Obamacare 2022 Rates for Waupaca County
Obamacare > Rates > Wisconsin > Waupaca County
Obamacare > Rates > Wisconsin > Waupaca County
ADVERTISEMENT
ADVERTISEMENT
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 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
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 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
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 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
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 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
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 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
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 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
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 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
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 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
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 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
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 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
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 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
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 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
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 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
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 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
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 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
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 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
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
Security Health PlanLocal: 1-715-221-9258x19258 | Toll Free: 1-844-293-9624 | TTY: 1-877-727-2232 |
Toc - Plan #9 Security Health Plan | ||||||||||||||||||||
Gold
(EPO) SimplyOne $3,500 - 30% |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$377.62 $428.59 $482.59 $674.42 $1,024.84 |
$666.49 $717.46 $771.46 $963.29 |
$955.36 $1,006.33 $1,060.33 $1,252.16 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$755.24 $857.18 $965.18 $1,348.84 $2,049.68 |
$1,044.11 $1,146.05 $1,254.05 $1,637.71 |
$1,332.98 $1,434.92 $1,542.92 $1,926.58 |
Toc - Plan #10 Security Health Plan | ||||||||||||||||||||
Silver
(EPO) SimplyOne $4,800 - 30% |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$406.01 $460.81 $518.86 $725.11 $1,101.87 |
$716.60 $771.40 $829.45 $1,035.70 |
$1,027.19 $1,081.99 $1,140.04 $1,346.29 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$812.02 $921.62 $1,037.72 $1,450.22 $2,203.74 |
$1,122.61 $1,232.21 $1,348.31 $1,760.81 |
$1,433.20 $1,542.80 $1,658.90 $2,071.40 |
Toc - Plan #11 Security Health Plan | ||||||||||||||||||||
Silver
(EPO) SimplyOne $6,950 - 30% |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$377.39 $428.33 $482.29 $674.00 $1,024.21 |
$666.09 $717.03 $770.99 $962.70 |
$954.79 $1,005.73 $1,059.69 $1,251.40 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$754.78 $856.66 $964.58 $1,348.00 $2,048.42 |
$1,043.48 $1,145.36 $1,253.28 $1,636.70 |
$1,332.18 $1,434.06 $1,541.98 $1,925.40 |
Toc - Plan #12 Security Health Plan | ||||||||||||||||||||
Silver
(EPO) SimplyOne $4,500 HDHP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$419.21 $475.79 $535.74 $748.69 $1,137.71 |
$739.90 $796.48 $856.43 $1,069.38 |
$1,060.59 $1,117.17 $1,177.12 $1,390.07 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$838.42 $951.58 $1,071.48 $1,497.38 $2,275.42 |
$1,159.11 $1,272.27 $1,392.17 $1,818.07 |
$1,479.80 $1,592.96 $1,712.86 $2,138.76 |
