regence bluecross blueshield of oregon
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Individual Nongrandfathered Health Plan 71281WA1350004
Plan Information
Plan Name: Gold 1200 EPO PeaceHealth
HIOS Plan ID: 71281WA1350004
Effective Date: 1/1/2021
Market Type: Individual
Exchange Status: Outside the Exchange
Metal Level: Gold
Plan Type: Non-Standardized Plan
Plan Geographic Availability
Area
Number
Available
in area?
1 N/A
2 N/A
3 Yes
4 N/A
5 N/A
6 N/A
7 N/A
8 N/A
9 N/A
Plan Rates
Age
Band Area 1 Area 2 Area 3 Area 4 Area 5 Area 6 Area 7 Area 8 Area 9 Area 1 Area 2 Area 3 Area 4 Area 5 Area 6 Area 7 Area 8 Area 9
0-14 332.29 332.29
15 361.83 361.83
16 373.12 373.12
17 384.42 384.42
18 396.58 396.58
19 408.74 408.74
20 421.34 421.34
21 434.37 499.53
22 434.37 499.53
23 434.37 499.53
24 434.37 499.53
25 436.11 501.52
26 444.79 511.51
27 455.22 523.50
28 472.16 542.98
29 486.06 558.97
30 493.01 566.96
31 503.43 578.95
32 513.86 590.94
33 520.38 598.43
34 527.33 606.42
35 530.80 610.42
36 534.28 614.42
37 537.75 618.41
38 541.23 622.41
39 548.17 630.40
40 555.12 638.39
41 565.55 650.38
42 575.54 661.87
43 589.44 677.86
44 606.81 697.84
45 627.23 721.31
46 651.56 749.29
47 678.92 780.76
48 710.19 816.72
49 741.04 852.19
50 775.78 892.15
51 810.10 931.62
52 847.89 975.07
53 886.11 1019.03
54 927.38 1066.49
55 968.65 1113.94
56 1013.39 1165.39
57 1058.56 1217.34
58 1106.77 1272.79
59 1130.67 1300.26
60 1178.88 1355.71
61 1220.58 1403.67
62 1247.95 1435.14
63 1282.26 1474.60
64 and over 1303.11 1498.58
Non-Smoker Rates Smoker Rates
Regence BlueCross BlueShield of Oregon (Clark County)
RATE SCHEDULE
Counties where this plan is available
Clark
Page 1 of 17
Individual Nongrandfathered Health Plan 71281WA1350005
Plan Information
Plan Name: Silver 3500 EPO PeaceHealth
HIOS Plan ID: 71281WA1350005
Effective Date: 1/1/2021
Market Type: Individual
Exchange Status: Outside the Exchange
Metal Level: Silver
Plan Type: Non-Standardized Plan
Plan Geographic Availability
Area
Number
Available
in area?
1 N/A
2 N/A
3 Yes
4 N/A
5 N/A
6 N/A
7 N/A
8 N/A
9 N/A
Plan Rates
Age
Band Area 1 Area 2 Area 3 Area 4 Area 5 Area 6 Area 7 Area 8 Area 9 Area 1 Area 2 Area 3 Area 4 Area 5 Area 6 Area 7 Area 8 Area 9
0-14 248.17 248.17
15 270.23 270.23
16 278.67 278.67
17 287.10 287.10
18 296.19 296.19
19 305.27 305.27
20 314.68 314.68
21 324.41 373.07
22 324.41 373.07
23 324.41 373.07
24 324.41 373.07
25 325.71 374.56
26 332.20 382.03
27 339.98 390.98
28 352.63 405.53
29 363.01 417.47
30 368.21 423.44
31 375.99 432.39
32 383.78 441.34
33 388.64 446.94
34 393.83 452.91
35 396.43 455.89
36 399.02 458.88
37 401.62 461.86
38 404.21 464.85
39 409.41 470.82
40 414.60 476.79
41 422.38 485.74
42 429.84 494.32
43 440.22 506.26
44 453.20 521.18
45 468.45 538.72
46 486.62 559.61
47 507.05 583.11
48 530.41 609.97
49 553.44 636.46
50 579.40 666.31
51 605.02 695.78
52 633.25 728.24
53 661.80 761.07
54 692.62 796.51
55 723.43 831.95
56 756.85 870.38
57 790.59 909.18
58 826.60 950.59
59 844.44 971.11
60 880.45 1012.52
61 911.59 1048.33
62 932.03 1071.83
63 957.66 1101.31
64 and over 973.23 1119.21
Non-Smoker Rates Smoker Rates
Regence BlueCross BlueShield of Oregon (Clark County)
RATE SCHEDULE
Counties where this plan is available
Clark
Page 2 of 17
Individual Nongrandfathered Health Plan 71281WA1350008
Plan Information
Plan Name: Silver Care on Demand 4000 EPO PeaceHealth
HIOS Plan ID: 71281WA1350008
Effective Date: 1/1/2021
Market Type: Individual
Exchange Status: Outside the Exchange
Metal Level: Silver
Plan Type: Non-Standardized Plan
Plan Geographic Availability
Area
Number
Available
in area?
