2019 Qualified Health Plan And Qualified Dental Plan .
2019 Qualified Health Planand Qualified Dental PlanCertification RequestsAugust 20182018September
TABLE OF CONTENTSSummary of Individual Market.1Summary of Dental Market.2At-a-Glance.3Number of Issuers by County.4Rating Areas and Rate Information.5Gold Plans.6Silver Plans.11Bronze Plans.20Catastrophic Plans.26Dental Plans.27Appendix I.30Appendix II.31Appendix III.32Appendix IV.34
SUMMARY OF INDIVIDUAL MARKETOverview7 Issuers38 RenewalsGold7 Issuers9 RenewalsSilver7 Issuers17 RenewalsBronze5 Issuers10 RenewalsCatastrophic2 Issuers2 Renewals140 Individual QHPs2 New10 Plans1 New17 Plans0 New11 Plans1 New2 Plans0 New
SUMMARY OF DENTAL MARKETFamily Dental2 Issuers1 Low1 Renewal2 Individual QDPs1 High1 NewPediatric Dental4 Issuers2 Low4 Renewals24 Individual QDPs2 High0 New
AT-A-GLANCE1All counties have individual health anddental plan coverage.2There is a wide variation in deductibles,particularly in silver plans.392% of Exchange consumers will havethe choice of two or more issuers.426 plans offer primary care visits with a copay,not subject to the deductible.3
NUMBER OF ISSUERS BY COUNTY2019WhatcomSan lnSpokaneMasonGrays aColumbiaWalla WallaAsotinKlickitatClark1345237648One Issuer:Chelan, Douglas, Ferry, Grays Harbor,Island, Pend Oreille, San Juan, Skagit,Skamania,2018WhatcomSan lnSpokaneMasonGrays YakimaWahkiakumCowlitzAdamsThree Issuers:Adams, Clark, Cowlitz, Grant, Jefferson,Kitsap, Snohomish. Whatcom, Whitman,Four Issuers:Benton, Columbia, Franklin, King,Pierce, Walla WallaWhitmanFranklinGarfieldBentonSkamaniaTwo Issuers:Asotin, Clallam, Garfield, Klickitat,Lewis, Lincoln, Kittitas, Mason,Okanogan, Pacific, Stevens,Wahkiakum, , YakimaFive Issuers:Spokane, ThurstonColumbiaWalla WallaAsotinKlickitat14Three Issuers:Benton, Clark, Columbia, Franklin,Stevens, Walla WallaGarfieldBentonSkamaniaTwo Issuers:Adams, Cowlitz, Grant, Jefferson,Klickitat, Lewis, Lincoln, Kitsap,Kittitas, Mason, Skamania, Snohomish,Whatcom, Whitman, YakimaFour Issuers:King, Pierce, Spokane, ThurstonWhitmanFranklinWahkiakumCowlitzAdamsOne Issuer:Asotin, Chelan, Clallam, Douglas,Ferry, Garfield, Grays Harbor, Island,Okanogan, Pacific, Pend Oreille, SanJuan, Skagit, Wahkiakum2345
RATING AREAS AND RATE INFORMATIONArea 1One County: KingArea 4Five Counties: Ferry, Lincoln, Pend Oreille,Spokane, StevensArea 7Five Counties: Adams, Chelan,Douglas, Grant, OkanoganArea 2Eight Counties: Cowlitz, Clallam, GraysHarbor, Jefferson, Lewis, Kitsap, Pacific,WahkiakumArea 5Three Counties: Mason, Pierce, ThurstonArea 8Five Counties: Island, San Juan, Skagit,Snohomish, WhatcomRATE INFORMATIONAll rates in this document are for a 40 year-old non-smoking individual.5Area 3Three Counties: Clark, Klickitat, SkamaniaArea 6Four Counties: Benton, Franklin, Kittitas,YakimaArea 9Five Counties: Asotin, Columbia,Garfield, Walla Walla, Whitman
GOLD PLANSBRIDGESPANPlan Name: Gold Essential 1200 Exchange EPO RealValuePlan Type: EPODeductible: 1,200Monthly Premium 537 (Rating Area 3)OOPM: 7,900Primary Care: 30% coinsuranceafter deductibleServices Before Deductible: 4 primary care visits at 30 copay Generic drugsOfferedNot Offered1 County: KlickitatPlan Type: HMODeductible: 1,000 medical, 500 drugPremium RangeLow: 400 (Rating Area 2)High: 456 (Rating Area 7)OOPM: 6,350Primary Care: 20% coinsurance afterdeductible; 3 free primary care visitsServices Before Deductible: 3 free primary care visits Generic drugsOfferedNot Offered19 Counties: Adams, Benton, Chelan, Columbia,Douglas, Franklin, Grant, Jefferson, King, Kittitas,Lewis, Lincoln, Pierce, Snohomish, Spokane,Stevens, Thurston, Walla Walla, Yakima6
