BluePreferred Underwritten -- District of Columbia
Monthly Premium Rates Effective: January 1, 2007
* To Include a Maternity Benefit Add $126 To the Monthly Premium Rate
Click on the desired link to go directly to the rates for that plan or scroll down. Links below indicate member's In-Network/Out-of-Network deductibles and Insurance Carrier's share of coinsurance.
100/300 Deductible with 90/70 Coinsurance
300/600 Deductible with 80/60 Coinsurance
500/1000 Deductible with 80/60 Coinsurance
750/1500 Deductible with 80/60 Coinsurance
| In Network: $100 Deductible, 90%/10% Coinsurance, $2,500 Out of Pocket | ||||
| Out of Network: $300 Deductible, 70%/30% Coinsurance, $5,000 Out of Pocket | ||||
| Prescription: $10/$25/$45 Copays, $100 Deductible, $1,500 Annual Max | ||||
| AGE AT EFFECTIVE DATE | INDIVIDUAL | INDIVIDUAL & CHILDREN | INDIVIDUAL & ADULT | FAMILY |
| 1-5 | $130 | |||
| 6-17 | $116 | $221 | $232 | $313 |
| 18-20 | $168 | $320 | $337 | $454 |
| 21 | $171 | $326 | $343 | $463 |
| 22 | $174 | $331 | $348 | $468 |
| 23 | $180 | $343 | $360 | $485 |
| 24 | $182 | $348 | $364 | $493 |
| 25 | $186 | $351 | $370 | $499 |
| 26 | $190 | $362 | $381 | $516 |
| 27 | $194 | $368 | $387 | $521 |
| 28 | $196 | $373 | $393 | $529 |
| 29 | $202 | $384 | $403 | $543 |
| 30 | $205 | $389 | $409 | $551 |
| 31 | $211 | $401 | $420 | $568 |
| 32 | $213 | $403 | $426 | $574 |
| 33 | $219 | $414 | $437 | $591 |
| 34 | $221 | $420 | $443 | $596 |
| 35 | $227 | $432 | $453 | $613 |
| 36 | $230 | $437 | $459 | $618 |
| 37 | $235 | $448 | $470 | $634 |
| 38 | $240 | $457 | $482 | $649 |
| 39 | $244 | $462 | $486 | $657 |
| 40 | $249 | $473 | $498 | $671 |
| 41 | $260 | $495 | $520 | $702 |
| 42 | $274 | $520 | $548 | $740 |
| 43 | $285 | $542 | $570 | $768 |
| 44 | $298 | $567 | $598 | $807 |
| 45 | $313 | $595 | $625 | $843 |
| 46 | $327 | $620 | $654 | $882 |
| 47 | $341 | $648 | $681 | $918 |
| 48 | $358 | $678 | $714 | $965 |
| 49 | $374 | $712 | $747 | $1,009 |
| 50 | $391 | $742 | $781 | $1,054 |
| 51 | $407 | $772 | $815 | $1,098 |
| 52 | $426 | $811 | $853 | $1,151 |
| 53 | $446 | $848 | $892 | $1,203 |
| 54 | $465 | $884 | $931 | $1,257 |
| 55 | $488 | $928 | $975 | $1,317 |
| 56 | $509 | $970 | $1,020 | $1,376 |
| 57 | $534 | $1,017 | $1,070 | $1,443 |
| 58 | $557 | $1,059 | $1,114 | $1,503 |
| 59 | $585 | $1,111 | $1,169 | $1,578 |
| 60 | $610 | $1,158 | $1,219 | $1,645 |
| 61 | $637 | $1,211 | $1,275 | $1,720 |
| 62 | $668 | $1,270 | $1,336 | $1,803 |
| 63 | $699 | $1,328 | $1,397 | $1,886 |
| 64 | $729 | $1,386 | $1,458 | $1,967 |
| 65 | $762 | $1,450 | $1,525 | $2,058 |
| 66 and over | $799 | $1,516 | $1,597 | $2,155 |
| * To Include a Maternity Benefit Add $126 To the Monthly Premium Rate | ||||
| In Network: $300 Deductible, 80%/20% Coinsurance, $2,500 Out of Pocket | ||||
| Out of Network: $600 Deductible, 60%/40% Coinsurance, $5,000 Out of Pocket | ||||
| Prescription: $10/$25/$45 Copays, $100 Deductible, $1,500 Annual Max | ||||
| AGE AT EFFECTIVE DATE | INDIVIDUAL | INDIVIDUAL & CHILDREN | INDIVIDUAL & ADULT | FAMILY |