1 N/A
2 N/A
3 Yes
4 N/A
5 N/A
6 N/A
7 N/A
8 N/A
9 N/A
Plan Rates
Age
Band Area 1 Area 2 Area 3 Area 4 Area 5 Area 6 Area 7 Area 8 Area 9 Area 1 Area 2 Area 3 Area 4 Area 5 Area 6 Area 7 Area 8 Area 9
0-14 238.50 238.50
15 259.70 259.70
16 267.80 267.80
17 275.91 275.91
18 284.64 284.64
19 293.37 293.37
20 302.41 302.41
21 311.76 358.52
22 311.76 358.52
23 311.76 358.52
24 311.76 358.52
25 313.01 359.96
26 319.24 367.13
27 326.72 375.73
28 338.88 389.72
29 348.86 401.19
30 353.85 406.92
31 361.33 415.53
32 368.81 424.13
33 373.49 429.51
34 378.48 435.25
35 380.97 438.12
36 383.46 440.98
37 385.96 443.85
38 388.45 446.72
39 393.44 452.46
40 398.43 458.19
41 405.91 466.80
42 413.08 475.04
43 423.06 486.52
44 435.53 500.86
45 450.18 517.71
46 467.64 537.79
47 487.28 560.37
48 509.73 586.19
49 531.86 611.64
50 556.80 640.32
51 581.43 668.65
52 608.56 699.84
53 635.99 731.39
54 665.61 765.45
55 695.22 799.51
56 727.34 836.44
57 759.76 873.72
58 794.36 913.52
59 811.51 933.24
60 846.12 973.03
61 876.05 1007.45
62 895.69 1030.04
63 920.32 1058.36
64 and over 935.28 1075.56
Non-Smoker Rates Smoker Rates
Regence BlueCross BlueShield of Oregon (Clark County)
RATE SCHEDULE
Counties where this plan is available
Clark
Page 3 of 17
Individual Nongrandfathered Health Plan 71281WA1350007
Plan Information
Plan Name: Bronze HDHP 5700 EPO PeaceHealth
HIOS Plan ID: 71281WA1350007
Effective Date: 1/1/2021
Market Type: Individual
Exchange Status: Outside the Exchange
Metal Level: Bronze
Plan Type: Non-Standardized Plan
Plan Geographic Availability
Area
Number
Available
in area?
1 N/A
2 N/A
3 Yes
4 N/A
5 N/A
6 N/A
7 N/A
8 N/A
9 N/A
Plan Rates
Age
Band Area 1 Area 2 Area 3 Area 4 Area 5 Area 6 Area 7 Area 8 Area 9 Area 1 Area 2 Area 3 Area 4 Area 5 Area 6 Area 7 Area 8 Area 9
0-14 208.21 208.21
15 226.72 226.72
16 233.79 233.79
17 240.87 240.87
18 248.49 248.49
19 256.11 256.11
20 264.00 264.00
21 272.17 313.00
22 272.17 313.00
23 272.17 313.00
24 272.17 313.00
25 273.26 314.25
26 278.70 320.51
27 285.23 328.02
28 295.85 340.23
29 304.56 350.24
30 308.91 355.25
31 315.45 362.76
32 321.98 370.27
33 326.06 374.97
34 330.41 379.98
35 332.59 382.48
36 334.77 384.98
37 336.95 387.49
38 339.12 389.99
39 343.48 395.00
40 347.83 400.01
41 354.37 407.52
42 360.63 414.72
43 369.33 424.73
44 380.22 437.25
45 393.01 451.97
46 408.26 469.49
47 425.40 489.21
48 445.00 511.75
49 464.32 533.97
50 486.10 559.01
51 507.60 583.74
52 531.28 610.97
53 555.23 638.51
54 581.08 668.25
55 606.94 697.98
56 634.97 730.22
57 663.28 762.77
58 693.49 797.51
59 708.46 814.73
60 738.67 849.47
61 764.80 879.52
62 781.94 899.24
63 803.45 923.96
64 and over 816.51 938.99
Non-Smoker Rates Smoker Rates
Regence BlueCross BlueShield of Oregon (Clark County)
RATE SCHEDULE
Counties where this plan is available
Clark
Page 4 of 17
Individual Nongrandfathered Health Plan 71281WA1350003
Plan Information
Plan Name: Bronze Essential 7500 EPO PeaceHealth
HIOS Plan ID: 71281WA1350003
Effective Date: 1/1/2021
Market Type: Individual
Exchange Status: Outside the Exchange
Metal Level: Bronze
Plan Type: Non-Standardized Plan
Plan Geographic Availability
Area
Number
Available
in area?
