Obamacare 2022 Rates for Dodge County
Obamacare > Rates > Wisconsin > Dodge County
Obamacare > Rates > Wisconsin > Dodge County
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QuartzLocal: 1-608-644-3430 | Toll Free: 1-800-362-3310 | TTY: 1-800-877-8973 |
Toc - Plan #1 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I406 with Dental |
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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 |
$409.85 $465.17 $523.78 $731.98 $1,112.32 |
$723.38 $778.70 $837.31 $1,045.51 |
$1,036.91 $1,092.23 $1,150.84 $1,359.04 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$819.70 $930.34 $1,047.56 $1,463.96 $2,224.64 |
$1,133.23 $1,243.87 $1,361.09 $1,777.49 |
$1,446.76 $1,557.40 $1,674.62 $2,091.02 |
Toc - Plan #2 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I407 Maintenance with Dental |
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Benefits & Coverage
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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 |
$467.35 $530.43 $597.26 $834.67 $1,268.37 |
$824.87 $887.95 $954.78 $1,192.19 |
$1,182.39 $1,245.47 $1,312.30 $1,549.71 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$934.70 $1,060.86 $1,194.52 $1,669.34 $2,536.74 |
$1,292.22 $1,418.38 $1,552.04 $2,026.86 |
$1,649.74 $1,775.90 $1,909.56 $2,384.38 |
Toc - Plan #3 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I409 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 |
$404.45 $459.05 $516.88 $722.34 $1,097.67 |
$713.85 $768.45 $826.28 $1,031.74 |
$1,023.25 $1,077.85 $1,135.68 $1,341.14 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$808.90 $918.10 $1,033.76 $1,444.68 $2,195.34 |
$1,118.30 $1,227.50 $1,343.16 $1,754.08 |
$1,427.70 $1,536.90 $1,652.56 $2,063.48 |
Toc - Plan #4 Quartz | ||||||||||||||||||||
Silver
(HMO) Tiered Choice Plus Silver I305 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 |
$412.55 $468.24 $527.24 $736.81 $1,119.66 |
$728.15 $783.84 $842.84 $1,052.41 |
$1,043.75 $1,099.44 $1,158.44 $1,368.01 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$825.10 $936.48 $1,054.48 $1,473.62 $2,239.32 |
$1,140.70 $1,252.08 $1,370.08 $1,789.22 |
$1,456.30 $1,567.68 $1,685.68 $2,104.82 |
Toc - Plan #5 Quartz | ||||||||||||||||||||
Silver
(HMO) Tiered Choice Plus Silver I306 with Dental |
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Benefits & Coverage
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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 |
$405.25 $459.95 $517.90 $723.77 $1,099.83 |
$715.26 $769.96 $827.91 $1,033.78 |
$1,025.27 $1,079.97 $1,137.92 $1,343.79 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$810.50 $919.90 $1,035.80 $1,447.54 $2,199.66 |
$1,120.51 $1,229.91 $1,345.81 $1,757.55 |
$1,430.52 $1,539.92 $1,655.82 $2,067.56 |
Toc - Plan #6 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One 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 |
$453.05 $514.20 $578.99 $809.13 $1,229.55 |
$799.63 $860.78 $925.57 $1,155.71 |
$1,146.21 $1,207.36 $1,272.15 $1,502.29 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$906.10 $1,028.40 $1,157.98 $1,618.26 $2,459.10 |
$1,252.68 $1,374.98 $1,504.56 $1,964.84 |
$1,599.26 $1,721.56 $1,851.14 $2,311.42 |
Toc - Plan #7 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One Bronze I201 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 |
$348.35 $395.37 $445.18 $622.14 $945.40 |
$614.83 $661.85 $711.66 $888.62 |
$881.31 $928.33 $978.14 $1,155.10 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$696.70 $790.74 $890.36 $1,244.28 $1,890.80 |
$963.18 $1,057.22 $1,156.84 $1,510.76 |
$1,229.66 $1,323.70 $1,423.32 $1,777.24 |
Toc - Plan #8 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One Bronze I202 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 |
$344.33 $390.81 $440.04 $614.96 $934.49 |
$607.74 $654.22 $703.45 $878.37 |
$871.15 $917.63 $966.86 $1,141.78 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$688.66 $781.62 $880.08 $1,229.92 $1,868.98 |
