Obamacare 2022 Rates for Green Lake County
Obamacare > Rates > Wisconsin > Green Lake County
Obamacare > Rates > Wisconsin > Green Lake County
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HealthPartnersLocal: 1-952-883-5900 | Toll Free: 1-855-813-3887 | TTY: 1-952-883-6060 |
Toc - Plan #1 HealthPartners | ||||||||||||||||||||
Gold
(PPO) Robin Oak $1,800 w/Copay P-S Gold |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$405.89 $460.69 $518.73 $724.92 $1,101.59 |
$716.40 $771.20 $829.24 $1,035.43 |
$1,026.91 $1,081.71 $1,139.75 $1,345.94 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$811.78 $921.38 $1,037.46 $1,449.84 $2,203.18 |
$1,122.29 $1,231.89 $1,347.97 $1,760.35 |
$1,432.80 $1,542.40 $1,658.48 $2,070.86 |
Toc - Plan #2 HealthPartners | ||||||||||||||||||||
Expanded Bronze
(PPO) Robin Oak $6,250 Plus Bronze |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$299.25 $339.65 $382.44 $534.46 $812.16 |
$528.18 $568.58 $611.37 $763.39 |
$757.11 $797.51 $840.30 $992.32 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$598.50 $679.30 $764.88 $1,068.92 $1,624.32 |
$827.43 $908.23 $993.81 $1,297.85 |
$1,056.36 $1,137.16 $1,222.74 $1,526.78 |
Toc - Plan #3 HealthPartners | ||||||||||||||||||||
Catastrophic
(PPO) Robin Oak $8,700 Catastrophic |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$227.18 $257.85 $290.34 $405.74 $616.57 |
$400.97 $431.64 $464.13 $579.53 |
$574.76 $605.43 $637.92 $753.32 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$454.36 $515.70 $580.68 $811.48 $1,233.14 |
$628.15 $689.49 $754.47 $985.27 |
$801.94 $863.28 $928.26 $1,159.06 |
Toc - Plan #4 HealthPartners | ||||||||||||||||||||
Silver
(PPO) Robin Oak $7,500 w/Copay P-S Silver |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$368.89 $418.69 $471.44 $658.84 $1,001.17 |
$651.09 $700.89 $753.64 $941.04 |
$933.29 $983.09 $1,035.84 $1,223.24 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$737.78 $837.38 $942.88 $1,317.68 $2,002.34 |
$1,019.98 $1,119.58 $1,225.08 $1,599.88 |
$1,302.18 $1,401.78 $1,507.28 $1,882.08 |
Toc - Plan #5 HealthPartners | ||||||||||||||||||||
Silver
(PPO) Robin Oak $4,500 Plus Silver |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$364.82 $414.07 $466.24 $651.57 $990.12 |
$643.91 $693.16 $745.33 $930.66 |
$923.00 $972.25 $1,024.42 $1,209.75 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$729.64 $828.14 $932.48 $1,303.14 $1,980.24 |
$1,008.73 $1,107.23 $1,211.57 $1,582.23 |
$1,287.82 $1,386.32 $1,490.66 $1,861.32 |
Toc - Plan #6 HealthPartners | ||||||||||||||||||||
Expanded Bronze
(PPO) Robin Oak $7,000 HSA Bronze |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$294.86 $334.67 $376.83 $526.62 $800.25 |
$520.43 $560.24 $602.40 $752.19 |
$746.00 $785.81 $827.97 $977.76 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$589.72 $669.34 $753.66 $1,053.24 $1,600.50 |
$815.29 $894.91 $979.23 $1,278.81 |
$1,040.86 $1,120.48 $1,204.80 $1,504.38 |
Toc - Plan #7 HealthPartners | ||||||||||||||||||||
Expanded Bronze
(PPO) Robin Oak $8,000 Plus Bronze |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$296.72 $336.78 $379.21 $529.94 $805.30 |
$523.71 $563.77 $606.20 $756.93 |
$750.70 $790.76 $833.19 $983.92 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$593.44 $673.56 $758.42 $1,059.88 $1,610.60 |
$820.43 $900.55 $985.41 $1,286.87 |
$1,047.42 $1,127.54 $1,212.40 $1,513.86 |
Toc - Plan #8 HealthPartners | ||||||||||||||||||||
Silver
(PPO) Robin Oak $25/$50 P-S Silver |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$433.71 $492.26 $554.28 $774.61 $1,177.09 |
$765.50 $824.05 $886.07 $1,106.40 |
$1,097.29 $1,155.84 $1,217.86 $1,438.19 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$867.42 $984.52 $1,108.56 $1,549.22 $2,354.18 |
$1,199.21 $1,316.31 $1,440.35 $1,881.01 |
$1,531.00 $1,648.10 $1,772.14 $2,212.80 |
ADVERTISEMENT
QuartzLocal: 1-608-644-3430 | Toll Free: 1-800-362-3310 | TTY: 1-800-877-8973 |
Toc - Plan #9 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I406 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 |
$396.78 $450.34 $507.08 $708.64 $1,076.85 |
$700.31 $753.87 $810.61 $1,012.17 |
$1,003.84 $1,057.40 $1,114.14 $1,315.70 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$793.56 $900.68 $1,014.16 $1,417.28 $2,153.70 |
$1,097.09 $1,204.21 $1,317.69 $1,720.81 |
$1,400.62 $1,507.74 $1,621.22 $2,024.34 |
Toc - Plan #10 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I407 Maintenance with Dental |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$452.45 $513.52 $578.22 $808.06 $1,227.93 |
$798.57 $859.64 $924.34 $1,154.18 |
$1,144.69 $1,205.76 $1,270.46 $1,500.30 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$904.90 $1,027.04 $1,156.44 $1,616.12 $2,455.86 |
$1,251.02 $1,373.16 $1,502.56 $1,962.24 |
$1,597.14 $1,719.28 $1,848.68 $2,308.36 |
Toc - Plan #11 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I409 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 |
$391.56 $444.41 $500.40 $699.31 $1,062.67 |