Toc - Plan #13 Security Health Plan | ||||||||||||||||||||
Expanded Bronze
(EPO) SimplyOne $6,200 HDHP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$309.36 $351.11 $395.35 $552.49 $839.57 |
$546.01 $587.76 $632.00 $789.14 |
$782.66 $824.41 $868.65 $1,025.79 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$618.72 $702.22 $790.70 $1,104.98 $1,679.14 |
$855.37 $938.87 $1,027.35 $1,341.63 |
$1,092.02 $1,175.52 $1,264.00 $1,578.28 |
Toc - Plan #14 Security Health Plan | ||||||||||||||||||||
Bronze
(EPO) SimplyOne $7,500 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$280.86 $318.76 $358.92 $501.59 $762.22 |
$495.71 $533.61 $573.77 $716.44 |
$710.56 $748.46 $788.62 $931.29 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$561.72 $637.52 $717.84 $1,003.18 $1,524.44 |
$776.57 $852.37 $932.69 $1,218.03 |
$991.42 $1,067.22 $1,147.54 $1,432.88 |
Toc - Plan #15 Security Health Plan | ||||||||||||||||||||
Bronze
(EPO) SimplyOne $8,700 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$273.58 $310.50 $349.62 $488.59 $742.46 |
$482.86 $519.78 $558.90 $697.87 |
$692.14 $729.06 $768.18 $907.15 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$547.16 $621.00 $699.24 $977.18 $1,484.92 |
$756.44 $830.28 $908.52 $1,186.46 |
$965.72 $1,039.56 $1,117.80 $1,395.74 |
Toc - Plan #16 Security Health Plan | ||||||||||||||||||||
Catastrophic
(EPO) SimplyOne Protection |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$187.16 $212.41 $239.18 $334.25 $507.92 |
$330.33 $355.58 $382.35 $477.42 |
$473.50 $498.75 $525.52 $620.59 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$374.32 $424.82 $478.36 $668.50 $1,015.84 |
$517.49 $567.99 $621.53 $811.67 |
$660.66 $711.16 $764.70 $954.84 |
Toc - Plan #17 Security Health Plan | ||||||||||||||||||||
Gold
(EPO) SimplyOne $1,500 - 30% |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$408.06 $463.13 $521.49 $728.77 $1,107.44 |
$720.22 $775.29 $833.65 $1,040.93 |
$1,032.38 $1,087.45 $1,145.81 $1,353.09 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$816.12 $926.26 $1,042.98 $1,457.54 $2,214.88 |
$1,128.28 $1,238.42 $1,355.14 $1,769.70 |
$1,440.44 $1,550.58 $1,667.30 $2,081.86 |
Toc - Plan #18 Security Health Plan | ||||||||||||||||||||
Expanded Bronze
(EPO) SimplyOne $8,700 Copay |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$286.39 $325.05 $366.00 $511.48 $777.25 |
$505.47 $544.13 $585.08 $730.56 |
$724.55 $763.21 $804.16 $949.64 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$572.78 $650.10 $732.00 $1,022.96 $1,554.50 |
$791.86 $869.18 $951.08 $1,242.04 |
$1,010.94 $1,088.26 $1,170.16 $1,461.12 |
ADVERTISEMENT
Molina HealthcareLocal: 1-888-560-2043 | Toll Free: 1-888-560-2043 |
Toc - Plan #19 Molina Healthcare | ||||||||||||||||||||
Gold
(HMO) Confident Care Gold 1 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$409.47 $464.74 $523.30 $731.31 $1,111.29 |
$722.71 $777.98 $836.54 $1,044.55 |
$1,035.95 $1,091.22 $1,149.78 $1,357.79 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$818.94 $929.48 $1,046.60 $1,462.62 $2,222.58 |
$1,132.18 $1,242.72 $1,359.84 $1,775.86 |
$1,445.42 $1,555.96 $1,673.08 $2,089.10 |
Toc - Plan #20 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Constant Care Silver 1 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$367.10 $416.65 $469.15 $655.63 $996.30 |
$647.93 $697.48 $749.98 $936.46 |
$928.76 $978.31 $1,030.81 $1,217.29 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$734.20 $833.30 $938.30 $1,311.26 $1,992.60 |
$1,015.03 $1,114.13 $1,219.13 $1,592.09 |
$1,295.86 $1,394.96 $1,499.96 $1,872.92 |
Toc - Plan #21 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Constant Care Silver 4 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$363.53 $412.61 $464.59 $649.27 $986.62 |
$641.63 $690.71 $742.69 $927.37 |
