Obamacare 2022 Rates for Calumet County
Obamacare > Rates > Wisconsin > Calumet County
Obamacare > Rates > Wisconsin > Calumet 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 |
$285.41 $323.93 $364.75 $509.73 $774.59 |
$503.74 $542.26 $583.08 $728.06 |
$722.07 $760.59 $801.41 $946.39 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$570.82 $647.86 $729.50 $1,019.46 $1,549.18 |
$789.15 $866.19 $947.83 $1,237.79 |
$1,007.48 $1,084.52 $1,166.16 $1,456.12 |
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 |
$389.91 $442.53 $498.29 $696.36 $1,058.18 |
$688.18 $740.80 $796.56 $994.63 |
$986.45 $1,039.07 $1,094.83 $1,292.90 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$779.82 $885.06 $996.58 $1,392.72 $2,116.36 |
$1,078.09 $1,183.33 $1,294.85 $1,690.99 |
$1,376.36 $1,481.60 $1,593.12 $1,989.26 |
Toc - Plan #3 Together with CCHP | ||||||||||||||||||||
Silver
(EPO) Together 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 |
$342.73 $388.99 $437.99 $612.10 $930.14 |
$604.91 $651.17 $700.17 $874.28 |
$867.09 $913.35 $962.35 $1,136.46 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$685.46 $777.98 $875.98 $1,224.20 $1,860.28 |
$947.64 $1,040.16 $1,138.16 $1,486.38 |
$1,209.82 $1,302.34 $1,400.34 $1,748.56 |
Toc - Plan #4 Together with CCHP | ||||||||||||||||||||
Gold
(EPO) Together Gold |
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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 |
$401.99 $456.25 $513.73 $717.94 $1,090.98 |
$709.51 $763.77 $821.25 $1,025.46 |
$1,017.03 $1,071.29 $1,128.77 $1,332.98 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$803.98 $912.50 $1,027.46 $1,435.88 $2,181.96 |
$1,111.50 $1,220.02 $1,334.98 $1,743.40 |
$1,419.02 $1,527.54 $1,642.50 $2,050.92 |
Toc - Plan #5 Together with CCHP | ||||||||||||||||||||
Expanded Bronze
(EPO) Together Bronze HDHP |
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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 |
$313.88 $356.24 $401.12 $560.57 $851.83 |
$553.99 $596.35 $641.23 $800.68 |
$794.10 $836.46 $881.34 $1,040.79 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$627.76 $712.48 $802.24 $1,121.14 $1,703.66 |
$867.87 $952.59 $1,042.35 $1,361.25 |
$1,107.98 $1,192.70 $1,282.46 $1,601.36 |
Toc - Plan #6 Together with CCHP | ||||||||||||||||||||
Silver
(EPO) Together Silver Select |
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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 |
$375.87 $426.60 $480.35 $671.29 $1,020.08 |
$663.40 $714.13 $767.88 $958.82 |
$950.93 $1,001.66 $1,055.41 $1,246.35 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$751.74 $853.20 $960.70 $1,342.58 $2,040.16 |
$1,039.27 $1,140.73 $1,248.23 $1,630.11 |
$1,326.80 $1,428.26 $1,535.76 $1,917.64 |
Toc - Plan #7 Together with CCHP | ||||||||||||||||||||
Catastrophic
(EPO) Together Catastrophic |
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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 |
$241.36 $273.93 $308.44 $431.04 $655.01 |
$425.99 $458.56 $493.07 $615.67 |
$610.62 $643.19 $677.70 $800.30 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$482.72 $547.86 $616.88 $862.08 $1,310.02 |
$667.35 $732.49 $801.51 $1,046.71 |
$851.98 $917.12 $986.14 $1,231.34 |
Toc - Plan #8 Together with CCHP | ||||||||||||||||||||
Expanded Bronze
(EPO) Together Bronze Copay |
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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 |
$314.66 $357.12 $402.12 $561.96 $853.95 |
$555.36 $597.82 $642.82 $802.66 |
$796.06 $838.52 $883.52 $1,043.36 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$629.32 $714.24 $804.24 $1,123.92 $1,707.90 |
$870.02 $954.94 $1,044.94 $1,364.62 |
$1,110.72 $1,195.64 $1,285.64 $1,605.32 |
ADVERTISEMENT
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
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 |
$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 |
$408.28 $463.39 $521.77 $729.18 $1,108.05 |
$720.61 $775.72 $834.10 $1,041.51 |
$1,032.94 $1,088.05 $1,146.43 $1,353.84 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$816.56 $926.78 $1,043.54 $1,458.36 $2,216.10 |
$1,128.89 $1,239.11 $1,355.87 $1,770.69 |
$1,441.22 $1,551.44 $1,668.20 $2,083.02 |
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
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 |
$405.38 $460.10 $518.07 $724.00 $1,100.19 |
$715.49 $770.21 $828.18 $1,034.11 |
$1,025.60 $1,080.32 $1,138.29 $1,344.22 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$810.76 $920.20 $1,036.14 $1,448.00 $2,200.38 |
$1,120.87 $1,230.31 $1,346.25 $1,758.11 |
$1,430.98 $1,540.42 $1,656.36 $2,068.22 |
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 |
$403.59 $458.07 $515.78 $720.81 $1,095.33 |
$712.33 $766.81 $824.52 $1,029.55 |
$1,021.07 $1,075.55 $1,133.26 $1,338.29 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$807.18 $916.14 $1,031.56 $1,441.62 $2,190.66 |
$1,115.92 $1,224.88 $1,340.30 $1,750.36 |
$1,424.66 $1,533.62 $1,649.04 $2,059.10 |
Toc - Plan #20 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One With Aurora Health Care Silver I301 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 |
$407.56 $462.58 $520.86 $727.89 $1,106.11 |
$719.34 $774.36 $832.64 $1,039.67 |
