Table: calendar_year_2023_cohs_rates

rating_period	calendar_year	model	county	health_plan	category_of_aid	lower_bound	midpoint	upper_bound
1/23-12/23	2023	COHS	Del Norte	Partnership Health Plan of California	Child - SIS	$103.32	$107.17	$111.20
1/23-12/23	2023	COHS	Del Norte	Partnership Health Plan of California	Adult - SIS	$313.26	$322.64	$332.37
1/23-12/23	2023	COHS	Del Norte	Partnership Health Plan of California	ACA Optional Expansion - SIS	$406.98	$418.60	$430.65
1/23-12/23	2023	COHS	Del Norte	Partnership Health Plan of California	SPD - SIS	$1,171.19	$1,200.66	$1,231.12
1/23-12/23	2023	COHS	Del Norte	Partnership Health Plan of California	SPD/Full-Dual - SIS	$563.15	$572.69	$582.54
1/23-12/23	2023	COHS	Del Norte	Partnership Health Plan of California	LTC - SIS	$1,171.19	$1,200.66	$1,231.12
1/23-12/23	2023	COHS	Del Norte	Partnership Health Plan of California	LTC/Full-Dual - SIS	$563.15	$572.69	$582.54
1/23-12/23	2023	COHS	Del Norte	Partnership Health Plan of California	Maternity - SIS	$10,943.36	$11,156.01	$11,374.62
1/23-12/23	2023	COHS	Del Norte	Partnership Health Plan of California	WCM - SIS	$1,990.45	$2,044.30	$2,099.99
1/23-12/23	2023	COHS	Del Norte	Partnership Health Plan of California	Child - UIS Federally Eligible	$31.50	$32.98	$34.54
1/23-12/23	2023	COHS	Del Norte	Partnership Health Plan of California	Adult - UIS Federally Eligible	$299.51	$308.09	$316.99
1/23-12/23	2023	COHS	Del Norte	Partnership Health Plan of California	ACA Optional Expansion - UIS Federally Eligible	$414.55	$426.17	$438.21
1/23-12/23	2023	COHS	Del Norte	Partnership Health Plan of California	SPD - UIS Federally Eligible	$870.78	$894.52	$919.07
1/23-12/23	2023	COHS	Del Norte	Partnership Health Plan of California	SPD/Full-Dual - UIS Federally Eligible	$195.13	$200.39	$205.85
1/23-12/23	2023	COHS	Del Norte	Partnership Health Plan of California	LTC - UIS Federally Eligible	$870.78	$894.52	$919.07
1/23-12/23	2023	COHS	Del Norte	Partnership Health Plan of California	LTC/Full-Dual - UIS Federally Eligible	$195.13	$200.39	$205.85
1/23-12/23	2023	COHS	Del Norte	Partnership Health Plan of California	Maternity - UIS Federally Eligible	$10,913.12	$11,125.18	$11,343.19
1/23-12/23	2023	COHS	Del Norte	Partnership Health Plan of California	WCM - UIS Federally Eligible	$829.87	$852.53	$875.96
1/23-12/23	2023	COHS	Del Norte	Partnership Health Plan of California	Child - UIS State-Only	$58.26	$60.29	$62.40
1/23-12/23	2023	COHS	Del Norte	Partnership Health Plan of California	Adult - UIS State-Only	$200.32	$205.97	$211.83
1/23-12/23	2023	COHS	Del Norte	Partnership Health Plan of California	ACA Optional Expansion - UIS State-Only	$303.14	$310.95	$319.03
1/23-12/23	2023	COHS	Del Norte	Partnership Health Plan of California	SPD - UIS State-Only	$769.09	$785.77	$803.00
1/23-12/23	2023	COHS	Del Norte	Partnership Health Plan of California	SPD/Full-Dual - UIS State-Only	$377.73	$384.36	$391.19
1/23-12/23	2023	COHS	Del Norte	Partnership Health Plan of California	LTC - UIS State-Only	$769.09	$785.77	$803.00
1/23-12/23	2023	COHS	Del Norte	Partnership Health Plan of California	LTC/Full-Dual - UIS State-Only	$377.73	$384.36	$391.19
1/23-12/23	2023	COHS	Del Norte	Partnership Health Plan of California	WCM - UIS State-Only	$1,162.74	$1,194.01	$1,226.33
1/23-12/23	2023	COHS	Humboldt	Partnership Health Plan of California	Child - SIS	$103.32	$107.17	$111.20
1/23-12/23	2023	COHS	Humboldt	Partnership Health Plan of California	Adult - SIS	$313.26	$322.64	$332.37
1/23-12/23	2023	COHS	Humboldt	Partnership Health Plan of California	ACA Optional Expansion - SIS	$406.98	$418.60	$430.65
1/23-12/23	2023	COHS	Humboldt	Partnership Health Plan of California	SPD - SIS	$1,171.19	$1,200.66	$1,231.12
1/23-12/23	2023	COHS	Humboldt	Partnership Health Plan of California	SPD/Full-Dual - SIS	$563.15	$572.69	$582.54
1/23-12/23	2023	COHS	Humboldt	Partnership Health Plan of California	LTC - SIS	$1,171.19	$1,200.66	$1,231.12
1/23-12/23	2023	COHS	Humboldt	Partnership Health Plan of California	LTC/Full-Dual - SIS	$563.15	$572.69	$582.54
1/23-12/23	2023	COHS	Humboldt	Partnership Health Plan of California	Maternity - SIS	$10,943.36	$11,156.01	$11,374.62
1/23-12/23	2023	COHS	Humboldt	Partnership Health Plan of California	WCM - SIS	$1,990.45	$2,044.30	$2,099.99
1/23-12/23	2023	COHS	Humboldt	Partnership Health Plan of California	Child - UIS Federally Eligible	$31.50	$32.98	$34.54
1/23-12/23	2023	COHS	Humboldt	Partnership Health Plan of California	Adult - UIS Federally Eligible	$299.51	$308.09	$316.99
1/23-12/23	2023	COHS	Humboldt	Partnership Health Plan of California	ACA Optional Expansion - UIS Federally Eligible	$414.55	$426.17	$438.21
1/23-12/23	2023	COHS	Humboldt	Partnership Health Plan of California	SPD - UIS Federally Eligible	$870.78	$894.52	$919.07
1/23-12/23	2023	COHS	Humboldt	Partnership Health Plan of California	SPD/Full-Dual - UIS Federally Eligible	$195.13	$200.39	$205.85
1/23-12/23	2023	COHS	Humboldt	Partnership Health Plan of California	LTC - UIS Federally Eligible	$870.78	$894.52	$919.07
1/23-12/23	2023	COHS	Humboldt	Partnership Health Plan of California	LTC/Full-Dual - UIS Federally Eligible	$195.13	$200.39	$205.85
1/23-12/23	2023	COHS	Humboldt	Partnership Health Plan of California	Maternity - UIS Federally Eligible	$10,913.12	$11,125.18	$11,343.19
1/23-12/23	2023	COHS	Humboldt	Partnership Health Plan of California	WCM - UIS Federally Eligible	$829.87	$852.53	$875.96
1/23-12/23	2023	COHS	Humboldt	Partnership Health Plan of California	Child - UIS State-Only	$58.26	$60.29	$62.40
1/23-12/23	2023	COHS	Humboldt	Partnership Health Plan of California	Adult - UIS State-Only	$200.32	$205.97	$211.83
1/23-12/23	2023	COHS	Humboldt	Partnership Health Plan of California	ACA Optional Expansion - UIS State-Only	$303.14	$310.95	$319.03
1/23-12/23	2023	COHS	Humboldt	Partnership Health Plan of California	SPD - UIS State-Only	$769.09	$785.77	$803.00
1/23-12/23	2023	COHS	Humboldt	Partnership Health Plan of California	SPD/Full-Dual - UIS State-Only	$377.73	$384.36	$391.19
1/23-12/23	2023	COHS	Humboldt	Partnership Health Plan of California	LTC - UIS State-Only	$769.09	$785.77	$803.00
1/23-12/23	2023	COHS	Humboldt	Partnership Health Plan of California	LTC/Full-Dual - UIS State-Only	$377.73	$384.36	$391.19
1/23-12/23	2023	COHS	Humboldt	Partnership Health Plan of California	WCM - UIS State-Only	$1,162.74	$1,194.01	$1,226.33
1/23-12/23	2023	COHS	Lake	Partnership Health Plan of California	Child - SIS	$103.32	$107.17	$111.20
1/23-12/23	2023	COHS	Lake	Partnership Health Plan of California	Adult - SIS	$313.26	$322.64	$332.37
1/23-12/23	2023	COHS	Lake	Partnership Health Plan of California	ACA Optional Expansion - SIS	$406.98	$418.60	$430.65
1/23-12/23	2023	COHS	Lake	Partnership Health Plan of California	SPD - SIS	$1,171.19	$1,200.66	$1,231.12
1/23-12/23	2023	COHS	Lake	Partnership Health Plan of California	SPD/Full-Dual - SIS	$563.15	$572.69	$582.54
1/23-12/23	2023	COHS	Lake	Partnership Health Plan of California	LTC - SIS	$1,171.19	$1,200.66	$1,231.12
1/23-12/23	2023	COHS	Lake	Partnership Health Plan of California	LTC/Full-Dual - SIS	$563.15	$572.69	$582.54
1/23-12/23	2023	COHS	Lake	Partnership Health Plan of California	Maternity - SIS	$10,943.36	$11,156.01	$11,374.62
1/23-12/23	2023	COHS	Lake	Partnership Health Plan of California	WCM - SIS	$1,990.45	$2,044.30	$2,099.99
1/23-12/23	2023	COHS	Lake	Partnership Health Plan of California	Child - UIS Federally Eligible	$31.50	$32.98	$34.54
1/23-12/23	2023	COHS	Lake	Partnership Health Plan of California	Adult - UIS Federally Eligible	$299.51	$308.09	$316.99
1/23-12/23	2023	COHS	Lake	Partnership Health Plan of California	ACA Optional Expansion - UIS Federally Eligible	$414.55	$426.17	$438.21
1/23-12/23	2023	COHS	Lake	Partnership Health Plan of California	SPD - UIS Federally Eligible	$870.78	$894.52	$919.07
1/23-12/23	2023	COHS	Lake	Partnership Health Plan of California	SPD/Full-Dual - UIS Federally Eligible	$195.13	$200.39	$205.85
1/23-12/23	2023	COHS	Lake	Partnership Health Plan of California	LTC - UIS Federally Eligible	$870.78	$894.52	$919.07
