Obamacare 2022 Rates for Rock County
Obamacare > Rates > Wisconsin > Rock County
Obamacare > Rates > Wisconsin > Rock 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 | ||||||||||||||||||||
Expanded Bronze
(HMO) Beloit One Bronze I202 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 |
$269.07 $305.39 $343.86 $480.55 $730.24 |
$474.90 $511.22 $549.69 $686.38 |
$680.73 $717.05 $755.52 $892.21 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$538.14 $610.78 $687.72 $961.10 $1,460.48 |
$743.97 $816.61 $893.55 $1,166.93 |
$949.80 $1,022.44 $1,099.38 $1,372.76 |
Toc - Plan #2 Quartz | ||||||||||||||||||||
Gold
(HMO) Beloit One Gold I401 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 |
$361.42 $410.20 $461.89 $645.48 $980.87 |
$637.90 $686.68 $738.37 $921.96 |
$914.38 $963.16 $1,014.85 $1,198.44 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$722.84 $820.40 $923.78 $1,290.96 $1,961.74 |
$999.32 $1,096.88 $1,200.26 $1,567.44 |
$1,275.80 $1,373.36 $1,476.74 $1,843.92 |
Toc - Plan #3 Quartz | ||||||||||||||||||||
Gold
(HMO) Beloit One Gold I402 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 |
$358.85 $407.29 $458.61 $640.90 $973.91 |
$633.37 $681.81 $733.13 $915.42 |
$907.89 $956.33 $1,007.65 $1,189.94 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$717.70 $814.58 $917.22 $1,281.80 $1,947.82 |
$992.22 $1,089.10 $1,191.74 $1,556.32 |
$1,266.74 $1,363.62 $1,466.26 $1,830.84 |
Toc - Plan #4 Quartz | ||||||||||||||||||||
Gold
(HMO) Beloit One Gold I405 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 |
$357.27 $405.49 $456.58 $638.07 $969.61 |
$630.58 $678.80 $729.89 $911.38 |
$903.89 $952.11 $1,003.20 $1,184.69 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$714.54 $810.98 $913.16 $1,276.14 $1,939.22 |
$987.85 $1,084.29 $1,186.47 $1,549.45 |
$1,261.16 $1,357.60 $1,459.78 $1,822.76 |
Toc - Plan #5 Quartz | ||||||||||||||||||||
Silver
(HMO) Beloit One Silver I301 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 |
$360.78 $409.48 $461.07 $644.35 $979.15 |
$636.77 $685.47 $737.06 $920.34 |
$912.76 $961.46 $1,013.05 $1,196.33 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$721.56 $818.96 $922.14 $1,288.70 $1,958.30 |
$997.55 $1,094.95 $1,198.13 $1,564.69 |
$1,273.54 $1,370.94 $1,474.12 $1,840.68 |
Toc - Plan #6 Quartz | ||||||||||||||||||||
Silver
(HMO) Beloit One Silver I302 with Dental |
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Benefits & Coverage
Plan Brochure
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Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$362.07 $410.95 $462.72 $646.65 $982.65 |
$639.05 $687.93 $739.70 $923.63 |
$916.03 $964.91 $1,016.68 $1,200.61 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$724.14 $821.90 $925.44 $1,293.30 $1,965.30 |
$1,001.12 $1,098.88 $1,202.42 $1,570.28 |
$1,278.10 $1,375.86 $1,479.40 $1,847.26 |
Toc - Plan #7 Quartz | ||||||||||||||||||||
Silver
(HMO) Beloit One Silver I303 with Dental |
||||||||||||||||||||
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 |
$354.02 $401.81 $452.44 $632.28 $960.81 |
$624.85 $672.64 $723.27 $903.11 |
$895.68 $943.47 $994.10 $1,173.94 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$708.04 $803.62 $904.88 $1,264.56 $1,921.62 |
$978.87 $1,074.45 $1,175.71 $1,535.39 |
$1,249.70 $1,345.28 $1,446.54 $1,806.22 |
Toc - Plan #8 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Beloit 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 |
$272.21 $308.95 $347.88 $486.16 $738.77 |
$480.45 $517.19 $556.12 $694.40 |
$688.69 $725.43 $764.36 $902.64 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$544.42 $617.90 $695.76 $972.32 $1,477.54 |
$752.66 $826.14 $904.00 $1,180.56 |
$960.90 $1,034.38 $1,112.24 $1,388.80 |