GOLD PLANSKAISER FOUNDATION HEALTH PLAN OF THE NORTHWESTGOLDPlan Name: KP WA Gold 0/20Plan Type: EPODeductible: No deductiblePremium RangeLow: 502 (Rating Area 3)High: 527 (Rating Area 2)OOPM: 7,250Primary Care: 20 copayServices Before Deductible:No deductible with this planOfferedNot Offered2 Counties: Clark, CowlitzKAISER FOUNDATION HEALTH PLAN OF THE NORTHWESTGOLDPlan Name: KP WA Gold 1000/20Plan Type: EPODeductible: 1,000Premium RangeLow: 471 (Rating Area 3)High: 495 (Rating Area 2)OOPM: 7,000Primary Care: 20 copaySelected Services Before Deductible*: Primary care Specialist care Urgent care Mental/behavioral health visits Generic and preferred drugsOffered2 Counties: Clark, Cowlitz*Full list of services before deductible can be found in Appendix IV on page 34.7Not Offered
GOLD PLANSKAISER FOUNDATION HEALTH PLAN OF WASHINGTONPlan Name: Flex Gold - 19Plan Type: HMODeductible: 1,150Premium RangeLow: 474 (Rating Area 1)High: 546 (Rating Areas 2, 6, 8, 9)OOPM: 6,500Primary Care: 15 copay after deductibleServices Before Deductible*: Preferred generic drugs Preferred brand drugs Pre-and Post-natal visits*Full list of services before deductible can be found in Appendix IV on page 34.LIFEWISEPlan Name: LifeWise Essential Gold EPO 1000Plan Type: EPODeductible: 1,000Premium RangeLow: 487 (Rating Area 4)High: 548 (Rating Area 3)OOPM: 6,000Y copay; 2 free primaryPrimary Care: 30care visitsSelected Services Before Deductible*: 2 free primary care visits Primary care Specialist care Urgent care Mental/behavioral health visitsOffered12 Counties: Adams, Asotin, Clallam, Clark,Columbia, Garfield, Jefferson, Okanogan,Spokane, Thurston, Walla Walla, Whitman*Full list of services before deductible can be found in Appendix IV on page 34.8Not Offered
GOLD PLANSMOLINAGOLDPlan Name: Molina Marketplace Choice Gold PlanPlan Type: HMODeductible: 2,925 medical, 0 drugPremium RangeLow: 480 (Rating Area 4)High: 551 (Rating Areas 3, 5)OOPM: 5,000Primary Care: 10 copaySelected Services Before Deductible*: Primary care Specialist care Urgent care Mental/behavioral health visits Generic and preferred drugsOffered12 Counties: Clark, Ferry, Lincoln, King, Klickitat,Mason, Pierce, Pend Oreille, Skamania,Spokane, Stevens, Thurston*Full list of services before deductible can be found in Appendix IV on page 34.PREMERAGOLDPlan Name: Premera Blue Cross PersonalCare GoldPlan Type: EPODeductible: 1,500Premium RangeLow: 612 (Rating Area 1)High: 633 (Rating Area 8)OOPM: 6,800Y copay; 2 free primaryPrimary Care: 15care visitsSelected Services Before Deductible*: 2 free primary care visits Primary care Specialist care Urgent care Generic drugs*Full list of services before deductible can be found in Appendix IV on page 34.9Not Offered
GOLD PLANSPREMERAPlan Name: Premera Blue Cross Preferred Gold EPO 1500Plan Type: EPODeductible: 1,500Premium RangeLow: 600 (Rating Area 6)High: 670 (Rating Area 3)OOPM: 6,800Primary Care: 15 copay; 2 free primarycare visitsSelected Services Before Deductible*: 2 free primary care visits Primary care Specialist care Urgent care Mental/behavioral health visits*Full list of services before deductible can be found in Appendix IV on page 34.PREMERAPlan Name: Premera Blue Cross Preferred Gold EPO 1000Plan Type: EPODeductible: 1,000Monthly Premium 631 (Rating Area 6)OOPM: 6,800Primary Care: 15 copay;2 free primarycare visitsSelected Services Before Deductible*: 2 free primary care visits Primary care Specialist care Urgent care Mental/behavioral health visits*Full list of services before deductible can be found in Appendix IV on page 34.10Offered1 County: FranklinNot Offered
SILVER PLANSBRIDGESPANPlan Name: Silver HDHP 3000 Exchange EPO RealValuePlan Type: EPOMonthly Premium 457 (Rating Area 3)Deductible: 3,000OOPM: 6,750Primary Care: 20% coinsurance after thedeductibleServices Before Deductible:No services available prior to deductibleOfferedNot Offered1 County: KlickitatCOORDINATED CAREPlan Name: Ambetter Balanced Care 1 (2019)Plan Type: HMODeductible: 5,500Premium RangeLow: 351 (Rating Area 2)High: 401 (Rating Area 7)OOPM: 6,500Primary Care: 30 copaySelected Services Before Deductible*: Primary care Specialist care Urgent care Mental/behavioral health visits Generic and preferred drugsOffered19 Counties: Adams, Benton, Chelan, Columbia,Douglas, Franklin, Grant, Jefferson, King, Kittitas,Lewis, Lincoln, Pierce, Snohomish, Spokane,Stevens, Thurston, Walla Walla, Yakima*Full list of services before deductible can be found in Appendix IV on page 34.11Not Offered
