475.54 468.77

48 410.79 459.68 445.30 424.76 432.57 426.40 472.41 528.63 512.10 488.47 497.45 490.36

49 428.63 479.64 464.64 443.21 451.35 444.92 492.93 551.59 534.33 509.69 519.05 511.66

50 448.73 502.13 486.43 463.99 472.52 465.78 516.04 577.45 559.39 533.59 543.39 535.65

51 468.58 524.34 507.94 484.51 493.42 486.39 538.87 602.99 584.13 557.19 567.43 559.35

52 490.44 548.80 531.64 507.11 516.43 509.08 564.01 631.12 611.38 583.18 593.90 585.44

53 512.55 573.54 555.60 529.98 539.72 532.03 589.43 659.57 638.94 609.47 620.67 611.83

54 536.42 600.25 581.48 554.66 564.85 556.80 616.88 690.29 668.70 637.86 649.58 640.32

55 560.29 626.96 607.35 579.34 589.98 581.58 644.33 721.01 698.45 666.24 678.48 668.82

56 586.17 655.92 635.40 606.10 617.23 608.44 674.09 754.31 730.71 697.01 709.82 699.71

57 612.30 685.16 663.73 633.11 644.75 635.56 704.14 787.93 763.29 728.08 741.46 730.90

58 640.19 716.37 693.96 661.95 674.11 664.51 736.21 823.82 798.05 761.24 775.23 764.19

59 654.00 731.83 708.94 676.24 688.67 678.86 752.10 841.60 815.28 777.68 791.97 780.68

60 681.89 763.04 739.17 705.08 718.03 707.80 784.18 877.49 850.05 810.84 825.74 813.98

61 706.01 790.03 765.32 730.02 743.43 732.84 811.91 908.53 880.12 839.52 854.95 842.77

62 721.84 807.74 782.48 746.38 760.10 749.27 830.12 928.90 899.85 858.34 874.11 861.66

63 741.69 829.95 803.99 766.91 781.00 769.87 852.94 954.44 924.59 881.94 898.15 885.36

64 and over 753.75 843.45 817.07 779.37 793.70 782.39 866.81 969.96 939.62 896.28 912.75 899.75



Yakima


Regence BlueShield

RATE SCHEDULE


King


Klickitat, Skamania

Page 8 of 12


Plan Information

Plan Name: Bronze Essential 7500 EPO Individual and Family Network





Metal Level: Bronze



Area

Number

Available

in area?

1 Yes

2 Yes

3 Yes

4 N/A

5 Yes

6 Yes

7 N/A

8 Yes

9 N/A

Plan Rates

Age


0-14 187.13 209.40 202.85 193.50 197.05 194.25 187.13 209.40 202.85 193.50 197.05 194.25

15 203.77 228.02 220.89 210.70 214.57 211.51 203.77 228.02 220.89 210.70 214.57 211.51

16 210.13 235.13 227.78 217.27 221.27 218.11 210.13 235.13 227.78 217.27 221.27 218.11

17 216.49 242.25 234.67 223.85 227.96 224.72 216.49 242.25 234.67 223.85 227.96 224.72

18 223.34 249.92 242.10 230.93 235.17 231.82 223.34 249.92 242.10 230.93 235.17 231.82

19 230.19 257.58 249.52 238.01 242.39 238.93 230.19 257.58 249.52 238.01 242.39 238.93

20 237.28 265.52 257.21 245.35 249.86 246.30 237.28 265.52 257.21 245.35 249.86 246.30

21 244.62 273.73 265.17 252.94 257.58 253.92 281.31 314.79 304.94 290.88 296.22 292.00

22 244.62 273.73 265.17 252.94 257.58 253.92 281.31 314.79 304.94 290.88 296.22 292.00

23 244.62 273.73 265.17 252.94 257.58 253.92 281.31 314.79 304.94 290.88 296.22 292.00

24 244.62 273.73 265.17 252.94 257.58 253.92 281.31 314.79 304.94 290.88 296.22 292.00

25 245.60 274.82 266.23 253.95 258.62 254.93 282.44 316.05 306.16 292.04 297.41 293.17

26 250.49 280.30 271.53 259.01 263.77 260.01 288.06 322.34 312.26 297.86 303.33 299.01