$691.10 $743.95 $799.94 $998.85 |
$990.64 $1,043.49 $1,099.48 $1,298.39 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$783.12 $888.82 $1,000.80 $1,398.62 $2,125.34 |
$1,082.66 $1,188.36 $1,300.34 $1,698.16 |
$1,382.20 $1,487.90 $1,599.88 $1,997.70 |
Toc - Plan #12 Quartz | ||||||||||||||||||||
Silver
(HMO) Tiered Choice Plus Silver I305 with Dental |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$399.40 $453.31 $510.43 $713.32 $1,083.96 |
$704.94 $758.85 $815.97 $1,018.86 |
$1,010.48 $1,064.39 $1,121.51 $1,324.40 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$798.80 $906.62 $1,020.86 $1,426.64 $2,167.92 |
$1,104.34 $1,212.16 $1,326.40 $1,732.18 |
$1,409.88 $1,517.70 $1,631.94 $2,037.72 |
Toc - Plan #13 Quartz | ||||||||||||||||||||
Silver
(HMO) Tiered Choice Plus Silver I306 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 |
$392.33 $445.29 $501.39 $700.69 $1,064.77 |
$692.46 $745.42 $801.52 $1,000.82 |
$992.59 $1,045.55 $1,101.65 $1,300.95 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$784.66 $890.58 $1,002.78 $1,401.38 $2,129.54 |
$1,084.79 $1,190.71 $1,302.91 $1,701.51 |
$1,384.92 $1,490.84 $1,603.04 $2,001.64 |
Toc - Plan #14 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 |
$438.60 $497.81 $560.53 $783.33 $1,190.35 |
$774.13 $833.34 $896.06 $1,118.86 |
$1,109.66 $1,168.87 $1,231.59 $1,454.39 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$877.20 $995.62 $1,121.06 $1,566.66 $2,380.70 |
$1,212.73 $1,331.15 $1,456.59 $1,902.19 |
$1,548.26 $1,666.68 $1,792.12 $2,237.72 |
Toc - Plan #15 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One Bronze I201 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 |
$337.24 $382.76 $430.99 $602.30 $915.26 |
$595.23 $640.75 $688.98 $860.29 |
$853.22 $898.74 $946.97 $1,118.28 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$674.48 $765.52 $861.98 $1,204.60 $1,830.52 |
$932.47 $1,023.51 $1,119.97 $1,462.59 |
$1,190.46 $1,281.50 $1,377.96 $1,720.58 |
Toc - Plan #16 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One Bronze I202 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 |
$333.35 $378.35 $426.01 $595.35 $904.70 |
$588.36 $633.36 $681.02 $850.36 |
$843.37 $888.37 $936.03 $1,105.37 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$666.70 $756.70 $852.02 $1,190.70 $1,809.40 |
$921.71 $1,011.71 $1,107.03 $1,445.71 |
$1,176.72 $1,266.72 $1,362.04 $1,700.72 |
Toc - Plan #17 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One Bronze I204 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 |
$352.84 $400.46 $450.92 $630.16 $957.59 |
$622.76 $670.38 $720.84 $900.08 |
$892.68 $940.30 $990.76 $1,170.00 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$705.68 $800.92 $901.84 $1,260.32 $1,915.18 |
$975.60 $1,070.84 $1,171.76 $1,530.24 |
$1,245.52 $1,340.76 $1,441.68 $1,800.16 |
Toc - Plan #18 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I406 |
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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 |
$380.15 $431.47 $485.83 $678.94 $1,031.72 |
$670.96 $722.28 $776.64 $969.75 |
$961.77 $1,013.09 $1,067.45 $1,260.56 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$760.30 $862.94 $971.66 $1,357.88 $2,063.44 |
$1,051.11 $1,153.75 $1,262.47 $1,648.69 |
$1,341.92 $1,444.56 $1,553.28 $1,939.50 |
Toc - Plan #19 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 |
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21 30 40 50 60 |
$433.48 $492.00 $553.98 $774.19 $1,176.46 |
$765.09 $823.61 $885.59 $1,105.80 |
$1,096.70 $1,155.22 $1,217.20 $1,437.41 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$866.96 $984.00 $1,107.96 $1,548.38 $2,352.92 |
$1,198.57 $1,315.61 $1,439.57 $1,879.99 |
$1,530.18 $1,647.22 $1,771.18 $2,211.60 |
Toc - Plan #20 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 |
$375.14 $425.78 $479.43 $670.00 $1,018.13 |
$662.12 $712.76 $766.41 $956.98 |
$949.10 $999.74 $1,053.39 $1,243.96 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$750.28 $851.56 $958.86 $1,340.00 $2,036.26 |
$1,037.26 $1,138.54 $1,245.84 $1,626.98 |
$1,324.24 $1,425.52 $1,532.82 $1,913.96 |
Toc - Plan #21 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 |
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21 30 40 50 60 |
$382.66 $434.31 $489.03 $683.42 $1,038.52 |
$675.39 $727.04 $781.76 $976.15 |
$968.12 $1,019.77 $1,074.49 $1,268.88 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$765.32 $868.62 $978.06 $1,366.84 $2,077.04 |
$1,058.05 $1,161.35 $1,270.79 $1,659.57 |
$1,350.78 $1,454.08 $1,563.52 $1,952.30 |
Toc - Plan #22 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 |
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21 30 40 50 60 |
$375.88 $426.62 $480.37 $671.32 $1,020.14 |
$663.43 $714.17 $767.92 $958.87 |
$950.98 $1,001.72 $1,055.47 $1,246.42 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$751.76 $853.24 $960.74 $1,342.64 $2,040.28 |
$1,039.31 $1,140.79 $1,248.29 $1,630.19 |
$1,326.86 $1,428.34 $1,535.84 $1,917.74 |
