Obamacare 2021 Rates for Oklahoma County

Obamacare > Rates > Oklahoma > Oklahoma County

Obamacare is also known as the Affordable Care Act. This page gives you an overview of the rates for individual and family health insurance plans available from , the marketplace for Oklahoma County, OK.

The health insurance rates listed below are for calendar year 2021.

For information on subsidies to make your coverage affordable, you must take one of the following actions:

  • Contact a licensed health insurance agent
  • Complete an application at Healthcare.gov
  • Contact the provider directly

Obamacare Providers, 55 Plans and 2021 Rates for Oklahoma County, Oklahoma

Below, you’ll find a summary of the 55 plans for Oklahoma County, Oklahoma and rates for each of these providers.‡ This chart is designed to give you a preview of your health insurance options.

You may also be interested in:

Obamacare Rates and Providers for Other Years

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Medica

Local: 1-888-592-8211 | Toll Free: 1-888-592-8211 | TTY: 1-800-676-3777
Toc - Plan #1 Medica
Gold

(PPO) Harmony by Medica Gold Copay

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$1,200 $3,600 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 		$455,92
$517,45
$582,65
$814,25
$1 237,33 		$804,69
$866,22
$931,42
$1 163,02 		$1 153,46
$1 214,99
$1 280,19
$1 511,79 		$1 502,23
$1 563,76
$1 628,96
$1 860,56 		$348,77
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$911,84
$1 034,90
$1 165,30
$1 628,50
$2 474,66 		$1 260,61
$1 383,67
$1 514,07
$1 977,27 		$1 609,38
$1 732,44
$1 862,84
$2 326,04 		$1 958,15
$2 081,21
$2 211,61
$2 674,81 		$348,77
Toc - Plan #2 Medica
Silver

(PPO) Harmony by Medica Silver Copay

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 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 		$457,96
$519,77
$585,26
$817,90
$1 242,88 		$808,29
$870,10
$935,59
$1 168,23 		$1 158,62
$1 220,43
$1 285,92
$1 518,56 		$1 508,95
$1 570,76
$1 636,25
$1 868,89 		$350,33
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$915,92
$1 039,54
$1 170,52
$1 635,80
$2 485,76 		$1 266,25
$1 389,87
$1 520,85
$1 986,13 		$1 616,58
$1 740,20
$1 871,18
$2 336,46 		$1 966,91
$2 090,53
$2 221,51
$2 686,79 		$350,33
Toc - Plan #3 Medica
Expanded Bronze

(PPO) Harmony by Medica Bronze Copay

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 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 		$328,69
$373,06
$420,06
$587,03
$892,05 		$580,13
$624,50
$671,50
$838,47 		$831,57
$875,94
$922,94
$1 089,91 		$1 083,01
$1 127,38
$1 174,38
$1 341,35 		$251,44
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$657,38
$746,12
$840,12
$1 174,06
$1 784,10 		$908,82
$997,56
$1 091,56
$1 425,50 		$1 160,26
$1 249,00
$1 343,00
$1 676,94 		$1 411,70
$1 500,44
$1 594,44
$1 928,38 		$251,44
Toc - Plan #4 Medica
Expanded Bronze

(PPO) Harmony by Medica Bronze H S A

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$6,700 $13,400 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 		$361,55
$410,34
$462,04
$645,71
$981,21 		$638,13
$686,92
$738,62
$922,29 		$914,71
$963,50
$1 015,20
$1 198,87 		$1 191,29
$1 240,08
$1 291,78
$1 475,45 		$276,58
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$723,10
$820,68
$924,08
$1 291,42
$1 962,42 		$999,68
$1 097,26
$1 200,66
$1 568,00 		$1 276,26
$1 373,84
$1 477,24
$1 844,58 		$1 552,84
$1 650,42
$1 753,82
$2 121,16 		$276,58
Toc - Plan #5 Medica
Catastrophic

(PPO) Harmony by Medica Catastrophic

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$8,550 $17,100 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 		$239,13
$271,40
$305,59
$427,06
$648,96 		$422,05
$454,32
$488,51
$609,98 		$604,97
$637,24
$671,43
$792,90 		$787,89
$820,16
$854,35
$975,82 		$182,92
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$478,26
$542,80
$611,18
$854,12
$1 297,92 		$661,18
$725,72
$794,10
$1 037,04 		$844,10
$908,64
$977,02
$1 219,96 		$1 027,02
$1 091,56
$1 159,94
$1 402,88 		$182,92
Toc - Plan #6 Medica
Gold

(PPO) Harmony by Medica Gold Share

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$550 $1,650 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 		$454,38
$515,71
$580,69
$811,51
$1 233,17 		$801,98
$863,31
$928,29
$1 159,11 		$1 149,58
$1 210,91
$1 275,89
$1 506,71 		$1 497,18
$1 558,51
$1 623,49
$1 854,31 		$347,60
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$908,76
$1 031,42
$1 161,38
$1 623,02
$2 466,34 		$1 256,36
$1 379,02
$1 508,98
$1 970,62 		$1 603,96
$1 726,62
$1 856,58
$2 318,22 		$1 951,56
$2 074,22
$2 204,18
$2 665,82 		$347,60
Toc - Plan #7 Medica
Expanded Bronze