27 256.36 286.87 277.90 265.08 269.95 266.10 294.82 329.90 319.58 304.84 310.44 306.02

28 265.90 297.54 288.24 274.94 279.99 276.01 305.79 342.18 331.47 316.18 321.99 317.41

29 273.73 306.30 296.72 283.04 288.24 284.13 314.79 352.25 341.23 325.49 331.47 326.75

30 277.64 310.68 300.97 287.08 292.36 288.19 319.29 357.29 346.11 330.15 336.21 331.42

31 283.51 317.25 307.33 293.15 298.54 294.29 326.04 364.84 353.43 337.13 343.32 338.43

32 289.39 323.82 313.69 299.22 304.72 300.38 332.79 372.40 360.75 344.11 350.43 345.44

33 293.05 327.93 317.67 303.02 308.59 304.19 337.01 377.12 365.32 348.47 354.87 349.82

34 296.97 332.31 321.91 307.07 312.71 308.25 341.51 382.15 370.20 353.13 359.61 354.49

35 298.93 334.50 324.04 309.09 314.77 310.28 343.76 384.67 372.64 355.45 361.98 356.83

36 300.88 336.69 326.16 311.11 316.83 312.32 346.01 387.19 375.08 357.78 364.35 359.16

37 302.84 338.88 328.28 313.14 318.89 314.35 348.27 389.71 377.52 360.11 366.72 361.50

38 304.80 341.07 330.40 315.16 320.95 316.38 350.52 392.23 379.96 362.43 369.09 363.84

39 308.71 345.45 334.64 319.21 325.07 320.44 355.02 397.26 384.84 367.09 373.83 368.51

40 312.62 349.83 338.88 323.25 329.19 324.50 359.52 402.30 389.72 371.74 378.57 373.18

41 318.50 356.40 345.25 329.32 335.38 330.60 366.27 409.86 397.04 378.72 385.68 380.19

42 324.12 362.69 351.35 335.14 341.30 336.44 372.74 417.10 404.05 385.41 392.49 386.90

43 331.95 371.45 359.83 343.24 349.54 344.56 381.74 427.17 413.81 394.72 401.97 396.25

44 341.73 382.40 370.44 353.35 359.85 354.72 392.99 439.76 426.01 406.36 413.82 407.93

45 353.23 395.27 382.90 365.24 371.95 366.65 406.22 454.56 440.34 420.03 427.75 421.65

46 366.93 410.59 397.75 379.41 386.38 380.87 421.97 472.18 457.41 436.32 444.33 438.00

47 382.34 427.84 414.46 395.34 402.61 396.87 439.69 492.02 476.63 454.64 463.00 456.40

48 399.95 447.55 433.55 413.55 421.15 415.15 459.95 514.68 498.58 475.58 484.32 477.42

49 417.32 466.98 452.38 431.51 439.44 433.18 479.92 537.03 520.23 496.24 505.36 498.16

50 436.89 488.88 473.59 451.75 460.05 453.49 502.43 562.21 544.63 519.51 529.05 521.52

51 456.22 510.51 494.54 471.73 480.40 473.55 524.65 587.08 568.72 542.49 552.46 544.59

52 477.50 534.32 517.61 493.73 502.81 495.64 549.12 614.47 595.25 567.79 578.23 569.99

53 499.02 558.41 540.94 515.99 525.47 517.99 573.88 642.17 622.08 593.39 604.29 595.69

54 522.26 584.41 566.13 540.02 549.94 542.11 600.60 672.08 651.05 621.02 632.44 623.43

55 545.50 610.42 591.32 564.05 574.41 566.23 627.33 701.98 680.02 648.66 660.58 651.17

56 570.70 638.61 618.64 590.10 600.95 592.39 656.30 734.40 711.43 678.62 691.09 681.24

57 596.14 667.08 646.21 616.41 627.73 618.79 685.56 767.14 743.15 708.87 721.89 711.61

58 623.29 697.46 675.65 644.48 656.33 646.98 716.79 802.08 777.00 741.16 754.78 744.02

59 636.75 712.52 690.23 658.40 670.49 660.94 732.26 819.40 793.77 757.15 771.07 760.08

60 663.90 742.90 719.67 686.47 699.09 689.13 763.48 854.34 827.62 789.44 803.95 792.50

