Master Monthly Rates Table

wdt_ID wdt_created_by wdt_created_at wdt_last_edited_by wdt_last_edited_at Plan Name Line of Business County Web ID Age 14 Age 15 Age 16 Age 17 Age 18 Age 19 Age 20 Age 21 Age 22 Age 23 Age 24 Age 25 Age 26 Age 27 Age 28 Age 29 Age 30 Age 31 Age 32 Age 33 Age 34 Age 35 Age 36 Age 37 Age 38 Age 39 Age 40 Age 41 Age 42 Age 43 Age 44 Age 45 Age 46 Age 47 Age 48 Age 49 Age 50 Age 51 Age 52 Age 53 Age 54 Age 55 Age 56 Age 57 Age 58 Age 59 Age 60 Age 61 Age 62 Age 63 Age 64
225 imLana 05/12/2025 02:48 PM imLana 05/12/2025 02:48 PM Active Choice PPO Individual and Family SF 2024-active-choice-ppo-silver-ifp-sf 336.77 366.70 378.15 389.59 401.92 414.25 427.01 440.22 440.22 440.22 440.22 441.98 450.78 461.35 478.52 492.60 499.65 510.21 520.78 527.38 534.43 537.95 541.47 544.99 548.51 555.56 562.60 573.16 583.29 597.38 614.99 635.68 660.33 688.06 719.76 751.01 786.23 821.01 859.31 898.05 939.87 981.69 1,027.03 1,072.81 1,121.68 1,145.89 1,194.75 1,237.01 1,264.75 1,299.52 1,320.65
226 imLana 05/12/2025 02:48 PM imLana 05/12/2025 02:48 PM Active Choice PPO Individual and Family SM 2024-active-choice-ppo-silver-ifp-sm 363.72 396.06 408.42 420.78 434.09 447.41 461.19 475.46 475.46 475.46 475.46 477.36 486.87 498.28 516.82 532.04 539.64 551.06 562.47 569.60 577.21 581.01 584.81 588.62 592.42 600.03 607.63 619.05 629.98 645.20 664.21 686.56 713.19 743.14 777.37 811.13 849.17 886.73 928.09 969.93 1,015.10 1,060.27 1,109.24 1,158.69 1,211.47 1,237.62 1,290.39 1,336.04 1,365.99 1,403.55 1,426.36
227 imLana 05/12/2025 02:48 PM imLana 05/12/2025 02:48 PM Amber 50 HMO Silver Individual and Family SF 2024-amber-50-hmo-silver-ifp-sf 348.79 379.80 391.65 403.51 416.27 429.04 442.26 455.94 455.94 455.94 455.94 457.76 466.88 477.83 495.61 510.20 517.49 528.44 539.38 546.22 553.51 557.16 560.81 564.45 568.10 575.40 582.69 593.63 604.12 618.71 636.95 658.38 683.91 712.64 745.46 777.83 814.31 850.33 890.00 930.12 973.43 1,016.75 1,063.71 1,111.13 1,161.74 1,186.81 1,237.42 1,281.19 1,309.92 1,345.94 1,367.81
228 imLana 05/12/2025 02:48 PM imLana 05/12/2025 02:48 PM Amber 50 HMO Silver Individual and Family SM 2024-amber-50-hmo-silver-ifp-sm 376.72 410.20 423.00 435.81 449.60 463.38 477.66 492.44 492.44 492.44 492.44 494.41 504.26 516.08 535.28 551.04 558.92 570.74 582.55 589.94 597.82 601.76 605.70 609.64 613.58 621.46 629.34 641.15 652.48 668.24 687.94 711.08 738.66 769.68 805.14 840.10 879.49 918.40 961.24 1,004.57 1,051.36 1,098.14 1,148.86 1,200.07 1,254.73 1,281.82 1,336.48 1,383.75 1,414.77 1,453.68 1,477.30
229 imLana 05/12/2025 02:48 PM imLana 05/12/2025 02:48 PM American Indian / Alaskan Native HMO Individual and Family SF 2024-american-indian-alaskan-native-hmo-ifp-sf 295.70 321.99 332.04 342.09 352.91 363.73 374.94 386.54 386.54 386.54 386.54 388.09 395.82 405.09 420.17 432.54 438.72 448.00 457.28 463.07 469.26 472.35 475.44 478.54 481.63 487.81 494.00 503.27 512.16 524.53 540.00 558.16 579.81 604.16 631.99 659.44 690.36 720.90 754.52 788.54 825.26 861.98 901.80 942.00 984.90 1,006.16 1,049.07 1,086.18 1,110.53 1,141.06 1,159.61