$1,031.12 $1,086.14 $1,144.42 $1,351.45 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$815.12 $925.16 $1,041.72 $1,455.78 $2,212.22 |
$1,126.90 $1,236.94 $1,353.50 $1,767.56 |
$1,438.68 $1,548.72 $1,665.28 $2,079.34 |
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 |
$409.02 $464.23 $522.72 $730.49 $1,110.06 |
$721.91 $777.12 $835.61 $1,043.38 |
$1,034.80 $1,090.01 $1,148.50 $1,356.27 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$818.04 $928.46 $1,045.44 $1,460.98 $2,220.12 |
$1,130.93 $1,241.35 $1,358.33 $1,773.87 |
$1,443.82 $1,554.24 $1,671.22 $2,086.76 |
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 |
$399.93 $453.91 $511.10 $714.26 $1,085.39 |
$705.87 $759.85 $817.04 $1,020.20 |
$1,011.81 $1,065.79 $1,122.98 $1,326.14 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$799.86 $907.82 $1,022.20 $1,428.52 $2,170.78 |
$1,105.80 $1,213.76 $1,328.14 $1,734.46 |
$1,411.74 $1,519.70 $1,634.08 $2,040.40 |
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 |
$307.50 $349.01 $392.98 $549.19 $834.55 |
$542.74 $584.25 $628.22 $784.43 |
$777.98 $819.49 $863.46 $1,019.67 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$615.00 $698.02 $785.96 $1,098.38 $1,669.10 |
$850.24 $933.26 $1,021.20 $1,333.62 |
$1,085.48 $1,168.50 $1,256.44 $1,568.86 |
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 |
$303.96 $344.98 $388.45 $542.86 $824.92 |
$536.48 $577.50 $620.97 $775.38 |
$769.00 $810.02 $853.49 $1,007.90 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$607.92 $689.96 $776.90 $1,085.72 $1,649.84 |
$840.44 $922.48 $1,009.42 $1,318.24 |
$1,072.96 $1,155.00 $1,241.94 $1,550.76 |
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 |
$321.72 $365.15 $411.16 $574.59 $873.15 |
$567.84 $611.27 $657.28 $820.71 |
$813.96 $857.39 $903.40 $1,066.83 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$643.44 $730.30 $822.32 $1,149.18 $1,746.30 |
$889.56 $976.42 $1,068.44 $1,395.30 |
$1,135.68 $1,222.54 $1,314.56 $1,641.42 |
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 |
$391.16 $443.97 $499.90 $698.61 $1,061.61 |
$690.40 $743.21 $799.14 $997.85 |
$989.64 $1,042.45 $1,098.38 $1,297.09 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$782.32 $887.94 $999.80 $1,397.22 $2,123.22 |
$1,081.56 $1,187.18 $1,299.04 $1,696.46 |
$1,380.80 $1,486.42 $1,598.28 $1,995.70 |
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 |
$388.39 $440.81 $496.35 $693.65 $1,054.07 |
$685.50 $737.92 $793.46 $990.76 |
$982.61 $1,035.03 $1,090.57 $1,287.87 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$776.78 $881.62 $992.70 $1,387.30 $2,108.14 |
$1,073.89 $1,178.73 $1,289.81 $1,684.41 |
$1,371.00 $1,475.84 $1,586.92 $1,981.52 |
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 |
$386.67 $438.87 $494.16 $690.59 $1,049.42 |
$682.47 $734.67 $789.96 $986.39 |
$978.27 $1,030.47 $1,085.76 $1,282.19 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$773.34 $877.74 $988.32 $1,381.18 $2,098.84 |
$1,069.14 $1,173.54 $1,284.12 $1,676.98 |
$1,364.94 $1,469.34 $1,579.92 $1,972.78 |
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 |
$390.48 $443.19 $499.02 $697.38 $1,059.74 |
$689.19 $741.90 $797.73 $996.09 |
$987.90 $1,040.61 $1,096.44 $1,294.80 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$780.96 $886.38 $998.04 $1,394.76 $2,119.48 |
$1,079.67 $1,185.09 $1,296.75 $1,693.47 |
$1,378.38 $1,483.80 $1,595.46 $1,992.18 |
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 |
$391.87 $444.77 $500.81 $699.87 $1,063.53 |
$691.65 $744.55 $800.59 $999.65 |
$991.43 $1,044.33 $1,100.37 $1,299.43 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$783.74 $889.54 $1,001.62 $1,399.74 $2,127.06 |
$1,083.52 $1,189.32 $1,301.40 $1,699.52 |
$1,383.30 $1,489.10 $1,601.18 $1,999.30 |
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 |
$383.16 $434.88 $489.68 $684.32 $1,039.89 |
$676.28 $728.00 $782.80 $977.44 |
$969.40 $1,021.12 $1,075.92 $1,270.56 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$766.32 $869.76 $979.36 $1,368.64 $2,079.78 |
$1,059.44 $1,162.88 $1,272.48 $1,661.76 |
$1,352.56 $1,456.00 $1,565.60 $1,954.88 |
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 |
$294.61 $334.38 $376.51 $526.17 $799.57 |
$519.99 $559.76 $601.89 $751.55 |
$745.37 $785.14 $827.27 $976.93 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$589.22 $668.76 $753.02 $1,052.34 $1,599.14 |
$814.60 $894.14 $978.40 $1,277.72 |
$1,039.98 $1,119.52 $1,203.78 $1,503.10 |
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 |
$291.21 $330.52 $372.17 $520.10 $790.34 |
$513.99 $553.30 $594.95 $742.88 |
$736.77 $776.08 $817.73 $965.66 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$582.42 $661.04 $744.34 $1,040.20 $1,580.68 |
$805.20 $883.82 $967.12 $1,262.98 |
$1,027.98 $1,106.60 $1,189.90 $1,485.76 |
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 |
$308.24 $349.85 $393.92 $550.51 $836.55 |
$544.04 $585.65 $629.72 $786.31 |
$779.84 $821.45 $865.52 $1,022.11 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$616.48 $699.70 $787.84 $1,101.02 $1,673.10 |
$852.28 $935.50 $1,023.64 $1,336.82 |
$1,088.08 $1,171.30 $1,259.44 $1,572.62 |
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 |
$421.56 $478.46 $538.74 $752.89 $1,144.09 |
$744.05 $800.95 $861.23 $1,075.38 |