$919.73 $968.81 $1,020.79 $1,205.47 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$727.06 $825.22 $929.18 $1,298.54 $1,973.24 |
$1,005.16 $1,103.32 $1,207.28 $1,576.64 |
$1,283.26 $1,381.42 $1,485.38 $1,854.74 |
Toc - Plan #22 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Constant Care Silver 7 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$356.92 $405.10 $456.14 $637.46 $968.68 |
$629.96 $678.14 $729.18 $910.50 |
$903.00 $951.18 $1,002.22 $1,183.54 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$713.84 $810.20 $912.28 $1,274.92 $1,937.36 |
$986.88 $1,083.24 $1,185.32 $1,547.96 |
$1,259.92 $1,356.28 $1,458.36 $1,821.00 |
Toc - Plan #23 Molina Healthcare | ||||||||||||||||||||
Gold
(HMO) Confident Care Gold 1 + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$403.99 $458.52 $516.29 $721.52 $1,096.42 |
$713.04 $767.57 $825.34 $1,030.57 |
$1,022.09 $1,076.62 $1,134.39 $1,339.62 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$807.98 $917.04 $1,032.58 $1,443.04 $2,192.84 |
$1,117.03 $1,226.09 $1,341.63 $1,752.09 |
$1,426.08 $1,535.14 $1,650.68 $2,061.14 |
Toc - Plan #24 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Constant Care Silver 1 + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$364.28 $413.46 $465.55 $650.61 $988.66 |
$642.96 $692.14 $744.23 $929.29 |
$921.64 $970.82 $1,022.91 $1,207.97 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$728.56 $826.92 $931.10 $1,301.22 $1,977.32 |
$1,007.24 $1,105.60 $1,209.78 $1,579.90 |
$1,285.92 $1,384.28 $1,488.46 $1,858.58 |
Toc - Plan #25 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Constant Care Silver 2 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$366.25 $415.70 $468.07 $654.13 $994.01 |
$646.43 $695.88 $748.25 $934.31 |
$926.61 $976.06 $1,028.43 $1,214.49 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$732.50 $831.40 $936.14 $1,308.26 $1,988.02 |
$1,012.68 $1,111.58 $1,216.32 $1,588.44 |
$1,292.86 $1,391.76 $1,496.50 $1,868.62 |
ADVERTISEMENT
Network HealthLocal: 1-920-720-1400x1400 | Toll Free: 1-855-275-1400 | TTY: 1-800-947-3529 |
Toc - Plan #26 Network Health | ||||||||||||||||||||
Expanded Bronze
(HMO) Prestige Bronze 20 HDHP + Dental + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$260.90 $296.13 $333.43 $465.97 $708.09 |
$460.49 $495.72 $533.02 $665.56 |
$660.08 $695.31 $732.61 $865.15 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$521.80 $592.26 $666.86 $931.94 $1,416.18 |
$721.39 $791.85 $866.45 $1,131.53 |
$920.98 $991.44 $1,066.04 $1,331.12 |
Toc - Plan #27 Network Health | ||||||||||||||||||||
Silver
(HMO) Prestige Silver 20 HDHP + Dental + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$399.84 $453.82 $511.00 $714.11 $1,085.16 |
$705.72 $759.70 $816.88 $1,019.99 |
$1,011.60 $1,065.58 $1,122.76 $1,325.87 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$799.68 $907.64 $1,022.00 $1,428.22 $2,170.32 |
$1,105.56 $1,213.52 $1,327.88 $1,734.10 |
$1,411.44 $1,519.40 $1,633.76 $2,039.98 |
Toc - Plan #28 Network Health | ||||||||||||||||||||
Expanded Bronze
(HMO) Prestige Bronze Essential + Dental + Vision + Fitness + 3 Free PCP Visits |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$252.89 $287.03 $323.19 $451.66 $686.33 |
$446.35 $480.49 $516.65 $645.12 |
$639.81 $673.95 $710.11 $838.58 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$505.78 $574.06 $646.38 $903.32 $1,372.66 |
$699.24 $767.52 $839.84 $1,096.78 |
$892.70 $960.98 $1,033.30 $1,290.24 |
Toc - Plan #29 Network Health | ||||||||||||||||||||
Silver
(HMO) Prestige Silver Essential + Dental + Vision + Fitness + 3 Free PCP Visits |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$388.89 $441.39 $497.00 $694.56 $1,055.44 |
$686.39 $738.89 $794.50 $992.06 |
$983.89 $1,036.39 $1,092.00 $1,289.56 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$777.78 $882.78 $994.00 $1,389.12 $2,110.88 |