Toc - Plan #23 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One Silver I303 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$420.22 $476.94 $537.03 $750.50 $1,140.45 |
$741.68 $798.40 $858.49 $1,071.96 |
$1,063.14 $1,119.86 $1,179.95 $1,393.42 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$840.44 $953.88 $1,074.06 $1,501.00 $2,280.90 |
$1,161.90 $1,275.34 $1,395.52 $1,822.46 |
$1,483.36 $1,596.80 $1,716.98 $2,143.92 |
Toc - Plan #24 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One Bronze I201 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$323.11 $366.72 $412.92 $577.06 $876.89 |
$570.28 $613.89 $660.09 $824.23 |
$817.45 $861.06 $907.26 $1,071.40 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$646.22 $733.44 $825.84 $1,154.12 $1,753.78 |
$893.39 $980.61 $1,073.01 $1,401.29 |
$1,140.56 $1,227.78 $1,320.18 $1,648.46 |
Toc - Plan #25 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One Bronze I202 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$319.38 $362.49 $408.16 $570.40 $866.77 |
$563.70 $606.81 $652.48 $814.72 |
$808.02 $851.13 $896.80 $1,059.04 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$638.76 $724.98 $816.32 $1,140.80 $1,733.54 |
$883.08 $969.30 $1,060.64 $1,385.12 |
$1,127.40 $1,213.62 $1,304.96 $1,629.44 |
Toc - Plan #26 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One Bronze I204 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$338.05 $383.68 $432.02 $603.74 $917.45 |
$596.65 $642.28 $690.62 $862.34 |
$855.25 $900.88 $949.22 $1,120.94 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$676.10 $767.36 $864.04 $1,207.48 $1,834.90 |
$934.70 $1,025.96 $1,122.64 $1,466.08 |
$1,193.30 $1,284.56 $1,381.24 $1,724.68 |
Toc - Plan #27 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I408 HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$406.00 $460.80 $518.86 $725.10 $1,101.86 |
$716.58 $771.38 $829.44 $1,035.68 |
$1,027.16 $1,081.96 $1,140.02 $1,346.26 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$812.00 $921.60 $1,037.72 $1,450.20 $2,203.72 |
$1,122.58 $1,232.18 $1,348.30 $1,760.78 |
$1,433.16 $1,542.76 $1,658.88 $2,071.36 |
Toc - Plan #28 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One Silver I304 HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$450.93 $511.80 $576.29 $805.36 $1,223.82 |
$795.89 $856.76 $921.25 $1,150.32 |
$1,140.85 $1,201.72 $1,266.21 $1,495.28 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$901.86 $1,023.60 $1,152.58 $1,610.72 $2,447.64 |
$1,246.82 $1,368.56 $1,497.54 $1,955.68 |
$1,591.78 $1,713.52 $1,842.50 $2,300.64 |
Toc - Plan #29 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One Bronze I203 HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$336.30 $381.70 $429.79 $600.63 $912.71 |
$593.57 $638.97 $687.06 $857.90 |
$850.84 $896.24 $944.33 $1,115.17 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$672.60 $763.40 $859.58 $1,201.26 $1,825.42 |
$929.87 $1,020.67 $1,116.85 $1,458.53 |
$1,187.14 $1,277.94 $1,374.12 $1,715.80 |
Toc - Plan #30 Quartz | ||||||||||||||||||||
Catastrophic
(HMO) Quartz One Catastrophic I101 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$247.11 $280.46 $315.79 $441.32 $670.63 |
$436.14 $469.49 $504.82 $630.35 |
$625.17 $658.52 $693.85 $819.38 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$494.22 $560.92 $631.58 $882.64 $1,341.26 |
$683.25 $749.95 $820.61 $1,071.67 |
$872.28 $938.98 $1,009.64 $1,260.70 |
ADVERTISEMENT
Dean Health PlanLocal: 1-800-279-1302 | Toll Free: 1-800-279-1302 | TTY: 1-800-279-1302 |
Toc - Plan #31 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 |
$187.77 $213.12 $239.97 $335.36 $509.61 |
$331.41 $356.76 $383.61 $479.00 |
$475.05 $500.40 $527.25 $622.64 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$375.54 $426.24 $479.94 $670.72 $1,019.22 |
$519.18 $569.88 $623.58 $814.36 |
$662.82 $713.52 $767.22 $958.00 |
Toc - Plan #32 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 |
$354.63 $402.50 $453.22 $633.37 $962.46 |
$625.92 $673.79 $724.51 $904.66 |
$897.21 $945.08 $995.80 $1,175.95 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$709.26 $805.00 $906.44 $1,266.74 $1,924.92 |
$980.55 $1,076.29 $1,177.73 $1,538.03 |
$1,251.84 $1,347.58 $1,449.02 $1,809.32 |
Toc - Plan #33 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 |
$344.93 $391.50 $440.82 $616.05 $936.15 |
$608.80 $655.37 $704.69 $879.92 |
$872.67 $919.24 $968.56 $1,143.79 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$689.86 $783.00 $881.64 $1,232.10 $1,872.30 |
$953.73 $1,046.87 $1,145.51 $1,495.97 |
$1,217.60 $1,310.74 $1,409.38 $1,759.84 |
Toc - Plan #34 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 |
$360.01 $408.61 $460.10 $642.98 $977.08 |
$635.42 $684.02 $735.51 $918.39 |
$910.83 $959.43 $1,010.92 $1,193.80 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$720.02 $817.22 $920.20 $1,285.96 $1,954.16 |
$995.43 $1,092.63 $1,195.61 $1,561.37 |
$1,270.84 $1,368.04 $1,471.02 $1,836.78 |
Toc - Plan #35 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 |