$1,066.54 $1,123.44 $1,183.72 $1,397.87 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$843.12 $956.92 $1,077.48 $1,505.78 $2,288.18 |
$1,165.61 $1,279.41 $1,399.97 $1,828.27 |
$1,488.10 $1,601.90 $1,722.46 $2,150.76 |
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 |
$411.17 $466.67 $525.47 $734.34 $1,115.90 |
$725.71 $781.21 $840.01 $1,048.88 |
$1,040.25 $1,095.75 $1,154.55 $1,363.42 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$822.34 $933.34 $1,050.94 $1,468.68 $2,231.80 |
$1,136.88 $1,247.88 $1,365.48 $1,783.22 |
$1,451.42 $1,562.42 $1,680.02 $2,097.76 |
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 |
$306.65 $348.04 $391.89 $547.67 $832.23 |
$541.23 $582.62 $626.47 $782.25 |
$775.81 $817.20 $861.05 $1,016.83 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$613.30 $696.08 $783.78 $1,095.34 $1,664.46 |
$847.88 $930.66 $1,018.36 $1,329.92 |
$1,082.46 $1,165.24 $1,252.94 $1,564.50 |
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 |
$225.32 $255.73 $287.95 $402.41 $611.50 |
$397.68 $428.09 $460.31 $574.77 |
$570.04 $600.45 $632.67 $747.13 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$450.64 $511.46 $575.90 $804.82 $1,223.00 |
$623.00 $683.82 $748.26 $977.18 |
$795.36 $856.18 $920.62 $1,149.54 |
ADVERTISEMENT
Molina HealthcareLocal: 1-888-560-2043 | Toll Free: 1-888-560-2043 |
Toc - Plan #39 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 |
$409.47 $464.74 $523.30 $731.31 $1,111.29 |
$722.71 $777.98 $836.54 $1,044.55 |
$1,035.95 $1,091.22 $1,149.78 $1,357.79 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$818.94 $929.48 $1,046.60 $1,462.62 $2,222.58 |
$1,132.18 $1,242.72 $1,359.84 $1,775.86 |
$1,445.42 $1,555.96 $1,673.08 $2,089.10 |
Toc - Plan #40 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 |
$367.10 $416.65 $469.15 $655.63 $996.30 |
$647.93 $697.48 $749.98 $936.46 |
$928.76 $978.31 $1,030.81 $1,217.29 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$734.20 $833.30 $938.30 $1,311.26 $1,992.60 |
$1,015.03 $1,114.13 $1,219.13 $1,592.09 |
$1,295.86 $1,394.96 $1,499.96 $1,872.92 |
Toc - Plan #41 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 |
$363.53 $412.61 $464.59 $649.27 $986.62 |
$641.63 $690.71 $742.69 $927.37 |
$919.73 $968.81 $1,020.79 $1,205.47 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$727.06 $825.22 $929.18 $1,298.54 $1,973.24 |
$1,005.16 $1,103.32 $1,207.28 $1,576.64 |
$1,283.26 $1,381.42 $1,485.38 $1,854.74 |
Toc - Plan #42 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 |
$356.92 $405.10 $456.14 $637.46 $968.68 |
$629.96 $678.14 $729.18 $910.50 |
$903.00 $951.18 $1,002.22 $1,183.54 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$713.84 $810.20 $912.28 $1,274.92 $1,937.36 |
$986.88 $1,083.24 $1,185.32 $1,547.96 |
$1,259.92 $1,356.28 $1,458.36 $1,821.00 |
Toc - Plan #43 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 |
$403.99 $458.52 $516.29 $721.52 $1,096.42 |
$713.04 $767.57 $825.34 $1,030.57 |
$1,022.09 $1,076.62 $1,134.39 $1,339.62 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$807.98 $917.04 $1,032.58 $1,443.04 $2,192.84 |
$1,117.03 $1,226.09 $1,341.63 $1,752.09 |
$1,426.08 $1,535.14 $1,650.68 $2,061.14 |
Toc - Plan #44 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 |
$364.28 $413.46 $465.55 $650.61 $988.66 |
$642.96 $692.14 $744.23 $929.29 |
$921.64 $970.82 $1,022.91 $1,207.97 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$728.56 $826.92 $931.10 $1,301.22 $1,977.32 |
$1,007.24 $1,105.60 $1,209.78 $1,579.90 |
$1,285.92 $1,384.28 $1,488.46 $1,858.58 |
Toc - Plan #45 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 |
$366.25 $415.70 $468.07 $654.13 $994.01 |
$646.43 $695.88 $748.25 $934.31 |
$926.61 $976.06 $1,028.43 $1,214.49 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$732.50 $831.40 $936.14 $1,308.26 $1,988.02 |
$1,012.68 $1,111.58 $1,216.32 $1,588.44 |
$1,292.86 $1,391.76 $1,496.50 $1,868.62 |
ADVERTISEMENT
Anthem Blue Cross and Blue ShieldLocal: 1-855-748-1813 | Toll Free: 1-855-748-1813 |
Toc - Plan #46 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(HMO) Anthem Bronze Pathway X 0 for HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$263.03 $298.54 $336.15 $469.77 $713.86 |
$464.25 $499.76 $537.37 $670.99 |
$665.47 $700.98 $738.59 $872.21 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$526.06 $597.08 $672.30 $939.54 $1,427.72 |
$727.28 $798.30 $873.52 $1,140.76 |
$928.50 $999.52 $1,074.74 $1,341.98 |
Toc - Plan #47 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(HMO) Anthem Bronze Pathway X 5000 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$260.11 $295.22 $332.42 $464.56 $705.94 |
$459.09 $494.20 $531.40 $663.54 |
$658.07 $693.18 $730.38 $862.52 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$520.22 $590.44 $664.84 $929.12 $1,411.88 |
$719.20 $789.42 $863.82 $1,128.10 |
$918.18 $988.40 $1,062.80 $1,327.08 |
Toc - Plan #48 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Bronze
(HMO) Anthem Bronze Pathway X 6550 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$252.21 $286.26 $322.32 $450.45 $684.50 |
$445.15 $479.20 $515.26 $643.39 |
$638.09 $672.14 $708.20 $836.33 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$504.42 $572.52 $644.64 $900.90 $1,369.00 |