SILVER PLANSCOORDINATED CAREPlan Name: Ambetter Balanced Care 1 (2019) VisionPlan Type: HMODeductible: 5,500Premium RangeLow: 356 (Rating Area 2)High: 406 (Rating Area 7)OOPM: 6,500Primary Care: 30 copaySelected Services Before Deductible*: Primary care Specialist care Urgent care Mental/behavioral health visits Adult vision frames or lensesOfferedNot Offered19 Counties: Adams, Benton, Chelan, Columbia,Douglas, Franklin, Grant, Jefferson, King, Kittitas,Lewis, Lincoln, Pierce, Snohomish, Spokane,Stevens, Thurston, Walla Walla, Yakima*Full list of services before deductible can be found in Appendix IV on page 34.COORDINATED CAREPlan Name: Ambetter Balanced Care 2 (2019)Plan Type: HMODeductible: 6,500Premium RangeLow: 348 (Rating Area 2)High: 397 (Rating Area 7)OOPM: 6,500Primary Care: 30 copaySelected Services Before Deductible*: Primary care Specialist care Urgent care Mental/behavioral health visits Generic and preferred drugsOffered19 Counties: Adams, Benton, Chelan, Columbia,Douglas, Franklin, Grant, Jefferson, King, Kittitas,Lewis, Lincoln, Pierce, Snohomish, Spokane,Stevens, Thurston, Walla Walla, Yakima*Full list of services before deductible can be found in Appendix IV on page 34.12Not Offered
SILVER PLANSCOORDINATED CAREGPlan Name: Ambetter Balanced Care 2 (2019) VisionPlan Type: HMODeductible: 6,500Premium RangeLow: 353 (Rating Area 2)High: 403 (Rating Area 7)OOPM: 6,500Primary Care: 30 copaySelected Services Before Deductible*: Primary care Specialist care Urgent care Mental/behavioral health visits Adult vision frames or lensesOfferedNot Offered19 Counties: Adams, Benton, Chelan, Columbia,Douglas, Franklin, Grant, Jefferson, King, Kittitas,Lewis, Lincoln, Pierce, Snohomish, Spokane,Stevens, Thurston, Walla Walla, Yakima*Full list of services before deductible can be found in Appendix IV on page 34.COORDINATED CAREPlan Name: Ambetter Balanced Care 3 (2019)Plan Type: HMODeductible: 3,000Premium RangeLow: 375 (Rating Area 2)High: 428 (Rating Area 7)OOPM: 6,750Primary Care: 30 copaySelected Services Before Deductible*: Primary care Specialist care Urgent care Mental/behavioral health visits Generic and preferred drugsOffered19 Counties: Adams, Benton, Chelan, Columbia,Douglas, Franklin, Grant, Jefferson, King, Kittitas,Lewis, Lincoln, Pierce, Snohomish, Spokane,Stevens, Thurston, Walla Walla, Yakima*Full list of services before deductible can be found in Appendix IV on page 34.13Not Offered
SILVER PLANSCOORDINATED CAREPlan Name: Ambetter Balanced Care 3 (2019) VisionPlan Type: HMODeductible: 3,000Premium RangeLow: 380 (Rating Area 2)High: 433 (Rating Area 7)OOPM: 6,750Primary Care: 30 copaySelected Services Before Deductible*: Primary care Specialist care Urgent care Mental/behavioral health visits Adult vision frames or lensesOfferedNot Offered19 Counties: Adams, Benton, Chelan, Columbia,Douglas, Franklin, Grant, Jefferson, King, Kittitas,Lewis, Lincoln, Pierce, Snohomish, Spokane,Stevens, Thurston, Walla Walla, Yakima*Full list of services before deductible can be found in Appendix IV on page 34.COORDINATED CAREPlan Name: Ambetter Balanced Care 4 (2019)Plan Type: HMODeductible: 7,050OOPM: 7,050Premium RangeLow: 338 (Rating Area 2)High: 385 (Rating Area 7)Primary Care: 30 copaySelected Services Before Deductible*: Primary care Specialist care Urgent care Mental/behavioral health visits Generic and preferred drugsOffered19 Counties: Adams, Benton, Chelan, Columbia,Douglas, Franklin, Grant, Jefferson, King, Kittitas,Lewis, Lincoln, Pierce, Snohomish, Spokane,Stevens, Thurston, Walla Walla, Yakima*Full list of services before deductible can be found in Appendix IV on page 34.14Not Offered