$952.07 $1,045.03 $1,143.49 $1,493.33 |
$1,215.48 $1,308.44 $1,406.90 $1,756.74 |
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]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$364.46 $413.65 $465.77 $650.91 $989.12 |
$643.27 $692.46 $744.58 $929.72 |
$922.08 $971.27 $1,023.39 $1,208.53 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$728.92 $827.30 $931.54 $1,301.82 $1,978.24 |
$1,007.73 $1,106.11 $1,210.35 $1,580.63 |
$1,286.54 $1,384.92 $1,489.16 $1,859.44 |
Toc - Plan #10 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I406 |
||||||||||||||||||||
Benefits & Coverage
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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 |
$392.67 $445.67 $501.83 $701.30 $1,065.69 |
$693.06 $746.06 $802.22 $1,001.69 |
$993.45 $1,046.45 $1,102.61 $1,302.08 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$785.34 $891.34 $1,003.66 $1,402.60 $2,131.38 |
$1,085.73 $1,191.73 $1,304.05 $1,702.99 |
$1,386.12 $1,492.12 $1,604.44 $2,003.38 |
Toc - Plan #11 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I407 Maintenance |
||||||||||||||||||||
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 |
|||||||||||||||||
21 30 40 50 60 |
$447.76 $508.20 $572.23 $799.69 $1,215.20 |
$790.29 $850.73 $914.76 $1,142.22 |
$1,132.82 $1,193.26 $1,257.29 $1,484.75 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$895.52 $1,016.40 $1,144.46 $1,599.38 $2,430.40 |
$1,238.05 $1,358.93 $1,486.99 $1,941.91 |
$1,580.58 $1,701.46 $1,829.52 $2,284.44 |
Toc - Plan #12 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I409 |
||||||||||||||||||||
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 |
$387.50 $439.80 $495.22 $692.06 $1,051.66 |
$683.93 $736.23 $791.65 $988.49 |
$980.36 $1,032.66 $1,088.08 $1,284.92 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$775.00 $879.60 $990.44 $1,384.12 $2,103.32 |
$1,071.43 $1,176.03 $1,286.87 $1,680.55 |
$1,367.86 $1,472.46 $1,583.30 $1,976.98 |
Toc - Plan #13 Quartz | ||||||||||||||||||||
Silver
(HMO) Tiered Choice Plus Silver I305 |
||||||||||||||||||||
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 |
|||||||||||||||||
21 30 40 50 60 |
$395.26 $448.62 $505.14 $705.93 $1,072.72 |
$697.63 $750.99 $807.51 $1,008.30 |
$1,000.00 $1,053.36 $1,109.88 $1,310.67 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$790.52 $897.24 $1,010.28 $1,411.86 $2,145.44 |
$1,092.89 $1,199.61 $1,312.65 $1,714.23 |
$1,395.26 $1,501.98 $1,615.02 $2,016.60 |
Toc - Plan #14 Quartz | ||||||||||||||||||||
Silver
(HMO) Tiered Choice Plus Silver I306 |
||||||||||||||||||||
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 |
|||||||||||||||||
21 30 40 50 60 |
$388.26 $440.67 $496.19 $693.43 $1,053.73 |
$685.28 $737.69 $793.21 $990.45 |
$982.30 $1,034.71 $1,090.23 $1,287.47 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$776.52 $881.34 $992.38 $1,386.86 $2,107.46 |
$1,073.54 $1,178.36 $1,289.40 $1,683.88 |
$1,370.56 $1,475.38 $1,586.42 $1,980.90 |
Toc - Plan #15 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One Silver I303 |
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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 |
$434.06 $492.65 $554.72 $775.21 $1,178.01 |
$766.11 $824.70 $886.77 $1,107.26 |
$1,098.16 $1,156.75 $1,218.82 $1,439.31 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$868.12 $985.30 $1,109.44 $1,550.42 $2,356.02 |
$1,200.17 $1,317.35 $1,441.49 $1,882.47 |
$1,532.22 $1,649.40 $1,773.54 $2,214.52 |
Toc - Plan #16 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One Bronze I201 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
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Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
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|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$333.75 $378.80 $426.52 $596.06 $905.77 |
$589.06 $634.11 $681.83 $851.37 |
$844.37 $889.42 $937.14 $1,106.68 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$667.50 $757.60 $853.04 $1,192.12 $1,811.54 |
