Anthem Blue Cross Individual Rates Rates effective 1/1/15
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- Albert Grant
- 7 years ago
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1 Anthem Blue Cross Individual Rates Rates effective 1/1/15 Rating Area 1 for Alpine, Amador, Butte, Calaveras, Colusa, Del Norte, Glenn, Humboldt, Lake, Lassen, Mendocino, Modoc, Nevada, Plumas, Shasta, Sierra, Siskiyou, Sutter, Tehama, Trinity, Tuolumne, Yuba Counties Rating Area 2 for Marin, Napa, Solano, Sonoma Counties Rating Area 3 for El Dorado, Placer, Sacramento, Yolo Counties Rating Area 4 for San Francisco County Rating Area 5 for Contra Costa County Rating Area 6 for Alameda County Rating Area 7 for Santa Clara County Rating Area 8 for San Mateo County Rating Area 9 for Monterey, San Benito, Santa Cruz Counties Rating Area 10 for Mariposa, Merced, San Joaquin, Stanislaus, Tulare Counties Rating Area 11 for Fresno, Kings, Madera Counties Rating Area 12 for San Luis Obispo, Santa Barbara, Ventura Counties Rating Area 13 for Imperial, Inyo, Mono Counties Rating Area 14 for Kern County Rating Area 15 for Los Angeles County Rating Area 16 for Los Angeles County Rating Area 17 for Riverside, San Bernardino Counties Rating Area 18 for Orange County Rating Area 19 for San Diego County Listing of ZIP Codes Where Plans are available in Specific Counties Anthem Blue Cross is the trade name of Blue Cross of California. Independent licensee of the Blue Cross Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross name and symbol are registered marks of the Blue Cross Association. Form CA_ABC_Rates_ Revised 9/22/14
2 OFF Exchange Plans for Rating Area 1 Counties Of: Alpine, Amador, Butte, Calaveras, Colusa, Del Norte, Glenn, Humboldt, Lake, Lassen, Mendocino, Modoc, Nevada, Plumas, Shasta, Sierra, Siskiyou, Sutter, Tehama, Trinity, Tuolumne, Yuba Anthem Minimum Coverage D D D Health Savings Account Anthem Silver 70 D Anthem Gold 80 D Anthem Platinum 90 D 1FZE 1FZ4 1FZQ 1FZX 1G09 1G0F Age Standard Rate Standard Rate Standard Rate Standard Rate Standard Rate Standard Rate 0 20 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, Page 1 of 76
3 OFF Exchange Only Plans for Rating Area 1 Counties Of: Alpine, Amador, Butte, Calaveras, Colusa, Del Norte, Glenn, Humboldt, Lake, Lassen, Mendocino, Modoc, Nevada, Plumas, Shasta, Sierra, Siskiyou, Sutter, Tehama, Trinity, Tuolumne, Yuba 5000/25% 5750/20% 6250/20% Anthem Silver 1750/30% Anthem Silver 2000/25% 1FZ5 1FZH 1FZL 1FZB 1FZ9 Age Standard Rate Standard Rate Standard Rate Standard Rate Standard Rate 0 20 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Page 2 of 76
4 ON Exchange Plans for Rating Area 1 Counties Of: Alpine, Amador, Butte, Calaveras, Colusa, Del Norte, Glenn, Humboldt, Lake, Lassen, Mendocino, Modoc, Nevada, Plumas, Shasta, Sierra, Siskiyou, Sutter, Tehama, Trinity, Tuolumne, Yuba Anthem Minimum Coverage Health Savings Account Anthem Silver 70, a Multi State Plan Anthem Gold 80, a Multi State Plan Anthem Platinum 90 1FZD 1FZ3 1FZP 1FZC 1G08 1G0E Age Standard Rate Standard Rate Standard Rate Standard Rate Standard Rate Standard Rate 0 20 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, Page 3 of 76