$348.35 $395.38 $445.20 $622.16 $945.43 |
$614.84 $661.87 $711.69 $888.65 |
$881.33 $928.36 $978.18 $1,155.14 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$696.70 $790.76 $890.40 $1,244.32 $1,890.86 |
$963.19 $1,057.25 $1,156.89 $1,510.81 |
$1,229.68 $1,323.74 $1,423.38 $1,777.30 |
Toc - Plan #36 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 |
$230.30 $261.39 $294.33 $411.32 $625.04 |
$406.48 $437.57 $470.51 $587.50 |
$582.66 $613.75 $646.69 $763.68 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$460.60 $522.78 $588.66 $822.64 $1,250.08 |
$636.78 $698.96 $764.84 $998.82 |
$812.96 $875.14 $941.02 $1,175.00 |
Toc - Plan #37 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 |
$339.85 $385.73 $434.32 $606.97 $922.35 |
$599.83 $645.71 $694.30 $866.95 |
$859.81 $905.69 $954.28 $1,126.93 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$679.70 $771.46 $868.64 $1,213.94 $1,844.70 |
$939.68 $1,031.44 $1,128.62 $1,473.92 |
$1,199.66 $1,291.42 $1,388.60 $1,733.90 |
Toc - Plan #38 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 |
$353.65 $401.39 $451.96 $631.62 $959.80 |
$624.19 $671.93 $722.50 $902.16 |
$894.73 $942.47 $993.04 $1,172.70 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$707.30 $802.78 $903.92 $1,263.24 $1,919.60 |
$977.84 $1,073.32 $1,174.46 $1,533.78 |
$1,248.38 $1,343.86 $1,445.00 $1,804.32 |
Toc - Plan #39 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 |
$243.24 $276.08 $310.86 $434.43 $660.16 |
$429.32 $462.16 $496.94 $620.51 |
$615.40 $648.24 $683.02 $806.59 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$486.48 $552.16 $621.72 $868.86 $1,320.32 |
$672.56 $738.24 $807.80 $1,054.94 |
$858.64 $924.32 $993.88 $1,241.02 |
Toc - Plan #40 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 |
$238.30 $270.47 $304.55 $425.61 $646.76 |
$420.60 $452.77 $486.85 $607.91 |
$602.90 $635.07 $669.15 $790.21 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$476.60 $540.94 $609.10 $851.22 $1,293.52 |
$658.90 $723.24 $791.40 $1,033.52 |
$841.20 $905.54 $973.70 $1,215.82 |
Toc - Plan #41 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 |
$339.58 $385.42 $433.98 $606.49 $921.62 |
$599.36 $645.20 $693.76 $866.27 |
$859.14 $904.98 $953.54 $1,126.05 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$679.16 $770.84 $867.96 $1,212.98 $1,843.24 |
$938.94 $1,030.62 $1,127.74 $1,472.76 |
$1,198.72 $1,290.40 $1,387.52 $1,732.54 |
Toc - Plan #42 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 |
$333.33 $378.33 $426.00 $595.33 $904.67 |
$588.33 $633.33 $681.00 $850.33 |
$843.33 $888.33 $936.00 $1,105.33 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$666.66 $756.66 $852.00 $1,190.66 $1,809.34 |
$921.66 $1,011.66 $1,107.00 $1,445.66 |
$1,176.66 $1,266.66 $1,362.00 $1,700.66 |
ADVERTISEMENT
Molina HealthcareLocal: 1-888-560-2043 | Toll Free: 1-888-560-2043 |
Toc - Plan #43 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 |
$395.36 $448.73 $505.27 $706.11 $1,073.00 |
$697.81 $751.18 $807.72 $1,008.56 |
$1,000.26 $1,053.63 $1,110.17 $1,311.01 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$790.72 $897.46 $1,010.54 $1,412.22 $2,146.00 |
$1,093.17 $1,199.91 $1,312.99 $1,714.67 |
$1,395.62 $1,502.36 $1,615.44 $2,017.12 |
Toc - Plan #44 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 |
$354.45 $402.30 $452.98 $633.04 $961.97 |
$625.60 $673.45 $724.13 $904.19 |
$896.75 $944.60 $995.28 $1,175.34 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$708.90 $804.60 $905.96 $1,266.08 $1,923.94 |
$980.05 $1,075.75 $1,177.11 $1,537.23 |
$1,251.20 $1,346.90 $1,448.26 $1,808.38 |
Toc - Plan #45 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 |
$351.01 $398.39 $448.58 $626.90 $952.63 |
$619.53 $666.91 $717.10 $895.42 |
$888.05 $935.43 $985.62 $1,163.94 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$702.02 $796.78 $897.16 $1,253.80 $1,905.26 |
$970.54 $1,065.30 $1,165.68 $1,522.32 |
$1,239.06 $1,333.82 $1,434.20 $1,790.84 |
Toc - Plan #46 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 |
$344.62 $391.14 $440.43 $615.49 $935.30 |
$608.26 $654.78 $704.07 $879.13 |
$871.90 $918.42 $967.71 $1,142.77 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$689.24 $782.28 $880.86 $1,230.98 $1,870.60 |
$952.88 $1,045.92 $1,144.50 $1,494.62 |
$1,216.52 $1,309.56 $1,408.14 $1,758.26 |
Toc - Plan #47 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 |
$390.07 $442.73 $498.51 $696.66 $1,058.64 |
$688.47 $741.13 $796.91 $995.06 |
$986.87 $1,039.53 $1,095.31 $1,293.46 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$780.14 $885.46 $997.02 $1,393.32 $2,117.28 |
$1,078.54 $1,183.86 $1,295.42 $1,691.72 |
$1,376.94 $1,482.26 $1,593.82 $1,990.12 |
Toc - Plan #48 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 |
$351.73 $399.21 $449.51 $628.19 $954.60 |
$620.80 $668.28 $718.58 $897.26 |
$889.87 $937.35 $987.65 $1,166.33 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$703.46 $798.42 $899.02 $1,256.38 $1,909.20 |