$697.36 $765.46 $837.58 $1,093.84 |
$890.30 $958.40 $1,030.52 $1,286.78 |
Toc - Plan #49 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Bronze
(HMO) Anthem Bronze Pathway X 8700 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$249.53 $283.22 $318.90 $445.66 $677.22 |
$440.42 $474.11 $509.79 $636.55 |
$631.31 $665.00 $700.68 $827.44 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$499.06 $566.44 $637.80 $891.32 $1,354.44 |
$689.95 $757.33 $828.69 $1,082.21 |
$880.84 $948.22 $1,019.58 $1,273.10 |
Toc - Plan #50 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(HMO) Anthem Silver Pathway X 4000 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$310.30 $352.19 $396.56 $554.20 $842.15 |
$547.68 $589.57 $633.94 $791.58 |
$785.06 $826.95 $871.32 $1,028.96 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$620.60 $704.38 $793.12 $1,108.40 $1,684.30 |
$857.98 $941.76 $1,030.50 $1,345.78 |
$1,095.36 $1,179.14 $1,267.88 $1,583.16 |
Toc - Plan #51 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(HMO) Anthem Silver Pathway X 5000 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$303.46 $344.43 $387.82 $541.98 $823.59 |
$535.61 $576.58 $619.97 $774.13 |
$767.76 $808.73 $852.12 $1,006.28 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$606.92 $688.86 $775.64 $1,083.96 $1,647.18 |
$839.07 $921.01 $1,007.79 $1,316.11 |
$1,071.22 $1,153.16 $1,239.94 $1,548.26 |
Toc - Plan #52 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(HMO) Anthem Silver Pathway X 6550 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$301.93 $342.69 $385.87 $539.25 $819.44 |
$532.91 $573.67 $616.85 $770.23 |
$763.89 $804.65 $847.83 $1,001.21 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$603.86 $685.38 $771.74 $1,078.50 $1,638.88 |
$834.84 $916.36 $1,002.72 $1,309.48 |
$1,065.82 $1,147.34 $1,233.70 $1,540.46 |
Toc - Plan #53 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Gold
(HMO) Anthem Gold Pathway X 2700 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$326.25 $370.29 $416.95 $582.68 $885.44 |
$575.83 $619.87 $666.53 $832.26 |
$825.41 $869.45 $916.11 $1,081.84 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$652.50 $740.58 $833.90 $1,165.36 $1,770.88 |
$902.08 $990.16 $1,083.48 $1,414.94 |
$1,151.66 $1,239.74 $1,333.06 $1,664.52 |
ADVERTISEMENT
Network HealthLocal: 1-920-720-1400x1400 | Toll Free: 1-855-275-1400 | TTY: 1-800-947-3529 |
Toc - Plan #54 Network Health | ||||||||||||||||||||
Expanded Bronze
(HMO) Prestige Bronze 20 HDHP + Dental + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$260.90 $296.13 $333.43 $465.97 $708.09 |
$460.49 $495.72 $533.02 $665.56 |
$660.08 $695.31 $732.61 $865.15 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$521.80 $592.26 $666.86 $931.94 $1,416.18 |
$721.39 $791.85 $866.45 $1,131.53 |
$920.98 $991.44 $1,066.04 $1,331.12 |
Toc - Plan #55 Network Health | ||||||||||||||||||||
Silver
(HMO) Prestige Silver 20 HDHP + Dental + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$399.84 $453.82 $511.00 $714.11 $1,085.16 |
$705.72 $759.70 $816.88 $1,019.99 |
$1,011.60 $1,065.58 $1,122.76 $1,325.87 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$799.68 $907.64 $1,022.00 $1,428.22 $2,170.32 |
$1,105.56 $1,213.52 $1,327.88 $1,734.10 |
$1,411.44 $1,519.40 $1,633.76 $2,039.98 |
Toc - Plan #56 Network Health | ||||||||||||||||||||
Expanded Bronze
(HMO) Prestige Bronze Essential + Dental + Vision + Fitness + 3 Free PCP Visits |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$252.89 $287.03 $323.19 $451.66 $686.33 |
$446.35 $480.49 $516.65 $645.12 |
$639.81 $673.95 $710.11 $838.58 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$505.78 $574.06 $646.38 $903.32 $1,372.66 |
$699.24 $767.52 $839.84 $1,096.78 |
$892.70 $960.98 $1,033.30 $1,290.24 |
Toc - Plan #57 Network Health | ||||||||||||||||||||
Silver
(HMO) Prestige Silver Essential + Dental + Vision + Fitness + 3 Free PCP Visits |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$388.89 $441.39 $497.00 $694.56 $1,055.44 |
$686.39 $738.89 $794.50 $992.06 |
$983.89 $1,036.39 $1,092.00 $1,289.56 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$777.78 $882.78 $994.00 $1,389.12 $2,110.88 |
$1,075.28 $1,180.28 $1,291.50 $1,686.62 |
$1,372.78 $1,477.78 $1,589.00 $1,984.12 |
Toc - Plan #58 Network Health | ||||||||||||||||||||
Gold
(HMO) Prestige Gold Essential + Dental + Vision + Fitness + 3 Free PCP Visits |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$360.58 $409.26 $460.82 $644.00 $978.61 |
$636.43 $685.11 $736.67 $919.85 |
$912.28 $960.96 $1,012.52 $1,195.70 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$721.16 $818.52 $921.64 $1,288.00 $1,957.22 |
$997.01 $1,094.37 $1,197.49 $1,563.85 |
$1,272.86 $1,370.22 $1,473.34 $1,839.70 |
Toc - Plan #59 Network Health | ||||||||||||||||||||
Expanded Bronze
(HMO) Prestige Bronze 0 + Dental + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$231.57 $262.83 $295.95 $413.58 $628.47 |
$408.72 $439.98 $473.10 $590.73 |
$585.87 $617.13 $650.25 $767.88 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$463.14 $525.66 $591.90 $827.16 $1,256.94 |
$640.29 $702.81 $769.05 $1,004.31 |
$817.44 $879.96 $946.20 $1,181.46 |