(PPO) Harmony by Medica Bronze Share Plus

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$2,300 $6,900 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 		$337,33
$382,86
$431,09
$602,45
$915,48 		$595,38
$640,91
$689,14
$860,50 		$853,43
$898,96
$947,19
$1 118,55 		$1 111,48
$1 157,01
$1 205,24
$1 376,60 		$258,05
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$674,66
$765,72
$862,18
$1 204,90
$1 830,96 		$932,71
$1 023,77
$1 120,23
$1 462,95 		$1 190,76
$1 281,82
$1 378,28
$1 721,00 		$1 448,81
$1 539,87
$1 636,33
$1 979,05 		$258,05
Toc - Plan #8 Medica
Bronze

(PPO) Harmony by Medica Bronze Value

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$7,900 $15,800 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 		$329,15
$373,58
$420,65
$587,85
$893,30 		$580,95
$625,38
$672,45
$839,65 		$832,75
$877,18
$924,25
$1 091,45 		$1 084,55
$1 128,98
$1 176,05
$1 343,25 		$251,80
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$658,30
$747,16
$841,30
$1 175,70
$1 786,60 		$910,10
$998,96
$1 093,10
$1 427,50 		$1 161,90
$1 250,76
$1 344,90
$1 679,30 		$1 413,70
$1 502,56
$1 596,70
$1 931,10 		$251,80
Toc - Plan #9 Medica
Gold

(PPO) Balance by Medica Gold Copay

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$1,200 $3,600 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 		$380,75
$432,14
$486,59
$680,01
$1 033,33 		$672,02
$723,41
$777,86
$971,28 		$963,29
$1 014,68
$1 069,13
$1 262,55 		$1 254,56
$1 305,95
$1 360,40
$1 553,82 		$291,27
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$761,50
$864,28
$973,18
$1 360,02
$2 066,66 		$1 052,77
$1 155,55
$1 264,45
$1 651,29 		$1 344,04
$1 446,82
$1 555,72
$1 942,56 		$1 635,31
$1 738,09
$1 846,99
$2 233,83 		$291,27
Toc - Plan #10 Medica
Silver

(PPO) Balance by Medica Silver Copay

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 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 		$382,46
$434,08
$488,77
$683,05
$1 037,97 		$675,03
$726,65
$781,34
$975,62 		$967,60
$1 019,22
$1 073,91
$1 268,19 		$1 260,17
$1 311,79
$1 366,48
$1 560,76 		$292,57
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$764,92
$868,16
$977,54
$1 366,10
$2 075,94 		$1 057,49
$1 160,73
$1 270,11
$1 658,67 		$1 350,06
$1 453,30
$1 562,68
$1 951,24 		$1 642,63
$1 745,87
$1 855,25
$2 243,81 		$292,57
Toc - Plan #11 Medica
Expanded Bronze

(PPO) Balance by Medica Bronze Copay

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 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 		$274,50
$311,55
$350,80
$490,25
$744,98 		$484,49
$521,54
$560,79
$700,24 		$694,48
$731,53
$770,78
$910,23 		$904,47
$941,52
$980,77
$1 120,22 		$209,99
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$549,00
$623,10
$701,60
$980,50
$1 489,96 		$758,99
$833,09
$911,59
$1 190,49 		$968,98
$1 043,08
$1 121,58
$1 400,48 		$1 178,97
$1 253,07
$1 331,57
$1 610,47 		$209,99
Toc - Plan #12 Medica
Expanded Bronze

(PPO) Balance by Medica Bronze HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$6,700 $13,400 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 		$301,94
$342,69
$385,87
$539,25
$819,44 		$532,92
$573,67
$616,85
$770,23 		$763,90
$804,65
$847,83
$1 001,21 		$994,88
$1 035,63
$1 078,81
$1 232,19 		$230,98
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$603,88
$685,38
$771,74
$1 078,50
$1 638,88 		$834,86
$916,36
$1 002,72
$1 309,48 		$1 065,84
$1 147,34
$1 233,70
$1 540,46 		$1 296,82
$1 378,32
$1 464,68
$1 771,44 		$230,98
Toc - Plan #13 Medica
Catastrophic

(PPO) Balance by Medica Catastrophic

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$8,550 $17,100 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 		$199,70
$226,65
$255,21
$356,65
$541,97 		$352,47
$379,42
$407,98
$509,42 		$505,24
$532,19
$560,75
$662,19 		$658,01
$684,96
$713,52
$814,96 		$152,77
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$399,40
$453,30
$510,42
$713,30
$1 083,94 		$552,17
$606,07
$663,19
$866,07 		$704,94
$758,84
$815,96
$1 018,84 		$857,71
$911,61
$968,73
$1 171,61 		$152,77
Toc - Plan #14 Medica
Gold

(PPO) Balance by Medica Gold Share

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$550 $1,650 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 		$379,47
$430,69
$484,95
$677,72
$1 029,86 		$669,76
$720,98
$775,24
$968,01 		$960,05
$1 011,27
$1 065,53
$1 258,30 		$1 250,34
$1 301,56
$1 355,82
$1 548,59 		$290,29
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$758,94
$861,38
$969,90
$1 355,44
$2 059,72 		$1 049,23
$1 151,67
$1 260,19
$1 645,73 		$1 339,52
$1 441,96
$1 550,48
$1 936,02 		$1 629,81
$1 732,25
$1 840,77
$2 226,31 		$290,29
Toc - Plan #15 Medica
Silver