SILVER PLANSKAISER FOUNDATION HEALTH PLAN OF THE NORTHWESTGOLDPlan Name: KP WA Silver 3500/30Plan Type: EPODeductible: 3,500Premium RangeLow: 457 (Rating Area 3)High: 479 (Rating Area 2)OOPM: 7,750Primary Care: 30 copaySelected Services Before Deductible*: Primary care Specialist care Urgent care Mental/behavioral health visits Outpatient rehab visitsOfferedNot Offered2 Counties: Clark, Cowlitz*Full list of services before deductible can be found in Appendix IV on page 34.KAISER FOUNDATION HEALTH PLAN OF THE NORTHWESTGOLDPlan Name: KP WA Silver 2500/30Plan Type: EPODeductible: 2,500Premium RangeLow: 480 (Rating Area 3)High: 502 (Rating Area 2)OOPM: 7,750Primary Care: 30 copaySelected Services Before Deductible*: Primary care Specialist care Urgent care Mental/behavioral health visits Outpatient rehab visitsOffered2 Counties: Clark, Cowlitz*Full list of services before deductible can be found in Appendix IV on page 34.15Not Offered
SILVER PLANSKAISER FOUNDATION HEALTH PLAN OF WASHINGTONGOLDPlan Name: Flex Silver - 19Plan Type: HMODeductible: 2,000Premium RangeLow: 439 (Rating Area 1)High: 505 (Rating Areas 2, 6, 8, 9)OOPM: 7,900Primary Care: 4 primary care visits at 20 copay; 20 copay after deductibleSelected Services Before Deductible*: Preferred generic drugs Pre- and Post- natal visits*Full list of services before deductible can be found in Appendix IV on page 34.KAISER FOUNDATION HEALTH PLAN OF WASHINGTONGOLDPlan Name: VisitsPlus Silver HD - 19Plan Type: HMODeductible: 7,150Premium RangeLow: 450 (Rating Area 1)High: 517 (Rating Areas 6, 8, 9)OOPM: 7,150Primary Care: 30 copaySelected Services Before Deductible*: Primary care visits Specialty care visits Preferred generic drugs Preferred brand drugs Pre- and Post- natal visits*Full list of services before deductible can be found in Appendix IV on page 34.16
SILVER PLANSLIFEWISEPlan Name: LifeWise Essential Silver EPO 4000Plan Type: EPODeductible: 4,000Premium RangeLow: 443 (Rating Area 4)High: 499 (Rating Area 3)OOPM: 7,350Primary Care: 30 copay; 2 free primarycare visitsSelected Services Before Deductible*: 2 free primary care visits Primary care Specialist care Urgent care Mental/behavioral health visitsOfferedNot Offered12 Counties: Adams, Asotin, Clallam, Clark,Columbia, Garfield, Jefferson, Okanogan,Spokane, Thurston, Walla Walla, Whitman*Full list of services before deductible can be found in Appendix IV on page 34.LIFEWISEGOLDPlan Name: LifeWise Essential Silver EPO HSA 3000Plan Type: EPODeductible: 3,000Premium RangeLow: 454 (Rating Area 4)High: 511 (Rating Area 3)OOPM: 6,600Primary Care: 30% coinsurance afterdeductibleServices Before Deductible:17 Diabetes care management Diabetes education Nutritional counselingOfferedNot Offered12 Counties: Adams, Asotin, Clallam, Clark,Columbia, Garfield, Jefferson, Okanogan,Spokane, Thurston, Walla Walla, Whitman
SILVER PLANSMOLINAGOLDPlan Name: Molina Marketplace Choice Silver PlanPlan Type: HMODeductible: 5,350 medical, 400 drugPremium RangeLow: 387 (Rating Area 4)High: 445 (Rating Areas 3, 5)OOPM: 7,900Primary Care: 30 copaySelected Services Before Deductible*: Primary care Specialist care Urgent care Mental/behavioral health visit Habilitation servicesOffered12 Counties: Clark, Ferry, Lincoln, King, Klickitat,Mason, Pierce, Pend Oreille, Skamania, Spokane,Stevens, Thurston*Full list of services before deductible can be found in Appendix IV on page 34.PREMERAGOLDPlan Name: Premera Blue Cross Preferred Silver EPO 4500Plan Type: EPODeductible: 4,500Premium RangeLow: 537 (Rating Area 6)High: 600 (Rating Area 3)OOPM: 7,350Primary Care: 30 copay; 2 free primarycare visitsSelected Services Before Deductible*: 2 free primary care visits Primary care Specialist care Urgent care Mental/behavioral health visits*Full list of services before deductible can be found in Appendix IV on page 34.18Not Offered
