Obamacare 2022 Rates for Dane County
Obamacare > Rates > Wisconsin > Dane County
Obamacare > Rates > Wisconsin > Dane County
ADVERTISEMENT
ADVERTISEMENT
QuartzLocal: 1-608-644-3430 | Toll Free: 1-800-362-3310 | TTY: 1-800-877-8973 |
Toc - Plan #1 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One 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 |
$294.18 $333.89 $375.95 $525.40 $798.39 |
$519.22 $558.93 $600.99 $750.44 |
$744.26 $783.97 $826.03 $975.48 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$588.36 $667.78 $751.90 $1,050.80 $1,596.78 |
$813.40 $892.82 $976.94 $1,275.84 |
$1,038.44 $1,117.86 $1,201.98 $1,500.88 |
Toc - Plan #2 Quartz | ||||||||||||||||||||
Gold
(HMO) Quartz One Gold I401 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 |
$395.15 $448.49 $504.99 $705.72 $1,072.41 |
$697.43 $750.77 $807.27 $1,008.00 |
$999.71 $1,053.05 $1,109.55 $1,310.28 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$790.30 $896.98 $1,009.98 $1,411.44 $2,144.82 |
$1,092.58 $1,199.26 $1,312.26 $1,713.72 |
$1,394.86 $1,501.54 $1,614.54 $2,016.00 |
Toc - Plan #3 Quartz | ||||||||||||||||||||
Gold
(HMO) Quartz One Gold I402 Maintenance 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 |
$392.34 $445.30 $501.41 $700.71 $1,064.80 |
$692.48 $745.44 $801.55 $1,000.85 |
$992.62 $1,045.58 $1,101.69 $1,300.99 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$784.68 $890.60 $1,002.82 $1,401.42 $2,129.60 |
$1,084.82 $1,190.74 $1,302.96 $1,701.56 |
$1,384.96 $1,490.88 $1,603.10 $2,001.70 |
Toc - Plan #4 Quartz | ||||||||||||||||||||
Gold
(HMO) Quartz One Gold I405 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 |
$390.61 $443.34 $499.19 $697.62 $1,060.10 |
$689.42 $742.15 $798.00 $996.43 |
$988.23 $1,040.96 $1,096.81 $1,295.24 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$781.22 $886.68 $998.38 $1,395.24 $2,120.20 |
$1,080.03 $1,185.49 $1,297.19 $1,694.05 |
$1,378.84 $1,484.30 $1,596.00 $1,992.86 |
Toc - Plan #5 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One Silver I301 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 |
$394.45 $447.70 $504.10 $704.48 $1,070.53 |
$696.20 $749.45 $805.85 $1,006.23 |
$997.95 $1,051.20 $1,107.60 $1,307.98 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$788.90 $895.40 $1,008.20 $1,408.96 $2,141.06 |
$1,090.65 $1,197.15 $1,309.95 $1,710.71 |
$1,392.40 $1,498.90 $1,611.70 $2,012.46 |
Toc - Plan #6 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One Silver I302 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 |
$395.86 $449.30 $505.90 $707.00 $1,074.35 |
$698.69 $752.13 $808.73 $1,009.83 |
$1,001.52 $1,054.96 $1,111.56 $1,312.66 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$791.72 $898.60 $1,011.80 $1,414.00 $2,148.70 |
$1,094.55 $1,201.43 $1,314.63 $1,716.83 |
$1,397.38 $1,504.26 $1,617.46 $2,019.66 |
Toc - Plan #7 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One Silver I303 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 |
$387.06 $439.31 $494.66 $691.29 $1,050.48 |
$683.16 $735.41 $790.76 $987.39 |
$979.26 $1,031.51 $1,086.86 $1,283.49 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$774.12 $878.62 $989.32 $1,382.58 $2,100.96 |
$1,070.22 $1,174.72 $1,285.42 $1,678.68 |
$1,366.32 $1,470.82 $1,581.52 $1,974.78 |
Toc - Plan #8 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One 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 |
$297.61 $337.79 $380.34 $531.53 $807.71 |
$525.28 $565.46 $608.01 $759.20 |
$752.95 $793.13 $835.68 $986.87 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$595.22 $675.58 $760.68 $1,063.06 $1,615.42 |
$822.89 $903.25 $988.35 $1,290.73 |
$1,050.56 $1,130.92 $1,216.02 $1,518.40 |
Toc - Plan #9 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One 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 |
$311.38 $353.41 $397.93 $556.11 $845.06 |
$549.58 $591.61 $636.13 $794.31 |
$787.78 $829.81 $874.33 $1,032.51 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$622.76 $706.82 $795.86 $1,112.22 $1,690.12 |
$860.96 $945.02 $1,034.06 $1,350.42 |
