COPAY RATES. Health Insurance for Individuals & Families Monthly Rate Guide. PreferredOne.com
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1 COPAY RATES Health Insurance for Individuals & Families 2014 Monthly Rate Guide PreferredOne.com
2 Monthly Rate Guide Follow these simple steps to find the correct rate table and calculate your 2014 Monthly Rate or visit PreferredOne.com to get a fast and free online rate quote. Step 1: DETERMINE YOUR RATE AREA See the map and list of counties on page 4 to locate the county where you reside and your corresponding Rate Area 2-9. Step 2: ARE YOU A SMOKER OR NON-SMOKER? Do you or any adult covered dependents over age 18 smoke? Use the Rate Table designated for Smokers or Non-Smokers. Step 3: CHOOSE YOUR PREFERREDONE NETWORK Choose the PreferredOne Network. The Select Network is only available in certain counties of Rate Area 7 & 8 (Metro Area) and offers the lowest rate. The Choice Network is available for all other Rate Areas listed on the map. Step 4: FIND THE RIGHT RATE TABLE ON PAGES 5-16 Pick the PreferredOne Coverage Option to find your rate by age. 2
3 Premium Calculation Worksheet 1. Use the Rate Tables on pages 5-16 to determine your monthly rate. 2. Determine the age of each applicant. 3. Rate up to 3 children under the age of Each dependent adult child (ages 21 through 25) receives an additional rate. 5. Add the rates to get your total monthly premium. 6. Go to PreferredOne.com to enroll online. Calculate your Premium Applicant Rate $ Spouse/Domestic Partner $ Child 1 (age 0-20) $ Child 2 (age 0-20) $ Child 3 (age 0-20) $ Adult Child (21 through 25) $ Adult Child (21 through 25) $ Adult Child (21 through 25) $ Total $ Child Only Policy Child 1 (age 0-20) $ *Only one child is allowed on a Child Only Policy 3
4 Network Rate Area Guide Choice Network Select Network AREA 2 Carlton, Itasca, Koochiching, Lake of the Woods, St. Louis AREA 3 Le Sueur, Martin, Nicollet, Rice, Watonwan AREA 4 Brown, Cottonwood, Jackson, Lincoln, Murray, Nobles, Pipestone, Redwood, Rock AREA 5 Big Stone, Chippewa, Kandiyohi, Lac Qui Parle, Lyon, McLeod, Meeker, Renville, Sibley, Swift, Yellow Medicine AREA 