| 07/15-06/16 |
2015-16 |
Two Plan |
Alameda |
Alameda Alliance for Health |
Adult |
$184.62 |
$191.06 |
$197.81 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Alameda |
Alameda Alliance for Health |
Aged & Disabled NonDual |
$712.24 |
$733.06 |
$754.75 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Alameda |
Alameda Alliance for Health |
Aged Dual |
$162.32 |
$167.27 |
$172.47 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Alameda |
Alameda Alliance for Health |
AIDS Dual |
$178.48 |
$184.44 |
$190.69 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Alameda |
Alameda Alliance for Health |
AIDS NonDual |
$800.33 |
$823.41 |
$847.42 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Alameda |
Alameda Alliance for Health |
BCCTP |
$945.42 |
$973.32 |
$1,002.39 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Alameda |
Alameda Alliance for Health |
Behavioral Health Treatment 0-6 |
$2,438.85 |
$2,491.64 |
$2,546.15 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Alameda |
Alameda Alliance for Health |
Behavioral Health Treatment 7-20 |
$1,870.56 |
$1,910.97 |
$1,952.71 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Alameda |
Alameda Alliance for Health |
Child |
$106.97 |
$111.22 |
$115.71 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Alameda |
Alameda Alliance for Health |
Disabled Dual |
$127.19 |
$131.75 |
$136.55 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Alameda |
Alameda Alliance for Health |
Hepatitis C 340B |
$6,390.37 |
$6,606.83 |
$6,831.70 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Alameda |
Alameda Alliance for Health |
Hepatitis C Non-340B |
$7,987.96 |
$8,258.54 |
$8,539.63 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Alameda |
Alameda Alliance for Health |
Maternity |
$7,140.82 |
$7,341.79 |
$7,550.01 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Alameda |
Alameda Alliance for Health |
Optional Expansion |
$361.64 |
$375.20 |
$389.37 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Alameda |
Alameda Alliance for Health |
Optional Expansion - Maternity |
$7,140.82 |
$7,341.79 |
$7,550.01 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Alameda |
Anthem Blue Cross |
Adult |
$202.58 |
$209.56 |
$216.89 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Alameda |
Anthem Blue Cross |
Aged & Disabled NonDual |
$755.79 |
$777.98 |
$801.09 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Alameda |
Anthem Blue Cross |
Aged Dual |
$176.19 |
$181.61 |
$187.30 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Alameda |
Anthem Blue Cross |
AIDS Dual |
$170.46 |
$176.36 |
$182.56 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Alameda |
Anthem Blue Cross |
AIDS NonDual |
$717.03 |
$738.06 |
$759.96 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Alameda |
Anthem Blue Cross |
BCCTP |
$919.58 |
$946.99 |
$975.56 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Alameda |
Anthem Blue Cross |
Behavioral Health Treatment 0-6 |
$2,438.85 |
$2,491.64 |
$2,546.15 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Alameda |
Anthem Blue Cross |
Behavioral Health Treatment 7-20 |
$1,870.56 |
$1,910.97 |
$1,952.71 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Alameda |
Anthem Blue Cross |
Child |
$98.65 |
$102.70 |
$106.98 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Alameda |
Anthem Blue Cross |
Disabled Dual |
$120.02 |
$124.69 |
$129.62 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Alameda |
Anthem Blue Cross |
Hepatitis C 340B |
$6,390.37 |
$6,606.83 |
$6,831.70 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Alameda |
Anthem Blue Cross |
Hepatitis C Non-340B |
$7,987.96 |
$8,258.54 |
$8,539.63 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Alameda |
Anthem Blue Cross |
Maternity |
$7,140.82 |
$7,341.79 |
$7,550.01 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Alameda |
Anthem Blue Cross |
Optional Expansion |
$332.85 |
$345.33 |
$358.37 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Alameda |
Anthem Blue Cross |
Optional Expansion - Maternity |
$7,140.82 |
$7,341.79 |
$7,550.01 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
Adult |
$237.15 |
$244.91 |
$253.02 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
Aged & Disabled NonDual |
$650.32 |
$669.26 |
$688.99 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
Aged Dual |
$92.85 |
$96.41 |
$100.17 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
AIDS Dual |
$172.95 |
$178.62 |
$184.56 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
AIDS NonDual |
$745.11 |
$766.67 |
$789.11 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
BCCTP |
$936.69 |
$964.38 |
$993.23 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
Behavioral Health Treatment 0-6 |
$2,251.33 |
$2,300.04 |
$2,350.34 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
Behavioral Health Treatment 7-20 |
$1,779.22 |
$1,817.64 |
$1,857.32 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
Child |
$86.17 |
$89.69 |
$93.41 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
Disabled Dual |
$124.57 |
$129.09 |
$133.84 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
Hepatitis C 340B |
$6,390.37 |
$6,606.83 |
$6,831.70 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
Hepatitis C Non-340B |
$7,987.96 |
$8,258.54 |
$8,539.63 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
Maternity |
$7,267.33 |
$7,471.83 |
$7,683.71 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
Optional Expansion |
$400.42 |
$415.44 |
$431.15 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Contra Costa |
Anthem Blue Cross |
Optional Expansion - Maternity |
$7,267.33 |
$7,471.83 |
$7,683.71 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Fresno |
Anthem Blue Cross |
Adult |
$236.33 |
$244.08 |
$252.20 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Fresno |
Anthem Blue Cross |
Aged & Disabled NonDual |
$731.72 |
$752.85 |
$774.85 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Fresno |
Anthem Blue Cross |
Aged Dual |
$127.96 |
$132.13 |
$136.50 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Fresno |
Anthem Blue Cross |
AIDS Dual |
$170.89 |
$176.37 |
$182.12 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Fresno |
Anthem Blue Cross |
AIDS NonDual |
$745.93 |
$767.42 |
$789.78 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Fresno |
Anthem Blue Cross |
BCCTP |
$901.66 |
$928.30 |
$956.05 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Fresno |
Anthem Blue Cross |
Behavioral Health Treatment 0-6 |
$2,738.39 |
$2,797.85 |
$2,859.25 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Fresno |
Anthem Blue Cross |
Behavioral Health Treatment 7-20 |
$1,753.87 |
$1,791.77 |