(PPO) Balance by Medica Silver Share

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$2,200 $6,600 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 		$386,98
$439,21
$494,55
$691,13
$1 050,24 		$683,01
$735,24
$790,58
$987,16 		$979,04
$1 031,27
$1 086,61
$1 283,19 		$1 275,07
$1 327,30
$1 382,64
$1 579,22 		$296,03
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$773,96
$878,42
$989,10
$1 382,26
$2 100,48 		$1 069,99
$1 174,45
$1 285,13
$1 678,29 		$1 366,02
$1 470,48
$1 581,16
$1 974,32 		$1 662,05
$1 766,51
$1 877,19
$2 270,35 		$296,03
Toc - Plan #16 Medica
Expanded Bronze

(PPO) Balance by Medica Bronze Share Plus

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$2,300 $6,900 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 		$281,72
$319,74
$360,02
$503,13
$764,55 		$497,22
$535,24
$575,52
$718,63 		$712,72
$750,74
$791,02
$934,13 		$928,22
$966,24
$1 006,52
$1 149,63 		$215,50
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$563,44
$639,48
$720,04
$1 006,26
$1 529,10 		$778,94
$854,98
$935,54
$1 221,76 		$994,44
$1 070,48
$1 151,04
$1 437,26 		$1 209,94
$1 285,98
$1 366,54
$1 652,76 		$215,50
Toc - Plan #17 Medica
Bronze

(PPO) Balance by Medica Bronze Value

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$7,900 $15,800 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 		$274,89
$311,99
$351,29
$490,93
$746,02 		$485,17
$522,27
$561,57
$701,21 		$695,45
$732,55
$771,85
$911,49 		$905,73
$942,83
$982,13
$1 121,77 		$210,28
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$549,78
$623,98
$702,58
$981,86
$1 492,04 		$760,06
$834,26
$912,86
$1 192,14 		$970,34
$1 044,54
$1 123,14
$1 402,42 		$1 180,62
$1 254,82
$1 333,42
$1 612,70 		$210,28

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UnitedHealthcare

Local: 1-800-980-5319 | Toll Free: 1-800-980-5319 | TTY: 1-800-980-5319
Toc - Plan #18 UnitedHealthcare
Gold

(HMO) Value Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-980-5319

Annual Out of Pocket Expenses:

Individual Family
$1,750 $3,500 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 		$390,89
$443,66
$499,56
$698,13
$1 060,88 		$689,92
$742,69
$798,59
$997,16 		$988,95
$1 041,72
$1 097,62
$1 296,19 		$1 287,98
$1 340,75
$1 396,65
$1 595,22 		$299,03
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$781,78
$887,32
$999,12
$1 396,26
$2 121,76 		$1 080,81
$1 186,35
$1 298,15
$1 695,29 		$1 379,84
$1 485,38
$1 597,18
$1 994,32 		$1 678,87
$1 784,41
$1 896,21
$2 293,35 		$299,03
Toc - Plan #19 UnitedHealthcare
Silver

(HMO) Value Silver 3 Free Visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-980-5319

Annual Out of Pocket Expenses:

Individual Family
$3,000 $6,000 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 		$393,10
$446,17
$502,38
$702,08
$1 066,87 		$693,82
$746,89
$803,10
$1 002,80 		$994,54
$1 047,61
$1 103,82
$1 303,52 		$1 295,26
$1 348,33
$1 404,54
$1 604,24 		$300,72
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$786,20
$892,34
$1 004,76
$1 404,16
$2 133,74 		$1 086,92
$1 193,06
$1 305,48
$1 704,88 		$1 387,64
$1 493,78
$1 606,20
$2 005,60 		$1 688,36
$1 794,50
$1 906,92
$2 306,32 		$300,72
Toc - Plan #20 UnitedHealthcare
Silver

(HMO) Balance Plus Silver 3 Free Visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-980-5319

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 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 		$392,50
$445,49
$501,62
$701,01
$1 065,25 		$692,76
$745,75
$801,88
$1 001,27 		$993,02
$1 046,01
$1 102,14
$1 301,53 		$1 293,28
$1 346,27
$1 402,40
$1 601,79 		$300,26
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$785,00
$890,98
$1 003,24
$1 402,02
$2 130,50 		$1 085,26
$1 191,24
$1 303,50
$1 702,28 		$1 385,52
$1 491,50
$1 603,76
$2 002,54 		$1 685,78
$1 791,76
$1 904,02
$2 302,80 		$300,26
Toc - Plan #21 UnitedHealthcare
Silver

(HMO) Balance Silver 3 Free Visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-980-5319

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 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 		$393,33
$446,43
$502,68
$702,49
$1 067,50 		$694,23
$747,33
$803,58
$1 003,39 		$995,13
$1 048,23
$1 104,48
$1 304,29 		$1 296,03
$1 349,13
$1 405,38
$1 605,19 		$300,90
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$786,66
$892,86
$1 005,36
$1 404,98
$2 135,00 		$1 087,56
$1 193,76
$1 306,26
$1 705,88 		$1 388,46
$1 494,66
$1 607,16
$2 006,78 		$1 689,36
$1 795,56
$1 908,06
$2 307,68 		$300,90
Toc - Plan #22 UnitedHealthcare
Expanded Bronze

