Rates - Level A

All rates automatically include Life and Accidental Death and Dismemberment coverage

2019 Monthly Premium Rates - Level A

Blue Shield
High Deductible PPO
HSA-Qualified Plan

Deductible $1,350/$2,700 - 90%/70%
Member
Only
Member
+ 1
Family
Blue Shield HD PPO
+ Chiropractic / Acupuncture
$200.00 $1,078.00 $1,896.00
Blue Shield HD PPO
+ Dental: DeltaCare
+ Vision
+ Chiropractic / Acupuncture
$200.00 $1,098.00 $1,934.00
Blue Shield HD PPO
+ Dental: DeltaPPO
+ Vision
+ Chiropractic / Acupuncture
$246.00 $1,184.00 $2,071.00
Blue Shield
HMO Access+

$25 office visit co-pay /
25% Hospital co-pay
Member
Only
Member
+ 1
Family
Blue Shield HMO Access+
+ Chiropractic / Acupuncture
$200.00 $1,091.00 $1,909.00
Blue Shield HMO Access+
+ Dental: DeltaCare
+ Vision
+ Chiropractic / Acupuncture
$200.00 $1,111.00 $1,947.00
Blue Shield HMO Access+
+ Dental: DeltaPPO
+ Vision
+ Chiropractic / Acupuncture
$246.00 $1,196.00 $2,083.00
Blue Shield
HMO Trio Narrow Network

$20 office visit co-pay /
25% Hospital co-pay
Member
Only
Member
+ 1
Family
Blue Shield HMO Trio Narrow Network
+ Chiropractic / Acupuncture
$125.00 $849.00 $1,504.00
Blue Shield HMO Trio Narrow Network
+ Dental: DeltaCare
+ Vision
+ Chiropractic / Acupuncture
$125.00 $869.00 $1,541.00
Blue Shield HMO Trio Narrow Network
+ Dental: DeltaPPO
+ Vision
+ Chiropractic / Acupuncture
$171.00 $955.00 $1,678.00
Kaiser Permanente
Traditional HMO

$30 office visit co-pay /
$500 Hospital co-pay
Member
Only
Member
+ 1
Family
Kaiser Permanente Traditional HMO
+ Chiropractic / Acupuncture
$200.00 $816.00 $1,389.00
Kaiser Permanente Traditional HMO
+ Dental: DeltaCare
+ Vision
+ Chiropractic / Acupuncture
$200.00 $835.00 $1,427.00
Kaiser Permanente Traditional HMO
+ Dental: DeltaPPO
+ Vision
+ Chiropractic / Acupuncture
$246.00 $921.00 $1,563.00
Kaiser Permanente
High Deductible HMO

$20 office visit co-pay / $1,500 Deductible
20% of some services
Member
Only
Member
+ 1
Family
Kaiser Permanente HD HMO
+ Chiropractic / Acupuncture
$125.00 $640.00 $1,118.00
Kaiser Permanente HD HMO
+ Dental: DeltaCare
+ Vision
+ Chiropractic / Acupuncture
$125.00 $659.00 $1,156.00
Kaiser Permanente HD HMO
+ Dental: DeltaPPO
+ Vision
+ Chiropractic / Acupuncture
$171.00 $745.00 $1,292.00
Kaiser Permanente
HSA-Qualified Deductible HMO

$30 office visit co-pay / $2,700 Deductible
30% of some services
Member
Only
Member
+ 1
Family
Kaiser Permanente HSA HMO
+ Chiropractic / Acupuncture
$125.00 $509.00 $866.00
Kaiser Permanente HSA HMO
+ Dental: DeltaCare
+ Vision
+ Chiropractic / Acupuncture
$125.00 $529.00 $904.00
Kaiser Permanente HSA HMO
+ Dental: DeltaPPO
+ Vision
+ Chiropractic / Acupuncture
$171.00 $614.00 $1,040.00
Level A Level B Level C contact us