$1,830.90 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Fresno |
Anthem Blue Cross |
Child |
$70.89 |
$73.84 |
$76.95 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Fresno |
Anthem Blue Cross |
Disabled Dual |
$156.86 |
$161.92 |
$167.22 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Fresno |
Anthem Blue Cross |
Hepatitis C 340B |
$6,390.37 |
$6,606.83 |
$6,831.70 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Fresno |
Anthem Blue Cross |
Hepatitis C Non-340B |
$7,987.96 |
$8,258.54 |
$8,539.63 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Fresno |
Anthem Blue Cross |
Maternity |
$7,070.91 |
$7,269.92 |
$7,476.11 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Fresno |
Anthem Blue Cross |
Optional Expansion |
$396.72 |
$411.61 |
$427.17 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Fresno |
Anthem Blue Cross |
Optional Expansion - Maternity |
$7,070.91 |
$7,269.92 |
$7,476.11 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kings |
Anthem Blue Cross |
Adult |
$208.90 |
$215.72 |
$222.86 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kings |
Anthem Blue Cross |
Aged & Disabled NonDual |
$612.30 |
$629.94 |
$648.30 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kings |
Anthem Blue Cross |
Aged Dual |
$97.40 |
$100.93 |
$104.65 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kings |
Anthem Blue Cross |
AIDS Dual |
$176.77 |
$182.35 |
$188.19 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kings |
Anthem Blue Cross |
AIDS NonDual |
$738.36 |
$759.63 |
$781.76 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kings |
Anthem Blue Cross |
BCCTP |
$1,013.31 |
$1,043.25 |
$1,074.43 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kings |
Anthem Blue Cross |
Behavioral Health Treatment 0-6 |
$2,298.52 |
$2,348.51 |
$2,400.14 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kings |
Anthem Blue Cross |
Behavioral Health Treatment 7-20 |
$1,783.88 |
$1,822.47 |
$1,862.31 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kings |
Anthem Blue Cross |
Child |
$71.82 |
$74.69 |
$77.71 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kings |
Anthem Blue Cross |
Disabled Dual |
$113.17 |
$117.21 |
$121.45 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kings |
Anthem Blue Cross |
Hepatitis C 340B |
$6,390.37 |
$6,606.83 |
$6,831.70 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kings |
Anthem Blue Cross |
Hepatitis C Non-340B |
$7,987.96 |
$8,258.54 |
$8,539.63 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kings |
Anthem Blue Cross |
Maternity |
$6,014.57 |
$6,183.84 |
$6,359.23 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kings |
Anthem Blue Cross |
Optional Expansion |
$364.73 |
$378.40 |
$392.70 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kings |
Anthem Blue Cross |
Optional Expansion - Maternity |
$6,014.57 |
$6,183.84 |
$6,359.23 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Madera |
Anthem Blue Cross |
Adult |
$188.12 |
$194.24 |
$200.64 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Madera |
Anthem Blue Cross |
Aged & Disabled NonDual |
$691.41 |
$711.21 |
$731.81 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Madera |
Anthem Blue Cross |
Aged Dual |
$92.84 |
$96.14 |
$99.61 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Madera |
Anthem Blue Cross |
AIDS Dual |
$169.84 |
$175.15 |
$180.72 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Madera |
Anthem Blue Cross |
AIDS NonDual |
$738.56 |
$759.73 |
$781.75 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Madera |
Anthem Blue Cross |
BCCTP |
$964.01 |
$992.19 |
$1,021.53 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Madera |
Anthem Blue Cross |
Behavioral Health Treatment 0-6 |
$2,286.36 |
$2,335.79 |
$2,386.84 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Madera |
Anthem Blue Cross |
Behavioral Health Treatment 7-20 |
$1,786.46 |
$1,824.94 |
$1,864.68 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Madera |
Anthem Blue Cross |
Child |
$72.92 |
$75.77 |
$78.77 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Madera |
Anthem Blue Cross |
Disabled Dual |
$105.85 |
$109.58 |
$113.50 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Madera |
Anthem Blue Cross |
Hepatitis C 340B |
$6,390.37 |
$6,606.83 |
$6,831.70 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Madera |
Anthem Blue Cross |
Hepatitis C Non-340B |
$7,987.96 |
$8,258.54 |
$8,539.63 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Madera |
Anthem Blue Cross |
Maternity |
$6,329.08 |
$6,507.21 |
$6,691.77 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Madera |
Anthem Blue Cross |
Optional Expansion |
$429.48 |
$445.60 |
$462.46 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Madera |
Anthem Blue Cross |
Optional Expansion - Maternity |
$6,329.08 |
$6,507.21 |
$6,691.77 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Francisco |
Anthem Blue Cross |
Adult |
$226.71 |
$234.89 |
$243.49 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Francisco |
Anthem Blue Cross |
Aged & Disabled NonDual |
$833.19 |
$857.99 |
$883.84 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Francisco |
Anthem Blue Cross |
Aged Dual |
$737.03 |
$752.61 |
$768.90 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Francisco |
Anthem Blue Cross |
AIDS Dual |
$186.67 |
$193.76 |
$201.24 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Francisco |
Anthem Blue Cross |
AIDS NonDual |
$754.13 |
$777.03 |
$800.92 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Francisco |
Anthem Blue Cross |
BCCTP |
$949.58 |
$978.72 |
$1,009.13 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Francisco |
Anthem Blue Cross |
Behavioral Health Treatment 0-6 |
$2,224.62 |
$2,272.90 |
$2,322.76 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Francisco |
Anthem Blue Cross |
Behavioral Health Treatment 7-20 |
$1,730.03 |
$1,767.52 |
$1,806.23 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Francisco |
Anthem Blue Cross |
Child |
$88.15 |
$92.37 |
$96.85 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Francisco |
Anthem Blue Cross |
Disabled Dual |
$333.43 |
$342.48 |
$351.99 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Francisco |
Anthem Blue Cross |
Hepatitis C 340B |
$6,390.37 |
$6,606.83 |
$6,831.70 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Francisco |
Anthem Blue Cross |
Hepatitis C Non-340B |
$7,987.96 |
$8,258.54 |
$8,539.63 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Francisco |
Anthem Blue Cross |
Maternity |
$7,865.46 |
$8,086.80 |
$8,316.13 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Francisco |
Anthem Blue Cross |
Optional Expansion |
$331.85 |
$344.28 |
$357.28 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Francisco |