(HMO) Balance Bronze 3 Free Telehealth Visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-980-5319

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 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 		$280,68
$318,57
$358,71
$501,29
$761,77 		$495,40
$533,29
$573,43
$716,01 		$710,12
$748,01
$788,15
$930,73 		$924,84
$962,73
$1 002,87
$1 145,45 		$214,72
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$561,36
$637,14
$717,42
$1 002,58
$1 523,54 		$776,08
$851,86
$932,14
$1 217,30 		$990,80
$1 066,58
$1 146,86
$1 432,02 		$1 205,52
$1 281,30
$1 361,58
$1 646,74 		$214,72
Toc - Plan #23 UnitedHealthcare
Expanded Bronze

(HMO) Balance Bronze 3 Free Visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-980-5319

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 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 		$276,47
$313,79
$353,33
$493,78
$750,34 		$487,97
$525,29
$564,83
$705,28 		$699,47
$736,79
$776,33
$916,78 		$910,97
$948,29
$987,83
$1 128,28 		$211,50
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$552,94
$627,58
$706,66
$987,56
$1 500,68 		$764,44
$839,08
$918,16
$1 199,06 		$975,94
$1 050,58
$1 129,66
$1 410,56 		$1 187,44
$1 262,08
$1 341,16
$1 622,06 		$211,50
Toc - Plan #24 UnitedHealthcare
Expanded Bronze

(HMO) Value Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-980-5319

Annual Out of Pocket Expenses:

Individual Family
$5,750 $11,500 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 		$280,61
$318,49
$358,62
$501,17
$761,58 		$495,28
$533,16
$573,29
$715,84 		$709,95
$747,83
$787,96
$930,51 		$924,62
$962,50
$1 002,63
$1 145,18 		$214,67
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$561,22
$636,98
$717,24
$1 002,34
$1 523,16 		$775,89
$851,65
$931,91
$1 217,01 		$990,56
$1 066,32
$1 146,58
$1 431,68 		$1 205,23
$1 280,99
$1 361,25
$1 646,35 		$214,67

ADVERTISEMENT

Bright Health

Local: 1-855-521-9351 | Toll Free: 1-855-521-9351

Toc - Plan #25 Bright Health
Gold

(PPO) Gold 1000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-521-9351

Annual Out of Pocket Expenses:

Individual Family
$1,000 $2,000 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 		$465,59
$528,44
$595,02
$831,54
$1 263,61 		$821,77
$884,62
$951,20
$1 187,72 		$1 177,95
$1 240,80
$1 307,38
$1 543,90 		$1 534,13
$1 596,98
$1 663,56
$1 900,08 		$356,18
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$931,18
$1 056,88
$1 190,04
$1 663,08
$2 527,22 		$1 287,36
$1 413,06
$1 546,22
$2 019,26 		$1 643,54
$1 769,24
$1 902,40
$2 375,44 		$1 999,72
$2 125,42
$2 258,58
$2 731,62 		$356,18
Toc - Plan #26 Bright Health
Silver

(PPO) Silver 5000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-521-9351

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 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 		$372,46
$422,75
$476,01
$665,22
$1 010,87 		$657,40
$707,69
$760,95
$950,16 		$942,34
$992,63
$1 045,89
$1 235,10 		$1 227,28
$1 277,57
$1 330,83
$1 520,04 		$284,94
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$744,92
$845,50
$952,02
$1 330,44
$2 021,74 		$1 029,86
$1 130,44
$1 236,96
$1 615,38 		$1 314,80
$1 415,38
$1 521,90
$1 900,32 		$1 599,74
$1 700,32
$1 806,84
$2 185,26 		$284,94
Toc - Plan #27 Bright Health
Silver

(PPO) Silver 3000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-521-9351

Annual Out of Pocket Expenses:

Individual Family
$3,000 $6,000 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 		$387,25
$439,53
$494,90
$691,62
$1 050,99 		$683,49
$735,77
$791,14
$987,86 		$979,73
$1 032,01
$1 087,38
$1 284,10 		$1 275,97
$1 328,25
$1 383,62
$1 580,34 		$296,24
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$774,50
$879,06
$989,80
$1 383,24
$2 101,98 		$1 070,74
$1 175,30
$1 286,04
$1 679,48 		$1 366,98
$1 471,54
$1 582,28
$1 975,72 		$1 663,22
$1 767,78
$1 878,52
$2 271,96 		$296,24
Toc - Plan #28 Bright Health
Silver

(PPO) Silver $0 Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-521-9351

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 		$409,41
$464,68
$523,23
$731,21
$1 111,14 		$722,61
$777,88
$836,43
$1 044,41 		$1 035,81
$1 091,08
$1 149,63
$1 357,61 		$1 349,01
$1 404,28
$1 462,83
$1 670,81 		$313,20
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$818,82
$929,36
$1 046,46
$1 462,42
$2 222,28 		$1 132,02
$1 242,56
$1 359,66
$1 775,62 		$1 445,22
$1 555,76
$1 672,86
$2 088,82 		$1 758,42
$1 868,96
$1 986,06
$2 402,02 		$313,20
Toc - Plan #29 Bright Health
Expanded Bronze