$922.81 $1,012.91 $1,108.35 $1,447.43 |
$1,178.12 $1,268.22 $1,363.66 $1,702.74 |
Toc - Plan #17 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One Bronze I202 |
||||||||||||||||||||
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 |
$329.89 $374.42 $421.60 $589.18 $895.32 |
$582.26 $626.79 $673.97 $841.55 |
$834.63 $879.16 $926.34 $1,093.92 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$659.78 $748.84 $843.20 $1,178.36 $1,790.64 |
$912.15 $1,001.21 $1,095.57 $1,430.73 |
$1,164.52 $1,253.58 $1,347.94 $1,683.10 |
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]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$349.18 $396.31 $446.25 $623.63 $947.66 |
$616.30 $663.43 $713.37 $890.75 |
$883.42 $930.55 $980.49 $1,157.87 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$698.36 $792.62 $892.50 $1,247.26 $1,895.32 |
$965.48 $1,059.74 $1,159.62 $1,514.38 |
$1,232.60 $1,326.86 $1,426.74 $1,781.50 |
Toc - Plan #19 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I408 HSA |
||||||||||||||||||||
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 |
|||||||||||||||||
21 30 40 50 60 |
$419.37 $475.98 $535.95 $748.98 $1,138.15 |
$740.18 $796.79 $856.76 $1,069.79 |
$1,060.99 $1,117.60 $1,177.57 $1,390.60 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$838.74 $951.96 $1,071.90 $1,497.96 $2,276.30 |
$1,159.55 $1,272.77 $1,392.71 $1,818.77 |
$1,480.36 $1,593.58 $1,713.52 $2,139.58 |
Toc - Plan #20 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One Silver I304 HSA |
||||||||||||||||||||
Benefits & Coverage
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Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
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|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$465.78 $528.66 $595.26 $831.88 $1,264.12 |
$822.10 $884.98 $951.58 $1,188.20 |
$1,178.42 $1,241.30 $1,307.90 $1,544.52 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$931.56 $1,057.32 $1,190.52 $1,663.76 $2,528.24 |
$1,287.88 $1,413.64 $1,546.84 $2,020.08 |
$1,644.20 $1,769.96 $1,903.16 $2,376.40 |
Toc - Plan #21 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]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$347.38 $394.27 $443.94 $620.41 $942.77 |
$613.12 $660.01 $709.68 $886.15 |
$878.86 $925.75 $975.42 $1,151.89 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$694.76 $788.54 $887.88 $1,240.82 $1,885.54 |
$960.50 $1,054.28 $1,153.62 $1,506.56 |
$1,226.24 $1,320.02 $1,419.36 $1,772.30 |
Toc - Plan #22 Quartz | ||||||||||||||||||||
Catastrophic
(HMO) Quartz One Catastrophic I101 |
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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 |
|||||||||||||||||
21 30 40 50 60 |
$255.24 $289.70 $326.19 $455.85 $692.72 |
$450.50 $484.96 $521.45 $651.11 |
$645.76 $680.22 $716.71 $846.37 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$510.48 $579.40 $652.38 $911.70 $1,385.44 |
$705.74 $774.66 $847.64 $1,106.96 |
$901.00 $969.92 $1,042.90 $1,302.22 |
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Security Health PlanLocal: 1-715-221-9258x19258 | Toll Free: 1-844-293-9624 | TTY: 1-877-727-2232 |
Toc - Plan #23 Security Health Plan | ||||||||||||||||||||
Gold
(HMO) Enrich $1,500 - 30% |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$369.40 $419.26 $472.08 $659.73 $1,002.53 |
$651.98 $701.84 $754.66 $942.31 |
$934.56 $984.42 $1,037.24 $1,224.89 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$738.80 $838.52 $944.16 $1,319.46 $2,005.06 |
$1,021.38 $1,121.10 $1,226.74 $1,602.04 |
$1,303.96 $1,403.68 $1,509.32 $1,884.62 |
Toc - Plan #24 Security Health Plan | ||||||||||||||||||||
Gold
(HMO) Enrich $3,500 - 30% |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$341.85 $387.99 $436.87 $610.52 $927.75 |
$603.36 $649.50 $698.38 $872.03 |
$864.87 $911.01 $959.89 $1,133.54 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$683.70 $775.98 $873.74 $1,221.04 $1,855.50 |