1/23-12/23	2023	COHS	Lake	Partnership Health Plan of California	LTC/Full-Dual - UIS Federally Eligible	$195.13	$200.39	$205.85
1/23-12/23	2023	COHS	Lake	Partnership Health Plan of California	Maternity - UIS Federally Eligible	$10,913.12	$11,125.18	$11,343.19
1/23-12/23	2023	COHS	Lake	Partnership Health Plan of California	WCM - UIS Federally Eligible	$829.87	$852.53	$875.96
1/23-12/23	2023	COHS	Lake	Partnership Health Plan of California	Child - UIS State-Only	$58.26	$60.29	$62.40
1/23-12/23	2023	COHS	Lake	Partnership Health Plan of California	Adult - UIS State-Only	$200.32	$205.97	$211.83
1/23-12/23	2023	COHS	Lake	Partnership Health Plan of California	ACA Optional Expansion - UIS State-Only	$303.14	$310.95	$319.03
1/23-12/23	2023	COHS	Lake	Partnership Health Plan of California	SPD - UIS State-Only	$769.09	$785.77	$803.00
1/23-12/23	2023	COHS	Lake	Partnership Health Plan of California	SPD/Full-Dual - UIS State-Only	$377.73	$384.36	$391.19
1/23-12/23	2023	COHS	Lake	Partnership Health Plan of California	LTC - UIS State-Only	$769.09	$785.77	$803.00
1/23-12/23	2023	COHS	Lake	Partnership Health Plan of California	LTC/Full-Dual - UIS State-Only	$377.73	$384.36	$391.19
1/23-12/23	2023	COHS	Lake	Partnership Health Plan of California	WCM - UIS State-Only	$1,162.74	$1,194.01	$1,226.33
1/23-12/23	2023	COHS	Lassen	Partnership Health Plan of California	Child - SIS	$103.32	$107.17	$111.20
1/23-12/23	2023	COHS	Lassen	Partnership Health Plan of California	Adult - SIS	$313.26	$322.64	$332.37
1/23-12/23	2023	COHS	Lassen	Partnership Health Plan of California	ACA Optional Expansion - SIS	$406.98	$418.60	$430.65
1/23-12/23	2023	COHS	Lassen	Partnership Health Plan of California	SPD - SIS	$1,171.19	$1,200.66	$1,231.12
1/23-12/23	2023	COHS	Lassen	Partnership Health Plan of California	SPD/Full-Dual - SIS	$563.15	$572.69	$582.54
1/23-12/23	2023	COHS	Lassen	Partnership Health Plan of California	LTC - SIS	$1,171.19	$1,200.66	$1,231.12
1/23-12/23	2023	COHS	Lassen	Partnership Health Plan of California	LTC/Full-Dual - SIS	$563.15	$572.69	$582.54
1/23-12/23	2023	COHS	Lassen	Partnership Health Plan of California	Maternity - SIS	$10,943.36	$11,156.01	$11,374.62
1/23-12/23	2023	COHS	Lassen	Partnership Health Plan of California	WCM - SIS	$1,990.45	$2,044.30	$2,099.99
1/23-12/23	2023	COHS	Lassen	Partnership Health Plan of California	Child - UIS Federally Eligible	$31.50	$32.98	$34.54
1/23-12/23	2023	COHS	Lassen	Partnership Health Plan of California	Adult - UIS Federally Eligible	$299.51	$308.09	$316.99
1/23-12/23	2023	COHS	Lassen	Partnership Health Plan of California	ACA Optional Expansion - UIS Federally Eligible	$414.55	$426.17	$438.21
1/23-12/23	2023	COHS	Lassen	Partnership Health Plan of California	SPD - UIS Federally Eligible	$870.78	$894.52	$919.07
1/23-12/23	2023	COHS	Lassen	Partnership Health Plan of California	SPD/Full-Dual - UIS Federally Eligible	$195.13	$200.39	$205.85
1/23-12/23	2023	COHS	Lassen	Partnership Health Plan of California	LTC - UIS Federally Eligible	$870.78	$894.52	$919.07
1/23-12/23	2023	COHS	Lassen	Partnership Health Plan of California	LTC/Full-Dual - UIS Federally Eligible	$195.13	$200.39	$205.85
1/23-12/23	2023	COHS	Lassen	Partnership Health Plan of California	Maternity - UIS Federally Eligible	$10,913.12	$11,125.18	$11,343.19
1/23-12/23	2023	COHS	Lassen	Partnership Health Plan of California	WCM - UIS Federally Eligible	$829.87	$852.53	$875.96
1/23-12/23	2023	COHS	Lassen	Partnership Health Plan of California	Child - UIS State-Only	$58.26	$60.29	$62.40
1/23-12/23	2023	COHS	Lassen	Partnership Health Plan of California	Adult - UIS State-Only	$200.32	$205.97	$211.83
1/23-12/23	2023	COHS	Lassen	Partnership Health Plan of California	ACA Optional Expansion - UIS State-Only	$303.14	$310.95	$319.03
1/23-12/23	2023	COHS	Lassen	Partnership Health Plan of California	SPD - UIS State-Only	$769.09	$785.77	$803.00
1/23-12/23	2023	COHS	Lassen	Partnership Health Plan of California	SPD/Full-Dual - UIS State-Only	$377.73	$384.36	$391.19
1/23-12/23	2023	COHS	Lassen	Partnership Health Plan of California	LTC - UIS State-Only	$769.09	$785.77	$803.00
1/23-12/23	2023	COHS	Lassen	Partnership Health Plan of California	LTC/Full-Dual - UIS State-Only	$377.73	$384.36	$391.19
1/23-12/23	2023	COHS	Lassen	Partnership Health Plan of California	WCM - UIS State-Only	$1,162.74	$1,194.01	$1,226.33
1/23-12/23	2023	COHS	Marin	Partnership Health Plan of California	Child - SIS	$103.32	$107.17	$111.20
1/23-12/23	2023	COHS	Marin	Partnership Health Plan of California	Adult - SIS	$313.26	$322.64	$332.37
1/23-12/23	2023	COHS	Marin	Partnership Health Plan of California	ACA Optional Expansion - SIS	$406.98	$418.60	$430.65
1/23-12/23	2023	COHS	Marin	Partnership Health Plan of California	SPD - SIS	$1,171.19	$1,200.66	$1,231.12
1/23-12/23	2023	COHS	Marin	Partnership Health Plan of California	SPD/Full-Dual - SIS	$563.15	$572.69	$582.54
1/23-12/23	2023	COHS	Marin	Partnership Health Plan of California	LTC - SIS	$1,171.19	$1,200.66	$1,231.12
1/23-12/23	2023	COHS	Marin	Partnership Health Plan of California	LTC/Full-Dual - SIS	$563.15	$572.69	$582.54
1/23-12/23	2023	COHS	Marin	Partnership Health Plan of California	Maternity - SIS	$10,943.36	$11,156.01	$11,374.62
1/23-12/23	2023	COHS	Marin	Partnership Health Plan of California	WCM - SIS	$1,990.45	$2,044.30	$2,099.99
1/23-12/23	2023	COHS	Marin	Partnership Health Plan of California	Child - UIS Federally Eligible	$31.50	$32.98	$34.54
1/23-12/23	2023	COHS	Marin	Partnership Health Plan of California	Adult - UIS Federally Eligible	$299.51	$308.09	$316.99
1/23-12/23	2023	COHS	Marin	Partnership Health Plan of California	ACA Optional Expansion - UIS Federally Eligible	$414.55	$426.17	$438.21
1/23-12/23	2023	COHS	Marin	Partnership Health Plan of California	SPD - UIS Federally Eligible	$870.78	$894.52	$919.07
1/23-12/23	2023	COHS	Marin	Partnership Health Plan of California	SPD/Full-Dual - UIS Federally Eligible	$195.13	$200.39	$205.85
1/23-12/23	2023	COHS	Marin	Partnership Health Plan of California	LTC - UIS Federally Eligible	$870.78	$894.52	$919.07
1/23-12/23	2023	COHS	Marin	Partnership Health Plan of California	LTC/Full-Dual - UIS Federally Eligible	$195.13	$200.39	$205.85
1/23-12/23	2023	COHS	Marin	Partnership Health Plan of California	Maternity - UIS Federally Eligible	$10,913.12	$11,125.18	$11,343.19
1/23-12/23	2023	COHS	Marin	Partnership Health Plan of California	WCM - UIS Federally Eligible	$829.87	$852.53	$875.96
1/23-12/23	2023	COHS	Marin	Partnership Health Plan of California	Child - UIS State-Only	$58.26	$60.29	$62.40
1/23-12/23	2023	COHS	Marin	Partnership Health Plan of California	Adult - UIS State-Only	$200.32	$205.97	$211.83
1/23-12/23	2023	COHS	Marin	Partnership Health Plan of California	ACA Optional Expansion - UIS State-Only	$303.14	$310.95	$319.03
1/23-12/23	2023	COHS	Marin	Partnership Health Plan of California	SPD - UIS State-Only	$769.09	$785.77	$803.00
1/23-12/23	2023	COHS	Marin	Partnership Health Plan of California	SPD/Full-Dual - UIS State-Only	$377.73	$384.36	$391.19
1/23-12/23	2023	COHS	Marin	Partnership Health Plan of California	LTC - UIS State-Only	$769.09	$785.77	$803.00
1/23-12/23	2023	COHS	Marin	Partnership Health Plan of California	LTC/Full-Dual - UIS State-Only	$377.73	$384.36	$391.19
1/23-12/23	2023	COHS	Marin	Partnership Health Plan of California	WCM - UIS State-Only	$1,162.74	$1,194.01	$1,226.33
1/23-12/23	2023	COHS	Mendocino	Partnership Health Plan of California	Child - SIS	$103.32	$107.17	$111.20
1/23-12/23	2023	COHS	Mendocino	Partnership Health Plan of California	Adult - SIS	$313.26	$322.64	$332.37
1/23-12/23	2023	COHS	Mendocino	Partnership Health Plan of California	ACA Optional Expansion - SIS	$406.98	$418.60	$430.65
1/23-12/23	2023	COHS	Mendocino	Partnership Health Plan of California	SPD - SIS	$1,171.19	$1,200.66	$1,231.12
1/23-12/23	2023	COHS	Mendocino	Partnership Health Plan of California	SPD/Full-Dual - SIS	$563.15	$572.69	$582.54
1/23-12/23	2023	COHS	Mendocino	Partnership Health Plan of California	LTC - SIS	$1,171.19	$1,200.66	$1,231.12
1/23-12/23	2023	COHS	Mendocino	Partnership Health Plan of California	LTC/Full-Dual - SIS	$563.15	$572.69	$582.54