(PPO) Bronze 8550

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-521-9351

Annual Out of Pocket Expenses:

Individual Family
$8,550 $17,100 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 		$289,71
$328,82
$370,25
$517,42
$786,27 		$511,34
$550,45
$591,88
$739,05 		$732,97
$772,08
$813,51
$960,68 		$954,60
$993,71
$1 035,14
$1 182,31 		$221,63
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$579,42
$657,64
$740,50
$1 034,84
$1 572,54 		$801,05
$879,27
$962,13
$1 256,47 		$1 022,68
$1 100,90
$1 183,76
$1 478,10 		$1 244,31
$1 322,53
$1 405,39
$1 699,73 		$221,63
Toc - Plan #30 Bright Health
Expanded Bronze

(PPO) Bronze 5900

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-521-9351

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 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 		$302,45
$343,28
$386,53
$540,17
$820,85 		$533,82
$574,65
$617,90
$771,54 		$765,19
$806,02
$849,27
$1 002,91 		$996,56
$1 037,39
$1 080,64
$1 234,28 		$231,37
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$604,90
$686,56
$773,06
$1 080,34
$1 641,70 		$836,27
$917,93
$1 004,43
$1 311,71 		$1 067,64
$1 149,30
$1 235,80
$1 543,08 		$1 299,01
$1 380,67
$1 467,17
$1 774,45 		$231,37
Toc - Plan #31 Bright Health
Expanded Bronze

(PPO) Bronze 7000 HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-521-9351

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 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 		$367,85
$417,51
$470,12
$656,99
$998,35 		$649,26
$698,92
$751,53
$938,40 		$930,67
$980,33
$1 032,94
$1 219,81 		$1 212,08
$1 261,74
$1 314,35
$1 501,22 		$281,41
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$735,70
$835,02
$940,24
$1 313,98
$1 996,70 		$1 017,11
$1 116,43
$1 221,65
$1 595,39 		$1 298,52
$1 397,84
$1 503,06
$1 876,80 		$1 579,93
$1 679,25
$1 784,47
$2 158,21 		$281,41
Toc - Plan #32 Bright Health
Expanded Bronze

(PPO) Bronze $0 Primary Care

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-521-9351

Annual Out of Pocket Expenses:

Individual Family
$7,200 $14,400 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 		$302,52
$343,36
$386,62
$540,30
$821,04 		$533,95
$574,79
$618,05
$771,73 		$765,38
$806,22
$849,48
$1 003,16 		$996,81
$1 037,65
$1 080,91
$1 234,59 		$231,43
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$605,04
$686,72
$773,24
$1 080,60
$1 642,08 		$836,47
$918,15
$1 004,67
$1 312,03 		$1 067,90
$1 149,58
$1 236,10
$1 543,46 		$1 299,33
$1 381,01
$1 467,53
$1 774,89 		$231,43
Toc - Plan #33 Bright Health
Catastrophic

(PPO) Catastrophic 3 $0 PCP Visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-521-9351

Annual Out of Pocket Expenses:

Individual Family
$8,550 $17,100 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 		$241,13
$273,69
$308,17
$430,67
$654,44 		$425,60
$458,16
$492,64
$615,14 		$610,07
$642,63
$677,11
$799,61 		$794,54
$827,10
$861,58
$984,08 		$184,47
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$482,26
$547,38
$616,34
$861,34
$1 308,88 		$666,73
$731,85
$800,81
$1 045,81 		$851,20
$916,32
$985,28
$1 230,28 		$1 035,67
$1 100,79
$1 169,75
$1 414,75 		$184,47
Toc - Plan #34 Bright Health
Silver

(PPO) Silver $0 Primary Care

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-521-9351

Annual Out of Pocket Expenses:

Individual Family
$6,700 $13,400 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 		$388,26
$440,68
$496,20
$693,44
$1 053,74 		$685,28
$737,70
$793,22
$990,46 		$982,30
$1 034,72
$1 090,24
$1 287,48 		$1 279,32
$1 331,74
$1 387,26
$1 584,50 		$297,02
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$776,52
$881,36
$992,40
$1 386,88
$2 107,48 		$1 073,54
$1 178,38
$1 289,42
$1 683,90 		$1 370,56
$1 475,40
$1 586,44
$1 980,92 		$1 667,58
$1 772,42
$1 883,46
$2 277,94 		$297,02
Toc - Plan #35 Bright Health
Expanded Bronze

(PPO) Bronze $0 Medical Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-521-9351

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 		$336,56
$382,00
$430,12
$601,10
$913,42 		$594,03
$639,47
$687,59
$858,57 		$851,50
$896,94
$945,06
$1 116,04 		$1 108,97
$1 154,41
$1 202,53
$1 373,51 		$257,47
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$673,12
$764,00
$860,24
$1 202,20
$1 826,84 		$930,59
$1 021,47
$1 117,71
$1 459,67 		$1 188,06
$1 278,94
$1 375,18
$1 717,14 		$1 445,53
$1 536,41
$1 632,65
$1 974,61 		$257,47