$1,099.16 $1,183.22 $1,272.26 $1,588.62 |
Toc - Plan #10 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One 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 |
$281.85 $319.89 $360.20 $503.37 $764.92 |
$497.46 $535.50 $575.81 $718.98 |
$713.07 $751.11 $791.42 $934.59 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$563.70 $639.78 $720.40 $1,006.74 $1,529.84 |
$779.31 $855.39 $936.01 $1,222.35 |
$994.92 $1,071.00 $1,151.62 $1,437.96 |
Toc - Plan #11 Quartz | ||||||||||||||||||||
Gold
(HMO) Quartz One 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 |
$378.58 $429.69 $483.82 $676.14 $1,027.46 |
$668.19 $719.30 $773.43 $965.75 |
$957.80 $1,008.91 $1,063.04 $1,255.36 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$757.16 $859.38 $967.64 $1,352.28 $2,054.92 |
$1,046.77 $1,148.99 $1,257.25 $1,641.89 |
$1,336.38 $1,438.60 $1,546.86 $1,931.50 |
Toc - Plan #12 Quartz | ||||||||||||||||||||
Gold
(HMO) Quartz One 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 |
$375.90 $426.64 $480.39 $671.34 $1,020.17 |
$663.46 $714.20 $767.95 $958.90 |
$951.02 $1,001.76 $1,055.51 $1,246.46 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$751.80 $853.28 $960.78 $1,342.68 $2,040.34 |
$1,039.36 $1,140.84 $1,248.34 $1,630.24 |
$1,326.92 $1,428.40 $1,535.90 $1,917.80 |
Toc - Plan #13 Quartz | ||||||||||||||||||||
Gold
(HMO) Quartz One 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 |
$374.24 $424.75 $478.27 $668.38 $1,015.67 |
$660.53 $711.04 $764.56 $954.67 |
$946.82 $997.33 $1,050.85 $1,240.96 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$748.48 $849.50 $956.54 $1,336.76 $2,031.34 |
$1,034.77 $1,135.79 $1,242.83 $1,623.05 |
$1,321.06 $1,422.08 $1,529.12 $1,909.34 |
Toc - Plan #14 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One 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 |
$377.92 $428.93 $482.97 $674.95 $1,025.66 |
$667.02 $718.03 $772.07 $964.05 |
$956.12 $1,007.13 $1,061.17 $1,253.15 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$755.84 $857.86 $965.94 $1,349.90 $2,051.32 |
$1,044.94 $1,146.96 $1,255.04 $1,639.00 |
$1,334.04 $1,436.06 $1,544.14 $1,928.10 |
Toc - Plan #15 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One 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 |
$379.27 $430.46 $484.70 $677.36 $1,029.32 |
$669.41 $720.60 $774.84 $967.50 |
$959.55 $1,010.74 $1,064.98 $1,257.64 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$758.54 $860.92 $969.40 $1,354.72 $2,058.64 |
$1,048.68 $1,151.06 $1,259.54 $1,644.86 |
$1,338.82 $1,441.20 $1,549.68 $1,935.00 |
Toc - Plan #16 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One 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 |
$370.84 $420.90 $473.93 $662.31 $1,006.44 |
$654.53 $704.59 $757.62 $946.00 |
$938.22 $988.28 $1,041.31 $1,229.69 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$741.68 $841.80 $947.86 $1,324.62 $2,012.88 |
$1,025.37 $1,125.49 $1,231.55 $1,608.31 |
$1,309.06 $1,409.18 $1,515.24 $1,892.00 |
Toc - Plan #17 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One 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 |
$285.14 $323.63 $364.40 $509.25 $773.85 |
$503.27 $541.76 $582.53 $727.38 |
$721.40 $759.89 $800.66 $945.51 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$570.28 $647.26 $728.80 $1,018.50 $1,547.70 |
$788.41 $865.39 $946.93 $1,236.63 |
$1,006.54 $1,083.52 $1,165.06 $1,454.76 |
Toc - Plan #18 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One 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 |
$298.33 $338.59 $381.25 $532.80 $809.64 |
$526.54 $566.80 $609.46 $761.01 |
$754.75 $795.01 $837.67 $989.22 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$596.66 $677.18 $762.50 $1,065.60 $1,619.28 |
$824.87 $905.39 $990.71 $1,293.81 |
$1,053.08 $1,133.60 $1,218.92 $1,522.02 |
Toc - Plan #19 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One 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 |
$296.79 $336.85 $379.29 $530.05 $805.46 |
$523.83 $563.89 $606.33 $757.09 |
