Obamacare 2022 Rates for Brown County
Obamacare > Rates > Wisconsin > Brown County
Obamacare > Rates > Wisconsin > Brown County
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Together with CCHPLocal: 1-844-201-4672 | Toll Free: 1-844-201-4672 | TTY: 1-844-531-4856 |
Toc - Plan #1 Together with CCHP | ||||||||||||||||||||
Expanded Bronze
(EPO) Together Bronze |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-201-4672
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$277.25 $314.67 $354.31 $495.15 $752.43 |
$489.34 $526.76 $566.40 $707.24 |
$701.43 $738.85 $778.49 $919.33 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$554.50 $629.34 $708.62 $990.30 $1,504.86 |
$766.59 $841.43 $920.71 $1,202.39 |
$978.68 $1,053.52 $1,132.80 $1,414.48 |
Toc - Plan #2 Together with CCHP | ||||||||||||||||||||
Silver
(EPO) Together Standard Silver |
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Benefits & Coverage
Plan Brochure
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Customer Service Phone: 1-844-201-4672
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$378.76 $429.88 $484.04 $676.44 $1,027.91 |
$668.50 $719.62 $773.78 $966.18 |
$958.24 $1,009.36 $1,063.52 $1,255.92 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$757.52 $859.76 $968.08 $1,352.88 $2,055.82 |
$1,047.26 $1,149.50 $1,257.82 $1,642.62 |
$1,337.00 $1,439.24 $1,547.56 $1,932.36 |
Toc - Plan #3 Together with CCHP | ||||||||||||||||||||
Silver
(EPO) Together Silver |
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Benefits & Coverage
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Customer Service Phone: 1-844-201-4672
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$332.93 $377.86 $425.47 $594.59 $903.54 |
$587.61 $632.54 $680.15 $849.27 |
$842.29 $887.22 $934.83 $1,103.95 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$665.86 $755.72 $850.94 $1,189.18 $1,807.08 |
$920.54 $1,010.40 $1,105.62 $1,443.86 |
$1,175.22 $1,265.08 $1,360.30 $1,698.54 |
Toc - Plan #4 Together with CCHP | ||||||||||||||||||||
Gold
(EPO) Together Gold |
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Benefits & Coverage
Plan Brochure
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Customer Service Phone: 1-844-201-4672
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$390.50 $443.20 $499.04 $697.41 $1,059.78 |
$689.22 $741.92 $797.76 $996.13 |
$987.94 $1,040.64 $1,096.48 $1,294.85 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$781.00 $886.40 $998.08 $1,394.82 $2,119.56 |
$1,079.72 $1,185.12 $1,296.80 $1,693.54 |
$1,378.44 $1,483.84 $1,595.52 $1,992.26 |
Toc - Plan #5 Together with CCHP | ||||||||||||||||||||
Expanded Bronze
(EPO) Together Bronze HDHP |
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Benefits & Coverage
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Customer Service Phone: 1-844-201-4672
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$304.90 $346.05 $389.65 $544.53 $827.47 |
$538.14 $579.29 $622.89 $777.77 |
$771.38 $812.53 $856.13 $1,011.01 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$609.80 $692.10 $779.30 $1,089.06 $1,654.94 |
$843.04 $925.34 $1,012.54 $1,322.30 |
$1,076.28 $1,158.58 $1,245.78 $1,555.54 |
Toc - Plan #6 Together with CCHP | ||||||||||||||||||||
Silver
(EPO) Together Silver Select |
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Benefits & Coverage
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Customer Service Phone: 1-844-201-4672
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$365.12 $414.40 $466.61 $652.09 $990.91 |
$644.43 $693.71 $745.92 $931.40 |
$923.74 $973.02 $1,025.23 $1,210.71 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$730.24 $828.80 $933.22 $1,304.18 $1,981.82 |
$1,009.55 $1,108.11 $1,212.53 $1,583.49 |
$1,288.86 $1,387.42 $1,491.84 $1,862.80 |
Toc - Plan #7 Together with CCHP | ||||||||||||||||||||
Catastrophic
(EPO) Together Catastrophic |
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Benefits & Coverage
Plan Brochure
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Customer Service Phone: 1-844-201-4672
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$234.45 $266.09 $299.62 $418.72 $636.28 |
$413.80 $445.44 $478.97 $598.07 |
$593.15 $624.79 $658.32 $777.42 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$468.90 $532.18 $599.24 $837.44 $1,272.56 |
$648.25 $711.53 $778.59 $1,016.79 |
$827.60 $890.88 $957.94 $1,196.14 |
Toc - Plan #8 Together with CCHP | ||||||||||||||||||||
Expanded Bronze
(EPO) Together Bronze Copay |
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Benefits & Coverage
Plan Brochure
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Customer Service Phone: 1-844-201-4672
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$305.66 $346.91 $390.62 $545.89 $829.53 |
$539.48 $580.73 $624.44 $779.71 |
$773.30 $814.55 $858.26 $1,013.53 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$611.32 $693.82 $781.24 $1,091.78 $1,659.06 |
$845.14 $927.64 $1,015.06 $1,325.60 |
$1,078.96 $1,161.46 $1,248.88 $1,559.42 |
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HealthPartnersLocal: 1-952-883-5900 | Toll Free: 1-855-813-3887 | TTY: 1-952-883-6060 |
Toc - Plan #9 HealthPartners | ||||||||||||||||||||
Gold
(PPO) Robin Oak $1,800 w/Copay P-S Gold |
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Benefits & Coverage
Plan Brochure
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Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$405.89 $460.69 $518.73 $724.92 $1,101.59 |
$716.40 $771.20 $829.24 $1,035.43 |
$1,026.91 $1,081.71 $1,139.75 $1,345.94 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$811.78 $921.38 $1,037.46 $1,449.84 $2,203.18 |
$1,122.29 $1,231.89 $1,347.97 $1,760.35 |
$1,432.80 $1,542.40 $1,658.48 $2,070.86 |
Toc - Plan #10 HealthPartners | ||||||||||||||||||||
Expanded Bronze
(PPO) Robin Oak $6,250 Plus Bronze |
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Benefits & Coverage
Plan Brochure
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Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$299.25 $339.65 $382.44 $534.46 $812.16 |
$528.18 $568.58 $611.37 $763.39 |
$757.11 $797.51 $840.30 $992.32 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$598.50 $679.30 $764.88 $1,068.92 $1,624.32 |
$827.43 $908.23 $993.81 $1,297.85 |
$1,056.36 $1,137.16 $1,222.74 $1,526.78 |
Toc - Plan #11 HealthPartners | ||||||||||||||||||||