ADVERTISEMENT

Blue Cross and Blue Shield of Oklahoma

Local: 1-866-520-2507 | Toll Free: 1-866-520-2507 | TTY: 1-800-722-0353
Toc - Plan #36 Blue Cross and Blue Shield of Oklahoma
Silver

(PPO) Blue Preferred Silver PPO_ 201

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-520-2507

Annual Out of Pocket Expenses:

Individual Family
$1,200 $3,600 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 		$545,47
$619,11
$697,11
$974,21
$1 480,41 		$962,76
$1 036,40
$1 114,40
$1 391,50 		$1 380,05
$1 453,69
$1 531,69
$1 808,79 		$1 797,34
$1 870,98
$1 948,98
$2 226,08 		$417,29
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1 090,94
$1 238,22
$1 394,22
$1 948,42
$2 960,82 		$1 508,23
$1 655,51
$1 811,51
$2 365,71 		$1 925,52
$2 072,80
$2 228,80
$2 783,00 		$2 342,81
$2 490,09
$2 646,09
$3 200,29 		$417,29
Toc - Plan #37 Blue Cross and Blue Shield of Oklahoma
Catastrophic

(PPO) Blue Preferred Security PPO_ 200

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-520-2507

Annual Out of Pocket Expenses:

Individual Family
$8,550 $17,100 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 		$335,57
$380,87
$428,86
$599,33
$910,74 		$592,28
$637,58
$685,57
$856,04 		$848,99
$894,29
$942,28
$1 112,75 		$1 105,70
$1 151,00
$1 198,99
$1 369,46 		$256,71
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$671,14
$761,74
$857,72
$1 198,66
$1 821,48 		$927,85
$1 018,45
$1 114,43
$1 455,37 		$1 184,56
$1 275,16
$1 371,14
$1 712,08 		$1 441,27
$1 531,87
$1 627,85
$1 968,79 		$256,71
Toc - Plan #38 Blue Cross and Blue Shield of Oklahoma
Gold

(PPO) Blue Preferred Gold PPO_ 205

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-520-2507

Annual Out of Pocket Expenses:

Individual Family
$500 $1,500 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 		$506,73
$575,13
$647,59
$905,01
$1 375,25 		$894,37
$962,77
$1 035,23
$1 292,65 		$1 282,01
$1 350,41
$1 422,87
$1 680,29 		$1 669,65
$1 738,05
$1 810,51
$2 067,93 		$387,64
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1 013,46
$1 150,26
$1 295,18
$1 810,02
$2 750,50 		$1 401,10
$1 537,90
$1 682,82
$2 197,66 		$1 788,74
$1 925,54
$2 070,46
$2 585,30 		$2 176,38
$2 313,18
$2 458,10
$2 972,94 		$387,64
Toc - Plan #39 Blue Cross and Blue Shield of Oklahoma
Bronze

(PPO) Blue Preferred Bronze PPO_ 206

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-520-2507

Annual Out of Pocket Expenses:

Individual Family
$5,000 $15,000 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 		$370,63
$420,67
$473,67
$661,95
$1 005,90 		$654,16
$704,20
$757,20
$945,48 		$937,69
$987,73
$1 040,73
$1 229,01 		$1 221,22
$1 271,26
$1 324,26
$1 512,54 		$283,53
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$741,26
$841,34
$947,34
$1 323,90
$2 011,80 		$1 024,79
$1 124,87
$1 230,87
$1 607,43 		$1 308,32
$1 408,40
$1 514,40
$1 890,96 		$1 591,85
$1 691,93
$1 797,93
$2 174,49 		$283,53
Toc - Plan #40 Blue Cross and Blue Shield of Oklahoma
Expanded Bronze

(PPO) Blue Advantage Bronze PPO_ 203

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-520-2507

Annual Out of Pocket Expenses:

Individual Family
$4,500 $13,300 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 		$311,19
$353,20
$397,70
$555,79
$844,58 		$549,25
$591,26
$635,76
$793,85 		$787,31
$829,32
$873,82
$1 031,91 		$1 025,37
$1 067,38
$1 111,88
$1 269,97 		$238,06
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$622,38
$706,40
$795,40
$1 111,58
$1 689,16 		$860,44
$944,46
$1 033,46
$1 349,64 		$1 098,50
$1 182,52
$1 271,52
$1 587,70 		$1 336,56
$1 420,58
$1 509,58
$1 825,76 		$238,06
Toc - Plan #41 Blue Cross and Blue Shield of Oklahoma
Silver

(PPO) Blue Advantage Silver PPO_ 204

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-520-2507

Annual Out of Pocket Expenses:

Individual Family
$1,500 $4,500 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 		$402,96
$457,36
$514,99
$719,69
$1 093,64 		$711,23
$765,63
$823,26
$1 027,96 		$1 019,50
$1 073,90
$1 131,53
$1 336,23 		$1 327,77
$1 382,17
$1 439,80
$1 644,50 		$308,27
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$805,92
$914,72
$1 029,98
$1 439,38
$2 187,28 		$1 114,19
$1 222,99
$1 338,25
$1 747,65 		$1 422,46
$1 531,26
$1 646,52
$2 055,92 		$1 730,73
$1 839,53
$1 954,79
$2 364,19 		$308,27
Toc - Plan #42 Blue Cross and Blue Shield of Oklahoma
Bronze