6 Becker, Clay, Douglas, Grant, Otter Tail, Pope, Stevens, Traverse, Wilkin AREA 7 Aitkin, Beltrami, Cass, Chisago, Crow Wing, Hubbard, Isanti, Kanabec, Mille Lacs, Morrison, Pine, Roseau, Todd, Wadena AREA 8 Anoka, Benton, Carver, Dakota, Hennepin, Ramsey, Scott, Sherburne, Stearns, Washington, Wright AREA 9 Clearwater, Kittson, Mahnomen, Marshall, Norman, Pennington, Polk, Red Lake 4
5 PreferredOne Copay Plans - Choice Network Rate Area 8-9 Non-Smoker 0-17 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ n/a 31 $ $ $ $ $ n/a 32 $ $ $ $ $ n/a 33 $ $ $ $ $ n/a 34 $ $ $ $ $ n/a 35 $ $ $ $ $ n/a 36 $ $ $ $ $ n/a 37 $ $ $ $ $ n/a 38 $ $ $ $ $ n/a 39 $ $ $ $ $ n/a 40 $ $ $ $ $ n/a 41 $ $ $ $ $ n/a 42 $ $ $ $ $ n/a 43 $ $ $ $ $ n/a 44 $ $ $ $ $ n/a 45 $ $ $ $ $ n/a 46 $ $ $ $ $ n/a 47 $ $ $ $ $ n/a 48 $ $ $ $ $ n/a 49 $ $ $ $ $ n/a 50 $ $ $ $ $ n/a 51 $ $ $ $ $ n/a 52 $ $ $ $ $ n/a 53 $ $ $ $ $ n/a 54 $ $ $ $ $ n/a 55 $ $ $ $ $ n/a 56 $ $ $ $ $ n/a 57 $ $ $ $ $ n/a 58 $ $ $ $ $ n/a 59 $ $ $ $ $ n/a 60 $ $ $ $ $ n/a 61 $ $ $ $ $ n/a 62 $ $ $ $ $ n/a 63 $ $ $ $ $ n/a 64 + $ $ $ $ $ n/a Counties include: Anoka, Benton, Carver, Clearwater, Dakota, Hennepin, Kittson, Mahnomen, Marshall, Norman, Pennington, Polk, Ramsey, Red Lake, Scott, Sherburne, Stearns, Washington, Wright 5
6 PreferredOne Copay Plans - Choice Network Rate Area 8-9 Smoker 0-17 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ n/a 31 $ $ $ $ $ n/a 32 $ $ $ $ $ n/a 33 $ $ $ $ $ n/a 34 $ $ $ $ $ n/a 35 $ $ $ $ $ n/a 36 $ $ $ $ $ n/a 37 $ $ $ $ $ n/a 38 $ $ $ $ $ n/a 39 $ $ $ $ $ n/a 40 $ $ $ $ $ n/a 41 $ $ $ $ $ n/a 42 $ $ $ $ $ n/a 43 $ $ $ $ $ n/a 44 $ $ $ $ $ n/a 45 $ $ $ $ $ n/a 46 $ $ $ $ $ n/a 47 $ $ $ $ $ n/a 48 $ $ $ $ $ n/a 49 $ $ $ $ $ n/a 50 $ $ $ $ $ n/a 51 $ $ $ $ $ n/a 52 $ $ $ $ $ n/a 53 $ $ $ $ $ n/a 54 $ $ $ $ $ n/a 55 $ $ $ $ $ n/a 56 $ $ $ $ $ n/a 57 $ $ $ $ $ n/a 58 $ $ $ $ $ n/a 59 $ $ $ $ $ n/a 60 $ $ $ $ $ n/a 61 $ $ $ $ $ n/a 62 $ $ $ $ $ n/a 63 $ $ $ $ $ n/a 64 + $ $ $ $ $ n/a Counties include: Anoka, Benton, Carver, Clearwater, Dakota, Hennepin, Kittson, Mahnomen, Marshall, Norman, Pennington, Polk, Ramsey, Red Lake, Scott, Sherburne, Stearns, Washington, Wright 6