Catastrophic
(PPO) Robin Oak $8,700 Catastrophic |
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Benefits & Coverage
Plan Brochure
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Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$227.18 $257.85 $290.34 $405.74 $616.57 |
$400.97 $431.64 $464.13 $579.53 |
$574.76 $605.43 $637.92 $753.32 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$454.36 $515.70 $580.68 $811.48 $1,233.14 |
$628.15 $689.49 $754.47 $985.27 |
$801.94 $863.28 $928.26 $1,159.06 |
Toc - Plan #12 HealthPartners | ||||||||||||||||||||
Silver
(PPO) Robin Oak $7,500 w/Copay P-S Silver |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$368.89 $418.69 $471.44 $658.84 $1,001.17 |
$651.09 $700.89 $753.64 $941.04 |
$933.29 $983.09 $1,035.84 $1,223.24 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$737.78 $837.38 $942.88 $1,317.68 $2,002.34 |
$1,019.98 $1,119.58 $1,225.08 $1,599.88 |
$1,302.18 $1,401.78 $1,507.28 $1,882.08 |
Toc - Plan #13 HealthPartners | ||||||||||||||||||||
Silver
(PPO) Robin Oak $4,500 Plus Silver |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$364.82 $414.07 $466.24 $651.57 $990.12 |
$643.91 $693.16 $745.33 $930.66 |
$923.00 $972.25 $1,024.42 $1,209.75 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$729.64 $828.14 $932.48 $1,303.14 $1,980.24 |
$1,008.73 $1,107.23 $1,211.57 $1,582.23 |
$1,287.82 $1,386.32 $1,490.66 $1,861.32 |
Toc - Plan #14 HealthPartners | ||||||||||||||||||||
Expanded Bronze
(PPO) Robin Oak $7,000 HSA Bronze |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$294.86 $334.67 $376.83 $526.62 $800.25 |
$520.43 $560.24 $602.40 $752.19 |
$746.00 $785.81 $827.97 $977.76 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$589.72 $669.34 $753.66 $1,053.24 $1,600.50 |
$815.29 $894.91 $979.23 $1,278.81 |
$1,040.86 $1,120.48 $1,204.80 $1,504.38 |
Toc - Plan #15 HealthPartners | ||||||||||||||||||||
Expanded Bronze
(PPO) Robin Oak $8,000 Plus Bronze |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$296.72 $336.78 $379.21 $529.94 $805.30 |
$523.71 $563.77 $606.20 $756.93 |
$750.70 $790.76 $833.19 $983.92 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$593.44 $673.56 $758.42 $1,059.88 $1,610.60 |
$820.43 $900.55 $985.41 $1,286.87 |
$1,047.42 $1,127.54 $1,212.40 $1,513.86 |
Toc - Plan #16 HealthPartners | ||||||||||||||||||||
Silver
(PPO) Robin Oak $25/$50 P-S Silver |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$433.71 $492.26 $554.28 $774.61 $1,177.09 |
$765.50 $824.05 $886.07 $1,106.40 |
$1,097.29 $1,155.84 $1,217.86 $1,438.19 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$867.42 $984.52 $1,108.56 $1,549.22 $2,354.18 |
$1,199.21 $1,316.31 $1,440.35 $1,881.01 |
$1,531.00 $1,648.10 $1,772.14 $2,212.80 |
ADVERTISEMENT
QuartzLocal: 1-608-644-3430 | Toll Free: 1-800-362-3310 | TTY: 1-800-877-8973 |
Toc - Plan #17 Quartz | ||||||||||||||||||||
Gold
(HMO) Quartz One With Aurora Health Care Gold I401 with Dental |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$425.29 $482.70 $543.51 $759.56 $1,154.22 |
$750.63 $808.04 $868.85 $1,084.90 |
$1,075.97 $1,133.38 $1,194.19 $1,410.24 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$850.58 $965.40 $1,087.02 $1,519.12 $2,308.44 |
$1,175.92 $1,290.74 $1,412.36 $1,844.46 |
$1,501.26 $1,616.08 $1,737.70 $2,169.80 |
Toc - Plan #18 Quartz | ||||||||||||||||||||
Gold
(HMO) Quartz One With Aurora Health Care Gold I402 Maintenance with Dental |
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Benefits & Coverage
Plan Brochure
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Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$422.27 $479.27 $539.65 $754.16 $1,146.02 |
$745.30 $802.30 $862.68 $1,077.19 |
$1,068.33 $1,125.33 $1,185.71 $1,400.22 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$844.54 $958.54 $1,079.30 $1,508.32 $2,292.04 |
$1,167.57 $1,281.57 $1,402.33 $1,831.35 |
$1,490.60 $1,604.60 $1,725.36 $2,154.38 |
Toc - Plan #19 Quartz | ||||||||||||||||||||
Gold
(HMO) Quartz One With Aurora Health Care Gold I405 with Dental |
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Benefits & Coverage
Plan Brochure
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Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$420.41 $477.15 $537.27 $750.84 $1,140.97 |
$742.02 $798.76 $858.88 $1,072.45 |
$1,063.63 $1,120.37 $1,180.49 $1,394.06 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$840.82 $954.30 $1,074.54 $1,501.68 $2,281.94 |
$1,162.43 $1,275.91 $1,396.15 $1,823.29 |
$1,484.04 $1,597.52 $1,717.76 $2,144.90 |
Toc - Plan #20 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One With Aurora Health Care Silver I301 with Dental |
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Benefits & Coverage
Plan Brochure
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Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$424.54 $481.85 $542.56 $758.22 $1,152.19 |
$749.31 $806.62 $867.33 $1,082.99 |
$1,074.08 $1,131.39 $1,192.10 $1,407.76 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$849.08 $963.70 $1,085.12 $1,516.44 $2,304.38 |
$1,173.85 $1,288.47 $1,409.89 $1,841.21 |
$1,498.62 $1,613.24 $1,734.66 $2,165.98 |
Toc - Plan #21 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One With Aurora Health Care Silver I302 with Dental |
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Benefits & Coverage
Plan Brochure
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Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$426.06 $483.57 $544.49 $760.93 $1,156.30 |
$751.99 $809.50 $870.42 $1,086.86 |
$1,077.92 $1,135.43 $1,196.35 $1,412.79 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$852.12 $967.14 $1,088.98 $1,521.86 $2,312.60 |
$1,178.05 $1,293.07 $1,414.91 $1,847.79 |
$1,503.98 $1,619.00 $1,740.84 $2,173.72 |
Toc - Plan #22 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One With Aurora Health Care Silver I303 with Dental |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$416.59 $472.82 $532.39 $744.02 $1,130.61 |
$735.28 $791.51 $851.08 $1,062.71 |
$1,053.97 $1,110.20 $1,169.77 $1,381.40 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$833.18 $945.64 $1,064.78 $1,488.04 $2,261.22 |
$1,151.87 $1,264.33 $1,383.47 $1,806.73 |
$1,470.56 $1,583.02 $1,702.16 $2,125.42 |
Toc - Plan #23 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One With Aurora Health Care Bronze I201 with Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$320.32 $363.55 $409.36 $572.07 $869.32 |
