Obamacare 2022 Rates for Seminole County

Bright HealthCare Local: 1-855-521-9335 | Toll Free: 1-855-521-9335

Toc - Plan #1 Bright HealthCare
Gold (EPO) Gold 1000 ($0 Telehealth + $0 Primary Care + $0 Specialist + $0 Mental Health + $0 Prescription List)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-521-9335 Annual Out of Pocket Expenses: Individual Family $1,000 $2,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$482.17 $547.27 $616.22 $861.16 $1,308.62	$851.03 $916.13 $985.08 $1,230.02	$1,219.89 $1,284.99 $1,353.94 $1,598.88	$1,588.75 $1,653.85 $1,722.80 $1,967.74	$368.86
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$964.34 $1,094.54 $1,232.44 $1,722.32 $2,617.24	$1,333.20 $1,463.40 $1,601.30 $2,091.18	$1,702.06 $1,832.26 $1,970.16 $2,460.04	$2,070.92 $2,201.12 $2,339.02 $2,828.90	$368.86

Toc - Plan #2 Bright HealthCare
Silver (EPO) Silver 5000 ($0 Telehealth + $0 Primary Care + $0 Mental Health + $0 Prescription List)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-521-9335 Annual Out of Pocket Expenses: Individual Family $5,000 $10,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$452.60 $513.70 $578.42 $808.34 $1,228.36	$798.84 $859.94 $924.66 $1,154.58	$1,145.08 $1,206.18 $1,270.90 $1,500.82	$1,491.32 $1,552.42 $1,617.14 $1,847.06	$346.24
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$905.20 $1,027.40 $1,156.84 $1,616.68 $2,456.72	$1,251.44 $1,373.64 $1,503.08 $1,962.92	$1,597.68 $1,719.88 $1,849.32 $2,309.16	$1,943.92 $2,066.12 $2,195.56 $2,655.40	$346.24

Toc - Plan #3 Bright HealthCare
Silver (EPO) Silver 3000 ($0 Telehealth + $0 Primary Care + $0 Mental Health + $0 Prescription List)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-521-9335 Annual Out of Pocket Expenses: Individual Family $3,000 $6,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$462.71 $525.18 $591.35 $826.41 $1,255.81	$816.69 $879.16 $945.33 $1,180.39	$1,170.67 $1,233.14 $1,299.31 $1,534.37	$1,524.65 $1,587.12 $1,653.29 $1,888.35	$353.98
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$925.42 $1,050.36 $1,182.70 $1,652.82 $2,511.62	$1,279.40 $1,404.34 $1,536.68 $2,006.80	$1,633.38 $1,758.32 $1,890.66 $2,360.78	$1,987.36 $2,112.30 $2,244.64 $2,714.76	$353.98

Toc - Plan #4 Bright HealthCare
Silver (EPO) Silver $0 Deductible ($0 Telehealth + $0 Primary Care + $0 Mental Health + $0 Prescription List)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-521-9335 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$504.05 $572.10 $644.18 $900.24 $1,368.00	$889.65 $957.70 $1,029.78 $1,285.84	$1,275.25 $1,343.30 $1,415.38 $1,671.44	$1,660.85 $1,728.90 $1,800.98 $2,057.04	$385.60
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,008.10 $1,144.20 $1,288.36 $1,800.48 $2,736.00	$1,393.70 $1,529.80 $1,673.96 $2,186.08	$1,779.30 $1,915.40 $2,059.56 $2,571.68	$2,164.90 $2,301.00 $2,445.16 $2,957.28	$385.60

Toc - Plan #5 Bright HealthCare
Expanded Bronze (EPO) Bronze 8700 + $0 Mental Health ($0 Telehealth + $0 Primary Care + $0 Prescription List)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-521-9335 Annual Out of Pocket Expenses: Individual Family $8,700 $17,400 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$338.71 $384.44 $432.87 $604.94 $919.26	$597.82 $643.55 $691.98 $864.05	$856.93 $902.66 $951.09 $1,123.16	$1,116.04 $1,161.77 $1,210.20 $1,382.27	$259.11
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$677.42 $768.88 $865.74 $1,209.88 $1,838.52	$936.53 $1,027.99 $1,124.85 $1,468.99	$1,195.64 $1,287.10 $1,383.96 $1,728.10	$1,454.75 $1,546.21 $1,643.07 $1,987.21	$259.11

Toc - Plan #6 Bright HealthCare
Expanded Bronze (EPO) Bronze 5300 HSA
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-521-9335 Annual Out of Pocket Expenses: Individual Family $5,300 $10,600 Annual Deductible $7,050 $14,100 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$373.89 $424.37 $477.84 $667.77 $1,014.75	$659.92 $710.40 $763.87 $953.80	$945.95 $996.43 $1,049.90 $1,239.83	$1,231.98 $1,282.46 $1,335.93 $1,525.86	$286.03
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$747.78 $848.74 $955.68 $1,335.54 $2,029.50	$1,033.81 $1,134.77 $1,241.71 $1,621.57	$1,319.84 $1,420.80 $1,527.74 $1,907.60	$1,605.87 $1,706.83 $1,813.77 $2,193.63	$286.03

Toc - Plan #7 Bright HealthCare
Catastrophic (EPO) Catastrophic 8700 ($0 Primary Care)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-521-9335 Annual Out of Pocket Expenses: Individual Family $8,700 $17,400 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$249.20 $282.84 $318.48 $445.07 $676.33	$439.84 $473.48 $509.12 $635.71	$630.48 $664.12 $699.76 $826.35	$821.12 $854.76 $890.40 $1,016.99	$190.64
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$498.40 $565.68 $636.96 $890.14 $1,352.66	$689.04 $756.32 $827.60 $1,080.78	$879.68 $946.96 $1,018.24 $1,271.42	$1,070.32 $1,137.60 $1,208.88 $1,462.06	$190.64

Toc - Plan #8 Bright HealthCare
Silver (EPO) Silver 6700 ($0 Telehealth + $0 Primary Care + $0 Specialist + $0 Mental Health + $0 Prescription List)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-521-9335 Annual Out of Pocket Expenses: Individual Family $6,700 $13,400 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$462.86 $525.34 $591.53 $826.66 $1,256.20	$816.95 $879.43 $945.62 $1,180.75	$1,171.04 $1,233.52 $1,299.71 $1,534.84	$1,525.13 $1,587.61 $1,653.80 $1,888.93	$354.09
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$925.72 $1,050.68 $1,183.06 $1,653.32 $2,512.40	$1,279.81 $1,404.77 $1,537.15 $2,007.41	$1,633.90 $1,758.86 $1,891.24 $2,361.50	$1,987.99 $2,112.95 $2,245.33 $2,715.59	$354.09

Toc - Plan #9 Bright HealthCare
Expanded Bronze (EPO) Bronze 7200 ($0 Telehealth + $0 Primary Care + $0 Mental Health + $0 Prescription List)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-521-9335 Annual Out of Pocket Expenses: Individual Family $7,200 $14,400 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$352.77 $400.39 $450.84 $630.05 $957.42	$622.64 $670.26 $720.71 $899.92	$892.51 $940.13 $990.58 $1,169.79	$1,162.38 $1,210.00 $1,260.45 $1,439.66	$269.87
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$705.54 $800.78 $901.68 $1,260.10 $1,914.84	$975.41 $1,070.65 $1,171.55 $1,529.97	$1,245.28 $1,340.52 $1,441.42 $1,799.84	$1,515.15 $1,610.39 $1,711.29 $2,069.71	$269.87

Toc - Plan #10 Bright HealthCare
Expanded Bronze (EPO) Bronze $0 Medical Deductible ($0 Telehealth + $0 Primary Care + $0 Specialist + $0 Mental Health + $0 Prescription
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-521-9335 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$393.66 $446.81 $503.10 $703.08 $1,068.40	$694.81 $747.96 $804.25 $1,004.23	$995.96 $1,049.11 $1,105.40 $1,305.38	$1,297.11 $1,350.26 $1,406.55 $1,606.53	$301.15
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$787.32 $893.62 $1,006.20 $1,406.16 $2,136.80	$1,088.47 $1,194.77 $1,307.35 $1,707.31	$1,389.62 $1,495.92 $1,608.50 $2,008.46	$1,690.77 $1,797.07 $1,909.65 $2,309.61	$301.15

Toc - Plan #11 Bright HealthCare
Expanded Bronze (EPO) Bronze 7200 + Adult Dental & Vision ($0 Telehealth + $0 Primary Care + $0 Mental Health + $0 Prescription List)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-521-9335 Annual Out of Pocket Expenses: Individual Family $7,200 $14,400 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$358.37 $406.75 $458.00 $640.05 $972.61	$632.52 $680.90 $732.15 $914.20	$906.67 $955.05 $1,006.30 $1,188.35	$1,180.82 $1,229.20 $1,280.45 $1,462.50	$274.15
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$716.74 $813.50 $916.00 $1,280.10 $1,945.22	$990.89 $1,087.65 $1,190.15 $1,554.25	$1,265.04 $1,361.80 $1,464.30 $1,828.40	$1,539.19 $1,635.95 $1,738.45 $2,102.55	$274.15

Toc - Plan #12 Bright HealthCare
Silver (EPO) Silver 6700 + Adult Dental & Vision ($0 Telehealth + $0 Primary Care + $0 Specialist + $0 Mental Health + $0 Presc
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-521-9335 Annual Out of Pocket Expenses: Individual Family $6,700 $13,400 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$468.46 $531.70 $598.69 $836.66 $1,271.39	$826.83 $890.07 $957.06 $1,195.03	$1,185.20 $1,248.44 $1,315.43 $1,553.40	$1,543.57 $1,606.81 $1,673.80 $1,911.77	$358.37
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$936.92 $1,063.40 $1,197.38 $1,673.32 $2,542.78	$1,295.29 $1,421.77 $1,555.75 $2,031.69	$1,653.66 $1,780.14 $1,914.12 $2,390.06	$2,012.03 $2,138.51 $2,272.49 $2,748.43	$358.37

Toc - Plan #13 Bright HealthCare
Gold (EPO) Gold $0 Deductible + Adult Dental & Vision ($0 Telehealth + $0 Primary Care + $0 Mental Health + $0 Prescription L
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-521-9335 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $6,500 $13,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$522.69 $593.26 $668.00 $933.53 $1,418.59	$922.55 $993.12 $1,067.86 $1,333.39	$1,322.41 $1,392.98 $1,467.72 $1,733.25	$1,722.27 $1,792.84 $1,867.58 $2,133.11	$399.86
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,045.38 $1,186.52 $1,336.00 $1,867.06 $2,837.18	$1,445.24 $1,586.38 $1,735.86 $2,266.92	$1,845.10 $1,986.24 $2,135.72 $2,666.78	$2,244.96 $2,386.10 $2,535.58 $3,066.64	$399.86

Toc - Plan #14 Bright HealthCare
Expanded Bronze (EPO) Bronze 8700 ($25 Generic)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-521-9335 Annual Out of Pocket Expenses: Individual Family $8,700 $17,400 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$332.78 $377.70 $425.29 $594.34 $903.16	$587.36 $632.28 $679.87 $848.92	$841.94 $886.86 $934.45 $1,103.50	$1,096.52 $1,141.44 $1,189.03 $1,358.08	$254.58
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$665.56 $755.40 $850.58 $1,188.68 $1,806.32	$920.14 $1,009.98 $1,105.16 $1,443.26	$1,174.72 $1,264.56 $1,359.74 $1,697.84	$1,429.30 $1,519.14 $1,614.32 $1,952.42	$254.58

Toc - Plan #15 Bright HealthCare
Silver (EPO) Silver 4000 ($35 Primary Care + $15 Generic)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-521-9335 Annual Out of Pocket Expenses: Individual Family $4,000 $8,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$430.38 $488.48 $550.03 $768.66 $1,168.05	$759.62 $817.72 $879.27 $1,097.90	$1,088.86 $1,146.96 $1,208.51 $1,427.14	$1,418.10 $1,476.20 $1,537.75 $1,756.38	$329.24
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$860.76 $976.96 $1,100.06 $1,537.32 $2,336.10	$1,190.00 $1,306.20 $1,429.30 $1,866.56	$1,519.24 $1,635.44 $1,758.54 $2,195.80	$1,848.48 $1,964.68 $2,087.78 $2,525.04	$329.24

Florida Blue (BlueCross BlueShield FL) Local: 1-800-352-2583 | Toll Free: 1-800-352-2583 | TTY: 1-800-955-8771

Toc - Plan #16 Florida Blue (BlueCross BlueShield FL)
Silver (EPO) BlueOptions Silver 1423 ($0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $5,950 $11,900 Annual Deductible $7,150 $14,300 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$807.87 $916.93 $1,032.46 $1,442.86 $2,192.56	$1,425.89 $1,534.95 $1,650.48 $2,060.88	$2,043.91 $2,152.97 $2,268.50 $2,678.90	$2,661.93 $2,770.99 $2,886.52 $3,296.92	$618.02
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,615.74 $1,833.86 $2,064.92 $2,885.72 $4,385.12	$2,233.76 $2,451.88 $2,682.94 $3,503.74	$2,851.78 $3,069.90 $3,300.96 $4,121.76	$3,469.80 $3,687.92 $3,918.98 $4,739.78	$618.02

Toc - Plan #17 Florida Blue (BlueCross BlueShield FL)
Bronze (EPO) BlueOptions Bronze 1419 ($0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $8,700 $17,400 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$504.03 $572.07 $644.15 $900.20 $1,367.94	$889.61 $957.65 $1,029.73 $1,285.78	$1,275.19 $1,343.23 $1,415.31 $1,671.36	$1,660.77 $1,728.81 $1,800.89 $2,056.94	$385.58
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,008.06 $1,144.14 $1,288.30 $1,800.40 $2,735.88	$1,393.64 $1,529.72 $1,673.88 $2,185.98	$1,779.22 $1,915.30 $2,059.46 $2,571.56	$2,164.80 $2,300.88 $2,445.04 $2,957.14	$385.58

Toc - Plan #18 Florida Blue (BlueCross BlueShield FL)
Silver (EPO) BlueOptions Silver 1431 ($0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $5,600 $11,200 Annual Deductible $7,800 $15,600 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$826.70 $938.30 $1,056.52 $1,476.49 $2,243.66	$1,459.13 $1,570.73 $1,688.95 $2,108.92	$2,091.56 $2,203.16 $2,321.38 $2,741.35	$2,723.99 $2,835.59 $2,953.81 $3,373.78	$632.43
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,653.40 $1,876.60 $2,113.04 $2,952.98 $4,487.32	$2,285.83 $2,509.03 $2,745.47 $3,585.41	$2,918.26 $3,141.46 $3,377.90 $4,217.84	$3,550.69 $3,773.89 $4,010.33 $4,850.27	$632.43

Toc - Plan #19 Florida Blue (BlueCross BlueShield FL)
Platinum (EPO) BlueOptions Platinum 1418 ($0 Virtual Visits /Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $1,250 $2,500 Annual Deductible $4,250 $8,500 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$1,007.11 $1,143.07 $1,287.09 $1,798.70 $2,733.30	$1,777.55 $1,913.51 $2,057.53 $2,569.14	$2,547.99 $2,683.95 $2,827.97 $3,339.58	$3,318.43 $3,454.39 $3,598.41 $4,110.02	$770.44
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$2,014.22 $2,286.14 $2,574.18 $3,597.40 $5,466.60	$2,784.66 $3,056.58 $3,344.62 $4,367.84	$3,555.10 $3,827.02 $4,115.06 $5,138.28	$4,325.54 $4,597.46 $4,885.50 $5,908.72	$770.44

Toc - Plan #20 Florida Blue (BlueCross BlueShield FL)
Expanded Bronze (EPO) BlueOptions Bronze 1416 ($0 Virtual Visits / 3 PCP Visits for $0 / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $7,900 $15,800 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$541.56 $614.67 $692.11 $967.23 $1,469.79	$955.85 $1,028.96 $1,106.40 $1,381.52	$1,370.14 $1,443.25 $1,520.69 $1,795.81	$1,784.43 $1,857.54 $1,934.98 $2,210.10	$414.29
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,083.12 $1,229.34 $1,384.22 $1,934.46 $2,939.58	$1,497.41 $1,643.63 $1,798.51 $2,348.75	$1,911.70 $2,057.92 $2,212.80 $2,763.04	$2,325.99 $2,472.21 $2,627.09 $3,177.33	$414.29

Toc - Plan #21 Florida Blue (BlueCross BlueShield FL)
Platinum (EPO) BlueOptions Platinum 1424 ($0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $2,000 $4,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$1,062.44 $1,205.87 $1,357.80 $1,897.52 $2,883.46	$1,875.21 $2,018.64 $2,170.57 $2,710.29	$2,687.98 $2,831.41 $2,983.34 $3,523.06	$3,500.75 $3,644.18 $3,796.11 $4,335.83	$812.77
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$2,124.88 $2,411.74 $2,715.60 $3,795.04 $5,766.92	$2,937.65 $3,224.51 $3,528.37 $4,607.81	$3,750.42 $4,037.28 $4,341.14 $5,420.58	$4,563.19 $4,850.05 $5,153.91 $6,233.35	$812.77

Toc - Plan #22 Florida Blue (BlueCross BlueShield FL)
Silver (EPO) BlueOptions Silver 1410 ($0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $6,000 $12,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$746.59 $847.38 $954.14 $1,333.41 $2,026.25	$1,317.73 $1,418.52 $1,525.28 $1,904.55	$1,888.87 $1,989.66 $2,096.42 $2,475.69	$2,460.01 $2,560.80 $2,667.56 $3,046.83	$571.14
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,493.18 $1,694.76 $1,908.28 $2,666.82 $4,052.50	$2,064.32 $2,265.90 $2,479.42 $3,237.96	$2,635.46 $2,837.04 $3,050.56 $3,809.10	$3,206.60 $3,408.18 $3,621.70 $4,380.24	$571.14

Toc - Plan #23 Florida Blue (BlueCross BlueShield FL)
Gold (EPO) BlueOptions Gold 1505 ($0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $5,000 $10,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$852.29 $967.35 $1,089.23 $1,522.19 $2,313.12	$1,504.29 $1,619.35 $1,741.23 $2,174.19	$2,156.29 $2,271.35 $2,393.23 $2,826.19	$2,808.29 $2,923.35 $3,045.23 $3,478.19	$652.00
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,704.58 $1,934.70 $2,178.46 $3,044.38 $4,626.24	$2,356.58 $2,586.70 $2,830.46 $3,696.38	$3,008.58 $3,238.70 $3,482.46 $4,348.38	$3,660.58 $3,890.70 $4,134.46 $5,000.38	$652.00

Toc - Plan #24 Florida Blue (BlueCross BlueShield FL)
Expanded Bronze (EPO) BlueOptions Bronze (HSA) 1705 (Rewards $$$ / $4 Condition Care Rx)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $6,850 $13,700 Annual Deductible $6,850 $13,700 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$526.55 $597.63 $672.93 $940.42 $1,429.06	$929.36 $1,000.44 $1,075.74 $1,343.23	$1,332.17 $1,403.25 $1,478.55 $1,746.04	$1,734.98 $1,806.06 $1,881.36 $2,148.85	$402.81
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,053.10 $1,195.26 $1,345.86 $1,880.84 $2,858.12	$1,455.91 $1,598.07 $1,748.67 $2,283.65	$1,858.72 $2,000.88 $2,151.48 $2,686.46	$2,261.53 $2,403.69 $2,554.29 $3,089.27	$402.81

Toc - Plan #25 Florida Blue (BlueCross BlueShield FL)
Silver (EPO) BlueOptions Silver 1706S ($0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $3,600 $7,200 Annual Deductible $8,150 $16,300 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$821.17 $932.03 $1,049.46 $1,466.61 $2,228.66	$1,449.37 $1,560.23 $1,677.66 $2,094.81	$2,077.57 $2,188.43 $2,305.86 $2,723.01	$2,705.77 $2,816.63 $2,934.06 $3,351.21	$628.20
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,642.34 $1,864.06 $2,098.92 $2,933.22 $4,457.32	$2,270.54 $2,492.26 $2,727.12 $3,561.42	$2,898.74 $3,120.46 $3,355.32 $4,189.62	$3,526.94 $3,748.66 $3,983.52 $4,817.82	$628.20

Toc - Plan #26 Florida Blue (BlueCross BlueShield FL)
Expanded Bronze (EPO) BlueOptions Bronze 1707S ($0 Virtual Visits / $30 PCP Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $7,900 $15,800 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$540.87 $613.89 $691.23 $965.99 $1,467.92	$954.64 $1,027.66 $1,105.00 $1,379.76	$1,368.41 $1,441.43 $1,518.77 $1,793.53	$1,782.18 $1,855.20 $1,932.54 $2,207.30	$413.77
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,081.74 $1,227.78 $1,382.46 $1,931.98 $2,935.84	$1,495.51 $1,641.55 $1,796.23 $2,345.75	$1,909.28 $2,055.32 $2,210.00 $2,759.52	$2,323.05 $2,469.09 $2,623.77 $3,173.29	$413.77

Toc - Plan #27 Florida Blue (BlueCross BlueShield FL)
Gold (EPO) BlueOptions Gold 1805 ($0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $1,500 $3,000 Annual Deductible $5,500 $11,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$823.36 $934.51 $1,052.25 $1,470.52 $2,234.60	$1,453.23 $1,564.38 $1,682.12 $2,100.39	$2,083.10 $2,194.25 $2,311.99 $2,730.26	$2,712.97 $2,824.12 $2,941.86 $3,360.13	$629.87
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,646.72 $1,869.02 $2,104.50 $2,941.04 $4,469.20	$2,276.59 $2,498.89 $2,734.37 $3,570.91	$2,906.46 $3,128.76 $3,364.24 $4,200.78	$3,536.33 $3,758.63 $3,994.11 $4,830.65	$629.87

Toc - Plan #28 Florida Blue (BlueCross BlueShield FL)
Expanded Bronze (EPO) BlueOptions Bronze 2119 ($0 Deductible / $30 PCP Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$576.36 $654.17 $736.59 $1,029.38 $1,564.24	$1,017.28 $1,095.09 $1,177.51 $1,470.30	$1,458.20 $1,536.01 $1,618.43 $1,911.22	$1,899.12 $1,976.93 $2,059.35 $2,352.14	$440.92
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,152.72 $1,308.34 $1,473.18 $2,058.76 $3,128.48	$1,593.64 $1,749.26 $1,914.10 $2,499.68	$2,034.56 $2,190.18 $2,355.02 $2,940.60	$2,475.48 $2,631.10 $2,795.94 $3,381.52	$440.92