7 PreferredOne Copay Plans - Choice Network Rate Area 5, 6, 7 Non-Smoker 0-17 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ n/a 31 $ $ $ $ $ n/a 32 $ $ $ $ $ n/a 33 $ $ $ $ $ n/a 34 $ $ $ $ $ n/a 35 $ $ $ $ $ n/a 36 $ $ $ $ $ n/a 37 $ $ $ $ $ n/a 38 $ $ $ $ $ n/a 39 $ $ $ $ $ n/a 40 $ $ $ $ $ n/a 41 $ $ $ $ $ n/a 42 $ $ $ $ $ n/a 43 $ $ $ $ $ n/a 44 $ $ $ $ $ n/a 45 $ $ $ $ $ n/a 46 $ $ $ $ $ n/a 47 $ $ $ $ $ n/a 48 $ $ $ $ $ n/a 49 $ $ $ $ $ n/a 50 $ $ $ $ $ n/a 51 $ $ $ $ $ n/a 52 $ $ $ $ $ n/a 53 $ $ $ $ $ n/a 54 $ $ $ $ $ n/a 55 $ $ $ $ $ n/a 56 $ $ $ $ $ n/a 57 $ $ $ $ $ n/a 58 $ $ $ $ $ n/a 59 $ $ $ $ $ n/a 60 $ $ $ $ $ n/a 61 $ $ $ $ $ n/a 62 $ $ $ $ $ n/a 63 $ $ $ $ $ n/a 64 + $ $ $ $ $ n/a Counties include: Aitkin, Becker, Beltrami, Big Stone, Cass, Chippewa, Chisago, Clay, Crow Wing, Douglas, Grant, Hubbard, Isanti, Kanabec, Kandiyohi, Lac Qui Parle. Lyon, McLeod, Meeker, Mille Lacs, Morrison, Otter Tail, Pine, Pope, Renwille, Roseau, Sibley, Stevens, Swift, Todd, Traverse, Wadena, Wilkin, Yellow Medicine 7
8 PreferredOne Copay Plans - Choice Network Rate Area 5, 6, 7 Smoker 0-17 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ n/a 31 $ $ $ $ $ n/a 32 $ $ $ $ $ n/a 33 $ $ $ $ $ n/a 34 $ $ $ $ $ n/a 35 $ $ $ $ $ n/a 36 $ $ $ $ $ n/a 37 $ $ $ $ $ n/a 38 $ $ $ $ $ n/a 39 $ $ $ $ $ n/a 40 $ $ $ $ $ n/a 41 $ $ $ $ $ n/a 42 $ $ $ $ $ n/a 43 $ $ $ $ $ n/a 44 $ $ $ $ $ n/a 45 $ $ $ $ $ n/a 46 $ $ $ $ $ n/a 47 $ $ $ $ $ n/a 48 $ $ $ $ $ n/a 49 $ $ $ $ $ n/a 50 $ $ $ $ $ n/a 51 $ $ $ $ $ n/a 52 $ $ $ $ $ n/a 53 $ $ $ $ $ n/a 54 $ $ $ $ $ n/a 55 $ $ $ $ $ n/a 56 $ $ $ $ $ n/a 57 $ $ $ $ $ n/a 58 $ $ $ $ $ n/a 59 $ $ $ $ $ n/a 60 $ $ $ $ $ n/a 61 $ $ $ $ $ n/a 62 $ $ $ $ $ n/a 63 $ $ $ $ $ n/a 64 + $ $ $ $ $ n/a Counties include: Aitkin, Becker, Beltrami, Big Stone, Cass, Chippewa, Chisago, Clay, Crow Wing, Douglas, Grant, Hubbard, Isanti, Kanabec, Kandiyohi, Lac Qui Parle. Lyon, McLeod, Meeker, Mille Lacs, Morrison, Otter Tail, Pine, Pope, Renwille, Roseau, Sibley, Stevens, Swift, Todd, Traverse, Wadena, Wilkin, Yellow Medicine 8
