Rates - Level B

All rates automatically include Life and Accidental Death and Dismemberment coverage

2018 Monthly Premium Rates - Level B

Blue Shield
HMO Access+

$25 office visit co-pay /
$100 + 25% Hospital co-pay
Member
Only
Member
+ 1
Family
Blue Shield HMO Access+
+ Chiropractic / Acupuncture
$300.00 $1,077.00 $1,789.00
Blue Shield HMO Access+
+ Dental: DeltaCare
+ Vision
+ Chiropractic / Acupuncture
$314.00 $1,111.00 $1,843.00
Blue Shield HMO Access+
+ Dental: DeltaPPO
+ Vision
+ Chiropractic / Acupuncture
$361.00 $1,199.00 $1,983.00
Blue Shield
HMO Trio ACO

$20 office visit co-pay / $1,500 Deductible
+ 25% Hospital co-pay
Member
Only
Member
+ 1
Family
Blue Shield HMO Trio ACO
+ Chiropractic / Acupuncture
$175.00 $806.00 $1,376.00
Blue Shield HMO Trio ACO
+ Dental: DeltaCare
+ Vision
+ Chiropractic / Acupuncture
$189.00 $841.00 $1,430.00
Blue Shield HMO Trio ACO
+ Dental: DeltaPPO
+ Vision
+ Chiropractic / Acupuncture
$236.00 $929.00 $1,570.00
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 $832.00 $1,419.00
Kaiser Permanente Traditional HMO
+ Dental: DeltaCare
+ Vision
+ Chiropractic / Acupuncture
$214.00 $866.00 $1,473.00
Kaiser Permanente Traditional HMO
+ Dental: DeltaPPO
+ Vision
+ Chiropractic / Acupuncture
$261.00 $954.00 $1,613.00
Kaiser Permanente
Deductible HMO

$20 office visit co-pay / $1,500 Deductible
20% of some services
Member
Only
Member
+ 1
Family
Kaiser Permanente Deductible HMO
+ Chiropractic / Acupuncture
$175.00 $703.00 $1,193.00
Kaiser Permanente Deductible HMO
+ Dental: DeltaCare
+ Vision
+ Chiropractic / Acupuncture
$189.00 $737.00 $1,247.00
Kaiser Permanente Deductible HMO
+ Dental: DeltaPPO
+ Vision
+ Chiropractic / Acupuncture
$236.00 $825.00 $1,388.00
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 $519.00 $885.00
Kaiser Permanente HSA HMO
+ Dental: DeltaCare
+ Vision
+ Chiropractic / Acupuncture
$139.00 $553.00 $939.00
Kaiser Permanente HSA HMO
+ Dental: DeltaPPO
+ Vision
+ Chiropractic / Acupuncture
$186.00 $641.00 $1,079.00
Level A Level B Level C contact us