Toc - Plan #9 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Beloit 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 |
$284.80 $323.24 $363.97 $508.64 $772.93 |
$502.67 $541.11 $581.84 $726.51 |
$720.54 $758.98 $799.71 $944.38 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$569.60 $646.48 $727.94 $1,017.28 $1,545.86 |
$787.47 $864.35 $945.81 $1,235.15 |
$1,005.34 $1,082.22 $1,163.68 $1,453.02 |
Toc - Plan #10 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I406 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 |
$405.20 $459.90 $517.84 $723.68 $1,099.70 |
$715.17 $769.87 $827.81 $1,033.65 |
$1,025.14 $1,079.84 $1,137.78 $1,343.62 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$810.40 $919.80 $1,035.68 $1,447.36 $2,199.40 |
$1,120.37 $1,229.77 $1,345.65 $1,757.33 |
$1,430.34 $1,539.74 $1,655.62 $2,067.30 |
Toc - Plan #11 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I407 Maintenance with Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$462.05 $524.42 $590.49 $825.20 $1,253.98 |
$815.51 $877.88 $943.95 $1,178.66 |
$1,168.97 $1,231.34 $1,297.41 $1,532.12 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$924.10 $1,048.84 $1,180.98 $1,650.40 $2,507.96 |
$1,277.56 $1,402.30 $1,534.44 $2,003.86 |
$1,631.02 $1,755.76 $1,887.90 $2,357.32 |
Toc - Plan #12 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 |
|||||||||||||||||
21 30 40 50 60 |
$399.86 $453.84 $511.02 $714.15 $1,085.22 |
$705.75 $759.73 $816.91 $1,020.04 |
$1,011.64 $1,065.62 $1,122.80 $1,325.93 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$799.72 $907.68 $1,022.04 $1,428.30 $2,170.44 |
$1,105.61 $1,213.57 $1,327.93 $1,734.19 |
$1,411.50 $1,519.46 $1,633.82 $2,040.08 |
Toc - Plan #13 Quartz | ||||||||||||||||||||
Silver
(HMO) Tiered Choice Plus Silver I305 with Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$407.87 $462.93 $521.26 $728.45 $1,106.96 |
$719.89 $774.95 $833.28 $1,040.47 |
$1,031.91 $1,086.97 $1,145.30 $1,352.49 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$815.74 $925.86 $1,042.52 $1,456.90 $2,213.92 |
$1,127.76 $1,237.88 $1,354.54 $1,768.92 |
$1,439.78 $1,549.90 $1,666.56 $2,080.94 |
Toc - Plan #14 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 |
|||||||||||||||||
21 30 40 50 60 |
$400.65 $454.73 $512.03 $715.56 $1,087.36 |
$707.14 $761.22 $818.52 $1,022.05 |
$1,013.63 $1,067.71 $1,125.01 $1,328.54 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$801.30 $909.46 $1,024.06 $1,431.12 $2,174.72 |
$1,107.79 $1,215.95 $1,330.55 $1,737.61 |
$1,414.28 $1,522.44 $1,637.04 $2,044.10 |
Toc - Plan #15 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Beloit 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]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$257.79 $292.59 $329.45 $460.41 $699.63 |
$455.00 $489.80 $526.66 $657.62 |
$652.21 $687.01 $723.87 $854.83 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$515.58 $585.18 $658.90 $920.82 $1,399.26 |
$712.79 $782.39 $856.11 $1,118.03 |
$910.00 $979.60 $1,053.32 $1,315.24 |
Toc - Plan #16 Quartz | ||||||||||||||||||||
Gold
(HMO) Beloit One Gold I401 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$346.27 $393.01 $442.52 $618.43 $939.76 |
$611.16 $657.90 $707.41 $883.32 |
$876.05 $922.79 $972.30 $1,148.21 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$692.54 $786.02 $885.04 $1,236.86 $1,879.52 |
$957.43 $1,050.91 $1,149.93 $1,501.75 |
$1,222.32 $1,315.80 $1,414.82 $1,766.64 |
Toc - Plan #17 Quartz | ||||||||||||||||||||
Gold
(HMO) Beloit One Gold I402 Maintenance |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$343.81 $390.22 $439.38 $614.04 $933.09 |
$606.82 $653.23 $702.39 $877.05 |