$565.36 $608.59 $654.40 $817.11 |
$810.40 $853.63 $899.44 $1,062.15 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$640.64 $727.10 $818.72 $1,144.14 $1,738.64 |
$885.68 $972.14 $1,063.76 $1,389.18 |
$1,130.72 $1,217.18 $1,308.80 $1,634.22 |
Toc - Plan #24 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One With Aurora Health Care Bronze I202 with Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$316.62 $359.36 $404.63 $565.47 $859.29 |
$558.83 $601.57 $646.84 $807.68 |
$801.04 $843.78 $889.05 $1,049.89 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$633.24 $718.72 $809.26 $1,130.94 $1,718.58 |
$875.45 $960.93 $1,051.47 $1,373.15 |
$1,117.66 $1,203.14 $1,293.68 $1,615.36 |
Toc - Plan #25 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One With Aurora Health Care Bronze I204 with Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$335.13 $380.37 $428.29 $598.53 $909.53 |
$591.50 $636.74 $684.66 $854.90 |
$847.87 $893.11 $941.03 $1,111.27 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$670.26 $760.74 $856.58 $1,197.06 $1,819.06 |
$926.63 $1,017.11 $1,112.95 $1,453.43 |
$1,183.00 $1,273.48 $1,369.32 $1,709.80 |
Toc - Plan #26 Quartz | ||||||||||||||||||||
Gold
(HMO) Quartz One With Aurora Health Care Gold I401 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$407.46 $462.46 $520.73 $727.72 $1,105.84 |
$719.16 $774.16 $832.43 $1,039.42 |
$1,030.86 $1,085.86 $1,144.13 $1,351.12 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$814.92 $924.92 $1,041.46 $1,455.44 $2,211.68 |
$1,126.62 $1,236.62 $1,353.16 $1,767.14 |
$1,438.32 $1,548.32 $1,664.86 $2,078.84 |
Toc - Plan #27 Quartz | ||||||||||||||||||||
Gold
(HMO) Quartz One With Aurora Health Care Gold I402 Maintenance |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$404.57 $459.18 $517.03 $722.55 $1,097.99 |
$714.06 $768.67 $826.52 $1,032.04 |
$1,023.55 $1,078.16 $1,136.01 $1,341.53 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$809.14 $918.36 $1,034.06 $1,445.10 $2,195.98 |
$1,118.63 $1,227.85 $1,343.55 $1,754.59 |
$1,428.12 $1,537.34 $1,653.04 $2,064.08 |
Toc - Plan #28 Quartz | ||||||||||||||||||||
Gold
(HMO) Quartz One With Aurora Health Care Gold I405 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$402.78 $457.15 $514.75 $719.36 $1,093.14 |
$710.91 $765.28 $822.88 $1,027.49 |
$1,019.04 $1,073.41 $1,131.01 $1,335.62 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$805.56 $914.30 $1,029.50 $1,438.72 $2,186.28 |
$1,113.69 $1,222.43 $1,337.63 $1,746.85 |
$1,421.82 $1,530.56 $1,645.76 $2,054.98 |
Toc - Plan #29 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One With Aurora Health Care Silver I301 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$406.75 $461.65 $519.81 $726.44 $1,103.89 |
$717.91 $772.81 $830.97 $1,037.60 |
$1,029.07 $1,083.97 $1,142.13 $1,348.76 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$813.50 $923.30 $1,039.62 $1,452.88 $2,207.78 |
$1,124.66 $1,234.46 $1,350.78 $1,764.04 |
$1,435.82 $1,545.62 $1,661.94 $2,075.20 |
Toc - Plan #30 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One With Aurora Health Care Silver I302 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$408.20 $463.30 $521.67 $729.03 $1,107.84 |
$720.47 $775.57 $833.94 $1,041.30 |
$1,032.74 $1,087.84 $1,146.21 $1,353.57 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$816.40 $926.60 $1,043.34 $1,458.06 $2,215.68 |
$1,128.67 $1,238.87 $1,355.61 $1,770.33 |
$1,440.94 $1,551.14 $1,667.88 $2,082.60 |
Toc - Plan #31 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One With Aurora Health Care Silver I303 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$399.13 $453.00 $510.08 $712.83 $1,083.22 |
$704.46 $758.33 $815.41 $1,018.16 |
$1,009.79 $1,063.66 $1,120.74 $1,323.49 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$798.26 $906.00 $1,020.16 $1,425.66 $2,166.44 |
$1,103.59 $1,211.33 $1,325.49 $1,730.99 |
$1,408.92 $1,516.66 $1,630.82 $2,036.32 |
Toc - Plan #32 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One With Aurora Health Care Bronze I201 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$306.89 $348.31 $392.20 $548.10 $832.88 |
$541.66 $583.08 $626.97 $782.87 |
$776.43 $817.85 $861.74 $1,017.64 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$613.78 $696.62 $784.40 $1,096.20 $1,665.76 |
$848.55 $931.39 $1,019.17 $1,330.97 |
$1,083.32 $1,166.16 $1,253.94 $1,565.74 |
Toc - Plan #33 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One With Aurora Health Care Bronze I202 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$303.35 $344.29 $387.67 $541.77 $823.27 |
$535.41 $576.35 $619.73 $773.83 |
$767.47 $808.41 $851.79 $1,005.89 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$606.70 $688.58 $775.34 $1,083.54 $1,646.54 |
$838.76 $920.64 $1,007.40 $1,315.60 |
$1,070.82 $1,152.70 $1,239.46 $1,547.66 |
Toc - Plan #34 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One With Aurora Health Care Bronze I204 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$321.08 $364.42 $410.34 $573.44 $871.40 |
$566.70 $610.04 $655.96 $819.06 |
$812.32 $855.66 $901.58 $1,064.68 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$642.16 $728.84 $820.68 $1,146.88 $1,742.80 |
$887.78 $974.46 $1,066.30 $1,392.50 |
$1,133.40 $1,220.08 $1,311.92 $1,638.12 |
Toc - Plan #35 Quartz | ||||||||||||||||||||
Gold
(HMO) Quartz One With Aurora Health Care Gold I403 HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$439.12 $498.40 $561.19 $784.26 $1,191.76 |
$775.04 $834.32 $897.11 $1,120.18 |
$1,110.96 $1,170.24 $1,233.03 $1,456.10 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$878.24 $996.80 $1,122.38 $1,568.52 $2,383.52 |
$1,214.16 $1,332.72 $1,458.30 $1,904.44 |
$1,550.08 $1,668.64 $1,794.22 $2,240.36 |
Toc - Plan #36 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One With Aurora Health Care Silver I304 HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$428.30 $486.12 $547.36 $764.94 $1,162.39 |
$755.95 $813.77 $875.01 $1,092.59 |
$1,083.60 $1,141.42 $1,202.66 $1,420.24 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$856.60 $972.24 $1,094.72 $1,529.88 $2,324.78 |
$1,184.25 $1,299.89 $1,422.37 $1,857.53 |
$1,511.90 $1,627.54 $1,750.02 $2,185.18 |
Toc - Plan #37 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One With Aurora Health Care Bronze I203 HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$319.42 $362.54 $408.22 $570.48 $866.90 |