5 OFF Exchange Plans for Rating Area 2 Counties Of: Marin, Napa, Solano, Sonoma Anthem Minimum Coverage D D D Health Savings Account Anthem Silver 70 D Anthem Gold 80 D Anthem Platinum 90 D 1FZE 1FZ4 1FZQ 1FZX 1G09 1G0F Age Standard Rate Standard Rate Standard Rate Standard Rate Standard Rate Standard Rate 0 20 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $1, $1, $ $ $ $ $1, $1, $ $ $ $ $1, $1, $ $ $ $ $1, $1, Page 4 of 76
6 5000/25% OFF Exchange Only Plans for Rating Area 2 Counties Of: Marin, Napa, Solano, Sonoma 5750/20% 6250/20% Anthem Silver 1750/30% Anthem Silver 2000/25% 1FZ5 1FZH 1FZL 1FZB 1FZ9 Age Standard Rate Standard Rate Standard Rate Standard Rate Standard Rate 0 20 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Page 5 of 76
7 ON Exchange Plans for Rating Area 2 Counties Of: Marin, Napa, Solano, Sonoma Anthem Minimum Coverage Health Savings Account Anthem Silver 70, a Multi State Plan Anthem Gold 80, a Multi State Plan Anthem Platinum 90 1FZD 1FZ3 1FZP 1FZC 1G08 1G0E Age Standard Rate Standard Rate Standard Rate Standard Rate Standard Rate Standard Rate 0 20 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $1, $1, $ $ $ $ $1, $1, $ $ $ $ $1, $1, $ $ $ $ $1, $1, Page 6 of 76
8 OFF Exchange Plans for Rating Area 3 Counties Of: El Dorado, Placer, Sacramento, Yolo Anthem Minimum Coverage D D D Health Savings Account Anthem Silver 70 D Anthem Gold 80 D Anthem Platinum 90 D 1FZE 1FZ4 1FZQ 1FZX 1G09 1G0F Age Standard Rate Standard Rate Standard Rate Standard Rate Standard Rate Standard Rate 0 20 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, Page 7 of 76
9 5000/25% OFF Exchange Only Plans for Rating Area 3 Counties Of: El Dorado, Placer, Sacramento, Yolo 5750/20% 6250/20% Anthem Silver 1750/30% Anthem Silver 2000/25% 1FZ5 1FZH 1FZL 1FZB 1FZ9 Age Standard Rate Standard Rate Standard Rate Standard Rate Standard Rate 0 20 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Page 8 of 76
10 OFF Exchange HMO Plans for Rating Area 3 Counties Of: El Dorado*, Placer*, Sacramento*, Yolo* Anthem Silver 70 D Anthem Gold 80 D Anthem Platinum HMO HMO 90 D HMO 1G02 1G0B 1G0H Age Standard Rate Standard Rate Standard Rate 0 20 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, *Please see appendix for a list of ZIP codes where these HMO plans are available in this county. Page 9 of 76
11 ON Exchange Plans for Rating Area 3 Counties Of: El Dorado, Placer, Sacramento, Yolo Anthem Minimum Coverage Health Savings Account Anthem Silver 70, a Multi State Plan Anthem Gold 80, a Multi State Plan Anthem Platinum 90 1FZD 1FZ3 1FZP 1FZC 1G08 1G0E Age Standard Rate Standard Rate Standard Rate Standard Rate Standard Rate Standard Rate 0 20 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, Page 10 of 76
12 ON Exchange HMO Plans for Rating Area 3 Counties Of: El Dorado*, Placer*, Sacramento*, Yolo* Anthem Silver 70 Anthem Gold 80 Anthem Platinum HMO HMO 90 HMO 1G01 1G0A 1G0G Age Standard Rate Standard Rate Standard Rate 0 20 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, *Please see appendix for a list of ZIP codes where these HMO plans are available in this county. Page 11 of 76
13 OFF Exchange EPO Plans for Rating Area 4 County Of: San Francisco Anthem Minimum Coverage D EPO D EPO D Health Savings Account EPO Anthem Silver 70 D EPO Anthem Gold 80 D EPO Anthem Platinum 90 D EPO 1FZG 1FZ7 1FZN 1FZS 1G07 1G0D Age Standard Rate Standard Rate Standard Rate Standard Rate Standard Rate Standard Rate 0 20 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $1, $1, $ $ $ $ $1, $1, $ $ $ $ $1, $1, $ $ $ $ $1, $1, $ $ $ $ $1, $1, $ $ $ $ $1, $1, $ $ $ $ $1, $1, Page 12 of 76
