Index | Exclusions & Limitations | Locate Providers | Brochure & Application
Plan Benefits:
Evolve Core | Evolve Plus | Evolve HSA 50 | Evolve HSA 80 | Evolve HSA 100
Plan Rates:
Evolve Core | Evolve Plus | Evolve HSA 50 | Evolve HSA 80 | Evolve HSA 100
Evolve HSA 100 Rates
Effective date : 7/1/2010
Valid thru : 9/30/2010
Counties : Available in all counties

Family Status :	Applicant	Applicant and Family
Age	Deductible : 5000
0-24	95.00	N/A
25	148.00	N/A
26	153.00	N/A
27	158.00	N/A
28	160.00	N/A
29	165.00	N/A
30	169.00	N/A
31	172.00	N/A
32	174.00	N/A
33	176.00	N/A
34	179.00	N/A
35	181.00	N/A
36	190.00	N/A
37	202.00	N/A
38	211.00	N/A
39	223.00	N/A
40	232.00	N/A
41	241.00	N/A
42	248.00	N/A
43	257.00	N/A
44	264.00	N/A
45	274.00	N/A
46	283.00	N/A
47	292.00	N/A
48	299.00	N/A
49	309.00	N/A
50	318.00	N/A
51	332.00	N/A
52	343.00	N/A
53	357.00	N/A
54	369.00	N/A
55	383.00	N/A
56	394.00	N/A
57	406.00	N/A
58	418.00	N/A
59	429.00	N/A
60	441.00	N/A
61	452.00	N/A
62	464.00	N/A
63	476.00	N/A
64	487.00	N/A
65+	499.00	N/A
Child	95.00	N/A
Age	Deductible : 10000
0-24	N/A	95.00
25	N/A	148.00
26	N/A	153.00
27	N/A	158.00
28	N/A	160.00
29	N/A	165.00
30	N/A	169.00
31	N/A	172.00
32	N/A	174.00
33	N/A	176.00
34	N/A	179.00
35	N/A	181.00
36	N/A	190.00
37	N/A	202.00
38	N/A	211.00
39	N/A	223.00
40	N/A	232.00
41	N/A	241.00
42	N/A	248.00
43	N/A	257.00
44	N/A	264.00
45	N/A	274.00
46	N/A	283.00
47	N/A	292.00
48	N/A	299.00
49	N/A	309.00
50	N/A	318.00
51	N/A	332.00
52	N/A	343.00
53	N/A	357.00
54	N/A	369.00
55	N/A	383.00
56	N/A	394.00
57	N/A	406.00
58	N/A	418.00
59	N/A	429.00
60	N/A	441.00
61	N/A	452.00
62	N/A	464.00
63	N/A	476.00
64	N/A	487.00
65+	N/A	499.00
Child	N/A	95.00

* - not all of the zip codes are eligible in this county