Toc - Plan #60 Network Health | ||||||||||||||||||||
Gold
(HMO) Prestige Gold 50 + Dental + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$368.43 $418.17 $470.86 $658.02 $999.92 |
$650.28 $700.02 $752.71 $939.87 |
$932.13 $981.87 $1,034.56 $1,221.72 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$736.86 $836.34 $941.72 $1,316.04 $1,999.84 |
$1,018.71 $1,118.19 $1,223.57 $1,597.89 |
$1,300.56 $1,400.04 $1,505.42 $1,879.74 |
Toc - Plan #61 Network Health | ||||||||||||||||||||
Gold
(HMO) Prestige Gold 0 HDHP + Dental + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$371.67 $421.85 $475.00 $663.80 $1,008.71 |
$656.00 $706.18 $759.33 $948.13 |
$940.33 $990.51 $1,043.66 $1,232.46 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$743.34 $843.70 $950.00 $1,327.60 $2,017.42 |
$1,027.67 $1,128.03 $1,234.33 $1,611.93 |
$1,312.00 $1,412.36 $1,518.66 $1,896.26 |
Toc - Plan #62 Network Health | ||||||||||||||||||||
Expanded Bronze
(HMO) Signature Prestige Bronze Copay + Dental + Vision + Fitness |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$255.77 $290.30 $326.87 $456.80 $694.15 |
$451.43 $485.96 $522.53 $652.46 |
$647.09 $681.62 $718.19 $848.12 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$511.54 $580.60 $653.74 $913.60 $1,388.30 |
$707.20 $776.26 $849.40 $1,109.26 |
$902.86 $971.92 $1,045.06 $1,304.92 |
ADVERTISEMENT
WPS Health PlanLocal: 1-920-490-6900 | Toll Free: 1-800-332-6249 | TTY: 1-888-332-0144 |
Toc - Plan #63 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 |
$290.15 $329.32 $370.81 $518.21 $787.47 |
$512.11 $551.28 $592.77 $740.17 |
$734.07 $773.24 $814.73 $962.13 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$580.30 $658.64 $741.62 $1,036.42 $1,574.94 |
$802.26 $880.60 $963.58 $1,258.38 |
$1,024.22 $1,102.56 $1,185.54 $1,480.34 |
Toc - Plan #64 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 |
$301.62 $342.34 $385.47 $538.69 $818.60 |
$532.36 $573.08 $616.21 $769.43 |
$763.10 $803.82 $846.95 $1,000.17 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$603.24 $684.68 $770.94 $1,077.38 $1,637.20 |
$833.98 $915.42 $1,001.68 $1,308.12 |
$1,064.72 $1,146.16 $1,232.42 $1,538.86 |
Toc - Plan #65 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 |
$290.90 $330.17 $371.77 $519.55 $789.50 |
$513.44 $552.71 $594.31 $742.09 |
$735.98 $775.25 $816.85 $964.63 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$581.80 $660.34 $743.54 $1,039.10 $1,579.00 |
$804.34 $882.88 $966.08 $1,261.64 |
$1,026.88 $1,105.42 $1,188.62 $1,484.18 |
Toc - Plan #66 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 |
$379.72 $430.98 $485.28 $678.18 $1,030.56 |
$670.21 $721.47 $775.77 $968.67 |
$960.70 $1,011.96 $1,066.26 $1,259.16 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$759.44 $861.96 $970.56 $1,356.36 $2,061.12 |
$1,049.93 $1,152.45 $1,261.05 $1,646.85 |
$1,340.42 $1,442.94 $1,551.54 $1,937.34 |
Toc - Plan #67 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 |
$383.08 $434.80 $489.58 $684.18 $1,039.68 |
$676.14 $727.86 $782.64 $977.24 |
$969.20 $1,020.92 $1,075.70 $1,270.30 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$766.16 $869.60 $979.16 $1,368.36 $2,079.36 |
$1,059.22 $1,162.66 $1,272.22 $1,661.42 |
$1,352.28 $1,455.72 $1,565.28 $1,954.48 |
Toc - Plan #68 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 |
$396.98 $450.57 $507.34 $709.01 $1,077.40 |
$700.67 $754.26 $811.03 $1,012.70 |
$1,004.36 $1,057.95 $1,114.72 $1,316.39 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$793.96 $901.14 $1,014.68 $1,418.02 $2,154.80 |
$1,097.65 $1,204.83 $1,318.37 $1,721.71 |
$1,401.34 $1,508.52 $1,622.06 $2,025.40 |
Toc - Plan #69 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 |
$519.34 $589.45 $663.72 $927.54 $1,409.49 |
$916.64 $986.75 $1,061.02 $1,324.84 |
$1,313.94 $1,384.05 $1,458.32 $1,722.14 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,038.68 $1,178.90 $1,327.44 $1,855.08 $2,818.98 |
$1,435.98 $1,576.20 $1,724.74 $2,252.38 |
$1,833.28 $1,973.50 $2,122.04 $2,649.68 |
Toc - Plan #70 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 |
$252.25 $286.30 $322.38 $450.52 $684.61 |
$445.22 $479.27 $515.35 $643.49 |
$638.19 $672.24 $708.32 $836.46 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$504.50 $572.60 $644.76 $901.04 $1,369.22 |
$697.47 $765.57 $837.73 $1,094.01 |
$890.44 $958.54 $1,030.70 $1,286.98 |
Toc - Plan #71 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 |
$302.24 $343.04 $386.26 $539.80 $820.28 |
$533.45 $574.25 $617.47 $771.01 |
$764.66 $805.46 $848.68 $1,002.22 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$604.48 $686.08 $772.52 $1,079.60 $1,640.56 |
$835.69 $917.29 $1,003.73 $1,310.81 |
$1,066.90 $1,148.50 $1,234.94 $1,542.02 |
Toc - Plan #72 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 |
$308.79 $350.48 $394.63 $551.50 $838.06 |
$545.01 $586.70 $630.85 $787.72 |
$781.23 $822.92 $867.07 $1,023.94 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$617.58 $700.96 $789.26 $1,103.00 $1,676.12 |
$853.80 $937.18 $1,025.48 $1,339.22 |
$1,090.02 $1,173.40 $1,261.70 $1,575.44 |
Toc - Plan #73 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 |
$302.93 $343.83 $387.14 $541.03 $822.15 |
$534.67 $575.57 $618.88 $772.77 |