1/23-12/23	2023	COHS	Mendocino	Partnership Health Plan of California	Maternity - SIS	$10,943.36	$11,156.01	$11,374.62
1/23-12/23	2023	COHS	Mendocino	Partnership Health Plan of California	WCM - SIS	$1,990.45	$2,044.30	$2,099.99
1/23-12/23	2023	COHS	Mendocino	Partnership Health Plan of California	Child - UIS Federally Eligible	$31.50	$32.98	$34.54
1/23-12/23	2023	COHS	Mendocino	Partnership Health Plan of California	Adult - UIS Federally Eligible	$299.51	$308.09	$316.99
1/23-12/23	2023	COHS	Mendocino	Partnership Health Plan of California	ACA Optional Expansion - UIS Federally Eligible	$414.55	$426.17	$438.21
1/23-12/23	2023	COHS	Mendocino	Partnership Health Plan of California	SPD - UIS Federally Eligible	$870.78	$894.52	$919.07
1/23-12/23	2023	COHS	Mendocino	Partnership Health Plan of California	SPD/Full-Dual - UIS Federally Eligible	$195.13	$200.39	$205.85
1/23-12/23	2023	COHS	Mendocino	Partnership Health Plan of California	LTC - UIS Federally Eligible	$870.78	$894.52	$919.07
1/23-12/23	2023	COHS	Mendocino	Partnership Health Plan of California	LTC/Full-Dual - UIS Federally Eligible	$195.13	$200.39	$205.85
1/23-12/23	2023	COHS	Mendocino	Partnership Health Plan of California	Maternity - UIS Federally Eligible	$10,913.12	$11,125.18	$11,343.19
1/23-12/23	2023	COHS	Mendocino	Partnership Health Plan of California	WCM - UIS Federally Eligible	$829.87	$852.53	$875.96
1/23-12/23	2023	COHS	Mendocino	Partnership Health Plan of California	Child - UIS State-Only	$58.26	$60.29	$62.40
1/23-12/23	2023	COHS	Mendocino	Partnership Health Plan of California	Adult - UIS State-Only	$200.32	$205.97	$211.83
1/23-12/23	2023	COHS	Mendocino	Partnership Health Plan of California	ACA Optional Expansion - UIS State-Only	$303.14	$310.95	$319.03
1/23-12/23	2023	COHS	Mendocino	Partnership Health Plan of California	SPD - UIS State-Only	$769.09	$785.77	$803.00
1/23-12/23	2023	COHS	Mendocino	Partnership Health Plan of California	SPD/Full-Dual - UIS State-Only	$377.73	$384.36	$391.19
1/23-12/23	2023	COHS	Mendocino	Partnership Health Plan of California	LTC - UIS State-Only	$769.09	$785.77	$803.00
1/23-12/23	2023	COHS	Mendocino	Partnership Health Plan of California	LTC/Full-Dual - UIS State-Only	$377.73	$384.36	$391.19
1/23-12/23	2023	COHS	Mendocino	Partnership Health Plan of California	WCM - UIS State-Only	$1,162.74	$1,194.01	$1,226.33
1/23-12/23	2023	COHS	Modoc	Partnership Health Plan of California	Child - SIS	$103.32	$107.17	$111.20
1/23-12/23	2023	COHS	Modoc	Partnership Health Plan of California	Adult - SIS	$313.26	$322.64	$332.37
1/23-12/23	2023	COHS	Modoc	Partnership Health Plan of California	ACA Optional Expansion - SIS	$406.98	$418.60	$430.65
1/23-12/23	2023	COHS	Modoc	Partnership Health Plan of California	SPD - SIS	$1,171.19	$1,200.66	$1,231.12
1/23-12/23	2023	COHS	Modoc	Partnership Health Plan of California	SPD/Full-Dual - SIS	$563.15	$572.69	$582.54
1/23-12/23	2023	COHS	Modoc	Partnership Health Plan of California	LTC - SIS	$1,171.19	$1,200.66	$1,231.12
1/23-12/23	2023	COHS	Modoc	Partnership Health Plan of California	LTC/Full-Dual - SIS	$563.15	$572.69	$582.54
1/23-12/23	2023	COHS	Modoc	Partnership Health Plan of California	Maternity - SIS	$10,943.36	$11,156.01	$11,374.62
1/23-12/23	2023	COHS	Modoc	Partnership Health Plan of California	WCM - SIS	$1,990.45	$2,044.30	$2,099.99
1/23-12/23	2023	COHS	Modoc	Partnership Health Plan of California	Child - UIS Federally Eligible	$31.50	$32.98	$34.54
1/23-12/23	2023	COHS	Modoc	Partnership Health Plan of California	Adult - UIS Federally Eligible	$299.51	$308.09	$316.99
1/23-12/23	2023	COHS	Modoc	Partnership Health Plan of California	ACA Optional Expansion - UIS Federally Eligible	$414.55	$426.17	$438.21
1/23-12/23	2023	COHS	Modoc	Partnership Health Plan of California	SPD - UIS Federally Eligible	$870.78	$894.52	$919.07
1/23-12/23	2023	COHS	Modoc	Partnership Health Plan of California	SPD/Full-Dual - UIS Federally Eligible	$195.13	$200.39	$205.85
1/23-12/23	2023	COHS	Modoc	Partnership Health Plan of California	LTC - UIS Federally Eligible	$870.78	$894.52	$919.07
1/23-12/23	2023	COHS	Modoc	Partnership Health Plan of California	LTC/Full-Dual - UIS Federally Eligible	$195.13	$200.39	$205.85
1/23-12/23	2023	COHS	Modoc	Partnership Health Plan of California	Maternity - UIS Federally Eligible	$10,913.12	$11,125.18	$11,343.19
1/23-12/23	2023	COHS	Modoc	Partnership Health Plan of California	WCM - UIS Federally Eligible	$829.87	$852.53	$875.96
1/23-12/23	2023	COHS	Modoc	Partnership Health Plan of California	Child - UIS State-Only	$58.26	$60.29	$62.40
1/23-12/23	2023	COHS	Modoc	Partnership Health Plan of California	Adult - UIS State-Only	$200.32	$205.97	$211.83
1/23-12/23	2023	COHS	Modoc	Partnership Health Plan of California	ACA Optional Expansion - UIS State-Only	$303.14	$310.95	$319.03
1/23-12/23	2023	COHS	Modoc	Partnership Health Plan of California	SPD - UIS State-Only	$769.09	$785.77	$803.00
1/23-12/23	2023	COHS	Modoc	Partnership Health Plan of California	SPD/Full-Dual - UIS State-Only	$377.73	$384.36	$391.19
1/23-12/23	2023	COHS	Modoc	Partnership Health Plan of California	LTC - UIS State-Only	$769.09	$785.77	$803.00
1/23-12/23	2023	COHS	Modoc	Partnership Health Plan of California	LTC/Full-Dual - UIS State-Only	$377.73	$384.36	$391.19
1/23-12/23	2023	COHS	Modoc	Partnership Health Plan of California	WCM - UIS State-Only	$1,162.74	$1,194.01	$1,226.33
1/23-12/23	2023	COHS	Napa	Partnership Health Plan of California	Child - SIS	$103.32	$107.17	$111.20
1/23-12/23	2023	COHS	Napa	Partnership Health Plan of California	Adult - SIS	$313.26	$322.64	$332.37
1/23-12/23	2023	COHS	Napa	Partnership Health Plan of California	ACA Optional Expansion - SIS	$406.98	$418.60	$430.65
1/23-12/23	2023	COHS	Napa	Partnership Health Plan of California	SPD - SIS	$1,171.19	$1,200.66	$1,231.12
1/23-12/23	2023	COHS	Napa	Partnership Health Plan of California	SPD/Full-Dual - SIS	$563.15	$572.69	$582.54
1/23-12/23	2023	COHS	Napa	Partnership Health Plan of California	LTC - SIS	$1,171.19	$1,200.66	$1,231.12
1/23-12/23	2023	COHS	Napa	Partnership Health Plan of California	LTC/Full-Dual - SIS	$563.15	$572.69	$582.54
1/23-12/23	2023	COHS	Napa	Partnership Health Plan of California	Maternity - SIS	$10,943.36	$11,156.01	$11,374.62
1/23-12/23	2023	COHS	Napa	Partnership Health Plan of California	WCM - SIS	$1,990.45	$2,044.30	$2,099.99
1/23-12/23	2023	COHS	Napa	Partnership Health Plan of California	Child - UIS Federally Eligible	$31.50	$32.98	$34.54
1/23-12/23	2023	COHS	Napa	Partnership Health Plan of California	Adult - UIS Federally Eligible	$299.51	$308.09	$316.99
1/23-12/23	2023	COHS	Napa	Partnership Health Plan of California	ACA Optional Expansion - UIS Federally Eligible	$414.55	$426.17	$438.21
1/23-12/23	2023	COHS	Napa	Partnership Health Plan of California	SPD - UIS Federally Eligible	$870.78	$894.52	$919.07
1/23-12/23	2023	COHS	Napa	Partnership Health Plan of California	SPD/Full-Dual - UIS Federally Eligible	$195.13	$200.39	$205.85
1/23-12/23	2023	COHS	Napa	Partnership Health Plan of California	LTC - UIS Federally Eligible	$870.78	$894.52	$919.07
1/23-12/23	2023	COHS	Napa	Partnership Health Plan of California	LTC/Full-Dual - UIS Federally Eligible	$195.13	$200.39	$205.85
1/23-12/23	2023	COHS	Napa	Partnership Health Plan of California	Maternity - UIS Federally Eligible	$10,913.12	$11,125.18	$11,343.19
1/23-12/23	2023	COHS	Napa	Partnership Health Plan of California	WCM - UIS Federally Eligible	$829.87	$852.53	$875.96
1/23-12/23	2023	COHS	Napa	Partnership Health Plan of California	Child - UIS State-Only	$58.26	$60.29	$62.40
1/23-12/23	2023	COHS	Napa	Partnership Health Plan of California	Adult - UIS State-Only	$200.32	$205.97	$211.83
1/23-12/23	2023	COHS	Napa	Partnership Health Plan of California	ACA Optional Expansion - UIS State-Only	$303.14	$310.95	$319.03
1/23-12/23	2023	COHS	Napa	Partnership Health Plan of California	SPD - UIS State-Only	$769.09	$785.77	$803.00
1/23-12/23	2023	COHS	Napa	Partnership Health Plan of California	SPD/Full-Dual - UIS State-Only	$377.73	$384.36	$391.19
1/23-12/23	2023	COHS	Napa	Partnership Health Plan of California	LTC - UIS State-Only	$769.09	$785.77	$803.00