$869.83 $916.24 $965.40 $1,140.06 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$687.62 $780.44 $878.76 $1,228.08 $1,866.18 |
$950.63 $1,043.45 $1,141.77 $1,491.09 |
$1,213.64 $1,306.46 $1,404.78 $1,754.10 |
Toc - Plan #18 Quartz | ||||||||||||||||||||
Gold
(HMO) Beloit One Gold I405 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$342.29 $388.50 $437.44 $611.33 $928.97 |
$604.14 $650.35 $699.29 $873.18 |
$865.99 $912.20 $961.14 $1,135.03 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$684.58 $777.00 $874.88 $1,222.66 $1,857.94 |
$946.43 $1,038.85 $1,136.73 $1,484.51 |
$1,208.28 $1,300.70 $1,398.58 $1,746.36 |
Toc - Plan #19 Quartz | ||||||||||||||||||||
Silver
(HMO) Beloit One Silver I301 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$345.66 $392.32 $441.75 $617.34 $938.11 |
$610.09 $656.75 $706.18 $881.77 |
$874.52 $921.18 $970.61 $1,146.20 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$691.32 $784.64 $883.50 $1,234.68 $1,876.22 |
$955.75 $1,049.07 $1,147.93 $1,499.11 |
$1,220.18 $1,313.50 $1,412.36 $1,763.54 |
Toc - Plan #20 Quartz | ||||||||||||||||||||
Silver
(HMO) Beloit One Silver I302 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$346.89 $393.72 $443.32 $619.54 $941.46 |
$612.26 $659.09 $708.69 $884.91 |
$877.63 $924.46 $974.06 $1,150.28 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$693.78 $787.44 $886.64 $1,239.08 $1,882.92 |
$959.15 $1,052.81 $1,152.01 $1,504.45 |
$1,224.52 $1,318.18 $1,417.38 $1,769.82 |
Toc - Plan #21 Quartz | ||||||||||||||||||||
Silver
(HMO) Beloit 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]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$339.19 $384.97 $433.47 $605.78 $920.54 |
$598.66 $644.44 $692.94 $865.25 |
$858.13 $903.91 $952.41 $1,124.72 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$678.38 $769.94 $866.94 $1,211.56 $1,841.08 |
$937.85 $1,029.41 $1,126.41 $1,471.03 |
$1,197.32 $1,288.88 $1,385.88 $1,730.50 |
Toc - Plan #22 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Beloit 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]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$260.80 $296.00 $333.30 $465.78 $707.80 |
$460.31 $495.51 $532.81 $665.29 |
$659.82 $695.02 $732.32 $864.80 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$521.60 $592.00 $666.60 $931.56 $1,415.60 |
$721.11 $791.51 $866.11 $1,131.07 |
$920.62 $991.02 $1,065.62 $1,330.58 |
Toc - Plan #23 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Beloit 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 |
|||||||||||||||||
21 30 40 50 60 |
$272.86 $309.69 $348.71 $487.32 $740.53 |
$481.59 $518.42 $557.44 $696.05 |
$690.32 $727.15 $766.17 $904.78 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$545.72 $619.38 $697.42 $974.64 $1,481.06 |
$754.45 $828.11 $906.15 $1,183.37 |
$963.18 $1,036.84 $1,114.88 $1,392.10 |
Toc - Plan #24 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I406 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$388.22 $440.62 $496.13 $693.34 $1,053.60 |
$685.20 $737.60 $793.11 $990.32 |
$982.18 $1,034.58 $1,090.09 $1,287.30 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$776.44 $881.24 $992.26 $1,386.68 $2,107.20 |
$1,073.42 $1,178.22 $1,289.24 $1,683.66 |
$1,370.40 $1,475.20 $1,586.22 $1,980.64 |
Toc - Plan #25 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]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$442.68 $502.43 $565.74 $790.61 $1,201.42 |
$781.33 $841.08 $904.39 $1,129.26 |
$1,119.98 $1,179.73 $1,243.04 $1,467.91 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$885.36 $1,004.86 $1,131.48 $1,581.22 $2,402.84 |
$1,224.01 $1,343.51 $1,470.13 $1,919.87 |
$1,562.66 $1,682.16 $1,808.78 $2,258.52 |