Toc - Plan #29 Florida Blue (BlueCross BlueShield FL)
Silver (EPO) BlueSelect Silver 1456 ($0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $5,950 $11,900 Annual Deductible $7,150 $14,300 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$525.58 $596.53 $671.69 $938.69 $1,426.42	$927.65 $998.60 $1,073.76 $1,340.76	$1,329.72 $1,400.67 $1,475.83 $1,742.83	$1,731.79 $1,802.74 $1,877.90 $2,144.90	$402.07
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,051.16 $1,193.06 $1,343.38 $1,877.38 $2,852.84	$1,453.23 $1,595.13 $1,745.45 $2,279.45	$1,855.30 $1,997.20 $2,147.52 $2,681.52	$2,257.37 $2,399.27 $2,549.59 $3,083.59	$402.07

Toc - Plan #30 Florida Blue (BlueCross BlueShield FL)
Bronze (EPO) BlueSelect Bronze 1452 ($0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $8,700 $17,400 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$378.43 $429.52 $483.63 $675.88 $1,027.06	$667.93 $719.02 $773.13 $965.38	$957.43 $1,008.52 $1,062.63 $1,254.88	$1,246.93 $1,298.02 $1,352.13 $1,544.38	$289.50
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$756.86 $859.04 $967.26 $1,351.76 $2,054.12	$1,046.36 $1,148.54 $1,256.76 $1,641.26	$1,335.86 $1,438.04 $1,546.26 $1,930.76	$1,625.36 $1,727.54 $1,835.76 $2,220.26	$289.50

Toc - Plan #31 Florida Blue (BlueCross BlueShield FL)
Silver (EPO) BlueSelect Silver 1464 ($0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $5,600 $11,200 Annual Deductible $7,800 $15,600 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$537.85 $610.46 $687.37 $960.60 $1,459.72	$949.31 $1,021.92 $1,098.83 $1,372.06	$1,360.77 $1,433.38 $1,510.29 $1,783.52	$1,772.23 $1,844.84 $1,921.75 $2,194.98	$411.46
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,075.70 $1,220.92 $1,374.74 $1,921.20 $2,919.44	$1,487.16 $1,632.38 $1,786.20 $2,332.66	$1,898.62 $2,043.84 $2,197.66 $2,744.12	$2,310.08 $2,455.30 $2,609.12 $3,155.58	$411.46

Toc - Plan #32 Florida Blue (BlueCross BlueShield FL)
Platinum (EPO) BlueSelect Platinum 1451 ($0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $1,250 $2,500 Annual Deductible $4,250 $8,500 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$657.10 $745.81 $839.77 $1,173.58 $1,783.37	$1,159.78 $1,248.49 $1,342.45 $1,676.26	$1,662.46 $1,751.17 $1,845.13 $2,178.94	$2,165.14 $2,253.85 $2,347.81 $2,681.62	$502.68
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,314.20 $1,491.62 $1,679.54 $2,347.16 $3,566.74	$1,816.88 $1,994.30 $2,182.22 $2,849.84	$2,319.56 $2,496.98 $2,684.90 $3,352.52	$2,822.24 $2,999.66 $3,187.58 $3,855.20	$502.68

Toc - Plan #33 Florida Blue (BlueCross BlueShield FL)
Expanded Bronze (EPO) BlueSelect Bronze 1449 ($0 Virtual Visits / 3 PCP Visits for $0 / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $7,900 $15,800 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$406.58 $461.47 $519.61 $726.15 $1,103.46	$717.61 $772.50 $830.64 $1,037.18	$1,028.64 $1,083.53 $1,141.67 $1,348.21	$1,339.67 $1,394.56 $1,452.70 $1,659.24	$311.03
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$813.16 $922.94 $1,039.22 $1,452.30 $2,206.92	$1,124.19 $1,233.97 $1,350.25 $1,763.33	$1,435.22 $1,545.00 $1,661.28 $2,074.36	$1,746.25 $1,856.03 $1,972.31 $2,385.39	$311.03

Toc - Plan #34 Florida Blue (BlueCross BlueShield FL)
Platinum (EPO) BlueSelect Platinum 1457 ($0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $2,000 $4,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$692.74 $786.26 $885.32 $1,237.23 $1,880.10	$1,222.69 $1,316.21 $1,415.27 $1,767.18	$1,752.64 $1,846.16 $1,945.22 $2,297.13	$2,282.59 $2,376.11 $2,475.17 $2,827.08	$529.95
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,385.48 $1,572.52 $1,770.64 $2,474.46 $3,760.20	$1,915.43 $2,102.47 $2,300.59 $3,004.41	$2,445.38 $2,632.42 $2,830.54 $3,534.36	$2,975.33 $3,162.37 $3,360.49 $4,064.31	$529.95

Toc - Plan #35 Florida Blue (BlueCross BlueShield FL)
Silver (EPO) BlueSelect Silver 1443 ($0 Labs / $0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $6,000 $12,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$485.75 $551.33 $620.79 $867.55 $1,318.33	$857.35 $922.93 $992.39 $1,239.15	$1,228.95 $1,294.53 $1,363.99 $1,610.75	$1,600.55 $1,666.13 $1,735.59 $1,982.35	$371.60
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$971.50 $1,102.66 $1,241.58 $1,735.10 $2,636.66	$1,343.10 $1,474.26 $1,613.18 $2,106.70	$1,714.70 $1,845.86 $1,984.78 $2,478.30	$2,086.30 $2,217.46 $2,356.38 $2,849.90	$371.60

Toc - Plan #36 Florida Blue (BlueCross BlueShield FL)
Gold (EPO) BlueSelect Gold 1535 ($0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $5,000 $10,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$563.98 $640.12 $720.77 $1,007.27 $1,530.64	$995.42 $1,071.56 $1,152.21 $1,438.71	$1,426.86 $1,503.00 $1,583.65 $1,870.15	$1,858.30 $1,934.44 $2,015.09 $2,301.59	$431.44
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,127.96 $1,280.24 $1,441.54 $2,014.54 $3,061.28	$1,559.40 $1,711.68 $1,872.98 $2,445.98	$1,990.84 $2,143.12 $2,304.42 $2,877.42	$2,422.28 $2,574.56 $2,735.86 $3,308.86	$431.44

Toc - Plan #37 Florida Blue (BlueCross BlueShield FL)
Expanded Bronze (EPO) BlueSelect Bronze (HSA) 1735 (Rewards $$$ / $4 Condition Care Rx)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $6,850 $13,700 Annual Deductible $6,850 $13,700 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$395.30 $448.67 $505.19 $706.01 $1,072.84	$697.70 $751.07 $807.59 $1,008.41	$1,000.10 $1,053.47 $1,109.99 $1,310.81	$1,302.50 $1,355.87 $1,412.39 $1,613.21	$302.40
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$790.60 $897.34 $1,010.38 $1,412.02 $2,145.68	$1,093.00 $1,199.74 $1,312.78 $1,714.42	$1,395.40 $1,502.14 $1,615.18 $2,016.82	$1,697.80 $1,804.54 $1,917.58 $2,319.22	$302.40

Toc - Plan #38 Florida Blue (BlueCross BlueShield FL)
Silver (EPO) BlueSelect Silver 1736S ($0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $3,600 $7,200 Annual Deductible $8,150 $16,300 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$534.26 $606.39 $682.78 $954.19 $1,449.98	$942.97 $1,015.10 $1,091.49 $1,362.90	$1,351.68 $1,423.81 $1,500.20 $1,771.61	$1,760.39 $1,832.52 $1,908.91 $2,180.32	$408.71
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,068.52 $1,212.78 $1,365.56 $1,908.38 $2,899.96	$1,477.23 $1,621.49 $1,774.27 $2,317.09	$1,885.94 $2,030.20 $2,182.98 $2,725.80	$2,294.65 $2,438.91 $2,591.69 $3,134.51	$408.71

Toc - Plan #39 Florida Blue (BlueCross BlueShield FL)
Expanded Bronze (EPO) BlueSelect Bronze 1737S ($0 Virtual Visits / $40 PCP Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $7,900 $15,800 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$406.09 $460.91 $518.98 $725.28 $1,102.13	$716.75 $771.57 $829.64 $1,035.94	$1,027.41 $1,082.23 $1,140.30 $1,346.60	$1,338.07 $1,392.89 $1,450.96 $1,657.26	$310.66
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$812.18 $921.82 $1,037.96 $1,450.56 $2,204.26	$1,122.84 $1,232.48 $1,348.62 $1,761.22	$1,433.50 $1,543.14 $1,659.28 $2,071.88	$1,744.16 $1,853.80 $1,969.94 $2,382.54	$310.66

Toc - Plan #40 Florida Blue (BlueCross BlueShield FL)
Gold (EPO) BlueSelect Gold 1835 ($0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $1,500 $3,000 Annual Deductible $5,500 $11,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$545.69 $619.36 $697.39 $974.60 $1,481.00	$963.14 $1,036.81 $1,114.84 $1,392.05	$1,380.59 $1,454.26 $1,532.29 $1,809.50	$1,798.04 $1,871.71 $1,949.74 $2,226.95	$417.45
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,091.38 $1,238.72 $1,394.78 $1,949.20 $2,962.00	$1,508.83 $1,656.17 $1,812.23 $2,366.65	$1,926.28 $2,073.62 $2,229.68 $2,784.10	$2,343.73 $2,491.07 $2,647.13 $3,201.55	$417.45

Toc - Plan #41 Florida Blue (BlueCross BlueShield FL)
Expanded Bronze (EPO) BlueSelect Bronze 2139 ($0 Deductible / $50 PCP Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$432.32 $490.68 $552.50 $772.12 $1,173.32	$763.04 $821.40 $883.22 $1,102.84	$1,093.76 $1,152.12 $1,213.94 $1,433.56	$1,424.48 $1,482.84 $1,544.66 $1,764.28	$330.72
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$864.64 $981.36 $1,105.00 $1,544.24 $2,346.64	$1,195.36 $1,312.08 $1,435.72 $1,874.96	$1,526.08 $1,642.80 $1,766.44 $2,205.68	$1,856.80 $1,973.52 $2,097.16 $2,536.40	$330.72

AvMed Local: 1-800-477-8768 | Toll Free:

Toc - Plan #42 AvMed
Gold (HMO) AvMed Entrust Gold 125 (2022)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: Annual Out of Pocket Expenses: Individual Family $2,000 $4,000 Annual Deductible $4,700 $9,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$430.88 $489.05 $550.67 $769.56 $1,169.41	$760.51 $818.68 $880.30 $1,099.19	$1,090.14 $1,148.31 $1,209.93 $1,428.82	$1,419.77 $1,477.94 $1,539.56 $1,758.45	$329.63
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$861.76 $978.10 $1,101.34 $1,539.12 $2,338.82	$1,191.39 $1,307.73 $1,430.97 $1,868.75	$1,521.02 $1,637.36 $1,760.60 $2,198.38	$1,850.65 $1,966.99 $2,090.23 $2,528.01	$329.63

Toc - Plan #43 AvMed
Silver (HMO) AvMed Entrust Silver 300 (2022)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: Annual Out of Pocket Expenses: Individual Family $3,000 $6,000 Annual Deductible $7,000 $14,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$420.49 $477.26 $537.39 $751.00 $1,141.21	$742.17 $798.94 $859.07 $1,072.68	$1,063.85 $1,120.62 $1,180.75 $1,394.36	$1,385.53 $1,442.30 $1,502.43 $1,716.04	$321.68
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$840.98 $954.52 $1,074.78 $1,502.00 $2,282.42	$1,162.66 $1,276.20 $1,396.46 $1,823.68	$1,484.34 $1,597.88 $1,718.14 $2,145.36	$1,806.02 $1,919.56 $2,039.82 $2,467.04	$321.68

Toc - Plan #44 AvMed
Silver (HMO) AvMed Entrust Silver 350 (2022)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: Annual Out of Pocket Expenses: Individual Family $3,500 $7,000 Annual Deductible $7,000 $14,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$395.92 $449.37 $505.99 $707.12 $1,074.54	$698.80 $752.25 $808.87 $1,010.00	$1,001.68 $1,055.13 $1,111.75 $1,312.88	$1,304.56 $1,358.01 $1,414.63 $1,615.76	$302.88
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$791.84 $898.74 $1,011.98 $1,414.24 $2,149.08	$1,094.72 $1,201.62 $1,314.86 $1,717.12	$1,397.60 $1,504.50 $1,617.74 $2,020.00	$1,700.48 $1,807.38 $1,920.62 $2,322.88	$302.88

Toc - Plan #45 AvMed
Silver (HMO) AvMed Entrust Silver 500 (2022)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: Annual Out of Pocket Expenses: Individual Family $5,500 $11,000 Annual Deductible $7,000 $14,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$397.26 $450.89 $507.70 $709.51 $1,078.18	$701.17 $754.80 $811.61 $1,013.42	$1,005.08 $1,058.71 $1,115.52 $1,317.33	$1,308.99 $1,362.62 $1,419.43 $1,621.24	$303.91
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$794.52 $901.78 $1,015.40 $1,419.02 $2,156.36	$1,098.43 $1,205.69 $1,319.31 $1,722.93	$1,402.34 $1,509.60 $1,623.22 $2,026.84	$1,706.25 $1,813.51 $1,927.13 $2,330.75	$303.91

Toc - Plan #46 AvMed
Silver (HMO) AvMed Entrust Silver 550 (2022)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: Annual Out of Pocket Expenses: Individual Family $6,500 $13,000 Annual Deductible $7,000 $14,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$391.55 $444.41 $500.41 $699.32 $1,062.68	$691.09 $743.95 $799.95 $998.86	$990.63 $1,043.49 $1,099.49 $1,298.40	$1,290.17 $1,343.03 $1,399.03 $1,597.94	$299.54
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$783.10 $888.82 $1,000.82 $1,398.64 $2,125.36	$1,082.64 $1,188.36 $1,300.36 $1,698.18	$1,382.18 $1,487.90 $1,599.90 $1,997.72	$1,681.72 $1,787.44 $1,899.44 $2,297.26	$299.54

Toc - Plan #47 AvMed
Expanded Bronze (HMO) AvMed Entrust Bronze 600 (2022)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: Annual Out of Pocket Expenses: Individual Family $6,500 $13,000 Annual Deductible $7,900 $15,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$317.28 $360.11 $405.48 $566.66 $861.09	$560.00 $602.83 $648.20 $809.38	$802.72 $845.55 $890.92 $1,052.10	$1,045.44 $1,088.27 $1,133.64 $1,294.82	$242.72
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$634.56 $720.22 $810.96 $1,133.32 $1,722.18	$877.28 $962.94 $1,053.68 $1,376.04	$1,120.00 $1,205.66 $1,296.40 $1,618.76	$1,362.72 $1,448.38 $1,539.12 $1,861.48	$242.72

Toc - Plan #48 AvMed
Expanded Bronze (HMO) AvMed Entrust Bronze 650 (2022)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: Annual Out of Pocket Expenses: Individual Family $8,200 $16,400 Annual Deductible $8,200 $16,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$303.46 $344.43 $387.82 $541.98 $823.59	$535.61 $576.58 $619.97 $774.13	$767.76 $808.73 $852.12 $1,006.28	$999.91 $1,040.88 $1,084.27 $1,238.43	$232.15
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$606.92 $688.86 $775.64 $1,083.96 $1,647.18	$839.07 $921.01 $1,007.79 $1,316.11	$1,071.22 $1,153.16 $1,239.94 $1,548.26	$1,303.37 $1,385.31 $1,472.09 $1,780.41	$232.15

Toc - Plan #49 AvMed
Catastrophic (HMO) AvMed Entrust Catastrophic 100 (2022)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: Annual Out of Pocket Expenses: Individual Family $8,700 $17,400 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$279.41 $317.13 $357.09 $499.03 $758.32	$493.16 $530.88 $570.84 $712.78	$706.91 $744.63 $784.59 $926.53	$920.66 $958.38 $998.34 $1,140.28	$213.75
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$558.82 $634.26 $714.18 $998.06 $1,516.64	$772.57 $848.01 $927.93 $1,211.81	$986.32 $1,061.76 $1,141.68 $1,425.56	$1,200.07 $1,275.51 $1,355.43 $1,639.31	$213.75

Toc - Plan #50 AvMed
Gold (HMO) AvMed Entrust Gold 125 Dental+Vision (2022)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: Annual Out of Pocket Expenses: Individual Family $2,000 $4,000 Annual Deductible $4,700 $9,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$435.32 $494.09 $556.34 $777.48 $1,181.45	$768.34 $827.11 $889.36 $1,110.50	$1,101.36 $1,160.13 $1,222.38 $1,443.52	$1,434.38 $1,493.15 $1,555.40 $1,776.54	$333.02
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$870.64 $988.18 $1,112.68 $1,554.96 $2,362.90	$1,203.66 $1,321.20 $1,445.70 $1,887.98	$1,536.68 $1,654.22 $1,778.72 $2,221.00	$1,869.70 $1,987.24 $2,111.74 $2,554.02	$333.02

Toc - Plan #51 AvMed
Silver (HMO) AvMed Entrust Silver 300 Dental+Vision (2022)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: Annual Out of Pocket Expenses: Individual Family $3,000 $6,000 Annual Deductible $7,000 $14,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$424.94 $482.30 $543.07 $758.94 $1,153.28	$750.02 $807.38 $868.15 $1,084.02	$1,075.10 $1,132.46 $1,193.23 $1,409.10	$1,400.18 $1,457.54 $1,518.31 $1,734.18	$325.08
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$849.88 $964.60 $1,086.14 $1,517.88 $2,306.56	$1,174.96 $1,289.68 $1,411.22 $1,842.96	$1,500.04 $1,614.76 $1,736.30 $2,168.04	$1,825.12 $1,939.84 $2,061.38 $2,493.12	$325.08

Toc - Plan #52 AvMed
Silver (HMO) AvMed Entrust Silver 350 Dental+Vision (2022)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: Annual Out of Pocket Expenses: Individual Family $3,500 $7,000 Annual Deductible $7,000 $14,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$400.36 $454.41 $511.66 $715.04 $1,086.58	$706.64 $760.69 $817.94 $1,021.32	$1,012.92 $1,066.97 $1,124.22 $1,327.60	$1,319.20 $1,373.25 $1,430.50 $1,633.88	$306.28
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$800.72 $908.82 $1,023.32 $1,430.08 $2,173.16	$1,107.00 $1,215.10 $1,329.60 $1,736.36	$1,413.28 $1,521.38 $1,635.88 $2,042.64	$1,719.56 $1,827.66 $1,942.16 $2,348.92	$306.28

Toc - Plan #53 AvMed
Silver (HMO) AvMed Entrust Silver 500 Dental+Vision (2022)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: Annual Out of Pocket Expenses: Individual Family $5,500 $11,000 Annual Deductible $7,000 $14,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$401.70 $455.93 $513.37 $717.44 $1,090.21	$709.00 $763.23 $820.67 $1,024.74	$1,016.30 $1,070.53 $1,127.97 $1,332.04	$1,323.60 $1,377.83 $1,435.27 $1,639.34	$307.30
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$803.40 $911.86 $1,026.74 $1,434.88 $2,180.42	$1,110.70 $1,219.16 $1,334.04 $1,742.18	$1,418.00 $1,526.46 $1,641.34 $2,049.48	$1,725.30 $1,833.76 $1,948.64 $2,356.78	$307.30

Toc - Plan #54 AvMed
Silver (HMO) AvMed Entrust Silver 550 Dental+Vision (2022)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: Annual Out of Pocket Expenses: Individual Family $6,500 $13,000 Annual Deductible $7,000 $14,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$395.99 $449.45 $506.08 $707.24 $1,074.72	$698.92 $752.38 $809.01 $1,010.17	$1,001.85 $1,055.31 $1,111.94 $1,313.10	$1,304.78 $1,358.24 $1,414.87 $1,616.03	$302.93
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$791.98 $898.90 $1,012.16 $1,414.48 $2,149.44	$1,094.91 $1,201.83 $1,315.09 $1,717.41	$1,397.84 $1,504.76 $1,618.02 $2,020.34	$1,700.77 $1,807.69 $1,920.95 $2,323.27	$302.93

Toc - Plan #55 AvMed
Expanded Bronze (HMO) AvMed Entrust Bronze 625 Dental+Vision (2022)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $8,350 $16,700 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$397.07 $450.67 $507.45 $709.16 $1,077.64	$700.83 $754.43 $811.21 $1,012.92	$1,004.59 $1,058.19 $1,114.97 $1,316.68	$1,308.35 $1,361.95 $1,418.73 $1,620.44	$303.76
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$794.14 $901.34 $1,014.90 $1,418.32 $2,155.28	$1,097.90 $1,205.10 $1,318.66 $1,722.08	$1,401.66 $1,508.86 $1,622.42 $2,025.84	$1,705.42 $1,812.62 $1,926.18 $2,329.60	$303.76

Ambetter from Sunshine Health Local: 1-877-687-1169 | Toll Free: 1-877-687-1169 | TTY: 1-800-955-8770

Toc - Plan #56 Ambetter from Sunshine Health
Gold (EPO) Ambetter Secure Care 5
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $1,450 $2,900 Annual Deductible $6,300 $12,600 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$475.13 $539.27 $607.21 $848.57 $1,289.49	$838.60 $902.74 $970.68 $1,212.04	$1,202.07 $1,266.21 $1,334.15 $1,575.51	$1,565.54 $1,629.68 $1,697.62 $1,938.98	$363.47
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$950.26 $1,078.54 $1,214.42 $1,697.14 $2,578.98	$1,313.73 $1,442.01 $1,577.89 $2,060.61	$1,677.20 $1,805.48 $1,941.36 $2,424.08	$2,040.67 $2,168.95 $2,304.83 $2,787.55	$363.47

Toc - Plan #57 Ambetter from Sunshine Health
Bronze (EPO) Ambetter Essential Care 1
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $8,600 $17,200 Annual Deductible $8,600 $17,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$334.29 $379.41 $427.21 $597.03 $907.24	$590.02 $635.14 $682.94 $852.76	$845.75 $890.87 $938.67 $1,108.49	$1,101.48 $1,146.60 $1,194.40 $1,364.22	$255.73
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$668.58 $758.82 $854.42 $1,194.06 $1,814.48	$924.31 $1,014.55 $1,110.15 $1,449.79	$1,180.04 $1,270.28 $1,365.88 $1,705.52	$1,435.77 $1,526.01 $1,621.61 $1,961.25	$255.73