1/23-12/23	2023	COHS	Napa	Partnership Health Plan of California	LTC/Full-Dual - UIS State-Only	$377.73	$384.36	$391.19
1/23-12/23	2023	COHS	Napa	Partnership Health Plan of California	WCM - UIS State-Only	$1,162.74	$1,194.01	$1,226.33
1/23-12/23	2023	COHS	Shasta	Partnership Health Plan of California	Child - SIS	$103.32	$107.17	$111.20
1/23-12/23	2023	COHS	Shasta	Partnership Health Plan of California	Adult - SIS	$313.26	$322.64	$332.37
1/23-12/23	2023	COHS	Shasta	Partnership Health Plan of California	ACA Optional Expansion - SIS	$406.98	$418.60	$430.65
1/23-12/23	2023	COHS	Shasta	Partnership Health Plan of California	SPD - SIS	$1,171.19	$1,200.66	$1,231.12
1/23-12/23	2023	COHS	Shasta	Partnership Health Plan of California	SPD/Full-Dual - SIS	$563.15	$572.69	$582.54
1/23-12/23	2023	COHS	Shasta	Partnership Health Plan of California	LTC - SIS	$1,171.19	$1,200.66	$1,231.12
1/23-12/23	2023	COHS	Shasta	Partnership Health Plan of California	LTC/Full-Dual - SIS	$563.15	$572.69	$582.54
1/23-12/23	2023	COHS	Shasta	Partnership Health Plan of California	Maternity - SIS	$10,943.36	$11,156.01	$11,374.62
1/23-12/23	2023	COHS	Shasta	Partnership Health Plan of California	WCM - SIS	$1,990.45	$2,044.30	$2,099.99
1/23-12/23	2023	COHS	Shasta	Partnership Health Plan of California	Child - UIS Federally Eligible	$31.50	$32.98	$34.54
1/23-12/23	2023	COHS	Shasta	Partnership Health Plan of California	Adult - UIS Federally Eligible	$299.51	$308.09	$316.99
1/23-12/23	2023	COHS	Shasta	Partnership Health Plan of California	ACA Optional Expansion - UIS Federally Eligible	$414.55	$426.17	$438.21
1/23-12/23	2023	COHS	Shasta	Partnership Health Plan of California	SPD - UIS Federally Eligible	$870.78	$894.52	$919.07
1/23-12/23	2023	COHS	Shasta	Partnership Health Plan of California	SPD/Full-Dual - UIS Federally Eligible	$195.13	$200.39	$205.85
1/23-12/23	2023	COHS	Shasta	Partnership Health Plan of California	LTC - UIS Federally Eligible	$870.78	$894.52	$919.07
1/23-12/23	2023	COHS	Shasta	Partnership Health Plan of California	LTC/Full-Dual - UIS Federally Eligible	$195.13	$200.39	$205.85
1/23-12/23	2023	COHS	Shasta	Partnership Health Plan of California	Maternity - UIS Federally Eligible	$10,913.12	$11,125.18	$11,343.19
1/23-12/23	2023	COHS	Shasta	Partnership Health Plan of California	WCM - UIS Federally Eligible	$829.87	$852.53	$875.96
1/23-12/23	2023	COHS	Shasta	Partnership Health Plan of California	Child - UIS State-Only	$58.26	$60.29	$62.40
1/23-12/23	2023	COHS	Shasta	Partnership Health Plan of California	Adult - UIS State-Only	$200.32	$205.97	$211.83
1/23-12/23	2023	COHS	Shasta	Partnership Health Plan of California	ACA Optional Expansion - UIS State-Only	$303.14	$310.95	$319.03
1/23-12/23	2023	COHS	Shasta	Partnership Health Plan of California	SPD - UIS State-Only	$769.09	$785.77	$803.00
1/23-12/23	2023	COHS	Shasta	Partnership Health Plan of California	SPD/Full-Dual - UIS State-Only	$377.73	$384.36	$391.19
1/23-12/23	2023	COHS	Shasta	Partnership Health Plan of California	LTC - UIS State-Only	$769.09	$785.77	$803.00
1/23-12/23	2023	COHS	Shasta	Partnership Health Plan of California	LTC/Full-Dual - UIS State-Only	$377.73	$384.36	$391.19
1/23-12/23	2023	COHS	Shasta	Partnership Health Plan of California	WCM - UIS State-Only	$1,162.74	$1,194.01	$1,226.33
1/23-12/23	2023	COHS	Siskiyou	Partnership Health Plan of California	Child - SIS	$103.32	$107.17	$111.20
1/23-12/23	2023	COHS	Siskiyou	Partnership Health Plan of California	Adult - SIS	$313.26	$322.64	$332.37
1/23-12/23	2023	COHS	Siskiyou	Partnership Health Plan of California	ACA Optional Expansion - SIS	$406.98	$418.60	$430.65
1/23-12/23	2023	COHS	Siskiyou	Partnership Health Plan of California	SPD - SIS	$1,171.19	$1,200.66	$1,231.12
1/23-12/23	2023	COHS	Siskiyou	Partnership Health Plan of California	SPD/Full-Dual - SIS	$563.15	$572.69	$582.54
1/23-12/23	2023	COHS	Siskiyou	Partnership Health Plan of California	LTC - SIS	$1,171.19	$1,200.66	$1,231.12
1/23-12/23	2023	COHS	Siskiyou	Partnership Health Plan of California	LTC/Full-Dual - SIS	$563.15	$572.69	$582.54
1/23-12/23	2023	COHS	Siskiyou	Partnership Health Plan of California	Maternity - SIS	$10,943.36	$11,156.01	$11,374.62
1/23-12/23	2023	COHS	Siskiyou	Partnership Health Plan of California	WCM - SIS	$1,990.45	$2,044.30	$2,099.99
1/23-12/23	2023	COHS	Siskiyou	Partnership Health Plan of California	Child - UIS Federally Eligible	$31.50	$32.98	$34.54
1/23-12/23	2023	COHS	Siskiyou	Partnership Health Plan of California	Adult - UIS Federally Eligible	$299.51	$308.09	$316.99
1/23-12/23	2023	COHS	Siskiyou	Partnership Health Plan of California	ACA Optional Expansion - UIS Federally Eligible	$414.55	$426.17	$438.21
1/23-12/23	2023	COHS	Siskiyou	Partnership Health Plan of California	SPD - UIS Federally Eligible	$870.78	$894.52	$919.07
1/23-12/23	2023	COHS	Siskiyou	Partnership Health Plan of California	SPD/Full-Dual - UIS Federally Eligible	$195.13	$200.39	$205.85
1/23-12/23	2023	COHS	Siskiyou	Partnership Health Plan of California	LTC - UIS Federally Eligible	$870.78	$894.52	$919.07
1/23-12/23	2023	COHS	Siskiyou	Partnership Health Plan of California	LTC/Full-Dual - UIS Federally Eligible	$195.13	$200.39	$205.85
1/23-12/23	2023	COHS	Siskiyou	Partnership Health Plan of California	Maternity - UIS Federally Eligible	$10,913.12	$11,125.18	$11,343.19
1/23-12/23	2023	COHS	Siskiyou	Partnership Health Plan of California	WCM - UIS Federally Eligible	$829.87	$852.53	$875.96
1/23-12/23	2023	COHS	Siskiyou	Partnership Health Plan of California	Child - UIS State-Only	$58.26	$60.29	$62.40
1/23-12/23	2023	COHS	Siskiyou	Partnership Health Plan of California	Adult - UIS State-Only	$200.32	$205.97	$211.83
1/23-12/23	2023	COHS	Siskiyou	Partnership Health Plan of California	ACA Optional Expansion - UIS State-Only	$303.14	$310.95	$319.03
1/23-12/23	2023	COHS	Siskiyou	Partnership Health Plan of California	SPD - UIS State-Only	$769.09	$785.77	$803.00
1/23-12/23	2023	COHS	Siskiyou	Partnership Health Plan of California	SPD/Full-Dual - UIS State-Only	$377.73	$384.36	$391.19
1/23-12/23	2023	COHS	Siskiyou	Partnership Health Plan of California	LTC - UIS State-Only	$769.09	$785.77	$803.00
1/23-12/23	2023	COHS	Siskiyou	Partnership Health Plan of California	LTC/Full-Dual - UIS State-Only	$377.73	$384.36	$391.19
1/23-12/23	2023	COHS	Siskiyou	Partnership Health Plan of California	WCM - UIS State-Only	$1,162.74	$1,194.01	$1,226.33
1/23-12/23	2023	COHS	Solano	Partnership Health Plan of California	Child - SIS	$103.32	$107.17	$111.20
1/23-12/23	2023	COHS	Solano	Partnership Health Plan of California	Adult - SIS	$313.26	$322.64	$332.37
1/23-12/23	2023	COHS	Solano	Partnership Health Plan of California	ACA Optional Expansion - SIS	$406.98	$418.60	$430.65
1/23-12/23	2023	COHS	Solano	Partnership Health Plan of California	SPD - SIS	$1,171.19	$1,200.66	$1,231.12
1/23-12/23	2023	COHS	Solano	Partnership Health Plan of California	SPD/Full-Dual - SIS	$563.15	$572.69	$582.54
1/23-12/23	2023	COHS	Solano	Partnership Health Plan of California	LTC - SIS	$1,171.19	$1,200.66	$1,231.12
1/23-12/23	2023	COHS	Solano	Partnership Health Plan of California	LTC/Full-Dual - SIS	$563.15	$572.69	$582.54
1/23-12/23	2023	COHS	Solano	Partnership Health Plan of California	Maternity - SIS	$10,943.36	$11,156.01	$11,374.62
1/23-12/23	2023	COHS	Solano	Partnership Health Plan of California	WCM - SIS	$1,990.45	$2,044.30	$2,099.99
1/23-12/23	2023	COHS	Solano	Partnership Health Plan of California	Child - UIS Federally Eligible	$31.50	$32.98	$34.54
1/23-12/23	2023	COHS	Solano	Partnership Health Plan of California	Adult - UIS Federally Eligible	$299.51	$308.09	$316.99
1/23-12/23	2023	COHS	Solano	Partnership Health Plan of California	ACA Optional Expansion - UIS Federally Eligible	$414.55	$426.17	$438.21
1/23-12/23	2023	COHS	Solano	Partnership Health Plan of California	SPD - UIS Federally Eligible	$870.78	$894.52	$919.07
1/23-12/23	2023	COHS	Solano	Partnership Health Plan of California	SPD/Full-Dual - UIS Federally Eligible	$195.13	$200.39	$205.85
1/23-12/23	2023	COHS	Solano	Partnership Health Plan of California	LTC - UIS Federally Eligible	$870.78	$894.52	$919.07
