2019 Individual Product Rates All Rating Areas

Transcription

1 Regence BlueCross BlueShield 2019 Individual Product s All Rating Areas Summary of Plan Options - All Rating Areas Metal Level HHS Plan ID Exchange Status Available in Rating Areas Bronze 77969OR Off Exchange 1 Bronze 77969OR Off Exchange 1 Silver 77969OR Off Exchange 1 Silver Silver 3000 EPO 77969OR Off Exchange 1 Silver Silver Plan EPO 77969OR Off Exchange 1 Bronze 77969OR Off Exchange 6 Bronze 77969OR Off Exchange 6 Silver 77969OR Off Exchange 6 Silver Silver Plan EPO 77969OR Off Exchange 6 *Plans may not be available in all counties within a rating area. See rate sheets for list of available counties. Policy Name Regence Dental, Vision and Individual Assistance Program Policy Additional Stand-alone Benefits RATES_0119_REG_OR_ALL s Effective 1/1/2019 Page 1 of 6

2 Regence BlueCross BlueShield 2019 Individual Product s Clackamas, Multnomah, Washington Rating Area 1 : OHSU PLUS *Plans are available in only Clackamas, Multnomah, and Washington counties. NON- Silver Silver Bronze Silver Silver Bronze Silver 3000 EPO OHSU Silver 3000 EPO OHSU HHS Plan ID 77969OR OR OR OR OR OR Exchange Status Off Exchange Off Exchange Off Exchange Off Exchange Off Exchange Off Exchange Monthly Premium Monthly Premium Monthly Premium Monthly Premium Monthly Premium Monthly Premium 0-20 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $1, $1, $ $ $ $ $1, $1, $ $ $ $ $1, $1, $ $ $ $ $1, $1, $ $ $1, $ $1, $1, $ $ $1, $ $1, $1, $ RATES_0119_REG_OR_A1 s Effective 1/1/2019 Page 2 of 6

3 Regence BlueCross BlueShield 2019 Individual Product s Clackamas, Multnomah, Washington Rating Area 1 : OHSU PLUS *Plans are available in only Clackamas, Multnomah, and Washington counties. NON- Silver Bronze Silver Bronze Silver Plan EPO OHSU Silver Plan EPO OHSU HHS Plan ID 77969OR OR OR OR Exchange Status Off Exchange Off Exchange Off Exchange Off Exchange Monthly Premium Monthly Premium Monthly Premium Monthly Premium 0-20 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $1, $ $ $ $1, $ $ $ $1, $ $ $ $1, $ $ $ $1, $ RATES_0119_REG_OR_A1 s Effective 1/1/2019 Page 3 of 6

4 Regence BlueCross BlueShield 2019 Individual Product s Baker, Crook, Gilliam, Grant, Harney, Hood River, Jefferson, Malheur, Morrow, Sherman, Umatilla, Union, Wallowa, Wasco, Wheeler Rating Area 6 : INDIVIDUAL AND FAMILY NETWORK NON- Silver Bronze Silver Silver Bronze Silver Silver Plan EPO Silver Plan EPO HHS Plan ID 77969OR OR OR OR OR OR Exchange Status Off Exchange Off Exchange Off Exchange Off Exchange Off Exchange Off Exchange Monthly Premium Monthly Premium Monthly Premium Monthly Premium Monthly Premium Monthly Premium 0-20 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $1, $ $ $ $1, $ $1, $ $ $ $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $1, $1, $1, $ $1, $1, $1, $1, $1, $ $1, $1, $1, $1, RATES_0119_REG_OR_A6 s Effective 1/1/2019 Page 4 of 6

5 Regence BlueCross BlueShield 2019 Individual Product s Baker, Crook, Gilliam, Grant, Harney, Hood River, Jefferson, Malheur, Morrow, Sherman, Umatilla, Union, Wallowa, Wasco, Wheeler Rating Area 6 : INDIVIDUAL AND FAMILY NETWORK NON- Bronze Bronze HHS Plan ID 77969OR OR Exchange Status Off Exchange Off Exchange Monthly Premium Monthly Premium 0-20 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $1, $ $1, RATES_0119_REG_OR_A6 s Effective 1/1/2019 Page 5 of 6

6 Regence BlueCross BlueShield 2019 Individual Product s How to Calculate Your Step 1: Choose your plan. (Example: ) Step 2: Find each member rate. Find your rate based on your age, area* and tobacco usage. Then, find the rate(s) associated with the other applicant(s). APPLICANT(S) Is Tobacco User? Monthly Self $ Spouse $ Per Child # of Children Monthly Children ( 0-20)** $ Per Child # of Children Monthly Children ( 21-24)*** $ Per Child # of Children Monthly Children ( 25)*** $ Step 3: Calculate the Total Monthly (Add monthly rate for Self, Spouse & Children) Total Monthly $ *Area is based on the location of the subsciber for all members. **You will only be charged for up to three children under 21 years of age per family. No additional charge thereafter for children under 21 years of age. Tobacco rates do not apply to children under 21 years of age. ***Tobacco rates are applicable for children 21 years of age or older. PLEASE NOTE: HSA Plans have single deductibles and family deductibles. The single deductibles apply when there is only one person on the contract. If there is more than one person on the contract (two adults, adult and child, two adults and child(ren)), then the family deductibles will apply. How To Calculate Your s Effective 1/1/2019 Page 6 of 6