$945.21 $1,037.49 $1,135.25 $1,482.55 |
$1,206.72 $1,299.00 $1,396.76 $1,744.06 |
Toc - Plan #25 Security Health Plan | ||||||||||||||||||||
Silver
(HMO) Enrich $4,800 - 30% |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$367.54 $417.15 $469.71 $656.41 $997.49 |
$648.70 $698.31 $750.87 $937.57 |
$929.86 $979.47 $1,032.03 $1,218.73 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$735.08 $834.30 $939.42 $1,312.82 $1,994.98 |
$1,016.24 $1,115.46 $1,220.58 $1,593.98 |
$1,297.40 $1,396.62 $1,501.74 $1,875.14 |
Toc - Plan #26 Security Health Plan | ||||||||||||||||||||
Silver
(HMO) Enrich $6,950 - 30% |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$341.64 $387.75 $436.60 $610.15 $927.18 |
$602.99 $649.10 $697.95 $871.50 |
$864.34 $910.45 $959.30 $1,132.85 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$683.28 $775.50 $873.20 $1,220.30 $1,854.36 |
$944.63 $1,036.85 $1,134.55 $1,481.65 |
$1,205.98 $1,298.20 $1,395.90 $1,743.00 |
Toc - Plan #27 Security Health Plan | ||||||||||||||||||||
Silver
(HMO) Enrich $4,500 HDHP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$379.50 $430.72 $484.98 $677.76 $1,029.93 |
$669.81 $721.03 $775.29 $968.07 |
$960.12 $1,011.34 $1,065.60 $1,258.38 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$759.00 $861.44 $969.96 $1,355.52 $2,059.86 |
$1,049.31 $1,151.75 $1,260.27 $1,645.83 |
$1,339.62 $1,442.06 $1,550.58 $1,936.14 |
Toc - Plan #28 Security Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) Enrich $6,200 HDHP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$280.05 $317.85 $357.89 $500.15 $760.03 |
$494.28 $532.08 $572.12 $714.38 |
$708.51 $746.31 $786.35 $928.61 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$560.10 $635.70 $715.78 $1,000.30 $1,520.06 |
$774.33 $849.93 $930.01 $1,214.53 |
$988.56 $1,064.16 $1,144.24 $1,428.76 |
Toc - Plan #29 Security Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) Enrich $8,700 Copay |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$259.26 $294.25 $331.33 $463.03 $703.61 |
$457.59 $492.58 $529.66 $661.36 |
$655.92 $690.91 $727.99 $859.69 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$518.52 $588.50 $662.66 $926.06 $1,407.22 |
$716.85 $786.83 $860.99 $1,124.39 |
$915.18 $985.16 $1,059.32 $1,322.72 |
Toc - Plan #30 Security Health Plan | ||||||||||||||||||||
Bronze
(HMO) Enrich $7,500 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$254.25 $288.56 $324.92 $454.07 $690.01 |
$448.74 $483.05 $519.41 $648.56 |
$643.23 $677.54 $713.90 $843.05 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$508.50 $577.12 $649.84 $908.14 $1,380.02 |
$702.99 $771.61 $844.33 $1,102.63 |
$897.48 $966.10 $1,038.82 $1,297.12 |
Toc - Plan #31 Security Health Plan | ||||||||||||||||||||
Bronze
(HMO) Enrich $8,700 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$247.66 $281.08 $316.50 $442.30 $672.13 |
$437.11 $470.53 $505.95 $631.75 |
$626.56 $659.98 $695.40 $821.20 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$495.32 $562.16 $633.00 $884.60 $1,344.26 |
$684.77 $751.61 $822.45 $1,074.05 |
$874.22 $941.06 $1,011.90 $1,263.50 |
Toc - Plan #32 Security Health Plan | ||||||||||||||||||||
Catastrophic
(HMO) Enrich Protection |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$169.43 $192.29 $216.52 $302.58 $459.80 |
$299.03 $321.89 $346.12 $432.18 |
$428.63 $451.49 $475.72 $561.78 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$338.86 $384.58 $433.04 $605.16 $919.60 |
$468.46 $514.18 $562.64 $734.76 |
$598.06 $643.78 $692.24 $864.36 |
ADVERTISEMENT
Dean Health PlanLocal: 1-800-279-1302 | Toll Free: 1-800-279-1302 | TTY: 1-800-279-1302 |
Toc - Plan #33 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 |
$226.43 $257.00 $289.38 $404.41 $614.54 |
$399.65 $430.22 $462.60 $577.63 |
$572.87 $603.44 $635.82 $750.85 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$452.86 $514.00 $578.76 $808.82 $1,229.08 |
$626.08 $687.22 $751.98 $982.04 |
$799.30 $860.44 $925.20 $1,155.26 |
Toc - Plan #34 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 |