$766.41 $807.31 $850.62 $1,004.51 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$605.86 $687.66 $774.28 $1,082.06 $1,644.30 |
$837.60 $919.40 $1,006.02 $1,313.80 |
$1,069.34 $1,151.14 $1,237.76 $1,545.54 |
Toc - Plan #74 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 |
$385.83 $437.92 $493.09 $689.09 $1,047.14 |
$680.99 $733.08 $788.25 $984.25 |
$976.15 $1,028.24 $1,083.41 $1,279.41 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$771.66 $875.84 $986.18 $1,378.18 $2,094.28 |
$1,066.82 $1,171.00 $1,281.34 $1,673.34 |
$1,361.98 $1,466.16 $1,576.50 $1,968.50 |
Toc - Plan #75 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 |
$388.51 $440.96 $496.52 $693.88 $1,054.42 |
$685.72 $738.17 $793.73 $991.09 |
$982.93 $1,035.38 $1,090.94 $1,288.30 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$777.02 $881.92 $993.04 $1,387.76 $2,108.84 |
$1,074.23 $1,179.13 $1,290.25 $1,684.97 |
$1,371.44 $1,476.34 $1,587.46 $1,982.18 |
Toc - Plan #76 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 |
$370.62 $420.65 $473.65 $661.93 $1,005.86 |
$654.14 $704.17 $757.17 $945.45 |
$937.66 $987.69 $1,040.69 $1,228.97 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$741.24 $841.30 $947.30 $1,323.86 $2,011.72 |
$1,024.76 $1,124.82 $1,230.82 $1,607.38 |
$1,308.28 $1,408.34 $1,514.34 $1,890.90 |
Toc - Plan #77 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 |
$310.35 $352.25 $396.63 $554.29 $842.29 |
$547.77 $589.67 $634.05 $791.71 |
$785.19 $827.09 $871.47 $1,029.13 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$620.70 $704.50 $793.26 $1,108.58 $1,684.58 |
$858.12 $941.92 $1,030.68 $1,346.00 |
$1,095.54 $1,179.34 $1,268.10 $1,583.42 |
Toc - Plan #78 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 |
$323.99 $367.73 $414.06 $578.65 $879.31 |
$571.84 $615.58 $661.91 $826.50 |
$819.69 $863.43 $909.76 $1,074.35 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$647.98 $735.46 $828.12 $1,157.30 $1,758.62 |
$895.83 $983.31 $1,075.97 $1,405.15 |
$1,143.68 $1,231.16 $1,323.82 $1,653.00 |
ADVERTISEMENT
Common Ground Healthcare CooperativeLocal: 1-877-514-2442 | Toll Free: 1-877-514-2442 | TTY: 1-844-472-2442 |
Toc - Plan #79 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 |
$274.62 $311.68 $350.95 $490.45 $745.29 |
$484.70 $521.76 $561.03 $700.53 |
$694.78 $731.84 $771.11 $910.61 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$549.24 $623.36 $701.90 $980.90 $1,490.58 |
$759.32 $833.44 $911.98 $1,190.98 |
$969.40 $1,043.52 $1,122.06 $1,401.06 |
Toc - Plan #80 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 |
$394.05 $447.23 $503.58 $703.75 $1,069.42 |
$695.49 $748.67 $805.02 $1,005.19 |
$996.93 $1,050.11 $1,106.46 $1,306.63 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$788.10 $894.46 $1,007.16 $1,407.50 $2,138.84 |
$1,089.54 $1,195.90 $1,308.60 $1,708.94 |
$1,390.98 $1,497.34 $1,610.04 $2,010.38 |
Toc - Plan #81 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 |
$418.40 $474.87 $534.70 $747.24 $1,135.50 |
$738.46 $794.93 $854.76 $1,067.30 |
$1,058.52 $1,114.99 $1,174.82 $1,387.36 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$836.80 $949.74 $1,069.40 $1,494.48 $2,271.00 |
$1,156.86 $1,269.80 $1,389.46 $1,814.54 |
$1,476.92 $1,589.86 $1,709.52 $2,134.60 |
Toc - Plan #82 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 |
$366.60 $416.08 $468.50 $654.73 $994.93 |
$647.04 $696.52 $748.94 $935.17 |
$927.48 $976.96 $1,029.38 $1,215.61 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$733.20 $832.16 $937.00 $1,309.46 $1,989.86 |
$1,013.64 $1,112.60 $1,217.44 $1,589.90 |
$1,294.08 $1,393.04 $1,497.88 $1,870.34 |
Toc - Plan #83 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 |
$355.95 $403.99 $454.89 $635.71 $966.02 |
$628.24 $676.28 $727.18 $908.00 |
$900.53 $948.57 $999.47 $1,180.29 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$711.90 $807.98 $909.78 $1,271.42 $1,932.04 |
$984.19 $1,080.27 $1,182.07 $1,543.71 |
$1,256.48 $1,352.56 $1,454.36 $1,816.00 |
Toc - Plan #84 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 |
$395.78 $449.20 $505.79 $706.85 $1,074.12 |
$698.54 $751.96 $808.55 $1,009.61 |
$1,001.30 $1,054.72 $1,111.31 $1,312.37 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$791.56 $898.40 $1,011.58 $1,413.70 $2,148.24 |
$1,094.32 $1,201.16 $1,314.34 $1,716.46 |
$1,397.08 $1,503.92 $1,617.10 $2,019.22 |
Toc - Plan #85 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 |
$368.94 $418.73 $471.49 $658.90 $1,001.27 |
$651.17 $700.96 $753.72 $941.13 |
$933.40 $983.19 $1,035.95 $1,223.36 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$737.88 $837.46 $942.98 $1,317.80 $2,002.54 |
$1,020.11 $1,119.69 $1,225.21 $1,600.03 |
$1,302.34 $1,401.92 $1,507.44 $1,882.26 |
Toc - Plan #86 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 |
$355.23 $403.17 $453.97 $634.42 $964.06 |
$626.97 $674.91 $725.71 $906.16 |
$898.71 $946.65 $997.45 $1,177.90 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$710.46 $806.34 $907.94 $1,268.84 $1,928.12 |
$982.20 $1,078.08 $1,179.68 $1,540.58 |
$1,253.94 $1,349.82 $1,451.42 $1,812.32 |
Toc - Plan #87 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 |
$369.99 $419.93 $472.83 $660.78 $1,004.12 |
$653.02 $702.96 $755.86 $943.81 |