$972.53 $1,067.49 $1,168.09 $1,525.45 |
$1,241.60 $1,336.56 $1,437.16 $1,794.52 |
Toc - Plan #49 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 |
$353.63 $401.38 $451.95 $631.59 $959.76 |
$624.16 $671.91 $722.48 $902.12 |
$894.69 $942.44 $993.01 $1,172.65 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$707.26 $802.76 $903.90 $1,263.18 $1,919.52 |
$977.79 $1,073.29 $1,174.43 $1,533.71 |
$1,248.32 $1,343.82 $1,444.96 $1,804.24 |
ADVERTISEMENT
WPS Health PlanLocal: 1-920-490-6900 | Toll Free: 1-800-332-6249 | TTY: 1-888-332-0144 |
Toc - Plan #50 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 |
$297.16 $337.28 $379.77 $530.73 $806.49 |
$524.49 $564.61 $607.10 $758.06 |
$751.82 $791.94 $834.43 $985.39 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$594.32 $674.56 $759.54 $1,061.46 $1,612.98 |
$821.65 $901.89 $986.87 $1,288.79 |
$1,048.98 $1,129.22 $1,214.20 $1,516.12 |
Toc - Plan #51 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 |
$308.91 $350.61 $394.79 $551.71 $838.38 |
$545.23 $586.93 $631.11 $788.03 |
$781.55 $823.25 $867.43 $1,024.35 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$617.82 $701.22 $789.58 $1,103.42 $1,676.76 |
$854.14 $937.54 $1,025.90 $1,339.74 |
$1,090.46 $1,173.86 $1,262.22 $1,576.06 |
Toc - Plan #52 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 |
$297.93 $338.15 $380.75 $532.10 $808.58 |
$525.85 $566.07 $608.67 $760.02 |
$753.77 $793.99 $836.59 $987.94 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$595.86 $676.30 $761.50 $1,064.20 $1,617.16 |
$823.78 $904.22 $989.42 $1,292.12 |
$1,051.70 $1,132.14 $1,217.34 $1,520.04 |
Toc - Plan #53 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 |
$388.90 $441.40 $497.01 $694.58 $1,055.47 |
$686.41 $738.91 $794.52 $992.09 |
$983.92 $1,036.42 $1,092.03 $1,289.60 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$777.80 $882.80 $994.02 $1,389.16 $2,110.94 |
$1,075.31 $1,180.31 $1,291.53 $1,686.67 |
$1,372.82 $1,477.82 $1,589.04 $1,984.18 |
Toc - Plan #54 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 |
$392.34 $445.31 $501.41 $700.72 $1,064.81 |
$692.48 $745.45 $801.55 $1,000.86 |
$992.62 $1,045.59 $1,101.69 $1,301.00 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$784.68 $890.62 $1,002.82 $1,401.44 $2,129.62 |
$1,084.82 $1,190.76 $1,302.96 $1,701.58 |
$1,384.96 $1,490.90 $1,603.10 $2,001.72 |
Toc - Plan #55 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 |
$406.58 $461.47 $519.61 $726.15 $1,103.46 |
$717.61 $772.50 $830.64 $1,037.18 |
$1,028.64 $1,083.53 $1,141.67 $1,348.21 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$813.16 $922.94 $1,039.22 $1,452.30 $2,206.92 |
$1,124.19 $1,233.97 $1,350.25 $1,763.33 |
$1,435.22 $1,545.00 $1,661.28 $2,074.36 |
Toc - Plan #56 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 |
$531.89 $603.70 $679.76 $949.96 $1,443.55 |
$938.79 $1,010.60 $1,086.66 $1,356.86 |
$1,345.69 $1,417.50 $1,493.56 $1,763.76 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,063.78 $1,207.40 $1,359.52 $1,899.92 $2,887.10 |
$1,470.68 $1,614.30 $1,766.42 $2,306.82 |
$1,877.58 $2,021.20 $2,173.32 $2,713.72 |
Toc - Plan #57 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 |
$258.35 $293.23 $330.17 $461.41 $701.16 |
$455.99 $490.87 $527.81 $659.05 |
$653.63 $688.51 $725.45 $856.69 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$516.70 $586.46 $660.34 $922.82 $1,402.32 |
$714.34 $784.10 $857.98 $1,120.46 |
$911.98 $981.74 $1,055.62 $1,318.10 |
Toc - Plan #58 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 |
$309.54 $351.33 $395.59 $552.84 $840.09 |
$546.34 $588.13 $632.39 $789.64 |
$783.14 $824.93 $869.19 $1,026.44 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$619.08 $702.66 $791.18 $1,105.68 $1,680.18 |
$855.88 $939.46 $1,027.98 $1,342.48 |
$1,092.68 $1,176.26 $1,264.78 $1,579.28 |
Toc - Plan #59 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 |
$316.25 $358.94 $404.17 $564.82 $858.30 |
$558.18 $600.87 $646.10 $806.75 |
$800.11 $842.80 $888.03 $1,048.68 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$632.50 $717.88 $808.34 $1,129.64 $1,716.60 |
$874.43 $959.81 $1,050.27 $1,371.57 |
$1,116.36 $1,201.74 $1,292.20 $1,613.50 |
Toc - Plan #60 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 |
$310.25 $352.13 $396.50 $554.11 $842.02 |
$547.59 $589.47 $633.84 $791.45 |
$784.93 $826.81 $871.18 $1,028.79 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$620.50 $704.26 $793.00 $1,108.22 $1,684.04 |
$857.84 $941.60 $1,030.34 $1,345.56 |
$1,095.18 $1,178.94 $1,267.68 $1,582.90 |
Toc - Plan #61 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 |
$395.15 $448.50 $505.00 $705.74 $1,072.44 |
$697.44 $750.79 $807.29 $1,008.03 |
$999.73 $1,053.08 $1,109.58 $1,310.32 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$790.30 $897.00 $1,010.00 $1,411.48 $2,144.88 |
$1,092.59 $1,199.29 $1,312.29 $1,713.77 |
$1,394.88 $1,501.58 $1,614.58 $2,016.06 |
Toc - Plan #62 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 |