$427.65 $485.38 $546.54 $763.78 $1,160.64 |
$754.80 $812.53 $873.69 $1,090.93 |
$1,081.95 $1,139.68 $1,200.84 $1,418.08 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$855.30 $970.76 $1,093.08 $1,527.56 $2,321.28 |
$1,182.45 $1,297.91 $1,420.23 $1,854.71 |
$1,509.60 $1,625.06 $1,747.38 $2,181.86 |
Toc - Plan #35 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 |
$415.96 $472.11 $531.59 $742.90 $1,128.91 |
$734.17 $790.32 $849.80 $1,061.11 |
$1,052.38 $1,108.53 $1,168.01 $1,379.32 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$831.92 $944.22 $1,063.18 $1,485.80 $2,257.82 |
$1,150.13 $1,262.43 $1,381.39 $1,804.01 |
$1,468.34 $1,580.64 $1,699.60 $2,122.22 |
Toc - Plan #36 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 |
$434.14 $492.75 $554.83 $775.38 $1,178.26 |
$766.26 $824.87 $886.95 $1,107.50 |
$1,098.38 $1,156.99 $1,219.07 $1,439.62 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$868.28 $985.50 $1,109.66 $1,550.76 $2,356.52 |
$1,200.40 $1,317.62 $1,441.78 $1,882.88 |
$1,532.52 $1,649.74 $1,773.90 $2,215.00 |
Toc - Plan #37 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 |
$420.08 $476.79 $536.87 $750.27 $1,140.10 |
$741.44 $798.15 $858.23 $1,071.63 |
$1,062.80 $1,119.51 $1,179.59 $1,392.99 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$840.16 $953.58 $1,073.74 $1,500.54 $2,280.20 |
$1,161.52 $1,274.94 $1,395.10 $1,821.90 |
$1,482.88 $1,596.30 $1,716.46 $2,143.26 |
Toc - Plan #38 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 |
$277.72 $315.22 $354.93 $496.01 $753.74 |
$490.18 $527.68 $567.39 $708.47 |
$702.64 $740.14 $779.85 $920.93 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$555.44 $630.44 $709.86 $992.02 $1,507.48 |
$767.90 $842.90 $922.32 $1,204.48 |
$980.36 $1,055.36 $1,134.78 $1,416.94 |
Toc - Plan #39 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 |
$409.82 $465.15 $523.76 $731.95 $1,112.26 |
$723.34 $778.67 $837.28 $1,045.47 |
$1,036.86 $1,092.19 $1,150.80 $1,358.99 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$819.64 $930.30 $1,047.52 $1,463.90 $2,224.52 |
$1,133.16 $1,243.82 $1,361.04 $1,777.42 |
$1,446.68 $1,557.34 $1,674.56 $2,090.94 |
Toc - Plan #40 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 |
$426.47 $484.04 $545.03 $761.67 $1,157.43 |
$752.72 $810.29 $871.28 $1,087.92 |
$1,078.97 $1,136.54 $1,197.53 $1,414.17 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$852.94 $968.08 $1,090.06 $1,523.34 $2,314.86 |
$1,179.19 $1,294.33 $1,416.31 $1,849.59 |
$1,505.44 $1,620.58 $1,742.56 $2,175.84 |
Toc - Plan #41 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 |
$293.33 $332.93 $374.87 $523.88 $796.09 |
$517.72 $557.32 $599.26 $748.27 |
$742.11 $781.71 $823.65 $972.66 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$586.66 $665.86 $749.74 $1,047.76 $1,592.18 |
$811.05 $890.25 $974.13 $1,272.15 |
$1,035.44 $1,114.64 $1,198.52 $1,496.54 |
Toc - Plan #42 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 |
$287.37 $326.17 $367.26 $513.25 $779.93 |
$507.21 $546.01 $587.10 $733.09 |
$727.05 $765.85 $806.94 $952.93 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$574.74 $652.34 $734.52 $1,026.50 $1,559.86 |
$794.58 $872.18 $954.36 $1,246.34 |
$1,014.42 $1,092.02 $1,174.20 $1,466.18 |
Toc - Plan #43 Dean Health Plan | ||||||||||||||||||||
Gold
(HMO) Dean Gold Copay Elite 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 |
$409.50 $464.78 $523.34 $731.37 $1,111.39 |
$722.77 $778.05 $836.61 $1,044.64 |
$1,036.04 $1,091.32 $1,149.88 $1,357.91 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$819.00 $929.56 $1,046.68 $1,462.74 $2,222.78 |
$1,132.27 $1,242.83 $1,359.95 $1,776.01 |
$1,445.54 $1,556.10 $1,673.22 $2,089.28 |
Toc - Plan #44 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Dean Silver Copay Elite 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 |
$401.97 $456.24 $513.72 $717.92 $1,090.95 |
$709.48 $763.75 $821.23 $1,025.43 |
$1,016.99 $1,071.26 $1,128.74 $1,332.94 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$803.94 $912.48 $1,027.44 $1,435.84 $2,181.90 |
