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    You have indicated (Two Party) coverage.
There are many plan options. Our experience has shown these designs have the best value:

Apply Now!

250 deductible options 500 deductible options 1000 deductible options 2500 deductible options
Select-Value=800 Physicians
Select-Med=1,900 Physicians
Select-Care=2,800 Physicians

Plan description for 80%
Plan description for 70%

  1. 80%

  2. 70%

  1. 80%
  2. 70%
  1. 80%
  2. 70%
  1. 80%
  2. 70%

    


 

80/20 - 250 Deductible                    

Office Copays-> $15 for Level 1 Doctors
$25 for Level 2 Doctors
Hospital Deductible $250 with 80/20 coverage
Rx Copays $10 for generic Rx
25% for name brand Rx
50% for Non Formulary Rx

Rate Example
Age 32 Single Male w/ One Child

  Select Med 
   Base-level
     -$236
   Mid-level
     - $264
   High-level
     - $295

 

 
To Calculate
Locate the age
of the oldest
family member
enrolling. Then
follow grid to the right to get price.
Base-Level 
Clarification>
Office & Rx copays apply AFTER the deductible is met.



 
Mid-Level
Clarification>
Office copays apply
immediately. Rx copays
apply after deductible
is met.
 

 

High-Level
Clarification>
Office & Rx copays apply
immediately. Deductible
applies to hospital billed
charges.


 

AGE
0-19 -->
20-24 ->
25-29 ->
30-34 ->
35-39 ->
40-44 ->
45-49 ->
50-54 ->
55-59 ->
60-64 ->

SelectValue
147
167
189
217
221
260
309
367
450
556

Select Med
160
181
206
236
240
282
336
398
489
604

SelectCare
176
199
227
259
364
310
369
438
538
665

SelectValue
167
189
215
246
250
295
350
416
510
631

Select Med
179
203
231
264
269
316
376
447
548
677

SelectCare
199
225
256
293
298
351
417
495
608
751

SelectValue
187
211
240
275
280
329
391
465
570
705

Select Med
200
227
258
295
300
353
420
499
612
757

SelectCare
222
252
286
327
333
392
466
554
680
840

 


 

70/30 - 250 Deductible

Office Copays-> $15 for Level 1 Doctors
$25 for Level 2 Doctors
Hospital Deductible $250 with 70/30 coverage
Rx Copays $10 for generic Rx
25% for name brand Rx
50% for Non Formulary Rx

Rate Example
Age 32 Single Male w/ One Child

    Select Med 
   Base-level
     -$225
   Mid-level
     - $250
   High-level
     - $279

 

 
To Calculate
Locate the age
of the oldest
family member
enrolling. Then
follow grid to the right to get price.
Base-Level
Clarification>
Office & Rx copays apply AFTER the deductible is met.


 
Mid-Level
Clarification>
Office copays apply
immediately. Rx copays
apply after deductible
is met.
 
High-Level
Clarification>
Office & Rx copays apply
immediately. Deductible
applies to hospital billed
charges.
 
AGE
0-19 -->
20-24 ->
25-29 ->
30-34 ->
35-39 ->
40-44 ->
45-49 ->
50-54 ->
55-59 ->
60-64 ->

SelectValue
141
159
181
207
211
248
295
350
430
531

Select Med
153
173
197
225
229
270
321
381
467
577

SelectCare
168
190
216
248
252
297
353
419
514
635

SelectValue
158
179
203
232
237
279
331
393
483
596

Select Med
170
192
218
250
254
299
356
422
518
640

SelectCare
188
213
242
277
282
332
395
468
575
710

SelectValue
176
200
227
260
264
311
370
439
539
666

Select Med
189
214
244
279
284
334
397
472
579
715

SelectCare
210
238
271
309
315
371
441
523
643
794

 


 

80/20 - 500 Deductible                  

Office Copays-> $15 for Level 1 Doctors
$25 for Level 2 Doctors
Hospital Deductible $500 with 80/20 coverage
Rx Copays $10 for generic Rx
25% for name brand Rx
50% for Non Formulary Rx

Rate Example
Age 36 Male w/ Spouse

Select Med 
  Base-level
     - $212
  Mid-level
     - $248
  High-level
     - $277

 

 
To Calculate
Locate the age
of the oldest
family member
enrolling. Then
follow grid to the right to get price.
Base-Level
Clarification>
Office & Rx copays apply AFTER the deductible is met.