$750.87 $790.93 $833.37 $984.13 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$593.58 $673.70 $758.58 $1,060.10 $1,610.92 |
$820.62 $900.74 $985.62 $1,287.14 |
$1,047.66 $1,127.78 $1,212.66 $1,514.18 |
Toc - Plan #20 Quartz | ||||||||||||||||||||
Catastrophic
(HMO) Quartz One 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 |
$218.07 $247.50 $278.69 $389.46 $591.83 |
$384.89 $414.32 $445.51 $556.28 |
$551.71 $581.14 $612.33 $723.10 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$436.14 $495.00 $557.38 $778.92 $1,183.66 |
$602.96 $661.82 $724.20 $945.74 |
$769.78 $828.64 $891.02 $1,112.56 |
Toc - Plan #21 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One 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 |
$397.95 $451.66 $508.57 $710.72 $1,080.01 |
$702.37 $756.08 $812.99 $1,015.14 |
$1,006.79 $1,060.50 $1,117.41 $1,319.56 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$795.90 $903.32 $1,017.14 $1,421.44 $2,160.02 |
$1,100.32 $1,207.74 $1,321.56 $1,725.86 |
$1,404.74 $1,512.16 $1,625.98 $2,030.28 |
Toc - Plan #22 Quartz | ||||||||||||||||||||
Gold
(HMO) Quartz One 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 |
$408.00 $463.07 $521.42 $728.68 $1,107.30 |
$720.12 $775.19 $833.54 $1,040.80 |
$1,032.24 $1,087.31 $1,145.66 $1,352.92 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$816.00 $926.14 $1,042.84 $1,457.36 $2,214.60 |
$1,128.12 $1,238.26 $1,354.96 $1,769.48 |
$1,440.24 $1,550.38 $1,667.08 $2,081.60 |
ADVERTISEMENT
Dean Health PlanLocal: 1-800-279-1302 | Toll Free: 1-800-279-1302 | TTY: 1-800-279-1302 |
Toc - Plan #23 Dean Health Plan | ||||||||||||||||||||
Catastrophic
(HMO) Dean Catastrophic Safety Net |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$173.55 $196.98 $221.80 $309.97 $471.02 |
$306.32 $329.75 $354.57 $442.74 |
$439.09 $462.52 $487.34 $575.51 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$347.10 $393.96 $443.60 $619.94 $942.04 |
$479.87 $526.73 $576.37 $752.71 |
$612.64 $659.50 $709.14 $885.48 |
Toc - Plan #24 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Dean Silver Copay Plus 4800X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$327.78 $372.03 $418.90 $585.41 $889.59 |
$578.53 $622.78 $669.65 $836.16 |
$829.28 $873.53 $920.40 $1,086.91 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$655.56 $744.06 $837.80 $1,170.82 $1,779.18 |
$906.31 $994.81 $1,088.55 $1,421.57 |
$1,157.06 $1,245.56 $1,339.30 $1,672.32 |
Toc - Plan #25 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Dean Silver Classic 5000X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$318.82 $361.86 $407.45 $569.41 $865.27 |
$562.72 $605.76 $651.35 $813.31 |
$806.62 $849.66 $895.25 $1,057.21 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$637.64 $723.72 $814.90 $1,138.82 $1,730.54 |
$881.54 $967.62 $1,058.80 $1,382.72 |
$1,125.44 $1,211.52 $1,302.70 $1,626.62 |
Toc - Plan #26 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Dean Silver Value Copay 5000X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$332.76 $377.68 $425.26 $594.30 $903.10 |
$587.32 $632.24 $679.82 $848.86 |
$841.88 $886.80 $934.38 $1,103.42 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$665.52 $755.36 $850.52 $1,188.60 $1,806.20 |
$920.08 $1,009.92 $1,105.08 $1,443.16 |
$1,174.64 $1,264.48 $1,359.64 $1,697.72 |
Toc - Plan #27 Dean Health Plan | ||||||||||||||||||||
Gold
(HMO) Dean Gold Value Copay 3700X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$321.98 $365.45 $411.49 $575.05 $873.85 |
$568.29 $611.76 $657.80 $821.36 |
$814.60 $858.07 $904.11 $1,067.67 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$643.96 $730.90 $822.98 $1,150.10 $1,747.70 |
$890.27 $977.21 $1,069.29 $1,396.41 |
$1,136.58 $1,223.52 $1,315.60 $1,642.72 |
Toc - Plan #28 Dean Health Plan | ||||||||||||||||||||
Bronze
(HMO) Dean Bronze Value Copay 8650X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$212.87 $241.60 $272.04 $380.18 $577.72 |
$375.71 $404.44 $434.88 $543.02 |
$538.55 $567.28 $597.72 $705.86 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$425.74 $483.20 $544.08 $760.36 $1,155.44 |