1 N/A
2 N/A
3 Yes
4 N/A
5 N/A
6 N/A
7 N/A
8 N/A
9 N/A
Plan Rates
Age
Band Area 1 Area 2 Area 3 Area 4 Area 5 Area 6 Area 7 Area 8 Area 9 Area 1 Area 2 Area 3 Area 4 Area 5 Area 6 Area 7 Area 8 Area 9
0-14 201.90 201.90
15 219.85 219.85
16 226.71 226.71
17 233.57 233.57
18 240.96 240.96
19 248.35 248.35
20 256.00 256.00
21 263.92 303.51
22 263.92 303.51
23 263.92 303.51
24 263.92 303.51
25 264.98 304.72
26 270.25 310.79
27 276.59 318.08
28 286.88 329.91
29 295.33 339.63
30 299.55 344.48
31 305.88 351.77
32 312.22 359.05
33 316.18 363.60
34 320.40 368.46
35 322.51 370.89
36 324.62 373.31
37 326.73 375.74
38 328.84 378.17
39 333.07 383.03
40 337.29 387.88
41 343.62 395.17
42 349.69 402.15
43 358.14 411.86
44 368.70 424.00
45 381.10 438.27
46 395.88 455.26
47 412.51 474.38
48 431.51 496.24
49 450.25 517.78
50 471.36 542.07
51 492.21 566.04
52 515.17 592.45
53 538.40 619.16
54 563.47 647.99
55 588.54 676.82
56 615.73 708.08
57 643.17 739.65
58 672.47 773.34
59 686.98 790.03
60 716.28 823.72
61 741.62 852.86
62 758.24 871.98
63 779.09 895.96
64 and over 791.76 910.52
Non-Smoker Rates Smoker Rates
Regence BlueCross BlueShield of Oregon (Clark County)
RATE SCHEDULE
Counties where this plan is available
Clark
Page 5 of 17
Individual Nongrandfathered Health Plan 71281WA1350009
Plan Information
Plan Name: Bronze Care on Demand 8000 EPO PeaceHealth
HIOS Plan ID: 71281WA1350009
Effective Date: 1/1/2021
Market Type: Individual
Exchange Status: Outside the Exchange
Metal Level: Bronze
Plan Type: Non-Standardized Plan
Plan Geographic Availability
Area
Number
Available
in area?
1 N/A
2 N/A
3 Yes
4 N/A
5 N/A
6 N/A
7 N/A
8 N/A
9 N/A
Plan Rates
Age
Band Area 1 Area 2 Area 3 Area 4 Area 5 Area 6 Area 7 Area 8 Area 9 Area 1 Area 2 Area 3 Area 4 Area 5 Area 6 Area 7 Area 8 Area 9
0-14 191.81 191.81
15 208.86 208.86
16 215.38 215.38
17 221.90 221.90
18 228.92 228.92
19 235.94 235.94
20 243.21 243.21
21 250.73 288.34
22 250.73 288.34
23 250.73 288.34
24 250.73 288.34
25 251.73 289.49
26 256.75 295.26
27 262.77 302.18
28 272.54 313.43
29 280.57 322.65
30 284.58 327.27
31 290.60 334.19
32 296.61 341.11
33 300.37 345.43
34 304.39 350.04
35 306.39 352.35
36 308.40 354.66
37 310.40 356.96
38 312.41 359.27
39 316.42 363.88
40 320.43 368.50
41 326.45 375.42
42 332.22 382.05
43 340.24 391.28
44 350.27 402.81
45 362.05 416.36
46 376.10 432.51
47 391.89 450.67
48 409.94 471.44
49 427.75 491.91
50 447.80 514.97
51 467.61 537.75
52 489.42 562.84
53 511.49 588.21
54 535.31 615.60
55 559.13 643.00
56 584.95 672.70
57 611.03 702.68
58 638.86 734.69
59 652.65 750.55
60 680.48 782.55
61 704.55 810.23
62 720.35 828.40
63 740.15 851.18
64 and over 752.19 865.02
Non-Smoker Rates Smoker Rates
Regence BlueCross BlueShield of Oregon (Clark County)
RATE SCHEDULE
Counties where this plan is available
Clark
Page 6 of 17
Individual Nongrandfathered Health Plan 71281WA1360005
Plan Information
Plan Name: Regence Cascade Gold
HIOS Plan ID: 71281WA1360005
Effective Date: 1/1/2021
Market Type: Individual
Exchange Status: Inside the Exchange
Metal Level: Gold
Plan Type: Standardized Non-Public Option Plan
Plan Geographic Availability
Area
Number
Available
in area?