$936.05 $985.99 $1,038.89 $1,226.84 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$739.98 $839.86 $945.66 $1,321.56 $2,008.24 |
$1,023.01 $1,122.89 $1,228.69 $1,604.59 |
$1,306.04 $1,405.92 $1,511.72 $1,887.62 |
Toc - Plan #88 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 |
$302.19 $342.98 $386.19 $539.70 $820.13 |
$533.36 $574.15 $617.36 $770.87 |
$764.53 $805.32 $848.53 $1,002.04 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$604.38 $685.96 $772.38 $1,079.40 $1,640.26 |
$835.55 $917.13 $1,003.55 $1,310.57 |
$1,066.72 $1,148.30 $1,234.72 $1,541.74 |
Toc - Plan #89 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 |
$187.46 $212.76 $239.57 $334.79 $508.75 |
$330.86 $356.16 $382.97 $478.19 |
$474.26 $499.56 $526.37 $621.59 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$374.92 $425.52 $479.14 $669.58 $1,017.50 |
$518.32 $568.92 $622.54 $812.98 |
$661.72 $712.32 $765.94 $956.38 |
Toc - Plan #90 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 |
$259.23 $294.21 $331.28 $462.96 $703.52 |
$457.53 $492.51 $529.58 $661.26 |
$655.83 $690.81 $727.88 $859.56 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$518.46 $588.42 $662.56 $925.92 $1,407.04 |
$716.76 $786.72 $860.86 $1,124.22 |
$915.06 $985.02 $1,059.16 $1,322.52 |
Toc - Plan #91 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 |
$267.38 $303.47 $341.70 $477.53 $725.65 |
$471.92 $508.01 $546.24 $682.07 |
$676.46 $712.55 $750.78 $886.61 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$534.76 $606.94 $683.40 $955.06 $1,451.30 |
$739.30 $811.48 $887.94 $1,159.60 |
$943.84 $1,016.02 $1,092.48 $1,364.14 |
Toc - Plan #92 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 |
$269.19 $305.52 $344.01 $480.75 $730.55 |
$475.11 $511.44 $549.93 $686.67 |
$681.03 $717.36 $755.85 $892.59 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$538.38 $611.04 $688.02 $961.50 $1,461.10 |
$744.30 $816.96 $893.94 $1,167.42 |
$950.22 $1,022.88 $1,099.86 $1,373.34 |
Toc - Plan #93 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 |
$420.21 $476.93 $537.01 $750.47 $1,140.42 |
$741.66 $798.38 $858.46 $1,071.92 |
$1,063.11 $1,119.83 $1,179.91 $1,393.37 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$840.42 $953.86 $1,074.02 $1,500.94 $2,280.84 |
$1,161.87 $1,275.31 $1,395.47 $1,822.39 |
$1,483.32 $1,596.76 $1,716.92 $2,143.84 |
Toc - Plan #94 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 |
$408.75 $463.92 $522.36 $730.00 $1,109.31 |
$721.43 $776.60 $835.04 $1,042.68 |
$1,034.11 $1,089.28 $1,147.72 $1,355.36 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$817.50 $927.84 $1,044.72 $1,460.00 $2,218.62 |
$1,130.18 $1,240.52 $1,357.40 $1,772.68 |
$1,442.86 $1,553.20 $1,670.08 $2,085.36 |
Toc - Plan #95 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 |
$257.50 $292.26 $329.08 $459.88 $698.84 |
$454.48 $489.24 $526.06 $656.86 |
$651.46 $686.22 $723.04 $853.84 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$515.00 $584.52 $658.16 $919.76 $1,397.68 |
$711.98 $781.50 $855.14 $1,116.74 |
$908.96 $978.48 $1,052.12 $1,313.72 |
Toc - Plan #96 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 |
$265.00 $300.76 $338.66 $473.27 $719.18 |
$467.72 $503.48 $541.38 $675.99 |
$670.44 $706.20 $744.10 $878.71 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$530.00 $601.52 $677.32 $946.54 $1,438.36 |
$732.72 $804.24 $880.04 $1,149.26 |
$935.44 $1,006.96 $1,082.76 $1,351.98 |
Toc - Plan #97 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 |
$302.13 $342.91 $386.11 $539.59 $819.96 |
$533.25 $574.03 $617.23 $770.71 |
$764.37 $805.15 $848.35 $1,001.83 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$604.26 $685.82 $772.22 $1,079.18 $1,639.92 |
$835.38 $916.94 $1,003.34 $1,310.30 |
$1,066.50 $1,148.06 $1,234.46 $1,541.42 |
Toc - Plan #98 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 |
$398.78 $452.60 $509.62 $712.20 $1,082.25 |
$703.84 $757.66 $814.68 $1,017.26 |
$1,008.90 $1,062.72 $1,119.74 $1,322.32 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$797.56 $905.20 $1,019.24 $1,424.40 $2,164.50 |
$1,102.62 $1,210.26 $1,324.30 $1,729.46 |
$1,407.68 $1,515.32 $1,629.36 $2,034.52 |
Toc - Plan #99 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 |
$371.91 $422.11 $475.29 $664.22 $1,009.34 |
$656.42 $706.62 $759.80 $948.73 |
$940.93 $991.13 $1,044.31 $1,233.24 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$743.82 $844.22 $950.58 $1,328.44 $2,018.68 |
$1,028.33 $1,128.73 $1,235.09 $1,612.95 |
$1,312.84 $1,413.24 $1,519.60 $1,897.46 |
Toc - Plan #100 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 |
$369.58 $419.46 $472.31 $660.05 $1,003.01 |
$652.30 $702.18 $755.03 $942.77 |
$935.02 $984.90 $1,037.75 $1,225.49 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$739.16 $838.92 $944.62 $1,320.10 $2,006.02 |
$1,021.88 $1,121.64 $1,227.34 $1,602.82 |
$1,304.60 $1,404.36 $1,510.06 $1,885.54 |
Toc - Plan #101 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 |
$358.92 $407.36 $458.68 $641.01 $974.07 |
$633.48 $681.92 $733.24 $915.57 |
$908.04 $956.48 $1,007.80 $1,190.13 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$717.84 $814.72 $917.36 $1,282.02 $1,948.14 |
$992.40 $1,089.28 $1,191.92 $1,556.58 |
$1,266.96 $1,363.84 $1,466.48 $1,831.14 |