$588.58 $646.04 $706.92 $923.20 |
$751.42 $808.88 $869.76 $1,086.04 |
Toc - Plan #29 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Dean Silver HSA-E 4500X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$314.12 $356.52 $401.44 $561.01 $852.51 |
$554.42 $596.82 $641.74 $801.31 |
$794.72 $837.12 $882.04 $1,041.61 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$628.24 $713.04 $802.88 $1,122.02 $1,705.02 |
$868.54 $953.34 $1,043.18 $1,362.32 |
$1,108.84 $1,193.64 $1,283.48 $1,602.62 |
Toc - Plan #30 Dean Health Plan | ||||||||||||||||||||
Gold
(HMO) Dean Gold Copay Plus 1500X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$326.87 $371.00 $417.74 $583.79 $887.13 |
$576.93 $621.06 $667.80 $833.85 |
$826.99 $871.12 $917.86 $1,083.91 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$653.74 $742.00 $835.48 $1,167.58 $1,774.26 |
$903.80 $992.06 $1,085.54 $1,417.64 |
$1,153.86 $1,242.12 $1,335.60 $1,667.70 |
Toc - Plan #31 Dean Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) Dean Bronze HSA-E 6950X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$224.82 $255.18 $287.33 $401.54 $610.17 |
$396.81 $427.17 $459.32 $573.53 |
$568.80 $599.16 $631.31 $745.52 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$449.64 $510.36 $574.66 $803.08 $1,220.34 |
$621.63 $682.35 $746.65 $975.07 |
$793.62 $854.34 $918.64 $1,147.06 |
Toc - Plan #32 Dean Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) Dean Bronze Copay Plus 8650X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$220.26 $250.00 $281.49 $393.39 $597.79 |
$388.76 $418.50 $449.99 $561.89 |
$557.26 $587.00 $618.49 $730.39 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$440.52 $500.00 $562.98 $786.78 $1,195.58 |
$609.02 $668.50 $731.48 $955.28 |
$777.52 $837.00 $899.98 $1,123.78 |
Toc - Plan #33 Dean Health Plan | ||||||||||||||||||||
Expanded Bronze
(EPO) Dean Focus Network Bronze Copay Plus 8650X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$205.99 $233.80 $263.26 $367.90 $559.06 |
$363.57 $391.38 $420.84 $525.48 |
$521.15 $548.96 $578.42 $683.06 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$411.98 $467.60 $526.52 $735.80 $1,118.12 |
$569.56 $625.18 $684.10 $893.38 |
$727.14 $782.76 $841.68 $1,050.96 |
Toc - Plan #34 Dean Health Plan | ||||||||||||||||||||
Gold
(EPO) Dean Focus Network Gold Value Copay 3700X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$300.01 $340.51 $383.42 $535.82 $814.24 |
$529.52 $570.02 $612.93 $765.33 |
$759.03 $799.53 $842.44 $994.84 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$600.02 $681.02 $766.84 $1,071.64 $1,628.48 |
$829.53 $910.53 $996.35 $1,301.15 |
$1,059.04 $1,140.04 $1,225.86 $1,530.66 |
Toc - Plan #35 Dean Health Plan | ||||||||||||||||||||
Silver
(EPO) Dean Focus Network Silver Value Copay 5000X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$309.96 $351.81 $396.14 $553.60 $841.24 |
$547.08 $588.93 $633.26 $790.72 |
$784.20 $826.05 $870.38 $1,027.84 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$619.92 $703.62 $792.28 $1,107.20 $1,682.48 |
$857.04 $940.74 $1,029.40 $1,344.32 |
$1,094.16 $1,177.86 $1,266.52 $1,581.44 |
Toc - Plan #36 Dean Health Plan | ||||||||||||||||||||
Bronze
(EPO) Dean Focus Network Bronze Value Copay 8650X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$199.17 $226.06 $254.55 $355.73 $540.56 |
$351.54 $378.43 $406.92 $508.10 |
$503.91 $530.80 $559.29 $660.47 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$398.34 $452.12 $509.10 $711.46 $1,081.12 |
$550.71 $604.49 $661.47 $863.83 |
$703.08 $756.86 $813.84 $1,016.20 |
Toc - Plan #37 Dean Health Plan | ||||||||||||||||||||
Silver
(EPO) Dean Focus Network Silver HSA-E 4500X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$292.73 $332.25 $374.11 $522.81 $794.46 |
$516.67 $556.19 $598.05 $746.75 |
$740.61 $780.13 $821.99 $970.69 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$585.46 $664.50 $748.22 $1,045.62 $1,588.92 |
$809.40 $888.44 $972.16 $1,269.56 |