 
Mid-Level
Clarification>
Office copays apply
immediately. Rx copays
apply after deductible
is met.
High-Level
Clarification>
Office & Rx copays apply
immediately. Deductible
applies to hospital billed
charges.

 
AGE
0-19 -->
20-24 ->
25-29 ->
30-34 ->
35-39 ->
40-44 ->
45-49 ->
50-54 ->
55-59 ->
60-64 ->

SelectValue
130
147
168
192
195
230
273
324
398
492

Select Med
142
160
182
208
212
250
297
353
433
535

SelectCare
156
176
201
229
233
275
327
388
476
588

SelectValue
151
171
195
223
227
267
318
377
463
572

Select Med
165
187
213
243
248
291
347
411
505
624

SelectCare
180
204
232
265
270
317
377
448
550
680

SelectValue
169
192
218
249
254
299
355
422
518
640

Select Med
185
209
238
272
277
326
388
460
565
698

SelectCare
201
228
259
296
302
355
422
501
615
760

 


 

70/30 - 500 Deductible                

Office Copays-> $15 for Level 1 Doctors
$25 for Level 2 Doctors
Hospital Deductible $500 with 70/30 coverage
Rx Copays $10 for generic Rx
25% for name brand Rx
50% for Non Formulary Rx

Rate Example
Age 36 Male w/ Spouse

Select Med 
  Base-level
     - $205
  Mid-level
     - $234 
  High-level
     - $262

 

 
To Calculate
Locate the age
of the oldest
family member
enrolling. Then
follow grid to the right to get price.
Base-Level
Clarification>
Office & Rx copays apply AFTER the deductible is met.


 
Mid-Level
Clarification>
Office copays apply
immediately. Rx copays
apply after deductible
is met.
 
High-Level
Clarification>
Office & Rx copays apply
immediately. Deductible
applies to hospital billed
charges.
 
AGE
0-19 -->
20-24 ->
25-29 ->
30-34 ->
35-39 ->
40-44 ->
45-49 ->
50-54 ->
55-59 ->
60-64 ->

SelectValue
126
143
162
185
189
222
264
314
385
476

Select Med
137
155
176
202
205
242
287
341
419
517

SelectCare
151
171
194
222
226
266
316
375
461
569

SelectValue
143
162
184
211
215
253
300
357
438
541

Select Med
156
177
201
230
234
276
328
389
478
590

SelectCare
170
193
219
250
255
300
357
424
520
643

SelectValue
160
181
206
236
240
283
336
399
490
605

Select Med
175
198
225
257
262
308
367
435
534
660

SelectCare
190
215
245
280
285
336
399
474
582
719

 


 

80/20 - 1000 Deductible              

Office Copays-> $15 for Level 1 Doctors
$25 for Level 2 Doctors
Hospital Deductible $1000 with 80/20 coverage
Rx Copays $10 for generic Rx
25% for name brand Rx
50% for Non Formulary Rx

Rate Example
Age 36 Male w/ Spouse

Select Med 
  Base-level
     - $192
  Mid-level
     - $n/a
  High-level
     - $255

 

 
To Calculate
Locate the age
of the oldest
family member
enrolling. Then
follow grid to the right to get price.
Base-Level
Clarification>
Office & Rx copays apply AFTER the deductible is met.



 
Mid-Level
Clarification>
Office copays apply
immediately. Rx copays
apply after deductible
is met.