9 PreferredOne Copay Plans - Choice Network Rate Area 3-4 Non-Smoker 0-17 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ n/a 31 $ $ $ $ $ n/a 32 $ $ $ $ $ n/a 33 $ $ $ $ $ n/a 34 $ $ $ $ $ n/a 35 $ $ $ $ $ n/a 36 $ $ $ $ $ n/a 37 $ $ $ $ $ n/a 38 $ $ $ $ $ n/a 39 $ $ $ $ $ n/a 40 $ $ $ $ $ n/a 41 $ $ $ $ $ n/a 42 $ $ $ $ $ n/a 43 $ $ $ $ $ n/a 44 $ $ $ $ $ n/a 45 $ $ $ $ $ n/a 46 $ $ $ $ $ n/a 47 $ $ $ $ $ n/a 48 $ $ $ $ $ n/a 49 $ $ $ $ $ n/a 50 $ $ $ $ $ n/a 51 $ $ $ $ $ n/a 52 $ $ $ $ $ n/a 53 $ $ $ $ $ n/a 54 $ $ $ $ $ n/a 55 $ $ $ $ $ n/a 56 $ $ $ $ $ n/a 57 $ $ $ $ $ n/a 58 $ $ $ $ $ n/a 59 $ $ $ $ $ n/a 60 $ $ $ $ $ n/a 61 $ $ $ $ $ n/a 62 $ $ $ $ $ n/a 63 $ $ $ $ $ n/a 64 + $ $ $ $ $ n/a Counties include: Brown, Cottonwood, Jackson, Le Sueur, Lincoln, Martin, Murray, Nicollet, Nobles, Pipestone, Redwood, Rice, Rock, Watonwan 9
10 PreferredOne Copay Plans - Choice Network Rate Area 3-4 Smoker 0-17 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ n/a 31 $ $ $ $ $ n/a 32 $ $ $ $ $ n/a 33 $ $ $ $ $ n/a 34 $ $ $ $ $ n/a 35 $ $ $ $ $ n/a 36 $ $ $ $ $ n/a 37 $ $ $ $ $ n/a 38 $ $ $ $ $ n/a 39 $ $ $ $ $ n/a 40 $ $ $ $ $ n/a 41 $ $ $ $ $ n/a 42 $ $ $ $ $ n/a 43 $ $ $ $ $ n/a 44 $ $ $ $ $ n/a 45 $ $ $ $ $ n/a 46 $ $ $ $ $ n/a 47 $ $ $ $ $ n/a 48 $ $ $ $ $ n/a 49 $ $ $ $ $ n/a 50 $ $ $ $ $ n/a 51 $ $ $ $ $ n/a 52 $ $ $ $ $ n/a 53 $ $ $ $ $ n/a 54 $ $ $ $ $ n/a 55 $ $ $ $ $ n/a 56 $ $ $ $ $ n/a 57 $ $ $ $ $ n/a 58 $ $ $ $ $ n/a 59 $ $ $ $ $ n/a 60 $ $ $ $ $ n/a 61 $ $ $ $ $ n/a 62 $ $ $ $ $ n/a 63 $ $ $ $ $ n/a 64 + $ $ $ $ $ n/a Counties include: Brown, Cottonwood, Jackson, Le Sueur, Lincoln, Martin, Murray, Nicollet, Nobles, Pipestone, Redwood, Rice, Rock, Watonwan 10
11 PreferredOne Copay Plans - Choice Network Rate Area 2 Non-Smoker 0-17 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ n/a 31 $ $ $ $ $ n/a 32 $ $ $ $ $ n/a 33 $ $ $ $ $ n/a 34 $ $ $ $ $ n/a 35 $ $ $ $ $ n/a 36 $ $ $ $ $ n/a 37 $ $ $ $ $ n/a 38 $ $ $ $ $ n/a 39 $ $ $ $ $ n/a 40 $ $ $ $ $ n/a 41 $ $ $ $ $ n/a 42 $ $ $ $ $ n/a 43 $ $ $ $ $ n/a 44 $ $ $ $ $ n/a 45 $ $ $ $ $ n/a 46 $ $ $ $ $ n/a 47 $ $ $ $ $ n/a 48 $ $ $ $ $ n/a 49 $ $ $ $ $ n/a 50 $ $ $ $ $ n/a 51 $ $ $ $ $ n/a 52 $ $ $ $ $ n/a 53 $ $ $ $ $ n/a 54 $ $ $ $ $ n/a 55 $ $ $ $ $ n/a 56 $ $ $ $ $ n/a 57 $ $ $ $ $ n/a 58 $ $ $ $ $ n/a 59 $ $ $ $ $ n/a 60 $ $ $ $ $ n/a 61 $ $ $ $ $ n/a 62 $ $ $ $ $ n/a 63 $ $ $ $ $ n/a 64 + $ $ $ $ $ n/a Counties include: Carlton, Itasca, Koochiching, Lake of the Woods, St. Louis 11