$1,033.34 $1,112.38 $1,196.10 $1,493.50 |
Toc - Plan #38 Dean Health Plan | ||||||||||||||||||||
Expanded Bronze
(EPO) Dean Focus Network Bronze HSA-E 6950X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$210.20 $238.58 $268.63 $375.42 $570.48 |
$371.00 $399.38 $429.43 $536.22 |
$531.80 $560.18 $590.23 $697.02 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$420.40 $477.16 $537.26 $750.84 $1,140.96 |
$581.20 $637.96 $698.06 $911.64 |
$742.00 $798.76 $858.86 $1,072.44 |
ADVERTISEMENT
Group Health Cooperative-SCWLocal: 1-608-828-4831 | Toll Free: 1-855-344-2729 | TTY: 1-608-828-4815 |
Toc - Plan #39 Group Health Cooperative-SCW | ||||||||||||||||||||
Platinum
(HMO) Platinum 500 Ded/1500 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$386.35 $438.50 $493.75 $690.01 $1,048.54 |
$681.91 $734.06 $789.31 $985.57 |
$977.47 $1,029.62 $1,084.87 $1,281.13 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$772.70 $877.00 $987.50 $1,380.02 $2,097.08 |
$1,068.26 $1,172.56 $1,283.06 $1,675.58 |
$1,363.82 $1,468.12 $1,578.62 $1,971.14 |
Toc - Plan #40 Group Health Cooperative-SCW | ||||||||||||||||||||
Gold
(HMO) Gold 2500 Ded/2500 MOOP HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$329.42 $373.90 $421.00 $588.35 $894.05 |
$581.43 $625.91 $673.01 $840.36 |
$833.44 $877.92 $925.02 $1,092.37 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$658.84 $747.80 $842.00 $1,176.70 $1,788.10 |
$910.85 $999.81 $1,094.01 $1,428.71 |
$1,162.86 $1,251.82 $1,346.02 $1,680.72 |
Toc - Plan #41 Group Health Cooperative-SCW | ||||||||||||||||||||
Expanded Bronze
(HMO) Bronze 4000 Ded/8500 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$271.51 $308.17 $346.99 $484.92 $736.88 |
$479.22 $515.88 $554.70 $692.63 |
$686.93 $723.59 $762.41 $900.34 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$543.02 $616.34 $693.98 $969.84 $1,473.76 |
$750.73 $824.05 $901.69 $1,177.55 |
$958.44 $1,031.76 $1,109.40 $1,385.26 |
Toc - Plan #42 Group Health Cooperative-SCW | ||||||||||||||||||||
Platinum
(HMO) Select Platinum 500 Ded/1500 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$368.07 $417.76 $470.40 $657.37 $998.94 |
$649.65 $699.34 $751.98 $938.95 |
$931.23 $980.92 $1,033.56 $1,220.53 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$736.14 $835.52 $940.80 $1,314.74 $1,997.88 |
$1,017.72 $1,117.10 $1,222.38 $1,596.32 |
$1,299.30 $1,398.68 $1,503.96 $1,877.90 |
Toc - Plan #43 Group Health Cooperative-SCW | ||||||||||||||||||||
Gold
(HMO) Select Gold 2500 Ded/2500 MOOP HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$313.87 $356.24 $401.13 $560.57 $851.84 |
$553.98 $596.35 $641.24 $800.68 |
$794.09 $836.46 $881.35 $1,040.79 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$627.74 $712.48 $802.26 $1,121.14 $1,703.68 |
$867.85 $952.59 $1,042.37 $1,361.25 |
$1,107.96 $1,192.70 $1,282.48 $1,601.36 |
Toc - Plan #44 Group Health Cooperative-SCW | ||||||||||||||||||||
Expanded Bronze
(HMO) Select Bronze 4000 Ded/8500 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$258.71 $293.64 $330.63 $462.06 $702.14 |
$456.63 $491.56 $528.55 $659.98 |
$654.55 $689.48 $726.47 $857.90 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$517.42 $587.28 $661.26 $924.12 $1,404.28 |
$715.34 $785.20 $859.18 $1,122.04 |
$913.26 $983.12 $1,057.10 $1,319.96 |
Toc - Plan #45 Group Health Cooperative-SCW | ||||||||||||||||||||
Expanded Bronze
(HMO) Bronze 7050 Ded/7050 MOOP HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$269.29 $305.64 $344.15 $480.94 $730.84 |
$475.30 $511.65 $550.16 $686.95 |
$681.31 $717.66 $756.17 $892.96 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$538.58 $611.28 $688.30 $961.88 $1,461.68 |
$744.59 $817.29 $894.31 $1,167.89 |
$950.60 $1,023.30 $1,100.32 $1,373.90 |
Toc - Plan #46 Group Health Cooperative-SCW | ||||||||||||||||||||
Expanded Bronze
(HMO) Select Bronze 7050 Ded/7050 MOOP HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$256.59 $291.23 $327.92 $458.26 $696.37 |
$452.88 $487.52 $524.21 $654.55 |