1/23-12/23	2023	COHS	Solano	Partnership Health Plan of California	LTC/Full-Dual - UIS Federally Eligible	$195.13	$200.39	$205.85
1/23-12/23	2023	COHS	Solano	Partnership Health Plan of California	Maternity - UIS Federally Eligible	$10,913.12	$11,125.18	$11,343.19
1/23-12/23	2023	COHS	Solano	Partnership Health Plan of California	WCM - UIS Federally Eligible	$829.87	$852.53	$875.96
1/23-12/23	2023	COHS	Solano	Partnership Health Plan of California	Child - UIS State-Only	$58.26	$60.29	$62.40
1/23-12/23	2023	COHS	Solano	Partnership Health Plan of California	Adult - UIS State-Only	$200.32	$205.97	$211.83
1/23-12/23	2023	COHS	Solano	Partnership Health Plan of California	ACA Optional Expansion - UIS State-Only	$303.14	$310.95	$319.03
1/23-12/23	2023	COHS	Solano	Partnership Health Plan of California	SPD - UIS State-Only	$769.09	$785.77	$803.00
1/23-12/23	2023	COHS	Solano	Partnership Health Plan of California	SPD/Full-Dual - UIS State-Only	$377.73	$384.36	$391.19
1/23-12/23	2023	COHS	Solano	Partnership Health Plan of California	LTC - UIS State-Only	$769.09	$785.77	$803.00
1/23-12/23	2023	COHS	Solano	Partnership Health Plan of California	LTC/Full-Dual - UIS State-Only	$377.73	$384.36	$391.19
1/23-12/23	2023	COHS	Solano	Partnership Health Plan of California	WCM - UIS State-Only	$1,162.74	$1,194.01	$1,226.33
1/23-12/23	2023	COHS	Sonoma	Partnership Health Plan of California	Child - SIS	$103.32	$107.17	$111.20
1/23-12/23	2023	COHS	Sonoma	Partnership Health Plan of California	Adult - SIS	$313.26	$322.64	$332.37
1/23-12/23	2023	COHS	Sonoma	Partnership Health Plan of California	ACA Optional Expansion - SIS	$406.98	$418.60	$430.65
1/23-12/23	2023	COHS	Sonoma	Partnership Health Plan of California	SPD - SIS	$1,171.19	$1,200.66	$1,231.12
1/23-12/23	2023	COHS	Sonoma	Partnership Health Plan of California	SPD/Full-Dual - SIS	$563.15	$572.69	$582.54
1/23-12/23	2023	COHS	Sonoma	Partnership Health Plan of California	LTC - SIS	$1,171.19	$1,200.66	$1,231.12
1/23-12/23	2023	COHS	Sonoma	Partnership Health Plan of California	LTC/Full-Dual - SIS	$563.15	$572.69	$582.54
1/23-12/23	2023	COHS	Sonoma	Partnership Health Plan of California	Maternity - SIS	$10,943.36	$11,156.01	$11,374.62
1/23-12/23	2023	COHS	Sonoma	Partnership Health Plan of California	WCM - SIS	$1,990.45	$2,044.30	$2,099.99
1/23-12/23	2023	COHS	Sonoma	Partnership Health Plan of California	Child - UIS Federally Eligible	$31.50	$32.98	$34.54
1/23-12/23	2023	COHS	Sonoma	Partnership Health Plan of California	Adult - UIS Federally Eligible	$299.51	$308.09	$316.99
1/23-12/23	2023	COHS	Sonoma	Partnership Health Plan of California	ACA Optional Expansion - UIS Federally Eligible	$414.55	$426.17	$438.21
1/23-12/23	2023	COHS	Sonoma	Partnership Health Plan of California	SPD - UIS Federally Eligible	$870.78	$894.52	$919.07
1/23-12/23	2023	COHS	Sonoma	Partnership Health Plan of California	SPD/Full-Dual - UIS Federally Eligible	$195.13	$200.39	$205.85
1/23-12/23	2023	COHS	Sonoma	Partnership Health Plan of California	LTC - UIS Federally Eligible	$870.78	$894.52	$919.07
1/23-12/23	2023	COHS	Sonoma	Partnership Health Plan of California	LTC/Full-Dual - UIS Federally Eligible	$195.13	$200.39	$205.85
1/23-12/23	2023	COHS	Sonoma	Partnership Health Plan of California	Maternity - UIS Federally Eligible	$10,913.12	$11,125.18	$11,343.19
1/23-12/23	2023	COHS	Sonoma	Partnership Health Plan of California	WCM - UIS Federally Eligible	$829.87	$852.53	$875.96
1/23-12/23	2023	COHS	Sonoma	Partnership Health Plan of California	Child - UIS State-Only	$58.26	$60.29	$62.40
1/23-12/23	2023	COHS	Sonoma	Partnership Health Plan of California	Adult - UIS State-Only	$200.32	$205.97	$211.83
1/23-12/23	2023	COHS	Sonoma	Partnership Health Plan of California	ACA Optional Expansion - UIS State-Only	$303.14	$310.95	$319.03
1/23-12/23	2023	COHS	Sonoma	Partnership Health Plan of California	SPD - UIS State-Only	$769.09	$785.77	$803.00
1/23-12/23	2023	COHS	Sonoma	Partnership Health Plan of California	SPD/Full-Dual - UIS State-Only	$377.73	$384.36	$391.19
1/23-12/23	2023	COHS	Sonoma	Partnership Health Plan of California	LTC - UIS State-Only	$769.09	$785.77	$803.00
1/23-12/23	2023	COHS	Sonoma	Partnership Health Plan of California	LTC/Full-Dual - UIS State-Only	$377.73	$384.36	$391.19
1/23-12/23	2023	COHS	Sonoma	Partnership Health Plan of California	WCM - UIS State-Only	$1,162.74	$1,194.01	$1,226.33
1/23-12/23	2023	COHS	Trinity	Partnership Health Plan of California	Child - SIS	$103.32	$107.17	$111.20
1/23-12/23	2023	COHS	Trinity	Partnership Health Plan of California	Adult - SIS	$313.26	$322.64	$332.37
1/23-12/23	2023	COHS	Trinity	Partnership Health Plan of California	ACA Optional Expansion - SIS	$406.98	$418.60	$430.65
1/23-12/23	2023	COHS	Trinity	Partnership Health Plan of California	SPD - SIS	$1,171.19	$1,200.66	$1,231.12
1/23-12/23	2023	COHS	Trinity	Partnership Health Plan of California	SPD/Full-Dual - SIS	$563.15	$572.69	$582.54
1/23-12/23	2023	COHS	Trinity	Partnership Health Plan of California	LTC - SIS	$1,171.19	$1,200.66	$1,231.12
1/23-12/23	2023	COHS	Trinity	Partnership Health Plan of California	LTC/Full-Dual - SIS	$563.15	$572.69	$582.54
1/23-12/23	2023	COHS	Trinity	Partnership Health Plan of California	Maternity - SIS	$10,943.36	$11,156.01	$11,374.62
1/23-12/23	2023	COHS	Trinity	Partnership Health Plan of California	WCM - SIS	$1,990.45	$2,044.30	$2,099.99
1/23-12/23	2023	COHS	Trinity	Partnership Health Plan of California	Child - UIS Federally Eligible	$31.50	$32.98	$34.54
1/23-12/23	2023	COHS	Trinity	Partnership Health Plan of California	Adult - UIS Federally Eligible	$299.51	$308.09	$316.99
1/23-12/23	2023	COHS	Trinity	Partnership Health Plan of California	ACA Optional Expansion - UIS Federally Eligible	$414.55	$426.17	$438.21
1/23-12/23	2023	COHS	Trinity	Partnership Health Plan of California	SPD - UIS Federally Eligible	$870.78	$894.52	$919.07
1/23-12/23	2023	COHS	Trinity	Partnership Health Plan of California	SPD/Full-Dual - UIS Federally Eligible	$195.13	$200.39	$205.85
1/23-12/23	2023	COHS	Trinity	Partnership Health Plan of California	LTC - UIS Federally Eligible	$870.78	$894.52	$919.07
1/23-12/23	2023	COHS	Trinity	Partnership Health Plan of California	LTC/Full-Dual - UIS Federally Eligible	$195.13	$200.39	$205.85
1/23-12/23	2023	COHS	Trinity	Partnership Health Plan of California	Maternity - UIS Federally Eligible	$10,913.12	$11,125.18	$11,343.19
1/23-12/23	2023	COHS	Trinity	Partnership Health Plan of California	WCM - UIS Federally Eligible	$829.87	$852.53	$875.96
1/23-12/23	2023	COHS	Trinity	Partnership Health Plan of California	Child - UIS State-Only	$58.26	$60.29	$62.40
1/23-12/23	2023	COHS	Trinity	Partnership Health Plan of California	Adult - UIS State-Only	$200.32	$205.97	$211.83
1/23-12/23	2023	COHS	Trinity	Partnership Health Plan of California	ACA Optional Expansion - UIS State-Only	$303.14	$310.95	$319.03
1/23-12/23	2023	COHS	Trinity	Partnership Health Plan of California	SPD - UIS State-Only	$769.09	$785.77	$803.00
1/23-12/23	2023	COHS	Trinity	Partnership Health Plan of California	SPD/Full-Dual - UIS State-Only	$377.73	$384.36	$391.19
1/23-12/23	2023	COHS	Trinity	Partnership Health Plan of California	LTC - UIS State-Only	$769.09	$785.77	$803.00
1/23-12/23	2023	COHS	Trinity	Partnership Health Plan of California	LTC/Full-Dual - UIS State-Only	$377.73	$384.36	$391.19
1/23-12/23	2023	COHS	Trinity	Partnership Health Plan of California	WCM - UIS State-Only	$1,162.74	$1,194.01	$1,226.33
1/23-12/23	2023	COHS	Yolo	Partnership Health Plan of California	Child - SIS	$103.32	$107.17	$111.20
1/23-12/23	2023	COHS	Yolo	Partnership Health Plan of California	Adult - SIS	$313.26	$322.64	$332.37
1/23-12/23	2023	COHS	Yolo	Partnership Health Plan of California	ACA Optional Expansion - SIS	$406.98	$418.60	$430.65
1/23-12/23	2023	COHS	Yolo	Partnership Health Plan of California	SPD - SIS	$1,171.19	$1,200.66	$1,231.12
1/23-12/23	2023	COHS	Yolo	Partnership Health Plan of California	SPD/Full-Dual - SIS	$563.15	$572.69	$582.54
1/23-12/23	2023	COHS	Yolo	Partnership Health Plan of California	LTC - SIS	$1,171.19	$1,200.66	$1,231.12
1/23-12/23	2023	COHS	Yolo	Partnership Health Plan of California	LTC/Full-Dual - SIS	$563.15	$572.69	$582.54