230 imLana 05/12/2025 02:48 PM imLana 05/12/2025 02:48 PM American Indian / Alaskan Native HMO Individual and Family SM 2024-american-indian-alaskan-native-hmo-ifp-sm 319.36 347.75 358.60 369.45 381.14 392.83 404.94 417.46 417.46 417.46 417.46 419.13 427.48 437.50 453.78 467.14 473.82 483.84 493.86 500.12 506.80 510.14 513.48 516.82 520.16 526.84 533.52 543.54 553.14 566.50 583.20 602.82 626.19 652.49 682.55 712.19 745.59 778.57 814.89 851.62 891.28 930.94 973.94 1,017.36 1,063.69 1,086.65 1,132.99 1,173.07 1,199.37 1,232.35 1,252.38
231 imLana 05/12/2025 02:48 PM imLana 05/12/2025 02:48 PM Bronze 60 HDHP HMO Employer Group SF 2024-bronze-60-hdhp-hmo-egp-sf 241.84 263.34 271.56 279.78 288.63 297.48 306.65 316.14 316.14 316.14 316.14 317.40 323.72 331.31 343.64 353.76 358.81 366.40 373.99 378.73 383.79 386.32 388.85 391.38 393.91 398.96 404.02 411.61 418.88 429.00 441.64 456.50 474.20 494.12 516.88 539.33 564.62 589.59 617.10 644.92 674.95 704.98 737.55 770.42 805.52 822.90 857.99 888.34 908.26 933.23 948.40
232 imLana 05/12/2025 02:48 PM imLana 05/12/2025 02:48 PM Bronze 60 HDHP HMO Employer Group SM 2024-bronze-60-hdhp-hmo-egp-sm 261.20 284.42 293.30 302.18 311.74 321.30 331.20 341.44 341.44 341.44 341.44 342.81 349.64 357.83 371.15 382.08 387.54 395.73 403.93 409.05 414.51 417.24 419.98 422.71 425.44 430.90 436.37 444.56 452.41 463.34 477.00 493.05 512.17 533.68 558.26 582.50 609.82 636.79 666.50 696.55 728.98 761.42 796.59 832.10 870.00 888.78 926.68 959.46 980.97 1,007.94 1,024.32
233 imLana 05/12/2025 02:48 PM imLana 05/12/2025 02:48 PM Bronze 60 HDHP HMO Individual and Family SF 2024-bronze-60-hdhp-hmo-ifp-sf 295.70 321.99 332.04 342.09 352.91 363.73 374.94 386.54 386.54 386.54 386.54 388.09 395.82 405.09 420.17 432.54 438.72 448.00 457.28 463.07 469.26 472.35 475.44 478.54 481.63 487.81 494.00 503.27 512.16 524.53 540.00 558.16 579.81 604.16 631.99 659.44 690.36 720.90 754.52 788.54 825.26 861.98 901.80 942.00 984.90 1,006.16 1,049.07 1,086.18 1,110.53 1,141.06 1,159.61
234 imLana 05/12/2025 02:48 PM imLana 05/12/2025 02:48 PM Bronze 60 HDHP HMO Individual and Family SM 2024-bronze-60-hdhp-hmo-ifp-sm 319.36 347.75 358.60 369.45 381.14 392.83 404.94 417.46 417.46 417.46 417.46 419.13 427.48 437.50 453.78 467.14 473.82 483.84 493.86 500.12 506.80 510.14 513.48 516.82 520.16 526.84 533.52 543.54 553.14 566.50 583.20 602.82 626.19 652.49 682.55 712.19 745.59 778.57 814.89 851.62 891.28 930.94 973.94 1,017.36 1,063.69 1,086.65 1,132.99 1,173.07 1,199.37 1,232.35 1,252.38
Plan Name Line of Business County Web ID Age 14 Age 15 Age 16 Age 17 Age 18 Age 19 Age 20 Age 21 Age 22 Age 23 Age 24 Age 25 Age 26 Age 27 Age 28 Age 29 Age 30 Age 31 Age 32 Age 33 Age 34 Age 35 Age 36 Age 37 Age 38 Age 39 Age 40 Age 41 Age 42 Age 43 Age 44 Age 45 Age 46 Age 47 Age 48 Age 49 Age 50 Age 51 Age 52 Age 53 Age 54 Age 55 Age 56 Age 57 Age 58 Age 59 Age 60 Age 61 Age 62 Age 63 Age 64