$649.17 $683.81 $720.50 $850.84 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$513.18 $582.46 $655.84 $916.52 $1,392.74 |
$709.47 $778.75 $852.13 $1,112.81 |
$905.76 $975.04 $1,048.42 $1,309.10 |
Toc - Plan #47 Group Health Cooperative-SCW | ||||||||||||||||||||
Gold
(HMO) Gold 2500 Ded/6500 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$327.54 $371.76 $418.60 $584.99 $888.94 |
$578.11 $622.33 $669.17 $835.56 |
$828.68 $872.90 $919.74 $1,086.13 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$655.08 $743.52 $837.20 $1,169.98 $1,777.88 |
$905.65 $994.09 $1,087.77 $1,420.55 |
$1,156.22 $1,244.66 $1,338.34 $1,671.12 |
Toc - Plan #48 Group Health Cooperative-SCW | ||||||||||||||||||||
Gold
(HMO) Select Gold 2500 Ded/6500 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$312.07 $354.20 $398.82 $557.35 $846.94 |
$550.80 $592.93 $637.55 $796.08 |
$789.53 $831.66 $876.28 $1,034.81 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$624.14 $708.40 $797.64 $1,114.70 $1,693.88 |
$862.87 $947.13 $1,036.37 $1,353.43 |
$1,101.60 $1,185.86 $1,275.10 $1,592.16 |
Toc - Plan #49 Group Health Cooperative-SCW | ||||||||||||||||||||
Gold
(HMO) Select Gold 1600 Ded/5400 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$318.84 $361.88 $407.47 $569.44 $865.32 |
$562.75 $605.79 $651.38 $813.35 |
$806.66 $849.70 $895.29 $1,057.26 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$637.68 $723.76 $814.94 $1,138.88 $1,730.64 |
$881.59 $967.67 $1,058.85 $1,382.79 |
$1,125.50 $1,211.58 $1,302.76 $1,626.70 |
Toc - Plan #50 Group Health Cooperative-SCW | ||||||||||||||||||||
Silver
(HMO) Select Silver 4550X Ded/7900 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$349.73 $396.95 $446.96 $624.62 $949.16 |
$617.28 $664.50 $714.51 $892.17 |
$884.83 $932.05 $982.06 $1,159.72 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$699.46 $793.90 $893.92 $1,249.24 $1,898.32 |
$967.01 $1,061.45 $1,161.47 $1,516.79 |
$1,234.56 $1,329.00 $1,429.02 $1,784.34 |
Toc - Plan #51 Group Health Cooperative-SCW | ||||||||||||||||||||
Expanded Bronze
(HMO) Select Bronze 6850 Ded/8200 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$263.97 $299.61 $337.36 $471.45 $716.41 |
$465.91 $501.55 $539.30 $673.39 |
$667.85 $703.49 $741.24 $875.33 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$527.94 $599.22 $674.72 $942.90 $1,432.82 |
$729.88 $801.16 $876.66 $1,144.84 |
$931.82 $1,003.10 $1,078.60 $1,346.78 |
Toc - Plan #52 Group Health Cooperative-SCW | ||||||||||||||||||||
Catastrophic
(HMO) Select Catastrophic 8700 Ded/8700 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$213.94 $242.82 $273.42 $382.10 $580.63 |
$377.61 $406.49 $437.09 $545.77 |
$541.28 $570.16 $600.76 $709.44 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$427.88 $485.64 $546.84 $764.20 $1,161.26 |
$591.55 $649.31 $710.51 $927.87 |
$755.22 $812.98 $874.18 $1,091.54 |
Toc - Plan #53 Group Health Cooperative-SCW | ||||||||||||||||||||
Gold
(HMO) Gold 1600 Ded/5400 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$334.65 $379.83 $427.68 $597.68 $908.23 |
$590.66 $635.84 $683.69 $853.69 |
$846.67 $891.85 $939.70 $1,109.70 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$669.30 $759.66 $855.36 $1,195.36 $1,816.46 |
$925.31 $1,015.67 $1,111.37 $1,451.37 |
$1,181.32 $1,271.68 $1,367.38 $1,707.38 |
Toc - Plan #54 Group Health Cooperative-SCW | ||||||||||||||||||||
Silver
(HMO) Silver 4550X Ded/7900 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$379.93 $431.22 $485.55 $678.56 $1,031.13 |
$670.58 $721.87 $776.20 $969.21 |
$961.23 $1,012.52 $1,066.85 $1,259.86 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$759.86 $862.44 $971.10 $1,357.12 $2,062.26 |
$1,050.51 $1,153.09 $1,261.75 $1,647.77 |
$1,341.16 $1,443.74 $1,552.40 $1,938.42 |
Toc - Plan #55 Group Health Cooperative-SCW | ||||||||||||||||||||
Expanded Bronze
(HMO) Bronze 6850 Ded/8200 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$277.04 $314.44 $354.06 $494.79 $751.88 |
$488.98 $526.38 $566.00 $706.73 |
$700.92 $738.32 $777.94 $918.67 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$554.08 $628.88 $708.12 $989.58 $1,503.76 |