$1,075.28 $1,180.28 $1,291.50 $1,686.62 |
$1,372.78 $1,477.78 $1,589.00 $1,984.12 |
Toc - Plan #30 Network Health | ||||||||||||||||||||
Gold
(HMO) Prestige Gold Essential + Dental + Vision + Fitness + 3 Free PCP Visits |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$360.58 $409.26 $460.82 $644.00 $978.61 |
$636.43 $685.11 $736.67 $919.85 |
$912.28 $960.96 $1,012.52 $1,195.70 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$721.16 $818.52 $921.64 $1,288.00 $1,957.22 |
$997.01 $1,094.37 $1,197.49 $1,563.85 |
$1,272.86 $1,370.22 $1,473.34 $1,839.70 |
Toc - Plan #31 Network Health | ||||||||||||||||||||
Expanded Bronze
(HMO) Prestige Bronze 0 + Dental + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$231.57 $262.83 $295.95 $413.58 $628.47 |
$408.72 $439.98 $473.10 $590.73 |
$585.87 $617.13 $650.25 $767.88 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$463.14 $525.66 $591.90 $827.16 $1,256.94 |
$640.29 $702.81 $769.05 $1,004.31 |
$817.44 $879.96 $946.20 $1,181.46 |
Toc - Plan #32 Network Health | ||||||||||||||||||||
Gold
(HMO) Prestige Gold 50 + Dental + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$368.43 $418.17 $470.86 $658.02 $999.92 |
$650.28 $700.02 $752.71 $939.87 |
$932.13 $981.87 $1,034.56 $1,221.72 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$736.86 $836.34 $941.72 $1,316.04 $1,999.84 |
$1,018.71 $1,118.19 $1,223.57 $1,597.89 |
$1,300.56 $1,400.04 $1,505.42 $1,879.74 |
Toc - Plan #33 Network Health | ||||||||||||||||||||
Gold
(HMO) Prestige Gold 0 HDHP + Dental + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$371.67 $421.85 $475.00 $663.80 $1,008.71 |
$656.00 $706.18 $759.33 $948.13 |
$940.33 $990.51 $1,043.66 $1,232.46 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$743.34 $843.70 $950.00 $1,327.60 $2,017.42 |
$1,027.67 $1,128.03 $1,234.33 $1,611.93 |
$1,312.00 $1,412.36 $1,518.66 $1,896.26 |
Toc - Plan #34 Network Health | ||||||||||||||||||||
Expanded Bronze
(HMO) Signature Prestige Bronze Copay + Dental + Vision + Fitness |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$255.77 $290.30 $326.87 $456.80 $694.15 |
$451.43 $485.96 $522.53 $652.46 |
$647.09 $681.62 $718.19 $848.12 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$511.54 $580.60 $653.74 $913.60 $1,388.30 |
$707.20 $776.26 $849.40 $1,109.26 |
$902.86 $971.92 $1,045.06 $1,304.92 |
ADVERTISEMENT
WPS Health PlanLocal: 1-920-490-6900 | Toll Free: 1-800-332-6249 | TTY: 1-888-332-0144 |
Toc - Plan #35 WPS Health Plan | ||||||||||||||||||||
Bronze
(HMO) WPS HMO Bronze $8,700 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$290.15 $329.32 $370.81 $518.21 $787.47 |
$512.11 $551.28 $592.77 $740.17 |
$734.07 $773.24 $814.73 $962.13 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$580.30 $658.64 $741.62 $1,036.42 $1,574.94 |
$802.26 $880.60 $963.58 $1,258.38 |
$1,024.22 $1,102.56 $1,185.54 $1,480.34 |
Toc - Plan #36 WPS Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) WPS HMO Bronze $6,500 with 3 Free PCP Visits | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$301.62 $342.34 $385.47 $538.69 $818.60 |
$532.36 $573.08 $616.21 $769.43 |
$763.10 $803.82 $846.95 $1,000.17 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$603.24 $684.68 $770.94 $1,077.38 $1,637.20 |
$833.98 $915.42 $1,001.68 $1,308.12 |
$1,064.72 $1,146.16 $1,232.42 $1,538.86 |
Toc - Plan #37 WPS Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) WPS HMO Bronze $7,500 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$290.90 $330.17 $371.77 $519.55 $789.50 |
$513.44 $552.71 $594.31 $742.09 |
$735.98 $775.25 $816.85 $964.63 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$581.80 $660.34 $743.54 $1,039.10 $1,579.00 |
$804.34 $882.88 $966.08 $1,261.64 |
$1,026.88 $1,105.42 $1,188.62 $1,484.18 |