Toc - Plan #58 Ambetter from Sunshine Health
Expanded Bronze (EPO) Ambetter Essential Care 2 HSA
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $6,900 $13,800 Annual Deductible $6,900 $13,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$367.60 $417.21 $469.78 $656.51 $997.64	$648.81 $698.42 $750.99 $937.72	$930.02 $979.63 $1,032.20 $1,218.93	$1,211.23 $1,260.84 $1,313.41 $1,500.14	$281.21
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$735.20 $834.42 $939.56 $1,313.02 $1,995.28	$1,016.41 $1,115.63 $1,220.77 $1,594.23	$1,297.62 $1,396.84 $1,501.98 $1,875.44	$1,578.83 $1,678.05 $1,783.19 $2,156.65	$281.21

Toc - Plan #59 Ambetter from Sunshine Health
Silver (EPO) Ambetter Balanced Care 11
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $6,000 $12,000 Annual Deductible $8,500 $17,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$467.15 $530.20 $597.00 $834.31 $1,267.81	$824.51 $887.56 $954.36 $1,191.67	$1,181.87 $1,244.92 $1,311.72 $1,549.03	$1,539.23 $1,602.28 $1,669.08 $1,906.39	$357.36
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$934.30 $1,060.40 $1,194.00 $1,668.62 $2,535.62	$1,291.66 $1,417.76 $1,551.36 $2,025.98	$1,649.02 $1,775.12 $1,908.72 $2,383.34	$2,006.38 $2,132.48 $2,266.08 $2,740.70	$357.36

Toc - Plan #60 Ambetter from Sunshine Health
Silver (EPO) Ambetter Balanced Care 12
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $6,500 $13,000 Annual Deductible $8,400 $16,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$460.70 $522.88 $588.76 $822.79 $1,250.31	$813.13 $875.31 $941.19 $1,175.22	$1,165.56 $1,227.74 $1,293.62 $1,527.65	$1,517.99 $1,580.17 $1,646.05 $1,880.08	$352.43
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$921.40 $1,045.76 $1,177.52 $1,645.58 $2,500.62	$1,273.83 $1,398.19 $1,529.95 $1,998.01	$1,626.26 $1,750.62 $1,882.38 $2,350.44	$1,978.69 $2,103.05 $2,234.81 $2,702.87	$352.43

Toc - Plan #61 Ambetter from Sunshine Health
Silver (EPO) Ambetter Balanced Care 24
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $7,450 $14,900 Annual Deductible $7,450 $14,900 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$475.46 $539.64 $607.63 $849.16 $1,290.37	$839.18 $903.36 $971.35 $1,212.88	$1,202.90 $1,267.08 $1,335.07 $1,576.60	$1,566.62 $1,630.80 $1,698.79 $1,940.32	$363.72
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$950.92 $1,079.28 $1,215.26 $1,698.32 $2,580.74	$1,314.64 $1,443.00 $1,578.98 $2,062.04	$1,678.36 $1,806.72 $1,942.70 $2,425.76	$2,042.08 $2,170.44 $2,306.42 $2,789.48	$363.72

Toc - Plan #62 Ambetter from Sunshine Health
Silver (EPO) Ambetter Balanced Care 29
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $5,450 $10,900 Annual Deductible $8,650 $17,300 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$455.33 $516.79 $581.90 $813.20 $1,235.73	$803.65 $865.11 $930.22 $1,161.52	$1,151.97 $1,213.43 $1,278.54 $1,509.84	$1,500.29 $1,561.75 $1,626.86 $1,858.16	$348.32
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$910.66 $1,033.58 $1,163.80 $1,626.40 $2,471.46	$1,258.98 $1,381.90 $1,512.12 $1,974.72	$1,607.30 $1,730.22 $1,860.44 $2,323.04	$1,955.62 $2,078.54 $2,208.76 $2,671.36	$348.32

Toc - Plan #63 Ambetter from Sunshine Health
Expanded Bronze (EPO) Ambetter Essential Care 5
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $8,300 $16,600 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$363.63 $412.71 $464.70 $649.42 $986.86	$641.80 $690.88 $742.87 $927.59	$919.97 $969.05 $1,021.04 $1,205.76	$1,198.14 $1,247.22 $1,299.21 $1,483.93	$278.17
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$727.26 $825.42 $929.40 $1,298.84 $1,973.72	$1,005.43 $1,103.59 $1,207.57 $1,577.01	$1,283.60 $1,381.76 $1,485.74 $1,855.18	$1,561.77 $1,659.93 $1,763.91 $2,133.35	$278.17

Toc - Plan #64 Ambetter from Sunshine Health
Expanded Bronze (EPO) Ambetter Essential Care 22
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $2,500 $5,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$388.85 $441.34 $496.94 $694.48 $1,055.32	$686.32 $738.81 $794.41 $991.95	$983.79 $1,036.28 $1,091.88 $1,289.42	$1,281.26 $1,333.75 $1,389.35 $1,586.89	$297.47
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$777.70 $882.68 $993.88 $1,388.96 $2,110.64	$1,075.17 $1,180.15 $1,291.35 $1,686.43	$1,372.64 $1,477.62 $1,588.82 $1,983.90	$1,670.11 $1,775.09 $1,886.29 $2,281.37	$297.47

Toc - Plan #65 Ambetter from Sunshine Health
Expanded Bronze (EPO) Ambetter Essential Care: $1,500 Medical Deductible
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $1,500 $3,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$399.50 $453.43 $510.55 $713.50 $1,084.23	$705.11 $759.04 $816.16 $1,019.11	$1,010.72 $1,064.65 $1,121.77 $1,324.72	$1,316.33 $1,370.26 $1,427.38 $1,630.33	$305.61
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$799.00 $906.86 $1,021.10 $1,427.00 $2,168.46	$1,104.61 $1,212.47 $1,326.71 $1,732.61	$1,410.22 $1,518.08 $1,632.32 $2,038.22	$1,715.83 $1,823.69 $1,937.93 $2,343.83	$305.61

Toc - Plan #66 Ambetter from Sunshine Health
Expanded Bronze (EPO) Ambetter Essential Care: $0 Medical Deductible
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$423.89 $481.10 $541.72 $757.05 $1,150.41	$748.16 $805.37 $865.99 $1,081.32	$1,072.43 $1,129.64 $1,190.26 $1,405.59	$1,396.70 $1,453.91 $1,514.53 $1,729.86	$324.27
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$847.78 $962.20 $1,083.44 $1,514.10 $2,300.82	$1,172.05 $1,286.47 $1,407.71 $1,838.37	$1,496.32 $1,610.74 $1,731.98 $2,162.64	$1,820.59 $1,935.01 $2,056.25 $2,486.91	$324.27

Toc - Plan #67 Ambetter from Sunshine Health
Silver (EPO) Ambetter Balanced Care 30
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $6,100 $12,200 Annual Deductible $6,100 $12,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$437.06 $496.05 $558.55 $780.58 $1,186.16	$771.41 $830.40 $892.90 $1,114.93	$1,105.76 $1,164.75 $1,227.25 $1,449.28	$1,440.11 $1,499.10 $1,561.60 $1,783.63	$334.35
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$874.12 $992.10 $1,117.10 $1,561.16 $2,372.32	$1,208.47 $1,326.45 $1,451.45 $1,895.51	$1,542.82 $1,660.80 $1,785.80 $2,229.86	$1,877.17 $1,995.15 $2,120.15 $2,564.21	$334.35

Toc - Plan #68 Ambetter from Sunshine Health
Silver (EPO) Ambetter Balanced Care 31
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $5,450 $10,900 Annual Deductible $6,450 $12,900 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$438.00 $497.12 $559.75 $782.24 $1,188.70	$773.06 $832.18 $894.81 $1,117.30	$1,108.12 $1,167.24 $1,229.87 $1,452.36	$1,443.18 $1,502.30 $1,564.93 $1,787.42	$335.06
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$876.00 $994.24 $1,119.50 $1,564.48 $2,377.40	$1,211.06 $1,329.30 $1,454.56 $1,899.54	$1,546.12 $1,664.36 $1,789.62 $2,234.60	$1,881.18 $1,999.42 $2,124.68 $2,569.66	$335.06

Toc - Plan #69 Ambetter from Sunshine Health
Silver (EPO) Ambetter Balanced Care 32
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $8,100 $16,200 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$445.28 $505.39 $569.06 $795.26 $1,208.47	$785.91 $846.02 $909.69 $1,135.89	$1,126.54 $1,186.65 $1,250.32 $1,476.52	$1,467.17 $1,527.28 $1,590.95 $1,817.15	$340.63
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$890.56 $1,010.78 $1,138.12 $1,590.52 $2,416.94	$1,231.19 $1,351.41 $1,478.75 $1,931.15	$1,571.82 $1,692.04 $1,819.38 $2,271.78	$1,912.45 $2,032.67 $2,160.01 $2,612.41	$340.63

Toc - Plan #70 Ambetter from Sunshine Health
Gold (EPO) Ambetter Secure Care 20
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $750 $1,500 Annual Deductible $7,500 $15,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$444.35 $504.33 $567.87 $793.59 $1,205.94	$784.27 $844.25 $907.79 $1,133.51	$1,124.19 $1,184.17 $1,247.71 $1,473.43	$1,464.11 $1,524.09 $1,587.63 $1,813.35	$339.92
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$888.70 $1,008.66 $1,135.74 $1,587.18 $2,411.88	$1,228.62 $1,348.58 $1,475.66 $1,927.10	$1,568.54 $1,688.50 $1,815.58 $2,267.02	$1,908.46 $2,028.42 $2,155.50 $2,606.94	$339.92

Toc - Plan #71 Ambetter from Sunshine Health
Silver (EPO) Ambetter Balanced Care 12 + Vision + Adult Dental
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $6,500 $13,000 Annual Deductible $8,400 $16,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$477.13 $541.53 $609.76 $852.14 $1,294.90	$842.13 $906.53 $974.76 $1,217.14	$1,207.13 $1,271.53 $1,339.76 $1,582.14	$1,572.13 $1,636.53 $1,704.76 $1,947.14	$365.00
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$954.26 $1,083.06 $1,219.52 $1,704.28 $2,589.80	$1,319.26 $1,448.06 $1,584.52 $2,069.28	$1,684.26 $1,813.06 $1,949.52 $2,434.28	$2,049.26 $2,178.06 $2,314.52 $2,799.28	$365.00

Toc - Plan #72 Ambetter from Sunshine Health
Expanded Bronze (EPO) Ambetter Essential Care 2 HSA + Vision + Adult Dental
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $6,900 $13,800 Annual Deductible $6,900 $13,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$380.71 $432.09 $486.53 $679.93 $1,033.22	$671.95 $723.33 $777.77 $971.17	$963.19 $1,014.57 $1,069.01 $1,262.41	$1,254.43 $1,305.81 $1,360.25 $1,553.65	$291.24
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$761.42 $864.18 $973.06 $1,359.86 $2,066.44	$1,052.66 $1,155.42 $1,264.30 $1,651.10	$1,343.90 $1,446.66 $1,555.54 $1,942.34	$1,635.14 $1,737.90 $1,846.78 $2,233.58	$291.24

Toc - Plan #73 Ambetter from Sunshine Health
Gold (EPO) Ambetter Secure Care 5 + Vision + Adult Dental
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $1,450 $2,900 Annual Deductible $6,300 $12,600 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$492.08 $558.50 $628.86 $878.84 $1,335.48	$868.51 $934.93 $1,005.29 $1,255.27	$1,244.94 $1,311.36 $1,381.72 $1,631.70	$1,621.37 $1,687.79 $1,758.15 $2,008.13	$376.43
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$984.16 $1,117.00 $1,257.72 $1,757.68 $2,670.96	$1,360.59 $1,493.43 $1,634.15 $2,134.11	$1,737.02 $1,869.86 $2,010.58 $2,510.54	$2,113.45 $2,246.29 $2,387.01 $2,886.97	$376.43

Toc - Plan #74 Ambetter from Sunshine Health
Bronze (EPO) Ambetter Essential Care 1 + Vision + Adult Dental
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $8,600 $17,200 Annual Deductible $8,600 $17,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$346.21 $392.94 $442.45 $618.32 $939.60	$611.06 $657.79 $707.30 $883.17	$875.91 $922.64 $972.15 $1,148.02	$1,140.76 $1,187.49 $1,237.00 $1,412.87	$264.85
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$692.42 $785.88 $884.90 $1,236.64 $1,879.20	$957.27 $1,050.73 $1,149.75 $1,501.49	$1,222.12 $1,315.58 $1,414.60 $1,766.34	$1,486.97 $1,580.43 $1,679.45 $2,031.19	$264.85

Toc - Plan #75 Ambetter from Sunshine Health
Silver (EPO) Ambetter Balanced Care 11 + Vision + Adult Dental
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $6,000 $12,000 Annual Deductible $8,500 $17,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$483.81 $549.11 $618.29 $864.06 $1,313.02	$853.91 $919.21 $988.39 $1,234.16	$1,224.01 $1,289.31 $1,358.49 $1,604.26	$1,594.11 $1,659.41 $1,728.59 $1,974.36	$370.10
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$967.62 $1,098.22 $1,236.58 $1,728.12 $2,626.04	$1,337.72 $1,468.32 $1,606.68 $2,098.22	$1,707.82 $1,838.42 $1,976.78 $2,468.32	$2,077.92 $2,208.52 $2,346.88 $2,838.42	$370.10

Toc - Plan #76 Ambetter from Sunshine Health
Silver (EPO) Ambetter Balanced Care 24 + Vision + Adult Dental
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $7,450 $14,900 Annual Deductible $7,450 $14,900 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$492.42 $558.88 $629.30 $879.44 $1,336.40	$869.11 $935.57 $1,005.99 $1,256.13	$1,245.80 $1,312.26 $1,382.68 $1,632.82	$1,622.49 $1,688.95 $1,759.37 $2,009.51	$376.69
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$984.84 $1,117.76 $1,258.60 $1,758.88 $2,672.80	$1,361.53 $1,494.45 $1,635.29 $2,135.57	$1,738.22 $1,871.14 $2,011.98 $2,512.26	$2,114.91 $2,247.83 $2,388.67 $2,888.95	$376.69

Toc - Plan #77 Ambetter from Sunshine Health
Expanded Bronze (EPO) Ambetter Essential Care 5 + Vision + Adult Dental
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $8,300 $16,600 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$376.60 $427.43 $481.28 $672.58 $1,022.06	$664.69 $715.52 $769.37 $960.67	$952.78 $1,003.61 $1,057.46 $1,248.76	$1,240.87 $1,291.70 $1,345.55 $1,536.85	$288.09
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$753.20 $854.86 $962.56 $1,345.16 $2,044.12	$1,041.29 $1,142.95 $1,250.65 $1,633.25	$1,329.38 $1,431.04 $1,538.74 $1,921.34	$1,617.47 $1,719.13 $1,826.83 $2,209.43	$288.09

Toc - Plan #78 Ambetter from Sunshine Health
Expanded Bronze (EPO) Ambetter Essential Care 22 + Vision + Adult Dental
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $2,500 $5,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$402.72 $457.08 $514.67 $719.24 $1,092.96	$710.79 $765.15 $822.74 $1,027.31	$1,018.86 $1,073.22 $1,130.81 $1,335.38	$1,326.93 $1,381.29 $1,438.88 $1,643.45	$308.07
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$805.44 $914.16 $1,029.34 $1,438.48 $2,185.92	$1,113.51 $1,222.23 $1,337.41 $1,746.55	$1,421.58 $1,530.30 $1,645.48 $2,054.62	$1,729.65 $1,838.37 $1,953.55 $2,362.69	$308.07

Toc - Plan #79 Ambetter from Sunshine Health
Expanded Bronze (EPO) Ambetter Essential Care: $1,500 Medical Deductible + Vision + Adult Dental
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $1,500 $3,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$413.75 $469.60 $528.76 $738.94 $1,122.90	$730.26 $786.11 $845.27 $1,055.45	$1,046.77 $1,102.62 $1,161.78 $1,371.96	$1,363.28 $1,419.13 $1,478.29 $1,688.47	$316.51
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$827.50 $939.20 $1,057.52 $1,477.88 $2,245.80	$1,144.01 $1,255.71 $1,374.03 $1,794.39	$1,460.52 $1,572.22 $1,690.54 $2,110.90	$1,777.03 $1,888.73 $2,007.05 $2,427.41	$316.51

Toc - Plan #80 Ambetter from Sunshine Health
Expanded Bronze (EPO) Ambetter Essential Care: $0 Medical Deductible + Vision + Adult Dental
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$439.01 $498.26 $561.04 $784.05 $1,191.44	$774.84 $834.09 $896.87 $1,119.88	$1,110.67 $1,169.92 $1,232.70 $1,455.71	$1,446.50 $1,505.75 $1,568.53 $1,791.54	$335.83
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$878.02 $996.52 $1,122.08 $1,568.10 $2,382.88	$1,213.85 $1,332.35 $1,457.91 $1,903.93	$1,549.68 $1,668.18 $1,793.74 $2,239.76	$1,885.51 $2,004.01 $2,129.57 $2,575.59	$335.83

Toc - Plan #81 Ambetter from Sunshine Health
Silver (EPO) Ambetter Balanced Care 31 + Vision + Adult Dental
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $5,450 $10,900 Annual Deductible $6,450 $12,900 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$453.62 $514.84 $579.71 $810.14 $1,231.09	$800.63 $861.85 $926.72 $1,157.15	$1,147.64 $1,208.86 $1,273.73 $1,504.16	$1,494.65 $1,555.87 $1,620.74 $1,851.17	$347.01
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$907.24 $1,029.68 $1,159.42 $1,620.28 $2,462.18	$1,254.25 $1,376.69 $1,506.43 $1,967.29	$1,601.26 $1,723.70 $1,853.44 $2,314.30	$1,948.27 $2,070.71 $2,200.45 $2,661.31	$347.01

Toc - Plan #82 Ambetter from Sunshine Health
Silver (EPO) Ambetter Balanced Care 32 + Vision + Adult Dental
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $8,100 $16,200 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$461.16 $523.41 $589.36 $823.62 $1,251.57	$813.94 $876.19 $942.14 $1,176.40	$1,166.72 $1,228.97 $1,294.92 $1,529.18	$1,519.50 $1,581.75 $1,647.70 $1,881.96	$352.78
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$922.32 $1,046.82 $1,178.72 $1,647.24 $2,503.14	$1,275.10 $1,399.60 $1,531.50 $2,000.02	$1,627.88 $1,752.38 $1,884.28 $2,352.80	$1,980.66 $2,105.16 $2,237.06 $2,705.58	$352.78

Toc - Plan #83 Ambetter from Sunshine Health
Gold (EPO) Ambetter Secure Care 20 + Vision + Adult Dental
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $750 $1,500 Annual Deductible $7,500 $15,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$460.20 $522.31 $588.12 $821.89 $1,248.95	$812.24 $874.35 $940.16 $1,173.93	$1,164.28 $1,226.39 $1,292.20 $1,525.97	$1,516.32 $1,578.43 $1,644.24 $1,878.01	$352.04
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$920.40 $1,044.62 $1,176.24 $1,643.78 $2,497.90	$1,272.44 $1,396.66 $1,528.28 $1,995.82	$1,624.48 $1,748.70 $1,880.32 $2,347.86	$1,976.52 $2,100.74 $2,232.36 $2,699.90	$352.04

Toc - Plan #84 Ambetter from Sunshine Health
Silver (EPO) Ambetter Balanced Care 29 + Vision + Adult Dental
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $5,450 $10,900 Annual Deductible $8,650 $17,300 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$471.57 $535.22 $602.65 $842.20 $1,279.80	$832.31 $895.96 $963.39 $1,202.94	$1,193.05 $1,256.70 $1,324.13 $1,563.68	$1,553.79 $1,617.44 $1,684.87 $1,924.42	$360.74
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$943.14 $1,070.44 $1,205.30 $1,684.40 $2,559.60	$1,303.88 $1,431.18 $1,566.04 $2,045.14	$1,664.62 $1,791.92 $1,926.78 $2,405.88	$2,025.36 $2,152.66 $2,287.52 $2,766.62	$360.74

Florida Blue HMO (a BlueCross BlueShield FL company) Local: 1-800-352-2583 | Toll Free: 1-800-352-2583 | TTY: 1-800-955-8771

Toc - Plan #85 Florida Blue HMO (a BlueCross BlueShield FL company)
Platinum (HMO) BlueCare Platinum 2151 ($0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $2,000 $4,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$819.03 $929.60 $1,046.72 $1,462.79 $2,222.85	$1,445.59 $1,556.16 $1,673.28 $2,089.35	$2,072.15 $2,182.72 $2,299.84 $2,715.91	$2,698.71 $2,809.28 $2,926.40 $3,342.47	$626.56
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,638.06 $1,859.20 $2,093.44 $2,925.58 $4,445.70	$2,264.62 $2,485.76 $2,720.00 $3,552.14	$2,891.18 $3,112.32 $3,346.56 $4,178.70	$3,517.74 $3,738.88 $3,973.12 $4,805.26	$626.56

Toc - Plan #86 Florida Blue HMO (a BlueCross BlueShield FL company)
Expanded Bronze (HMO) BlueCare Bronze 2153 ($0 Virtual Visits / 3 PCP Visits for $0 / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $7,900 $15,800 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$484.01 $549.35 $618.56 $864.44 $1,313.60	$854.28 $919.62 $988.83 $1,234.71	$1,224.55 $1,289.89 $1,359.10 $1,604.98	$1,594.82 $1,660.16 $1,729.37 $1,975.25	$370.27
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$968.02 $1,098.70 $1,237.12 $1,728.88 $2,627.20	$1,338.29 $1,468.97 $1,607.39 $2,099.15	$1,708.56 $1,839.24 $1,977.66 $2,469.42	$2,078.83 $2,209.51 $2,347.93 $2,839.69	$370.27

Toc - Plan #87 Florida Blue HMO (a BlueCross BlueShield FL company)
Bronze (HMO) BlueCare Bronze 2154 ($0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $8,700 $17,400 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$437.26 $496.29 $558.82 $780.95 $1,186.72	$771.76 $830.79 $893.32 $1,115.45	$1,106.26 $1,165.29 $1,227.82 $1,449.95	$1,440.76 $1,499.79 $1,562.32 $1,784.45	$334.50
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$874.52 $992.58 $1,117.64 $1,561.90 $2,373.44	$1,209.02 $1,327.08 $1,452.14 $1,896.40	$1,543.52 $1,661.58 $1,786.64 $2,230.90	$1,878.02 $1,996.08 $2,121.14 $2,565.40	$334.50