Anthem Blue Cross |
Optional Expansion - Maternity |
$7,865.46 |
$8,086.80 |
$8,316.13 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
Adult |
$208.80 |
$215.70 |
$222.94 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
Aged & Disabled NonDual |
$522.04 |
$537.41 |
$553.42 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
Aged Dual |
$- |
$- |
$- |
| 07/15-06/16 |
2015-16 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
AIDS Dual |
$179.60 |
$185.35 |
$191.38 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
AIDS NonDual |
$749.54 |
$771.25 |
$793.84 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
BCCTP |
$925.97 |
$953.38 |
$981.93 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
Behavioral Health Treatment 0-6 |
$2,099.91 |
$2,145.39 |
$2,192.36 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
Behavioral Health Treatment 7-20 |
$1,538.72 |
$1,571.96 |
$1,606.28 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
Child |
$81.66 |
$84.97 |
$88.46 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
Disabled Dual |
$124.38 |
$128.82 |
$133.49 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
Hepatitis C 340B |
$6,390.37 |
$6,606.83 |
$6,831.70 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
Hepatitis C Non-340B |
$7,987.96 |
$8,258.54 |
$8,539.63 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
Maternity |
$7,174.12 |
$7,376.00 |
$7,585.16 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
Optional Expansion |
$346.33 |
$359.31 |
$372.88 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Santa Clara |
Anthem Blue Cross |
Optional Expansion - Maternity |
$7,174.12 |
$7,376.00 |
$7,585.16 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Tulare |
Anthem Blue Cross |
Adult |
$214.44 |
$221.40 |
$228.68 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Tulare |
Anthem Blue Cross |
Aged & Disabled NonDual |
$620.52 |
$638.42 |
$657.05 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Tulare |
Anthem Blue Cross |
Aged Dual |
$90.06 |
$93.33 |
$96.78 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Tulare |
Anthem Blue Cross |
AIDS Dual |
$178.29 |
$183.84 |
$189.65 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Tulare |
Anthem Blue Cross |
AIDS NonDual |
$738.11 |
$759.26 |
$781.26 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Tulare |
Anthem Blue Cross |
BCCTP |
$934.01 |
$961.44 |
$990.01 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Tulare |
Anthem Blue Cross |
Behavioral Health Treatment 0-6 |
$2,420.06 |
$2,472.34 |
$2,526.32 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Tulare |
Anthem Blue Cross |
Behavioral Health Treatment 7-20 |
$1,817.80 |
$1,856.69 |
$1,896.85 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Tulare |
Anthem Blue Cross |
Child |
$64.10 |
$66.70 |
$69.45 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Tulare |
Anthem Blue Cross |
Disabled Dual |
$118.71 |
$122.82 |
$127.14 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Tulare |
Anthem Blue Cross |
Hepatitis C 340B |
$6,390.37 |
$6,606.83 |
$6,831.70 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Tulare |
Anthem Blue Cross |
Hepatitis C Non-340B |
$7,987.96 |
$8,258.54 |
$8,539.63 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Tulare |
Anthem Blue Cross |
Maternity |
$6,615.85 |
$6,802.05 |
$6,994.97 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Tulare |
Anthem Blue Cross |
Optional Expansion |
$360.96 |
$374.49 |
$388.64 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Tulare |
Anthem Blue Cross |
Optional Expansion - Maternity |
$6,615.85 |
$6,802.05 |
$6,994.97 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Fresno |
CalViva Health |
Adult |
$234.77 |
$242.50 |
$250.61 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Fresno |
CalViva Health |
Aged & Disabled NonDual |
$771.43 |
$793.65 |
$816.78 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Fresno |
CalViva Health |
Aged Dual |
$213.36 |
$218.96 |
$224.84 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Fresno |
CalViva Health |
AIDS Dual |
$166.76 |
$172.31 |
$178.14 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Fresno |
CalViva Health |
AIDS NonDual |
$812.36 |
$836.01 |
$860.63 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Fresno |
CalViva Health |
BCCTP |
$981.03 |
$1,010.01 |
$1,040.20 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Fresno |
CalViva Health |
Behavioral Health Treatment 0-6 |
$2,738.39 |
$2,797.85 |
$2,859.25 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Fresno |
CalViva Health |
Behavioral Health Treatment 7-20 |
$1,753.87 |
$1,791.77 |
$1,830.90 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Fresno |
CalViva Health |
Child |
$79.63 |
$82.92 |
$86.39 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Fresno |
CalViva Health |
Disabled Dual |
$212.91 |
$218.84 |
$225.06 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Fresno |
CalViva Health |
Hepatitis C 340B |
$6,390.37 |
$6,606.83 |
$6,831.70 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Fresno |
CalViva Health |
Hepatitis C Non-340B |
$7,987.96 |
$8,258.54 |
$8,539.63 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Fresno |
CalViva Health |
Maternity |
$7,070.91 |
$7,269.92 |
$7,476.11 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Fresno |
CalViva Health |
Optional Expansion |
$395.15 |
$409.97 |
$425.48 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Fresno |
CalViva Health |
Optional Expansion - Maternity |
$7,070.91 |
$7,269.92 |
$7,476.11 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kings |
CalViva Health |
Adult |
$193.42 |
$199.81 |
$206.51 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kings |
CalViva Health |
Aged & Disabled NonDual |
$642.51 |
$661.04 |
$680.32 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kings |
CalViva Health |
Aged Dual |
$81.46 |
$84.59 |
$87.88 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kings |
CalViva Health |
AIDS Dual |
$170.50 |
$175.97 |
$181.70 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kings |
CalViva Health |
AIDS NonDual |
$755.93 |
$777.72 |
$800.39 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kings |
CalViva Health |
BCCTP |
$940.87 |
$968.71 |
$997.71 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kings |
CalViva Health |
Behavioral Health Treatment 0-6 |
$2,298.52 |
$2,348.51 |
$2,400.14 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kings |
CalViva Health |
Behavioral Health Treatment 7-20 |
$1,783.88 |
$1,822.47 |
$1,862.31 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kings |
CalViva Health |
Child |
$69.29 |
$72.08 |