$397.90 $451.62 $508.52 $710.65 $1,079.90 |
$702.29 $756.01 $812.91 $1,015.04 |
$1,006.68 $1,060.40 $1,117.30 $1,319.43 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$795.80 $903.24 $1,017.04 $1,421.30 $2,159.80 |
$1,100.19 $1,207.63 $1,321.43 $1,725.69 |
$1,404.58 $1,512.02 $1,625.82 $2,030.08 |
Toc - Plan #63 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 |
$379.58 $430.82 $485.10 $677.93 $1,030.18 |
$669.96 $721.20 $775.48 $968.31 |
$960.34 $1,011.58 $1,065.86 $1,258.69 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$759.16 $861.64 $970.20 $1,355.86 $2,060.36 |
$1,049.54 $1,152.02 $1,260.58 $1,646.24 |
$1,339.92 $1,442.40 $1,550.96 $1,936.62 |
Toc - Plan #64 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 |
$317.85 $360.76 $406.21 $567.68 $862.64 |
$561.01 $603.92 $649.37 $810.84 |
$804.17 $847.08 $892.53 $1,054.00 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$635.70 $721.52 $812.42 $1,135.36 $1,725.28 |
$878.86 $964.68 $1,055.58 $1,378.52 |
$1,122.02 $1,207.84 $1,298.74 $1,621.68 |
Toc - Plan #65 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 |
$331.82 $376.62 $424.07 $592.63 $900.56 |
$585.66 $630.46 $677.91 $846.47 |
$839.50 $884.30 $931.75 $1,100.31 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$663.64 $753.24 $848.14 $1,185.26 $1,801.12 |
$917.48 $1,007.08 $1,101.98 $1,439.10 |
$1,171.32 $1,260.92 $1,355.82 $1,692.94 |
ADVERTISEMENT
Common Ground Healthcare CooperativeLocal: 1-877-514-2442 | Toll Free: 1-877-514-2442 | TTY: 1-844-472-2442 |
Toc - Plan #66 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 |
$267.49 $303.59 $341.84 $477.72 $725.95 |
$472.11 $508.21 $546.46 $682.34 |
$676.73 $712.83 $751.08 $886.96 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$534.98 $607.18 $683.68 $955.44 $1,451.90 |
$739.60 $811.80 $888.30 $1,160.06 |
$944.22 $1,016.42 $1,092.92 $1,364.68 |
Toc - Plan #67 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 |
$383.82 $435.63 $490.51 $685.49 $1,041.67 |
$677.44 $729.25 $784.13 $979.11 |
$971.06 $1,022.87 $1,077.75 $1,272.73 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$767.64 $871.26 $981.02 $1,370.98 $2,083.34 |
$1,061.26 $1,164.88 $1,274.64 $1,664.60 |
$1,354.88 $1,458.50 $1,568.26 $1,958.22 |
Toc - Plan #68 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 |
$407.54 $462.55 $520.82 $727.85 $1,106.03 |
$719.30 $774.31 $832.58 $1,039.61 |
$1,031.06 $1,086.07 $1,144.34 $1,351.37 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$815.08 $925.10 $1,041.64 $1,455.70 $2,212.06 |
$1,126.84 $1,236.86 $1,353.40 $1,767.46 |
$1,438.60 $1,548.62 $1,665.16 $2,079.22 |
Toc - Plan #69 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 |
$357.09 $405.29 $456.35 $637.74 $969.11 |
$630.26 $678.46 $729.52 $910.91 |
$903.43 $951.63 $1,002.69 $1,184.08 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$714.18 $810.58 $912.70 $1,275.48 $1,938.22 |
$987.35 $1,083.75 $1,185.87 $1,548.65 |
$1,260.52 $1,356.92 $1,459.04 $1,821.82 |
Toc - Plan #70 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 |
$346.71 $393.51 $443.09 $619.21 $940.96 |
$611.94 $658.74 $708.32 $884.44 |
$877.17 $923.97 $973.55 $1,149.67 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$693.42 $787.02 $886.18 $1,238.42 $1,881.92 |
$958.65 $1,052.25 $1,151.41 $1,503.65 |
$1,223.88 $1,317.48 $1,416.64 $1,768.88 |
Toc - Plan #71 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 |
$385.51 $437.54 $492.67 $688.50 $1,046.25 |
$680.42 $732.45 $787.58 $983.41 |
$975.33 $1,027.36 $1,082.49 $1,278.32 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$771.02 $875.08 $985.34 $1,377.00 $2,092.50 |
$1,065.93 $1,169.99 $1,280.25 $1,671.91 |
$1,360.84 $1,464.90 $1,575.16 $1,966.82 |
Toc - Plan #72 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 |
$359.36 $407.87 $459.25 $641.81 $975.29 |
$634.27 $682.78 $734.16 $916.72 |
$909.18 $957.69 $1,009.07 $1,191.63 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$718.72 $815.74 $918.50 $1,283.62 $1,950.58 |
$993.63 $1,090.65 $1,193.41 $1,558.53 |
$1,268.54 $1,365.56 $1,468.32 $1,833.44 |
Toc - Plan #73 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 |
$346.01 $392.71 $442.19 $617.96 $939.05 |
$610.70 $657.40 $706.88 $882.65 |
$875.39 $922.09 $971.57 $1,147.34 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$692.02 $785.42 $884.38 $1,235.92 $1,878.10 |
$956.71 $1,050.11 $1,149.07 $1,500.61 |
$1,221.40 $1,314.80 $1,413.76 $1,765.30 |
Toc - Plan #74 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 |
$360.39 $409.03 $460.56 $643.64 $978.07 |
$636.08 $684.72 $736.25 $919.33 |
$911.77 $960.41 $1,011.94 $1,195.02 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$720.78 $818.06 $921.12 $1,287.28 $1,956.14 |
$996.47 $1,093.75 $1,196.81 $1,562.97 |
$1,272.16 $1,369.44 $1,472.50 $1,838.66 |
Toc - Plan #75 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 |
$294.35 $334.08 $376.17 $525.69 $798.84 |
$519.52 $559.25 $601.34 $750.86 |
$744.69 $784.42 $826.51 $976.03 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$588.70 $668.16 $752.34 $1,051.38 $1,597.68 |