Toc - Plan #38 WPS Health Plan | ||||||||||||||||||||
Silver
(HMO) WPS HMO Silver $7,500 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$379.72 $430.98 $485.28 $678.18 $1,030.56 |
$670.21 $721.47 $775.77 $968.67 |
$960.70 $1,011.96 $1,066.26 $1,259.16 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$759.44 $861.96 $970.56 $1,356.36 $2,061.12 |
$1,049.93 $1,152.45 $1,261.05 $1,646.85 |
$1,340.42 $1,442.94 $1,551.54 $1,937.34 |
Toc - Plan #39 WPS Health Plan | ||||||||||||||||||||
Silver
(HMO) WPS HMO Silver $4,500 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$383.08 $434.80 $489.58 $684.18 $1,039.68 |
$676.14 $727.86 $782.64 $977.24 |
$969.20 $1,020.92 $1,075.70 $1,270.30 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$766.16 $869.60 $979.16 $1,368.36 $2,079.36 |
$1,059.22 $1,162.66 $1,272.22 $1,661.42 |
$1,352.28 $1,455.72 $1,565.28 $1,954.48 |
Toc - Plan #40 WPS Health Plan | ||||||||||||||||||||
Silver
(HMO) WPS HMO Silver $5,000 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$396.98 $450.57 $507.34 $709.01 $1,077.40 |
$700.67 $754.26 $811.03 $1,012.70 |
$1,004.36 $1,057.95 $1,114.72 $1,316.39 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$793.96 $901.14 $1,014.68 $1,418.02 $2,154.80 |
$1,097.65 $1,204.83 $1,318.37 $1,721.71 |
$1,401.34 $1,508.52 $1,622.06 $2,025.40 |
Toc - Plan #41 WPS Health Plan | ||||||||||||||||||||
Gold
(HMO) WPS HMO Gold $3,000 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$519.34 $589.45 $663.72 $927.54 $1,409.49 |
$916.64 $986.75 $1,061.02 $1,324.84 |
$1,313.94 $1,384.05 $1,458.32 $1,722.14 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,038.68 $1,178.90 $1,327.44 $1,855.08 $2,818.98 |
$1,435.98 $1,576.20 $1,724.74 $2,252.38 |
$1,833.28 $1,973.50 $2,122.04 $2,649.68 |
Toc - Plan #42 WPS Health Plan | ||||||||||||||||||||
Catastrophic
(HMO) WPS HMO Catastrophic $8,700 with 3 Free PCP Visits | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$252.25 $286.30 $322.38 $450.52 $684.61 |
$445.22 $479.27 $515.35 $643.49 |
$638.19 $672.24 $708.32 $836.46 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$504.50 $572.60 $644.76 $901.04 $1,369.22 |
$697.47 $765.57 $837.73 $1,094.01 |
$890.44 $958.54 $1,030.70 $1,286.98 |
Toc - Plan #43 WPS Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) WPS HMO HDHP Bronze $7,050 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$302.24 $343.04 $386.26 $539.80 $820.28 |
$533.45 $574.25 $617.47 $771.01 |
$764.66 $805.46 $848.68 $1,002.22 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$604.48 $686.08 $772.52 $1,079.60 $1,640.56 |
$835.69 $917.29 $1,003.73 $1,310.81 |
$1,066.90 $1,148.50 $1,234.94 $1,542.02 |
Toc - Plan #44 WPS Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) WPS HMO HDHP Bronze $6,830 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$308.79 $350.48 $394.63 $551.50 $838.06 |
$545.01 $586.70 $630.85 $787.72 |
$781.23 $822.92 $867.07 $1,023.94 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$617.58 $700.96 $789.26 $1,103.00 $1,676.12 |
$853.80 $937.18 $1,025.48 $1,339.22 |
$1,090.02 $1,173.40 $1,261.70 $1,575.44 |
Toc - Plan #45 WPS Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) WPS HMO HDHP Bronze $6,000 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$302.93 $343.83 $387.14 $541.03 $822.15 |
$534.67 $575.57 $618.88 $772.77 |
$766.41 $807.31 $850.62 $1,004.51 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$605.86 $687.66 $774.28 $1,082.06 $1,644.30 |
$837.60 $919.40 $1,006.02 $1,313.80 |
$1,069.34 $1,151.14 $1,237.76 $1,545.54 |
Toc - Plan #46 WPS Health Plan | ||||||||||||||||||||
Silver
(HMO) WPS HMO HDHP Silver $4,500 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$385.83 $437.92 $493.09 $689.09 $1,047.14 |
$680.99 $733.08 $788.25 $984.25 |