$563.78 $606.90 $652.58 $814.84 |
$808.14 $851.26 $896.94 $1,059.20 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$638.84 $725.08 $816.44 $1,140.96 $1,733.80 |
$883.20 $969.44 $1,060.80 $1,385.32 |
$1,127.56 $1,213.80 $1,305.16 $1,629.68 |
Toc - Plan #38 Quartz | ||||||||||||||||||||
Catastrophic
(HMO) Quartz One With Aurora Health Care Catastrophic I101 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$234.70 $266.38 $299.94 $419.17 $636.97 |
$414.24 $445.92 $479.48 $598.71 |
$593.78 $625.46 $659.02 $778.25 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$469.40 $532.76 $599.88 $838.34 $1,273.94 |
$648.94 $712.30 $779.42 $1,017.88 |
$828.48 $891.84 $958.96 $1,197.42 |
ADVERTISEMENT
Dean Health PlanLocal: 1-800-279-1302 | Toll Free: 1-800-279-1302 | TTY: 1-800-279-1302 |
Toc - Plan #39 Dean Health Plan | ||||||||||||||||||||
Gold
(HMO) Prevea360 Gold Copay Plus 1500X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$394.29 $447.52 $503.91 $704.21 $1,070.11 |
$695.92 $749.15 $805.54 $1,005.84 |
$997.55 $1,050.78 $1,107.17 $1,307.47 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$788.58 $895.04 $1,007.82 $1,408.42 $2,140.22 |
$1,090.21 $1,196.67 $1,309.45 $1,710.05 |
$1,391.84 $1,498.30 $1,611.08 $2,011.68 |
Toc - Plan #40 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Prevea360 Silver Copay Plus 4800X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$395.37 $448.74 $505.28 $706.13 $1,073.03 |
$697.83 $751.20 $807.74 $1,008.59 |
$1,000.29 $1,053.66 $1,110.20 $1,311.05 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$790.74 $897.48 $1,010.56 $1,412.26 $2,146.06 |
$1,093.20 $1,199.94 $1,313.02 $1,714.72 |
$1,395.66 $1,502.40 $1,615.48 $2,017.18 |
Toc - Plan #41 Dean Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) Prevea360 Bronze Copay Plus 8650X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$266.17 $302.11 $340.17 $475.39 $722.40 |
$469.79 $505.73 $543.79 $679.01 |
$673.41 $709.35 $747.41 $882.63 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$532.34 $604.22 $680.34 $950.78 $1,444.80 |
$735.96 $807.84 $883.96 $1,154.40 |
$939.58 $1,011.46 $1,087.58 $1,358.02 |
Toc - Plan #42 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Prevea360 Silver Classic 5000X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$384.65 $436.57 $491.58 $686.98 $1,043.93 |
$678.90 $730.82 $785.83 $981.23 |
$973.15 $1,025.07 $1,080.08 $1,275.48 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$769.30 $873.14 $983.16 $1,373.96 $2,087.86 |
$1,063.55 $1,167.39 $1,277.41 $1,668.21 |
$1,357.80 $1,461.64 $1,571.66 $1,962.46 |
Toc - Plan #43 Dean Health Plan | ||||||||||||||||||||
Gold
(HMO) Prevea360 Gold Value Copay 3700X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$388.45 $440.89 $496.44 $693.77 $1,054.25 |
$685.61 $738.05 $793.60 $990.93 |
$982.77 $1,035.21 $1,090.76 $1,288.09 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$776.90 $881.78 $992.88 $1,387.54 $2,108.50 |
$1,074.06 $1,178.94 $1,290.04 $1,684.70 |
$1,371.22 $1,476.10 $1,587.20 $1,981.86 |
Toc - Plan #44 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Prevea360 Silver Value Copay 5000X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$401.36 $455.54 $512.94 $716.83 $1,089.29 |
$708.40 $762.58 $819.98 $1,023.87 |
$1,015.44 $1,069.62 $1,127.02 $1,330.91 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$802.72 $911.08 $1,025.88 $1,433.66 $2,178.58 |
$1,109.76 $1,218.12 $1,332.92 $1,740.70 |
$1,416.80 $1,525.16 $1,639.96 $2,047.74 |
Toc - Plan #45 Dean Health Plan | ||||||||||||||||||||
Bronze
(HMO) Prevea360 Bronze Value Copay 8650X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$257.32 $292.05 $328.85 $459.56 $698.35 |
$454.17 $488.90 $525.70 $656.41 |
$651.02 $685.75 $722.55 $853.26 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$514.64 $584.10 $657.70 $919.12 $1,396.70 |
$711.49 $780.95 $854.55 $1,115.97 |
$908.34 $977.80 $1,051.40 $1,312.82 |
Toc - Plan #46 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Prevea360 Silver HSA-E 4500X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$378.98 $430.14 $484.33 $676.86 $1,028.55 |
$668.90 $720.06 $774.25 $966.78 |
$958.82 $1,009.98 $1,064.17 $1,256.70 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$757.96 $860.28 $968.66 $1,353.72 $2,057.10 |
$1,047.88 $1,150.20 $1,258.58 $1,643.64 |
$1,337.80 $1,440.12 $1,548.50 $1,933.56 |
Toc - Plan #47 Dean Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) Prevea360 Bronze HSA-E 6950X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$271.66 $308.34 $347.18 $485.19 $737.29 |
$479.48 $516.16 $555.00 $693.01 |
$687.30 $723.98 $762.82 $900.83 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$543.32 $616.68 $694.36 $970.38 $1,474.58 |
$751.14 $824.50 $902.18 $1,178.20 |
$958.96 $1,032.32 $1,110.00 $1,386.02 |
Toc - Plan #48 Dean Health Plan | ||||||||||||||||||||
Catastrophic
(HMO) Prevea360 Catastrophic Safety Net |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$210.04 $238.40 $268.43 $375.13 $570.05 |
$370.72 $399.08 $429.11 $535.81 |
$531.40 $559.76 $589.79 $696.49 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$420.08 $476.80 $536.86 $750.26 $1,140.10 |
$580.76 $637.48 $697.54 $910.94 |
$741.44 $798.16 $858.22 $1,071.62 |
ADVERTISEMENT
Molina HealthcareLocal: 1-888-560-2043 | Toll Free: 1-888-560-2043 |
Toc - Plan #49 Molina Healthcare | ||||||||||||||||||||
Gold
(HMO) Confident Care Gold 1 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$366.23 $415.67 $468.04 $654.08 $993.94 |
$646.39 $695.83 $748.20 $934.24 |
$926.55 $975.99 $1,028.36 $1,214.40 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$732.46 $831.34 $936.08 $1,308.16 $1,987.88 |
$1,012.62 $1,111.50 $1,216.24 $1,588.32 |
$1,292.78 $1,391.66 $1,496.40 $1,868.48 |
Toc - Plan #50 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Constant Care Silver 1 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$328.33 $372.65 $419.61 $586.40 $891.09 |
$579.50 $623.82 $670.78 $837.57 |
$830.67 $874.99 $921.95 $1,088.74 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$656.66 $745.30 $839.22 $1,172.80 $1,782.18 |
$907.83 $996.47 $1,090.39 $1,423.97 |
$1,159.00 $1,247.64 $1,341.56 $1,675.14 |