Toc - Plan #26 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]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$383.10 $434.82 $489.60 $684.21 $1,039.73 |
$676.17 $727.89 $782.67 $977.28 |
$969.24 $1,020.96 $1,075.74 $1,270.35 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$766.20 $869.64 $979.20 $1,368.42 $2,079.46 |
$1,059.27 $1,162.71 $1,272.27 $1,661.49 |
$1,352.34 $1,455.78 $1,565.34 $1,954.56 |
Toc - Plan #27 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]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$390.78 $443.53 $499.41 $697.92 $1,060.55 |
$689.72 $742.47 $798.35 $996.86 |
$988.66 $1,041.41 $1,097.29 $1,295.80 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$781.56 $887.06 $998.82 $1,395.84 $2,121.10 |
$1,080.50 $1,186.00 $1,297.76 $1,694.78 |
$1,379.44 $1,484.94 $1,596.70 $1,993.72 |
Toc - Plan #28 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]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$383.86 $435.67 $490.56 $685.56 $1,041.78 |
$677.51 $729.32 $784.21 $979.21 |
$971.16 $1,022.97 $1,077.86 $1,272.86 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$767.72 $871.34 $981.12 $1,371.12 $2,083.56 |
$1,061.37 $1,164.99 $1,274.77 $1,664.77 |
$1,355.02 $1,458.64 $1,568.42 $1,958.42 |
Toc - Plan #29 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Beloit 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 |
$271.45 $308.09 $346.91 $484.81 $736.71 |
$479.11 $515.75 $554.57 $692.47 |
$686.77 $723.41 $762.23 $900.13 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$542.90 $616.18 $693.82 $969.62 $1,473.42 |
$750.56 $823.84 $901.48 $1,177.28 |
$958.22 $1,031.50 $1,109.14 $1,384.94 |
Toc - Plan #30 Quartz | ||||||||||||||||||||
Catastrophic
(HMO) Beloit 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 |
$199.46 $226.38 $254.90 $356.22 $541.31 |
$352.04 $378.96 $407.48 $508.80 |
$504.62 $531.54 $560.06 $661.38 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$398.92 $452.76 $509.80 $712.44 $1,082.62 |
$551.50 $605.34 $662.38 $865.02 |
$704.08 $757.92 $814.96 $1,017.60 |
Toc - Plan #31 Quartz | ||||||||||||||||||||
Silver
(HMO) Beloit 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 |
$363.98 $413.11 $465.16 $650.06 $987.82 |
$642.42 $691.55 $743.60 $928.50 |
$920.86 $969.99 $1,022.04 $1,206.94 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$727.96 $826.22 $930.32 $1,300.12 $1,975.64 |
$1,006.40 $1,104.66 $1,208.76 $1,578.56 |
$1,284.84 $1,383.10 $1,487.20 $1,857.00 |
Toc - Plan #32 Quartz | ||||||||||||||||||||
Gold
(HMO) Beloit One Gold I403 HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$373.17 $423.55 $476.91 $666.48 $1,012.78 |
$658.64 $709.02 $762.38 $951.95 |
$944.11 $994.49 $1,047.85 $1,237.42 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$746.34 $847.10 $953.82 $1,332.96 $2,025.56 |
$1,031.81 $1,132.57 $1,239.29 $1,618.43 |
$1,317.28 $1,418.04 $1,524.76 $1,903.90 |
Toc - Plan #33 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 |
$414.61 $470.58 $529.87 $740.48 $1,125.24 |
$731.78 $787.75 $847.04 $1,057.65 |
$1,048.95 $1,104.92 $1,164.21 $1,374.82 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$829.22 $941.16 $1,059.74 $1,480.96 $2,250.48 |
$1,146.39 $1,258.33 $1,376.91 $1,798.13 |
$1,463.56 $1,575.50 $1,694.08 $2,115.30 |
ADVERTISEMENT
Dean Health PlanLocal: 1-800-279-1302 | Toll Free: 1-800-279-1302 | TTY: 1-800-279-1302 |
Toc - Plan #34 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 |
$379.28 $430.49 $484.72 $677.40 $1,029.37 |
$669.43 $720.64 $774.87 $967.55 |
$959.58 $1,010.79 $1,065.02 $1,257.70 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$758.56 $860.98 $969.44 $1,354.80 $2,058.74 |
$1,048.71 $1,151.13 $1,259.59 $1,644.95 |
$1,338.86 $1,441.28 $1,549.74 $1,935.10 |