Toc - Plan #102 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 |
$358.19 $406.54 $457.76 $639.72 $972.11 |
$632.20 $680.55 $731.77 $913.73 |
$906.21 $954.56 $1,005.78 $1,187.74 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$716.38 $813.08 $915.52 $1,279.44 $1,944.22 |
$990.39 $1,087.09 $1,189.53 $1,553.45 |
$1,264.40 $1,361.10 $1,463.54 $1,827.46 |
Toc - Plan #103 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 |
$372.96 $423.30 $476.64 $666.10 $1,012.20 |
$658.27 $708.61 $761.95 $951.41 |
$943.58 $993.92 $1,047.26 $1,236.72 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$745.92 $846.60 $953.28 $1,332.20 $2,024.40 |
$1,031.23 $1,131.91 $1,238.59 $1,617.51 |
$1,316.54 $1,417.22 $1,523.90 $1,902.82 |
Toc - Plan #104 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 |
$305.06 $346.23 $389.85 $544.82 $827.90 |
$538.42 $579.59 $623.21 $778.18 |
$771.78 $812.95 $856.57 $1,011.54 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$610.12 $692.46 $779.70 $1,089.64 $1,655.80 |
$843.48 $925.82 $1,013.06 $1,323.00 |
$1,076.84 $1,159.18 $1,246.42 $1,556.36 |
Toc - Plan #105 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 |
$305.13 $346.31 $389.94 $544.94 $828.09 |
$538.55 $579.73 $623.36 $778.36 |
$771.97 $813.15 $856.78 $1,011.78 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$610.26 $692.62 $779.88 $1,089.88 $1,656.18 |
$843.68 $926.04 $1,013.30 $1,323.30 |
$1,077.10 $1,159.46 $1,246.72 $1,556.72 |
Toc - Plan #106 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 |
$260.41 $295.55 $332.79 $465.07 $706.72 |
$459.62 $494.76 $532.00 $664.28 |
$658.83 $693.97 $731.21 $863.49 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$520.82 $591.10 $665.58 $930.14 $1,413.44 |
$720.03 $790.31 $864.79 $1,129.35 |
$919.24 $989.52 $1,064.00 $1,328.56 |
Toc - Plan #107 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 |
$262.13 $297.51 $334.99 $468.15 $711.40 |
$462.65 $498.03 $535.51 $668.67 |
$663.17 $698.55 $736.03 $869.19 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$524.26 $595.02 $669.98 $936.30 $1,422.80 |
$724.78 $795.54 $870.50 $1,136.82 |
$925.30 $996.06 $1,071.02 $1,337.34 |
Toc - Plan #108 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 |
$270.30 $306.78 $345.43 $482.74 $733.57 |
$477.07 $513.55 $552.20 $689.51 |
$683.84 $720.32 $758.97 $896.28 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$540.60 $613.56 $690.86 $965.48 $1,467.14 |
$747.37 $820.33 $897.63 $1,172.25 |
$954.14 $1,027.10 $1,104.40 $1,379.02 |
Toc - Plan #109 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 |
$267.90 $304.06 $342.37 $478.46 $727.07 |
$472.84 $509.00 $547.31 $683.40 |
$677.78 $713.94 $752.25 $888.34 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$535.80 $608.12 $684.74 $956.92 $1,454.14 |
$740.74 $813.06 $889.68 $1,161.86 |
$945.68 $1,018.00 $1,094.62 $1,366.80 |
Toc - Plan #110 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 |
$272.10 $308.83 $347.73 $485.96 $738.46 |
$480.25 $516.98 $555.88 $694.11 |
$688.40 $725.13 $764.03 $902.26 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$544.20 $617.66 $695.46 $971.92 $1,476.92 |
$752.35 $825.81 $903.61 $1,180.07 |
$960.50 $1,033.96 $1,111.76 $1,388.22 |
Toc - Plan #111 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 |
$411.75 $467.33 $526.21 $735.37 $1,117.47 |
$726.73 $782.31 $841.19 $1,050.35 |
$1,041.71 $1,097.29 $1,156.17 $1,365.33 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$823.50 $934.66 $1,052.42 $1,470.74 $2,234.94 |
$1,138.48 $1,249.64 $1,367.40 $1,785.72 |
$1,453.46 $1,564.62 $1,682.38 $2,100.70 |
Toc - Plan #112 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 |
$423.22 $480.35 $540.87 $755.86 $1,148.60 |
$746.98 $804.11 $864.63 $1,079.62 |
$1,070.74 $1,127.87 $1,188.39 $1,403.38 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$846.44 $960.70 $1,081.74 $1,511.72 $2,297.20 |
$1,170.20 $1,284.46 $1,405.50 $1,835.48 |
$1,493.96 $1,608.22 $1,729.26 $2,159.24 |
Toc - Plan #113 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 |
$277.53 $314.99 $354.68 $495.66 $753.20 |
$489.84 $527.30 $566.99 $707.97 |
$702.15 $739.61 $779.30 $920.28 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$555.06 $629.98 $709.36 $991.32 $1,506.40 |
$767.37 $842.29 $921.67 $1,203.63 |
$979.68 $1,054.60 $1,133.98 $1,415.94 |
Toc - Plan #114 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 |
$397.04 $450.63 $507.41 $709.10 $1,077.55 |
$700.77 $754.36 $811.14 $1,012.83 |
$1,004.50 $1,058.09 $1,114.87 $1,316.56 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$794.08 $901.26 $1,014.82 $1,418.20 $2,155.10 |
$1,097.81 $1,204.99 $1,318.55 $1,721.93 |
$1,401.54 $1,508.72 $1,622.28 $2,025.66 |
Toc - Plan #115 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 |
$421.40 $478.28 $538.54 $752.60 $1,143.66 |
$743.76 $800.64 $860.90 $1,074.96 |
$1,066.12 $1,123.00 $1,183.26 $1,397.32 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$842.80 $956.56 $1,077.08 $1,505.20 $2,287.32 |
$1,165.16 $1,278.92 $1,399.44 $1,827.56 |
$1,487.52 $1,601.28 $1,721.80 $2,149.92 |
‡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 Calumet County here.
Calumet County is in “Rating Area 11” of Wisconsin.
Currently, there are 115 plans offered in Rating Area 11.