Toc - Plan #51 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Constant Care Silver 4 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$325.14 $369.04 $415.53 $580.70 $882.43 |
$573.87 $617.77 $664.26 $829.43 |
$822.60 $866.50 $912.99 $1,078.16 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$650.28 $738.08 $831.06 $1,161.40 $1,764.86 |
$899.01 $986.81 $1,079.79 $1,410.13 |
$1,147.74 $1,235.54 $1,328.52 $1,658.86 |
Toc - Plan #52 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Constant Care Silver 7 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$319.23 $362.32 $407.97 $570.14 $866.38 |
$563.44 $606.53 $652.18 $814.35 |
$807.65 $850.74 $896.39 $1,058.56 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$638.46 $724.64 $815.94 $1,140.28 $1,732.76 |
$882.67 $968.85 $1,060.15 $1,384.49 |
$1,126.88 $1,213.06 $1,304.36 $1,628.70 |
Toc - Plan #53 Molina Healthcare | ||||||||||||||||||||
Gold
(HMO) Confident Care Gold 1 + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$361.33 $410.10 $461.77 $645.33 $980.64 |
$637.74 $686.51 $738.18 $921.74 |
$914.15 $962.92 $1,014.59 $1,198.15 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$722.66 $820.20 $923.54 $1,290.66 $1,961.28 |
$999.07 $1,096.61 $1,199.95 $1,567.07 |
$1,275.48 $1,373.02 $1,476.36 $1,843.48 |
Toc - Plan #54 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Constant Care Silver 1 + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$325.81 $369.80 $416.39 $581.90 $884.26 |
$575.06 $619.05 $665.64 $831.15 |
$824.31 $868.30 $914.89 $1,080.40 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$651.62 $739.60 $832.78 $1,163.80 $1,768.52 |
$900.87 $988.85 $1,082.03 $1,413.05 |
$1,150.12 $1,238.10 $1,331.28 $1,662.30 |
Toc - Plan #55 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Constant Care Silver 2 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$327.58 $371.80 $418.64 $585.05 $889.05 |
$578.18 $622.40 $669.24 $835.65 |
$828.78 $873.00 $919.84 $1,086.25 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$655.16 $743.60 $837.28 $1,170.10 $1,778.10 |
$905.76 $994.20 $1,087.88 $1,420.70 |
$1,156.36 $1,244.80 $1,338.48 $1,671.30 |
ADVERTISEMENT
WPS Health PlanLocal: 1-920-490-6900 | Toll Free: 1-800-332-6249 | TTY: 1-888-332-0144 |
Toc - Plan #56 WPS Health Plan | ||||||||||||||||||||
Bronze
(HMO) WPS HMO Bronze $8,700 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$280.40 $318.25 $358.35 $500.79 $761.01 |
$494.91 $532.76 $572.86 $715.30 |
$709.42 $747.27 $787.37 $929.81 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$560.80 $636.50 $716.70 $1,001.58 $1,522.02 |
$775.31 $851.01 $931.21 $1,216.09 |
$989.82 $1,065.52 $1,145.72 $1,430.60 |
Toc - Plan #57 WPS Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) WPS HMO Bronze $6,500 with 3 Free PCP Visits | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$291.48 $330.83 $372.51 $520.58 $791.08 |
$514.46 $553.81 $595.49 $743.56 |
$737.44 $776.79 $818.47 $966.54 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$582.96 $661.66 $745.02 $1,041.16 $1,582.16 |
$805.94 $884.64 $968.00 $1,264.14 |
$1,028.92 $1,107.62 $1,190.98 $1,487.12 |
Toc - Plan #58 WPS Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) WPS HMO Bronze $7,500 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$281.12 $319.07 $359.27 $502.08 $762.96 |
$496.18 $534.13 $574.33 $717.14 |
$711.24 $749.19 $789.39 $932.20 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$562.24 $638.14 $718.54 $1,004.16 $1,525.92 |
$777.30 $853.20 $933.60 $1,219.22 |
$992.36 $1,068.26 $1,148.66 $1,434.28 |
Toc - Plan #59 WPS Health Plan | ||||||||||||||||||||
Silver
(HMO) WPS HMO Silver $7,500 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$366.96 $416.50 $468.97 $655.39 $995.93 |
$647.68 $697.22 $749.69 $936.11 |
$928.40 $977.94 $1,030.41 $1,216.83 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$733.92 $833.00 $937.94 $1,310.78 $1,991.86 |
$1,014.64 $1,113.72 $1,218.66 $1,591.50 |
$1,295.36 $1,394.44 $1,499.38 $1,872.22 |
Toc - Plan #60 WPS Health Plan | ||||||||||||||||||||
Silver
(HMO) WPS HMO Silver $4,500 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$370.21 $420.19 $473.13 $661.20 $1,004.75 |
$653.42 $703.40 $756.34 $944.41 |
$936.63 $986.61 $1,039.55 $1,227.62 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$740.42 $840.38 $946.26 $1,322.40 $2,009.50 |
$1,023.63 $1,123.59 $1,229.47 $1,605.61 |
$1,306.84 $1,406.80 $1,512.68 $1,888.82 |
Toc - Plan #61 WPS Health Plan | ||||||||||||||||||||
Silver
(HMO) WPS HMO Silver $5,000 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$383.64 $435.43 $490.29 $685.18 $1,041.20 |
$677.12 $728.91 $783.77 $978.66 |
$970.60 $1,022.39 $1,077.25 $1,272.14 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$767.28 $870.86 $980.58 $1,370.36 $2,082.40 |
$1,060.76 $1,164.34 $1,274.06 $1,663.84 |
$1,354.24 $1,457.82 $1,567.54 $1,957.32 |
Toc - Plan #62 WPS Health Plan | ||||||||||||||||||||
Gold
(HMO) WPS HMO Gold $3,000 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$501.89 $569.65 $641.42 $896.38 $1,362.13 |
$885.84 $953.60 $1,025.37 $1,280.33 |
$1,269.79 $1,337.55 $1,409.32 $1,664.28 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,003.78 $1,139.30 $1,282.84 $1,792.76 $2,724.26 |
$1,387.73 $1,523.25 $1,666.79 $2,176.71 |
$1,771.68 $1,907.20 $2,050.74 $2,560.66 |
Toc - Plan #63 WPS Health Plan | ||||||||||||||||||||
Catastrophic
(HMO) WPS HMO Catastrophic $8,700 with 3 Free PCP Visits | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$243.77 $276.68 $311.54 $435.37 $661.59 |
$430.25 $463.16 $498.02 $621.85 |
$616.73 $649.64 $684.50 $808.33 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$487.54 $553.36 $623.08 $870.74 $1,323.18 |
$674.02 $739.84 $809.56 $1,057.22 |
$860.50 $926.32 $996.04 $1,243.70 |
Toc - Plan #64 WPS Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) WPS HMO HDHP Bronze $7,050 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$292.08 $331.51 $373.28 $521.65 $792.71 |
$515.52 $554.95 $596.72 $745.09 |
$738.96 $778.39 $820.16 $968.53 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$584.16 $663.02 $746.56 $1,043.30 $1,585.42 |
$807.60 $886.46 $970.00 $1,266.74 |
$1,031.04 $1,109.90 $1,193.44 $1,490.18 |
Toc - Plan #65 WPS Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) WPS HMO HDHP Bronze $6,830 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$298.41 $338.70 $381.37 $532.96 $809.88 |
$526.69 $566.98 $609.65 $761.24 |