1 N/A
2 N/A
3 Yes
4 N/A
5 N/A
6 N/A
7 N/A
8 N/A
9 N/A
Plan Rates
Age
Band Area 1 Area 2 Area 3 Area 4 Area 5 Area 6 Area 7 Area 8 Area 9 Area 1 Area 2 Area 3 Area 4 Area 5 Area 6 Area 7 Area 8 Area 9
0-14 356.44 356.44
15 388.12 388.12
16 400.23 400.23
17 412.35 412.35
18 425.39 425.39
19 438.44 438.44
20 451.95 451.95
21 465.93 535.82
22 465.93 535.82
23 465.93 535.82
24 465.93 535.82
25 467.79 537.96
26 477.11 548.68
27 488.29 561.54
28 506.47 582.44
29 521.38 599.58
30 528.83 608.16
31 540.01 621.01
32 551.20 633.87
33 558.18 641.91
34 565.64 650.48
35 569.37 654.77
36 573.09 659.06
37 576.82 663.34
38 580.55 667.63
39 588.00 676.20
40 595.46 684.78
41 606.64 697.64
42 617.36 709.96
43 632.27 727.11
44 650.90 748.54
45 672.80 773.72
46 698.90 803.73
47 728.25 837.49
48 761.80 876.06
49 794.88 914.11
50 832.15 956.97
51 868.96 999.30
52 909.50 1045.92
53 950.50 1093.07
54 994.76 1143.97
55 1039.02 1194.88
56 1087.01 1250.07
57 1135.47 1305.79
58 1187.19 1365.27
59 1212.82 1394.74
60 1264.53 1454.21
61 1309.26 1505.65
62 1338.62 1539.41
63 1375.43 1581.74
64 and over 1397.79 1607.46
Non-Smoker Rates Smoker Rates
Regence BlueCross BlueShield of Oregon (Clark County)
RATE SCHEDULE
Counties where this plan is available
Clark
Page 7 of 17
Individual Nongrandfathered Health Plan 71281WA1360006
Plan Information
Plan Name: Regence Cascade Silver
HIOS Plan ID: 71281WA1360006
Effective Date: 1/1/2021
Market Type: Individual
Exchange Status: Inside the Exchange
Metal Level: Silver
Plan Type: Standardized Non-Public Option Plan
Plan Geographic Availability
Area
Number
Available
in area?
1 N/A
2 N/A
3 Yes
4 N/A
5 N/A
6 N/A
7 N/A
8 N/A
9 N/A
Plan Rates
Age
Band Area 1 Area 2 Area 3 Area 4 Area 5 Area 6 Area 7 Area 8 Area 9 Area 1 Area 2 Area 3 Area 4 Area 5 Area 6 Area 7 Area 8 Area 9
0-14 303.52 303.52
15 330.50 330.50
16 340.82 340.82
17 351.13 351.13
18 362.24 362.24
19 373.35 373.35
20 384.86 384.86
21 396.76 456.27
22 396.76 456.27
23 396.76 456.27
24 396.76 456.27
25 398.35 458.10
26 406.28 467.22
27 415.80 478.18
28 431.28 495.97
29 443.97 510.57
30 450.32 517.87
31 459.84 528.82
32 469.37 539.77
33 475.32 546.62
34 481.67 553.92
35 484.84 557.57
36 488.01 561.22
37 491.19 564.87
38 494.36 568.52
39 500.71 575.82
40 507.06 583.12
41 516.58 594.07
42 525.71 604.56
43 538.40 619.16
44 554.27 637.41
45 572.92 658.86
46 595.14 684.41
47 620.14 713.16
48 648.70 746.01
49 676.87 778.40
50 708.61 814.91
51 739.96 850.95
52 774.48 890.65
53 809.39 930.80
54 847.08 974.14
55 884.77 1017.49
56 925.64 1064.49
57 966.90 1111.94
58 1010.94 1162.59
59 1032.77 1187.68
60 1076.81 1238.33
61 1114.90 1282.13
62 1139.89 1310.88
63 1171.24 1346.92
64 and over 1190.28 1368.81
Non-Smoker Rates Smoker Rates
Regence BlueCross BlueShield of Oregon (Clark County)
RATE SCHEDULE
Counties where this plan is available
Clark
Page 8 of 17
Individual Nongrandfathered Health Plan 71281WA1360001
Plan Information
Plan Name: Alliance Silver 3000 Exchange EPO Legacy LHP
HIOS Plan ID: 71281WA1360001
Effective Date: 1/1/2021
Market Type: Individual
Exchange Status: Inside the Exchange
Metal Level: Silver
Plan Type: Non-Standardized Plan
Plan Geographic Availability
Area
Number
Available
in area?