61 687.38 769.18 745.12 710.75 723.81 713.50 790.49 884.56 856.89 817.37 832.39 820.53

62 702.79 786.43 761.83 726.69 740.04 729.50 808.21 904.39 876.10 835.69 851.05 838.92

63 722.12 808.05 782.78 746.67 760.39 749.56 830.44 929.26 900.19 858.67 874.45 861.99

64 and over 733.86 821.19 795.50 758.81 772.74 761.75 843.93 944.37 914.82 872.63 888.66 876.00



Yakima


Regence BlueShield

RATE SCHEDULE


King


Klickitat, Skamania

Page 9 of 12


Plan Information

Plan Name: Bronze Essential 7500 Exchange EPO Individual and Family Network





Metal Level: Bronze



Area

Number

Available

in area?

1 Yes

2 Yes

3 Yes

4 N/A

5 Yes

6 Yes

7 N/A

8 Yes

9 N/A

Plan Rates

Age


0-14 185.96 208.09 201.58 192.29 195.82 193.03 185.96 208.09 201.58 192.29 195.82 193.03

15 202.49 226.59 219.50 209.38 213.23 210.19 202.49 226.59 219.50 209.38 213.23 210.19

16 208.81 233.66 226.35 215.91 219.88 216.75 208.81 233.66 226.35 215.91 219.88 216.75

17 215.13 240.74 233.21 222.45 226.54 223.31 215.13 240.74 233.21 222.45 226.54 223.31

18 221.94 248.35 240.58 229.49 233.70 230.37 221.94 248.35 240.58 229.49 233.70 230.37

19 228.75 255.97 247.96 236.53 240.87 237.44 228.75 255.97 247.96 236.53 240.87 237.44

20 235.80 263.86 255.60 243.81 248.29 244.76 235.80 263.86 255.60 243.81 248.29 244.76

21 243.09 272.02 263.51 251.36 255.97 252.33 279.55 312.82 303.04 289.06 294.37 290.18

22 243.09 272.02 263.51 251.36 255.97 252.33 279.55 312.82 303.04 289.06 294.37 290.18

23 243.09 272.02 263.51 251.36 255.97 252.33 279.55 312.82 303.04 289.06 294.37 290.18

24 243.09 272.02 263.51 251.36 255.97 252.33 279.55 312.82 303.04 289.06 294.37 290.18

25 244.06 273.11 264.56 252.36 257.00 253.34 280.67 314.07 304.25 290.21 295.55 291.34

26 248.92 278.55 269.83 257.39 262.12 258.38 286.26 320.33 310.31 296.00 301.43 297.14

27 254.76 285.07 276.16 263.42 268.26 264.44 292.97 327.84 317.58 302.93 308.50 304.11

28 264.24 295.68 286.43 273.22 278.24 274.28 303.87 340.04 329.40 314.21 319.98 315.42

29 272.02 304.39 294.87 281.27 286.43 282.35 312.82 350.05 339.10 323.46 329.40 324.71

30 275.91 308.74 299.08 285.29 290.53 286.39 317.29 355.05 343.95 328.08 334.11 329.35

31 281.74 315.27 305.41 291.32 296.67 292.45 324.00 362.56 351.22 335.02 341.17 336.31

32 287.58 321.80 311.73 297.35 302.82 298.50 330.71 370.07 358.49 341.96 348.24 343.28

33 291.22 325.88 315.68 301.12 306.66 302.29 334.91 374.76 363.04 346.29 352.66 347.63

34 295.11 330.23 319.90 305.15 310.75 306.33 339.38 379.76 367.89 350.92 357.36 352.27

35 297.06 332.41 322.01 307.16 312.80 308.34 341.61 382.27 370.31 353.23 359.72 354.60

36 299.00 334.58 324.12 309.17 314.85 310.36 343.85 384.77 372.73 355.54 362.07 356.92

37 300.95 336.76 326.22 311.18 316.90 312.38 346.09 387.27 375.16 357.85 364.43 359.24

38 302.89 338.93 328.33 313.19 318.94 314.40 348.32 389.77 377.58 360.17 366.78 361.56

39 306.78 343.29 332.55 317.21 323.04 318.44 352.80 394.78 382.43 364.79 371.49 366.20

40 310.67 347.64 336.77 321.23 327.13 322.47 357.27 399.78 387.28 369.42 376.20 370.85