12 PreferredOne Copay Plans - Choice Network Rate Area 2 Smoker 0-17 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ n/a 31 $ $ $ $ $ n/a 32 $ $ $ $ $ n/a 33 $ $ $ $ $ n/a 34 $ $ $ $ $ n/a 35 $ $ $ $ $ n/a 36 $ $ $ $ $ n/a 37 $ $ $ $ $ n/a 38 $ $ $ $ $ n/a 39 $ $ $ $ $ n/a 40 $ $ $ $ $ n/a 41 $ $ $ $ $ n/a 42 $ $ $ $ $ n/a 43 $ $ $ $ $ n/a 44 $ $ $ $ $ n/a 45 $ $ $ $ $ n/a 46 $ $ $ $ $ n/a 47 $ $ $ $ $ n/a 48 $ $ $ $ $ n/a 49 $ $ $ $ $ n/a 50 $ $ $ $ $ n/a 51 $ $ $ $ $ n/a 52 $ $ $ $ $ n/a 53 $ $ $ $ $ n/a 54 $ $ $ $ $ n/a 55 $ $ $ $ $ n/a 56 $ $ $ $ $ n/a 57 $ $ $ $ $ n/a 58 $ $ $ $ $ n/a 59 $ $ $ $ $ n/a 60 $ $ $ $ $ n/a 61 $ $ $ $ $ n/a 62 $ $ $ $ $ n/a 63 $ $ $ $ $ n/a 64 + $ $ $ $ $ n/a Counties include: Carlton, Itasca, Koochiching, Lake of the Woods, St. Louis 12
13 PreferredOne Copay Plans - Select Network Rate Area 7 Non-Smoker 0-17 $ $ $ $ $99.45 $ $ $ $ $ $99.45 $ $ $ $ $ $99.45 $ $ $ $ $ $99.45 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ n/a 31 $ $ $ $ $ n/a 32 $ $ $ $ $ n/a 33 $ $ $ $ $ n/a 34 $ $ $ $ $ n/a 35 $ $ $ $ $ n/a 36 $ $ $ $ $ n/a 37 $ $ $ $ $ n/a 38 $ $ $ $ $ n/a 39 $ $ $ $ $ n/a 40 $ $ $ $ $ n/a 41 $ $ $ $ $ n/a 42 $ $ $ $ $ n/a 43 $ $ $ $ $ n/a 44 $ $ $ $ $ n/a 45 $ $ $ $ $ n/a 46 $ $ $ $ $ n/a 47 $ $ $ $ $ n/a 48 $ $ $ $ $ n/a 49 $ $ $ $ $ n/a 50 $ $ $ $ $ n/a 51 $ $ $ $ $ n/a 52 $ $ $ $ $ n/a 53 $ $ $ $ $ n/a 54 $ $ $ $ $ n/a 55 $ $ $ $ $ n/a 56 $ $ $ $ $ n/a 57 $ $ $ $ $ n/a 58 $ $ $ $ $ n/a 59 $ $ $ $ $ n/a 60 $ $ $ $ $ n/a 61 $ $ $ $ $ n/a 62 $ $ $ $ $ n/a 63 $ $ $ $ $ n/a 64 + $ $ $ $ $ n/a Counties include: Chisago 13