1 N/A
2 N/A
3 Yes
4 N/A
5 N/A
6 N/A
7 N/A
8 N/A
9 N/A
Plan Rates
Age
Band Area 1 Area 2 Area 3 Area 4 Area 5 Area 6 Area 7 Area 8 Area 9 Area 1 Area 2 Area 3 Area 4 Area 5 Area 6 Area 7 Area 8 Area 9
0-14 292.67 292.67
15 318.69 318.69
16 328.64 328.64
17 338.58 338.58
18 349.30 349.30
19 360.01 360.01
20 371.10 371.10
21 382.58 439.97
22 382.58 439.97
23 382.58 439.97
24 382.58 439.97
25 384.11 441.73
26 391.76 450.53
27 400.94 461.09
28 415.86 478.24
29 428.11 492.32
30 434.23 499.36
31 443.41 509.92
32 452.59 520.48
33 458.33 527.08
34 464.45 534.12
35 467.51 537.64
36 470.57 541.16
37 473.63 544.68
38 476.69 548.20
39 482.82 555.24
40 488.94 562.28
41 498.12 572.84
42 506.92 582.96
43 519.16 597.04
44 534.46 614.63
45 552.45 635.31
46 573.87 659.95
47 597.97 687.67
48 625.52 719.35
49 652.68 750.58
50 683.29 785.78
51 713.51 820.54
52 746.80 858.82
53 780.46 897.53
54 816.81 939.33
55 853.15 981.13
56 892.56 1026.44
57 932.35 1072.20
58 974.81 1121.04
59 995.86 1145.23
60 1038.32 1194.07
61 1075.05 1236.31
62 1099.15 1264.03
63 1129.38 1298.78
64 and over 1147.74 1319.90
Non-Smoker Rates Smoker Rates
Regence BlueCross BlueShield of Oregon (Clark County)
RATE SCHEDULE
Counties where this plan is available
Clark
Page 9 of 17
Individual Nongrandfathered Health Plan 71281WA1350010
Plan Information
Plan Name: Alliance Silver 3000 EPO Legacy LHP
HIOS Plan ID: 71281WA1350010
Effective Date: 1/1/2021
Market Type: Individual
Exchange Status: Outside the Exchange
Metal Level: Silver
Plan Type: Non-Standardized Plan
Plan Geographic Availability
Area
Number
Available
in area?
1 N/A
2 N/A
3 Yes
4 N/A
5 N/A
6 N/A
7 N/A
8 N/A
9 N/A
Plan Rates
Age
Band Area 1 Area 2 Area 3 Area 4 Area 5 Area 6 Area 7 Area 8 Area 9 Area 1 Area 2 Area 3 Area 4 Area 5 Area 6 Area 7 Area 8 Area 9
0-14 259.11 259.11
15 282.14 282.14
16 290.94 290.94
17 299.75 299.75
18 309.23 309.23
19 318.72 318.72
20 328.54 328.54
21 338.70 389.51
22 338.70 389.51
23 338.70 389.51
24 338.70 389.51
25 340.05 391.06
26 346.83 398.85
27 354.96 408.20
28 368.17 423.39
29 379.01 435.86
30 384.42 442.09
31 392.55 451.44
32 400.68 460.78
33 405.76 466.63
34 411.18 472.86
35 413.89 475.98
36 416.60 479.09
37 419.31 482.21
38 422.02 485.32
39 427.44 491.56
40 432.86 497.79
41 440.99 507.14
42 448.78 516.09
43 459.62 528.56
44 473.16 544.14
45 489.08 562.45
46 508.05 584.26
47 529.39 608.80
48 553.77 636.84
49 577.82 664.50
50 604.92 695.66
51 631.68 726.43
52 661.14 760.31
53 690.95 794.59
54 723.12 831.59
55 755.30 868.60
56 790.19 908.72
57 825.41 949.22
58 863.01 992.46
59 881.64 1013.88
60 919.23 1057.12
61 951.75 1094.51
62 973.09 1119.05
63 999.84 1149.82
64 and over 1016.10 1168.52
Non-Smoker Rates Smoker Rates
Regence BlueCross BlueShield of Oregon (Clark County)
RATE SCHEDULE
Counties where this plan is available
Clark
Page 10 of 17
Individual Nongrandfathered Health Plan 71281WA1360007
Plan Information
Plan Name: Regence Cascade Bronze
HIOS Plan ID: 71281WA1360007
Effective Date: 1/1/2021
Market Type: Individual
Exchange Status: Inside the Exchange
Metal Level: Bronze
Plan Type: Standardized Non-Public Option Plan
Plan Geographic Availability
Area
Number
Available
in area?