$75.03 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kings |
CalViva Health |
Disabled Dual |
$108.04 |
$111.95 |
$116.05 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kings |
CalViva Health |
Hepatitis C 340B |
$6,390.37 |
$6,606.83 |
$6,831.70 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kings |
CalViva Health |
Hepatitis C Non-340B |
$7,987.96 |
$8,258.54 |
$8,539.63 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kings |
CalViva Health |
Maternity |
$6,014.57 |
$6,183.84 |
$6,359.23 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kings |
CalViva Health |
Optional Expansion |
$377.22 |
$391.37 |
$406.16 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kings |
CalViva Health |
Optional Expansion - Maternity |
$6,014.57 |
$6,183.84 |
$6,359.23 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Madera |
CalViva Health |
Adult |
$220.17 |
$227.35 |
$234.86 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Madera |
CalViva Health |
Aged & Disabled NonDual |
$789.30 |
$812.01 |
$835.63 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Madera |
CalViva Health |
Aged Dual |
$107.70 |
$111.34 |
$115.17 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Madera |
CalViva Health |
AIDS Dual |
$170.34 |
$175.88 |
$181.68 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Madera |
CalViva Health |
AIDS NonDual |
$753.75 |
$775.53 |
$798.18 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Madera |
CalViva Health |
BCCTP |
$1,026.78 |
$1,056.96 |
$1,088.38 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Madera |
CalViva Health |
Behavioral Health Treatment 0-6 |
$2,286.36 |
$2,335.79 |
$2,386.84 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Madera |
CalViva Health |
Behavioral Health Treatment 7-20 |
$1,786.46 |
$1,824.94 |
$1,864.68 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Madera |
CalViva Health |
Child |
$77.14 |
$80.20 |
$83.42 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Madera |
CalViva Health |
Disabled Dual |
$129.76 |
$134.20 |
$138.85 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Madera |
CalViva Health |
Hepatitis C 340B |
$6,390.37 |
$6,606.83 |
$6,831.70 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Madera |
CalViva Health |
Hepatitis C Non-340B |
$7,987.96 |
$8,258.54 |
$8,539.63 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Madera |
CalViva Health |
Maternity |
$6,329.08 |
$6,507.21 |
$6,691.77 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Madera |
CalViva Health |
Optional Expansion |
$433.73 |
$450.01 |
$467.03 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Madera |
CalViva Health |
Optional Expansion - Maternity |
$6,329.08 |
$6,507.21 |
$6,691.77 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
Adult |
$234.91 |
$242.73 |
$250.91 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
Aged & Disabled NonDual |
$699.05 |
$719.43 |
$740.67 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
Aged Dual |
$148.20 |
$152.84 |
$157.73 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
AIDS Dual |
$174.99 |
$180.75 |
$186.79 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
AIDS NonDual |
$885.62 |
$911.20 |
$937.82 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
BCCTP |
$964.60 |
$993.02 |
$1,022.61 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
Child |
$82.85 |
$86.28 |
$89.90 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
Disabled Dual |
$152.39 |
$157.36 |
$162.57 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
Maternity |
$7,267.33 |
$7,471.83 |
$7,683.71 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
Behavioral Health Treatment 0-6 |
$2,251.33 |
$2,300.04 |
$2,350.34 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
Behavioral Health Treatment 7-20 |
$1,779.22 |
$1,817.64 |
$1,857.32 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
Hepatitis C 340B |
$6,390.37 |
$6,606.83 |
$6,831.70 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
Hepatitis C Non-340B |
$7,987.96 |
$8,258.54 |
$8,539.63 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
Optional Expansion |
$422.41 |
$438.27 |
$454.85 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Contra Costa |
Contra Costa Health Plan |
Optional Expansion - Maternity |
$7,267.33 |
$7,471.83 |
$7,683.71 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kern |
Health Net of California |
Adult |
$210.58 |
$217.48 |
$224.70 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kern |
Health Net of California |
Aged & Disabled NonDual |
$631.00 |
$649.27 |
$668.28 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kern |
Health Net of California |
Aged Dual |
$170.89 |
$175.58 |
$180.50 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kern |
Health Net of California |
AIDS Dual |
$171.04 |
$176.55 |
$182.32 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kern |
Health Net of California |
AIDS NonDual |
$740.93 |
$762.10 |
$784.13 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kern |
Health Net of California |
BCCTP |
$914.47 |
$941.23 |
$969.10 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kern |
Health Net of California |
Behavioral Health Treatment 0-6 |
$2,303.39 |
$2,353.27 |
$2,404.77 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kern |
Health Net of California |
Behavioral Health Treatment 7-20 |
$1,831.67 |
$1,871.30 |
$1,912.22 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kern |
Health Net of California |
Child |
$66.00 |
$68.77 |
$71.70 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kern |
Health Net of California |
Disabled Dual |
$122.69 |
$126.83 |
$131.19 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kern |
Health Net of California |
Hepatitis C 340B |
$6,390.37 |
$6,606.83 |
$6,831.70 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kern |
Health Net of California |
Hepatitis C Non-340B |
$7,987.96 |
$8,258.54 |
$8,539.63 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kern |
Health Net of California |
Maternity |
$5,685.06 |
$5,845.05 |
$6,010.82 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kern |
Health Net of California |
Optional Expansion |
$400.41 |
$415.44 |
$431.15 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kern |
Health Net of California |
Optional Expansion - Maternity |
$5,685.06 |
$5,845.05 |
$6,010.82 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Los Angeles |
Health Net of California |
Adult |
$163.16 |
$168.62 |
$174.35 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Los Angeles |
Health Net of California |
Aged & Disabled NonDual |
$471.08 |
$484.74 |
$498.97 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Los Angeles |
Health Net of California |
Aged Dual |
$- |
$- |
$- |