 
High-Level
Clarification>
Office & Rx copays apply
immediately. Deductible
applies to hospital billed
charges.
AGE
0-19 -->
20-24 ->
25-29 ->
30-34 ->
35-39 ->
40-44 ->
45-49 ->
50-54 ->
55-59 ->
60-64 ->

SelectValue
118
133
152
173
176
208
247
293
360
445

SelectMed
128
145
165
188
192
226
268
319
391
483

SelectCare
141
159
181
207
211
248
295
351
430
532

Not
Available

SelectValue
1159
180
205
234
238
280
333
396
486
600

SelectMed
170
192
219
250
255
300
356
423
519
642

SelectCare
187
211
241
275
280
330
392
465
571
706

 


 

70/30 - 1000 Deductible             

Office Copays-> $15 for Level 1 Doctors
$25 for Level 2 Doctors
Hospital Deductible $1000 with 70/30 coverage
Rx Copays $10 for generic Rx
25% for name brand Rx
50% for Non Formulary Rx

Rate Example
Age 36 Male w/ Spouse

Select Med 
  Base-level
     - $186
  Mid-level
     - $n/a
  High-level
     - $236

 

 
To Calculate
Locate the age
of the oldest
family member
enrolling. Then
follow grid to the right to get price.
Base-Level
Clarification>
Office & Rx copays apply AFTER the deductible is met.


 
Mid-Level
Clarification>
Office copays apply
immediately. Rx copays
apply after deductible
is met.
 
High-Level
Clarification>
Office & Rx copays apply
immediately. Deductible
applies to hospital billed
charges.
 
AGE
0-19 -->
20-24 ->
25-29 ->
30-34 ->
35-39 ->
40-44 ->
45-49 ->
50-54 ->
55-59 ->
60-64 ->

SelectValue
114
130
147
168
171
202
240
285
350
432

SelectMed
124
141
160
183
186
219
261
310
380
470

SelectCare
137
155
176
201
205
241
287
341
418
517

Not
Available

SelectValue
150
170
193
221
225
265
315
374
459
568

SelectMed
161
182
207
236
241
283
337
400
491
607

SelectCare
177
200
227
260
265
312
371
440
540
667

 


 

80/20 - 2500 Deductible       

Office Copays-> $15 for Level 1 Doctors
$25 for Level 2 Doctors
Hospital Deductible $2500 with 80/20 coverage
Rx Copays $10 for generic Rx
25% for name brand Rx
50% for Non Formulary Rx

Rate Example
Age 38 Single Male w/ One Child

   Select Med 
   Base-level
     -$169
   Mid-level
     - $n/a
   High-level
     - $
n/a

 

 
To Calculate
Locate the age
of the oldest
family member
enrolling. Then
follow grid to the right to get price.
Base-Level
Clarification>
Office & Rx copays apply AFTER the deductible is met.


 
Mid-Level
Clarification>
Office copays apply
immediately. Rx copays
apply after deductible
is met.
 
High-Level
Clarification>
Office & Rx copays apply
immediately. Deductible
applies to hospital billed
charges.
 
AGE
0-19 -->
20-24 ->
25-29 ->
30-34 ->
35-39 ->
40-44 ->
45-49 ->
50-54 ->
55-59 ->
60-64 ->

SelectValue
104
117
134
153
155
183
218
258
317
392

SelectMed
113
128
145
166
169
199
237
281
345
426

SelectCare
124
140
160
183
186
219
260
309
379
469

Not
Available
Not
Available

 


 

70/30 - 2500 Deductible       

Office Copays-> $15 for Level 1 Doctors
$25 for Level 2 Doctors
Hospital Deductible $2500 with 70/30 coverage
Rx Copays $10 for generic Rx
25% for name brand Rx
50% for Non Formulary Rx

Rate Example
Age 38 Single Male w/ One Child

   Select Med 
   Base-level
     -$163
   Mid-level
     - $n/a
   High-level
     - $
n/a

 

 
To Calculate
Locate the age
of the oldest
family member
enrolling. Then
follow grid to the right to get price.
Base-Level
Clarification>
Office & Rx copays apply AFTER the deductible is met.


 
Mid-Level
Clarification>
Office copays apply
immediately. Rx copays
apply after deductible
is met.
 
High-Level
Clarification>
Office & Rx copays apply
immediately. Deductible
applies to hospital billed
charges.
 
AGE
0-19 -->
20-24 ->
25-29 ->
30-34 ->
35-39 ->
40-44 ->
45-49 ->
50-54 ->
55-59 ->
60-64 ->

SelectValue
102
115
131
150
152
179
213
253
311
384

SelectMed
111
125
142
163
166
195
232
275
338
418

SelectCare
122
138
157
179
182
215
255
303
372
459

Not
Available
Not
Available

 


 

Disclaimer   

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.