1 N/A
2 N/A
3 Yes
4 N/A
5 N/A
6 N/A
7 N/A
8 N/A
9 N/A
Plan Rates
Age
Band Area 1 Area 2 Area 3 Area 4 Area 5 Area 6 Area 7 Area 8 Area 9 Area 1 Area 2 Area 3 Area 4 Area 5 Area 6 Area 7 Area 8 Area 9
0-14 207.96 207.96
15 226.44 226.44
16 233.51 233.51
17 240.58 240.58
18 248.19 248.19
19 255.80 255.80
20 263.68 263.68
21 271.84 312.62
22 271.84 312.62
23 271.84 312.62
24 271.84 312.62
25 272.93 313.87
26 278.36 320.12
27 284.89 327.62
28 295.49 339.81
29 304.19 349.82
30 308.54 354.82
31 315.06 362.32
32 321.59 369.82
33 325.66 374.51
34 330.01 379.52
35 332.19 382.02
36 334.36 384.52
37 336.54 387.02
38 338.71 389.52
39 343.06 394.52
40 347.41 399.52
41 353.94 407.03
42 360.19 414.22
43 368.89 424.22
44 379.76 436.72
45 392.54 451.42
46 407.76 468.92
47 424.89 488.62
48 444.46 511.13
49 463.76 533.32
50 485.51 558.33
51 506.98 583.03
52 530.63 610.23
53 554.55 637.74
54 580.38 667.44
55 606.20 697.13
56 634.20 729.33
57 662.47 761.85
58 692.65 796.55
59 707.60 813.74
60 737.77 848.44
61 763.87 878.45
62 781.00 898.15
63 802.47 922.84
64 and over 815.52 937.85
Non-Smoker Rates Smoker Rates
Regence BlueCross BlueShield of Oregon (Clark County)
RATE SCHEDULE
Counties where this plan is available
Clark
Page 11 of 17
Individual Nongrandfathered Health Plan 71281WA1350011
Plan Information
Plan Name: Alliance Bronze HDHP 5700 EPO Legacy LHP
HIOS Plan ID: 71281WA1350011
Effective Date: 1/1/2021
Market Type: Individual
Exchange Status: Outside the Exchange
Metal Level: Bronze
Plan Type: Non-Standardized Plan
Plan Geographic Availability
Area
Number
Available
in area?
1 N/A
2 N/A
3 Yes
4 N/A
5 N/A
6 N/A
7 N/A
8 N/A
9 N/A
Plan Rates
Age
Band Area 1 Area 2 Area 3 Area 4 Area 5 Area 6 Area 7 Area 8 Area 9 Area 1 Area 2 Area 3 Area 4 Area 5 Area 6 Area 7 Area 8 Area 9
0-14 205.85 205.85
15 224.15 224.15
16 231.15 231.15
17 238.14 238.14
18 245.68 245.68
19 253.21 253.21
20 261.02 261.02
21 269.09 309.45
22 269.09 309.45
23 269.09 309.45
24 269.09 309.45
25 270.17 310.69
26 275.55 316.88
27 282.01 324.31
28 292.50 336.38
29 301.11 346.28
30 305.42 351.23
31 311.88 358.66
32 318.33 366.08
33 322.37 370.73
34 326.68 375.68
35 328.83 378.15
36 330.98 380.63
37 333.13 383.10
38 335.29 385.58
39 339.59 390.53
40 343.90 395.48
41 350.36 402.91
42 356.54 410.03
43 365.16 419.93
44 375.92 432.31
45 388.57 446.85
46 403.64 464.18
47 420.59 483.68
48 439.96 505.96
49 459.07 527.93
50 480.59 552.68
51 501.85 577.13
52 525.26 604.05
53 548.94 631.29
54 574.51 660.68
55 600.07 690.08
56 627.79 721.96
57 655.77 754.14
58 685.64 788.49
59 700.44 805.51
60 730.31 839.86
61 756.14 869.56
62 773.10 889.06
63 794.35 913.51
64 and over 807.27 928.35
Non-Smoker Rates Smoker Rates
Regence BlueCross BlueShield of Oregon (Clark County)
RATE SCHEDULE
Counties where this plan is available
Clark
Page 12 of 17
Individual Nongrandfathered Health Plan 71281WA1360002
Plan Information
Plan Name: Alliance Bronze HDHP 5700 Exchange EPO Legacy LHP
HIOS Plan ID: 71281WA1360002
Effective Date: 1/1/2021
Market Type: Individual
Exchange Status: Inside the Exchange
Metal Level: Bronze
Plan Type: Non-Standardized Plan
Plan Geographic Availability
Area
Number
Available
in area?
1 N/A
2 N/A
3 Yes
4 N/A
5 N/A
6 N/A
7 N/A
8 N/A
9 N/A
Plan Rates
Age
Band Area 1 Area 2 Area 3 Area 4 Area 5 Area 6 Area 7 Area 8 Area 9 Area 1 Area 2 Area 3 Area 4 Area 5 Area 6 Area 7 Area 8 Area 9
0-14 205.06 205.06
15 223.29 223.29
16 230.25 230.25
17 237.22 237.22
18 244.73 244.73
19 252.24 252.24
20 260.01 260.01
21 268.05 308.26
22 268.05 308.26
23 268.05 308.26
24 268.05 308.26
25 269.12 309.49
26 274.48 315.66
27 280.92 323.05
28 291.37 335.08
29 299.95 344.94
30 304.24 349.87
31 310.67 357.27
32 317.10 364.67
33 321.12 369.29
34 325.41 374.22
35 327.56 376.69
36 329.70 379.16
37 331.85 381.62
38 333.99 384.09
39 338.28 389.02
40 342.57 393.95
41 349.00 401.35
42 355.17 408.44
43 363.74 418.31
44 374.47 430.64
45 387.06 445.12
46 402.08 462.39
47 418.96 481.81
48 438.26 504.00
49 457.29 525.89
50 478.74 550.55
51 499.91 574.90
52 523.23 601.72
53 546.82 628.85
54 572.29 658.13
55 597.75 687.41
56 625.36 719.16
57 653.24 751.22
58 682.99 785.44
59 697.73 802.39
60 727.49 836.61
61 753.22 866.20
62 770.11 885.62
63 791.28 909.98
64 and over 804.15 924.77
Non-Smoker Rates Smoker Rates
Regence BlueCross BlueShield of Oregon (Clark County)
RATE SCHEDULE
Counties where this plan is available
Clark
Page 13 of 17
Individual Nongrandfathered Health Plan 71281WA1350012
Plan Information
Plan Name: Alliance Bronze Essential 7500 EPO Legacy LHP
HIOS Plan ID: 71281WA1350012
Effective Date: 1/1/2021
Market Type: Individual
Exchange Status: Outside the Exchange
Metal Level: Bronze
Plan Type: Non-Standardized Plan
Plan Geographic Availability
Area
Number
Available
in area?