| 07/15-06/16 |
2015-16 |
Two Plan |
Los Angeles |
Health Net of California |
AIDS Dual |
$172.62 |
$178.01 |
$183.65 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Los Angeles |
Health Net of California |
AIDS NonDual |
$739.77 |
$760.94 |
$782.96 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Los Angeles |
Health Net of California |
BCCTP |
$923.98 |
$951.10 |
$979.34 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Los Angeles |
Health Net of California |
Behavioral Health Treatment 0-6 |
$2,346.37 |
$2,397.12 |
$2,449.52 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Los Angeles |
Health Net of California |
Behavioral Health Treatment 7-20 |
$1,771.34 |
$1,809.53 |
$1,848.97 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Los Angeles |
Health Net of California |
Child |
$73.54 |
$76.45 |
$79.51 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Los Angeles |
Health Net of California |
Disabled Dual |
$101.42 |
$104.98 |
$108.71 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Los Angeles |
Health Net of California |
Hepatitis C 340B |
$6,390.37 |
$6,606.83 |
$6,831.70 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Los Angeles |
Health Net of California |
Hepatitis C Non-340B |
$7,987.96 |
$8,258.54 |
$8,539.63 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Los Angeles |
Health Net of California |
Maternity |
$6,401.39 |
$6,581.53 |
$6,768.17 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Joaquin |
Health Net of California |
Adult |
$187.44 |
$193.59 |
$200.02 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Joaquin |
Health Net of California |
Aged & Disabled NonDual |
$709.86 |
$730.21 |
$751.39 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Joaquin |
Health Net of California |
Aged Dual |
$81.43 |
$84.60 |
$87.93 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Joaquin |
Health Net of California |
AIDS Dual |
$171.26 |
$176.74 |
$182.49 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Joaquin |
Health Net of California |
AIDS NonDual |
$755.71 |
$777.24 |
$799.64 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Joaquin |
Health Net of California |
BCCTP |
$942.35 |
$969.82 |
$998.42 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Joaquin |
Health Net of California |
Behavioral Health Treatment 0-6 |
$2,290.64 |
$2,340.28 |
$2,391.55 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Joaquin |
Health Net of California |
Behavioral Health Treatment 7-20 |
$1,744.03 |
$1,781.73 |
$1,820.67 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Joaquin |
Health Net of California |
Child |
$67.45 |
$70.23 |
$73.17 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Joaquin |
Health Net of California |
Disabled Dual |
$109.99 |
$113.94 |
$118.09 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Joaquin |
Health Net of California |
Hepatitis C 340B |
$6,390.37 |
$6,606.83 |
$6,831.70 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Joaquin |
Health Net of California |
Hepatitis C Non-340B |
$7,987.96 |
$8,258.54 |
$8,539.63 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Joaquin |
Health Net of California |
Maternity |
$6,318.75 |
$6,496.61 |
$6,680.89 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Joaquin |
Health Net of California |
Optional Expansion |
$328.40 |
$340.70 |
$353.56 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Joaquin |
Health Net of California |
Optional Expansion - Maternity |
$6,318.75 |
$6,496.61 |
$6,680.89 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Stanislaus |
Health Net of California |
Adult |
$221.66 |
$229.05 |
$236.79 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Stanislaus |
Health Net of California |
Aged & Disabled NonDual |
$824.87 |
$848.84 |
$873.79 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Stanislaus |
Health Net of California |
Aged Dual |
$91.00 |
$94.45 |
$98.09 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Stanislaus |
Health Net of California |
AIDS Dual |
$170.83 |
$176.48 |
$182.40 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Stanislaus |
Health Net of California |
AIDS NonDual |
$810.84 |
$834.37 |
$858.85 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Stanislaus |
Health Net of California |
BCCTP |
$975.78 |
$1,004.56 |
$1,034.54 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Stanislaus |
Health Net of California |
Behavioral Health Treatment 0-6 |
$2,320.07 |
$2,370.54 |
$2,422.66 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Stanislaus |
Health Net of California |
Behavioral Health Treatment 7-20 |
$1,700.46 |
$1,737.53 |
$1,775.80 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Stanislaus |
Health Net of California |
Child |
$69.35 |
$72.39 |
$75.59 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Stanislaus |
Health Net of California |
Disabled Dual |
$103.70 |
$107.62 |
$111.75 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Stanislaus |
Health Net of California |
Hepatitis C 340B |
$6,390.37 |
$6,606.83 |
$6,831.70 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Stanislaus |
Health Net of California |
Hepatitis C Non-340B |
$7,987.96 |
$8,258.54 |
$8,539.63 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Stanislaus |
Health Net of California |
Maternity |
$6,494.44 |
$6,677.22 |
$6,866.60 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Stanislaus |
Health Net of California |
Optional Expansion |
$441.59 |
$458.17 |
$475.51 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Stanislaus |
Health Net of California |
Optional Expansion - Maternity |
$6,494.44 |
$6,677.22 |
$6,866.60 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Tulare |
Health Net of California |
Adult |
$203.17 |
$209.84 |
$216.81 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Tulare |
Health Net of California |
Aged & Disabled NonDual |
$663.95 |
$683.14 |
$703.11 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Tulare |
Health Net of California |
Aged Dual |
$95.71 |
$99.16 |
$102.79 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Tulare |
Health Net of California |
AIDS Dual |
$172.79 |
$178.36 |
$184.20 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Tulare |
Health Net of California |
AIDS NonDual |
$727.84 |
$748.76 |
$770.52 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Tulare |
Health Net of California |
BCCTP |
$925.97 |
$953.26 |
$981.68 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Tulare |
Health Net of California |
Behavioral Health Treatment 0-6 |
$2,420.06 |
$2,472.34 |
$2,526.32 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Tulare |
Health Net of California |
Behavioral Health Treatment 7-20 |
$1,817.80 |
$1,856.69 |