SILVER PLANSPREMERAGOLDPlan Name: Premera Blue Cross PersonalCare SilverPlan Type: EPODeductible: 4,500Premium RangeLow: 520 (Rating Area 1)High: 538 (Rating Area 8)OOPM: 7,350Primary Care: 30 copay; 2 free primarycare visitsSelected Services Before Deductible*: 2 free primary care visits Primary care Specialist care Urgent care Mental/behavioral health visits*Full list of services before deductible can be found in Appendix IV on page 34.19OfferedNot Offered3 Counties: King, Pierce, Snohomish
BRONZE PLANSBRIDGESPANPlan Name: Bronze HDHP 6000 Exchange EPO RealValuePlan Type: EPODeductible: 6,000Monthly Premium 331 (Rating Area 3)OOPM: 6,750Primary Care: 30% coinsurance afterdeductibleServices Before Deductible:No services available prior to the deductibleOfferedNot Offered1 Counties: KlickitatKAISER FOUNDATION HEALTH PLAN OF THE NORTHWESTPlan Name: KP Bronze 6500/50Plan Type: EPODeductible: 6,500Premium RangeLow: 319 (Rating Area 3)High: 335 (Rating Area 2)OOPM: 7,750Primary Care: 50 copay with deductible;50% coinsurance after deductibleServices Before Deductible: 2 primary care visits are covered Pre- and post- natal visitsOffered2 Counties: Clark; Cowlitz20Not Offered
BRONZE PLANSKAISER FOUNDATION HEALTH PLAN OF THE NORTHWESTPlan Name: KP WA Bronze 5700/30% HSAPlan Type: EPODeductible: 5,700Premium RangeLow: 312 (Rating Area 3)High: 327 (Rating Area 2)OOPM: 6,550Primary Care: 30 coinsurance afterdeductibleServices Before Deductible: 3 primary care visits at 50 copay Pre- and post- natal visitsOfferedNot Offered2 Counties: Clark; CowlitzKAISER FOUNDATION HEALTH PLAN OF THE NORTHWESTGOLDPlan Name: KP WA Bronze 5000/50Plan Type: EPODeductible: 5,000Premium RangeLow: 330 (Rating Area 3)High: 347 (Rating Area 2)OOPM: 7,750Y copay with deductible;Primary Care: 5040% coinsurance after deductibleServices Before Deductible:21 3 primary care visits at 50 copay Pre- and post- natal visitsOffered2 Counties: Clark; CowlitzNot Offered
BRONZE PLANSKAISER FOUNDATION HEALTH PLAN OF WASHINGTONGOLDPlan Name: Flex Bronze - 19Plan Type: HMODeductible: 5,500Premium RangeLow: 320 (Rating Area 1)High: 368 (Rating Areas 2, 6, 8, 9)OOPM: 7,150Primary Care: 3 primary care visits at 40 copay; and 20% coinsurance after deductibleSelected Services Before Deductible*: Preferred generic drugs Pre-and post-natal visits*Full list of services before deductible can be found in Appendix IV on page 34.KAISER FOUNDATION HEALTH PLAN OF WASHINGTONGOLDPlan Name: Core Bronze HSA - 19Plan Type: HMODeductible: 4,750OOPM: 6,550Primary Care: 20% coinsurance after deductibleServices Before Deductible: Pre- and post- natal visits22Premium RangeLow: 319 (Rating Area 1)High: 367 (Rating Areas 2,6, 8, 9)
BRONZE PLANSLIFEWISEGOLDPlan Name: LifeWise Essential Bronze EPO 6350Plan Type: EPODeductible: 6,350Premium RangeLow: 335 (Rating Area 4)High: 377 (Rating Area 3)OOPM: 7,850Primary Care: 50 copay; 2 free primary carevisitsSelected Services Before Deductible*: 2 free primary care visits Primary care Urgent care Diabetes care managementOfferedNot Offered12 Counties: Adams, Asotin, Clallam, Clark,Columbia, Garfield, Jefferson, Okanogan,Spokane, Thurston, Walla Walla, Whitman*Full list of services before deductible can be found in Appendix IV on page 34.PREMERAPlan Name: Premera Blue Cross Preferred Bronze HSA EPO 5250Plan Type: EPODeductible: 5,250OOPM: 6,700Y coinsurance afterPrimary Care: 40%deductibleServices Before Deductible:23 Diabetes care management Diabetes education Nutritional counselingPremium RangeLow: 420 (Rating Area 6)High: 469 (Rating Area 3)