$766.02 $840.82 $920.06 $1,201.52 |
$977.96 $1,052.76 $1,132.00 $1,413.46 |
Toc - Plan #56 Group Health Cooperative-SCW | ||||||||||||||||||||
Platinum
(HMO) Platinum No Ded/2000 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$387.73 $440.08 $495.52 $692.49 $1,052.30 |
$684.35 $736.70 $792.14 $989.11 |
$980.97 $1,033.32 $1,088.76 $1,285.73 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$775.46 $880.16 $991.04 $1,384.98 $2,104.60 |
$1,072.08 $1,176.78 $1,287.66 $1,681.60 |
$1,368.70 $1,473.40 $1,584.28 $1,978.22 |
Toc - Plan #57 Group Health Cooperative-SCW | ||||||||||||||||||||
Platinum
(HMO) Select Platinum No Ded/2000 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$369.40 $419.27 $472.09 $659.74 $1,002.54 |
$651.99 $701.86 $754.68 $942.33 |
$934.58 $984.45 $1,037.27 $1,224.92 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$738.80 $838.54 $944.18 $1,319.48 $2,005.08 |
$1,021.39 $1,121.13 $1,226.77 $1,602.07 |
$1,303.98 $1,403.72 $1,509.36 $1,884.66 |
Toc - Plan #58 Group Health Cooperative-SCW | ||||||||||||||||||||
Bronze
(HMO) Bronze 8700 Ded/8700 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$265.23 $301.04 $338.97 $473.70 $719.84 |
$468.14 $503.95 $541.88 $676.61 |
$671.05 $706.86 $744.79 $879.52 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$530.46 $602.08 $677.94 $947.40 $1,439.68 |
$733.37 $804.99 $880.85 $1,150.31 |
$936.28 $1,007.90 $1,083.76 $1,353.22 |
Toc - Plan #59 Group Health Cooperative-SCW | ||||||||||||||||||||
Bronze
(HMO) Select Bronze 8700 Ded/8700 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$252.73 $286.85 $322.99 $451.38 $685.91 |
$446.07 $480.19 $516.33 $644.72 |
$639.41 $673.53 $709.67 $838.06 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$505.46 $573.70 $645.98 $902.76 $1,371.82 |
$698.80 $767.04 $839.32 $1,096.10 |
$892.14 $960.38 $1,032.66 $1,289.44 |
Toc - Plan #60 Group Health Cooperative-SCW | ||||||||||||||||||||
Silver
(HMO) Silver 4900 Ded/7900 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$394.20 $447.41 $503.78 $704.03 $1,069.84 |
$695.76 $748.97 $805.34 $1,005.59 |
$997.32 $1,050.53 $1,106.90 $1,307.15 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$788.40 $894.82 $1,007.56 $1,408.06 $2,139.68 |
$1,089.96 $1,196.38 $1,309.12 $1,709.62 |
$1,391.52 $1,497.94 $1,610.68 $2,011.18 |
Toc - Plan #61 Group Health Cooperative-SCW | ||||||||||||||||||||
Silver
(HMO) Select Silver 4900 Ded/7900 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$362.12 $411.00 $462.79 $646.74 $982.78 |
$639.14 $688.02 $739.81 $923.76 |
$916.16 $965.04 $1,016.83 $1,200.78 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$724.24 $822.00 $925.58 $1,293.48 $1,965.56 |
$1,001.26 $1,099.02 $1,202.60 $1,570.50 |
$1,278.28 $1,376.04 $1,479.62 $1,847.52 |
Toc - Plan #62 Group Health Cooperative-SCW | ||||||||||||||||||||
Gold
(HMO) Gold 1500 Ded/8550 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$318.64 $361.66 $407.23 $569.09 $864.79 |
$562.40 $605.42 $650.99 $812.85 |
$806.16 $849.18 $894.75 $1,056.61 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$637.28 $723.32 $814.46 $1,138.18 $1,729.58 |
$881.04 $967.08 $1,058.22 $1,381.94 |
$1,124.80 $1,210.84 $1,301.98 $1,625.70 |
Toc - Plan #63 Group Health Cooperative-SCW | ||||||||||||||||||||
Silver
(HMO) Silver 8100X Ded/8150 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$385.80 $437.89 $493.06 $689.04 $1,047.06 |
$680.94 $733.03 $788.20 $984.18 |
$976.08 $1,028.17 $1,083.34 $1,279.32 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$771.60 $875.78 $986.12 $1,378.08 $2,094.12 |
$1,066.74 $1,170.92 $1,281.26 $1,673.22 |
$1,361.88 $1,466.06 $1,576.40 $1,968.36 |
Toc - Plan #64 Group Health Cooperative-SCW | ||||||||||||||||||||
Gold
(HMO) Select Gold 1500 Ded/8550 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$303.60 $344.58 $388.00 $542.22 $823.96 |
$535.85 $576.83 $620.25 $774.47 |
$768.10 $809.08 $852.50 $1,006.72 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$607.20 $689.16 $776.00 $1,084.44 $1,647.92 |