1/23-12/23	2023	COHS	Yolo	Partnership Health Plan of California	Maternity - SIS	$10,943.36	$11,156.01	$11,374.62
1/23-12/23	2023	COHS	Yolo	Partnership Health Plan of California	WCM - SIS	$1,990.45	$2,044.30	$2,099.99
1/23-12/23	2023	COHS	Yolo	Partnership Health Plan of California	Child - UIS Federally Eligible	$31.50	$32.98	$34.54
1/23-12/23	2023	COHS	Yolo	Partnership Health Plan of California	Adult - UIS Federally Eligible	$299.51	$308.09	$316.99
1/23-12/23	2023	COHS	Yolo	Partnership Health Plan of California	ACA Optional Expansion - UIS Federally Eligible	$414.55	$426.17	$438.21
1/23-12/23	2023	COHS	Yolo	Partnership Health Plan of California	SPD - UIS Federally Eligible	$870.78	$894.52	$919.07
1/23-12/23	2023	COHS	Yolo	Partnership Health Plan of California	SPD/Full-Dual - UIS Federally Eligible	$195.13	$200.39	$205.85
1/23-12/23	2023	COHS	Yolo	Partnership Health Plan of California	LTC - UIS Federally Eligible	$870.78	$894.52	$919.07
1/23-12/23	2023	COHS	Yolo	Partnership Health Plan of California	LTC/Full-Dual - UIS Federally Eligible	$195.13	$200.39	$205.85
1/23-12/23	2023	COHS	Yolo	Partnership Health Plan of California	Maternity - UIS Federally Eligible	$10,913.12	$11,125.18	$11,343.19
1/23-12/23	2023	COHS	Yolo	Partnership Health Plan of California	WCM - UIS Federally Eligible	$829.87	$852.53	$875.96
1/23-12/23	2023	COHS	Yolo	Partnership Health Plan of California	Child - UIS State-Only	$58.26	$60.29	$62.40
1/23-12/23	2023	COHS	Yolo	Partnership Health Plan of California	Adult - UIS State-Only	$200.32	$205.97	$211.83
1/23-12/23	2023	COHS	Yolo	Partnership Health Plan of California	ACA Optional Expansion - UIS State-Only	$303.14	$310.95	$319.03
1/23-12/23	2023	COHS	Yolo	Partnership Health Plan of California	SPD - UIS State-Only	$769.09	$785.77	$803.00
1/23-12/23	2023	COHS	Yolo	Partnership Health Plan of California	SPD/Full-Dual - UIS State-Only	$377.73	$384.36	$391.19
1/23-12/23	2023	COHS	Yolo	Partnership Health Plan of California	LTC - UIS State-Only	$769.09	$785.77	$803.00
1/23-12/23	2023	COHS	Yolo	Partnership Health Plan of California	LTC/Full-Dual - UIS State-Only	$377.73	$384.36	$391.19
1/23-12/23	2023	COHS	Yolo	Partnership Health Plan of California	WCM - UIS State-Only	$1,162.74	$1,194.01	$1,226.33
1/23-12/23	2023	COHS	Merced	Central California Alliance for Health	Child - SIS	$87.64	$90.91	$94.34
1/23-12/23	2023	COHS	Merced	Central California Alliance for Health	Adult - SIS	$309.08	$318.23	$327.73
1/23-12/23	2023	COHS	Merced	Central California Alliance for Health	ACA Optional Expansion - SIS	$335.52	$345.21	$355.26
1/23-12/23	2023	COHS	Merced	Central California Alliance for Health	SPD - SIS	$1,113.84	$1,142.28	$1,171.70
1/23-12/23	2023	COHS	Merced	Central California Alliance for Health	SPD/Full-Dual - SIS	$432.72	$440.39	$448.31
1/23-12/23	2023	COHS	Merced	Central California Alliance for Health	LTC - SIS	$1,113.84	$1,142.28	$1,171.70
1/23-12/23	2023	COHS	Merced	Central California Alliance for Health	LTC/Full-Dual - SIS	$432.72	$440.39	$448.31
1/23-12/23	2023	COHS	Merced	Central California Alliance for Health	Maternity - SIS	$10,845.80	$11,058.65	$11,277.54
1/23-12/23	2023	COHS	Merced	Central California Alliance for Health	WCM - SIS	$1,503.05	$1,543.95	$1,586.28
1/23-12/23	2023	COHS	Merced	Central California Alliance for Health	Child - UIS Federally Eligible	$33.84	$35.28	$36.78
1/23-12/23	2023	COHS	Merced	Central California Alliance for Health	Adult - UIS Federally Eligible	$290.13	$298.39	$306.96
1/23-12/23	2023	COHS	Merced	Central California Alliance for Health	ACA Optional Expansion - UIS Federally Eligible	$340.28	$349.88	$359.83
1/23-12/23	2023	COHS	Merced	Central California Alliance for Health	SPD - UIS Federally Eligible	$843.51	$866.53	$890.36
1/23-12/23	2023	COHS	Merced	Central California Alliance for Health	SPD/Full-Dual - UIS Federally Eligible	$121.66	$125.27	$129.03
1/23-12/23	2023	COHS	Merced	Central California Alliance for Health	LTC - UIS Federally Eligible	$843.51	$866.53	$890.36
1/23-12/23	2023	COHS	Merced	Central California Alliance for Health	LTC/Full-Dual - UIS Federally Eligible	$121.66	$125.27	$129.03
1/23-12/23	2023	COHS	Merced	Central California Alliance for Health	Maternity - UIS Federally Eligible	$10,967.37	$11,182.60	$11,403.95
1/23-12/23	2023	COHS	Merced	Central California Alliance for Health	WCM - UIS Federally Eligible	$575.40	$591.26	$607.69
1/23-12/23	2023	COHS	Merced	Central California Alliance for Health	Child - UIS State-Only	$46.47	$48.11	$49.82
1/23-12/23	2023	COHS	Merced	Central California Alliance for Health	Adult - UIS State-Only	$185.62	$190.91	$196.41
1/23-12/23	2023	COHS	Merced	Central California Alliance for Health	ACA Optional Expansion - UIS State-Only	$272.86	$279.87	$287.14
1/23-12/23	2023	COHS	Merced	Central California Alliance for Health	SPD - UIS State-Only	$752.35	$769.36	$786.93
1/23-12/23	2023	COHS	Merced	Central California Alliance for Health	SPD/Full-Dual - UIS State-Only	$265.40	$270.42	$275.61
1/23-12/23	2023	COHS	Merced	Central California Alliance for Health	LTC - UIS State-Only	$752.35	$769.36	$786.93
1/23-12/23	2023	COHS	Merced	Central California Alliance for Health	LTC/Full-Dual - UIS State-Only	$265.40	$270.42	$275.61
1/23-12/23	2023	COHS	Merced	Central California Alliance for Health	WCM - UIS State-Only	$939.10	$964.40	$990.58
1/23-12/23	2023	COHS	Monterey	Central California Alliance for Health	Child - SIS	$87.64	$90.91	$94.34
1/23-12/23	2023	COHS	Monterey	Central California Alliance for Health	Adult - SIS	$309.08	$318.23	$327.73
1/23-12/23	2023	COHS	Monterey	Central California Alliance for Health	ACA Optional Expansion - SIS	$335.52	$345.21	$355.26
1/23-12/23	2023	COHS	Monterey	Central California Alliance for Health	SPD - SIS	$1,113.84	$1,142.28	$1,171.70
1/23-12/23	2023	COHS	Monterey	Central California Alliance for Health	SPD/Full-Dual - SIS	$432.72	$440.39	$448.31
1/23-12/23	2023	COHS	Monterey	Central California Alliance for Health	LTC - SIS	$1,113.84	$1,142.28	$1,171.70
1/23-12/23	2023	COHS	Monterey	Central California Alliance for Health	LTC/Full-Dual - SIS	$432.72	$440.39	$448.31
1/23-12/23	2023	COHS	Monterey	Central California Alliance for Health	Maternity - SIS	$10,845.80	$11,058.65	$11,277.54
1/23-12/23	2023	COHS	Monterey	Central California Alliance for Health	WCM - SIS	$1,503.05	$1,543.95	$1,586.28
1/23-12/23	2023	COHS	Monterey	Central California Alliance for Health	Child - UIS Federally Eligible	$33.84	$35.28	$36.78
1/23-12/23	2023	COHS	Monterey	Central California Alliance for Health	Adult - UIS Federally Eligible	$290.13	$298.39	$306.96
1/23-12/23	2023	COHS	Monterey	Central California Alliance for Health	ACA Optional Expansion - UIS Federally Eligible	$340.28	$349.88	$359.83
1/23-12/23	2023	COHS	Monterey	Central California Alliance for Health	SPD - UIS Federally Eligible	$843.51	$866.53	$890.36
1/23-12/23	2023	COHS	Monterey	Central California Alliance for Health	SPD/Full-Dual - UIS Federally Eligible	$121.66	$125.27	$129.03
1/23-12/23	2023	COHS	Monterey	Central California Alliance for Health	LTC - UIS Federally Eligible	$843.51	$866.53	$890.36
1/23-12/23	2023	COHS	Monterey	Central California Alliance for Health	LTC/Full-Dual - UIS Federally Eligible	$121.66	$125.27	$129.03
1/23-12/23	2023	COHS	Monterey	Central California Alliance for Health	Maternity - UIS Federally Eligible	$10,967.37	$11,182.60	$11,403.95
1/23-12/23	2023	COHS	Monterey	Central California Alliance for Health	WCM - UIS Federally Eligible	$575.40	$591.26	$607.69
1/23-12/23	2023	COHS	Monterey	Central California Alliance for Health	Child - UIS State-Only	$46.47	$48.11	$49.82
1/23-12/23	2023	COHS	Monterey	Central California Alliance for Health	Adult - UIS State-Only	$185.62	$190.91	$196.41
1/23-12/23	2023	COHS	Monterey	Central California Alliance for Health	ACA Optional Expansion - UIS State-Only	$272.86	$279.87	$287.14
1/23-12/23	2023	COHS	Monterey	Central California Alliance for Health	SPD - UIS State-Only	$752.35	$769.36	$786.93
1/23-12/23	2023	COHS	Monterey	Central California Alliance for Health	SPD/Full-Dual - UIS State-Only	$265.40	$270.42	$275.61
