|
Blue Advantage
$20 Office Visits — 80 / 20% Coinsurance
Copays before the deductible for office,
clinic and urgent care center visits
Updated Oct 2009
|
|
Age |
$500
|
$1,000
|
|
Male
|
Female
|
Male
|
Female
|
| Under 20 |
$134.43
|
$134.43
|
$126.71
|
$126.71
|
| 20 - 24 |
$159.47
|
$170.24
|
$151.87
|
$161.58
|
| 25 - 29 |
$168.36
|
$195.27
|
$159.59
|
$185.09
|
| 30 - 34 |
$215.05
|
$254.48
|
$204.40
|
$241.49
|
| 35 - 39 |
$236.46
|
$274.13
|
$224.06
|
$260.91
|
| 40 - 44 |
$283.14
|
$308.30
|
$268.87
|
$292.15
|
| 45 - 49 |
$318.94
|
$335.09
|
$301.74
|
$317.54
|
| 50 - 54 |
$380.02
|
$390.66
|
$360.24
|
$370.07
|
| 55 - 59 |
$428.34
|
$440.86
|
$407.04
|
$418.74
|
| 60 - 64 |
$507.20
|
$507.20
|
$481.10
|
$481.10
|
| Child |
$105.77*
|
$99.33*
|
|
|
HSA - Health Savings Account
High Deductible Health Plan
You open a separate Tax Deductible Account
and pay for your own expenses
Updated Oct 2009
|
|
Age |
$2,500 Single
$5,000 Family
|
$3,500 Single
$7,000 Family
|
|
Male
|
Female
|
Male
|
Female
|
| Under 20 |
$73.48
|
$73.48
|
$68.09
|
$68.09
|
| 20 - 24 |
$88.10
|
$93.37
|
$79.91
|
$85.06
|
| 25 - 29 |
$92.08
|
$107.87
|
$83.77
|
$98.28
|
| 30 - 34 |
$118.17
|
$140.75
|
$108.69
|
$129.64
|
| 35 - 39 |
$130.22
|
$151.28
|
$120.51
|
$140.28
|
| 40 - 44 |
$156.43
|
$169.53
|
$144.03
|
$156.08
|
| 45 - 49 |
$176.09
|
$185.45
|
$162.51
|
$170.47
|
| 50 - 54 |
$208.96
|
$214.11
|
$192.70
|
$197.73
|
| 55 - 59 |
$236.69
|
$243.13
|
$217.27
|
$222.65
|
| 60 - 64 |
$278.69
|
$278.69
|
$256.93
|
$256.93
|
| Child |
$57.92*
|
$53.82*
|
|
Add up rate for EACH spouse, then add * Child rate for up to 3
children (rest covered no extra charge)
*
ValueCare Network uses (ie Jordan Valley,
Pioneer, Primary Children's, St Marks, University of Utah, Davis, Tooele
Regional, Timpanogos, Mountain View, Utah Valley, Ogden Regional, Dixie,
Castleview, Logan Regional, Brigham Community, Bear River)
Note: The new Traditional Network uses (virtually - 98% of)
ALL Doctors & ALL Hospitals in Utah |
|
Apply by the 20th for effective dates of the 1st of the next month |
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Get
Application Now |
If you like what you see, submit form above or
call Greg at (801) 406-9502 or
email inquiries to:
gwdavies@gmail.com
If you like what you see, submit form above or
call Greg at (801) 406-9502 or
email inquiries to:
446save@gmail.com |
 |
BlueAdvantage Plan with Regence
ValueCare OR Traditional Network
Rate Sheet for
Traditional Health Plans -
Summary of Benefits -
Drug Plan
Rate Sheet
for HSA Health Savings Account Plans -
Summary of Benefits (HSA)
|
Deductible Options
|
$500, $1000 |
|
Annual Out-of-Pocket Maximum (includes medical deductible)
|
$2,500, $5,000, $7,500 (dependent on deductible) |
|
Coinsurance Level
|
80%/20% In-Network
60%/40% Out-of-Network |
|
Physician Network
|
Regence ValueCare Network / Traditional is ALL Utah Providers &
Facilities (Costs a little more) |
|
Maximum Benefit
|
$2 Million |
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Office/Clinic & Urgent Care / Preventive Care
|
$20 Copay
(Deductible Waived) |
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Supplemental Accidental Injury / Life-Threatening Illness
|
$1,000 per member per calendar year |
|
Prescriptions
|
$5 for generic
25% for non-formulary
50% for formulary |
|
Maternity
|
$5000 Copayment
per pregnancy (Deductible Waived) |
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Mental Health Condition Services
|
After Deductible, We pay 50% of Eligible Medical Expenses - You Pay 50%
Note: Does NOT go towards out of pocket maximum |
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Minor Diagnostic Tests
|
You pay $20 Copayment per visit (Deductible Waived) |
|
|
$5000 Copayment
per pregnancy (Deductible Waived) |
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Maternity
|
$5000 Copayment
per pregnancy (Deductible Waived) |
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Special Beginnings (Maternity Program / Pre-Natal)
|
You pay Nothing |
Regence HSA Healthplan - ValueCare or Traditional Network
Rate Sheet for
Traditional Health Plans -
Summary of Benefits -
Drug Plan
Rate Sheet
for HSA Health Savings Account Plans -
Summary of Benefits (HSA)
|
Deductible Options
|
Single/Family: $1,500/3,000 $2,500/5,000 $3,500/7,000 |
|
Annual Out-of-Pocket Maximum (includes medical deductible)
|
$5,000
Single (One Person), $10,000 Family |
|
Coinsurance Level
|
80%/20% In-Network
60%/40% Out-of-Network |
|
Physician Network
|
Regence ValueCare Network / Traditional is ALL Utah Providers &
Facilities (Costs a little more) |
|
Maximum Benefit
|
$2 Million |
|
All Medical Services
|
After Deductible, We pay 80% You pay 20% |
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Supplemental Accident
|
N/A |
|
Prescriptions
|
Discount Card |
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Maternity
|
Not Covered (No In-Network Discounting, Non Covered Event) |
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HSA Account
|
Eligible for you to open an HSA Account. You withdraw from this account to
pay for all medically necessary expenditures. Can be tax deductible in most
cases. |
If you like what you see, submit form above or
call Greg at (801) 406-9502 or
email inquiries to:
446save@gmail.com |
|
** The information generated on this page must be considered an
estimate only. Actual rates will be the rates in effect on the date the
application is signed. All quotes are subject to verification by insurer.
Contact us for details. Page layout design copyright © 2000 Utah Health and
Life Insurance Benefit Plans (www.446save.com).
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