$976.15 $1,028.24 $1,083.41 $1,279.41 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$771.66 $875.84 $986.18 $1,378.18 $2,094.28 |
$1,066.82 $1,171.00 $1,281.34 $1,673.34 |
$1,361.98 $1,466.16 $1,576.50 $1,968.50 |
Toc - Plan #47 WPS Health Plan | ||||||||||||||||||||
Silver
(HMO) WPS HMO HDHP Silver $5,250 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$388.51 $440.96 $496.52 $693.88 $1,054.42 |
$685.72 $738.17 $793.73 $991.09 |
$982.93 $1,035.38 $1,090.94 $1,288.30 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$777.02 $881.92 $993.04 $1,387.76 $2,108.84 |
$1,074.23 $1,179.13 $1,290.25 $1,684.97 |
$1,371.44 $1,476.34 $1,587.46 $1,982.18 |
Toc - Plan #48 WPS Health Plan | ||||||||||||||||||||
Silver
(HMO) WPS HMO HDHP Silver $6,125 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$370.62 $420.65 $473.65 $661.93 $1,005.86 |
$654.14 $704.17 $757.17 $945.45 |
$937.66 $987.69 $1,040.69 $1,228.97 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$741.24 $841.30 $947.30 $1,323.86 $2,011.72 |
$1,024.76 $1,124.82 $1,230.82 $1,607.38 |
$1,308.28 $1,408.34 $1,514.34 $1,890.90 |
Toc - Plan #49 WPS Health Plan | ||||||||||||||||||||
Bronze
(POS) WPS POS Bronze $8,700 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$310.35 $352.25 $396.63 $554.29 $842.29 |
$547.77 $589.67 $634.05 $791.71 |
$785.19 $827.09 $871.47 $1,029.13 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$620.70 $704.50 $793.26 $1,108.58 $1,684.58 |
$858.12 $941.92 $1,030.68 $1,346.00 |
$1,095.54 $1,179.34 $1,268.10 $1,583.42 |
Toc - Plan #50 WPS Health Plan | ||||||||||||||||||||
Expanded Bronze
(POS) WPS POS HDHP Bronze $6,000 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$323.99 $367.73 $414.06 $578.65 $879.31 |
$571.84 $615.58 $661.91 $826.50 |
$819.69 $863.43 $909.76 $1,074.35 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$647.98 $735.46 $828.12 $1,157.30 $1,758.62 |
$895.83 $983.31 $1,075.97 $1,405.15 |
$1,143.68 $1,231.16 $1,323.82 $1,653.00 |
ADVERTISEMENT
Common Ground Healthcare CooperativeLocal: 1-877-514-2442 | Toll Free: 1-877-514-2442 | TTY: 1-844-472-2442 |
Toc - Plan #51 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Solutions Bronze $0 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$274.62 $311.68 $350.95 $490.45 $745.29 |
$484.70 $521.76 $561.03 $700.53 |
$694.78 $731.84 $771.11 $910.61 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$549.24 $623.36 $701.90 $980.90 $1,490.58 |
$759.32 $833.44 $911.98 $1,190.98 |
$969.40 $1,043.52 $1,122.06 $1,401.06 |
Toc - Plan #52 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Solutions Silver $0 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$394.05 $447.23 $503.58 $703.75 $1,069.42 |
$695.49 $748.67 $805.02 $1,005.19 |
$996.93 $1,050.11 $1,106.46 $1,306.63 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$788.10 $894.46 $1,007.16 $1,407.50 $2,138.84 |
$1,089.54 $1,195.90 $1,308.60 $1,708.94 |
$1,390.98 $1,497.34 $1,610.04 $2,010.38 |
Toc - Plan #53 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Solutions Gold $0 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$418.40 $474.87 $534.70 $747.24 $1,135.50 |
$738.46 $794.93 $854.76 $1,067.30 |
$1,058.52 $1,114.99 $1,174.82 $1,387.36 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$836.80 $949.74 $1,069.40 $1,494.48 $2,271.00 |
$1,156.86 $1,269.80 $1,389.46 $1,814.54 |
$1,476.92 $1,589.86 $1,709.52 $2,134.60 |
Toc - Plan #54 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Value 2 Gold $3000 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$366.60 $416.08 $468.50 $654.73 $994.93 |
$647.04 $696.52 $748.94 $935.17 |
$927.48 $976.96 $1,029.38 $1,215.61 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$733.20 $832.16 $937.00 $1,309.46 $1,989.86 |
$1,013.64 $1,112.60 $1,217.44 $1,589.90 |
$1,294.08 $1,393.04 $1,497.88 $1,870.34 |