41 316.50 354.17 343.09 327.26 333.28 328.53 363.98 407.29 394.55 376.35 383.27 377.81

42 322.09 360.42 349.15 333.05 339.17 334.33 370.41 414.49 401.52 383.00 390.04 384.48

43 329.87 369.13 357.58 341.09 347.36 342.41 379.35 424.50 411.22 392.25 399.46 393.77

44 339.60 380.01 368.12 351.14 357.60 352.50 390.54 437.01 423.34 403.81 411.23 405.38

45 351.02 392.79 380.51 362.96 369.63 364.36 403.68 451.71 437.58 417.40 425.07 419.01

46 364.64 408.03 395.26 377.03 383.96 378.49 419.33 469.23 454.55 433.59 441.55 435.26

47 379.95 425.16 411.87 392.87 400.09 394.39 436.94 488.94 473.65 451.80 460.10 453.55

48 397.45 444.75 430.84 410.97 418.52 412.56 457.07 511.46 495.46 472.61 481.29 474.44

49 414.71 464.06 449.55 428.81 436.69 430.47 476.92 533.67 516.98 493.13 502.19 495.04

50 434.16 485.82 470.63 448.92 457.17 450.66 499.28 558.70 541.22 516.26 525.74 518.26

51 453.36 507.31 491.45 468.78 477.39 470.59 521.37 583.41 565.16 539.09 549.00 541.18

52 474.51 530.98 514.37 490.65 499.66 492.54 545.69 610.63 591.53 564.24 574.61 566.42

53 495.90 554.92 537.56 512.76 522.19 514.75 570.29 638.15 618.19 589.68 600.51 591.96

54 519.00 580.76 562.59 536.64 546.50 538.72 596.85 667.87 646.98 617.14 628.48 619.53

55 542.09 606.60 587.63 560.52 570.82 562.69 623.40 697.59 675.77 644.60 656.44 647.09

56 567.13 634.62 614.77 586.41 597.19 588.68 652.20 729.81 706.98 674.37 686.76 676.98

57 592.41 662.91 642.17 612.55 623.81 614.92 681.27 762.34 738.50 704.44 717.38 707.16

58 619.39 693.10 671.42 640.45 652.22 642.93 712.30 797.07 772.14 736.52 750.05 739.37

59 632.76 708.06 685.92 654.28 666.30 656.81 727.68 814.27 788.80 752.42 766.24 755.33

60 659.75 738.26 715.16 682.18 694.71 684.82 758.71 848.99 822.44 784.50 798.92 787.54

61 683.08 764.37 740.46 706.31 719.29 709.04 785.55 879.03 851.53 812.25 827.18 815.40

62 698.40 781.51 757.06 722.14 735.41 724.94 803.16 898.73 870.62 830.46 845.72 833.68

63 717.60 803.00 777.88 742.00 755.63 744.87 825.24 923.45 894.56 853.30 868.98 856.60

64 and over 729.27 816.05 790.53 754.07 767.91 756.98 838.65 938.46 909.11 867.17 883.11 870.53



Yakima


Regence BlueShield

RATE SCHEDULE


King


Klickitat, Skamania

Page 10 of 12


Plan Information

Plan Name: Bronze Care on Demand 8000 EPO Individual and Family Network





Metal Level: Bronze



Area

Number

Available

in area?

1 Yes

2 Yes

3 Yes

4 N/A

5 Yes

6 Yes

7 N/A

8 Yes

9 N/A

Plan Rates

Age


0-14 177.78 198.93 192.71 183.82 187.20 184.53 177.78 198.93 192.71 183.82 187.20 184.53

15 193.58 216.62 209.84 200.16 203.84 200.94 193.58 216.62 209.84 200.16 203.84 200.94

16 199.62 223.38 216.39 206.41 210.20 207.21 199.62 223.38 216.39 206.41 210.20 207.21

17 205.67 230.14 222.94 212.66 216.57 213.48 205.67 230.14 222.94 212.66 216.57 213.48

18 212.17 237.42 229.99 219.39 223.42 220.23 212.17 237.42 229.99 219.39 223.42 220.23

19 218.68 244.70 237.05 226.11 230.27 226.99 218.68 244.70 237.05 226.11 230.27 226.99

