MSA Washington: Health Savings Accounts in Washington

Asuris Northwest Health - Online Application

Emerge HSA 80 Rates
Effective date : 10/1/2010
Valid thru : 6/30/2011
Counties : Adams, Benton, Chelan, Douglas, Ferry, Franklin, Grant, Kittitas, Lincoln, Okanogan, Pend Oreille, Spokane, Stevens, Whitman

Family Status :	Applicant Non-Smoker	Applicant Smoker	Family Non-Smoker	Family Smoker
Age	Deductible : 2000
0-24	132.00	151.00	N/A	N/A
25-29	151.00	174.00	N/A	N/A
30-34	175.00	202.00	N/A	N/A
35-39	207.00	238.00	N/A	N/A
40-44	244.00	280.00	N/A	N/A
45-49	295.00	339.00	N/A	N/A
50-54	351.00	403.00	N/A	N/A
55-59	412.00	473.00	N/A	N/A
60+	482.00	554.00	N/A	N/A
Child	132.00	132.00	N/A	N/A
Age	Deductible : 3500
0-24	105.00	121.00	N/A	N/A
25-29	120.00	138.00	N/A	N/A
30-34	140.00	161.00	N/A	N/A
35-39	165.00	190.00	N/A	N/A
40-44	194.00	223.00	N/A	N/A
45-49	235.00	270.00	N/A	N/A
50-54	280.00	322.00	N/A	N/A
55-59	328.00	377.00	N/A	N/A
60+	385.00	442.00	N/A	N/A
Child	105.00	105.00	N/A	N/A
Age	Deductible : 4000
0-24	N/A	N/A	132.00	151.00
25-29	N/A	N/A	151.00	174.00
30-34	N/A	N/A	175.00	202.00
35-39	N/A	N/A	207.00	238.00
40-44	N/A	N/A	244.00	280.00
45-49	N/A	N/A	295.00	339.00
50-54	N/A	N/A	351.00	403.00
55-59	N/A	N/A	412.00	473.00
60+	N/A	N/A	482.00	554.00
Child	N/A	N/A	132.00	132.00
Age	Deductible : 7000
0-24	N/A	N/A	105.00	121.00
25-29	N/A	N/A	120.00	138.00
30-34	N/A	N/A	140.00	161.00
35-39	N/A	N/A	165.00	190.00
40-44	N/A	N/A	194.00	223.00
45-49	N/A	N/A	235.00	270.00
50-54	N/A	N/A	280.00	322.00
55-59	N/A	N/A	328.00	377.00
60+	N/A	N/A	385.00	442.00
Child	N/A	N/A	105.00	105.00