Toc - Plan #88 Florida Blue HMO (a BlueCross BlueShield FL company)
Gold (HMO) BlueCare Gold 2156 ($0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $5,000 $10,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$704.53 $799.64 $900.39 $1,258.29 $1,912.09	$1,243.50 $1,338.61 $1,439.36 $1,797.26	$1,782.47 $1,877.58 $1,978.33 $2,336.23	$2,321.44 $2,416.55 $2,517.30 $2,875.20	$538.97
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,409.06 $1,599.28 $1,800.78 $2,516.58 $3,824.18	$1,948.03 $2,138.25 $2,339.75 $3,055.55	$2,487.00 $2,677.22 $2,878.72 $3,594.52	$3,025.97 $3,216.19 $3,417.69 $4,133.49	$538.97

Toc - Plan #89 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver (HMO) BlueCare Silver 2157 ($0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $6,000 $12,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$586.32 $665.47 $749.32 $1,047.17 $1,591.27	$1,034.85 $1,114.00 $1,197.85 $1,495.70	$1,483.38 $1,562.53 $1,646.38 $1,944.23	$1,931.91 $2,011.06 $2,094.91 $2,392.76	$448.53
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,172.64 $1,330.94 $1,498.64 $2,094.34 $3,182.54	$1,621.17 $1,779.47 $1,947.17 $2,542.87	$2,069.70 $2,228.00 $2,395.70 $2,991.40	$2,518.23 $2,676.53 $2,844.23 $3,439.93	$448.53

Toc - Plan #90 Florida Blue HMO (a BlueCross BlueShield FL company)
Expanded Bronze (HMO) BlueCare Bronze 2159 ($0 Deductible / $50 PCP Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$526.10 $597.12 $672.36 $939.61 $1,427.84	$928.57 $999.59 $1,074.83 $1,342.08	$1,331.04 $1,402.06 $1,477.30 $1,744.55	$1,733.51 $1,804.53 $1,879.77 $2,147.02	$402.47
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,052.20 $1,194.24 $1,344.72 $1,879.22 $2,855.68	$1,454.67 $1,596.71 $1,747.19 $2,281.69	$1,857.14 $1,999.18 $2,149.66 $2,684.16	$2,259.61 $2,401.65 $2,552.13 $3,086.63	$402.47

Toc - Plan #91 Florida Blue HMO (a BlueCross BlueShield FL company)
Expanded Bronze (HMO) myBlue Bronze 1601 ($0 Virtual Visits / 3 PCP Visits for $0 / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $8,500 $17,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$335.34 $380.61 $428.56 $598.92 $910.11	$591.88 $637.15 $685.10 $855.46	$848.42 $893.69 $941.64 $1,112.00	$1,104.96 $1,150.23 $1,198.18 $1,368.54	$256.54
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$670.68 $761.22 $857.12 $1,197.84 $1,820.22	$927.22 $1,017.76 $1,113.66 $1,454.38	$1,183.76 $1,274.30 $1,370.20 $1,710.92	$1,440.30 $1,530.84 $1,626.74 $1,967.46	$256.54

Toc - Plan #92 Florida Blue HMO (a BlueCross BlueShield FL company)
Expanded Bronze (HMO) myBlue Bronze 1602 ($0 Labs / $0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $8,700 $17,400 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$298.07 $338.31 $380.93 $532.35 $808.96	$526.09 $566.33 $608.95 $760.37	$754.11 $794.35 $836.97 $988.39	$982.13 $1,022.37 $1,064.99 $1,216.41	$228.02
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$596.14 $676.62 $761.86 $1,064.70 $1,617.92	$824.16 $904.64 $989.88 $1,292.72	$1,052.18 $1,132.66 $1,217.90 $1,520.74	$1,280.20 $1,360.68 $1,445.92 $1,748.76	$228.02

Toc - Plan #93 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver (HMO) myBlue Silver 1603 ($0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $5,900 $11,800 Annual Deductible $7,200 $14,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$426.09 $483.61 $544.54 $761.00 $1,156.41	$752.05 $809.57 $870.50 $1,086.96	$1,078.01 $1,135.53 $1,196.46 $1,412.92	$1,403.97 $1,461.49 $1,522.42 $1,738.88	$325.96
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$852.18 $967.22 $1,089.08 $1,522.00 $2,312.82	$1,178.14 $1,293.18 $1,415.04 $1,847.96	$1,504.10 $1,619.14 $1,741.00 $2,173.92	$1,830.06 $1,945.10 $2,066.96 $2,499.88	$325.96

Toc - Plan #94 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver (HMO) myBlue Silver 1604 ($0 Labs / $0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $5,500 $11,000 Annual Deductible $8,000 $16,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$403.26 $457.70 $515.37 $720.22 $1,094.45	$711.75 $766.19 $823.86 $1,028.71	$1,020.24 $1,074.68 $1,132.35 $1,337.20	$1,328.73 $1,383.17 $1,440.84 $1,645.69	$308.49
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$806.52 $915.40 $1,030.74 $1,440.44 $2,188.90	$1,115.01 $1,223.89 $1,339.23 $1,748.93	$1,423.50 $1,532.38 $1,647.72 $2,057.42	$1,731.99 $1,840.87 $1,956.21 $2,365.91	$308.49

Toc - Plan #95 Florida Blue HMO (a BlueCross BlueShield FL company)
Gold (HMO) myBlue Gold 1605 ($0 Labs / $0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $940 $1,880 Annual Deductible $4,700 $9,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$447.77 $508.22 $572.25 $799.72 $1,215.25	$790.31 $850.76 $914.79 $1,142.26	$1,132.85 $1,193.30 $1,257.33 $1,484.80	$1,475.39 $1,535.84 $1,599.87 $1,827.34	$342.54
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$895.54 $1,016.44 $1,144.50 $1,599.44 $2,430.50	$1,238.08 $1,358.98 $1,487.04 $1,941.98	$1,580.62 $1,701.52 $1,829.58 $2,284.52	$1,923.16 $2,044.06 $2,172.12 $2,627.06	$342.54

Toc - Plan #96 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver (HMO) myBlue Silver 1710 ($0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $6,200 $12,400 Annual Deductible $8,550 $17,100 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$438.30 $497.47 $560.15 $782.80 $1,189.55	$773.60 $832.77 $895.45 $1,118.10	$1,108.90 $1,168.07 $1,230.75 $1,453.40	$1,444.20 $1,503.37 $1,566.05 $1,788.70	$335.30
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$876.60 $994.94 $1,120.30 $1,565.60 $2,379.10	$1,211.90 $1,330.24 $1,455.60 $1,900.90	$1,547.20 $1,665.54 $1,790.90 $2,236.20	$1,882.50 $2,000.84 $2,126.20 $2,571.50	$335.30

Toc - Plan #97 Florida Blue HMO (a BlueCross BlueShield FL company)
Expanded Bronze (HMO) myBlue Bronze 1711S ($0 Virtual Visits / $60 PCP Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $7,800 $15,600 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$333.43 $378.44 $426.12 $595.51 $904.93	$588.50 $633.51 $681.19 $850.58	$843.57 $888.58 $936.26 $1,105.65	$1,098.64 $1,143.65 $1,191.33 $1,360.72	$255.07
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$666.86 $756.88 $852.24 $1,191.02 $1,809.86	$921.93 $1,011.95 $1,107.31 $1,446.09	$1,177.00 $1,267.02 $1,362.38 $1,701.16	$1,432.07 $1,522.09 $1,617.45 $1,956.23	$255.07

Toc - Plan #98 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver (HMO) myBlue Silver 1712S ($0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $3,950 $7,900 Annual Deductible $8,550 $17,100 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$433.79 $492.35 $554.38 $774.75 $1,177.31	$765.64 $824.20 $886.23 $1,106.60	$1,097.49 $1,156.05 $1,218.08 $1,438.45	$1,429.34 $1,487.90 $1,549.93 $1,770.30	$331.85
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$867.58 $984.70 $1,108.76 $1,549.50 $2,354.62	$1,199.43 $1,316.55 $1,440.61 $1,881.35	$1,531.28 $1,648.40 $1,772.46 $2,213.20	$1,863.13 $1,980.25 $2,104.31 $2,545.05	$331.85

Toc - Plan #99 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver (HMO) myBlue Silver 2017 ($0 Labs / $0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $6,000 $12,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$396.27 $449.77 $506.43 $707.74 $1,075.48	$699.42 $752.92 $809.58 $1,010.89	$1,002.57 $1,056.07 $1,112.73 $1,314.04	$1,305.72 $1,359.22 $1,415.88 $1,617.19	$303.15
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$792.54 $899.54 $1,012.86 $1,415.48 $2,150.96	$1,095.69 $1,202.69 $1,316.01 $1,718.63	$1,398.84 $1,505.84 $1,619.16 $2,021.78	$1,701.99 $1,808.99 $1,922.31 $2,324.93	$303.15

Toc - Plan #100 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver (HMO) myBlue Silver 2127 ($0 Labs / $0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $7,000 $14,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$387.41 $439.71 $495.11 $691.91 $1,051.43	$683.78 $736.08 $791.48 $988.28	$980.15 $1,032.45 $1,087.85 $1,284.65	$1,276.52 $1,328.82 $1,384.22 $1,581.02	$296.37
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$774.82 $879.42 $990.22 $1,383.82 $2,102.86	$1,071.19 $1,175.79 $1,286.59 $1,680.19	$1,367.56 $1,472.16 $1,582.96 $1,976.56	$1,663.93 $1,768.53 $1,879.33 $2,272.93	$296.37

Toc - Plan #101 Florida Blue HMO (a BlueCross BlueShield FL company)
Expanded Bronze (HMO) myBlue Bronze 2129 ($0 Deductible / $0 Virtual Visits / $35 PCP Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$363.48 $412.55 $464.53 $649.18 $986.48	$641.54 $690.61 $742.59 $927.24	$919.60 $968.67 $1,020.65 $1,205.30	$1,197.66 $1,246.73 $1,298.71 $1,483.36	$278.06
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$726.96 $825.10 $929.06 $1,298.36 $1,972.96	$1,005.02 $1,103.16 $1,207.12 $1,576.42	$1,283.08 $1,381.22 $1,485.18 $1,854.48	$1,561.14 $1,659.28 $1,763.24 $2,132.54	$278.06

Toc - Plan #102 Florida Blue HMO (a BlueCross BlueShield FL company)
Expanded Bronze (HMO) myBlue Bronze 2126 (3 PCP Visits for $0 / $0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $8,200 $16,400 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$335.29 $380.55 $428.50 $598.83 $909.98	$591.79 $637.05 $685.00 $855.33	$848.29 $893.55 $941.50 $1,111.83	$1,104.79 $1,150.05 $1,198.00 $1,368.33	$256.50
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$670.58 $761.10 $857.00 $1,197.66 $1,819.96	$927.08 $1,017.60 $1,113.50 $1,454.16	$1,183.58 $1,274.10 $1,370.00 $1,710.66	$1,440.08 $1,530.60 $1,626.50 $1,967.16	$256.50

Toc - Plan #103 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver (HMO) myBlue Silver 2237 ($0 Labs / $0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $8,650 $17,300 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$374.80 $425.40 $478.99 $669.39 $1,017.21	$661.52 $712.12 $765.71 $956.11	$948.24 $998.84 $1,052.43 $1,242.83	$1,234.96 $1,285.56 $1,339.15 $1,529.55	$286.72
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$749.60 $850.80 $957.98 $1,338.78 $2,034.42	$1,036.32 $1,137.52 $1,244.70 $1,625.50	$1,323.04 $1,424.24 $1,531.42 $1,912.22	$1,609.76 $1,710.96 $1,818.14 $2,198.94	$286.72

Toc - Plan #104 Florida Blue HMO (a BlueCross BlueShield FL company)
Expanded Bronze (HMO) myBlue Bronze 2219 ($0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $2,700 $5,400 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$326.62 $370.71 $417.42 $583.34 $886.45	$576.48 $620.57 $667.28 $833.20	$826.34 $870.43 $917.14 $1,083.06	$1,076.20 $1,120.29 $1,167.00 $1,332.92	$249.86
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$653.24 $741.42 $834.84 $1,166.68 $1,772.90	$903.10 $991.28 $1,084.70 $1,416.54	$1,152.96 $1,241.14 $1,334.56 $1,666.40	$1,402.82 $1,491.00 $1,584.42 $1,916.26	$249.86

Toc - Plan #105 Florida Blue HMO (a BlueCross BlueShield FL company)
Expanded Bronze (HMO) myBlue Bronze 2266 ($0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $2,900 $5,800 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$327.55 $371.77 $418.61 $585.00 $888.97	$578.13 $622.35 $669.19 $835.58	$828.71 $872.93 $919.77 $1,086.16	$1,079.29 $1,123.51 $1,170.35 $1,336.74	$250.58
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$655.10 $743.54 $837.22 $1,170.00 $1,777.94	$905.68 $994.12 $1,087.80 $1,420.58	$1,156.26 $1,244.70 $1,338.38 $1,671.16	$1,406.84 $1,495.28 $1,588.96 $1,921.74	$250.58

Toc - Plan #106 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver (HMO) myBlue Silver 2237D ($0 Labs / $0 Virtual Visits / Adult Dental / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $8,650 $17,300 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$383.32 $435.07 $489.88 $684.61 $1,040.33	$676.56 $728.31 $783.12 $977.85	$969.80 $1,021.55 $1,076.36 $1,271.09	$1,263.04 $1,314.79 $1,369.60 $1,564.33	$293.24
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$766.64 $870.14 $979.76 $1,369.22 $2,080.66	$1,059.88 $1,163.38 $1,273.00 $1,662.46	$1,353.12 $1,456.62 $1,566.24 $1,955.70	$1,646.36 $1,749.86 $1,859.48 $2,248.94	$293.24

Health First Commercial Plans, Inc. Local: 1-855-443-4735 | Toll Free: 1-855-443-4735 | TTY: 1-800-955-8771

Toc - Plan #107 Health First Commercial Plans, Inc.
Gold (HMO) AdventHealth GYM ACCESS Gold HMO 90 HSA 1745
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-443-4735 Annual Out of Pocket Expenses: Individual Family $1,700 $3,400 Annual Deductible $4,000 $8,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$476.18 $540.47 $608.56 $850.46 $1,292.36	$840.46 $904.75 $972.84 $1,214.74	$1,204.74 $1,269.03 $1,337.12 $1,579.02	$1,569.02 $1,633.31 $1,701.40 $1,943.30	$364.28
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$952.36 $1,080.94 $1,217.12 $1,700.92 $2,584.72	$1,316.64 $1,445.22 $1,581.40 $2,065.20	$1,680.92 $1,809.50 $1,945.68 $2,429.48	$2,045.20 $2,173.78 $2,309.96 $2,793.76	$364.28

Toc - Plan #108 Health First Commercial Plans, Inc.
Silver (HMO) AdventHealth GYM ACCESS Silver HMO 80 1696
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-443-4735 Annual Out of Pocket Expenses: Individual Family $4,950 $9,900 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$436.61 $495.55 $557.99 $779.79 $1,184.96	$770.62 $829.56 $892.00 $1,113.80	$1,104.63 $1,163.57 $1,226.01 $1,447.81	$1,438.64 $1,497.58 $1,560.02 $1,781.82	$334.01
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$873.22 $991.10 $1,115.98 $1,559.58 $2,369.92	$1,207.23 $1,325.11 $1,449.99 $1,893.59	$1,541.24 $1,659.12 $1,784.00 $2,227.60	$1,875.25 $1,993.13 $2,118.01 $2,561.61	$334.01

Toc - Plan #109 Health First Commercial Plans, Inc.
Catastrophic (HMO) AdventHealth GYM ACCESS Catastrophic HMO 1748
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-443-4735 Annual Out of Pocket Expenses: Individual Family $8,700 $17,400 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$175.61 $199.32 $224.43 $313.64 $476.61	$309.95 $333.66 $358.77 $447.98	$444.29 $468.00 $493.11 $582.32	$578.63 $602.34 $627.45 $716.66	$134.34
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$351.22 $398.64 $448.86 $627.28 $953.22	$485.56 $532.98 $583.20 $761.62	$619.90 $667.32 $717.54 $895.96	$754.24 $801.66 $851.88 $1,030.30	$134.34

Toc - Plan #110 Health First Commercial Plans, Inc.
Gold (HMO) AdventHealth GYM ACCESS Gold HMO 70 1743
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-443-4735 Annual Out of Pocket Expenses: Individual Family $1,500 $3,000 Annual Deductible $7,250 $14,500 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$479.83 $544.60 $613.22 $856.97 $1,302.25	$846.90 $911.67 $980.29 $1,224.04	$1,213.97 $1,278.74 $1,347.36 $1,591.11	$1,581.04 $1,645.81 $1,714.43 $1,958.18	$367.07
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$959.66 $1,089.20 $1,226.44 $1,713.94 $2,604.50	$1,326.73 $1,456.27 $1,593.51 $2,081.01	$1,693.80 $1,823.34 $1,960.58 $2,448.08	$2,060.87 $2,190.41 $2,327.65 $2,815.15	$367.07

Toc - Plan #111 Health First Commercial Plans, Inc.
Gold (HMO) AdventHealth GYM ACCESS Gold HMO 100 1738
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-443-4735 Annual Out of Pocket Expenses: Individual Family $2,650 $5,300 Annual Deductible $6,800 $13,600 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$475.94 $540.20 $608.26 $850.03 $1,291.71	$840.04 $904.30 $972.36 $1,214.13	$1,204.14 $1,268.40 $1,336.46 $1,578.23	$1,568.24 $1,632.50 $1,700.56 $1,942.33	$364.10
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$951.88 $1,080.40 $1,216.52 $1,700.06 $2,583.42	$1,315.98 $1,444.50 $1,580.62 $2,064.16	$1,680.08 $1,808.60 $1,944.72 $2,428.26	$2,044.18 $2,172.70 $2,308.82 $2,792.36	$364.10

Toc - Plan #112 Health First Commercial Plans, Inc.
Gold (HMO) AdventHealth GYM ACCESS Gold HMO 80 1741
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-443-4735 Annual Out of Pocket Expenses: Individual Family $2,900 $5,800 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$459.58 $521.63 $587.35 $820.82 $1,247.31	$811.16 $873.21 $938.93 $1,172.40	$1,162.74 $1,224.79 $1,290.51 $1,523.98	$1,514.32 $1,576.37 $1,642.09 $1,875.56	$351.58
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$919.16 $1,043.26 $1,174.70 $1,641.64 $2,494.62	$1,270.74 $1,394.84 $1,526.28 $1,993.22	$1,622.32 $1,746.42 $1,877.86 $2,344.80	$1,973.90 $2,098.00 $2,229.44 $2,696.38	$351.58

Toc - Plan #113 Health First Commercial Plans, Inc.
Silver (HMO) AdventHealth GYM ACCESS Silver HMO 100 1668
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-443-4735 Annual Out of Pocket Expenses: Individual Family $5,750 $11,500 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$450.40 $511.21 $575.61 $804.42 $1,222.39	$794.96 $855.77 $920.17 $1,148.98	$1,139.52 $1,200.33 $1,264.73 $1,493.54	$1,484.08 $1,544.89 $1,609.29 $1,838.10	$344.56
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$900.80 $1,022.42 $1,151.22 $1,608.84 $2,444.78	$1,245.36 $1,366.98 $1,495.78 $1,953.40	$1,589.92 $1,711.54 $1,840.34 $2,297.96	$1,934.48 $2,056.10 $2,184.90 $2,642.52	$344.56

Toc - Plan #114 Health First Commercial Plans, Inc.
Expanded Bronze (HMO) AdventHealth GYM ACCESS Bronze HMO 100 HSA 1660
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-443-4735 Annual Out of Pocket Expenses: Individual Family $6,900 $13,800 Annual Deductible $6,900 $13,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$317.13 $359.94 $405.29 $566.39 $860.68	$559.73 $602.54 $647.89 $808.99	$802.33 $845.14 $890.49 $1,051.59	$1,044.93 $1,087.74 $1,133.09 $1,294.19	$242.60
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$634.26 $719.88 $810.58 $1,132.78 $1,721.36	$876.86 $962.48 $1,053.18 $1,375.38	$1,119.46 $1,205.08 $1,295.78 $1,617.98	$1,362.06 $1,447.68 $1,538.38 $1,860.58	$242.60

Toc - Plan #115 Health First Commercial Plans, Inc.
Expanded Bronze (HMO) AdventHealthGYM ACCESS Bronze HMO 50 1797
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-443-4735 Annual Out of Pocket Expenses: Individual Family $6,900 $13,800 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$306.03 $347.34 $391.10 $546.57 $830.56	$540.14 $581.45 $625.21 $780.68	$774.25 $815.56 $859.32 $1,014.79	$1,008.36 $1,049.67 $1,093.43 $1,248.90	$234.11
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$612.06 $694.68 $782.20 $1,093.14 $1,661.12	$846.17 $928.79 $1,016.31 $1,327.25	$1,080.28 $1,162.90 $1,250.42 $1,561.36	$1,314.39 $1,397.01 $1,484.53 $1,795.47	$234.11

Toc - Plan #116 Health First Commercial Plans, Inc.
Expanded Bronze (HMO) AdventHealth GYM ACCESS Bronze HMO 60 1657
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-443-4735 Annual Out of Pocket Expenses: Individual Family $7,550 $15,100 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$313.96 $356.35 $401.24 $560.74 $852.09	$554.14 $596.53 $641.42 $800.92	$794.32 $836.71 $881.60 $1,041.10	$1,034.50 $1,076.89 $1,121.78 $1,281.28	$240.18
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$627.92 $712.70 $802.48 $1,121.48 $1,704.18	$868.10 $952.88 $1,042.66 $1,361.66	$1,108.28 $1,193.06 $1,282.84 $1,601.84	$1,348.46 $1,433.24 $1,523.02 $1,842.02	$240.18

Toc - Plan #117 Health First Commercial Plans, Inc.
Expanded Bronze (HMO) AdventHealth Bronze HMO 60 1752
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-443-4735 Annual Out of Pocket Expenses: Individual Family $8,500 $17,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$309.02 $350.74 $394.93 $551.92 $838.69	$545.42 $587.14 $631.33 $788.32	$781.82 $823.54 $867.73 $1,024.72	$1,018.22 $1,059.94 $1,104.13 $1,261.12	$236.40
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$618.04 $701.48 $789.86 $1,103.84 $1,677.38	$854.44 $937.88 $1,026.26 $1,340.24	$1,090.84 $1,174.28 $1,262.66 $1,576.64	$1,327.24 $1,410.68 $1,499.06 $1,813.04	$236.40

Toc - Plan #118 Health First Commercial Plans, Inc.
Gold (HMO) AdventHealth Gold HMO 80 1772
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-443-4735 Annual Out of Pocket Expenses: Individual Family $1,600 $3,200 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$459.98 $522.08 $587.86 $821.53 $1,248.40	$811.87 $873.97 $939.75 $1,173.42	$1,163.76 $1,225.86 $1,291.64 $1,525.31	$1,515.65 $1,577.75 $1,643.53 $1,877.20	$351.89
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$919.96 $1,044.16 $1,175.72 $1,643.06 $2,496.80	$1,271.85 $1,396.05 $1,527.61 $1,994.95	$1,623.74 $1,747.94 $1,879.50 $2,346.84	$1,975.63 $2,099.83 $2,231.39 $2,698.73	$351.89