Toc - Plan #35 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 |
$380.34 $431.68 $486.07 $679.28 $1,032.24 |
$671.30 $722.64 $777.03 $970.24 |
$962.26 $1,013.60 $1,067.99 $1,261.20 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$760.68 $863.36 $972.14 $1,358.56 $2,064.48 |
$1,051.64 $1,154.32 $1,263.10 $1,649.52 |
$1,342.60 $1,445.28 $1,554.06 $1,940.48 |
Toc - Plan #36 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 |
$256.50 $291.13 $327.81 $458.11 $696.14 |
$452.72 $487.35 $524.03 $654.33 |
$648.94 $683.57 $720.25 $850.55 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$513.00 $582.26 $655.62 $916.22 $1,392.28 |
$709.22 $778.48 $851.84 $1,112.44 |
$905.44 $974.70 $1,048.06 $1,308.66 |
Toc - Plan #37 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 |
$370.01 $419.96 $472.88 $660.84 $1,004.22 |
$653.07 $703.02 $755.94 $943.90 |
$936.13 $986.08 $1,039.00 $1,226.96 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$740.02 $839.92 $945.76 $1,321.68 $2,008.44 |
$1,023.08 $1,122.98 $1,228.82 $1,604.74 |
$1,306.14 $1,406.04 $1,511.88 $1,887.80 |
Toc - Plan #38 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 |
$373.66 $424.10 $477.54 $667.36 $1,014.11 |
$659.51 $709.95 $763.39 $953.21 |
$945.36 $995.80 $1,049.24 $1,239.06 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$747.32 $848.20 $955.08 $1,334.72 $2,028.22 |
$1,033.17 $1,134.05 $1,240.93 $1,620.57 |
$1,319.02 $1,419.90 $1,526.78 $1,906.42 |
Toc - Plan #39 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 |
$386.06 $438.18 $493.39 $689.51 $1,047.78 |
$681.40 $733.52 $788.73 $984.85 |
$976.74 $1,028.86 $1,084.07 $1,280.19 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$772.12 $876.36 $986.78 $1,379.02 $2,095.56 |
$1,067.46 $1,171.70 $1,282.12 $1,674.36 |
$1,362.80 $1,467.04 $1,577.46 $1,969.70 |
Toc - Plan #40 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 |
$248.02 $281.50 $316.96 $442.96 $673.11 |
$437.75 $471.23 $506.69 $632.69 |
$627.48 $660.96 $696.42 $822.42 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$496.04 $563.00 $633.92 $885.92 $1,346.22 |
$685.77 $752.73 $823.65 $1,075.65 |
$875.50 $942.46 $1,013.38 $1,265.38 |
Toc - Plan #41 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 |
$364.59 $413.82 $465.95 $651.17 $989.51 |
$643.51 $692.74 $744.87 $930.09 |
$922.43 $971.66 $1,023.79 $1,209.01 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$729.18 $827.64 $931.90 $1,302.34 $1,979.02 |
$1,008.10 $1,106.56 $1,210.82 $1,581.26 |
$1,287.02 $1,385.48 $1,489.74 $1,860.18 |
Toc - Plan #42 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 |
$261.75 $297.09 $334.52 $467.48 $710.39 |
$461.99 $497.33 $534.76 $667.72 |
$662.23 $697.57 $735.00 $867.96 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$523.50 $594.18 $669.04 $934.96 $1,420.78 |
$723.74 $794.42 $869.28 $1,135.20 |
$923.98 $994.66 $1,069.52 $1,335.44 |
Toc - Plan #43 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 |
$202.73 $230.10 $259.08 $362.07 $550.20 |
$357.82 $385.19 $414.17 $517.16 |
$512.91 $540.28 $569.26 $672.25 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$405.46 $460.20 $518.16 $724.14 $1,100.40 |
$560.55 $615.29 $673.25 $879.23 |
$715.64 $770.38 $828.34 $1,034.32 |
Toc - Plan #44 Dean Health Plan | ||||||||||||||||||||
Silver
(EPO) Dean Focus Network Silver Value Copay 5000X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$358.90 $407.36 $458.68 $641.00 $974.07 |
$633.46 $681.92 $733.24 $915.56 |
$908.02 $956.48 $1,007.80 $1,190.12 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$717.80 $814.72 $917.36 $1,282.00 $1,948.14 |
$992.36 $1,089.28 $1,191.92 $1,556.56 |
$1,266.92 $1,363.84 $1,466.48 $1,831.12 |