$1,896.85 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Tulare |
Health Net of California |
Child |
$66.04 |
$68.75 |
$71.61 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Tulare |
Health Net of California |
Disabled Dual |
$122.66 |
$126.96 |
$131.47 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Tulare |
Health Net of California |
Hepatitis C 340B |
$6,390.37 |
$6,606.83 |
$6,831.70 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Tulare |
Health Net of California |
Hepatitis C Non-340B |
$7,987.96 |
$8,258.54 |
$8,539.63 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Tulare |
Health Net of California |
Maternity |
$6,615.85 |
$6,802.05 |
$6,994.97 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Tulare |
Health Net of California |
Optional Expansion |
$358.33 |
$371.76 |
$385.81 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Tulare |
Health Net of California |
Optional Expansion - Maternity |
$6,615.85 |
$6,802.05 |
$6,994.97 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Los Angeles |
Health Net of California |
Optional Expansion |
$321.70 |
$333.75 |
$346.35 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Los Angeles |
Health Net of California |
Optional Expansion - Maternity |
$6,401.39 |
$6,581.53 |
$6,768.17 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
Adult |
$207.83 |
$214.72 |
$221.93 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
Aged & Disabled NonDual |
$625.56 |
$643.68 |
$662.54 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
Aged Dual |
$82.59 |
$85.81 |
$89.21 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
AIDS Dual |
$171.78 |
$177.29 |
$183.06 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
AIDS NonDual |
$836.54 |
$860.72 |
$885.88 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
BCCTP |
$1,011.71 |
$1,041.66 |
$1,072.87 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
Child |
$73.42 |
$76.43 |
$79.60 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
Disabled Dual |
$106.43 |
$110.37 |
$114.51 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
Maternity |
$6,318.75 |
$6,496.61 |
$6,680.89 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
Adult |
$263.98 |
$272.70 |
$281.83 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
Aged & Disabled NonDual |
$989.21 |
$1,017.79 |
$1,047.54 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
Aged Dual |
$110.61 |
$114.76 |
$119.14 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
AIDS Dual |
$183.72 |
$189.85 |
$196.28 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
AIDS NonDual |
$748.42 |
$770.14 |
$792.75 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
BCCTP |
$907.29 |
$934.35 |
$962.55 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
Child |
$74.43 |
$77.70 |
$81.16 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
Disabled Dual |
$122.34 |
$126.97 |
$131.84 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
Maternity |
$6,494.44 |
$6,677.22 |
$6,866.60 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
Behavioral Health Treatment 0-6 |
$2,290.64 |
$2,340.28 |
$2,391.55 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
Behavioral Health Treatment 7-20 |
$1,744.03 |
$1,781.73 |
$1,820.67 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
Hepatitis C 340B |
$6,390.37 |
$6,606.83 |
$6,831.70 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
Hepatitis C Non-340B |
$7,987.96 |
$8,258.54 |
$8,539.63 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
Optional Expansion |
$339.95 |
$352.69 |
$366.01 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Joaquin |
Health Plan of San Joaquin |
Optional Expansion - Maternity |
$6,318.75 |
$6,496.61 |
$6,680.89 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
Behavioral Health Treatment 0-6 |
$2,320.07 |
$2,370.54 |
$2,422.66 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
Behavioral Health Treatment 7-20 |
$1,700.46 |
$1,737.53 |
$1,775.80 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
Hepatitis C 340B |
$6,390.37 |
$6,606.83 |
$6,831.70 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
Hepatitis C Non-340B |
$7,987.96 |
$8,258.54 |
$8,539.63 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
Optional Expansion |
$452.33 |
$469.31 |
$487.07 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Stanislaus |
Health Plan of San Joaquin |
Optional Expansion - Maternity |
$6,494.44 |
$6,677.22 |
$6,866.60 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Riverside |
Inland Empire Health Plan |
Adult |
$222.45 |
$229.66 |
$237.20 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Riverside |
Inland Empire Health Plan |
Aged & Disabled NonDual |
$662.96 |
$681.99 |
$701.79 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Riverside |
Inland Empire Health Plan |
Aged Dual |
$- |
$- |
$- |
| 07/15-06/16 |
2015-16 |
Two Plan |
Riverside |
Inland Empire Health Plan |
AIDS Dual |
$172.83 |
$178.33 |
$184.09 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Riverside |
Inland Empire Health Plan |
AIDS NonDual |
$835.17 |
$859.13 |
$884.05 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Riverside |
Inland Empire Health Plan |
BCCTP |
$916.39 |
$943.65 |
$972.05 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Riverside |
Inland Empire Health Plan |
Child |
$72.96 |
$75.89 |
$78.98 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Riverside |
Inland Empire Health Plan |
Disabled Dual |
$104.77 |
$108.56 |
$112.55 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Riverside |
Inland Empire Health Plan |
Maternity |
$5,510.75 |
$5,665.86 |
$5,826.58 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
Adult |
$218.43 |
$225.57 |
$233.04 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
Aged & Disabled NonDual |
$623.44 |
$641.44 |
$660.18 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
Aged Dual |
$- |
$- |
$- |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
AIDS Dual |
$176.84 |
$182.53 |
$188.50 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
AIDS NonDual |
$741.36 |
$762.84 |
$785.20 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
BCCTP |
$936.49 |
$964.04 |
$992.75 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
Child |
$76.75 |
$79.83 |
$83.09 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
Disabled Dual |
$102.90 |
$106.68 |
$110.65 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
Maternity |
$5,805.96 |
$5,969.39 |
$6,138.71 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Riverside |
Inland Empire Health Plan |
Behavioral Health Treatment 0-6 |
$2,215.51 |
$2,263.37 |
$2,312.79 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Riverside |
Inland Empire Health Plan |
