2018 Community Psychiatry BCBSM Rates

Run Date:

10/2017

BENEFIT AND RATE SCHEDULE

COMMUNITY PSYCHIATRY MANAGEMENT, LLC

Rate Effective:

01/2018

Renewal Month:

January

Group Division:

007024338-0000

402623

Customer ID:

Commercial Benefit Rates

Medical + Pharmacy

Medical + Pharmacy

Age Band

Total

Dental

Vision

Age Band

Total

Dental

Vision

0 1 2 3 4 5 6 7 8 9

$287.33 $287.33 $287.33 $287.33 $287.33 $287.33 $287.33 $287.33 $287.33 $287.33 $287.33 $287.33 $287.33 $287.33 $287.33 $309.94 $318.59 $327.23 $336.54 $339.40 $349.14 $359.19 $359.40 $359.64 $359.91 $361.53 $368.53 $376.87 $390.28 $401.34 $407.06 $415.47 $423.90

$254.35 $254.35 $254.35 $254.35 $254.35 $254.35 $254.35 $254.35 $254.35 $254.35 $254.35 $254.35 $254.35 $254.35 $254.35 $276.96 $285.61 $294.25 $303.56 $312.87 $322.52 $332.49 $332.49 $332.49 $332.49 $333.82 $340.47 $348.45 $361.42 $372.06 $377.38 $385.36 $393.34

$32.98 $32.98 $32.98 $32.98 $32.98 $32.98 $32.98 $32.98 $32.98 $32.98 $32.98 $32.98 $32.98 $32.98 $32.98 $32.98 $32.98 $32.98 $32.98 $23.88 $23.88 $23.88 $24.09 $24.33 $24.60 $24.88 $25.17 $25.46 $25.79 $26.12 $26.48 $26.84 $27.22

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $2.65 $2.74 $2.82 $2.82 $2.82 $2.82 $2.83 $2.89 $2.96 $3.07 $3.16 $3.20 $3.27 $3.34

33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64

$429.33 $435.10 $438.21 $441.35 $444.48 $447.64 $453.51 $459.37 $467.95 $476.22 $487.50 $501.48 $517.84 $537.21 $558.95 $583.74 $608.19 $635.69 $662.87 $692.73 $722.95 $755.55 $788.14 $823.45 $859.11 $897.12 $916.37 $954.42 $987.45

$398.32 $403.64 $406.30 $408.96 $411.62 $414.28 $419.60 $424.92 $432.90 $440.55 $451.19 $464.49 $480.12 $498.74 $519.68 $543.62 $567.23 $593.83 $620.09 $649.02 $678.28 $709.87 $741.45 $775.70 $810.28 $847.18 $865.47 $902.38 $934.30 $955.24 $981.51 $997.47 $997.47

$27.63 $28.04 $28.46 $28.92 $29.37 $29.85 $30.35 $30.85 $31.38 $31.93 $32.48 $33.05 $33.65 $34.24 $34.86 $35.51 $36.15 $36.82 $37.52 $38.21 $38.92 $39.66 $40.40 $41.17 $41.96 $42.75 $43.56 $44.39 $45.23 $46.09 $46.97 $47.86 $47.86

$3.38 $3.42 $3.45 $3.47 $3.49 $3.51 $3.56 $3.60 $3.67 $3.74 $3.83 $3.94 $4.07 $4.23 $4.41 $4.61 $4.81 $5.04 $5.26 $5.50 $5.75 $6.02 $6.29 $6.58 $6.87 $7.19 $7.34 $7.65 $7.92 $8.10 $8.32 $8.46 $8.46

10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32

$1,009.43 $1,036.80 $1,053.79 $1,053.79

65+

Medicare Supplemental Benefit Rates

Medical + Pharmacy

Age Band

Total

Dental

Vision

All

$831.15

$774.83

$47.86

$8.46

08385906

Reference Number:

Made with FlippingBook - Online magazine maker