$813.87 $893.33 $977.51 $1,276.55 |
$1,039.04 $1,118.50 $1,202.68 $1,501.72 |
Toc - Plan #76 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 |
$182.60 $207.24 $233.35 $326.11 $495.55 |
$322.28 $346.92 $373.03 $465.79 |
$461.96 $486.60 $512.71 $605.47 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$365.20 $414.48 $466.70 $652.22 $991.10 |
$504.88 $554.16 $606.38 $791.90 |
$644.56 $693.84 $746.06 $931.58 |
Toc - Plan #77 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 |
$252.50 $286.58 $322.68 $450.95 $685.26 |
$445.66 $479.74 $515.84 $644.11 |
$638.82 $672.90 $709.00 $837.27 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$505.00 $573.16 $645.36 $901.90 $1,370.52 |
$698.16 $766.32 $838.52 $1,095.06 |
$891.32 $959.48 $1,031.68 $1,288.22 |
Toc - Plan #78 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 |
$260.45 $295.59 $332.84 $465.14 $706.82 |
$459.68 $494.82 $532.07 $664.37 |
$658.91 $694.05 $731.30 $863.60 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$520.90 $591.18 $665.68 $930.28 $1,413.64 |
$720.13 $790.41 $864.91 $1,129.51 |
$919.36 $989.64 $1,064.14 $1,328.74 |
Toc - Plan #79 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 |
$262.20 $297.59 $335.08 $468.28 $711.59 |
$462.78 $498.17 $535.66 $668.86 |
$663.36 $698.75 $736.24 $869.44 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$524.40 $595.18 $670.16 $936.56 $1,423.18 |
$724.98 $795.76 $870.74 $1,137.14 |
$925.56 $996.34 $1,071.32 $1,337.72 |
Toc - Plan #80 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 |
$409.31 $464.55 $523.08 $731.00 $1,110.83 |
$722.42 $777.66 $836.19 $1,044.11 |
$1,035.53 $1,090.77 $1,149.30 $1,357.22 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$818.62 $929.10 $1,046.16 $1,462.00 $2,221.66 |
$1,131.73 $1,242.21 $1,359.27 $1,775.11 |
$1,444.84 $1,555.32 $1,672.38 $2,088.22 |
Toc - Plan #81 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 |
$398.14 $451.88 $508.81 $711.06 $1,080.52 |
$702.71 $756.45 $813.38 $1,015.63 |
$1,007.28 $1,061.02 $1,117.95 $1,320.20 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$796.28 $903.76 $1,017.62 $1,422.12 $2,161.04 |
$1,100.85 $1,208.33 $1,322.19 $1,726.69 |
$1,405.42 $1,512.90 $1,626.76 $2,031.26 |
Toc - Plan #82 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 |
$250.82 $284.67 $320.54 $447.95 $680.71 |
$442.69 $476.54 $512.41 $639.82 |
$634.56 $668.41 $704.28 $831.69 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$501.64 $569.34 $641.08 $895.90 $1,361.42 |
$693.51 $761.21 $832.95 $1,087.77 |
$885.38 $953.08 $1,024.82 $1,279.64 |
Toc - Plan #83 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 |
$258.12 $292.96 $329.87 $460.99 $700.52 |
$455.58 $490.42 $527.33 $658.45 |
$653.04 $687.88 $724.79 $855.91 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$516.24 $585.92 $659.74 $921.98 $1,401.04 |
$713.70 $783.38 $857.20 $1,119.44 |
$911.16 $980.84 $1,054.66 $1,316.90 |
Toc - Plan #84 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 |
$294.29 $334.01 $376.09 $525.59 $798.69 |
$519.42 $559.14 $601.22 $750.72 |
$744.55 $784.27 $826.35 $975.85 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$588.58 $668.02 $752.18 $1,051.18 $1,597.38 |
$813.71 $893.15 $977.31 $1,276.31 |
$1,038.84 $1,118.28 $1,202.44 $1,501.44 |
Toc - Plan #85 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 |
$388.43 $440.86 $496.40 $693.72 $1,054.17 |
$685.57 $738.00 $793.54 $990.86 |
$982.71 $1,035.14 $1,090.68 $1,288.00 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$776.86 $881.72 $992.80 $1,387.44 $2,108.34 |
$1,074.00 $1,178.86 $1,289.94 $1,684.58 |
$1,371.14 $1,476.00 $1,587.08 $1,981.72 |
Toc - Plan #86 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 |
$362.26 $411.16 $462.96 $646.98 $983.15 |
$639.38 $688.28 $740.08 $924.10 |
$916.50 $965.40 $1,017.20 $1,201.22 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$724.52 $822.32 $925.92 $1,293.96 $1,966.30 |
$1,001.64 $1,099.44 $1,203.04 $1,571.08 |
$1,278.76 $1,376.56 $1,480.16 $1,848.20 |
Toc - Plan #87 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 |
$359.99 $408.58 $460.05 $642.92 $976.98 |
$635.37 $683.96 $735.43 $918.30 |
$910.75 $959.34 $1,010.81 $1,193.68 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$719.98 $817.16 $920.10 $1,285.84 $1,953.96 |
$995.36 $1,092.54 $1,195.48 $1,561.22 |
$1,270.74 $1,367.92 $1,470.86 $1,836.60 |
Toc - Plan #88 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 |
$349.60 $396.79 $446.78 $624.37 $948.80 |
$617.04 $664.23 $714.22 $891.81 |
$884.48 $931.67 $981.66 $1,159.25 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$699.20 $793.58 $893.56 $1,248.74 $1,897.60 |
$966.64 $1,061.02 $1,161.00 $1,516.18 |
$1,234.08 $1,328.46 $1,428.44 $1,783.62 |
Toc - Plan #89 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 |
$348.90 $395.99 $445.88 $623.12 $946.89 |
$615.80 $662.89 $712.78 $890.02 |
$882.70 $929.79 $979.68 $1,156.92 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$697.80 $791.98 $891.76 $1,246.24 $1,893.78 |