BRONZE PLANSPREMERAGOLDPlan Name: Premera Blue Cross PersonalCare BronzePlan Type: EPODeductible: 6,350Premium RangeLow: 418 (Rating Area 1)High: 433 (Rating Area 8)OOPM: 7,850Primary Care: 50 copay; 2 free primarycare visitsServices Before Deductible: 2 free primary care visits Primary care Urgent care Diabetes care managementOfferedNot Offered3 Counties: King, Pierce, SnohomishPREMERAPlan Name: Premera Blue Cross PersonalCare Bronze HSAPlan Type: EPODeductible: 5,250Premium RangeLow: 457 (Rating Area 1)High: 473 (Rating Area 8)OOPM: 6,700Y coinsurance afterPrimary Care: 40%deductibleServices Before Deductible:24 Diabetes care management Diabetes education Nutritional counselingOfferedNot Offered3 Counties: King, Pierce, Snohomish
BRONZE PLANSPREMERAPlan Name: Premera Blue Cross Preferred Bronze EPO 6350Plan Type: EPODeductible: 6,350Premium RangeLow: 411 (Rating Area 6)High: 459 (Rating Area 3)OOPM: 7,850Primary Care: 50 copay; 2 free primarycare visitsSelected Services Before Deductible*: 2 free primary care visits Primary care Urgent care Diabetes care management*Full list of services before deductible can be found in Appendix IV on page 34.25
CATASTROPHIC PLANSKAISER FOUNDATION HEALTH PLAN OF THE NORTHWESTGOLDPlan Name: KP WA Catastrophic 7900/0Plan Type: EPODeductible: 7,900Premium RangeLow: 319 (Rating Area 3)High: 335 (Rating Area 2)OOPM: 7,900Primary Care: 0 copay with deductible;3 no charge primary care visits beforedeductibleServices Before Deductible: 3 no charge primary care visitsOfferedNot Offered2 Counties: Clark, CowlitzKAISER FOUNDATION HEATH PLAN OF WASHINGTONGOLDPlan Name: Core Basic Plus Catastrophic - 19Plan Type: HMODeductible: 7,900OOPM: 7,900Primary Care: No charge after deductible;3 no charge primary care visits before deductibleServices Before Deductible:26 3 no charge primary care visits Prenatal and postnatal carePremium RangeLow: 258 (Rating Area 1)High: 296 (Rating Areas 2, 6, 8, 9)
DENTAL PLANSDELTA DENTALPlan Name: Delta Dental Individual - Washington Kids PlanPlan Type: Child-OnlyCoverage: HighMonthly PremiumPer Member: 37.53Plan Type: PPODeductible: 85Annual Benefit Limit:UnlimitedOOPM: 350/child; 700/2 pediatric enrolleesOfferedNot OfferedAll 39 CountiesDELTA DENTALPlan Name: Delta Dental Individual & Family - Washington Family Plan (QDP)Plan Type: FamilyCoverage: HighMonthly PremiumPremium- Child: 40.86Premium- Adult: 38.08Plan Type: PPOARY pediatric enrollee; 50Deductible: 85/adult enrolleeAnnual Benefit Limit: Unlimited forpediatric; 1,000 / adultOOPM: 350/child; 700/2 pediatricenrollees; N/A for adult27OfferedAll 39 CountiesNot Offered
DENTAL PLANSDENTEGRA DENTALPlan Name: Dentegra Dental PPO Family Basic PlanPlan Type: FamilyCoverage: LowMonthly PremiumPremium- Child: 31.53Premium- Adult: 26.43Plan Type: PPODeductible: 75 pediatric enrollee; 50 adultenrolleeAnnual Benefit Limit: Unlimited for pediatric; 1,000 / adultOOPM: 350/child; 700/2 pediatric enrollees;N/A for adultOfferedNot Offered12 Counties: Clark, Cowlitz, King, Kitsap, Mason, Pierce,San Juan, Skagit, Snohomish, Spokane, Thurston,WhatcomKAISER FOUNDATION HEALTH PLAN OF THE NORTHWESTGOLDPlan Name: KP WA Pediatric Dental 100Plan Type: Child-OnlyCoverage: HighMonthly PremiumPer Member: 25.89Plan Type: PPODeductible: 50Annual Benefit Limit: UnlimitedOOPM: 350/child; 700/2 childrenOffered2 Counties: Clark, Cowlitz28Not Offered
DENTAL PLANSLIFEWISEPlan Name: LifeWise Individual Pediatric Dental PlanPlan Type: Child-OnlyCoverage: HighMonthly PremiumPer Member: 33.17Plan Type: PPODeductible: 65Annual Benefit Limit: UnlimitedOOPM: 350/child; 700/2 childrenPREMERAPlan Name: Premera Blue Cross Individual Pediatric Dental PlanPlan Type: Child-OnlyCoverage: LowMonthly PremiumPer Member: 33.17Plan Type: PPOARDeductible: 65Annual Benefit Limit: UnlimitedOOPM: 350/child; 700/2 childrenOfferedNot Offered14 Counties: Benton, Cowlitz, Franklin, Grant,Grays Harbor, King, Kitsap, Pacific, Pierce,Skamania, Snohomish, Stevens, Wahkiakum,Whatcom29