Toc - Plan #45 Dean Health Plan | ||||||||||||||||||||
Bronze
(EPO) Dean Focus Network Bronze Value Copay 8650X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$231.69 $262.97 $296.10 $413.80 $628.81 |
$408.93 $440.21 $473.34 $591.04 |
$586.17 $617.45 $650.58 $768.28 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$463.38 $525.94 $592.20 $827.60 $1,257.62 |
$640.62 $703.18 $769.44 $1,004.84 |
$817.86 $880.42 $946.68 $1,182.08 |
Toc - Plan #46 Dean Health Plan | ||||||||||||||||||||
Silver
(EPO) Dean Focus Network Silver HSA-E 4500X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$339.14 $384.92 $433.42 $605.70 $920.42 |
$598.58 $644.36 $692.86 $865.14 |
$858.02 $903.80 $952.30 $1,124.58 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$678.28 $769.84 $866.84 $1,211.40 $1,840.84 |
$937.72 $1,029.28 $1,126.28 $1,470.84 |
$1,197.16 $1,288.72 $1,385.72 $1,730.28 |
Toc - Plan #47 Dean Health Plan | ||||||||||||||||||||
Expanded Bronze
(EPO) Dean Focus Network Bronze HSA-E 6950X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$244.37 $277.36 $312.30 $436.44 $663.22 |
$431.31 $464.30 $499.24 $623.38 |
$618.25 $651.24 $686.18 $810.32 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$488.74 $554.72 $624.60 $872.88 $1,326.44 |
$675.68 $741.66 $811.54 $1,059.82 |
$862.62 $928.60 $998.48 $1,246.76 |
Toc - Plan #48 Dean Health Plan | ||||||||||||||||||||
Gold
(EPO) Dean Focus Network Gold Value Copay 3700X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$347.49 $394.40 $444.09 $620.61 $943.08 |
$613.32 $660.23 $709.92 $886.44 |
$879.15 $926.06 $975.75 $1,152.27 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$694.98 $788.80 $888.18 $1,241.22 $1,886.16 |
$960.81 $1,054.63 $1,154.01 $1,507.05 |
$1,226.64 $1,320.46 $1,419.84 $1,772.88 |
Toc - Plan #49 Dean Health Plan | ||||||||||||||||||||
Expanded Bronze
(EPO) Dean Focus Network Bronze Copay Plus 8650X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$239.53 $271.87 $306.12 $427.80 $650.09 |
$422.77 $455.11 $489.36 $611.04 |
$606.01 $638.35 $672.60 $794.28 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$479.06 $543.74 $612.24 $855.60 $1,300.18 |
$662.30 $726.98 $795.48 $1,038.84 |
$845.54 $910.22 $978.72 $1,222.08 |
ADVERTISEMENT
MercyCare Health PlansLocal: 1-800-895-2421 | Toll Free: 1-800-895-2421 |
Toc - Plan #50 MercyCare Health Plans | ||||||||||||||||||||
Gold
(HMO) MercyCare HMO Gold Option A |
||||||||||||||||||||
Benefits & Coverage
Provider Directory
Customer Service Phone: 1-800-895-2421
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$296.89 $336.97 $379.42 $530.24 $805.75 |
$524.01 $564.09 $606.54 $757.36 |
$751.13 $791.21 $833.66 $984.48 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$593.78 $673.94 $758.84 $1,060.48 $1,611.50 |
$820.90 $901.06 $985.96 $1,287.60 |
$1,048.02 $1,128.18 $1,213.08 $1,514.72 |
Toc - Plan #51 MercyCare Health Plans | ||||||||||||||||||||
Silver
(HMO) MercyCare HMO Silver Option A |
||||||||||||||||||||
Benefits & Coverage
Provider Directory
Customer Service Phone: 1-800-895-2421
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$344.24 $390.72 $439.94 $614.82 $934.27 |
$607.59 $654.07 $703.29 $878.17 |
$870.94 $917.42 $966.64 $1,141.52 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$688.48 $781.44 $879.88 $1,229.64 $1,868.54 |
$951.83 $1,044.79 $1,143.23 $1,492.99 |
$1,215.18 $1,308.14 $1,406.58 $1,756.34 |
Toc - Plan #52 MercyCare Health Plans | ||||||||||||||||||||
Bronze
(HMO) MercyCare HMO Bronze Option A |
||||||||||||||||||||
Benefits & Coverage
Provider Directory
Customer Service Phone: 1-800-895-2421
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$219.31 $248.91 $280.27 $391.68 $595.19 |
$387.08 $416.68 $448.04 $559.45 |