(PPO) Blue Advantage Bronze PPO_ 202

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-520-2507

Annual Out of Pocket Expenses:

Individual Family
$5,000 $15,000 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 		$286,99
$325,74
$366,78
$512,57
$778,90 		$506,54
$545,29
$586,33
$732,12 		$726,09
$764,84
$805,88
$951,67 		$945,64
$984,39
$1 025,43
$1 171,22 		$219,55
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$573,98
$651,48
$733,56
$1 025,14
$1 557,80 		$793,53
$871,03
$953,11
$1 244,69 		$1 013,08
$1 090,58
$1 172,66
$1 464,24 		$1 232,63
$1 310,13
$1 392,21
$1 683,79 		$219,55
Toc - Plan #43 Blue Cross and Blue Shield of Oklahoma
Gold

(PPO) Blue Advantage Gold PPO_ 309

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-520-2507

Annual Out of Pocket Expenses:

Individual Family
$1,200 $3,600 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 		$400,43
$454,49
$511,75
$715,17
$1 086,77 		$706,76
$760,82
$818,08
$1 021,50 		$1 013,09
$1 067,15
$1 124,41
$1 327,83 		$1 319,42
$1 373,48
$1 430,74
$1 634,16 		$306,33
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$800,86
$908,98
$1 023,50
$1 430,34
$2 173,54 		$1 107,19
$1 215,31
$1 329,83
$1 736,67 		$1 413,52
$1 521,64
$1 636,16
$2 043,00 		$1 719,85
$1 827,97
$1 942,49
$2 349,33 		$306,33
Toc - Plan #44 Blue Cross and Blue Shield of Oklahoma
Silver

(PPO) Blue Advantage Silver PPO_ 501

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-520-2507

Annual Out of Pocket Expenses:

Individual Family
$3,500 $10,500 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 		$396,27
$449,76
$506,43
$707,73
$1 075,47 		$699,41
$752,90
$809,57
$1 010,87 		$1 002,55
$1 056,04
$1 112,71
$1 314,01 		$1 305,69
$1 359,18
$1 415,85
$1 617,15 		$303,14
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$792,54
$899,52
$1 012,86
$1 415,46
$2 150,94 		$1 095,68
$1 202,66
$1 316,00
$1 718,60 		$1 398,82
$1 505,80
$1 619,14
$2 021,74 		$1 701,96
$1 808,94
$1 922,28
$2 324,88 		$303,14

ADVERTISEMENT

Oscar Insurance Company

Local:  | Toll Free: 

Toc - Plan #45 Oscar Insurance Company
Expanded Bronze

(PPO) Oscar Bronze Classic PCP Copay

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 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 		$301,61
$342,32
$385,44
$538,66
$818,54 		$532,33
$573,04
$616,16
$769,38 		$763,05
$803,76
$846,88
$1 000,10 		$993,77
$1 034,48
$1 077,60
$1 230,82 		$230,72
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$603,22
$684,64
$770,88
$1 077,32
$1 637,08 		$833,94
$915,36
$1 001,60
$1 308,04 		$1 064,66
$1 146,08
$1 232,32
$1 538,76 		$1 295,38
$1 376,80
$1 463,04
$1 769,48 		$230,72
Toc - Plan #46 Oscar Insurance Company
Expanded Bronze

(PPO) Oscar Bronze Classic

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 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 		$293,66
$333,30
$375,29
$524,47
$796,98 		$518,31
$557,95
$599,94
$749,12 		$742,96
$782,60
$824,59
$973,77 		$967,61
$1 007,25
$1 049,24
$1 198,42 		$224,65
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$587,32
$666,60
$750,58
$1 048,94
$1 593,96 		$811,97
$891,25
$975,23
$1 273,59 		$1 036,62
$1 115,90
$1 199,88
$1 498,24 		$1 261,27
$1 340,55
$1 424,53
$1 722,89 		$224,65
Toc - Plan #47 Oscar Insurance Company
Expanded Bronze

(PPO) Oscar Bronze Classic Next

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

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 		$354,92
$402,82
$453,57
$633,87
$963,23 		$626,43
$674,33
$725,08
$905,38 		$897,94
$945,84
$996,59
$1 176,89 		$1 169,45
$1 217,35
$1 268,10
$1 448,40 		$271,51
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$709,84
$805,64
$907,14
$1 267,74
$1 926,46 		$981,35
$1 077,15
$1 178,65
$1 539,25 		$1 252,86
$1 348,66
$1 450,16
$1 810,76 		$1 524,37
$1 620,17
$1 721,67
$2 082,27 		$271,51
Toc - Plan #48 Oscar Insurance Company
Silver

(PPO) Oscar Silver Saver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$4,200 $8,400 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 		$387,19
$439,45
$494,82
$691,51
$1 050,81 		$683,38
$735,64
$791,01
$987,70 		$979,57
$1 031,83
$1 087,20
$1 283,89 		$1 275,76
$1 328,02
$1 383,39
$1 580,08 		$296,19
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$774,38
$878,90
$989,64
$1 383,02
$2 101,62 		$1 070,57
$1 175,09
$1 285,83
$1 679,21 		$1 366,76
$1 471,28
$1 582,02
$1 975,40 		$1 662,95
$1 767,47
$1 878,21
$2 271,59 		$296,19
Toc - Plan #49 Oscar Insurance Company
Silver