1/23-12/23	2023	COHS	Monterey	Central California Alliance for Health	LTC - UIS State-Only	$752.35	$769.36	$786.93
1/23-12/23	2023	COHS	Monterey	Central California Alliance for Health	LTC/Full-Dual - UIS State-Only	$265.40	$270.42	$275.61
1/23-12/23	2023	COHS	Monterey	Central California Alliance for Health	WCM - UIS State-Only	$939.10	$964.40	$990.58
1/23-12/23	2023	COHS	Santa Cruz	Central California Alliance for Health	Child - SIS	$87.64	$90.91	$94.34
1/23-12/23	2023	COHS	Santa Cruz	Central California Alliance for Health	Adult - SIS	$309.08	$318.23	$327.73
1/23-12/23	2023	COHS	Santa Cruz	Central California Alliance for Health	ACA Optional Expansion - SIS	$335.52	$345.21	$355.26
1/23-12/23	2023	COHS	Santa Cruz	Central California Alliance for Health	SPD - SIS	$1,113.84	$1,142.28	$1,171.70
1/23-12/23	2023	COHS	Santa Cruz	Central California Alliance for Health	SPD/Full-Dual - SIS	$432.72	$440.39	$448.31
1/23-12/23	2023	COHS	Santa Cruz	Central California Alliance for Health	LTC - SIS	$1,113.84	$1,142.28	$1,171.70
1/23-12/23	2023	COHS	Santa Cruz	Central California Alliance for Health	LTC/Full-Dual - SIS	$432.72	$440.39	$448.31
1/23-12/23	2023	COHS	Santa Cruz	Central California Alliance for Health	Maternity - SIS	$10,845.80	$11,058.65	$11,277.54
1/23-12/23	2023	COHS	Santa Cruz	Central California Alliance for Health	WCM - SIS	$1,503.05	$1,543.95	$1,586.28
1/23-12/23	2023	COHS	Santa Cruz	Central California Alliance for Health	Child - UIS Federally Eligible	$33.84	$35.28	$36.78
1/23-12/23	2023	COHS	Santa Cruz	Central California Alliance for Health	Adult - UIS Federally Eligible	$290.13	$298.39	$306.96
1/23-12/23	2023	COHS	Santa Cruz	Central California Alliance for Health	ACA Optional Expansion - UIS Federally Eligible	$340.28	$349.88	$359.83
1/23-12/23	2023	COHS	Santa Cruz	Central California Alliance for Health	SPD - UIS Federally Eligible	$843.51	$866.53	$890.36
1/23-12/23	2023	COHS	Santa Cruz	Central California Alliance for Health	SPD/Full-Dual - UIS Federally Eligible	$121.66	$125.27	$129.03
1/23-12/23	2023	COHS	Santa Cruz	Central California Alliance for Health	LTC - UIS Federally Eligible	$843.51	$866.53	$890.36
1/23-12/23	2023	COHS	Santa Cruz	Central California Alliance for Health	LTC/Full-Dual - UIS Federally Eligible	$121.66	$125.27	$129.03
1/23-12/23	2023	COHS	Santa Cruz	Central California Alliance for Health	Maternity - UIS Federally Eligible	$10,967.37	$11,182.60	$11,403.95
1/23-12/23	2023	COHS	Santa Cruz	Central California Alliance for Health	WCM - UIS Federally Eligible	$575.40	$591.26	$607.69
1/23-12/23	2023	COHS	Santa Cruz	Central California Alliance for Health	Child - UIS State-Only	$46.47	$48.11	$49.82
1/23-12/23	2023	COHS	Santa Cruz	Central California Alliance for Health	Adult - UIS State-Only	$185.62	$190.91	$196.41
1/23-12/23	2023	COHS	Santa Cruz	Central California Alliance for Health	ACA Optional Expansion - UIS State-Only	$272.86	$279.87	$287.14
1/23-12/23	2023	COHS	Santa Cruz	Central California Alliance for Health	SPD - UIS State-Only	$752.35	$769.36	$786.93
1/23-12/23	2023	COHS	Santa Cruz	Central California Alliance for Health	SPD/Full-Dual - UIS State-Only	$265.40	$270.42	$275.61
1/23-12/23	2023	COHS	Santa Cruz	Central California Alliance for Health	LTC - UIS State-Only	$752.35	$769.36	$786.93
1/23-12/23	2023	COHS	Santa Cruz	Central California Alliance for Health	LTC/Full-Dual - UIS State-Only	$265.40	$270.42	$275.61
1/23-12/23	2023	COHS	Santa Cruz	Central California Alliance for Health	WCM - UIS State-Only	$939.10	$964.40	$990.58
1/23-12/23	2023	COHS	San Luis Obispo	CenCal Health	Child - SIS	$103.35	$107.07	$110.96
1/23-12/23	2023	COHS	San Luis Obispo	CenCal Health	Adult - SIS	$268.29	$276.40	$284.82
1/23-12/23	2023	COHS	San Luis Obispo	CenCal Health	ACA Optional Expansion - SIS	$333.01	$342.68	$352.73
1/23-12/23	2023	COHS	San Luis Obispo	CenCal Health	SPD - SIS	$1,006.60	$1,031.54	$1,057.33
1/23-12/23	2023	COHS	San Luis Obispo	CenCal Health	SPD/Full-Dual - SIS	$658.57	$669.42	$680.61
1/23-12/23	2023	COHS	San Luis Obispo	CenCal Health	LTC - SIS	$1,006.60	$1,031.54	$1,057.33
1/23-12/23	2023	COHS	San Luis Obispo	CenCal Health	LTC/Full-Dual - SIS	$658.57	$669.42	$680.61
1/23-12/23	2023	COHS	San Luis Obispo	CenCal Health	Maternity - SIS	$8,665.06	$8,834.72	$9,009.20
1/23-12/23	2023	COHS	San Luis Obispo	CenCal Health	WCM - SIS	$1,571.89	$1,614.77	$1,659.14
1/23-12/23	2023	COHS	San Luis Obispo	CenCal Health	Child - UIS Federally Eligible	$29.65	$30.94	$32.29
1/23-12/23	2023	COHS	San Luis Obispo	CenCal Health	Adult - UIS Federally Eligible	$190.85	$196.45	$202.26
1/23-12/23	2023	COHS	San Luis Obispo	CenCal Health	ACA Optional Expansion - UIS Federally Eligible	$298.35	$306.82	$315.60
1/23-12/23	2023	COHS	San Luis Obispo	CenCal Health	SPD - UIS Federally Eligible	$675.85	$694.44	$713.68
1/23-12/23	2023	COHS	San Luis Obispo	CenCal Health	SPD/Full-Dual - UIS Federally Eligible	$170.34	$175.08	$180.00
1/23-12/23	2023	COHS	San Luis Obispo	CenCal Health	LTC - UIS Federally Eligible	$675.85	$694.44	$713.68
1/23-12/23	2023	COHS	San Luis Obispo	CenCal Health	LTC/Full-Dual - UIS Federally Eligible	$170.34	$175.08	$180.00
1/23-12/23	2023	COHS	San Luis Obispo	CenCal Health	Maternity - UIS Federally Eligible	$8,714.94	$8,885.59	$9,061.07
1/23-12/23	2023	COHS	San Luis Obispo	CenCal Health	WCM - UIS Federally Eligible	$622.41	$639.58	$657.35
1/23-12/23	2023	COHS	San Luis Obispo	CenCal Health	Child - UIS State-Only	$61.06	$63.16	$65.35
1/23-12/23	2023	COHS	San Luis Obispo	CenCal Health	Adult - UIS State-Only	$170.61	$175.49	$180.55
1/23-12/23	2023	COHS	San Luis Obispo	CenCal Health	ACA Optional Expansion - UIS State-Only	$271.78	$278.89	$286.26
1/23-12/23	2023	COHS	San Luis Obispo	CenCal Health	SPD - UIS State-Only	$696.26	$711.45	$727.14
1/23-12/23	2023	COHS	San Luis Obispo	CenCal Health	SPD/Full-Dual - UIS State-Only	$305.48	$311.76	$318.26
1/23-12/23	2023	COHS	San Luis Obispo	CenCal Health	LTC - UIS State-Only	$696.26	$711.45	$727.14
1/23-12/23	2023	COHS	San Luis Obispo	CenCal Health	LTC/Full-Dual - UIS State-Only	$305.48	$311.76	$318.26
1/23-12/23	2023	COHS	San Luis Obispo	CenCal Health	WCM - UIS State-Only	$955.17	$981.02	$1,007.76
1/23-12/23	2023	COHS	Santa Barbara	CenCal Health	Child - SIS	$103.35	$107.07	$110.96
1/23-12/23	2023	COHS	Santa Barbara	CenCal Health	Adult - SIS	$268.29	$276.40	$284.82
1/23-12/23	2023	COHS	Santa Barbara	CenCal Health	ACA Optional Expansion - SIS	$333.01	$342.68	$352.73
1/23-12/23	2023	COHS	Santa Barbara	CenCal Health	SPD - SIS	$1,006.60	$1,031.54	$1,057.33
1/23-12/23	2023	COHS	Santa Barbara	CenCal Health	SPD/Full-Dual - SIS	$658.57	$669.42	$680.61
1/23-12/23	2023	COHS	Santa Barbara	CenCal Health	LTC - SIS	$1,006.60	$1,031.54	$1,057.33
1/23-12/23	2023	COHS	Santa Barbara	CenCal Health	LTC/Full-Dual - SIS	$658.57	$669.42	$680.61
1/23-12/23	2023	COHS	Santa Barbara	CenCal Health	Maternity - SIS	$8,665.06	$8,834.72	$9,009.20
1/23-12/23	2023	COHS	Santa Barbara	CenCal Health	WCM - SIS	$1,571.89	$1,614.77	$1,659.14
1/23-12/23	2023	COHS	Santa Barbara	CenCal Health	Child - UIS Federally Eligible	$29.65	$30.94	$32.29
1/23-12/23	2023	COHS	Santa Barbara	CenCal Health	Adult - UIS Federally Eligible	$190.85	$196.45	$202.26
1/23-12/23	2023	COHS	Santa Barbara	CenCal Health	ACA Optional Expansion - UIS Federally Eligible	$298.35	$306.82	$315.60
1/23-12/23	2023	COHS	Santa Barbara	CenCal Health	SPD - UIS Federally Eligible	$675.85	$694.44	$713.68
1/23-12/23	2023	COHS	Santa Barbara	CenCal Health	SPD/Full-Dual - UIS Federally Eligible	$170.34	$175.08	$180.00
1/23-12/23	2023	COHS	Santa Barbara	CenCal Health	LTC - UIS Federally Eligible	$675.85	$694.44	$713.68
1/23-12/23	2023	COHS	Santa Barbara	CenCal Health	LTC/Full-Dual - UIS Federally Eligible	$170.34	$175.08	$180.00
1/23-12/23	2023	COHS	Santa Barbara	CenCal Health	Maternity - UIS Federally Eligible	$8,714.94	$8,885.59	$9,061.07
1/23-12/23	2023	COHS	Santa Barbara	CenCal Health	WCM - UIS Federally Eligible	$622.41	$639.58	$657.35
1/23-12/23	2023	COHS	Santa Barbara	CenCal Health	Child - UIS State-Only	$61.06	$63.16	$65.35
1/23-12/23	2023	COHS	Santa Barbara	CenCal Health	Adult - UIS State-Only	$170.61	$175.49	$180.55
