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    You have indicated you are (Single) 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 Female

Select Med 
    Base-level
     -$125
   Mid-level
     - $140
   High-level
     - $156

 

  
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
82
87
100
115
154
142
165
189
226
275

SelectMed
89
94
109
125
135
154
179
206
245
298

SelectCare
98
104
120
137
148
170
197
226
270
328

SelectValue
93
99
114
130
140
161
187
215
256
312

SelectMed
100
106
122
140
151
173
201
230
275
334

SelectCare
111
117
135
155
167
192
222
256
305
371

SelectValue
104
110
127
145
157
180
209
240
286
348

SelectMed
112
118
136
156
168
193
224
257
307
374

SelectCare
124
131
151
173
187
214
249
286
341
415

 

 

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 Female

  Select Med 
    Base-level
     -$119
   Mid-level
     - $132
   High-level
     - $148

 

  
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
79
83
96
110
118
136
157
181
216
262

SelectMed
85
90
104
119
129
147
171
196
234
285

SelectCare
94
99
115
131
141
162
188
216
258
314

 SelectValue
88
93
108
123
133
152
177
203
242
295

SelectMed
95
100
115
132
143
164
190
218
260
316

SelectCare
105
111
128
147
158
181
210
242
288
351

SelectValue
98
104
120
137
148
170
197
227
270
329

SelectMed
106
112
129
148
159
183
212
243
290
353

SelectCare
117
124
143
164
177
203
235
270
322
392

 

 

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 Single Male

Select Med 
   Base-level
      - $119
  Mid-level
     - $139 
  High-level
     - $155

 

  
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
73
77
89
101
110
126
146
167
200
243

SelectMed
79
84
96
110
119
137
158
182
217
264

SelectCare
87
92
106
121
131
150
174
200
239
291

SelectValue
85
89
103
118
127
146
169
195
232
283

SelectMed
92
98
113
129
139
159
185
212
253
308

SelectCare
100
106
123
140
151
174
201
231
276
336

SelectValue
95
100
115
132
142
163
189
218
260
316

SelectMed
103
109
126
144
155
178
207
237
283
345

SelectCare
112
119
137
157
169
194
225
259
308
375

 

 

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 Single Male

Select Med 
   Base-level
      - $115
  Mid-level
     - $131
  High-level
     - $147

 

  
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
70
74
86
98
106
122
141
162
193
235

SelectMed
76
81
93
107
115
132
153
176
210
255

SelectCare
84
89
103
117
127
145
168
194
231
281

SelectValue
80
85
98
112
120
138
160
184
219
267

SelectMed
87
92
106
122
131
151
175
201
239
291

SelectCare
95
100
116
133
143
164
190
219
261
317

SelectValue
89
95
109
125
135
155
179
206
245
299

SelectMed
98
103
119
136
147
169
195
224
268
326

SelectCare
106
112
130
148
160
184
213
244
292
355

 

 

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 42 Single Female

Select Med 
    Base-level
     -$123
   Mid-level
     - $n/a
   High-level
     - $164

 

  
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
66
70
80
92
99
114
132
151
180
220

SelectMed
71
76
87
100
108
123
143
164
196
239

SelectCare
79
83
96
110
118
136
157
181
216
263

 Not
Available		 Not
Available		 Not
Available

SelectValue
89
94
108
124
134
153
178
204
244
296

SelectMed
95
100
116
132
143
164
190
218
260
317

SelectCare
104
110
127
146
157
180
209
240
286
349

 

 

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 42 Single Female

Select Med 
    Base-level
     -$120
   Mid-level
     - $n/a
   High-level
     - $155

 

  
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
64
68
78
89
96
110
128
147
175
213

SelectMed
69
73
85
97
105
120
139
160
191
232

SelectCare
76
81
93
107
115
132
153
176
210
255

 Not
Available

 

 Not
Available

 

 Not
Available

 

SelectValue
84
89
102
117
126
145
168
193
230
280

SelectMed
90
95
109
125
135
155
180
206
246
300

SelectCare
99
104
120
138
149
170
198
227
271
330

 

 

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 42 Single Male

  Select Med 
    Base-level
     -$109
   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
58
61
71
81
87
100
116
133
159
194

SelectMed
63
67
77
88
95
109
126
145
173
210

SelectCare
69
73
85
97
104
120
139
159
190
231

 Not
Available		 Not
Available		 Not
Available		 Not
Available		 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 42 Single Male

Select Med 
    Base-level
     -$107
   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
57
60
69
79
86
98
114
131
156
190

SelectMed
62
65
75
86
93
107
124
142
169
206

SelectCare
68
72
83
95
102
117
136
156
186
227

 Not
Available		 Not
Available		 Not
Available		 Not
Available		 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.

 

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