$754.97 $795.26 $837.93 $989.52 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$596.82 $677.40 $762.74 $1,065.92 $1,619.76 |
$825.10 $905.68 $991.02 $1,294.20 |
$1,053.38 $1,133.96 $1,219.30 $1,522.48 |
Toc - Plan #66 WPS Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) WPS HMO HDHP Bronze $6,000 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$292.74 $332.26 $374.12 $522.83 $794.50 |
$516.69 $556.21 $598.07 $746.78 |
$740.64 $780.16 $822.02 $970.73 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$585.48 $664.52 $748.24 $1,045.66 $1,589.00 |
$809.43 $888.47 $972.19 $1,269.61 |
$1,033.38 $1,112.42 $1,196.14 $1,493.56 |
Toc - Plan #67 WPS Health Plan | ||||||||||||||||||||
Silver
(HMO) WPS HMO HDHP Silver $4,500 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$372.86 $423.20 $476.52 $665.93 $1,011.94 |
$658.10 $708.44 $761.76 $951.17 |
$943.34 $993.68 $1,047.00 $1,236.41 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$745.72 $846.40 $953.04 $1,331.86 $2,023.88 |
$1,030.96 $1,131.64 $1,238.28 $1,617.10 |
$1,316.20 $1,416.88 $1,523.52 $1,902.34 |
Toc - Plan #68 WPS Health Plan | ||||||||||||||||||||
Silver
(HMO) WPS HMO HDHP Silver $5,250 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$375.45 $426.14 $479.83 $670.55 $1,018.97 |
$662.67 $713.36 $767.05 $957.77 |
$949.89 $1,000.58 $1,054.27 $1,244.99 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$750.90 $852.28 $959.66 $1,341.10 $2,037.94 |
$1,038.12 $1,139.50 $1,246.88 $1,628.32 |
$1,325.34 $1,426.72 $1,534.10 $1,915.54 |
Toc - Plan #69 WPS Health Plan | ||||||||||||||||||||
Silver
(HMO) WPS HMO HDHP Silver $6,125 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$358.17 $406.52 $457.74 $639.69 $972.07 |
$632.17 $680.52 $731.74 $913.69 |
$906.17 $954.52 $1,005.74 $1,187.69 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$716.34 $813.04 $915.48 $1,279.38 $1,944.14 |
$990.34 $1,087.04 $1,189.48 $1,553.38 |
$1,264.34 $1,361.04 $1,463.48 $1,827.38 |
Toc - Plan #70 WPS Health Plan | ||||||||||||||||||||
Bronze
(POS) WPS POS Bronze $8,700 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$299.92 $340.41 $383.30 $535.66 $813.98 |
$529.36 $569.85 $612.74 $765.10 |
$758.80 $799.29 $842.18 $994.54 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$599.84 $680.82 $766.60 $1,071.32 $1,627.96 |
$829.28 $910.26 $996.04 $1,300.76 |
$1,058.72 $1,139.70 $1,225.48 $1,530.20 |
Toc - Plan #71 WPS Health Plan | ||||||||||||||||||||
Expanded Bronze
(POS) WPS POS HDHP Bronze $6,000 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$313.10 $355.37 $400.14 $559.20 $849.75 |
$552.62 $594.89 $639.66 $798.72 |
$792.14 $834.41 $879.18 $1,038.24 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$626.20 $710.74 $800.28 $1,118.40 $1,699.50 |
$865.72 $950.26 $1,039.80 $1,357.92 |
$1,105.24 $1,189.78 $1,279.32 $1,597.44 |
ADVERTISEMENT
Common Ground Healthcare CooperativeLocal: 1-877-514-2442 | Toll Free: 1-877-514-2442 | TTY: 1-844-472-2442 |
Toc - Plan #72 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Solutions Bronze $0 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$268.59 $304.84 $343.24 $479.68 $728.92 |
$474.05 $510.30 $548.70 $685.14 |
$679.51 $715.76 $754.16 $890.60 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$537.18 $609.68 $686.48 $959.36 $1,457.84 |
$742.64 $815.14 $891.94 $1,164.82 |
$948.10 $1,020.60 $1,097.40 $1,370.28 |
Toc - Plan #73 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Solutions Silver $0 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$385.40 $437.41 $492.52 $688.30 $1,045.93 |
$680.22 $732.23 $787.34 $983.12 |
$975.04 $1,027.05 $1,082.16 $1,277.94 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$770.80 $874.82 $985.04 $1,376.60 $2,091.86 |
$1,065.62 $1,169.64 $1,279.86 $1,671.42 |
$1,360.44 $1,464.46 $1,574.68 $1,966.24 |
Toc - Plan #74 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Solutions Gold $0 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$409.21 $464.44 $522.96 $730.83 $1,110.57 |
$722.25 $777.48 $836.00 $1,043.87 |
$1,035.29 $1,090.52 $1,149.04 $1,356.91 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$818.42 $928.88 $1,045.92 $1,461.66 $2,221.14 |
$1,131.46 $1,241.92 $1,358.96 $1,774.70 |
$1,444.50 $1,554.96 $1,672.00 $2,087.74 |
Toc - Plan #75 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Value 2 Gold $3000 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$358.55 $406.95 $458.22 $640.36 $973.09 |
$632.84 $681.24 $732.51 $914.65 |
$907.13 $955.53 $1,006.80 $1,188.94 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$717.10 $813.90 $916.44 $1,280.72 $1,946.18 |
$991.39 $1,088.19 $1,190.73 $1,555.01 |
$1,265.68 $1,362.48 $1,465.02 $1,829.30 |
Toc - Plan #76 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Value 1 Gold $3600 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$348.14 $395.12 $444.90 $621.75 $944.81 |
$614.46 $661.44 $711.22 $888.07 |
$880.78 $927.76 $977.54 $1,154.39 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$696.28 $790.24 $889.80 $1,243.50 $1,889.62 |
$962.60 $1,056.56 $1,156.12 $1,509.82 |
$1,228.92 $1,322.88 $1,422.44 $1,776.14 |
Toc - Plan #77 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Value Premier Gold $1800 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$387.09 $439.34 $494.69 $691.33 $1,050.54 |
$683.21 $735.46 $790.81 $987.45 |
$979.33 $1,031.58 $1,086.93 $1,283.57 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$774.18 $878.68 $989.38 $1,382.66 $2,101.08 |
$1,070.30 $1,174.80 $1,285.50 $1,678.78 |
$1,366.42 $1,470.92 $1,581.62 $1,974.90 |
Toc - Plan #78 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Value Plus Gold $2000 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$360.84 $409.54 $461.14 $644.44 $979.28 |
$636.87 $685.57 $737.17 $920.47 |
$912.90 $961.60 $1,013.20 $1,196.50 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$721.68 $819.08 $922.28 $1,288.88 $1,958.56 |
$997.71 $1,095.11 $1,198.31 $1,564.91 |
$1,273.74 $1,371.14 $1,474.34 $1,840.94 |
Toc - Plan #79 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Value Plus Silver $4000 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$347.43 $394.32 $444.00 $620.49 $942.90 |
$613.21 $660.10 $709.78 $886.27 |
$878.99 $925.88 $975.56 $1,152.05 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$694.86 $788.64 $888.00 $1,240.98 $1,885.80 |
$960.64 $1,054.42 $1,153.78 $1,506.76 |
$1,226.42 $1,320.20 $1,419.56 $1,772.54 |