$1,111.45 $1,219.99 $1,334.95 $1,743.35 |
$1,418.96 $1,527.50 $1,642.46 $2,050.86 |
ADVERTISEMENT
Molina HealthcareLocal: 1-888-560-2043 | Toll Free: 1-888-560-2043 |
Toc - Plan #45 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 #46 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 #47 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 #48 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 #49 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 #50 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 #51 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
WPS Health PlanLocal: 1-920-490-6900 | Toll Free: 1-800-332-6249 | TTY: 1-888-332-0144 |
Toc - Plan #52 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 #53 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 #54 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 #55 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 #56 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 #57 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 #58 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 #59 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 #60 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 #61 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 #62 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 #63 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 #64 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 #65 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 #66 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 #67 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 #68 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 #69 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 #70 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 #71 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 #72 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 #73 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 #74 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 #75 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 #76 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 #77 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 #78 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 #79 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 #80 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 #81 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 #82 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 #83 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 #84 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 #85 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 #86 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 #87 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 #88 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 #89 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 #90 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 #91 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 #92 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 #93 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 #94 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 #95 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 #96 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 #97 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 #98 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 #99 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 #100 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 #101 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 #102 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 #103 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 #104 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 |
ADVERTISEMENT
Group Health Cooperative-SCWLocal: 1-608-828-4831 | Toll Free: 1-855-344-2729 | TTY: 1-608-828-4815 |
Toc - Plan #105 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 |