Behavioral Health Treatment 7-20 |
$1,709.80 |
$1,746.63 |
$1,784.67 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Riverside |
Inland Empire Health Plan |
Hepatitis C 340B |
$6,390.37 |
$6,606.83 |
$6,831.70 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Riverside |
Inland Empire Health Plan |
Hepatitis C Non-340B |
$7,987.96 |
$8,258.54 |
$8,539.63 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Riverside |
Inland Empire Health Plan |
Optional Expansion |
$388.75 |
$403.33 |
$418.58 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Riverside |
Inland Empire Health Plan |
Optional Expansion - Maternity |
$5,510.75 |
$5,665.86 |
$5,826.58 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
Behavioral Health Treatment 0-6 |
$2,162.81 |
$2,209.60 |
$2,257.92 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
Behavioral Health Treatment 7-20 |
$1,623.92 |
$1,658.96 |
$1,695.14 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
Hepatitis C 340B |
$6,390.37 |
$6,606.83 |
$6,831.70 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
Hepatitis C Non-340B |
$7,987.96 |
$8,258.54 |
$8,539.63 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
Optional Expansion |
$363.27 |
$376.89 |
$391.13 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Bernardino |
Inland Empire Health Plan |
Optional Expansion - Maternity |
$5,805.96 |
$5,969.39 |
$6,138.71 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kern |
Kern Health Systems |
Adult |
$221.25 |
$228.46 |
$236.00 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kern |
Kern Health Systems |
Aged & Disabled NonDual |
$679.14 |
$698.74 |
$719.15 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kern |
Kern Health Systems |
Aged Dual |
$109.79 |
$113.47 |
$117.34 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kern |
Kern Health Systems |
AIDS Dual |
$176.07 |
$181.69 |
$187.57 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kern |
Kern Health Systems |
AIDS NonDual |
$834.76 |
$858.68 |
$883.56 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kern |
Kern Health Systems |
BCCTP |
$994.48 |
$1,023.47 |
$1,053.64 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kern |
Kern Health Systems |
Behavioral Health Treatment 0-6 |
$2,303.39 |
$2,353.27 |
$2,404.77 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kern |
Kern Health Systems |
Behavioral Health Treatment 7-20 |
$1,831.67 |
$1,871.30 |
$1,912.22 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kern |
Kern Health Systems |
Child |
$66.51 |
$69.26 |
$72.17 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kern |
Kern Health Systems |
Disabled Dual |
$129.58 |
$133.98 |
$138.60 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kern |
Kern Health Systems |
Hepatitis C 340B |
$6,390.37 |
$6,606.83 |
$6,831.70 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kern |
Kern Health Systems |
Hepatitis C Non-340B |
$7,987.96 |
$8,258.54 |
$8,539.63 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kern |
Kern Health Systems |
Maternity |
$5,685.06 |
$5,845.05 |
$6,010.82 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kern |
Kern Health Systems |
Optional Expansion |
$402.96 |
$418.08 |
$433.89 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Kern |
Kern Health Systems |
Optional Expansion - Maternity |
$5,685.06 |
$5,845.05 |
$6,010.82 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Los Angeles |
LA Care |
Adult |
$177.67 |
$183.67 |
$189.97 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Los Angeles |
LA Care |
Aged & Disabled NonDual |
$553.76 |
$569.79 |
$586.48 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Los Angeles |
LA Care |
Aged Dual |
$- |
$- |
$- |
| 07/15-06/16 |
2015-16 |
Two Plan |
Los Angeles |
LA Care |
AIDS Dual |
$180.23 |
$186.04 |
$192.13 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Los Angeles |
LA Care |
AIDS NonDual |
$748.90 |
$770.66 |
$793.30 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Los Angeles |
LA Care |
BCCTP |
$907.79 |
$934.69 |
$962.71 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Los Angeles |
LA Care |
Child |
$79.47 |
$82.64 |
$85.97 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Los Angeles |
LA Care |
Disabled Dual |
$114.76 |
$118.87 |
$123.20 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Los Angeles |
LA Care |
Maternity |
$6,401.39 |
$6,581.53 |
$6,768.17 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Los Angeles |
LA Care |
Behavioral Health Treatment 0-6 |
$2,346.37 |
$2,397.12 |
$2,449.52 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Los Angeles |
LA Care |
Behavioral Health Treatment 7-20 |
$1,771.34 |
$1,809.53 |
$1,848.97 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Los Angeles |
LA Care |
Hepatitis C 340B |
$6,390.37 |
$6,606.83 |
$6,831.70 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Los Angeles |
LA Care |
Hepatitis C Non-340B |
$7,987.96 |
$8,258.54 |
$8,539.63 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Los Angeles |
LA Care |
Optional Expansion |
$328.13 |
$340.43 |
$353.28 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Los Angeles |
LA Care |
Optional Expansion - Maternity |
$6,401.39 |
$6,581.53 |
$6,768.17 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Riverside |
Molina Healthcare |
Adult |
$182.58 |
$188.50 |
$194.69 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Riverside |
Molina Healthcare |
Aged & Disabled NonDual |
$494.91 |
$509.16 |
$523.99 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Riverside |
Molina Healthcare |
Aged Dual |
$- |
$- |
$- |
| 07/15-06/16 |
2015-16 |
Two Plan |
Riverside |
Molina Healthcare |
AIDS Dual |
$176.64 |
$182.10 |
$187.82 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Riverside |
Molina Healthcare |
AIDS NonDual |
$770.52 |
$792.26 |
$814.86 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Riverside |
Molina Healthcare |
BCCTP |
$895.90 |
$921.84 |
$948.85 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Riverside |
Molina Healthcare |
Behavioral Health Treatment 0-6 |
$2,215.51 |
$2,263.37 |
$2,312.79 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Riverside |
Molina Healthcare |
Behavioral Health Treatment 7-20 |
$1,709.80 |
$1,746.63 |
$1,784.67 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Riverside |
Molina Healthcare |
Child |
$67.49 |
$70.16 |
$72.98 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Riverside |
Molina Healthcare |
Disabled Dual |
$103.64 |
$107.25 |
$111.05 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Riverside |
Molina Healthcare |
Hepatitis C 340B |
$6,390.37 |
$6,606.83 |
$6,831.70 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Riverside |
Molina Healthcare |
