Rates - Level B

All rates automatically include Life and Accidental Death and Dismemberment coverage

2019 Monthly Premium Rates - Level B

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
$303.00 $1,181.00 $1,999.00
Blue Shield HD PPO
+ Dental: DeltaCare
+ Vision
+ Chiropractic / Acupuncture
$316.00 $1,214.00 $2,050.00
Blue Shield HD PPO
+ Dental: DeltaPPO
+ Vision
+ Chiropractic / Acupuncture
$359.00 $1,297.00 $2,184.00
Blue Shield
HMO Access+

$25 office visit co-pay /
25% Hospital co-pay
Member
Only
Member
+ 1
Family
Blue Shield HMO Access+
+ Chiropractic / Acupuncture
$303.00 $1,194.00 $2,012.00
Blue Shield HMO Access+
+ Dental: DeltaCare
+ Vision
+ Chiropractic / Acupuncture
$313.00 $1,224.00 $2,060.00
Blue Shield HMO Access+
+ Dental: DeltaPPO
+ Vision
+ Chiropractic / Acupuncture
$359.00 $1,309.00 $2,196.00
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
$178.00 $902.00 $1,557.00
Blue Shield HMO Trio Narrow Network
+ Dental: DeltaCare
+ Vision
+ Chiropractic / Acupuncture
$188.00 $932.00 $1,604.00
Blue Shield HMO Trio Narrow Network
+ Dental: DeltaPPO
+ Vision
+ Chiropractic / Acupuncture
$234.00 $1,018.00 $1,741.00
Kaiser Permanente
Traditional HMO

$30 office visit co-pay /
$500 Hospital co-pay
Member
Only
Member
+ 1
Family
Kaiser Permanente Traditional HMO
+ Chiropractic / Acupuncture
$203.00 $819.00 $1,392.00
Kaiser Permanente Traditional HMO
+ Dental: DeltaCare
+ Vision
+ Chiropractic / Acupuncture
$213.00 $848.00 $1,440.00
Kaiser Permanente Traditional HMO
+ Dental: DeltaPPO
+ Vision
+ Chiropractic / Acupuncture
$259.00 $934.00 $1,576.00
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
$178.00 $693.00 $1,171.00
Kaiser Permanente HD HMO
+ Dental: DeltaCare
+ Vision
+ Chiropractic / Acupuncture
$188.00 $722.00 $1,219.00
Kaiser Permanente HD HMO
+ Dental: DeltaPPO
+ Vision
+ Chiropractic / Acupuncture
$234.00 $808.00 $1,355.00
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
$128.00 $512.00 $869.00
Kaiser Permanente HSA HMO
+ Dental: DeltaCare
+ Vision
+ Chiropractic / Acupuncture
$138.00 $542.00 $917.00
Kaiser Permanente HSA HMO
+ Dental: DeltaPPO
+ Vision
+ Chiropractic / Acupuncture
$184.00 $627.00 $1,053.00
Level A Level B Level C contact us