$554.85 $584.45 $615.81 $727.22 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$438.62 $497.82 $560.54 $783.36 $1,190.38 |
$606.39 $665.59 $728.31 $951.13 |
$774.16 $833.36 $896.08 $1,118.90 |
Toc - Plan #53 MercyCare Health Plans | ||||||||||||||||||||
Gold
(HMO) MercyCare HMO Gold Option B |
||||||||||||||||||||
Benefits & Coverage
Provider Directory
Customer Service Phone: 1-800-895-2421
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$276.67 $314.02 $353.58 $494.13 $750.87 |
$488.32 $525.67 $565.23 $705.78 |
$699.97 $737.32 $776.88 $917.43 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$553.34 $628.04 $707.16 $988.26 $1,501.74 |
$764.99 $839.69 $918.81 $1,199.91 |
$976.64 $1,051.34 $1,130.46 $1,411.56 |
Toc - Plan #54 MercyCare Health Plans | ||||||||||||||||||||
Gold
(HMO) MercyCare HMO Gold Option C |
||||||||||||||||||||
Benefits & Coverage
Provider Directory
Customer Service Phone: 1-800-895-2421
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$294.63 $334.41 $376.54 $526.21 $799.63 |
$520.03 $559.81 $601.94 $751.61 |
$745.43 $785.21 $827.34 $977.01 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$589.26 $668.82 $753.08 $1,052.42 $1,599.26 |
$814.66 $894.22 $978.48 $1,277.82 |
$1,040.06 $1,119.62 $1,203.88 $1,503.22 |
Toc - Plan #55 MercyCare Health Plans | ||||||||||||||||||||
Silver
(HMO) MercyCare HMO Silver Option B |
||||||||||||||||||||
Benefits & Coverage
Provider Directory
Customer Service Phone: 1-800-895-2421
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$337.97 $383.59 $431.92 $603.60 $917.23 |
$596.51 $642.13 $690.46 $862.14 |
$855.05 $900.67 $949.00 $1,120.68 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$675.94 $767.18 $863.84 $1,207.20 $1,834.46 |
$934.48 $1,025.72 $1,122.38 $1,465.74 |
$1,193.02 $1,284.26 $1,380.92 $1,724.28 |
Toc - Plan #56 MercyCare Health Plans | ||||||||||||||||||||
Silver
(HMO) MercyCare HMO Silver Option C |
||||||||||||||||||||
Benefits & Coverage
Provider Directory
Customer Service Phone: 1-800-895-2421
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$346.17 $392.90 $442.40 $618.26 $939.50 |
$610.99 $657.72 $707.22 $883.08 |
$875.81 $922.54 $972.04 $1,147.90 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$692.34 $785.80 $884.80 $1,236.52 $1,879.00 |
$957.16 $1,050.62 $1,149.62 $1,501.34 |
$1,221.98 $1,315.44 $1,414.44 $1,766.16 |
Toc - Plan #57 MercyCare Health Plans | ||||||||||||||||||||
Expanded Bronze
(HMO) MercyCare HMO Bronze Option B |
||||||||||||||||||||
Benefits & Coverage
Provider Directory
Customer Service Phone: 1-800-895-2421
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$235.92 $267.77 $301.51 $421.35 $640.28 |
$416.40 $448.25 $481.99 $601.83 |
$596.88 $628.73 $662.47 $782.31 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$471.84 $535.54 $603.02 $842.70 $1,280.56 |
$652.32 $716.02 $783.50 $1,023.18 |
$832.80 $896.50 $963.98 $1,203.66 |
Toc - Plan #58 MercyCare Health Plans | ||||||||||||||||||||
Bronze
(HMO) MercyCare HMO Bronze Option C |
||||||||||||||||||||
Benefits & Coverage
Provider Directory
Customer Service Phone: 1-800-895-2421
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$216.93 $246.21 $277.23 $387.43 $588.74 |
$382.88 $412.16 $443.18 $553.38 |
$548.83 $578.11 $609.13 $719.33 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$433.86 $492.42 $554.46 $774.86 $1,177.48 |
$599.81 $658.37 $720.41 $940.81 |
$765.76 $824.32 $886.36 $1,106.76 |
ADVERTISEMENT
Group Health Cooperative-SCWLocal: 1-608-828-4831 | Toll Free: 1-855-344-2729 | TTY: 1-608-828-4815 |