Toc - Plan #119 Health First Commercial Plans, Inc.
Bronze (HMO) AdventHealth Bronze HMO 100 1776
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-443-4735 Annual Out of Pocket Expenses: Individual Family $8,700 $17,400 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$299.33 $339.74 $382.54 $534.60 $812.38	$528.32 $568.73 $611.53 $763.59	$757.31 $797.72 $840.52 $992.58	$986.30 $1,026.71 $1,069.51 $1,221.57	$228.99
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$598.66 $679.48 $765.08 $1,069.20 $1,624.76	$827.65 $908.47 $994.07 $1,298.19	$1,056.64 $1,137.46 $1,223.06 $1,527.18	$1,285.63 $1,366.45 $1,452.05 $1,756.17	$228.99

Toc - Plan #120 Health First Commercial Plans, Inc.
Expanded Bronze (HMO) AdventHealth Bronze HMO 100 HSA 1795
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-443-4735 Annual Out of Pocket Expenses: Individual Family $6,900 $13,800 Annual Deductible $6,900 $13,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$313.67 $356.02 $400.88 $560.22 $851.31	$553.63 $595.98 $640.84 $800.18	$793.59 $835.94 $880.80 $1,040.14	$1,033.55 $1,075.90 $1,120.76 $1,280.10	$239.96
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$627.34 $712.04 $801.76 $1,120.44 $1,702.62	$867.30 $952.00 $1,041.72 $1,360.40	$1,107.26 $1,191.96 $1,281.68 $1,600.36	$1,347.22 $1,431.92 $1,521.64 $1,840.32	$239.96

Toc - Plan #121 Health First Commercial Plans, Inc.
Silver (HMO) AdventHealth Silver HMO 65 1810
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-443-4735 Annual Out of Pocket Expenses: Individual Family $2,900 $5,800 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$403.07 $457.49 $515.13 $719.89 $1,093.94	$711.42 $765.84 $823.48 $1,028.24	$1,019.77 $1,074.19 $1,131.83 $1,336.59	$1,328.12 $1,382.54 $1,440.18 $1,644.94	$308.35
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$806.14 $914.98 $1,030.26 $1,439.78 $2,187.88	$1,114.49 $1,223.33 $1,338.61 $1,748.13	$1,422.84 $1,531.68 $1,646.96 $2,056.48	$1,731.19 $1,840.03 $1,955.31 $2,364.83	$308.35

Toc - Plan #122 Health First Commercial Plans, Inc.
Expanded Bronze (HMO) AdventHealth Bronze VALUE RX 50 1820
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-443-4735 Annual Out of Pocket Expenses: Individual Family $8,300 $16,600 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$290.81 $330.07 $371.65 $519.39 $789.26	$513.28 $552.54 $594.12 $741.86	$735.75 $775.01 $816.59 $964.33	$958.22 $997.48 $1,039.06 $1,186.80	$222.47
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$581.62 $660.14 $743.30 $1,038.78 $1,578.52	$804.09 $882.61 $965.77 $1,261.25	$1,026.56 $1,105.08 $1,188.24 $1,483.72	$1,249.03 $1,327.55 $1,410.71 $1,706.19	$222.47

Toc - Plan #123 Health First Commercial Plans, Inc.
Silver (HMO) AdventHealth Silver VALUE RX 80 1821
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-443-4735 Annual Out of Pocket Expenses: Individual Family $7,100 $14,200 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$388.08 $440.47 $495.96 $693.10 $1,053.24	$684.96 $737.35 $792.84 $989.98	$981.84 $1,034.23 $1,089.72 $1,286.86	$1,278.72 $1,331.11 $1,386.60 $1,583.74	$296.88
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$776.16 $880.94 $991.92 $1,386.20 $2,106.48	$1,073.04 $1,177.82 $1,288.80 $1,683.08	$1,369.92 $1,474.70 $1,585.68 $1,979.96	$1,666.80 $1,771.58 $1,882.56 $2,276.84	$296.88

Toc - Plan #124 Health First Commercial Plans, Inc.
Gold (HMO) AdventHealth Gold VALUE RX 75 1825
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-443-4735 Annual Out of Pocket Expenses: Individual Family $4,000 $8,000 Annual Deductible $8,650 $17,300 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$415.66 $471.78 $531.21 $742.37 $1,128.10	$733.64 $789.76 $849.19 $1,060.35	$1,051.62 $1,107.74 $1,167.17 $1,378.33	$1,369.60 $1,425.72 $1,485.15 $1,696.31	$317.98
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$831.32 $943.56 $1,062.42 $1,484.74 $2,256.20	$1,149.30 $1,261.54 $1,380.40 $1,802.72	$1,467.28 $1,579.52 $1,698.38 $2,120.70	$1,785.26 $1,897.50 $2,016.36 $2,438.68	$317.98

Oscar Insurance Company of Florida Local: 1-855-672-2755 | Toll Free: 1-855-672-2755

Toc - Plan #125 Oscar Insurance Company of Florida
Expanded Bronze (EPO) Bronze Simple
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $8,000 $16,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$286.31 $324.95 $365.89 $511.33 $777.01	$505.33 $543.97 $584.91 $730.35	$724.35 $762.99 $803.93 $949.37	$943.37 $982.01 $1,022.95 $1,168.39	$219.02
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$572.62 $649.90 $731.78 $1,022.66 $1,554.02	$791.64 $868.92 $950.80 $1,241.68	$1,010.66 $1,087.94 $1,169.82 $1,460.70	$1,229.68 $1,306.96 $1,388.84 $1,679.72	$219.02

Toc - Plan #126 Oscar Insurance Company of Florida
Expanded Bronze (EPO) Bronze Classic- PCP Saver
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $7,500 $15,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$294.20 $333.91 $375.98 $525.43 $798.44	$519.26 $558.97 $601.04 $750.49	$744.32 $784.03 $826.10 $975.55	$969.38 $1,009.09 $1,051.16 $1,200.61	$225.06
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$588.40 $667.82 $751.96 $1,050.86 $1,596.88	$813.46 $892.88 $977.02 $1,275.92	$1,038.52 $1,117.94 $1,202.08 $1,500.98	$1,263.58 $1,343.00 $1,427.14 $1,726.04	$225.06

Toc - Plan #127 Oscar Insurance Company of Florida
Expanded Bronze (EPO) Bronze Classic
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $7,500 $15,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$287.09 $325.83 $366.88 $512.72 $779.13	$506.70 $545.44 $586.49 $732.33	$726.31 $765.05 $806.10 $951.94	$945.92 $984.66 $1,025.71 $1,171.55	$219.61
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$574.18 $651.66 $733.76 $1,025.44 $1,558.26	$793.79 $871.27 $953.37 $1,245.05	$1,013.40 $1,090.88 $1,172.98 $1,464.66	$1,233.01 $1,310.49 $1,392.59 $1,684.27	$219.61

Toc - Plan #128 Oscar Insurance Company of Florida
Expanded Bronze (EPO) Bronze Elite- $0 Ded+PCP Saver
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$335.13 $380.36 $428.28 $598.52 $909.51	$591.49 $636.72 $684.64 $854.88	$847.85 $893.08 $941.00 $1,111.24	$1,104.21 $1,149.44 $1,197.36 $1,367.60	$256.36
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$670.26 $760.72 $856.56 $1,197.04 $1,819.02	$926.62 $1,017.08 $1,112.92 $1,453.40	$1,182.98 $1,273.44 $1,369.28 $1,709.76	$1,439.34 $1,529.80 $1,625.64 $1,966.12	$256.36

Toc - Plan #129 Oscar Insurance Company of Florida
Silver (EPO) Silver Classic
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $5,750 $11,500 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$372.54 $422.82 $476.10 $665.34 $1,011.05	$657.53 $707.81 $761.09 $950.33	$942.52 $992.80 $1,046.08 $1,235.32	$1,227.51 $1,277.79 $1,331.07 $1,520.31	$284.99
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$745.08 $845.64 $952.20 $1,330.68 $2,022.10	$1,030.07 $1,130.63 $1,237.19 $1,615.67	$1,315.06 $1,415.62 $1,522.18 $1,900.66	$1,600.05 $1,700.61 $1,807.17 $2,185.65	$284.99

Toc - Plan #130 Oscar Insurance Company of Florida
Silver (EPO) Silver Simple- Specialist Saver
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $6,450 $12,900 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$370.56 $420.57 $473.56 $661.80 $1,005.67	$654.03 $704.04 $757.03 $945.27	$937.50 $987.51 $1,040.50 $1,228.74	$1,220.97 $1,270.98 $1,323.97 $1,512.21	$283.47
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$741.12 $841.14 $947.12 $1,323.60 $2,011.34	$1,024.59 $1,124.61 $1,230.59 $1,607.07	$1,308.06 $1,408.08 $1,514.06 $1,890.54	$1,591.53 $1,691.55 $1,797.53 $2,174.01	$283.47

Toc - Plan #131 Oscar Insurance Company of Florida
Silver (EPO) Silver Classic- PCP Saver
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $6,000 $12,000 Annual Deductible $8,450 $16,900 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$372.87 $423.19 $476.51 $665.92 $1,011.93	$658.10 $708.42 $761.74 $951.15	$943.33 $993.65 $1,046.97 $1,236.38	$1,228.56 $1,278.88 $1,332.20 $1,521.61	$285.23
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$745.74 $846.38 $953.02 $1,331.84 $2,023.86	$1,030.97 $1,131.61 $1,238.25 $1,617.07	$1,316.20 $1,416.84 $1,523.48 $1,902.30	$1,601.43 $1,702.07 $1,808.71 $2,187.53	$285.23

Toc - Plan #132 Oscar Insurance Company of Florida
Catastrophic (EPO) Secure
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $8,700 $17,400 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$222.20 $252.18 $283.95 $396.83 $603.01	$392.17 $422.15 $453.92 $566.80	$562.14 $592.12 $623.89 $736.77	$732.11 $762.09 $793.86 $906.74	$169.97
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$444.40 $504.36 $567.90 $793.66 $1,206.02	$614.37 $674.33 $737.87 $963.63	$784.34 $844.30 $907.84 $1,133.60	$954.31 $1,014.27 $1,077.81 $1,303.57	$169.97

Toc - Plan #133 Oscar Insurance Company of Florida
Expanded Bronze (EPO) Bronze Elite- $0 Ded+Specialist Saver
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$335.30 $380.55 $428.50 $598.82 $909.97	$591.79 $637.04 $684.99 $855.31	$848.28 $893.53 $941.48 $1,111.80	$1,104.77 $1,150.02 $1,197.97 $1,368.29	$256.49
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$670.60 $761.10 $857.00 $1,197.64 $1,819.94	$927.09 $1,017.59 $1,113.49 $1,454.13	$1,183.58 $1,274.08 $1,369.98 $1,710.62	$1,440.07 $1,530.57 $1,626.47 $1,967.11	$256.49

Toc - Plan #134 Oscar Insurance Company of Florida
Gold (EPO) Gold Classic
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $3,500 $7,000 Annual Deductible $6,000 $12,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$399.62 $453.56 $510.70 $713.70 $1,084.54	$705.32 $759.26 $816.40 $1,019.40	$1,011.02 $1,064.96 $1,122.10 $1,325.10	$1,316.72 $1,370.66 $1,427.80 $1,630.80	$305.70
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$799.24 $907.12 $1,021.40 $1,427.40 $2,169.08	$1,104.94 $1,212.82 $1,327.10 $1,733.10	$1,410.64 $1,518.52 $1,632.80 $2,038.80	$1,716.34 $1,824.22 $1,938.50 $2,344.50	$305.70

Toc - Plan #135 Oscar Insurance Company of Florida
Expanded Bronze (EPO) Bronze Simple- HSA
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $5,200 $10,400 Annual Deductible $7,000 $14,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$309.49 $351.26 $395.52 $552.74 $839.94	$546.25 $588.02 $632.28 $789.50	$783.01 $824.78 $869.04 $1,026.26	$1,019.77 $1,061.54 $1,105.80 $1,263.02	$236.76
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$618.98 $702.52 $791.04 $1,105.48 $1,679.88	$855.74 $939.28 $1,027.80 $1,342.24	$1,092.50 $1,176.04 $1,264.56 $1,579.00	$1,329.26 $1,412.80 $1,501.32 $1,815.76	$236.76

Toc - Plan #136 Oscar Insurance Company of Florida
Silver (EPO) Silver Simple
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $4,200 $8,400 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$369.51 $419.38 $472.22 $659.92 $1,002.82	$652.18 $702.05 $754.89 $942.59	$934.85 $984.72 $1,037.56 $1,225.26	$1,217.52 $1,267.39 $1,320.23 $1,507.93	$282.67
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$739.02 $838.76 $944.44 $1,319.84 $2,005.64	$1,021.69 $1,121.43 $1,227.11 $1,602.51	$1,304.36 $1,404.10 $1,509.78 $1,885.18	$1,587.03 $1,686.77 $1,792.45 $2,167.85	$282.67

Toc - Plan #137 Oscar Insurance Company of Florida
Silver (EPO) Silver Elite
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $7,000 $14,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$377.27 $428.19 $482.13 $673.78 $1,023.87	$665.87 $716.79 $770.73 $962.38	$954.47 $1,005.39 $1,059.33 $1,250.98	$1,243.07 $1,293.99 $1,347.93 $1,539.58	$288.60
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$754.54 $856.38 $964.26 $1,347.56 $2,047.74	$1,043.14 $1,144.98 $1,252.86 $1,636.16	$1,331.74 $1,433.58 $1,541.46 $1,924.76	$1,620.34 $1,722.18 $1,830.06 $2,213.36	$288.60

Toc - Plan #138 Oscar Insurance Company of Florida
Silver (EPO) Silver Classic- $0 Ded
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$379.56 $430.79 $485.06 $677.87 $1,030.09	$669.91 $721.14 $775.41 $968.22	$960.26 $1,011.49 $1,065.76 $1,258.57	$1,250.61 $1,301.84 $1,356.11 $1,548.92	$290.35
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$759.12 $861.58 $970.12 $1,355.74 $2,060.18	$1,049.47 $1,151.93 $1,260.47 $1,646.09	$1,339.82 $1,442.28 $1,550.82 $1,936.44	$1,630.17 $1,732.63 $1,841.17 $2,226.79	$290.35

Toc - Plan #139 Oscar Insurance Company of Florida
Gold (EPO) Gold Classic- Low Ded
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $1,250 $2,500 Annual Deductible $7,000 $14,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$400.60 $454.67 $511.96 $715.46 $1,087.21	$707.05 $761.12 $818.41 $1,021.91	$1,013.50 $1,067.57 $1,124.86 $1,328.36	$1,319.95 $1,374.02 $1,431.31 $1,634.81	$306.45
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$801.20 $909.34 $1,023.92 $1,430.92 $2,174.42	$1,107.65 $1,215.79 $1,330.37 $1,737.37	$1,414.10 $1,522.24 $1,636.82 $2,043.82	$1,720.55 $1,828.69 $1,943.27 $2,350.27	$306.45

Toc - Plan #140 Oscar Insurance Company of Florida
Expanded Bronze (EPO) Bronze Classic- $0 PCP
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $8,000 $16,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$302.11 $342.88 $386.09 $539.55 $819.90	$533.22 $573.99 $617.20 $770.66	$764.33 $805.10 $848.31 $1,001.77	$995.44 $1,036.21 $1,079.42 $1,232.88	$231.11
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$604.22 $685.76 $772.18 $1,079.10 $1,639.80	$835.33 $916.87 $1,003.29 $1,310.21	$1,066.44 $1,147.98 $1,234.40 $1,541.32	$1,297.55 $1,379.09 $1,465.51 $1,772.43	$231.11

Toc - Plan #141 Oscar Insurance Company of Florida
Expanded Bronze (EPO) Bronze Classic- Specialist Saver
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $3,500 $7,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$321.92 $365.37 $411.41 $574.94 $873.67	$568.18 $611.63 $657.67 $821.20	$814.44 $857.89 $903.93 $1,067.46	$1,060.70 $1,104.15 $1,150.19 $1,313.72	$246.26
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$643.84 $730.74 $822.82 $1,149.88 $1,747.34	$890.10 $977.00 $1,069.08 $1,396.14	$1,136.36 $1,223.26 $1,315.34 $1,642.40	$1,382.62 $1,469.52 $1,561.60 $1,888.66	$246.26

Toc - Plan #142 Oscar Insurance Company of Florida
Expanded Bronze (EPO) Bronze Classic- $4700 Ded
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $4,700 $9,400 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$307.48 $348.98 $392.95 $549.14 $834.47	$542.69 $584.19 $628.16 $784.35	$777.90 $819.40 $863.37 $1,019.56	$1,013.11 $1,054.61 $1,098.58 $1,254.77	$235.21
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$614.96 $697.96 $785.90 $1,098.28 $1,668.94	$850.17 $933.17 $1,021.11 $1,333.49	$1,085.38 $1,168.38 $1,256.32 $1,568.70	$1,320.59 $1,403.59 $1,491.53 $1,803.91	$235.21

Toc - Plan #143 Oscar Insurance Company of Florida
Silver (EPO) Silver Simple- PCP Saver
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $5,000 $10,000 Annual Deductible $8,600 $17,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$366.53 $415.99 $468.41 $654.60 $994.72	$646.91 $696.37 $748.79 $934.98	$927.29 $976.75 $1,029.17 $1,215.36	$1,207.67 $1,257.13 $1,309.55 $1,495.74	$280.38
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$733.06 $831.98 $936.82 $1,309.20 $1,989.44	$1,013.44 $1,112.36 $1,217.20 $1,589.58	$1,293.82 $1,392.74 $1,497.58 $1,869.96	$1,574.20 $1,673.12 $1,777.96 $2,150.34	$280.38

Toc - Plan #144 Oscar Insurance Company of Florida
Silver (EPO) Silver Classic- Low Ded
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $1,500 $3,000 Annual Deductible $8,000 $16,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$371.65 $421.82 $474.96 $663.76 $1,008.64	$655.96 $706.13 $759.27 $948.07	$940.27 $990.44 $1,043.58 $1,232.38	$1,224.58 $1,274.75 $1,327.89 $1,516.69	$284.31
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$743.30 $843.64 $949.92 $1,327.52 $2,017.28	$1,027.61 $1,127.95 $1,234.23 $1,611.83	$1,311.92 $1,412.26 $1,518.54 $1,896.14	$1,596.23 $1,696.57 $1,802.85 $2,180.45	$284.31

Toc - Plan #145 Oscar Insurance Company of Florida
Silver (EPO) Silver Elite- $0 PCP
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $3,500 $7,000 Annual Deductible $7,500 $15,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$381.16 $432.61 $487.11 $680.74 $1,034.45	$672.74 $724.19 $778.69 $972.32	$964.32 $1,015.77 $1,070.27 $1,263.90	$1,255.90 $1,307.35 $1,361.85 $1,555.48	$291.58
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$762.32 $865.22 $974.22 $1,361.48 $2,068.90	$1,053.90 $1,156.80 $1,265.80 $1,653.06	$1,345.48 $1,448.38 $1,557.38 $1,944.64	$1,637.06 $1,739.96 $1,848.96 $2,236.22	$291.58

Toc - Plan #146 Oscar Insurance Company of Florida
Silver (EPO) Silver Simple- HSA
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $4,500 $9,000 Annual Deductible $4,500 $9,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$375.85 $426.58 $480.33 $671.26 $1,020.04	$663.37 $714.10 $767.85 $958.78	$950.89 $1,001.62 $1,055.37 $1,246.30	$1,238.41 $1,289.14 $1,342.89 $1,533.82	$287.52
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$751.70 $853.16 $960.66 $1,342.52 $2,040.08	$1,039.22 $1,140.68 $1,248.18 $1,630.04	$1,326.74 $1,428.20 $1,535.70 $1,917.56	$1,614.26 $1,715.72 $1,823.22 $2,205.08	$287.52

Toc - Plan #147 Oscar Insurance Company of Florida
Silver (EPO) Silver Elite- $0 Ded
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$372.96 $423.30 $476.63 $666.09 $1,012.20	$658.27 $708.61 $761.94 $951.40	$943.58 $993.92 $1,047.25 $1,236.71	$1,228.89 $1,279.23 $1,332.56 $1,522.02	$285.31
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$745.92 $846.60 $953.26 $1,332.18 $2,024.40	$1,031.23 $1,131.91 $1,238.57 $1,617.49	$1,316.54 $1,417.22 $1,523.88 $1,902.80	$1,601.85 $1,702.53 $1,809.19 $2,188.11	$285.31

Toc - Plan #148 Oscar Insurance Company of Florida
Gold (EPO) Gold Simple
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $2,000 $4,000 Annual Deductible $6,550 $13,100 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$385.20 $437.19 $492.28 $687.95 $1,045.41	$679.87 $731.86 $786.95 $982.62	$974.54 $1,026.53 $1,081.62 $1,277.29	$1,269.21 $1,321.20 $1,376.29 $1,571.96	$294.67
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$770.40 $874.38 $984.56 $1,375.90 $2,090.82	$1,065.07 $1,169.05 $1,279.23 $1,670.57	$1,359.74 $1,463.72 $1,573.90 $1,965.24	$1,654.41 $1,758.39 $1,868.57 $2,259.91	$294.67

Toc - Plan #149 Oscar Insurance Company of Florida
Gold (EPO) Gold Classic- $0 PCP
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $5,000 $10,000 Annual Deductible $6,750 $13,500 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$391.75 $444.62 $500.64 $699.64 $1,063.17	$691.43 $744.30 $800.32 $999.32	$991.11 $1,043.98 $1,100.00 $1,299.00	$1,290.79 $1,343.66 $1,399.68 $1,598.68	$299.68
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$783.50 $889.24 $1,001.28 $1,399.28 $2,126.34	$1,083.18 $1,188.92 $1,300.96 $1,698.96	$1,382.86 $1,488.60 $1,600.64 $1,998.64	$1,682.54 $1,788.28 $1,900.32 $2,298.32	$299.68