APPENDIX IAll plans listed have met the 19 certification criteria.INDIVIDUAL MARKETBridgeSpan Health CompanyGold Essential 1200 Exchange EPO RealValueSilver HDHP 3000 Exchange EPO RealValueBronze HDHP 6000 Exchange EPO RealValueCoordinated CareAmbetter Secure Care 1 (2019) with 3 Free PCP VisitsAmbetter Balanced Care 1 (2019)Ambetter Balanced Care 1 (2019) VisionAmbetter Balanced Care 2 (2019)Ambetter Balanced Care 2 (2019) VisionAmbetter Balanced Care 3 (2019)Ambetter Balanced Care 3 (2019) VisionAmbetter Balanced Care 4 (2019)Kaiser Foundation Health Plan of the NorthwestKP WA Gold 0/20KP WA Gold 1000/20KP WA Silver 3500/30KP WA Silver 2500/30KP Bronze 6500/50KP WA Bronze 5700/30% HSAKP WA Bronze 5000/50KP WA Catastrophic 7900/0Kaiser Foundation Health Plan of WashingtonFlex Gold - 19Flex Silver - 19VisitsPlus Silver HD - 19Flex Bronze - 19Core Bronze HSA - 19Core Basic Plus Catastrophic - 19LifeWise Health Plan of WashingtonLifeWise Essential Gold EPO 1000LifeWise Essential Silver EPO 4000LifeWise Essential Silver EPO HSA 3000LifeWise Essential Bronze EPO 635030INDIVIDUAL MARKETMolina Healthcare of WashingtonMolina Marketplace Choice Gold PlanMolina Marketplace Choice Silver PlanPremera Blue CrossPremera Blue Cross Preferred Gold EPO 1500Premera Blue Cross Preferred Gold EPO 1000Premera Blue Cross PersonalCare GoldPremera Blue Cross Preferred Silver EPO 4500Premera Blue Cross PersonalCare SilverPremera Blue Cross Preferred Bronze 5250 HSAPremera Blue Cross PersonalCare BronzePremrea Blue Cross PersonalCare Bronze HSAPremera Blue Cross Preferred Bronze EPO 6350
APPENDIX IIAll plans listed have met the 10 certi ication criteria.DENTALDeltaDelta Dental Individual - Washington Kids PlanDelta Dental Individual and Family - Washington Family (QDP)DentegraDentegra Dental PPO Family Basic PlanKaiser Foundation Health Plan of the NorthwestKP WA Pediatric Dental 100LifeWise Health Plan of WashingtonLifeWise Individual Pediatric Dental PlanPremera Blue CrossPremera Blue Cross Individual Pediatric Dental Plan31
APPENDIX IIICarriers by CountyCOUNTY/CARRIERADAMSCoordinated CareLifewise2019 Carriers2COUNTY/CARRIERGRAYS HARBORPremera2019 Carriers1ISLANDKaiser Foundation of WA13JEFFERSONCoordinated CareLifewise24CHELANCoordinated Care1CLALLAMLifewise1KINGCoordinated CareKaiser Foundation of WAMolinaPremera2CLARKKaiser of NWLifewiseMolina3KITSAPKaiser Foundation of WAPremera2COLUMBIACoordinated CareKaiser Foundation of WALifewise3KITTITASCoordinated CareKaiser Foundation of WAKLICKITATBridgeSpanMolina2COWLITZKaiser of NWPremera2LEWISCoordinated CareKaiser Foundation of WA2DOUGLASCoordinated Care12FERRYMolina1LINCOLNCoordinated CareMolina2FRANKLINCoordinated CareKaiser Foundation of WAPremera3MASONKaiser Foundation of remera1GRANTCoordinated CarePremera2PEND OREILLEMolina1ASOTINLifewise1BENTONCoordinated CareKaiser Foundation of WAPremera32
APPENDIX III (Cont’d)Carriers by CountyCOUNTY/CARRIERPIERCECoordinated CareKaiser Foundation of WAMolinaPremera2019 Carriers4SAN JUANKaiser Foundation of WA1SKAGITKaiser Foundation of WA1SKAMANIAMolinaPremera2SNOHOMISHCoordinated CareKaiser Foundation of WAPremera3SPOKANECoordinated CareKaiser Foundation of WALifewiseMolina4STEVENSCoordinated CareMolinaPremera3THURSTONCoordinated CareKaiser Foundation of WALifewiseMolina4WAHKIAKUMPremera1WALLA WALLACoordinated CareKaiser Foundation of WALifewise3WHATCOMKaiser Foundation of WAPremera233COUNTY/CARRIERWHITMANKaiser Foundation of WALifewiseYAKIMACoordinated CareKaiser Foundation of WA2019 Carriers22