Toc - Plan #59 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 #60 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 #61 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 #62 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 #63 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 #64 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 #65 Group Health Cooperative-SCW | ||||||||||||||||||||
Silver
(HMO) Silver 4550X Ded/7900 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$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 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
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 #66 Group Health Cooperative-SCW | ||||||||||||||||||||
Expanded Bronze
(HMO) Bronze 6850 Ded/8200 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$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 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
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 #67 Group Health Cooperative-SCW | ||||||||||||||||||||
Platinum
(HMO) Platinum No Ded/2000 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$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 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
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 #68 Group Health Cooperative-SCW | ||||||||||||||||||||
Bronze
(HMO) Bronze 8700 Ded/8700 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$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 |
|||||||||||||||||
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 #69 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]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
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 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
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 #70 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]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
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 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
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 #71 Group Health Cooperative-SCW | ||||||||||||||||||||
Silver
(HMO) Silver 8100X Ded/8150 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$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 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
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 #72 Group Health Cooperative-SCW | ||||||||||||||||||||
Catastrophic
(HMO) Catastrophic 8700 Ded/8700 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$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 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
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 #73 Group Health Cooperative-SCW | ||||||||||||||||||||
Platinum
(HMO) Platinum 1000 Ded/4400 MOOP Primary Care Preferred |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$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 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
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 #74 Group Health Cooperative-SCW | ||||||||||||||||||||
Gold
(HMO) Gold 4500 Ded/8500 MOOP Primary Care Preferred |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$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 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
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 #75 Group Health Cooperative-SCW | ||||||||||||||||||||
Silver
(HMO) Silver 8500 Ded/8500 MOOP Primary Care Preferred |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$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 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
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 Rock County here.
Rock County is in “Rating Area 14” of Wisconsin.
Currently, there are 75 plans offered in Rating Area 14.