$405.66 $460.43 $518.44 $724.51 $1,100.96 |
$715.99 $770.76 $828.77 $1,034.84 |
$1,026.32 $1,081.09 $1,139.10 $1,345.17 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$811.32 $920.86 $1,036.88 $1,449.02 $2,201.92 |
$1,121.65 $1,231.19 $1,347.21 $1,759.35 |
$1,431.98 $1,541.52 $1,657.54 $2,069.68 |
Toc - Plan #106 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 |
$345.90 $392.59 $442.05 $617.77 $938.75 |
$610.51 $657.20 $706.66 $882.38 |
$875.12 $921.81 $971.27 $1,146.99 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$691.80 $785.18 $884.10 $1,235.54 $1,877.50 |
$956.41 $1,049.79 $1,148.71 $1,500.15 |
$1,221.02 $1,314.40 $1,413.32 $1,764.76 |
Toc - Plan #107 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 |
$285.09 $323.58 $364.34 $509.17 $773.72 |
$503.18 $541.67 $582.43 $727.26 |
$721.27 $759.76 $800.52 $945.35 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$570.18 $647.16 $728.68 $1,018.34 $1,547.44 |
$788.27 $865.25 $946.77 $1,236.43 |
$1,006.36 $1,083.34 $1,164.86 $1,454.52 |
Toc - Plan #108 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 |
$282.75 $320.92 $361.36 $504.99 $767.38 |
$499.06 $537.23 $577.67 $721.30 |
$715.37 $753.54 $793.98 $937.61 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$565.50 $641.84 $722.72 $1,009.98 $1,534.76 |
$781.81 $858.15 $939.03 $1,226.29 |
$998.12 $1,074.46 $1,155.34 $1,442.60 |
Toc - Plan #109 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 |
$343.92 $390.35 $439.53 $614.24 $933.39 |
$607.02 $653.45 $702.63 $877.34 |
$870.12 $916.55 $965.73 $1,140.44 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$687.84 $780.70 $879.06 $1,228.48 $1,866.78 |
$950.94 $1,043.80 $1,142.16 $1,491.58 |
$1,214.04 $1,306.90 $1,405.26 $1,754.68 |
Toc - Plan #110 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 |
$351.38 $398.82 $449.06 $627.56 $953.64 |
$620.19 $667.63 $717.87 $896.37 |
$889.00 $936.44 $986.68 $1,165.18 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$702.76 $797.64 $898.12 $1,255.12 $1,907.28 |
$971.57 $1,066.45 $1,166.93 $1,523.93 |
$1,240.38 $1,335.26 $1,435.74 $1,792.74 |
Toc - Plan #111 Group Health Cooperative-SCW | ||||||||||||||||||||
Silver
(HMO) Silver 4550X Ded/7900 MOOP |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
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 |
$398.93 $452.78 $509.83 $712.48 $1,082.69 |
$704.11 $757.96 $815.01 $1,017.66 |
$1,009.29 $1,063.14 $1,120.19 $1,322.84 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$797.86 $905.56 $1,019.66 $1,424.96 $2,165.38 |
$1,103.04 $1,210.74 $1,324.84 $1,730.14 |
$1,408.22 $1,515.92 $1,630.02 $2,035.32 |
Toc - Plan #112 Group Health Cooperative-SCW | ||||||||||||||||||||
Expanded Bronze
(HMO) Bronze 6850 Ded/8200 MOOP |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
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 |
$290.89 $330.16 $371.76 $519.53 $789.47 |
$513.42 $552.69 $594.29 $742.06 |
$735.95 $775.22 $816.82 $964.59 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$581.78 $660.32 $743.52 $1,039.06 $1,578.94 |
$804.31 $882.85 $966.05 $1,261.59 |
$1,026.84 $1,105.38 $1,188.58 $1,484.12 |
Toc - Plan #113 Group Health Cooperative-SCW | ||||||||||||||||||||
Platinum
(HMO) Platinum No Ded/2000 MOOP |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
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 |
$407.12 $462.08 $520.30 $727.11 $1,104.92 |
$718.57 $773.53 $831.75 $1,038.56 |
$1,030.02 $1,084.98 $1,143.20 $1,350.01 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$814.24 $924.16 $1,040.60 $1,454.22 $2,209.84 |
$1,125.69 $1,235.61 $1,352.05 $1,765.67 |
$1,437.14 $1,547.06 $1,663.50 $2,077.12 |
Toc - Plan #114 Group Health Cooperative-SCW | ||||||||||||||||||||
Bronze
(HMO) Bronze 8700 Ded/8700 MOOP |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
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 |
$278.50 $316.09 $355.92 $497.39 $755.83 |
$491.55 $529.14 $568.97 $710.44 |