1 N/A
2 N/A
3 Yes
4 N/A
5 N/A
6 N/A
7 N/A
8 N/A
9 N/A
Plan Rates
Age
Band Area 1 Area 2 Area 3 Area 4 Area 5 Area 6 Area 7 Area 8 Area 9 Area 1 Area 2 Area 3 Area 4 Area 5 Area 6 Area 7 Area 8 Area 9
0-14 199.63 199.63
15 217.37 217.37
16 224.16 224.16
17 230.94 230.94
18 238.25 238.25
19 245.55 245.55
20 253.12 253.12
21 260.95 300.09
22 260.95 300.09
23 260.95 300.09
24 260.95 300.09
25 261.99 301.29
26 267.21 307.29
27 273.48 314.50
28 283.65 326.20
29 292.00 335.80
30 296.18 340.60
31 302.44 347.81
32 308.70 355.01
33 312.62 359.51
34 316.79 364.31
35 318.88 366.71
36 320.97 369.11
37 323.06 371.51
38 325.14 373.92
39 329.32 378.72
40 333.49 383.52
41 339.76 390.72
42 345.76 397.62
43 354.11 407.23
44 364.55 419.23
45 376.81 433.33
46 391.43 450.14
47 407.86 469.04
48 426.65 490.65
49 445.18 511.96
50 466.06 535.97
51 486.67 559.67
52 509.37 585.78
53 532.34 612.19
54 557.13 640.70
55 581.92 669.21
56 608.80 700.12
57 635.94 731.33
58 664.90 764.64
59 679.25 781.14
60 708.22 814.45
61 733.27 843.26
62 749.71 862.17
63 770.32 885.87
64 and over 782.85 900.27
Non-Smoker Rates Smoker Rates
Regence BlueCross BlueShield of Oregon (Clark County)
RATE SCHEDULE
Counties where this plan is available
Clark
Page 14 of 17
Individual Nongrandfathered Health Plan 71281WA1360003
Plan Information
Plan Name: Alliance Bronze Essential 7500 Exchange EPO Legacy LHP
HIOS Plan ID: 71281WA1360003
Effective Date: 1/1/2021
Market Type: Individual
Exchange Status: Inside the Exchange
Metal Level: Bronze
Plan Type: Non-Standardized Plan
Plan Geographic Availability
Area
Number
Available
in area?
1 N/A
2 N/A
3 Yes
4 N/A
5 N/A
6 N/A
7 N/A
8 N/A
9 N/A
Plan Rates
Age
Band Area 1 Area 2 Area 3 Area 4 Area 5 Area 6 Area 7 Area 8 Area 9 Area 1 Area 2 Area 3 Area 4 Area 5 Area 6 Area 7 Area 8 Area 9
0-14 198.36 198.36
15 216.00 216.00
16 222.74 222.74
17 229.48 229.48
18 236.74 236.74
19 244.00 244.00
20 251.52 251.52
21 259.30 298.20
22 259.30 298.20
23 259.30 298.20
24 259.30 298.20
25 260.34 299.39
26 265.52 305.35
27 271.75 312.51
28 281.86 324.14
29 290.16 333.68
30 294.31 338.45
31 300.53 345.61
32 306.75 352.76
33 310.64 357.24
34 314.79 362.01
35 316.86 364.39
36 318.94 366.78
37 321.01 369.17
38 323.09 371.55
39 327.24 376.32
40 331.39 381.09
41 337.61 388.25
42 343.57 395.11
43 351.87 404.65
44 362.24 416.58
45 374.43 430.59
46 388.95 447.29
47 405.29 466.08
48 423.96 487.55
49 442.37 508.72
50 463.11 532.58
51 483.59 556.13
52 506.15 582.08
53 528.97 608.32
54 553.61 636.65
55 578.24 664.97
56 604.95 695.69
57 631.91 726.70
58 660.70 759.80
59 674.96 776.20
60 703.74 809.30
61 728.63 837.93
62 744.97 856.71
63 765.45 880.27
64 and over 777.90 894.59
Non-Smoker Rates Smoker Rates
Regence BlueCross BlueShield of Oregon (Clark County)
RATE SCHEDULE
Counties where this plan is available
Clark
Page 15 of 17
Individual Nongrandfathered Health Plan 71281WA1350013
Plan Information
Plan Name: Alliance Bronze Care on Demand 8000 EPO Legacy LHP
HIOS Plan ID: 71281WA1350013
Effective Date: 1/1/2021
Market Type: Individual
Exchange Status: Outside the Exchange
Metal Level: Bronze
Plan Type: Non-Standardized Plan
Plan Geographic Availability
Area
Number
Available
in area?