Hepatitis C Non-340B |
$7,987.96 |
$8,258.54 |
$8,539.63 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Riverside |
Molina Healthcare |
Maternity |
$5,510.75 |
$5,665.86 |
$5,826.58 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Riverside |
Molina Healthcare |
Optional Expansion |
$386.36 |
$400.85 |
$416.01 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Riverside |
Molina Healthcare |
Optional Expansion - Maternity |
$5,510.75 |
$5,665.86 |
$5,826.58 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Bernardino |
Molina Healthcare |
Adult |
$172.86 |
$178.52 |
$184.45 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Bernardino |
Molina Healthcare |
Aged & Disabled NonDual |
$471.41 |
$485.07 |
$499.30 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Bernardino |
Molina Healthcare |
Aged Dual |
$- |
$- |
$- |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Bernardino |
Molina Healthcare |
AIDS Dual |
$165.03 |
$170.07 |
$175.35 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Bernardino |
Molina Healthcare |
AIDS NonDual |
$763.71 |
$785.38 |
$807.92 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Bernardino |
Molina Healthcare |
BCCTP |
$919.21 |
$945.95 |
$973.79 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Bernardino |
Molina Healthcare |
Behavioral Health Treatment 0-6 |
$2,162.81 |
$2,209.60 |
$2,257.92 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Bernardino |
Molina Healthcare |
Behavioral Health Treatment 7-20 |
$1,623.92 |
$1,658.96 |
$1,695.14 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Bernardino |
Molina Healthcare |
Child |
$69.26 |
$71.99 |
$74.88 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Bernardino |
Molina Healthcare |
Disabled Dual |
$100.07 |
$103.63 |
$107.37 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Bernardino |
Molina Healthcare |
Hepatitis C 340B |
$6,390.37 |
$6,606.83 |
$6,831.70 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Bernardino |
Molina Healthcare |
Hepatitis C Non-340B |
$7,987.96 |
$8,258.54 |
$8,539.63 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Bernardino |
Molina Healthcare |
Maternity |
$5,805.96 |
$5,969.39 |
$6,138.71 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Bernardino |
Molina Healthcare |
Optional Expansion |
$362.51 |
$376.10 |
$390.31 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Bernardino |
Molina Healthcare |
Optional Expansion - Maternity |
$5,805.96 |
$5,969.39 |
$6,138.71 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Francisco |
San Francisco Health Plan |
Adult |
$204.96 |
$212.17 |
$219.72 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Francisco |
San Francisco Health Plan |
Aged & Disabled NonDual |
$691.49 |
$712.05 |
$733.47 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Francisco |
San Francisco Health Plan |
Aged Dual |
$253.15 |
$260.04 |
$267.26 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Francisco |
San Francisco Health Plan |
AIDS Dual |
$208.27 |
$215.29 |
$222.66 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Francisco |
San Francisco Health Plan |
AIDS NonDual |
$1,131.57 |
$1,164.69 |
$1,199.17 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Francisco |
San Francisco Health Plan |
BCCTP |
$979.55 |
$1,008.86 |
$1,039.40 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Francisco |
San Francisco Health Plan |
Behavioral Health Treatment 0-6 |
$2,224.62 |
$2,272.90 |
$2,322.76 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Francisco |
San Francisco Health Plan |
Behavioral Health Treatment 7-20 |
$1,730.03 |
$1,767.52 |
$1,806.23 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Francisco |
San Francisco Health Plan |
Child |
$100.28 |
$104.59 |
$109.13 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Francisco |
San Francisco Health Plan |
Disabled Dual |
$176.37 |
$182.20 |
$188.33 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Francisco |
San Francisco Health Plan |
Hepatitis C 340B |
$6,390.37 |
$6,606.83 |
$6,831.70 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Francisco |
San Francisco Health Plan |
Hepatitis C Non-340B |
$7,987.96 |
$8,258.54 |
$8,539.63 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Francisco |
San Francisco Health Plan |
Maternity |
$7,865.46 |
$8,086.80 |
$8,316.13 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Francisco |
San Francisco Health Plan |
Optional Expansion |
$347.17 |
$360.18 |
$373.79 |
| 07/15-06/16 |
2015-16 |
Two Plan |
San Francisco |
San Francisco Health Plan |
Optional Expansion - Maternity |
$7,865.46 |
$8,086.80 |
$8,316.13 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Santa Clara |
Santa Clara Family Health |
Adult |
$208.45 |
$215.35 |
$222.58 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Santa Clara |
Santa Clara Family Health |
Aged & Disabled NonDual |
$531.18 |
$546.80 |
$563.07 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Santa Clara |
Santa Clara Family Health |
Aged Dual |
$- |
$- |
$- |
| 07/15-06/16 |
2015-16 |
Two Plan |
Santa Clara |
Santa Clara Family Health |
AIDS Dual |
$181.49 |
$187.36 |
$193.52 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Santa Clara |
Santa Clara Family Health |
AIDS NonDual |
$805.02 |
$828.07 |
$852.06 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Santa Clara |
Santa Clara Family Health |
BCCTP |
$855.46 |
$880.71 |
$907.01 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Santa Clara |
Santa Clara Family Health |
Child |
$94.29 |
$98.00 |
$101.91 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Santa Clara |
Santa Clara Family Health |
Disabled Dual |
$132.25 |
$136.95 |
$141.89 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Santa Clara |
Santa Clara Family Health |
Maternity |
$7,174.12 |
$7,376.00 |
$7,585.16 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Santa Clara |
Santa Clara Family Health |
Behavioral Health Treatment 0-6 |
$2,099.91 |
$2,145.39 |
$2,192.36 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Santa Clara |
Santa Clara Family Health |
Behavioral Health Treatment 7-20 |
$1,538.72 |
$1,571.96 |
$1,606.28 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Santa Clara |
Santa Clara Family Health |
Hepatitis C 340B |
$6,390.37 |
$6,606.83 |
$6,831.70 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Santa Clara |
Santa Clara Family Health |
Hepatitis C Non-340B |
$7,987.96 |
$8,258.54 |
$8,539.63 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Santa Clara |
Santa Clara Family Health |
Optional Expansion |
$356.75 |
$370.12 |
$384.11 |
| 07/15-06/16 |
2015-16 |
Two Plan |
Santa Clara |
Santa Clara Family Health |
Optional Expansion - Maternity |
$7,174.12 |
$7,376.00 |
$7,585.16 |