20 225.42 252.24 244.35 233.08 237.37 233.98 225.42 252.24 244.35 233.08 237.37 233.98

21 232.39 260.04 251.91 240.29 244.71 241.22 267.25 299.05 289.70 276.33 281.41 277.40

22 232.39 260.04 251.91 240.29 244.71 241.22 267.25 299.05 289.70 276.33 281.41 277.40

23 232.39 260.04 251.91 240.29 244.71 241.22 267.25 299.05 289.70 276.33 281.41 277.40

24 232.39 260.04 251.91 240.29 244.71 241.22 267.25 299.05 289.70 276.33 281.41 277.40

25 233.32 261.08 252.92 241.25 245.69 242.19 268.32 300.25 290.86 277.44 282.54 278.51

26 237.97 266.29 257.96 246.06 250.58 247.01 273.66 306.23 296.65 282.97 288.17 284.06

27 243.54 272.53 264.00 251.83 256.45 252.80 280.08 313.41 303.60 289.60 294.92 290.72

28 252.61 282.67 273.83 261.20 266.00 262.21 290.50 325.07 314.90 300.38 305.90 301.54

29 260.04 290.99 281.89 268.89 273.83 269.93 299.05 334.64 324.17 309.22 314.90 310.42

30 263.76 295.15 285.92 272.73 277.74 273.79 303.33 339.42 328.81 313.64 319.40 314.85

31 269.34 301.39 291.96 278.50 283.62 279.57 309.74 346.60 335.76 320.27 326.16 321.51

32 274.92 307.63 298.01 284.26 289.49 285.36 316.15 353.78 342.71 326.90 332.91 328.17

33 278.40 311.53 301.79 287.87 293.16 288.98 320.16 358.26 347.06 331.05 337.13 332.33

34 282.12 315.69 305.82 291.71 297.07 292.84 324.44 363.05 351.69 335.47 341.63 336.77

35 283.98 317.77 307.83 293.64 299.03 294.77 326.58 365.44 354.01 337.68 343.89 338.99

36 285.84 319.85 309.85 295.56 300.99 296.70 328.72 367.83 356.33 339.89 346.14 341.21

37 287.70 321.93 311.87 297.48 302.95 298.63 330.85 370.23 358.65 342.10 348.39 343.43

38 289.56 324.02 313.88 299.40 304.90 300.56 332.99 372.62 360.96 344.31 350.64 345.65

39 293.28 328.18 317.91 303.25 308.82 304.42 337.27 377.40 365.60 348.73 355.14 350.08

40 296.99 332.34 321.94 307.09 312.74 308.28 341.54 382.19 370.23 353.16 359.65 354.52

41 302.57 338.58 327.99 312.86 318.61 314.07 347.96 389.36 377.19 359.79 366.40 361.18

42 307.92 344.56 333.78 318.39 324.24 319.62 354.10 396.24 383.85 366.14 372.87 367.56

43 315.35 352.88 341.84 326.08 332.07 327.34 362.66 405.81 393.12 374.99 381.88 376.44

44 324.65 363.28 351.92 335.69 341.86 336.99 373.35 417.77 404.71 386.04 393.13 387.53

45 335.57 375.50 363.76 346.98 353.36 348.32 385.91 431.83 418.32 399.03 406.36 400.57

46 348.59 390.07 377.87 360.44 367.06 361.83 400.87 448.58 434.55 414.50 422.12 416.11

47 363.23 406.45 393.74 375.58 382.48 377.03 417.71 467.42 452.80 431.91 439.85 433.58

48 379.96 425.17 411.87 392.88 400.10 394.40 436.95 488.95 473.66 451.81 460.11 453.56

49 396.46 443.64 429.76 409.94 417.47 411.52 455.93 510.18 494.22 471.43 480.09 473.25

50 415.05 464.44 449.91 429.16 437.05 430.82 477.31 534.11 517.40 493.53 502.60 495.44

51 433.41 484.98 469.81 448.14 456.38 449.88 498.42 557.73 540.29 515.36 524.83 517.36

52 453.63 507.61 491.73 469.05 477.67 470.86 521.67 583.75 565.49 539.41 549.32 541.49

53 474.08 530.49 513.90 490.19 499.20 492.09 545.19 610.06 590.98 563.72 574.08 565.90