| 1-5 | $96 | |||
| 6-17 | $85 | $162 | $170 | $230 |
| 18-20 | $123 | $235 | $247 | $333 |
| 21 | $126 | $239 | $252 | $339 |
| 22 | $127 | $243 | $255 | $343 |
| 23 | $132 | $252 | $264 | $356 |
| 24 | $134 | $255 | $267 | $362 |
| 25 | $136 | $258 | $271 | $366 |
| 26 | $140 | $265 | $279 | $378 |
| 27 | $142 | $270 | $284 | $381 |
| 28 | $144 | $273 | $288 | $387 |
| 29 | $148 | $282 | $296 | $398 |
| 30 | $150 | $285 | $300 | $404 |
| 31 | $154 | $294 | $308 | $416 |
| 32 | $156 | $296 | $312 | $420 |
| 33 | $160 | $303 | $320 | $433 |
| 34 | $162 | $308 | $324 | $437 |
| 35 | $166 | $316 | $332 | $449 |
| 36 | $168 | $320 | $336 | $452 |
| 37 | $173 | $329 | $344 | $464 |
| 38 | $176 | $335 | $353 | $475 |
| 39 | $179 | $338 | $356 | $481 |
| 40 | $182 | $347 | $365 | $491 |
| 41 | $191 | $362 | $380 | $514 |
| 42 | $200 | $380 | $401 | $542 |
| 43 | $209 | $397 | $418 | $562 |
| 44 | $218 | $415 | $438 | $591 |
| 45 | $229 | $436 | $457 | $617 |
| 46 | $239 | $454 | $478 | $645 |
| 47 | $250 | $474 | $498 | $671 |
| 48 | $262 | $496 | $522 | $706 |
| 49 | $274 | $521 | $547 | $738 |
| 50 | $286 | $543 | $572 | $771 |
| 51 | $298 | $565 | $596 | $803 |
| 52 | $312 | $593 | $624 | $842 |
| 53 | $327 | $620 | $652 | $880 |
| 54 | $340 | $646 | $681 | $919 |
| 55 | $357 | $679 | $713 | $963 |
| 56 | $372 | $709 | $746 | $1,006 |
| 57 | $391 | $744 | $782 | $1,055 |
| 58 | $407 | $774 | $814 | $1,099 |
| 59 | $428 | $812 | $855 | $1,153 |
| 60 | $446 | $847 | $891 | $1,203 |
| 61 | $466 | $885 | $932 | $1,257 |
| 62 | $488 | $928 | $977 | $1,318 |
| 63 | $511 | $971 | $1,021 | $1,378 |
| 64 | $532 | $1,013 | $1,066 | $1,437 |
| 65 | $557 | $1,060 | $1,114 | $1,504 |
| 66 and over | $584 | $1,108 | $1,167 | $1,575 |
| * To Include a Maternity Benefit Add $126 To the Monthly Premium Rate | ||||
| In Network: $500 Deductible, 80%/20% Coinsurance, $2,500 Out of Pocket | ||||
| Out of Network: $1,000 Deductible, 60%/40% Coinsurance, $5,000 Out of Pocket | ||||
| Prescription: $10/$25/$45 Copays, $100 Deductible, $1,500 Annual Max | ||||
| AGE AT EFFECTIVE DATE | INDIVIDUAL | INDIVIDUAL & CHILDREN | INDIVIDUAL & ADULT | FAMILY |
| 1-5 | $89 | - | - | - |
| 6-17 | $80 | $152 | $159 | $215 |
| 18-20 | $115 | $220 | $231 | $312 |
| 21 | $118 | $224 | $235 | $317 |
| 22 | $119 | $227 | $239 | $321 |
| 23 | $123 | $235 | $247 | $333 |
| 24 | $125 | $239 | $250 | $338 |
| 25 | $127 | $241 | $254 | $342 |
| 26 | $131 | $248 | $261 | $354 |
| 27 | $133 | $252 | $265 | $357 |
| 28 | $135 | $256 | $269 | $363 |
| 29 | $139 | $264 | $277 | $372 |
| 30 | $140 | $267 | $281 | $378 |
| 31 | $144 | $275 | $288 | $389 |
| 32 | $146 | $277 | $292 | $393 |
| 33 | $150 | $284 | $299 | $405 |
| 34 | $152 | $288 | $303 | $409 |
| 35 | $156 | $296 | $311 | $420 |
| 36 | $157 | $299 | $315 | $423 |
| 37 | $161 | $307 | $322 | $435 |
| 38 | $165 | $313 | $330 | $444 |
| 39 | $167 | $316 | $333 | $450 |
| 40 | $170 | $324 | $341 | $460 |
| 41 | $178 | $339 | $356 | $481 |
| 42 | $187 | $356 | $375 | $507 |
| 43 | $195 | $371 | $391 | $526 |