Toc - Plan #80 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Value Premier Silver $3000 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$361.87 $410.71 $462.45 $646.27 $982.08 |
$638.69 $687.53 $739.27 $923.09 |
$915.51 $964.35 $1,016.09 $1,199.91 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$723.74 $821.42 $924.90 $1,292.54 $1,964.16 |
$1,000.56 $1,098.24 $1,201.72 $1,569.36 |
$1,277.38 $1,375.06 $1,478.54 $1,846.18 |
Toc - Plan #81 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Value 2 Silver $6500 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$295.56 $335.45 $377.71 $527.85 $802.12 |
$521.65 $561.54 $603.80 $753.94 |
$747.74 $787.63 $829.89 $980.03 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$591.12 $670.90 $755.42 $1,055.70 $1,604.24 |
$817.21 $896.99 $981.51 $1,281.79 |
$1,043.30 $1,123.08 $1,207.60 $1,507.88 |
Toc - Plan #82 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Catastrophic
(EPO) CGHC Catastrophic $8700 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$183.35 $208.09 $234.31 $327.44 $497.58 |
$323.60 $348.34 $374.56 $467.69 |
$463.85 $488.59 $514.81 $607.94 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$366.70 $416.18 $468.62 $654.88 $995.16 |
$506.95 $556.43 $608.87 $795.13 |
$647.20 $696.68 $749.12 $935.38 |
Toc - Plan #83 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Value Plus Bronze $8700 Deductible ($35 PCP Copay) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$253.54 $287.75 $324.01 $452.80 $688.07 |
$447.49 $481.70 $517.96 $646.75 |
$641.44 $675.65 $711.91 $840.70 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$507.08 $575.50 $648.02 $905.60 $1,376.14 |
$701.03 $769.45 $841.97 $1,099.55 |
$894.98 $963.40 $1,035.92 $1,293.50 |
Toc - Plan #84 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Value Premier Bronze $8150 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$261.51 $296.81 $334.20 $467.04 $709.72 |
$461.56 $496.86 $534.25 $667.09 |
$661.61 $696.91 $734.30 $867.14 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$523.02 $593.62 $668.40 $934.08 $1,419.44 |
$723.07 $793.67 $868.45 $1,134.13 |
$923.12 $993.72 $1,068.50 $1,334.18 |
Toc - Plan #85 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC HSA Bronze $7000 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$263.28 $298.81 $336.46 $470.20 $714.51 |
$464.68 $500.21 $537.86 $671.60 |
$666.08 $701.61 $739.26 $873.00 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$526.56 $597.62 $672.92 $940.40 $1,429.02 |
$727.96 $799.02 $874.32 $1,141.80 |
$929.36 $1,000.42 $1,075.72 $1,343.20 |
Toc - Plan #86 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC HSA Gold $2800 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$410.98 $466.45 $525.22 $734.00 $1,115.38 |
$725.37 $780.84 $839.61 $1,048.39 |
$1,039.76 $1,095.23 $1,154.00 $1,362.78 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$821.96 $932.90 $1,050.44 $1,468.00 $2,230.76 |
$1,136.35 $1,247.29 $1,364.83 $1,782.39 |
$1,450.74 $1,561.68 $1,679.22 $2,096.78 |
Toc - Plan #87 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC HSA Silver $3000 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$399.77 $453.73 $510.90 $713.97 $1,084.95 |
$705.59 $759.55 $816.72 $1,019.79 |
$1,011.41 $1,065.37 $1,122.54 $1,325.61 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$799.54 $907.46 $1,021.80 $1,427.94 $2,169.90 |
$1,105.36 $1,213.28 $1,327.62 $1,733.76 |
$1,411.18 $1,519.10 $1,633.44 $2,039.58 |
Toc - Plan #88 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Bronze
(EPO) CGHC Value 1 Bronze $8700 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$251.85 $285.84 $321.85 $449.79 $683.49 |
$444.51 $478.50 $514.51 $642.45 |
$637.17 $671.16 $707.17 $835.11 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$503.70 $571.68 $643.70 $899.58 $1,366.98 |
$696.36 $764.34 $836.36 $1,092.24 |
$889.02 $957.00 $1,029.02 $1,284.90 |
Toc - Plan #89 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Value 2 Bronze $6000 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$259.18 $294.16 $331.22 $462.88 $703.39 |
$457.45 $492.43 $529.49 $661.15 |
$655.72 $690.70 $727.76 $859.42 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$518.36 $588.32 $662.44 $925.76 $1,406.78 |
$716.63 $786.59 $860.71 $1,124.03 |
$914.90 $984.86 $1,058.98 $1,322.30 |
Toc - Plan #90 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Value 1 Silver $7500 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$295.50 $335.38 $377.64 $527.74 $801.96 |
$521.55 $561.43 $603.69 $753.79 |
$747.60 $787.48 $829.74 $979.84 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$591.00 $670.76 $755.28 $1,055.48 $1,603.92 |
$817.05 $896.81 $981.33 $1,281.53 |
$1,043.10 $1,122.86 $1,207.38 $1,507.58 |
Toc - Plan #91 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Value Premier Gold $1800 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$390.02 $442.66 $498.43 $696.56 $1,058.49 |
$688.38 $741.02 $796.79 $994.92 |
$986.74 $1,039.38 $1,095.15 $1,293.28 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$780.04 $885.32 $996.86 $1,393.12 $2,116.98 |
$1,078.40 $1,183.68 $1,295.22 $1,691.48 |
$1,376.76 $1,482.04 $1,593.58 $1,989.84 |
Toc - Plan #92 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Value Plus Gold $2000 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$363.75 $412.84 $464.86 $649.63 $987.18 |
$642.01 $691.10 $743.12 $927.89 |
$920.27 $969.36 $1,021.38 $1,206.15 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$727.50 $825.68 $929.72 $1,299.26 $1,974.36 |
$1,005.76 $1,103.94 $1,207.98 $1,577.52 |
$1,284.02 $1,382.20 $1,486.24 $1,855.78 |
Toc - Plan #93 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Value 2 Gold $3000 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$361.46 $410.25 $461.94 $645.56 $980.98 |
$637.97 $686.76 $738.45 $922.07 |
$914.48 $963.27 $1,014.96 $1,198.58 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$722.92 $820.50 $923.88 $1,291.12 $1,961.96 |
$999.43 $1,097.01 $1,200.39 $1,567.63 |
$1,275.94 $1,373.52 $1,476.90 $1,844.14 |
Toc - Plan #94 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Value 1 Gold $3600 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$351.04 $398.41 $448.61 $626.93 $952.69 |
$619.58 $666.95 $717.15 $895.47 |
$888.12 $935.49 $985.69 $1,164.01 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$702.08 $796.82 $897.22 $1,253.86 $1,905.38 |