Toc - Plan #150 Oscar Insurance Company of Florida
Gold (EPO) Gold Elite- $0 Ded
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $8,000 $16,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$430.25 $488.33 $549.85 $768.41 $1,167.68	$759.39 $817.47 $878.99 $1,097.55	$1,088.53 $1,146.61 $1,208.13 $1,426.69	$1,417.67 $1,475.75 $1,537.27 $1,755.83	$329.14
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$860.50 $976.66 $1,099.70 $1,536.82 $2,335.36	$1,189.64 $1,305.80 $1,428.84 $1,865.96	$1,518.78 $1,634.94 $1,757.98 $2,195.10	$1,847.92 $1,964.08 $2,087.12 $2,524.24	$329.14

Toc - Plan #151 Oscar Insurance Company of Florida
Gold (EPO) Gold Elite
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $500 $1,000 Annual Deductible $5,000 $10,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$408.65 $463.80 $522.24 $729.82 $1,109.04	$721.26 $776.41 $834.85 $1,042.43	$1,033.87 $1,089.02 $1,147.46 $1,355.04	$1,346.48 $1,401.63 $1,460.07 $1,667.65	$312.61
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$817.30 $927.60 $1,044.48 $1,459.64 $2,218.08	$1,129.91 $1,240.21 $1,357.09 $1,772.25	$1,442.52 $1,552.82 $1,669.70 $2,084.86	$1,755.13 $1,865.43 $1,982.31 $2,397.47	$312.61

Toc - Plan #152 Oscar Insurance Company of Florida
Gold (EPO) Gold Classic- HSA
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $2,850 $5,700 Annual Deductible $5,500 $11,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$384.18 $436.03 $490.97 $686.13 $1,042.64	$678.07 $729.92 $784.86 $980.02	$971.96 $1,023.81 $1,078.75 $1,273.91	$1,265.85 $1,317.70 $1,372.64 $1,567.80	$293.89
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$768.36 $872.06 $981.94 $1,372.26 $2,085.28	$1,062.25 $1,165.95 $1,275.83 $1,666.15	$1,356.14 $1,459.84 $1,569.72 $1,960.04	$1,650.03 $1,753.73 $1,863.61 $2,253.93	$293.89

Toc - Plan #153 Oscar Insurance Company of Florida
Expanded Bronze (EPO) Bronze Classic- $4000 Ded
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $4,000 $8,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$323.47 $367.12 $413.38 $577.69 $877.86	$570.91 $614.56 $660.82 $825.13	$818.35 $862.00 $908.26 $1,072.57	$1,065.79 $1,109.44 $1,155.70 $1,320.01	$247.44
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$646.94 $734.24 $826.76 $1,155.38 $1,755.72	$894.38 $981.68 $1,074.20 $1,402.82	$1,141.82 $1,229.12 $1,321.64 $1,650.26	$1,389.26 $1,476.56 $1,569.08 $1,897.70	$247.44

Toc - Plan #154 Oscar Insurance Company of Florida
Expanded Bronze (EPO) Bronze Elite- $1000 Ded
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $1,000 $2,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$330.82 $375.47 $422.78 $590.83 $897.82	$583.89 $628.54 $675.85 $843.90	$836.96 $881.61 $928.92 $1,096.97	$1,090.03 $1,134.68 $1,181.99 $1,350.04	$253.07
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$661.64 $750.94 $845.56 $1,181.66 $1,795.64	$914.71 $1,004.01 $1,098.63 $1,434.73	$1,167.78 $1,257.08 $1,351.70 $1,687.80	$1,420.85 $1,510.15 $1,604.77 $1,940.87	$253.07

Toc - Plan #155 Oscar Insurance Company of Florida
Expanded Bronze (EPO) Bronze Elite- $0 Ded
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$331.90 $376.69 $424.15 $592.75 $900.74	$585.79 $630.58 $678.04 $846.64	$839.68 $884.47 $931.93 $1,100.53	$1,093.57 $1,138.36 $1,185.82 $1,354.42	$253.89
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$663.80 $753.38 $848.30 $1,185.50 $1,801.48	$917.69 $1,007.27 $1,102.19 $1,439.39	$1,171.58 $1,261.16 $1,356.08 $1,693.28	$1,425.47 $1,515.05 $1,609.97 $1,947.17	$253.89

Toc - Plan #156 Oscar Insurance Company of Florida
Silver (EPO) Silver Simple- For Diabetes
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $6,450 $12,900 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$371.63 $421.79 $474.93 $663.71 $1,008.58	$655.92 $706.08 $759.22 $948.00	$940.21 $990.37 $1,043.51 $1,232.29	$1,224.50 $1,274.66 $1,327.80 $1,516.58	$284.29
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$743.26 $843.58 $949.86 $1,327.42 $2,017.16	$1,027.55 $1,127.87 $1,234.15 $1,611.71	$1,311.84 $1,412.16 $1,518.44 $1,896.00	$1,596.13 $1,696.45 $1,802.73 $2,180.29	$284.29

Cigna Healthcare Local: 1-877-900-1237 | Toll Free: 1-877-900-1237 | TTY: 1-800-676-3777

Toc - Plan #157 Cigna Healthcare
Bronze (EPO) Cigna Connect 8700A ($0 Telehealth)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-900-1237 Annual Out of Pocket Expenses: Individual Family $8,700 $17,400 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$300.77 $341.37 $384.38 $537.17 $816.28	$530.86 $571.46 $614.47 $767.26	$760.95 $801.55 $844.56 $997.35	$991.04 $1,031.64 $1,074.65 $1,227.44	$230.09
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$601.54 $682.74 $768.76 $1,074.34 $1,632.56	$831.63 $912.83 $998.85 $1,304.43	$1,061.72 $1,142.92 $1,228.94 $1,534.52	$1,291.81 $1,373.01 $1,459.03 $1,764.61	$230.09

Toc - Plan #158 Cigna Healthcare
Expanded Bronze (EPO) Cigna Connect 7300 ($0 Telehealth)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-900-1237 Annual Out of Pocket Expenses: Individual Family $7,300 $14,600 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$317.10 $359.91 $405.26 $566.34 $860.61	$559.68 $602.49 $647.84 $808.92	$802.26 $845.07 $890.42 $1,051.50	$1,044.84 $1,087.65 $1,133.00 $1,294.08	$242.58
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$634.20 $719.82 $810.52 $1,132.68 $1,721.22	$876.78 $962.40 $1,053.10 $1,375.26	$1,119.36 $1,204.98 $1,295.68 $1,617.84	$1,361.94 $1,447.56 $1,538.26 $1,860.42	$242.58

Toc - Plan #159 Cigna Healthcare
Expanded Bronze (EPO) Cigna Connect 8200 ($0 Telehealth)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-900-1237 Annual Out of Pocket Expenses: Individual Family $8,200 $16,400 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$314.39 $356.83 $401.78 $561.49 $853.24	$554.90 $597.34 $642.29 $802.00	$795.41 $837.85 $882.80 $1,042.51	$1,035.92 $1,078.36 $1,123.31 $1,283.02	$240.51
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$628.78 $713.66 $803.56 $1,122.98 $1,706.48	$869.29 $954.17 $1,044.07 $1,363.49	$1,109.80 $1,194.68 $1,284.58 $1,604.00	$1,350.31 $1,435.19 $1,525.09 $1,844.51	$240.51

Toc - Plan #160 Cigna Healthcare
Silver (EPO) Cigna Connect 6000 ($0 Telehealth)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-900-1237 Annual Out of Pocket Expenses: Individual Family $6,000 $12,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$381.79 $433.33 $487.93 $681.88 $1,036.18	$673.86 $725.40 $780.00 $973.95	$965.93 $1,017.47 $1,072.07 $1,266.02	$1,258.00 $1,309.54 $1,364.14 $1,558.09	$292.07
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$763.58 $866.66 $975.86 $1,363.76 $2,072.36	$1,055.65 $1,158.73 $1,267.93 $1,655.83	$1,347.72 $1,450.80 $1,560.00 $1,947.90	$1,639.79 $1,742.87 $1,852.07 $2,239.97	$292.07

Toc - Plan #161 Cigna Healthcare
Silver (EPO) Cigna Connect 4500 ($0 Telehealth)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-900-1237 Annual Out of Pocket Expenses: Individual Family $4,500 $9,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$387.47 $439.78 $495.18 $692.02 $1,051.59	$683.88 $736.19 $791.59 $988.43	$980.29 $1,032.60 $1,088.00 $1,284.84	$1,276.70 $1,329.01 $1,384.41 $1,581.25	$296.41
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$774.94 $879.56 $990.36 $1,384.04 $2,103.18	$1,071.35 $1,175.97 $1,286.77 $1,680.45	$1,367.76 $1,472.38 $1,583.18 $1,976.86	$1,664.17 $1,768.79 $1,879.59 $2,273.27	$296.41

Toc - Plan #162 Cigna Healthcare
Silver (EPO) Cigna Connect 8700B ($0 Telehealth)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-900-1237 Annual Out of Pocket Expenses: Individual Family $8,700 $17,400 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$391.21 $444.03 $499.97 $698.71 $1,061.75	$690.49 $743.31 $799.25 $997.99	$989.77 $1,042.59 $1,098.53 $1,297.27	$1,289.05 $1,341.87 $1,397.81 $1,596.55	$299.28
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$782.42 $888.06 $999.94 $1,397.42 $2,123.50	$1,081.70 $1,187.34 $1,299.22 $1,696.70	$1,380.98 $1,486.62 $1,598.50 $1,995.98	$1,680.26 $1,785.90 $1,897.78 $2,295.26	$299.28

Toc - Plan #163 Cigna Healthcare
Silver (EPO) Cigna Connect 3500 ($0 Tier 1 RX, $0 Telehealth)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-900-1237 Annual Out of Pocket Expenses: Individual Family $3,500 $7,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$400.02 $454.02 $511.22 $714.43 $1,085.65	$706.03 $760.03 $817.23 $1,020.44	$1,012.04 $1,066.04 $1,123.24 $1,326.45	$1,318.05 $1,372.05 $1,429.25 $1,632.46	$306.01
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$800.04 $908.04 $1,022.44 $1,428.86 $2,171.30	$1,106.05 $1,214.05 $1,328.45 $1,734.87	$1,412.06 $1,520.06 $1,634.46 $2,040.88	$1,718.07 $1,826.07 $1,940.47 $2,346.89	$306.01

Toc - Plan #164 Cigna Healthcare
Gold (EPO) Cigna Connect 2000 ($0 Tier 1 RX, $0 Telehealth)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-900-1237 Annual Out of Pocket Expenses: Individual Family $2,000 $4,000 Annual Deductible $8,000 $16,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$433.72 $492.27 $554.30 $774.63 $1,177.12	$765.52 $824.07 $886.10 $1,106.43	$1,097.32 $1,155.87 $1,217.90 $1,438.23	$1,429.12 $1,487.67 $1,549.70 $1,770.03	$331.80
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$867.44 $984.54 $1,108.60 $1,549.26 $2,354.24	$1,199.24 $1,316.34 $1,440.40 $1,881.06	$1,531.04 $1,648.14 $1,772.20 $2,212.86	$1,862.84 $1,979.94 $2,104.00 $2,544.66	$331.80

Toc - Plan #165 Cigna Healthcare
Expanded Bronze (EPO) Cigna Connect 8000 ($0 Telehealth)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-900-1237 Annual Out of Pocket Expenses: Individual Family $8,000 $16,000 Annual Deductible $8,700 $16,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$313.27 $355.57 $400.37 $559.51 $850.23	$552.93 $595.23 $640.03 $799.17	$792.59 $834.89 $879.69 $1,038.83	$1,032.25 $1,074.55 $1,119.35 $1,278.49	$239.66
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$626.54 $711.14 $800.74 $1,119.02 $1,700.46	$866.20 $950.80 $1,040.40 $1,358.68	$1,105.86 $1,190.46 $1,280.06 $1,598.34	$1,345.52 $1,430.12 $1,519.72 $1,838.00	$239.66

Toc - Plan #166 Cigna Healthcare
Expanded Bronze (EPO) Cigna Connect 6800 Enhanced Diabetes Care ($0 Preferred Insulin)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-900-1237 Annual Out of Pocket Expenses: Individual Family $6,800 $13,600 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$314.26 $356.69 $401.63 $561.27 $852.91	$554.67 $597.10 $642.04 $801.68	$795.08 $837.51 $882.45 $1,042.09	$1,035.49 $1,077.92 $1,122.86 $1,282.50	$240.41
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$628.52 $713.38 $803.26 $1,122.54 $1,705.82	$868.93 $953.79 $1,043.67 $1,362.95	$1,109.34 $1,194.20 $1,284.08 $1,603.36	$1,349.75 $1,434.61 $1,524.49 $1,843.77	$240.41

Toc - Plan #167 Cigna Healthcare
Silver (EPO) Cigna Connect 8400 ($0 Tier 1 RX, $0 Telehealth)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-900-1237 Annual Out of Pocket Expenses: Individual Family $8,400 $16,800 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$399.15 $453.04 $510.12 $712.89 $1,083.31	$704.50 $758.39 $815.47 $1,018.24	$1,009.85 $1,063.74 $1,120.82 $1,323.59	$1,315.20 $1,369.09 $1,426.17 $1,628.94	$305.35
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$798.30 $906.08 $1,020.24 $1,425.78 $2,166.62	$1,103.65 $1,211.43 $1,325.59 $1,731.13	$1,409.00 $1,516.78 $1,630.94 $2,036.48	$1,714.35 $1,822.13 $1,936.29 $2,341.83	$305.35

Toc - Plan #168 Cigna Healthcare
Silver (EPO) Cigna Connect 3000 ($0 Telehealth)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-900-1237 Annual Out of Pocket Expenses: Individual Family $3,000 $6,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$377.63 $428.61 $482.62 $674.45 $1,024.90	$666.52 $717.50 $771.51 $963.34	$955.41 $1,006.39 $1,060.40 $1,252.23	$1,244.30 $1,295.28 $1,349.29 $1,541.12	$288.89
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$755.26 $857.22 $965.24 $1,348.90 $2,049.80	$1,044.15 $1,146.11 $1,254.13 $1,637.79	$1,333.04 $1,435.00 $1,543.02 $1,926.68	$1,621.93 $1,723.89 $1,831.91 $2,215.57	$288.89

Toc - Plan #169 Cigna Healthcare
Silver (EPO) Cigna Connect 0 ($0 Deductible, $0 Telehealth)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-900-1237 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$408.74 $463.92 $522.37 $730.01 $1,109.33	$721.43 $776.61 $835.06 $1,042.70	$1,034.12 $1,089.30 $1,147.75 $1,355.39	$1,346.81 $1,401.99 $1,460.44 $1,668.08	$312.69
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$817.48 $927.84 $1,044.74 $1,460.02 $2,218.66	$1,130.17 $1,240.53 $1,357.43 $1,772.71	$1,442.86 $1,553.22 $1,670.12 $2,085.40	$1,755.55 $1,865.91 $1,982.81 $2,398.09	$312.69

Toc - Plan #170 Cigna Healthcare
Silver (EPO) Cigna Connect 4200 Enhanced Asthma COPD Care ($0 Telehealth)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-900-1237 Annual Out of Pocket Expenses: Individual Family $4,200 $8,400 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$392.24 $445.19 $501.28 $700.54 $1,064.54	$692.30 $745.25 $801.34 $1,000.60	$992.36 $1,045.31 $1,101.40 $1,300.66	$1,292.42 $1,345.37 $1,401.46 $1,600.72	$300.06
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$784.48 $890.38 $1,002.56 $1,401.08 $2,129.08	$1,084.54 $1,190.44 $1,302.62 $1,701.14	$1,384.60 $1,490.50 $1,602.68 $2,001.20	$1,684.66 $1,790.56 $1,902.74 $2,301.26	$300.06

Toc - Plan #171 Cigna Healthcare
Gold (EPO) Cigna Connect 1250 Enhanced Diabetes Care ($0 Preferred Insulin)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-900-1237 Annual Out of Pocket Expenses: Individual Family $1,250 $2,500 Annual Deductible $7,500 $15,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$451.25 $512.17 $576.70 $805.93 $1,224.69	$796.46 $857.38 $921.91 $1,151.14	$1,141.67 $1,202.59 $1,267.12 $1,496.35	$1,486.88 $1,547.80 $1,612.33 $1,841.56	$345.21
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$902.50 $1,024.34 $1,153.40 $1,611.86 $2,449.38	$1,247.71 $1,369.55 $1,498.61 $1,957.07	$1,592.92 $1,714.76 $1,843.82 $2,302.28	$1,938.13 $2,059.97 $2,189.03 $2,647.49	$345.21

Toc - Plan #172 Cigna Healthcare
Expanded Bronze (EPO) Cigna Connect 5400 ($0 Telehealth)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-900-1237 Annual Out of Pocket Expenses: Individual Family $5,400 $10,800 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$316.03 $358.70 $403.89 $564.43 $857.71	$557.79 $600.46 $645.65 $806.19	$799.55 $842.22 $887.41 $1,047.95	$1,041.31 $1,083.98 $1,129.17 $1,289.71	$241.76
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$632.06 $717.40 $807.78 $1,128.86 $1,715.42	$873.82 $959.16 $1,049.54 $1,370.62	$1,115.58 $1,200.92 $1,291.30 $1,612.38	$1,357.34 $1,442.68 $1,533.06 $1,854.14	$241.76

Toc - Plan #173 Cigna Healthcare
Silver (EPO) Cigna Connect 3500 Enhanced Diabetes Care ($0 Preferred Insulin)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-900-1237 Annual Out of Pocket Expenses: Individual Family $3,500 $7,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$401.79 $456.03 $513.49 $717.59 $1,090.45	$709.16 $763.40 $820.86 $1,024.96	$1,016.53 $1,070.77 $1,128.23 $1,332.33	$1,323.90 $1,378.14 $1,435.60 $1,639.70	$307.37
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$803.58 $912.06 $1,026.98 $1,435.18 $2,180.90	$1,110.95 $1,219.43 $1,334.35 $1,742.55	$1,418.32 $1,526.80 $1,641.72 $2,049.92	$1,725.69 $1,834.17 $1,949.09 $2,357.29	$307.37

Molina Healthcare Local: 1-888-560-5716 | Toll Free: 1-888-560-5716 | TTY: 1-800-955-8771

Toc - Plan #174 Molina Healthcare
Gold (HMO) Confident Care Gold 1
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-560-5716 Annual Out of Pocket Expenses: Individual Family $2,100 $4,200 Annual Deductible $8,550 $17,100 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$461.84 $524.19 $590.23 $824.85 $1,253.44	$815.15 $877.50 $943.54 $1,178.16	$1,168.46 $1,230.81 $1,296.85 $1,531.47	$1,521.77 $1,584.12 $1,650.16 $1,884.78	$353.31
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$923.68 $1,048.38 $1,180.46 $1,649.70 $2,506.88	$1,276.99 $1,401.69 $1,533.77 $2,003.01	$1,630.30 $1,755.00 $1,887.08 $2,356.32	$1,983.61 $2,108.31 $2,240.39 $2,709.63	$353.31

Toc - Plan #175 Molina Healthcare
Silver (HMO) Constant Care Silver 1
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-560-5716 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $8,500 $17,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$410.95 $466.43 $525.20 $733.96 $1,115.32	$725.33 $780.81 $839.58 $1,048.34	$1,039.71 $1,095.19 $1,153.96 $1,362.72	$1,354.09 $1,409.57 $1,468.34 $1,677.10	$314.38
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$821.90 $932.86 $1,050.40 $1,467.92 $2,230.64	$1,136.28 $1,247.24 $1,364.78 $1,782.30	$1,450.66 $1,561.62 $1,679.16 $2,096.68	$1,765.04 $1,876.00 $1,993.54 $2,411.06	$314.38

Toc - Plan #176 Molina Healthcare
Bronze (HMO) Core Care Bronze 1
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-560-5716 Annual Out of Pocket Expenses: Individual Family $6,100 $12,200 Annual Deductible $8,550 $17,100 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$311.36 $353.40 $397.92 $556.09 $845.03	$549.55 $591.59 $636.11 $794.28	$787.74 $829.78 $874.30 $1,032.47	$1,025.93 $1,067.97 $1,112.49 $1,270.66	$238.19
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$622.72 $706.80 $795.84 $1,112.18 $1,690.06	$860.91 $944.99 $1,034.03 $1,350.37	$1,099.10 $1,183.18 $1,272.22 $1,588.56	$1,337.29 $1,421.37 $1,510.41 $1,826.75	$238.19

Toc - Plan #177 Molina Healthcare
Silver (HMO) Constant Care Silver 4
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-560-5716 Annual Out of Pocket Expenses: Individual Family $7,450 $14,900 Annual Deductible $7,450 $14,900 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$406.84 $461.77 $519.95 $726.62 $1,104.17	$718.08 $773.01 $831.19 $1,037.86	$1,029.32 $1,084.25 $1,142.43 $1,349.10	$1,340.56 $1,395.49 $1,453.67 $1,660.34	$311.24
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$813.68 $923.54 $1,039.90 $1,453.24 $2,208.34	$1,124.92 $1,234.78 $1,351.14 $1,764.48	$1,436.16 $1,546.02 $1,662.38 $2,075.72	$1,747.40 $1,857.26 $1,973.62 $2,386.96	$311.24

Toc - Plan #178 Molina Healthcare
Expanded Bronze (HMO) Core Care Bronze 4
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-560-5716 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $8,550 $17,100 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$347.34 $394.23 $443.90 $620.35 $942.68	$613.05 $659.94 $709.61 $886.06	$878.76 $925.65 $975.32 $1,151.77	$1,144.47 $1,191.36 $1,241.03 $1,417.48	$265.71
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$694.68 $788.46 $887.80 $1,240.70 $1,885.36	$960.39 $1,054.17 $1,153.51 $1,506.41	$1,226.10 $1,319.88 $1,419.22 $1,772.12	$1,491.81 $1,585.59 $1,684.93 $2,037.83	$265.71

Toc - Plan #179 Molina Healthcare
Silver (HMO) Constant Care Silver 7
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-560-5716 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $8,550 $17,100 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$402.37 $456.68 $514.22 $718.62 $1,092.02	$710.18 $764.49 $822.03 $1,026.43	$1,017.99 $1,072.30 $1,129.84 $1,334.24	$1,325.80 $1,380.11 $1,437.65 $1,642.05	$307.81
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$804.74 $913.36 $1,028.44 $1,437.24 $2,184.04	$1,112.55 $1,221.17 $1,336.25 $1,745.05	$1,420.36 $1,528.98 $1,644.06 $2,052.86	$1,728.17 $1,836.79 $1,951.87 $2,360.67	$307.81