14 PreferredOne Copay Plans - Select Network Rate Area 7 Smoker 0-17 $ $ $ $ $99.45 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ n/a 31 $ $ $ $ $ n/a 32 $ $ $ $ $ n/a 33 $ $ $ $ $ n/a 34 $ $ $ $ $ n/a 35 $ $ $ $ $ n/a 36 $ $ $ $ $ n/a 37 $ $ $ $ $ n/a 38 $ $ $ $ $ n/a 39 $ $ $ $ $ n/a 40 $ $ $ $ $ n/a 41 $ $ $ $ $ n/a 42 $ $ $ $ $ n/a 43 $ $ $ $ $ n/a 44 $ $ $ $ $ n/a 45 $ $ $ $ $ n/a 46 $ $ $ $ $ n/a 47 $ $ $ $ $ n/a 48 $ $ $ $ $ n/a 49 $ $ $ $ $ n/a 50 $ $ $ $ $ n/a 51 $ $ $ $ $ n/a 52 $ $ $ $ $ n/a 53 $ $ $ $ $ n/a 54 $ $ $ $ $ n/a 55 $ $ $ $ $ n/a 56 $ $ $ $ $ n/a 57 $ $ $ $ $ n/a 58 $ $ $ $ $ n/a 59 $ $ $ $ $ n/a 60 $ $ $ $ $ n/a 61 $ $ $ $ $ n/a 62 $ $ $ $ $ n/a 63 $ $ $ $ $ n/a 64 + $ $ $ $ $ n/a Counties include: Chisago 14
15 PreferredOne Copay Plans - Select Network Rate Area 8 Non-Smoker 0-17 $ $ $ $ $94.48 $ $ $ $ $ $94.48 $ $ $ $ $ $94.48 $ $ $ $ $ $94.48 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ n/a 31 $ $ $ $ $ n/a 32 $ $ $ $ $ n/a 33 $ $ $ $ $ n/a 34 $ $ $ $ $ n/a 35 $ $ $ $ $ n/a 36 $ $ $ $ $ n/a 37 $ $ $ $ $ n/a 38 $ $ $ $ $ n/a 39 $ $ $ $ $ n/a 40 $ $ $ $ $ n/a 41 $ $ $ $ $ n/a 42 $ $ $ $ $ n/a 43 $ $ $ $ $ n/a 44 $ $ $ $ $ n/a 45 $ $ $ $ $ n/a 46 $ $ $ $ $ n/a 47 $ $ $ $ $ n/a 48 $ $ $ $ $ n/a 49 $ $ $ $ $ n/a 50 $ $ $ $ $ n/a 51 $ $ $ $ $ n/a 52 $ $ $ $ $ n/a 53 $ $ $ $ $ n/a 54 $ $ $ $ $ n/a 55 $ $ $ $ $ n/a 56 $ $ $ $ $ n/a 57 $ $ $ $ $ n/a 58 $ $ $ $ $ n/a 59 $ $ $ $ $ n/a 60 $ $ $ $ $ n/a 61 $ $ $ $ $ n/a 62 $ $ $ $ $ n/a 63 $ $ $ $ $ n/a 64 + $ $ $ $ $ n/a Counties include: Anoka, Carver, Dakota, Hennepin, Ramsey, Scott, Sherburne, Washington 15
16 PreferredOne Copay Plans - Select Network Rate Area 8 Smoker 0-17 $ $ $ $ $94.48 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ n/a 31 $ $ $ $ $ n/a 32 $ $ $ $ $ n/a 33 $ $ $ $ $ n/a 34 $ $ $ $ $ n/a 35 $ $ $ $ $ n/a 36 $ $ $ $ $ n/a 37 $ $ $ $ $ n/a 38 $ $ $ $ $ n/a 39 $ $ $ $ $ n/a 40 $ $ $ $ $ n/a 41 $ $ $ $ $ n/a 42 $ $ $ $ $ n/a 43 $ $ $ $ $ n/a 44 $ $ $ $ $ n/a 45 $ $ $ $ $ n/a 46 $ $ $ $ $ n/a 47 $ $ $ $ $ n/a 48 $ $ $ $ $ n/a 49 $ $ $ $ $ n/a 50 $ $ $ $ $ n/a 51 $ $ $ $ $ n/a 52 $ $ $ $ $ n/a 53 $ $ $ $ $ n/a 54 $ $ $ $ $ n/a 55 $ $ $ $ $ n/a 56 $ $ $ $ $ n/a 57 $ $ $ $ $ n/a 58 $ $ $ $ $ n/a 59 $ $ $ $ $ n/a 60 $ $ $ $ $ n/a 61 $ $ $ $ $ n/a 62 $ $ $ $ $ n/a 63 $ $ $ $ $ n/a 64 + $ $ $ $ $ n/a Counties include: Anoka, Carver, Dakota, Hennepin, Ramsey, Scott, Sherburne, Washington 16 1/2014
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