Toc - Plan #55 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Value 1 Gold $3600 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$355.95 $403.99 $454.89 $635.71 $966.02 |
$628.24 $676.28 $727.18 $908.00 |
$900.53 $948.57 $999.47 $1,180.29 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$711.90 $807.98 $909.78 $1,271.42 $1,932.04 |
$984.19 $1,080.27 $1,182.07 $1,543.71 |
$1,256.48 $1,352.56 $1,454.36 $1,816.00 |
Toc - Plan #56 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Value Premier Gold $1800 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$395.78 $449.20 $505.79 $706.85 $1,074.12 |
$698.54 $751.96 $808.55 $1,009.61 |
$1,001.30 $1,054.72 $1,111.31 $1,312.37 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$791.56 $898.40 $1,011.58 $1,413.70 $2,148.24 |
$1,094.32 $1,201.16 $1,314.34 $1,716.46 |
$1,397.08 $1,503.92 $1,617.10 $2,019.22 |
Toc - Plan #57 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Value Plus Gold $2000 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$368.94 $418.73 $471.49 $658.90 $1,001.27 |
$651.17 $700.96 $753.72 $941.13 |
$933.40 $983.19 $1,035.95 $1,223.36 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$737.88 $837.46 $942.98 $1,317.80 $2,002.54 |
$1,020.11 $1,119.69 $1,225.21 $1,600.03 |
$1,302.34 $1,401.92 $1,507.44 $1,882.26 |
Toc - Plan #58 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Value Plus Silver $4000 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$355.23 $403.17 $453.97 $634.42 $964.06 |
$626.97 $674.91 $725.71 $906.16 |
$898.71 $946.65 $997.45 $1,177.90 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$710.46 $806.34 $907.94 $1,268.84 $1,928.12 |
$982.20 $1,078.08 $1,179.68 $1,540.58 |
$1,253.94 $1,349.82 $1,451.42 $1,812.32 |
Toc - Plan #59 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Value Premier Silver $3000 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$369.99 $419.93 $472.83 $660.78 $1,004.12 |
$653.02 $702.96 $755.86 $943.81 |
$936.05 $985.99 $1,038.89 $1,226.84 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$739.98 $839.86 $945.66 $1,321.56 $2,008.24 |
$1,023.01 $1,122.89 $1,228.69 $1,604.59 |
$1,306.04 $1,405.92 $1,511.72 $1,887.62 |
Toc - Plan #60 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Value 2 Silver $6500 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$302.19 $342.98 $386.19 $539.70 $820.13 |
$533.36 $574.15 $617.36 $770.87 |
$764.53 $805.32 $848.53 $1,002.04 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$604.38 $685.96 $772.38 $1,079.40 $1,640.26 |
$835.55 $917.13 $1,003.55 $1,310.57 |
$1,066.72 $1,148.30 $1,234.72 $1,541.74 |
Toc - Plan #61 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Catastrophic
(EPO) CGHC Catastrophic $8700 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$187.46 $212.76 $239.57 $334.79 $508.75 |
$330.86 $356.16 $382.97 $478.19 |
$474.26 $499.56 $526.37 $621.59 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$374.92 $425.52 $479.14 $669.58 $1,017.50 |
$518.32 $568.92 $622.54 $812.98 |
$661.72 $712.32 $765.94 $956.38 |
Toc - Plan #62 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Value Plus Bronze $8700 Deductible ($35 PCP Copay) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$259.23 $294.21 $331.28 $462.96 $703.52 |
$457.53 $492.51 $529.58 $661.26 |
$655.83 $690.81 $727.88 $859.56 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$518.46 $588.42 $662.56 $925.92 $1,407.04 |
$716.76 $786.72 $860.86 $1,124.22 |
$915.06 $985.02 $1,059.16 $1,322.52 |
Toc - Plan #63 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Value Premier Bronze $8150 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$267.38 $303.47 $341.70 $477.53 $725.65 |
$471.92 $508.01 $546.24 $682.07 |
$676.46 $712.55 $750.78 $886.61 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$534.76 $606.94 $683.40 $955.06 $1,451.30 |