$839.45 $921.41 $1,008.25 $1,316.69 |
$1,071.70 $1,153.66 $1,240.50 $1,548.94 |
Toc - Plan #65 Group Health Cooperative-SCW | ||||||||||||||||||||
Silver
(HMO) Select Silver 8000X Ded/8550 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$357.13 $405.35 $456.42 $637.84 $969.25 |
$630.34 $678.56 $729.63 $911.05 |
$903.55 $951.77 $1,002.84 $1,184.26 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$714.26 $810.70 $912.84 $1,275.68 $1,938.50 |
$987.47 $1,083.91 $1,186.05 $1,548.89 |
$1,260.68 $1,357.12 $1,459.26 $1,822.10 |
Toc - Plan #66 Group Health Cooperative-SCW | ||||||||||||||||||||
Catastrophic
(HMO) Catastrophic 8700 Ded/8700 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$224.50 $254.81 $286.91 $400.95 $609.28 |
$396.24 $426.55 $458.65 $572.69 |
$567.98 $598.29 $630.39 $744.43 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$449.00 $509.62 $573.82 $801.90 $1,218.56 |
$620.74 $681.36 $745.56 $973.64 |
$792.48 $853.10 $917.30 $1,145.38 |
Toc - Plan #67 Group Health Cooperative-SCW | ||||||||||||||||||||
Platinum
(HMO) Platinum 1000 Ded/4400 MOOP Primary Care Preferred |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$359.03 $407.50 $458.84 $641.22 $974.40 |
$633.69 $682.16 $733.50 $915.88 |
$908.35 $956.82 $1,008.16 $1,190.54 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$718.06 $815.00 $917.68 $1,282.44 $1,948.80 |
$992.72 $1,089.66 $1,192.34 $1,557.10 |
$1,267.38 $1,364.32 $1,467.00 $1,831.76 |
Toc - Plan #68 Group Health Cooperative-SCW | ||||||||||||||||||||
Gold
(HMO) Gold 4500 Ded/8500 MOOP Primary Care Preferred |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$309.79 $351.61 $395.91 $553.28 $840.75 |
$546.78 $588.60 $632.90 $790.27 |
$783.77 $825.59 $869.89 $1,027.26 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$619.58 $703.22 $791.82 $1,106.56 $1,681.50 |
$856.57 $940.21 $1,028.81 $1,343.55 |
$1,093.56 $1,177.20 $1,265.80 $1,580.54 |
Toc - Plan #69 Group Health Cooperative-SCW | ||||||||||||||||||||
Silver
(HMO) Silver 8500 Ded/8500 MOOP Primary Care Preferred |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$392.99 $446.05 $502.25 $701.88 $1,066.58 |
$693.63 $746.69 $802.89 $1,002.52 |
$994.27 $1,047.33 $1,103.53 $1,303.16 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$785.98 $892.10 $1,004.50 $1,403.76 $2,133.16 |
$1,086.62 $1,192.74 $1,305.14 $1,704.40 |
$1,387.26 $1,493.38 $1,605.78 $2,005.04 |
Toc - Plan #70 Group Health Cooperative-SCW | ||||||||||||||||||||
Platinum
(HMO) Select Platinum 1000 Ded/4400 MOOP Primary Care Preferred |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$342.06 $388.24 $437.15 $610.91 $928.34 |
$603.74 $649.92 $698.83 $872.59 |
$865.42 $911.60 $960.51 $1,134.27 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$684.12 $776.48 $874.30 $1,221.82 $1,856.68 |
$945.80 $1,038.16 $1,135.98 $1,483.50 |
$1,207.48 $1,299.84 $1,397.66 $1,745.18 |
Toc - Plan #71 Group Health Cooperative-SCW | ||||||||||||||||||||
Gold
(HMO) Select Gold 4500 Ded/8500 MOOP Primary Care Preferred |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$295.16 $335.01 $377.22 $527.16 $801.07 |
$520.96 $560.81 $603.02 $752.96 |
$746.76 $786.61 $828.82 $978.76 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$590.32 $670.02 $754.44 $1,054.32 $1,602.14 |
$816.12 $895.82 $980.24 $1,280.12 |
$1,041.92 $1,121.62 $1,206.04 $1,505.92 |
Toc - Plan #72 Group Health Cooperative-SCW | ||||||||||||||||||||
Silver
(HMO) Select Silver 8500 Ded/8500 MOOP Primary Care Preferred |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$360.51 $409.18 $460.73 $643.87 $978.42 |
$636.30 $684.97 $736.52 $919.66 |
$912.09 $960.76 $1,012.31 $1,195.45 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$721.02 $818.36 $921.46 $1,287.74 $1,956.84 |
$996.81 $1,094.15 $1,197.25 $1,563.53 |
$1,272.60 $1,369.94 $1,473.04 $1,839.32 |
‡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 Dane County here.
Dane County is in “Rating Area 2” of Wisconsin.
Currently, there are 72 plans offered in Rating Area 2.