1/23-12/23	2023	COHS	Santa Barbara	CenCal Health	ACA Optional Expansion - UIS State-Only	$271.78	$278.89	$286.26
1/23-12/23	2023	COHS	Santa Barbara	CenCal Health	SPD - UIS State-Only	$696.26	$711.45	$727.14
1/23-12/23	2023	COHS	Santa Barbara	CenCal Health	SPD/Full-Dual - UIS State-Only	$305.48	$311.76	$318.26
1/23-12/23	2023	COHS	Santa Barbara	CenCal Health	LTC - UIS State-Only	$696.26	$711.45	$727.14
1/23-12/23	2023	COHS	Santa Barbara	CenCal Health	LTC/Full-Dual - UIS State-Only	$305.48	$311.76	$318.26
1/23-12/23	2023	COHS	Santa Barbara	CenCal Health	WCM - UIS State-Only	$955.17	$981.02	$1,007.76
1/23-12/23	2023	COHS	Orange	CalOptima	Child - SIS	$99.09	$102.60	$106.27
1/23-12/23	2023	COHS	Orange	CalOptima	Adult - SIS	$212.50	$218.98	$225.70
1/23-12/23	2023	COHS	Orange	CalOptima	ACA Optional Expansion - SIS	$304.58	$313.34	$322.43
1/23-12/23	2023	COHS	Orange	CalOptima	SPD - SIS	$949.31	$971.98	$995.41
1/23-12/23	2023	COHS	Orange	CalOptima	SPD/Full-Dual - SIS	$456.76	$464.64	$472.77
1/23-12/23	2023	COHS	Orange	CalOptima	LTC - SIS	$949.31	$971.98	$995.41
1/23-12/23	2023	COHS	Orange	CalOptima	LTC/Full-Dual - SIS	$456.76	$464.64	$472.77
1/23-12/23	2023	COHS	Orange	CalOptima	Maternity - SIS	$8,897.75	$9,070.60	$9,248.29
1/23-12/23	2023	COHS	Orange	CalOptima	WCM - SIS	$1,761.91	$1,806.69	$1,852.98
1/23-12/23	2023	COHS	Orange	CalOptima	Child - UIS Federally Eligible	$32.09	$33.38	$34.73
1/23-12/23	2023	COHS	Orange	CalOptima	Adult - UIS Federally Eligible	$178.51	$183.69	$189.06
1/23-12/23	2023	COHS	Orange	CalOptima	ACA Optional Expansion - UIS Federally Eligible	$292.09	$300.28	$308.77
1/23-12/23	2023	COHS	Orange	CalOptima	SPD - UIS Federally Eligible	$755.35	$775.86	$797.07
1/23-12/23	2023	COHS	Orange	CalOptima	SPD/Full-Dual - UIS Federally Eligible	$119.05	$122.45	$125.99
1/23-12/23	2023	COHS	Orange	CalOptima	LTC - UIS Federally Eligible	$755.35	$775.86	$797.07
1/23-12/23	2023	COHS	Orange	CalOptima	LTC/Full-Dual - UIS Federally Eligible	$119.05	$122.45	$125.99
1/23-12/23	2023	COHS	Orange	CalOptima	Maternity - UIS Federally Eligible	$8,897.75	$9,070.60	$9,248.29
1/23-12/23	2023	COHS	Orange	CalOptima	WCM - UIS Federally Eligible	$552.77	$567.90	$583.55
1/23-12/23	2023	COHS	Orange	CalOptima	Child - UIS State-Only	$53.32	$55.18	$57.12
1/23-12/23	2023	COHS	Orange	CalOptima	Adult - UIS State-Only	$163.08	$167.59	$172.26
1/23-12/23	2023	COHS	Orange	CalOptima	ACA Optional Expansion - UIS State-Only	$296.91	$304.53	$312.41
1/23-12/23	2023	COHS	Orange	CalOptima	SPD - UIS State-Only	$845.65	$863.24	$881.40
1/23-12/23	2023	COHS	Orange	CalOptima	SPD/Full-Dual - UIS State-Only	$321.56	$327.08	$332.78
1/23-12/23	2023	COHS	Orange	CalOptima	LTC - UIS State-Only	$845.65	$863.24	$881.40
1/23-12/23	2023	COHS	Orange	CalOptima	LTC/Full-Dual - UIS State-Only	$321.56	$327.08	$332.78
1/23-12/23	2023	COHS	Orange	CalOptima	WCM - UIS State-Only	$1,205.52	$1,235.08	$1,265.62
1/23-12/23	2023	COHS	Ventura	Gold Coast Health Plan	Child - SIS	$95.22	$98.77	$102.49
1/23-12/23	2023	COHS	Ventura	Gold Coast Health Plan	Adult - SIS	$286.20	$294.81	$303.77
1/23-12/23	2023	COHS	Ventura	Gold Coast Health Plan	ACA Optional Expansion - SIS	$347.35	$357.36	$367.74
1/23-12/23	2023	COHS	Ventura	Gold Coast Health Plan	SPD - SIS	$1,177.76	$1,206.22	$1,235.67
1/23-12/23	2023	COHS	Ventura	Gold Coast Health Plan	SPD/Full-Dual - SIS	$579.28	$589.20	$599.45
1/23-12/23	2023	COHS	Ventura	Gold Coast Health Plan	LTC - SIS	$1,177.76	$1,206.22	$1,235.67
1/23-12/23	2023	COHS	Ventura	Gold Coast Health Plan	LTC/Full-Dual - SIS	$579.28	$589.20	$599.45
1/23-12/23	2023	COHS	Ventura	Gold Coast Health Plan	Maternity - SIS	$9,668.75	$9,858.70	$10,054.06
1/23-12/23	2023	COHS	Ventura	Gold Coast Health Plan	Child - UIS Federally Eligible	$29.55	$30.83	$32.19
1/23-12/23	2023	COHS	Ventura	Gold Coast Health Plan	Adult - UIS Federally Eligible	$270.10	$277.90	$285.99
1/23-12/23	2023	COHS	Ventura	Gold Coast Health Plan	ACA Optional Expansion - UIS Federally Eligible	$350.87	$360.85	$371.20
1/23-12/23	2023	COHS	Ventura	Gold Coast Health Plan	SPD - UIS Federally Eligible	$801.99	$824.20	$847.20
1/23-12/23	2023	COHS	Ventura	Gold Coast Health Plan	SPD/Full-Dual - UIS Federally Eligible	$120.73	$124.34	$128.10
1/23-12/23	2023	COHS	Ventura	Gold Coast Health Plan	LTC - UIS Federally Eligible	$801.99	$824.20	$847.20
1/23-12/23	2023	COHS	Ventura	Gold Coast Health Plan	LTC/Full-Dual - UIS Federally Eligible	$120.73	$124.34	$128.10
1/23-12/23	2023	COHS	Ventura	Gold Coast Health Plan	Maternity - UIS Federally Eligible	$9,668.75	$9,858.70	$10,054.06
1/23-12/23	2023	COHS	Ventura	Gold Coast Health Plan	Child - UIS State-Only	$48.63	$50.44	$52.33
1/23-12/23	2023	COHS	Ventura	Gold Coast Health Plan	Adult - UIS State-Only	$219.87	$225.74	$231.83
1/23-12/23	2023	COHS	Ventura	Gold Coast Health Plan	ACA Optional Expansion - UIS State-Only	$387.86	$396.54	$405.52
1/23-12/23	2023	COHS	Ventura	Gold Coast Health Plan	SPD - UIS State-Only	$1,021.52	$1,041.80	$1,062.74
1/23-12/23	2023	COHS	Ventura	Gold Coast Health Plan	SPD/Full-Dual - UIS State-Only	$321.64	$327.84	$334.25
1/23-12/23	2023	COHS	Ventura	Gold Coast Health Plan	LTC - UIS State-Only	$1,021.52	$1,041.80	$1,062.74
1/23-12/23	2023	COHS	Ventura	Gold Coast Health Plan	LTC/Full-Dual - UIS State-Only	$321.64	$327.84	$334.25
1/23-12/23	2023	COHS	San Mateo	Health Plan of San Mateo	Child - SIS	$103.41	$107.45	$111.68
1/23-12/23	2023	COHS	San Mateo	Health Plan of San Mateo	Adult - SIS	$286.61	$295.62	$304.98
1/23-12/23	2023	COHS	San Mateo	Health Plan of San Mateo	ACA Optional Expansion - SIS	$327.88	$337.50	$347.50
1/23-12/23	2023	COHS	San Mateo	Health Plan of San Mateo	SPD - SIS	$1,162.84	$1,190.06	$1,218.21
1/23-12/23	2023	COHS	San Mateo	Health Plan of San Mateo	SPD/Full-Dual - SIS	$807.74	$820.56	$833.78
1/23-12/23	2023	COHS	San Mateo	Health Plan of San Mateo	LTC - SIS	$1,162.84	$1,190.06	$1,218.21
1/23-12/23	2023	COHS	San Mateo	Health Plan of San Mateo	LTC/Full-Dual - SIS	$807.74	$820.56	$833.78
1/23-12/23	2023	COHS	San Mateo	Health Plan of San Mateo	Maternity - SIS	$10,152.74	$10,351.90	$10,556.71
1/23-12/23	2023	COHS	San Mateo	Health Plan of San Mateo	WCM - SIS	$1,857.84	$1,908.35	$1,960.65
1/23-12/23	2023	COHS	San Mateo	Health Plan of San Mateo	Child - UIS Federally Eligible	$30.40	$31.81	$33.30
1/23-12/23	2023	COHS	San Mateo	Health Plan of San Mateo	Adult - UIS Federally Eligible	$257.08	$264.74	$272.68
1/23-12/23	2023	COHS	San Mateo	Health Plan of San Mateo	ACA Optional Expansion - UIS Federally Eligible	$264.99	$272.86	$281.02
1/23-12/23	2023	COHS	San Mateo	Health Plan of San Mateo	SPD - UIS Federally Eligible	$704.16	$724.14	$744.84
1/23-12/23	2023	COHS	San Mateo	Health Plan of San Mateo	SPD/Full-Dual - UIS Federally Eligible	$133.23	$137.30	$141.52
1/23-12/23	2023	COHS	San Mateo	Health Plan of San Mateo	LTC - UIS Federally Eligible	$704.16	$724.14	$744.84
1/23-12/23	2023	COHS	San Mateo	Health Plan of San Mateo	LTC/Full-Dual - UIS Federally Eligible	$133.23	$137.30	$141.52
1/23-12/23	2023	COHS	San Mateo	Health Plan of San Mateo	Maternity - UIS Federally Eligible	$10,152.74	$10,351.90	$10,556.71
1/23-12/23	2023	COHS	San Mateo	Health Plan of San Mateo	WCM - UIS Federally Eligible	$617.53	$635.13	$653.36
1/23-12/23	2023	COHS	San Mateo	Health Plan of San Mateo	Child - UIS State-Only	$60.50	$62.79	$65.17
1/23-12/23	2023	COHS	San Mateo	Health Plan of San Mateo	Adult - UIS State-Only	$195.46	$201.26	$207.28
1/23-12/23	2023	COHS	San Mateo	Health Plan of San Mateo	ACA Optional Expansion - UIS State-Only	$297.13	$304.49	$312.12
1/23-12/23	2023	COHS	San Mateo	Health Plan of San Mateo	SPD - UIS State-Only	$908.99	$927.17	$945.94
1/23-12/23	2023	COHS	San Mateo	Health Plan of San Mateo	SPD/Full-Dual - UIS State-Only	$625.70	$635.63	$645.86
1/23-12/23	2023	COHS	San Mateo	Health Plan of San Mateo	LTC - UIS State-Only	$908.99	$927.17	$945.94
1/23-12/23	2023	COHS	San Mateo	Health Plan of San Mateo	LTC/Full-Dual - UIS State-Only	$625.70	$635.63	$645.86
1/23-12/23	2023	COHS	San Mateo	Health Plan of San Mateo	WCM - UIS State-Only	$1,233.73	$1,266.47	$1,300.34