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You have indicated you are (Single)
for HSA coverage.
There are many plan options.
Our experience has shown these designs have the best value:
Apply Now!
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Preventative Care |
-> |
$15 for
primary Doctors
$25 for specialist Doctors |
|
Doctor Office Visits |
-> |
$15 after deductible for primary doctors
$25 after deductible for specialist doctors |
| Deductible |
-> |
1500
(Single)
3000 (Family) |
| Rx Copays |
-> |
AFTER YOUR DEDUCTIBLE IS MET:
$10 for generic Rx
25% for name brand Rx
50% for Non Formulary Rx |
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Rate Example
Age 32
Single Female
 |
Select Med
IHC-Med
- $86
Select-Med
-
$93
IHC-Care
-
$102 |
|
|
To Calculate
Locate the age
of the oldest
family member
enrolling. Then
follow grid to the right to get price. |
IHC-Med |
Select-Med |
IHC-Care |
AGE
0-19 -->
20-24 ->
25-29 ->
30-34 ->
35-39 ->
40-44 ->
45-49 ->
50-54 ->
55-59 ->
60-64 -> |
Single
63
67
76
86
93
106
122
139
165
200 |
Single
68
72
82
93
101
115
132
151
179
217 |
Single
75
79
90
102
110
126
145
166
197
238 |
|
Preventative Care |
-> |
$15 for
primary Doctors
$25 for specialist Doctors |
|
Doctor Office Visits |
-> |
$15 after deductible for primary doctors
$25 after deductible for specialist doctors |
| Deductible |
-> |
2700
(Single)
5400 (Family) |
| Rx Copays |
-> |
AFTER YOUR DEDUCTIBLE IS MET:
$10 for generic Rx
25% for name brand Rx
50% for Non Formulary Rx |
|
Rate Example
Age 32
Single Female
 |
Select Med
IHC-Med
- $78
Select-Med
-
$84
IHC-Care
-
$92 |
|
|
To Calculate
Locate the age
of the oldest
family member
enrolling. Then
follow grid to the right to get price. |
IHC-Med |
Select-Med |
IHC-Care |
AGE
0-19 -->
20-24 ->
25-29 ->
30-34 ->
35-39 ->
40-44 ->
45-49 ->
50-54 ->
55-59 ->
60-64 -> |
Single
57
60
69
78
84
96
110
126
149
180 |
Single
52
65
75
84
91
103
119
136
161
195 |
Single
68
71
81
92
99
113
131
149
177
215 |
|
Preventative Care |
-> |
$15 for
primary Doctors
$25 for specialist Doctors |
|
Doctor Office Visits |
-> |
Covered 100% after deductible |
| Deductible |
-> |
5000
(Single)
10000 (Family) |
| Rx Copays |
-> |
Covered 100% after deductible |
|
Rate Example
Age 32
Single Female
 |
Select Med
IHC-Med
- $66
Select-Med
-
$71
IHC-Care
-
$78 |
|
|
To Calculate
Locate the age
of the oldest
family member
enrolling. Then
follow grid to the right to get price. |
IHC-Med |
Select-Med |
IHC-Care |
AGE
0-19 -->
20-24 ->
25-29 ->
30-34 ->
35-39 ->
40-44 ->
45-49 ->
50-54 ->
55-59 ->
60-64 -> |
Single
49
51
58
66
71
81
93
106
125
151 |
Single
53
55
63
71
77
87
100
115
136
164 |
Single
57
60
69
78
84
96
110
126
149
180 |
A. These are only estimated monthly
premiums and are subject to change based on underwriting review
B. Premium rates are based on the age
of the oldest family member. The enrollment application must be written with the
oldest family member as the applicant.
C. Premiums under these plans are
subject to adjustment each January 1, if your original effective date is
January 1 through June 30, or each July 1, if your original effective date is
July 1 through December 31.
D. Premiums will increase on the first
of the month following the birthday on which the subscriber (policyholder) moves
from one age category to another.
E. Approval of your application
is subject to IHC Health Plans underwriting requirements and is not guaranteed.
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