54 496.15 555.19 537.83 513.02 522.45 515.01 570.58 638.47 618.50 589.98 600.82 592.26

55 518.23 579.90 561.76 535.85 545.70 537.92 595.96 666.88 646.03 616.23 627.55 618.61

56 542.17 606.68 587.71 560.60 570.90 562.77 623.49 697.69 675.86 644.69 656.54 647.18

57 566.33 633.73 613.91 585.59 596.35 587.86 651.28 728.79 705.99 673.43 685.80 676.03

58 592.13 662.59 641.87 612.26 623.51 614.63 680.95 761.98 738.15 704.10 717.04 706.83

59 604.91 676.90 655.72 625.48 636.97 627.90 695.65 778.43 754.08 719.30 732.52 722.08

60 630.71 705.76 683.69 652.15 664.13 654.67 725.31 811.62 786.24 749.97 763.75 752.87

61 653.02 730.72 707.87 675.22 687.63 677.83 750.97 840.33 814.05 776.50 790.77 779.51

62 667.66 747.11 723.74 690.36 703.04 693.03 767.80 859.17 832.30 793.91 808.50 796.98

63 686.02 767.65 743.64 709.34 722.37 712.08 788.92 882.80 855.19 815.74 830.73 818.90

64 and over 697.17 780.12 755.73 720.87 734.12 723.66 801.75 897.15 869.09 828.99 844.23 832.20



Yakima


Regence BlueShield

RATE SCHEDULE


King


Klickitat, Skamania

Page 11 of 12


Plan Information

Plan Name: Bronze Care on Demand 8000 Exchange EPO Individual and Family Network





Metal Level: Bronze



Area

Number

Available

in area?

1 Yes

2 Yes

3 Yes

4 N/A

5 Yes

6 Yes

7 N/A

8 Yes

9 N/A

Plan Rates

Age


0-14 177.00 198.06 191.87 183.02 186.38 183.72 177.00 198.06 191.87 183.02 186.38 183.72

15 192.73 215.67 208.92 199.28 202.95 200.05 192.73 215.67 208.92 199.28 202.95 200.05

16 198.75 222.40 215.44 205.50 209.28 206.30 198.75 222.40 215.44 205.50 209.28 206.30

17 204.76 229.13 221.96 211.72 215.61 212.54 204.76 229.13 221.96 211.72 215.61 212.54

18 211.24 236.38 228.99 218.42 222.44 219.27 211.24 236.38 228.99 218.42 222.44 219.27

19 217.72 243.63 236.01 225.12 229.26 225.99 217.72 243.63 236.01 225.12 229.26 225.99

20 224.43 251.14 243.28 232.06 236.32 232.96 224.43 251.14 243.28 232.06 236.32 232.96

21 231.37 258.90 250.81 239.24 243.63 240.16 266.08 297.74 288.43 275.12 280.18 276.19

22 231.37 258.90 250.81 239.24 243.63 240.16 266.08 297.74 288.43 275.12 280.18 276.19

23 231.37 258.90 250.81 239.24 243.63 240.16 266.08 297.74 288.43 275.12 280.18 276.19

24 231.37 258.90 250.81 239.24 243.63 240.16 266.08 297.74 288.43 275.12 280.18 276.19

25 232.30 259.94 251.81 240.19 244.61 241.12 267.14 298.93 289.58 276.22 281.30 277.29

26 236.92 265.12 256.82 244.98 249.48 245.93 272.46 304.88 295.35 281.72 286.90 282.81

27 242.48 271.33 262.84 250.72 255.33 251.69 278.85 312.03 302.27 288.33 293.63 289.44

28 251.50 281.43 272.63 260.05 264.83 261.06 289.22 323.64 313.52 299.06 304.55 300.21

29 258.90 289.71 280.65 267.71 272.62 268.74 297.74 333.17 322.75 307.86 313.52 309.05

30 262.60 293.85 284.66 271.53 276.52 272.58 302.00 337.93 327.36 312.26 318.00 313.47

31 268.16 300.07 290.68 277.28 282.37 278.35 308.38 345.08 334.29 318.87 324.73 320.10

32 273.71 306.28 296.70 283.02 288.22 284.11 314.77 352.22 341.21 325.47 331.45 326.73

33 277.18 310.17 300.46 286.61 291.87 287.71 318.76 356.69 345.53 329.60 335.65 330.87