Toc - Plan #180 Molina Healthcare
Gold (HMO) Confident Care Gold 1 + Vision
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-560-5716 Annual Out of Pocket Expenses: Individual Family $2,100 $4,200 Annual Deductible $8,550 $17,100 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$467.18 $530.25 $597.05 $834.38 $1,267.92	$824.57 $887.64 $954.44 $1,191.77	$1,181.96 $1,245.03 $1,311.83 $1,549.16	$1,539.35 $1,602.42 $1,669.22 $1,906.55	$357.39
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$934.36 $1,060.50 $1,194.10 $1,668.76 $2,535.84	$1,291.75 $1,417.89 $1,551.49 $2,026.15	$1,649.14 $1,775.28 $1,908.88 $2,383.54	$2,006.53 $2,132.67 $2,266.27 $2,740.93	$357.39

Toc - Plan #181 Molina Healthcare
Silver (HMO) Constant Care Silver 1 + Vision
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-560-5716 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $8,500 $17,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$414.42 $470.37 $529.63 $740.16 $1,124.74	$731.45 $787.40 $846.66 $1,057.19	$1,048.48 $1,104.43 $1,163.69 $1,374.22	$1,365.51 $1,421.46 $1,480.72 $1,691.25	$317.03
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$828.84 $940.74 $1,059.26 $1,480.32 $2,249.48	$1,145.87 $1,257.77 $1,376.29 $1,797.35	$1,462.90 $1,574.80 $1,693.32 $2,114.38	$1,779.93 $1,891.83 $2,010.35 $2,431.41	$317.03

Toc - Plan #182 Molina Healthcare
Silver (HMO) Constant Care Silver 2
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-560-5716 Annual Out of Pocket Expenses: Individual Family $5,200 $10,400 Annual Deductible $8,150 $16,300 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$408.69 $463.87 $522.31 $729.93 $1,109.20	$721.34 $776.52 $834.96 $1,042.58	$1,033.99 $1,089.17 $1,147.61 $1,355.23	$1,346.64 $1,401.82 $1,460.26 $1,667.88	$312.65
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$817.38 $927.74 $1,044.62 $1,459.86 $2,218.40	$1,130.03 $1,240.39 $1,357.27 $1,772.51	$1,442.68 $1,553.04 $1,669.92 $2,085.16	$1,755.33 $1,865.69 $1,982.57 $2,397.81	$312.65

Florida Health Care Plans Local: 1-386-676-7110 | Toll Free: 1-800-232-0578 | TTY: 1-800-955-8771

Toc - Plan #183 Florida Health Care Plans
Catastrophic (HMO) Gym Access IND Essential Plus Catastrophic HMO 36
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $8,700 $17,400 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$230.94 $262.12 $295.14 $412.46 $626.77	$407.61 $438.79 $471.81 $589.13	$584.28 $615.46 $648.48 $765.80	$760.95 $792.13 $825.15 $942.47	$176.67
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$461.88 $524.24 $590.28 $824.92 $1,253.54	$638.55 $700.91 $766.95 $1,001.59	$815.22 $877.58 $943.62 $1,178.26	$991.89 $1,054.25 $1,120.29 $1,354.93	$176.67

Toc - Plan #184 Florida Health Care Plans
Catastrophic (POS) Gym Access IND Essential Plus Catastrophic POS 37
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $8,700 $17,400 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$249.42 $283.09 $318.75 $445.46 $676.91	$440.22 $473.89 $509.55 $636.26	$631.02 $664.69 $700.35 $827.06	$821.82 $855.49 $891.15 $1,017.86	$190.80
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$498.84 $566.18 $637.50 $890.92 $1,353.82	$689.64 $756.98 $828.30 $1,081.72	$880.44 $947.78 $1,019.10 $1,272.52	$1,071.24 $1,138.58 $1,209.90 $1,463.32	$190.80

Toc - Plan #185 Florida Health Care Plans
Silver (HMO) Gym Access IND Essential Plus Silver HMO 53
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $2,900 $5,800 Annual Deductible $8,550 $17,100 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$415.61 $471.72 $531.15 $742.29 $1,127.98	$733.55 $789.66 $849.09 $1,060.23	$1,051.49 $1,107.60 $1,167.03 $1,378.17	$1,369.43 $1,425.54 $1,484.97 $1,696.11	$317.94
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$831.22 $943.44 $1,062.30 $1,484.58 $2,255.96	$1,149.16 $1,261.38 $1,380.24 $1,802.52	$1,467.10 $1,579.32 $1,698.18 $2,120.46	$1,785.04 $1,897.26 $2,016.12 $2,438.40	$317.94

Toc - Plan #186 Florida Health Care Plans
Gold (HMO) Gym Access IND Essential Plus Gold HMO 63
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $2,000 $4,000 Annual Deductible $5,100 $10,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$420.93 $477.75 $537.94 $751.77 $1,142.39	$742.94 $799.76 $859.95 $1,073.78	$1,064.95 $1,121.77 $1,181.96 $1,395.79	$1,386.96 $1,443.78 $1,503.97 $1,717.80	$322.01
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$841.86 $955.50 $1,075.88 $1,503.54 $2,284.78	$1,163.87 $1,277.51 $1,397.89 $1,825.55	$1,485.88 $1,599.52 $1,719.90 $2,147.56	$1,807.89 $1,921.53 $2,041.91 $2,469.57	$322.01

Toc - Plan #187 Florida Health Care Plans
Platinum (HMO) Gym Access IND Essential Plus Platinum HMO 65
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $2,000 $4,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$587.50 $666.81 $750.82 $1,049.27 $1,594.47	$1,036.93 $1,116.24 $1,200.25 $1,498.70	$1,486.36 $1,565.67 $1,649.68 $1,948.13	$1,935.79 $2,015.10 $2,099.11 $2,397.56	$449.43
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,175.00 $1,333.62 $1,501.64 $2,098.54 $3,188.94	$1,624.43 $1,783.05 $1,951.07 $2,547.97	$2,073.86 $2,232.48 $2,400.50 $2,997.40	$2,523.29 $2,681.91 $2,849.93 $3,446.83	$449.43

Toc - Plan #188 Florida Health Care Plans
Silver (POS) Gym Access IND Essential Plus Silver POS 54
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $2,900 $5,800 Annual Deductible $8,550 $17,100 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$428.83 $486.72 $548.05 $765.89 $1,163.85	$756.89 $814.78 $876.11 $1,093.95	$1,084.95 $1,142.84 $1,204.17 $1,422.01	$1,413.01 $1,470.90 $1,532.23 $1,750.07	$328.06
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$857.66 $973.44 $1,096.10 $1,531.78 $2,327.70	$1,185.72 $1,301.50 $1,424.16 $1,859.84	$1,513.78 $1,629.56 $1,752.22 $2,187.90	$1,841.84 $1,957.62 $2,080.28 $2,515.96	$328.06

Toc - Plan #189 Florida Health Care Plans
Platinum (HMO) Gym Access IND Platinum HMO 4000
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $4,000 $8,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$579.83 $658.11 $741.02 $1,035.57 $1,573.66	$1,023.40 $1,101.68 $1,184.59 $1,479.14	$1,466.97 $1,545.25 $1,628.16 $1,922.71	$1,910.54 $1,988.82 $2,071.73 $2,366.28	$443.57
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,159.66 $1,316.22 $1,482.04 $2,071.14 $3,147.32	$1,603.23 $1,759.79 $1,925.61 $2,514.71	$2,046.80 $2,203.36 $2,369.18 $2,958.28	$2,490.37 $2,646.93 $2,812.75 $3,401.85	$443.57

Toc - Plan #190 Florida Health Care Plans
Platinum (POS) Gym Access IND Platinum POS 4000
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $4,000 $8,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$626.22 $710.75 $800.30 $1,118.42 $1,699.55	$1,105.27 $1,189.80 $1,279.35 $1,597.47	$1,584.32 $1,668.85 $1,758.40 $2,076.52	$2,063.37 $2,147.90 $2,237.45 $2,555.57	$479.05
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,252.44 $1,421.50 $1,600.60 $2,236.84 $3,399.10	$1,731.49 $1,900.55 $2,079.65 $2,715.89	$2,210.54 $2,379.60 $2,558.70 $3,194.94	$2,689.59 $2,858.65 $3,037.75 $3,673.99	$479.05

Toc - Plan #191 Florida Health Care Plans
Gold (HMO) Gym Access IND Gold HMO 55001
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $2,800 $5,600 Annual Deductible $6,400 $12,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$433.70 $492.25 $554.27 $774.60 $1,177.07	$765.48 $824.03 $886.05 $1,106.38	$1,097.26 $1,155.81 $1,217.83 $1,438.16	$1,429.04 $1,487.59 $1,549.61 $1,769.94	$331.78
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$867.40 $984.50 $1,108.54 $1,549.20 $2,354.14	$1,199.18 $1,316.28 $1,440.32 $1,880.98	$1,530.96 $1,648.06 $1,772.10 $2,212.76	$1,862.74 $1,979.84 $2,103.88 $2,544.54	$331.78

Toc - Plan #192 Florida Health Care Plans
Gold (POS) Gym Access IND Gold POS 55001
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $2,800 $5,600 Annual Deductible $6,400 $12,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$468.40 $531.63 $598.62 $836.56 $1,271.24	$826.73 $889.96 $956.95 $1,194.89	$1,185.06 $1,248.29 $1,315.28 $1,553.22	$1,543.39 $1,606.62 $1,673.61 $1,911.55	$358.33
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$936.80 $1,063.26 $1,197.24 $1,673.12 $2,542.48	$1,295.13 $1,421.59 $1,555.57 $2,031.45	$1,653.46 $1,779.92 $1,913.90 $2,389.78	$2,011.79 $2,138.25 $2,272.23 $2,748.11	$358.33

Toc - Plan #193 Florida Health Care Plans
Gold (HMO) Gym Access IND Gold HMO 4500
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $2,550 $5,100 Annual Deductible $4,700 $9,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$426.68 $484.28 $545.29 $762.04 $1,158.00	$753.09 $810.69 $871.70 $1,088.45	$1,079.50 $1,137.10 $1,198.11 $1,414.86	$1,405.91 $1,463.51 $1,524.52 $1,741.27	$326.41
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$853.36 $968.56 $1,090.58 $1,524.08 $2,316.00	$1,179.77 $1,294.97 $1,416.99 $1,850.49	$1,506.18 $1,621.38 $1,743.40 $2,176.90	$1,832.59 $1,947.79 $2,069.81 $2,503.31	$326.41

Toc - Plan #194 Florida Health Care Plans
Expanded Bronze (HMO) Gym Access IND Bronze HMO HSA 5065
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $6,300 $12,600 Annual Deductible $7,050 $14,100 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$295.06 $334.89 $377.08 $526.97 $800.79	$520.78 $560.61 $602.80 $752.69	$746.50 $786.33 $828.52 $978.41	$972.22 $1,012.05 $1,054.24 $1,204.13	$225.72
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$590.12 $669.78 $754.16 $1,053.94 $1,601.58	$815.84 $895.50 $979.88 $1,279.66	$1,041.56 $1,121.22 $1,205.60 $1,505.38	$1,267.28 $1,346.94 $1,431.32 $1,731.10	$225.72

Toc - Plan #195 Florida Health Care Plans
Expanded Bronze (HMO) Gym Access IND Bronze HMO HSA 6060
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $7,050 $14,100 Annual Deductible $7,050 $14,100 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$295.52 $335.41 $377.67 $527.79 $802.03	$521.59 $561.48 $603.74 $753.86	$747.66 $787.55 $829.81 $979.93	$973.73 $1,013.62 $1,055.88 $1,206.00	$226.07
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$591.04 $670.82 $755.34 $1,055.58 $1,604.06	$817.11 $896.89 $981.41 $1,281.65	$1,043.18 $1,122.96 $1,207.48 $1,507.72	$1,269.25 $1,349.03 $1,433.55 $1,733.79	$226.07

Toc - Plan #196 Florida Health Care Plans
Expanded Bronze (HMO) Gym Access IND Bronze HMO BC 3841
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $8,000 $16,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$311.09 $353.08 $397.57 $555.60 $844.29	$549.07 $591.06 $635.55 $793.58	$787.05 $829.04 $873.53 $1,031.56	$1,025.03 $1,067.02 $1,111.51 $1,269.54	$237.98
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$622.18 $706.16 $795.14 $1,111.20 $1,688.58	$860.16 $944.14 $1,033.12 $1,349.18	$1,098.14 $1,182.12 $1,271.10 $1,587.16	$1,336.12 $1,420.10 $1,509.08 $1,825.14	$237.98

Toc - Plan #197 Florida Health Care Plans
Expanded Bronze (POS) Gym Access IND Bronze POS BC 3841
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $8,000 $16,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$335.97 $381.33 $429.37 $600.05 $911.83	$592.99 $638.35 $686.39 $857.07	$850.01 $895.37 $943.41 $1,114.09	$1,107.03 $1,152.39 $1,200.43 $1,371.11	$257.02
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$671.94 $762.66 $858.74 $1,200.10 $1,823.66	$928.96 $1,019.68 $1,115.76 $1,457.12	$1,185.98 $1,276.70 $1,372.78 $1,714.14	$1,443.00 $1,533.72 $1,629.80 $1,971.16	$257.02

Toc - Plan #198 Florida Health Care Plans
Silver (HMO) Gym Access IND Silver HMO BC 0941
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $5,000 $10,000 Annual Deductible $7,500 $15,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$400.83 $454.94 $512.26 $715.88 $1,087.85	$707.46 $761.57 $818.89 $1,022.51	$1,014.09 $1,068.20 $1,125.52 $1,329.14	$1,320.72 $1,374.83 $1,432.15 $1,635.77	$306.63
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$801.66 $909.88 $1,024.52 $1,431.76 $2,175.70	$1,108.29 $1,216.51 $1,331.15 $1,738.39	$1,414.92 $1,523.14 $1,637.78 $2,045.02	$1,721.55 $1,829.77 $1,944.41 $2,351.65	$306.63

Toc - Plan #199 Florida Health Care Plans
Silver (POS) Gym Access IND Silver POS BC 0941
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $5,000 $10,000 Annual Deductible $7,500 $15,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$432.89 $491.33 $553.24 $773.15 $1,174.87	$764.05 $822.49 $884.40 $1,104.31	$1,095.21 $1,153.65 $1,215.56 $1,435.47	$1,426.37 $1,484.81 $1,546.72 $1,766.63	$331.16
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$865.78 $982.66 $1,106.48 $1,546.30 $2,349.74	$1,196.94 $1,313.82 $1,437.64 $1,877.46	$1,528.10 $1,644.98 $1,768.80 $2,208.62	$1,859.26 $1,976.14 $2,099.96 $2,539.78	$331.16

Toc - Plan #200 Florida Health Care Plans
Silver (HMO) Gym Access IND Silver HMO BC 7741
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $6,000 $12,000 Annual Deductible $8,600 $17,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$384.53 $436.44 $491.42 $686.76 $1,043.60	$678.69 $730.60 $785.58 $980.92	$972.85 $1,024.76 $1,079.74 $1,275.08	$1,267.01 $1,318.92 $1,373.90 $1,569.24	$294.16
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$769.06 $872.88 $982.84 $1,373.52 $2,087.20	$1,063.22 $1,167.04 $1,277.00 $1,667.68	$1,357.38 $1,461.20 $1,571.16 $1,961.84	$1,651.54 $1,755.36 $1,865.32 $2,256.00	$294.16

Toc - Plan #201 Florida Health Care Plans
Silver (POS) Gym Access IND Silver POS BC 7741
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $6,000 $12,000 Annual Deductible $8,600 $17,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$415.29 $471.35 $530.74 $741.70 $1,127.09	$732.98 $789.04 $848.43 $1,059.39	$1,050.67 $1,106.73 $1,166.12 $1,377.08	$1,368.36 $1,424.42 $1,483.81 $1,694.77	$317.69
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$830.58 $942.70 $1,061.48 $1,483.40 $2,254.18	$1,148.27 $1,260.39 $1,379.17 $1,801.09	$1,465.96 $1,578.08 $1,696.86 $2,118.78	$1,783.65 $1,895.77 $2,014.55 $2,436.47	$317.69

Toc - Plan #202 Florida Health Care Plans
Gold (HMO) Gym Access IND Gold HMO BC 5651
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $5,900 $11,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$444.23 $504.20 $567.73 $793.39 $1,205.64	$784.07 $844.04 $907.57 $1,133.23	$1,123.91 $1,183.88 $1,247.41 $1,473.07	$1,463.75 $1,523.72 $1,587.25 $1,812.91	$339.84
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$888.46 $1,008.40 $1,135.46 $1,586.78 $2,411.28	$1,228.30 $1,348.24 $1,475.30 $1,926.62	$1,568.14 $1,688.08 $1,815.14 $2,266.46	$1,907.98 $2,027.92 $2,154.98 $2,606.30	$339.84

Toc - Plan #203 Florida Health Care Plans
Gold (POS) Gym Access IND Gold POS BC 5651
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $5,900 $11,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$479.77 $544.54 $613.14 $856.87 $1,302.09	$846.79 $911.56 $980.16 $1,223.89	$1,213.81 $1,278.58 $1,347.18 $1,590.91	$1,580.83 $1,645.60 $1,714.20 $1,957.93	$367.02
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$959.54 $1,089.08 $1,226.28 $1,713.74 $2,604.18	$1,326.56 $1,456.10 $1,593.30 $2,080.76	$1,693.58 $1,823.12 $1,960.32 $2,447.78	$2,060.60 $2,190.14 $2,327.34 $2,814.80	$367.02

Toc - Plan #204 Florida Health Care Plans
Platinum (HMO) Gym Access IND Platinum HMO BC 5841
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $800 $1,600 Annual Deductible $2,500 $5,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$571.17 $648.27 $729.95 $1,020.10 $1,550.15	$1,008.11 $1,085.21 $1,166.89 $1,457.04	$1,445.05 $1,522.15 $1,603.83 $1,893.98	$1,881.99 $1,959.09 $2,040.77 $2,330.92	$436.94
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,142.34 $1,296.54 $1,459.90 $2,040.20 $3,100.30	$1,579.28 $1,733.48 $1,896.84 $2,477.14	$2,016.22 $2,170.42 $2,333.78 $2,914.08	$2,453.16 $2,607.36 $2,770.72 $3,351.02	$436.94

Toc - Plan #205 Florida Health Care Plans
Platinum (POS) Gym Access IND Platinum POS BC 5841
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $800 $1,600 Annual Deductible $2,500 $5,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$616.86 $700.14 $788.35 $1,101.71 $1,674.16	$1,088.76 $1,172.04 $1,260.25 $1,573.61	$1,560.66 $1,643.94 $1,732.15 $2,045.51	$2,032.56 $2,115.84 $2,204.05 $2,517.41	$471.90
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,233.72 $1,400.28 $1,576.70 $2,203.42 $3,348.32	$1,705.62 $1,872.18 $2,048.60 $2,675.32	$2,177.52 $2,344.08 $2,520.50 $3,147.22	$2,649.42 $2,815.98 $2,992.40 $3,619.12	$471.90

Toc - Plan #206 Florida Health Care Plans
Platinum (HMO) Gym Access IND Platinum HMO BC 1941
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $2,000 $4,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$590.28 $669.97 $754.38 $1,054.24 $1,602.02	$1,041.85 $1,121.54 $1,205.95 $1,505.81	$1,493.42 $1,573.11 $1,657.52 $1,957.38	$1,944.99 $2,024.68 $2,109.09 $2,408.95	$451.57
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,180.56 $1,339.94 $1,508.76 $2,108.48 $3,204.04	$1,632.13 $1,791.51 $1,960.33 $2,560.05	$2,083.70 $2,243.08 $2,411.90 $3,011.62	$2,535.27 $2,694.65 $2,863.47 $3,463.19	$451.57

Toc - Plan #207 Florida Health Care Plans
Platinum (POS) Gym Access IND Platinum POS BC 1941
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $2,000 $4,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$637.50 $723.57 $814.73 $1,138.58 $1,730.19	$1,125.19 $1,211.26 $1,302.42 $1,626.27	$1,612.88 $1,698.95 $1,790.11 $2,113.96	$2,100.57 $2,186.64 $2,277.80 $2,601.65	$487.69
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,275.00 $1,447.14 $1,629.46 $2,277.16 $3,460.38	$1,762.69 $1,934.83 $2,117.15 $2,764.85	$2,250.38 $2,422.52 $2,604.84 $3,252.54	$2,738.07 $2,910.21 $3,092.53 $3,740.23	$487.69

Toc - Plan #208 Florida Health Care Plans
Platinum (HMO) Gym Access IND Platinum HMO 91
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $250 $500 Annual Deductible $2,500 $5,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$585.81 $664.90 $748.67 $1,046.26 $1,589.90	$1,033.96 $1,113.05 $1,196.82 $1,494.41	$1,482.11 $1,561.20 $1,644.97 $1,942.56	$1,930.26 $2,009.35 $2,093.12 $2,390.71	$448.15
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,171.62 $1,329.80 $1,497.34 $2,092.52 $3,179.80	$1,619.77 $1,777.95 $1,945.49 $2,540.67	$2,067.92 $2,226.10 $2,393.64 $2,988.82	$2,516.07 $2,674.25 $2,841.79 $3,436.97	$448.15

Toc - Plan #209 Florida Health Care Plans
Platinum (HMO) Gym Access IND Platinum HMO 92
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $500 $1,000 Annual Deductible $3,000 $6,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$585.19 $664.19 $747.87 $1,045.15 $1,588.20	$1,032.86 $1,111.86 $1,195.54 $1,492.82	$1,480.53 $1,559.53 $1,643.21 $1,940.49	$1,928.20 $2,007.20 $2,090.88 $2,388.16	$447.67
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,170.38 $1,328.38 $1,495.74 $2,090.30 $3,176.40	$1,618.05 $1,776.05 $1,943.41 $2,537.97	$2,065.72 $2,223.72 $2,391.08 $2,985.64	$2,513.39 $2,671.39 $2,838.75 $3,433.31	$447.67

Toc - Plan #210 Florida Health Care Plans
Expanded Bronze (HMO) Gym Access IND Bronze Standardized HMO
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $7,150 $14,300 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$303.35 $344.30 $387.68 $541.78 $823.28	$535.41 $576.36 $619.74 $773.84	$767.47 $808.42 $851.80 $1,005.90	$999.53 $1,040.48 $1,083.86 $1,237.96	$232.06
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$606.70 $688.60 $775.36 $1,083.56 $1,646.56	$838.76 $920.66 $1,007.42 $1,315.62	$1,070.82 $1,152.72 $1,239.48 $1,547.68	$1,302.88 $1,384.78 $1,471.54 $1,779.74	$232.06