1 N/A
2 N/A
3 Yes
4 N/A
5 N/A
6 N/A
7 N/A
8 N/A
9 N/A
Plan Rates
Age
Band Area 1 Area 2 Area 3 Area 4 Area 5 Area 6 Area 7 Area 8 Area 9 Area 1 Area 2 Area 3 Area 4 Area 5 Area 6 Area 7 Area 8 Area 9
0-14 189.66 189.66
15 206.52 206.52
16 212.96 212.96
17 219.41 219.41
18 226.35 226.35
19 233.29 233.29
20 240.48 240.48
21 247.92 285.11
22 247.92 285.11
23 247.92 285.11
24 247.92 285.11
25 248.91 286.25
26 253.87 291.95
27 259.82 298.79
28 269.49 309.91
29 277.42 319.04
30 281.39 323.60
31 287.34 330.44
32 293.29 337.28
33 297.01 341.56
34 300.97 346.12
35 302.96 348.40
36 304.94 350.68
37 306.92 352.96
38 308.91 355.24
39 312.88 359.81
40 316.84 364.37
41 322.79 371.21
42 328.49 377.77
43 336.43 386.89
44 346.34 398.30
45 358.00 411.70
46 371.88 427.66
47 387.50 445.62
48 405.35 466.15
49 422.95 486.39
50 442.79 509.20
51 462.37 531.73
52 483.94 556.53
53 505.76 581.62
54 529.31 608.71
55 552.86 635.79
56 578.40 665.16
57 604.18 694.81
58 631.70 726.46
59 645.34 742.14
60 672.85 773.78
61 696.66 801.15
62 712.27 819.12
63 731.86 841.64
64 and over 743.76 855.32
Non-Smoker Rates Smoker Rates
Regence BlueCross BlueShield of Oregon (Clark County)
RATE SCHEDULE
Counties where this plan is available
Clark
Page 16 of 17
Individual Nongrandfathered Health Plan 71281WA1360004
Plan Information
Plan Name: Alliance Bronze Care on Demand 8000 Exchange EPO Legacy LHP
HIOS Plan ID: 71281WA1360004
Effective Date: 1/1/2021
Market Type: Individual
Exchange Status: Inside the Exchange
Metal Level: Bronze
Plan Type: Non-Standardized Plan
Plan Geographic Availability
Area
Number
Available
in area?
1 N/A
2 N/A
3 Yes
4 N/A
5 N/A
6 N/A
7 N/A
8 N/A
9 N/A
Plan Rates
Age
Band Area 1 Area 2 Area 3 Area 4 Area 5 Area 6 Area 7 Area 8 Area 9 Area 1 Area 2 Area 3 Area 4 Area 5 Area 6 Area 7 Area 8 Area 9
0-14 188.82 188.82
15 205.60 205.60
16 212.02 212.02
17 218.44 218.44
18 225.35 225.35
19 232.26 232.26
20 239.42 239.42
21 246.82 283.84
22 246.82 283.84
23 246.82 283.84
24 246.82 283.84
25 247.81 284.98
26 252.74 290.66
27 258.67 297.47
28 268.29 308.54
29 276.19 317.62
30 280.14 322.16
31 286.06 328.97
32 291.99 335.79
33 295.69 340.04
34 299.64 344.59
35 301.61 346.86
36 303.59 349.13
37 305.56 351.40
38 307.54 353.67
39 311.49 358.21
40 315.44 362.75
41 321.36 369.56
42 327.04 376.09
43 334.93 385.17
44 344.81 396.53
45 356.41 409.87
46 370.23 425.76
47 385.78 443.65
48 403.55 464.08
49 421.07 484.24
50 440.82 506.94
51 460.32 529.37
52 481.79 554.06
53 503.51 579.04
54 526.96 606.00
55 550.41 632.97
56 575.83 662.21
57 601.50 691.73
58 628.90 723.23
59 642.47 738.84
60 669.87 770.35
61 693.56 797.60
62 709.11 815.48
63 728.61 837.90
64 and over 740.46 851.52
Non-Smoker Rates Smoker Rates
Regence BlueCross BlueShield of Oregon (Clark County)
RATE SCHEDULE
Counties where this plan is available
Clark
Page 17 of 17
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