$970.62 $1,065.36 $1,165.76 $1,522.40 |
$1,239.16 $1,333.90 $1,434.30 $1,790.94 |
Toc - Plan #95 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Value Plus Silver $4000 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$350.33 $397.61 $447.71 $625.67 $950.77 |
$618.33 $665.61 $715.71 $893.67 |
$886.33 $933.61 $983.71 $1,161.67 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$700.66 $795.22 $895.42 $1,251.34 $1,901.54 |
$968.66 $1,063.22 $1,163.42 $1,519.34 |
$1,236.66 $1,331.22 $1,431.42 $1,787.34 |
Toc - Plan #96 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Value Premier Silver $3000 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$364.78 $414.01 $466.17 $651.47 $989.97 |
$643.83 $693.06 $745.22 $930.52 |
$922.88 $972.11 $1,024.27 $1,209.57 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$729.56 $828.02 $932.34 $1,302.94 $1,979.94 |
$1,008.61 $1,107.07 $1,211.39 $1,581.99 |
$1,287.66 $1,386.12 $1,490.44 $1,861.04 |
Toc - Plan #97 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Value 1 Silver $7500 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$298.36 $338.63 $381.29 $532.86 $809.73 |
$526.60 $566.87 $609.53 $761.10 |
$754.84 $795.11 $837.77 $989.34 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$596.72 $677.26 $762.58 $1,065.72 $1,619.46 |
$824.96 $905.50 $990.82 $1,293.96 |
$1,053.20 $1,133.74 $1,219.06 $1,522.20 |
Toc - Plan #98 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Value 2 Silver $6500 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$298.43 $338.71 $381.38 $532.98 $809.91 |
$526.72 $567.00 $609.67 $761.27 |
$755.01 $795.29 $837.96 $989.56 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$596.86 $677.42 $762.76 $1,065.96 $1,619.82 |
$825.15 $905.71 $991.05 $1,294.25 |
$1,053.44 $1,134.00 $1,219.34 $1,522.54 |
Toc - Plan #99 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Bronze
(EPO) CGHC Value 1 Bronze $8700 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$254.69 $289.06 $325.48 $454.86 $691.21 |
$449.52 $483.89 $520.31 $649.69 |
$644.35 $678.72 $715.14 $844.52 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$509.38 $578.12 $650.96 $909.72 $1,382.42 |
$704.21 $772.95 $845.79 $1,104.55 |
$899.04 $967.78 $1,040.62 $1,299.38 |
Toc - Plan #100 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Value Plus Bronze $8700 Deductible ($35 PCP Copay+ Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$256.38 $290.98 $327.64 $457.87 $695.78 |
$452.50 $487.10 $523.76 $653.99 |
$648.62 $683.22 $719.88 $850.11 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$512.76 $581.96 $655.28 $915.74 $1,391.56 |
$708.88 $778.08 $851.40 $1,111.86 |
$905.00 $974.20 $1,047.52 $1,307.98 |
Toc - Plan #101 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Value Premier Bronze $8150 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$264.37 $300.04 $337.85 $472.14 $717.46 |
$466.60 $502.27 $540.08 $674.37 |
$668.83 $704.50 $742.31 $876.60 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$528.74 $600.08 $675.70 $944.28 $1,434.92 |
$730.97 $802.31 $877.93 $1,146.51 |
$933.20 $1,004.54 $1,080.16 $1,348.74 |
Toc - Plan #102 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Value 2 Bronze $6000 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$262.02 $297.38 $334.85 $467.95 $711.10 |
$462.46 $497.82 $535.29 $668.39 |
$662.90 $698.26 $735.73 $868.83 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$524.04 $594.76 $669.70 $935.90 $1,422.20 |
$724.48 $795.20 $870.14 $1,136.34 |
$924.92 $995.64 $1,070.58 $1,336.78 |
Toc - Plan #103 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC HSA Bronze $7000 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$266.13 $302.05 $340.10 $475.29 $722.25 |
$469.71 $505.63 $543.68 $678.87 |
$673.29 $709.21 $747.26 $882.45 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$532.26 $604.10 $680.20 $950.58 $1,444.50 |
$735.84 $807.68 $883.78 $1,154.16 |
$939.42 $1,011.26 $1,087.36 $1,357.74 |
Toc - Plan #104 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC HSA Silver $3000 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$402.71 $457.07 $514.65 $719.23 $1,092.93 |
$710.78 $765.14 $822.72 $1,027.30 |
$1,018.85 $1,073.21 $1,130.79 $1,335.37 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$805.42 $914.14 $1,029.30 $1,438.46 $2,185.86 |
$1,113.49 $1,222.21 $1,337.37 $1,746.53 |
$1,421.56 $1,530.28 $1,645.44 $2,054.60 |
Toc - Plan #105 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC HSA Gold $2800 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$413.93 $469.80 $528.99 $739.27 $1,123.39 |
$730.58 $786.45 $845.64 $1,055.92 |
$1,047.23 $1,103.10 $1,162.29 $1,372.57 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$827.86 $939.60 $1,057.98 $1,478.54 $2,246.78 |
$1,144.51 $1,256.25 $1,374.63 $1,795.19 |
$1,461.16 $1,572.90 $1,691.28 $2,111.84 |
Toc - Plan #106 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Solutions Bronze $0 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$271.44 $308.07 $346.89 $484.78 $736.66 |
$479.08 $515.71 $554.53 $692.42 |
$686.72 $723.35 $762.17 $900.06 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$542.88 $616.14 $693.78 $969.56 $1,473.32 |
$750.52 $823.78 $901.42 $1,177.20 |
$958.16 $1,031.42 $1,109.06 $1,384.84 |
Toc - Plan #107 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Solutions Silver $0 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$388.33 $440.74 $496.27 $693.53 $1,053.89 |
$685.39 $737.80 $793.33 $990.59 |
$982.45 $1,034.86 $1,090.39 $1,287.65 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$776.66 $881.48 $992.54 $1,387.06 $2,107.78 |
$1,073.72 $1,178.54 $1,289.60 $1,684.12 |
$1,370.78 $1,475.60 $1,586.66 $1,981.18 |
Toc - Plan #108 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Solutions Gold $0 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$412.15 $467.78 $526.71 $736.08 $1,118.55 |
$727.44 $783.07 $842.00 $1,051.37 |
$1,042.73 $1,098.36 $1,157.29 $1,366.66 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$824.30 $935.56 $1,053.42 $1,472.16 $2,237.10 |
$1,139.59 $1,250.85 $1,368.71 $1,787.45 |
$1,454.88 $1,566.14 $1,684.00 $2,102.74 |
‡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 Brown County here.
Brown County is in “Rating Area 16” of Wisconsin.
Currently, there are 108 plans offered in Rating Area 16.