APPENDIX IVFull list of plan services before deductible. This is a summary intended for certification only. Please seethe carrier's plan booklet for additional information on accessing plan benefits.GOLD PLANSGold Essential 1200 Exchange EPO RealValue4 primary care visits at 30 copay, generic drugs, diabetes educationAmbetter Secure Care 1 (2019) with 3 Free PCP Visits3 free primary care visits; generic drugsKP WA Gold 0/20No deductible is applicable with this health planKP WA Gold 1000/20Primary care, Specialist visit, urgent care, pre- and post- natal visits, diagnostic tests, mental/behavioral health visits,outpatient rehab visits, chiropractic care, acupuncture, generic and preferred brand drugs, diabetes care management,nutritional counseling, diabetes educationFlex Gold - 195 primary care visits at 15 copay; pre- and post- natal visits, generic and preferred brand drugsLifeWise Essential Gold EPO 10002 free primary care visits, primary care, specialist visit, urgent care, mental/behavioral health visits, chiropractic care,acupuncture, diabetes education, nutritional counseling, diabetes care managementMolina Marketplace Choice GoldPrimary care, Specialist visit, urgent care, pre- and post- natal visits, mental/behavioral health visits, generic drugs,preferred brand drugs, non-preferred brand drugs, and specialty drugs, outpatient rehab visits, habilitation services,chiropractic care, durable medical equipment, acupuncture, rehab speech and physical therapy, diagnostics, dialysis,di
COORDINATED CARE Plan Name: Ambetter Balanced Care 1 (2019) Plan Type: HMO Deductible: 5,500 OOPM: 6,500 Primary Care: 30 copay Selected Services Before Deductible*: Plan Type: EPO Deductible: 3,000 OOPM: 6,750 Primary Care: 20% coi
2019 Alfa Romeo Giulia 2019 BMW X7 2019 Alfa Romeo Stelvio 2019 BMW Z4 2019 Audi A3 2019 Buick Cascada 2019 Audi A4 2019 Buick Enclave 2019 Audi A5 2019 Buick Encore 2019 Audi A6 2019 Buick Envision 2019 Audi A7 2019 Buick LaCrosse 2019 Audi A8 2019 Buick Regal 2019 Audi Allroad
Generic Denomination: Air Conditioner Definition of Qualified Installer or Qualified Service Person The air conditioner must be installed, maintained, repaired and removed by a qualified installer or qualified service person. When any of these jobs is to be done, ask a qualified installer or qualified service person to do them for you.
HONOUR BOARD VOLUNTEERS 2019 - CURRENT David Staniforth Boorowa 2019 Bruce Gruber Boorowa 2019 Lindsay Cosgrove Boorowa 2019 Dennis Osborne Boorowa 2019 John Cook Boorowa 2019 Sue Cook Boorowa 2019 Mick Hughes Boorowa 2019 Daryl Heath Boorowa 2019 Lesley Heath Boorowa 2019 Russell Good Boorowa 2019 John Peterson Boorowa 2019 Heather Bottomley Boorowa 2019 James Armstrong Boorowa 2019
Qualified Appraisals- If the claimed deduction for a donated property is more than 5,000, the donor must get a qualified appraisal by a qualified appraiser. A qualified appraiser is an individual who: (1) per-forms appraisals on a regular basis; (2) is qualified to make appraisals of the type of property being valu.
This is the Summary Plan Description (SPD) for the Berkshire Hathaway Consolidated Pension Plan (Plan). The Plan is a tax-qualified defined benefit pension plan which provides retirement benefits for participants and their beneficiaries. The Plan was formed on December 31, 2016 through the consolidation of tax-qualified defined
age one year and over enrolled in any health or welfare plan offered by Trinity Health. New hires are eligible for benefits on the first day of the month following 30 days of employment. Orientation DateEnrollment Deadline Effective of Benefits 1/7/2019 2/5/2019 3/1/2019 1/21/2019 2/19/2019 3/1/2019 2/4/2019 3/5/2019 4/1/2019
Aetna Better Health of Michigan Meridian Health Plan . Pre-Paid Inpatient Health Plan Southwest Michigan Behavioral Health . Molina Healthcare . Pre-Paid Inpatient Health Plan Detroit-Wayne Mental Health Authority . 11 . Region 9 - Macomb County . MI Health Link health plan options Aetna Better Health of Michigan .
organizations based on the Baldrige Excellence Framework, examiners develop skills that can be applied at their own organizations, including analysis, consensus- building, team-building, interpersonal relations, written communication, interviewing, and systems thinking. The following is the fee structure for 2020 examiner training: First year examiner - 425 Second year examiner - 225 .