Toc - Plan #211 Florida Health Care Plans
Silver (HMO) Gym Access IND Silver Standardized HMO 1
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $3,800 $7,600 Annual Deductible $8,550 $17,100 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$419.29 $475.90 $535.86 $748.86 $1,137.96	$740.05 $796.66 $856.62 $1,069.62	$1,060.81 $1,117.42 $1,177.38 $1,390.38	$1,381.57 $1,438.18 $1,498.14 $1,711.14	$320.76
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$838.58 $951.80 $1,071.72 $1,497.72 $2,275.92	$1,159.34 $1,272.56 $1,392.48 $1,818.48	$1,480.10 $1,593.32 $1,713.24 $2,139.24	$1,800.86 $1,914.08 $2,034.00 $2,460.00	$320.76

Toc - Plan #212 Florida Health Care Plans
Expanded Bronze (HMO) Gym Access IND Bronze HMO 1340
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $8,700 $17,400 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$287.66 $326.49 $367.63 $513.76 $780.70	$507.72 $546.55 $587.69 $733.82	$727.78 $766.61 $807.75 $953.88	$947.84 $986.67 $1,027.81 $1,173.94	$220.06
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$575.32 $652.98 $735.26 $1,027.52 $1,561.40	$795.38 $873.04 $955.32 $1,247.58	$1,015.44 $1,093.10 $1,175.38 $1,467.64	$1,235.50 $1,313.16 $1,395.44 $1,687.70	$220.06

Toc - Plan #213 Florida Health Care Plans
Expanded Bronze (HMO) Gym Access IND Bronze HMO 1041
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $7,200 $14,400 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$303.31 $344.25 $387.63 $541.71 $823.17	$535.34 $576.28 $619.66 $773.74	$767.37 $808.31 $851.69 $1,005.77	$999.40 $1,040.34 $1,083.72 $1,237.80	$232.03
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$606.62 $688.50 $775.26 $1,083.42 $1,646.34	$838.65 $920.53 $1,007.29 $1,315.45	$1,070.68 $1,152.56 $1,239.32 $1,547.48	$1,302.71 $1,384.59 $1,471.35 $1,779.51	$232.03

Toc - Plan #214 Florida Health Care Plans
Expanded Bronze (POS) Gym Access IND Bronze POS 1042
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $7,550 $15,100 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$327.57 $371.79 $418.64 $585.04 $889.03	$578.16 $622.38 $669.23 $835.63	$828.75 $872.97 $919.82 $1,086.22	$1,079.34 $1,123.56 $1,170.41 $1,336.81	$250.59
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$655.14 $743.58 $837.28 $1,170.08 $1,778.06	$905.73 $994.17 $1,087.87 $1,420.67	$1,156.32 $1,244.76 $1,338.46 $1,671.26	$1,406.91 $1,495.35 $1,589.05 $1,921.85	$250.59

Toc - Plan #215 Florida Health Care Plans
Gold (HMO) Gym Access IND Gold HMO H.S.A 9010
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $1,700 $3,400 Annual Deductible $4,000 $8,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$407.40 $462.40 $520.66 $727.62 $1,105.69	$719.06 $774.06 $832.32 $1,039.28	$1,030.72 $1,085.72 $1,143.98 $1,350.94	$1,342.38 $1,397.38 $1,455.64 $1,662.60	$311.66
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$814.80 $924.80 $1,041.32 $1,455.24 $2,211.38	$1,126.46 $1,236.46 $1,352.98 $1,766.90	$1,438.12 $1,548.12 $1,664.64 $2,078.56	$1,749.78 $1,859.78 $1,976.30 $2,390.22	$311.66

Toc - Plan #216 Florida Health Care Plans
Expanded Bronze (HMO) Gym Access IND Bronze HMO OA 1211
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$333.56 $378.59 $426.28 $595.73 $905.27	$588.73 $633.76 $681.45 $850.90	$843.90 $888.93 $936.62 $1,106.07	$1,099.07 $1,144.10 $1,191.79 $1,361.24	$255.17
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$667.12 $757.18 $852.56 $1,191.46 $1,810.54	$922.29 $1,012.35 $1,107.73 $1,446.63	$1,177.46 $1,267.52 $1,362.90 $1,701.80	$1,432.63 $1,522.69 $1,618.07 $1,956.97	$255.17

Toc - Plan #217 Florida Health Care Plans
Silver (HMO) Gym Access IND Silver HMO OA 1009
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $8,550 $17,100 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$429.05 $486.97 $548.33 $766.28 $1,164.44	$757.27 $815.19 $876.55 $1,094.50	$1,085.49 $1,143.41 $1,204.77 $1,422.72	$1,413.71 $1,471.63 $1,532.99 $1,750.94	$328.22
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$858.10 $973.94 $1,096.66 $1,532.56 $2,328.88	$1,186.32 $1,302.16 $1,424.88 $1,860.78	$1,514.54 $1,630.38 $1,753.10 $2,189.00	$1,842.76 $1,958.60 $2,081.32 $2,517.22	$328.22

Toc - Plan #218 Florida Health Care Plans
Expanded Bronze (HMO) Gym Access IND Bronze HMO OA 0928
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $2,900 $5,800 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$316.32 $359.02 $404.26 $564.95 $858.50	$558.31 $601.01 $646.25 $806.94	$800.30 $843.00 $888.24 $1,048.93	$1,042.29 $1,084.99 $1,130.23 $1,290.92	$241.99
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$632.64 $718.04 $808.52 $1,129.90 $1,717.00	$874.63 $960.03 $1,050.51 $1,371.89	$1,116.62 $1,202.02 $1,292.50 $1,613.88	$1,358.61 $1,444.01 $1,534.49 $1,855.87	$241.99

Toc - Plan #219 Florida Health Care Plans
Gold (HMO) Gym Access IND Gold HMO OA 28
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $8,500 $17,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$448.42 $508.95 $573.08 $800.87 $1,217.00	$791.46 $851.99 $916.12 $1,143.91	$1,134.50 $1,195.03 $1,259.16 $1,486.95	$1,477.54 $1,538.07 $1,602.20 $1,829.99	$343.04
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$896.84 $1,017.90 $1,146.16 $1,601.74 $2,434.00	$1,239.88 $1,360.94 $1,489.20 $1,944.78	$1,582.92 $1,703.98 $1,832.24 $2,287.82	$1,925.96 $2,047.02 $2,175.28 $2,630.86	$343.04

UnitedHealthcare Local: 1-888-200-0405 | Toll Free: 1-888-200-0405 | TTY: 1-888-200-0405

Toc - Plan #220 UnitedHealthcare
Gold (HMO) UHC Gold Advantage+ ($1 Rx + Unlimited Free Primary Care & Virtual Visits)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-200-0405 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $5,000 $10,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$418.53 $475.03 $534.88 $747.49 $1,135.88	$738.70 $795.20 $855.05 $1,067.66	$1,058.87 $1,115.37 $1,175.22 $1,387.83	$1,379.04 $1,435.54 $1,495.39 $1,708.00	$320.17
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$837.06 $950.06 $1,069.76 $1,494.98 $2,271.76	$1,157.23 $1,270.23 $1,389.93 $1,815.15	$1,477.40 $1,590.40 $1,710.10 $2,135.32	$1,797.57 $1,910.57 $2,030.27 $2,455.49	$320.17

Toc - Plan #221 UnitedHealthcare
Gold (HMO) UHC Gold Advantage+ Extra ($1 Rx + Dental + Vision + 6 Free Virtual Visits)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-200-0405 Annual Out of Pocket Expenses: Individual Family $500 $1,000 Annual Deductible $5,500 $11,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$429.09 $487.02 $548.38 $766.36 $1,164.56	$757.35 $815.28 $876.64 $1,094.62	$1,085.61 $1,143.54 $1,204.90 $1,422.88	$1,413.87 $1,471.80 $1,533.16 $1,751.14	$328.26
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$858.18 $974.04 $1,096.76 $1,532.72 $2,329.12	$1,186.44 $1,302.30 $1,425.02 $1,860.98	$1,514.70 $1,630.56 $1,753.28 $2,189.24	$1,842.96 $1,958.82 $2,081.54 $2,517.50	$328.26

Toc - Plan #222 UnitedHealthcare
Gold (HMO) UHC Gold Value+ ($2 Rx + 3 Free Primary Care & 6 Free Virtual Visits)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-200-0405 Annual Out of Pocket Expenses: Individual Family $2,500 $5,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$399.74 $453.71 $510.87 $713.94 $1,084.90	$705.54 $759.51 $816.67 $1,019.74	$1,011.34 $1,065.31 $1,122.47 $1,325.54	$1,317.14 $1,371.11 $1,428.27 $1,631.34	$305.80
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$799.48 $907.42 $1,021.74 $1,427.88 $2,169.80	$1,105.28 $1,213.22 $1,327.54 $1,733.68	$1,411.08 $1,519.02 $1,633.34 $2,039.48	$1,716.88 $1,824.82 $1,939.14 $2,345.28	$305.80

Toc - Plan #223 UnitedHealthcare
Gold (HMO) UHC Gold Value+ ($2 Rx + 6 Free Virtual Visits)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-200-0405 Annual Out of Pocket Expenses: Individual Family $2,800 $5,600 Annual Deductible $8,000 $16,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$397.98 $451.71 $508.62 $710.80 $1,080.12	$702.44 $756.17 $813.08 $1,015.26	$1,006.90 $1,060.63 $1,117.54 $1,319.72	$1,311.36 $1,365.09 $1,422.00 $1,624.18	$304.46
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$795.96 $903.42 $1,017.24 $1,421.60 $2,160.24	$1,100.42 $1,207.88 $1,321.70 $1,726.06	$1,404.88 $1,512.34 $1,626.16 $2,030.52	$1,709.34 $1,816.80 $1,930.62 $2,334.98	$304.46

Toc - Plan #224 UnitedHealthcare
Silver (HMO) UHC Silver Value+ ($3 Rx + 3 Free Primary Care & 6 Free Virtual Visits)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-200-0405 Annual Out of Pocket Expenses: Individual Family $6,500 $13,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$373.62 $424.06 $477.49 $667.29 $1,014.01	$659.44 $709.88 $763.31 $953.11	$945.26 $995.70 $1,049.13 $1,238.93	$1,231.08 $1,281.52 $1,334.95 $1,524.75	$285.82
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$747.24 $848.12 $954.98 $1,334.58 $2,028.02	$1,033.06 $1,133.94 $1,240.80 $1,620.40	$1,318.88 $1,419.76 $1,526.62 $1,906.22	$1,604.70 $1,705.58 $1,812.44 $2,192.04	$285.82

Toc - Plan #225 UnitedHealthcare
Silver (HMO) UHC Silver Virtual First ($3 Rx + Unlimited Free App-based Care) (Disponible en español)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-200-0405 Annual Out of Pocket Expenses: Individual Family $6,200 $12,400 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$366.58 $416.07 $468.49 $654.71 $994.89	$647.01 $696.50 $748.92 $935.14	$927.44 $976.93 $1,029.35 $1,215.57	$1,207.87 $1,257.36 $1,309.78 $1,496.00	$280.43
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$733.16 $832.14 $936.98 $1,309.42 $1,989.78	$1,013.59 $1,112.57 $1,217.41 $1,589.85	$1,294.02 $1,393.00 $1,497.84 $1,870.28	$1,574.45 $1,673.43 $1,778.27 $2,150.71	$280.43

Toc - Plan #226 UnitedHealthcare
Silver (HMO) UHC Silver Value+ Saver ($3 Rx + 6 Free Virtual Visits)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-200-0405 Annual Out of Pocket Expenses: Individual Family $5,700 $11,400 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$372.74 $423.06 $476.36 $665.72 $1,011.62	$657.89 $708.21 $761.51 $950.87	$943.04 $993.36 $1,046.66 $1,236.02	$1,228.19 $1,278.51 $1,331.81 $1,521.17	$285.15
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$745.48 $846.12 $952.72 $1,331.44 $2,023.24	$1,030.63 $1,131.27 $1,237.87 $1,616.59	$1,315.78 $1,416.42 $1,523.02 $1,901.74	$1,600.93 $1,701.57 $1,808.17 $2,186.89	$285.15

Toc - Plan #227 UnitedHealthcare
Silver (HMO) UHC Silver Value+ Saver ($3 Rx + 3 Free Primary Care & 6 Free Virtual Visits)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-200-0405 Annual Out of Pocket Expenses: Individual Family $6,400 $12,800 Annual Deductible $8,000 $16,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$373.03 $423.39 $476.74 $666.24 $1,012.42	$658.40 $708.76 $762.11 $951.61	$943.77 $994.13 $1,047.48 $1,236.98	$1,229.14 $1,279.50 $1,332.85 $1,522.35	$285.37
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$746.06 $846.78 $953.48 $1,332.48 $2,024.84	$1,031.43 $1,132.15 $1,238.85 $1,617.85	$1,316.80 $1,417.52 $1,524.22 $1,903.22	$1,602.17 $1,702.89 $1,809.59 $2,188.59	$285.37

Toc - Plan #228 UnitedHealthcare
Silver (HMO) UHC Silver Value+ Base ($3 Rx + 3 Free Primary Care & 6 Free Virtual Visits)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-200-0405 Annual Out of Pocket Expenses: Individual Family $6,500 $13,000 Annual Deductible $7,500 $15,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$387.71 $440.05 $495.49 $692.45 $1,052.24	$684.31 $736.65 $792.09 $989.05	$980.91 $1,033.25 $1,088.69 $1,285.65	$1,277.51 $1,329.85 $1,385.29 $1,582.25	$296.60
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$775.42 $880.10 $990.98 $1,384.90 $2,104.48	$1,072.02 $1,176.70 $1,287.58 $1,681.50	$1,368.62 $1,473.30 $1,584.18 $1,978.10	$1,665.22 $1,769.90 $1,880.78 $2,274.70	$296.60

Toc - Plan #229 UnitedHealthcare
Silver (HMO) UHC Silver Value+ ($3 Rx + 6 Free Virtual Visits)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-200-0405 Annual Out of Pocket Expenses: Individual Family $5,000 $10,000 Annual Deductible $6,500 $13,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$391.23 $444.05 $499.99 $698.74 $1,061.80	$690.52 $743.34 $799.28 $998.03	$989.81 $1,042.63 $1,098.57 $1,297.32	$1,289.10 $1,341.92 $1,397.86 $1,596.61	$299.29
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$782.46 $888.10 $999.98 $1,397.48 $2,123.60	$1,081.75 $1,187.39 $1,299.27 $1,696.77	$1,381.04 $1,486.68 $1,598.56 $1,996.06	$1,680.33 $1,785.97 $1,897.85 $2,295.35	$299.29

Toc - Plan #230 UnitedHealthcare
Silver (HMO) UHC Silver Virtual First Saver ($3 Rx + Unlimited Free App-based Care) (Disponible en español)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-200-0405 Annual Out of Pocket Expenses: Individual Family $6,000 $12,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$365.11 $414.40 $466.61 $652.09 $990.91	$644.42 $693.71 $745.92 $931.40	$923.73 $973.02 $1,025.23 $1,210.71	$1,203.04 $1,252.33 $1,304.54 $1,490.02	$279.31
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$730.22 $828.80 $933.22 $1,304.18 $1,981.82	$1,009.53 $1,108.11 $1,212.53 $1,583.49	$1,288.84 $1,387.42 $1,491.84 $1,862.80	$1,568.15 $1,666.73 $1,771.15 $2,142.11	$279.31

Toc - Plan #231 UnitedHealthcare
Silver (HMO) UHC Silver Advantage+ Saver ($5 Rx + 3 Free Primary Care & 6 Free Virtual Visits)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-200-0405 Annual Out of Pocket Expenses: Individual Family $3,500 $7,000 Annual Deductible $8,000 $16,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$371.27 $421.40 $474.49 $663.10 $1,007.64	$655.29 $705.42 $758.51 $947.12	$939.31 $989.44 $1,042.53 $1,231.14	$1,223.33 $1,273.46 $1,326.55 $1,515.16	$284.02
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$742.54 $842.80 $948.98 $1,326.20 $2,015.28	$1,026.56 $1,126.82 $1,233.00 $1,610.22	$1,310.58 $1,410.84 $1,517.02 $1,894.24	$1,594.60 $1,694.86 $1,801.04 $2,178.26	$284.02

Toc - Plan #232 UnitedHealthcare
Silver (HMO) UHC Silver Advantage+ Base ($3 Rx + 3 Free Primary Care & 6 Free Virtual Visits)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-200-0405 Annual Out of Pocket Expenses: Individual Family $3,000 $6,000 Annual Deductible $8,000 $16,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$373.33 $423.73 $477.11 $666.76 $1,013.21	$658.93 $709.33 $762.71 $952.36	$944.53 $994.93 $1,048.31 $1,237.96	$1,230.13 $1,280.53 $1,333.91 $1,523.56	$285.60
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$746.66 $847.46 $954.22 $1,333.52 $2,026.42	$1,032.26 $1,133.06 $1,239.82 $1,619.12	$1,317.86 $1,418.66 $1,525.42 $1,904.72	$1,603.46 $1,704.26 $1,811.02 $2,190.32	$285.60

Toc - Plan #233 UnitedHealthcare
Silver (HMO) UHC Silver Advantage+ Extra ($3 Rx + Dental + Vision + 3 Free Primary Care & 6 Free Virtual Visits)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-200-0405 Annual Out of Pocket Expenses: Individual Family $6,000 $12,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$384.77 $436.72 $491.74 $687.21 $1,044.28	$679.12 $731.07 $786.09 $981.56	$973.47 $1,025.42 $1,080.44 $1,275.91	$1,267.82 $1,319.77 $1,374.79 $1,570.26	$294.35
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$769.54 $873.44 $983.48 $1,374.42 $2,088.56	$1,063.89 $1,167.79 $1,277.83 $1,668.77	$1,358.24 $1,462.14 $1,572.18 $1,963.12	$1,652.59 $1,756.49 $1,866.53 $2,257.47	$294.35

Toc - Plan #234 UnitedHealthcare
Silver (HMO) UHC Silver Advantage+ Extra Saver ($3 Rx + Dental + Vision + 3 Free Primary Care & 6 Free Virtual Visits)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-200-0405 Annual Out of Pocket Expenses: Individual Family $5,000 $10,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$385.07 $437.05 $492.12 $687.73 $1,045.08	$679.65 $731.63 $786.70 $982.31	$974.23 $1,026.21 $1,081.28 $1,276.89	$1,268.81 $1,320.79 $1,375.86 $1,571.47	$294.58
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$770.14 $874.10 $984.24 $1,375.46 $2,090.16	$1,064.72 $1,168.68 $1,278.82 $1,670.04	$1,359.30 $1,463.26 $1,573.40 $1,964.62	$1,653.88 $1,757.84 $1,867.98 $2,259.20	$294.58

Toc - Plan #235 UnitedHealthcare
Bronze (HMO) UHC Bronze Essential+ (Low Premium)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-200-0405 Annual Out of Pocket Expenses: Individual Family $8,700 $17,400 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$293.50 $333.12 $375.09 $524.19 $796.55	$518.03 $557.65 $599.62 $748.72	$742.56 $782.18 $824.15 $973.25	$967.09 $1,006.71 $1,048.68 $1,197.78	$224.53
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$587.00 $666.24 $750.18 $1,048.38 $1,593.10	$811.53 $890.77 $974.71 $1,272.91	$1,036.06 $1,115.30 $1,199.24 $1,497.44	$1,260.59 $1,339.83 $1,423.77 $1,721.97	$224.53

Toc - Plan #236 UnitedHealthcare
Expanded Bronze (HMO) UHC Bronze Value+ ($3 Rx + 6 Free Virtual Visits)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-200-0405 Annual Out of Pocket Expenses: Individual Family $6,500 $13,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$309.93 $351.77 $396.09 $553.54 $841.16	$547.03 $588.87 $633.19 $790.64	$784.13 $825.97 $870.29 $1,027.74	$1,021.23 $1,063.07 $1,107.39 $1,264.84	$237.10
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$619.86 $703.54 $792.18 $1,107.08 $1,682.32	$856.96 $940.64 $1,029.28 $1,344.18	$1,094.06 $1,177.74 $1,266.38 $1,581.28	$1,331.16 $1,414.84 $1,503.48 $1,818.38	$237.10

Toc - Plan #237 UnitedHealthcare
Bronze (HMO) UHC Bronze Value+ Saver ($5 Rx + 3 Free Primary Care & 6 Free Virtual Visits)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-200-0405 Annual Out of Pocket Expenses: Individual Family $6,350 $12,700 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$301.72 $342.45 $385.59 $538.86 $818.85	$532.53 $573.26 $616.40 $769.67	$763.34 $804.07 $847.21 $1,000.48	$994.15 $1,034.88 $1,078.02 $1,231.29	$230.81
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$603.44 $684.90 $771.18 $1,077.72 $1,637.70	$834.25 $915.71 $1,001.99 $1,308.53	$1,065.06 $1,146.52 $1,232.80 $1,539.34	$1,295.87 $1,377.33 $1,463.61 $1,770.15	$230.81

Toc - Plan #238 UnitedHealthcare
Expanded Bronze (HMO) UHC Bronze Value+ ($3 Rx + 3 Free Primary Care & 6 Free Virtual Visits)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-200-0405 Annual Out of Pocket Expenses: Individual Family $7,500 $15,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$311.99 $354.11 $398.72 $557.21 $846.73	$550.66 $592.78 $637.39 $795.88	$789.33 $831.45 $876.06 $1,034.55	$1,028.00 $1,070.12 $1,114.73 $1,273.22	$238.67
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$623.98 $708.22 $797.44 $1,114.42 $1,693.46	$862.65 $946.89 $1,036.11 $1,353.09	$1,101.32 $1,185.56 $1,274.78 $1,591.76	$1,339.99 $1,424.23 $1,513.45 $1,830.43	$238.67

Toc - Plan #239 UnitedHealthcare
Expanded Bronze (HMO) UHC Bronze Virtual First ($3 Rx + Unlimited Free App-based Care) (Disponible en español)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-200-0405 Annual Out of Pocket Expenses: Individual Family $7,250 $14,500 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$304.06 $345.11 $388.59 $543.06 $825.23	$536.67 $577.72 $621.20 $775.67	$769.28 $810.33 $853.81 $1,008.28	$1,001.89 $1,042.94 $1,086.42 $1,240.89	$232.61
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$608.12 $690.22 $777.18 $1,086.12 $1,650.46	$840.73 $922.83 $1,009.79 $1,318.73	$1,073.34 $1,155.44 $1,242.40 $1,551.34	$1,305.95 $1,388.05 $1,475.01 $1,783.95	$232.61

‡Source: HealthCare.gov has released sample rates for all counties in the 36 states served by HealthCare.gov. We have integrated that data into our tables and provide you that information for Seminole County here.

Seminole County is in “Rating Area 57” of Florida.

Currently, there are 239 plans offered in Rating Area 57.