(PPO) Oscar Silver Classic Next

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 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 		$397,27
$450,89
$507,70
$709,50
$1 078,16 		$701,17
$754,79
$811,60
$1 013,40 		$1 005,07
$1 058,69
$1 115,50
$1 317,30 		$1 308,97
$1 362,59
$1 419,40
$1 621,20 		$303,90
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$794,54
$901,78
$1 015,40
$1 419,00
$2 156,32 		$1 098,44
$1 205,68
$1 319,30
$1 722,90 		$1 402,34
$1 509,58
$1 623,20
$2 026,80 		$1 706,24
$1 813,48
$1 927,10
$2 330,70 		$303,90
Toc - Plan #50 Oscar Insurance Company
Catastrophic

(PPO) Oscar Secure

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$8,550 $17,100 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 		$245,32
$278,43
$313,51
$438,13
$665,77 		$432,98
$466,09
$501,17
$625,79 		$620,64
$653,75
$688,83
$813,45 		$808,30
$841,41
$876,49
$1 001,11 		$187,66
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$490,64
$556,86
$627,02
$876,26
$1 331,54 		$678,30
$744,52
$814,68
$1 063,92 		$865,96
$932,18
$1 002,34
$1 251,58 		$1 053,62
$1 119,84
$1 190,00
$1 439,24 		$187,66
Toc - Plan #51 Oscar Insurance Company
Gold

(PPO) Oscar Gold Classic

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$2,500 $5,000 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 		$424,08
$481,31
$541,96
$757,38
$1 150,91 		$748,49
$805,72
$866,37
$1 081,79 		$1 072,90
$1 130,13
$1 190,78
$1 406,20 		$1 397,31
$1 454,54
$1 515,19
$1 730,61 		$324,41
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$848,16
$962,62
$1 083,92
$1 514,76
$2 301,82 		$1 172,57
$1 287,03
$1 408,33
$1 839,17 		$1 496,98
$1 611,44
$1 732,74
$2 163,58 		$1 821,39
$1 935,85
$2 057,15
$2 487,99 		$324,41
Toc - Plan #52 Oscar Insurance Company
Expanded Bronze

(PPO) Oscar Bronze HDHP

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

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 		$311,97
$354,07
$398,68
$557,16
$846,65 		$550,62
$592,72
$637,33
$795,81 		$789,27
$831,37
$875,98
$1 034,46 		$1 027,92
$1 070,02
$1 114,63
$1 273,11 		$238,65
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$623,94
$708,14
$797,36
$1 114,32
$1 693,30 		$862,59
$946,79
$1 036,01
$1 352,97 		$1 101,24
$1 185,44
$1 274,66
$1 591,62 		$1 339,89
$1 424,09
$1 513,31
$1 830,27 		$238,65
Toc - Plan #53 Oscar Insurance Company
Silver

(PPO) Oscar Silver Saver 2

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

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 		$387,34
$439,62
$495,01
$691,77
$1 051,21 		$683,65
$735,93
$791,32
$988,08 		$979,96
$1 032,24
$1 087,63
$1 284,39 		$1 276,27
$1 328,55
$1 383,94
$1 580,70 		$296,31
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$774,68
$879,24
$990,02
$1 383,54
$2 102,42 		$1 070,99
$1 175,55
$1 286,33
$1 679,85 		$1 367,30
$1 471,86
$1 582,64
$1 976,16 		$1 663,61
$1 768,17
$1 878,95
$2 272,47 		$296,31
Toc - Plan #54 Oscar Insurance Company
Silver

(PPO) Oscar Silver Classic Copay

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 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 		$404,68
$459,30
$517,16
$722,73
$1 098,27 		$714,25
$768,87
$826,73
$1 032,30 		$1 023,82
$1 078,44
$1 136,30
$1 341,87 		$1 333,39
$1 388,01
$1 445,87
$1 651,44 		$309,57
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$809,36
$918,60
$1 034,32
$1 445,46
$2 196,54 		$1 118,93
$1 228,17
$1 343,89
$1 755,03 		$1 428,50
$1 537,74
$1 653,46
$2 064,60 		$1 738,07
$1 847,31
$1 963,03
$2 374,17 		$309,57
Toc - Plan #55 Oscar Insurance Company
Silver

(PPO) Oscar Silver Classic $0 Ded

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

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 		$416,78
$473,03
$532,63
$744,35
$1 131,11 		$735,61
$791,86
$851,46
$1 063,18 		$1 054,44
$1 110,69
$1 170,29
$1 382,01 		$1 373,27
$1 429,52
$1 489,12
$1 700,84 		$318,83
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$833,56
$946,06
$1 065,26
$1 488,70
$2 262,22 		$1 152,39
$1 264,89
$1 384,09
$1 807,53 		$1 471,22
$1 583,72
$1 702,92
$2 126,36 		$1 790,05
$1 902,55
$2 021,75
$2 445,19 		$318,83

‡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 Oklahoma County here.

Oklahoma County is in “Rating Area 3” of Oklahoma.

Currently, there are 55 plans offered in Rating Area 3.

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2021 Obamacare Plans for Oklahoma County, OK

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