| 44 | $204 | $388 | $409 | $553 |
| 45 | $214 | $408 | $428 | $577 |
| 46 | $224 | $425 | $447 | $604 |
| 47 | $233 | $443 | $466 | $628 |
| 48 | $245 | $464 | $489 | $660 |
| 49 | $256 | $487 | $511 | $690 |
| 50 | $267 | $508 | $535 | $721 |
| 51 | $279 | $528 | $557 | $751 |
| 52 | $292 | $555 | $583 | $787 |
| 53 | $305 | $580 | $610 | $823 |
| 54 | $318 | $604 | $637 | $859 |
| 55 | $334 | $635 | $667 | $901 |
| 56 | $348 | $663 | $697 | $941 |
| 57 | $365 | $696 | $731 | $986 |
| 58 | $381 | $724 | $761 | $1,028 |
| 59 | $400 | $760 | $799 | $1,079 |
| 60 | $417 | $792 | $833 | $1,125 |
| 61 | $436 | $828 | $871 | $1,176 |
| 62 | $457 | $868 | $913 | $1,232 |
| 63 | $478 | $908 | $955 | $1,289 |
| 64 | $498 | $947 | $997 | $1,344 |
| 65 | $521 | $991 | $1,042 | $1,406 |
| 66 and over | $546 | $1,036 | $1,091 | $1,473 |
| * To Include a Maternity Benefit Add $126 To the Monthly Premium Rate | ||||
| In Network: $750 Deductible, 80%/20% Coinsurance, $3,500 Out of Pocket | ||||
| Out of Network: $1,500 Deductible, 60%/40% Coinsurance, $7,000 Out of Pocket | ||||
| Prescription: $10/$25/$45 Copays, $100 Deductible, $1,500 Annual Max | ||||
| AGE AT EFFECTIVE DATE | INDIVIDUAL | INDIVIDUAL & CHILDREN | INDIVIDUAL & ADULT | FAMILY |
| 1-5 | $82 | |||
| 6-17 | $73 | $140 | $147 | $198 |
| 18-20 | $106 | $202 | $213 | $286 |
| 21 | $108 | $206 | $216 | $291 |
| 22 | $110 | $209 | $219 | $295 |
| 23 | $113 | $216 | $227 | $306 |
| 24 | $115 | $219 | $230 | $311 |
| 25 | $117 | $222 | $233 | $315 |
| 26 | $120 | $228 | $240 | $325 |
| 27 | $122 | $232 | $244 | $328 |
| 28 | $124 | $235 | $248 | $333 |
| 29 | $128 | $242 | $254 | $342 |
| 30 | $129 | $245 | $258 | $347 |
| 31 | $133 | $253 | $265 | $358 |
| 32 | $134 | $254 | $268 | $361 |
| 33 | $138 | $261 | $275 | $372 |
| 34 | $139 | $265 | $279 | $376 |
| 35 | $143 | $272 | $285 | $386 |
| 36 | $145 | $275 | $289 | $389 |
| 37 | $148 | $282 | $296 | $399 |
| 38 | $151 | $288 | $303 | $408 |
| 39 | $154 | $290 | $306 | $413 |
| 40 | $156 | $298 | $314 | $422 |
| 41 | $164 | $311 | $327 | $442 |
| 42 | $172 | $327 | $345 | $465 |
| 43 | $179 | $341 | $359 | $483 |
| 44 | $187 | $357 | $376 | $508 |
| 45 | $196 | $375 | $393 | $530 |
| 46 | $205 | $390 | $411 | $554 |
| 47 | $214 | $407 | $428 | $577 |
| 48 | $225 | $426 | $449 | $606 |
| 49 | $235 | $447 | $469 | $634 |
| 50 | $246 | $467 | $491 | $662 |
| 51 | $256 | $485 | $512 | $689 |
| 52 | $268 | $509 | $535 | $723 |
| 53 | $280 | $533 | $560 | $755 |
| 54 | $292 | $555 | $585 | $789 |
| 55 | $306 | $583 | $612 | $827 |
| 56 | $320 | $609 | $640 | $864 |
| 57 | $335 | $639 | $671 | $906 |
| 58 | $349 | $665 | $699 | $943 |
| 59 | $367 | $697 | $734 | $990 |
| 60 | $383 | $727 | $765 | $1,033 |
| 61 | $400 | $760 | $800 | $1,079 |
| 62 | $419 | $797 | $838 | $1,131 |
| 63 | $439 | $833 | $876 | $1,183 |
| 64 | $457 | $870 | $915 | $1,234 |
| 65 | $478 | $910 | $956 | $1,291 |
| 66 and over | $501 | $951 | $1,002 | $1,352 |
| * To Include a Maternity Benefit Add $126 To the Monthly Premium Rate | ||||