$964.70 $1,058.88 $1,158.66 $1,513.14 |
$1,231.60 $1,325.78 $1,425.56 $1,780.04 |
Toc - Plan #90 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 |
$363.29 $412.32 $464.27 $648.81 $985.93 |
$641.20 $690.23 $742.18 $926.72 |
$919.11 $968.14 $1,020.09 $1,204.63 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$726.58 $824.64 $928.54 $1,297.62 $1,971.86 |
$1,004.49 $1,102.55 $1,206.45 $1,575.53 |
$1,282.40 $1,380.46 $1,484.36 $1,853.44 |
Toc - Plan #91 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 |
$297.14 $337.25 $379.74 $530.68 $806.42 |
$524.45 $564.56 $607.05 $757.99 |
$751.76 $791.87 $834.36 $985.30 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$594.28 $674.50 $759.48 $1,061.36 $1,612.84 |
$821.59 $901.81 $986.79 $1,288.67 |
$1,048.90 $1,129.12 $1,214.10 $1,515.98 |
Toc - Plan #92 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 |
$297.21 $337.32 $379.82 $530.80 $806.61 |
$524.57 $564.68 $607.18 $758.16 |
$751.93 $792.04 $834.54 $985.52 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$594.42 $674.64 $759.64 $1,061.60 $1,613.22 |
$821.78 $902.00 $987.00 $1,288.96 |
$1,049.14 $1,129.36 $1,214.36 $1,516.32 |
Toc - Plan #93 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 |
$253.65 $287.88 $324.16 $453.01 $688.39 |
$447.69 $481.92 $518.20 $647.05 |
$641.73 $675.96 $712.24 $841.09 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$507.30 $575.76 $648.32 $906.02 $1,376.78 |
$701.34 $769.80 $842.36 $1,100.06 |
$895.38 $963.84 $1,036.40 $1,294.10 |
Toc - Plan #94 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 |
$255.33 $289.79 $326.30 $456.00 $692.94 |
$450.65 $485.11 $521.62 $651.32 |
$645.97 $680.43 $716.94 $846.64 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$510.66 $579.58 $652.60 $912.00 $1,385.88 |
$705.98 $774.90 $847.92 $1,107.32 |
$901.30 $970.22 $1,043.24 $1,302.64 |
Toc - Plan #95 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 |
$263.29 $298.82 $336.47 $470.21 $714.53 |
$464.70 $500.23 $537.88 $671.62 |
$666.11 $701.64 $739.29 $873.03 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$526.58 $597.64 $672.94 $940.42 $1,429.06 |
$727.99 $799.05 $874.35 $1,141.83 |
$929.40 $1,000.46 $1,075.76 $1,343.24 |
Toc - Plan #96 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 |
$260.95 $296.17 $333.49 $466.04 $708.20 |
$460.57 $495.79 $533.11 $665.66 |
$660.19 $695.41 $732.73 $865.28 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$521.90 $592.34 $666.98 $932.08 $1,416.40 |
$721.52 $791.96 $866.60 $1,131.70 |
$921.14 $991.58 $1,066.22 $1,331.32 |
Toc - Plan #97 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 |
$265.04 $300.81 $338.71 $473.35 $719.30 |
$467.79 $503.56 $541.46 $676.10 |
$670.54 $706.31 $744.21 $878.85 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$530.08 $601.62 $677.42 $946.70 $1,438.60 |
$732.83 $804.37 $880.17 $1,149.45 |
$935.58 $1,007.12 $1,082.92 $1,352.20 |
Toc - Plan #98 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 |
$401.07 $455.20 $512.55 $716.29 $1,088.47 |
$707.88 $762.01 $819.36 $1,023.10 |
$1,014.69 $1,068.82 $1,126.17 $1,329.91 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$802.14 $910.40 $1,025.10 $1,432.58 $2,176.94 |
$1,108.95 $1,217.21 $1,331.91 $1,739.39 |
$1,415.76 $1,524.02 $1,638.72 $2,046.20 |
Toc - Plan #99 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 |
$412.24 $467.88 $526.83 $736.25 $1,118.80 |
$727.60 $783.24 $842.19 $1,051.61 |
$1,042.96 $1,098.60 $1,157.55 $1,366.97 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$824.48 $935.76 $1,053.66 $1,472.50 $2,237.60 |
$1,139.84 $1,251.12 $1,369.02 $1,787.86 |
$1,455.20 $1,566.48 $1,684.38 $2,103.22 |
Toc - Plan #100 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 |
$270.33 $306.82 $345.47 $482.80 $733.66 |
$477.13 $513.62 $552.27 $689.60 |
$683.93 $720.42 $759.07 $896.40 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$540.66 $613.64 $690.94 $965.60 $1,467.32 |
$747.46 $820.44 $897.74 $1,172.40 |
$954.26 $1,027.24 $1,104.54 $1,379.20 |
Toc - Plan #101 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 |
$386.74 $438.94 $494.24 $690.70 $1,049.59 |
$682.59 $734.79 $790.09 $986.55 |
$978.44 $1,030.64 $1,085.94 $1,282.40 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$773.48 $877.88 $988.48 $1,381.40 $2,099.18 |
$1,069.33 $1,173.73 $1,284.33 $1,677.25 |
$1,365.18 $1,469.58 $1,580.18 $1,973.10 |
Toc - Plan #102 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 |
$410.47 $465.87 $524.56 $733.08 $1,113.98 |
$724.47 $779.87 $838.56 $1,047.08 |
$1,038.47 $1,093.87 $1,152.56 $1,361.08 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$820.94 $931.74 $1,049.12 $1,466.16 $2,227.96 |
$1,134.94 $1,245.74 $1,363.12 $1,780.16 |
$1,448.94 $1,559.74 $1,677.12 $2,094.16 |
‡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 Green Lake County here.
Green Lake County is in “Rating Area 15” of Wisconsin.
Currently, there are 102 plans offered in Rating Area 15.