$704.60 $742.19 $782.02 $923.49 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$557.00 $632.18 $711.84 $994.78 $1,511.66 |
$770.05 $845.23 $924.89 $1,207.83 |
$983.10 $1,058.28 $1,137.94 $1,420.88 |
Toc - Plan #115 Group Health Cooperative-SCW | ||||||||||||||||||||
Silver
(HMO) Silver 4900 Ded/7900 MOOP |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
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 |
$413.90 $469.78 $528.97 $739.23 $1,123.33 |
$730.54 $786.42 $845.61 $1,055.87 |
$1,047.18 $1,103.06 $1,162.25 $1,372.51 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$827.80 $939.56 $1,057.94 $1,478.46 $2,246.66 |
$1,144.44 $1,256.20 $1,374.58 $1,795.10 |
$1,461.08 $1,572.84 $1,691.22 $2,111.74 |
Toc - Plan #116 Group Health Cooperative-SCW | ||||||||||||||||||||
Gold
(HMO) Gold 1500 Ded/8550 MOOP |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
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 |
$334.58 $379.74 $427.59 $597.55 $908.03 |
$590.53 $635.69 $683.54 $853.50 |
$846.48 $891.64 $939.49 $1,109.45 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$669.16 $759.48 $855.18 $1,195.10 $1,816.06 |
$925.11 $1,015.43 $1,111.13 $1,451.05 |
$1,181.06 $1,271.38 $1,367.08 $1,707.00 |
Toc - Plan #117 Group Health Cooperative-SCW | ||||||||||||||||||||
Silver
(HMO) Silver 8100X Ded/8150 MOOP |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
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 |
$405.09 $459.78 $517.71 $723.49 $1,099.41 |
$714.99 $769.68 $827.61 $1,033.39 |
$1,024.89 $1,079.58 $1,137.51 $1,343.29 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$810.18 $919.56 $1,035.42 $1,446.98 $2,198.82 |
$1,120.08 $1,229.46 $1,345.32 $1,756.88 |
$1,429.98 $1,539.36 $1,655.22 $2,066.78 |
Toc - Plan #118 Group Health Cooperative-SCW | ||||||||||||||||||||
Catastrophic
(HMO) Catastrophic 8700 Ded/8700 MOOP |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
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 |
$235.72 $267.55 $301.25 $421.00 $639.75 |
$416.05 $447.88 $481.58 $601.33 |
$596.38 $628.21 $661.91 $781.66 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$471.44 $535.10 $602.50 $842.00 $1,279.50 |
$651.77 $715.43 $782.83 $1,022.33 |
$832.10 $895.76 $963.16 $1,202.66 |
Toc - Plan #119 Group Health Cooperative-SCW | ||||||||||||||||||||
Platinum
(HMO) Platinum 1000 Ded/4400 MOOP Primary Care Preferred |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
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 |
$376.98 $427.87 $481.78 $673.28 $1,023.12 |
$665.37 $716.26 $770.17 $961.67 |
$953.76 $1,004.65 $1,058.56 $1,250.06 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$753.96 $855.74 $963.56 $1,346.56 $2,046.24 |
$1,042.35 $1,144.13 $1,251.95 $1,634.95 |
$1,330.74 $1,432.52 $1,540.34 $1,923.34 |
Toc - Plan #120 Group Health Cooperative-SCW | ||||||||||||||||||||
Gold
(HMO) Gold 4500 Ded/8500 MOOP Primary Care Preferred |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
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 |
$325.28 $369.19 $415.70 $580.94 $882.79 |
$574.12 $618.03 $664.54 $829.78 |
$822.96 $866.87 $913.38 $1,078.62 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$650.56 $738.38 $831.40 $1,161.88 $1,765.58 |
$899.40 $987.22 $1,080.24 $1,410.72 |
$1,148.24 $1,236.06 $1,329.08 $1,659.56 |
Toc - Plan #121 Group Health Cooperative-SCW | ||||||||||||||||||||
Silver
(HMO) Silver 8500 Ded/8500 MOOP Primary Care Preferred |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
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 |
$412.64 $468.35 $527.36 $736.98 $1,119.91 |
$728.31 $784.02 $843.03 $1,052.65 |
$1,043.98 $1,099.69 $1,158.70 $1,368.32 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$825.28 $936.70 $1,054.72 $1,473.96 $2,239.82 |
$1,140.95 $1,252.37 $1,370.39 $1,789.63 |
$1,456.62 $1,568.04 $1,686.06 $2,105.30 |
‡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 Dodge County here.
Dodge County is in “Rating Area 11” of Wisconsin.
Currently, there are 121 plans offered in Rating Area 11.