14 Pathway EPO 5000/25% OFF Exchange Only EPO Plans for Rating Area 4 County Of: San Francisco Pathway EPO 5750/20% Pathway EPO 6250/20% Anthem Silver Pathway EPO 1750/30% Anthem Silver Pathway EPO 2000/25% 1FZK 1FZJ 1FZ8 1G0J 1FZA Age Standard Rate Standard Rate Standard Rate Standard Rate Standard Rate 0 20 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Page 13 of 76
15 ON Exchange EPO Plans for Rating Area 4 County Of: San Francisco Anthem Minimum Coverage EPO EPO Health Savings Account EPO Anthem Silver 70 EPO, a Multi State Plan Anthem Gold 80 EPO, a Multi State Plan Anthem Platinum 90 EPO 1FZF 1FZ6 1FZM 1FZR 1G06 1G0C Age Standard Rate Standard Rate Standard Rate Standard Rate Standard Rate Standard Rate 0 20 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $1, $1, $ $ $ $ $1, $1, $ $ $ $ $1, $1, $ $ $ $ $1, $1, $ $ $ $ $1, $1, $ $ $ $ $1, $1, $ $ $ $ $1, $1, Page 14 of 76
16 OFF Exchange Plans for Rating Area 5 County Of: Contra Costa Anthem Minimum Coverage D D D Health Savings Account Anthem Silver 70 D Anthem Gold 80 D Anthem Platinum 90 D 1FZE 1FZ4 1FZQ 1FZX 1G09 1G0F Age Standard Rate Standard Rate Standard Rate Standard Rate Standard Rate Standard Rate 0 20 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $1, $1, $ $ $ $ $1, $1, $ $ $ $ $1, $1, $ $ $ $ $1, $1, $ $ $ $ $1, $1, Page 15 of 76
17 5000/25% OFF Exchange Only Plans for Rating Area 5 County Of: Contra Costa 5750/20% 6250/20% Anthem Silver 1750/30% Anthem Silver 2000/25% 1FZ5 1FZH 1FZL 1FZB 1FZ9 Age Standard Rate Standard Rate Standard Rate Standard Rate Standard Rate 0 20 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Page 16 of 76
18 ON Exchange Plans for Rating Area 5 County Of: Contra Costa Anthem Minimum Coverage Health Savings Account Anthem Silver 70, a Multi State Plan Anthem Gold 80, a Multi State Plan Anthem Platinum 90 1FZD 1FZ3 1FZP 1FZC 1G08 1G0E Age Standard Rate Standard Rate Standard Rate Standard Rate Standard Rate Standard Rate 0 20 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $1, $1, $ $ $ $ $1, $1, $ $ $ $ $1, $1, $ $ $ $ $1, $1, $ $ $ $ $1, $1, Page 17 of 76
19 OFF Exchange Plans for Rating Area 6 County Of: Alameda Anthem Minimum Coverage D D D Health Savings Account Anthem Silver 70 D Anthem Gold 80 D Anthem Platinum 90 D 1FZE 1FZ4 1FZQ 1FZX 1G09 1G0F Age Standard Rate Standard Rate Standard Rate Standard Rate Standard Rate Standard Rate 0 20 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $1, $1, $ $ $ $ $1, $1, $ $ $ $ $1, $1, $ $ $ $ $1, $1, Page 18 of 76
20 5000/25% OFF Exchange Only Plans for Rating Area 6 County Of: Alameda 5750/20% 6250/20% Anthem Silver 1750/30% Anthem Silver 2000/25% 1FZ5 1FZH 1FZL 1FZB 1FZ9 Age Standard Rate Standard Rate Standard Rate Standard Rate Standard Rate 0 20 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Page 19 of 76
21 ON Exchange Plans for Rating Area 6 County Of: Alameda Anthem Minimum Coverage Health Savings Account Anthem Silver 70, a Multi State Plan Anthem Gold 80, a Multi State Plan Anthem Platinum 90 1FZD 1FZ3 1FZP 1FZC 1G08 1G0E Age Standard Rate Standard Rate Standard Rate Standard Rate Standard Rate Standard Rate 0 20 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $ $1, $ $ $ $ $1, $1, $ $ $ $ $1, $1, $ $ $ $ $1, $1, $ $ $ $ $1, $1, Page 20 of 76
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