34 280.88 314.31 304.48 290.43 295.77 291.56 323.02 361.45 350.15 334.00 340.14 335.29

35 282.73 316.38 306.48 292.35 297.72 293.48 325.14 363.84 352.46 336.20 342.38 337.50

36 284.59 318.45 308.49 294.26 299.67 295.40 327.27 366.22 354.76 338.40 344.62 339.71

37 286.44 320.52 310.50 296.17 301.62 297.32 329.40 368.60 357.07 340.60 346.86 341.92

38 288.29 322.59 312.50 298.09 303.57 299.24 331.53 370.98 359.38 342.80 349.10 344.13

39 291.99 326.74 316.52 301.92 307.46 303.08 335.79 375.75 363.99 347.20 353.58 348.55

40 295.69 330.88 320.53 305.74 311.36 306.93 340.04 380.51 368.61 351.61 358.07 352.97

41 301.24 337.09 326.55 311.49 317.21 312.69 346.43 387.66 375.53 358.21 364.79 359.59

42 306.57 343.05 332.32 316.99 322.81 318.21 352.55 394.50 382.16 364.54 371.24 365.95

43 313.97 351.33 340.34 324.64 330.61 325.90 361.06 404.03 391.39 373.34 380.20 374.78

44 323.22 361.69 350.37 334.21 340.35 335.51 371.71 415.94 402.93 384.35 391.41 385.83

45 334.10 373.86 362.16 345.46 351.81 346.79 384.21 429.93 416.49 397.28 404.58 398.81

46 347.06 388.35 376.21 358.85 365.45 360.24 399.11 446.61 432.64 412.68 420.27 414.28

47 361.63 404.67 392.01 373.93 380.80 375.37 415.88 465.37 450.81 430.02 437.92 431.68

48 378.29 423.31 410.07 391.15 398.34 392.66 435.03 486.80 471.58 449.82 458.09 451.56

49 394.72 441.69 427.87 408.14 415.64 409.72 453.92 507.94 492.05 469.36 477.98 471.17

50 413.23 462.40 447.94 427.28 435.13 428.93 475.21 531.76 515.13 491.37 500.40 493.27

51 431.51 482.85 467.75 446.18 454.37 447.90 496.23 555.28 537.91 513.10 522.53 515.09

52 451.63 505.38 489.57 466.99 475.57 468.80 519.38 581.19 563.01 537.04 546.91 539.12

53 471.99 528.16 511.64 488.04 497.01 489.93 542.79 607.39 588.39 561.25 571.56 563.42

54 493.97 552.76 535.47 510.77 520.16 512.75 568.07 635.67 615.79 587.39 598.18 589.66

55 515.96 577.35 559.30 533.50 543.30 535.56 593.35 663.96 643.19 613.52 624.80 615.90

56 539.79 604.02 585.13 558.14 568.39 560.30 620.75 694.62 672.90 641.86 653.65 644.34

57 563.85 630.95 611.21 583.02 593.73 585.27 648.43 725.59 702.89 670.47 682.79 673.07

58 589.53 659.68 639.05 609.57 620.78 611.93 677.96 758.64 734.91 701.01 713.89 703.72

59 602.26 673.92 652.85 622.73 634.18 625.14 692.59 775.01 750.77 716.14 729.30 718.91

60 627.94 702.66 680.68 649.29 661.22 651.80 722.13 808.06 782.79 746.68 760.40 749.57

61 650.15 727.52 704.76 672.25 684.61 674.86 747.67 836.65 810.48 773.09 787.30 776.08

62 664.73 743.83 720.56 687.33 699.96 689.99 764.43 855.40 828.65 790.43 804.95 793.48

63 683.00 764.28 740.38 706.23 719.20 708.96 785.45 878.92 851.43 812.16 827.08 815.30

64 and over 694.11 776.70 752.42 717.71 730.89 720.48 798.23 893.22 865.28 825.36 840.53 828.56



Yakima


Regence BlueShield

RATE SCHEDULE


King


Klickitat, Skamania

Page 12 of 12

Documents

Regence BlueShield RATE SCHEDULE Plan Information Plan ......Individual Nongrandfathered Health Plan 87718WA2190002 Plan Information Plan Name: Regence Cascade Silver Individual and