$739.30 $811.48 $887.94 $1,159.60 |
$943.84 $1,016.02 $1,092.48 $1,364.14 |
Toc - Plan #64 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC HSA Bronze $7000 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$269.19 $305.52 $344.01 $480.75 $730.55 |
$475.11 $511.44 $549.93 $686.67 |
$681.03 $717.36 $755.85 $892.59 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$538.38 $611.04 $688.02 $961.50 $1,461.10 |
$744.30 $816.96 $893.94 $1,167.42 |
$950.22 $1,022.88 $1,099.86 $1,373.34 |
Toc - Plan #65 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC HSA Gold $2800 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$420.21 $476.93 $537.01 $750.47 $1,140.42 |
$741.66 $798.38 $858.46 $1,071.92 |
$1,063.11 $1,119.83 $1,179.91 $1,393.37 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$840.42 $953.86 $1,074.02 $1,500.94 $2,280.84 |
$1,161.87 $1,275.31 $1,395.47 $1,822.39 |
$1,483.32 $1,596.76 $1,716.92 $2,143.84 |
Toc - Plan #66 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC HSA Silver $3000 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$408.75 $463.92 $522.36 $730.00 $1,109.31 |
$721.43 $776.60 $835.04 $1,042.68 |
$1,034.11 $1,089.28 $1,147.72 $1,355.36 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$817.50 $927.84 $1,044.72 $1,460.00 $2,218.62 |
$1,130.18 $1,240.52 $1,357.40 $1,772.68 |
$1,442.86 $1,553.20 $1,670.08 $2,085.36 |
Toc - Plan #67 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Bronze
(EPO) CGHC Value 1 Bronze $8700 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$257.50 $292.26 $329.08 $459.88 $698.84 |
$454.48 $489.24 $526.06 $656.86 |
$651.46 $686.22 $723.04 $853.84 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$515.00 $584.52 $658.16 $919.76 $1,397.68 |
$711.98 $781.50 $855.14 $1,116.74 |
$908.96 $978.48 $1,052.12 $1,313.72 |
Toc - Plan #68 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Value 2 Bronze $6000 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$265.00 $300.76 $338.66 $473.27 $719.18 |
$467.72 $503.48 $541.38 $675.99 |
$670.44 $706.20 $744.10 $878.71 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$530.00 $601.52 $677.32 $946.54 $1,438.36 |
$732.72 $804.24 $880.04 $1,149.26 |
$935.44 $1,006.96 $1,082.76 $1,351.98 |
Toc - Plan #69 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Value 1 Silver $7500 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$302.13 $342.91 $386.11 $539.59 $819.96 |
$533.25 $574.03 $617.23 $770.71 |
$764.37 $805.15 $848.35 $1,001.83 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$604.26 $685.82 $772.22 $1,079.18 $1,639.92 |
$835.38 $916.94 $1,003.34 $1,310.30 |
$1,066.50 $1,148.06 $1,234.46 $1,541.42 |
Toc - Plan #70 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Value Premier Gold $1800 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$398.78 $452.60 $509.62 $712.20 $1,082.25 |
$703.84 $757.66 $814.68 $1,017.26 |
$1,008.90 $1,062.72 $1,119.74 $1,322.32 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$797.56 $905.20 $1,019.24 $1,424.40 $2,164.50 |
$1,102.62 $1,210.26 $1,324.30 $1,729.46 |
$1,407.68 $1,515.32 $1,629.36 $2,034.52 |
Toc - Plan #71 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Value Plus Gold $2000 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$371.91 $422.11 $475.29 $664.22 $1,009.34 |
$656.42 $706.62 $759.80 $948.73 |
$940.93 $991.13 $1,044.31 $1,233.24 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$743.82 $844.22 $950.58 $1,328.44 $2,018.68 |
$1,028.33 $1,128.73 $1,235.09 $1,612.95 |
$1,312.84 $1,413.24 $1,519.60 $1,897.46 |
Toc - Plan #72 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Value 2 Gold $3000 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$369.58 $419.46 $472.31 $660.05 $1,003.01 |
$652.30 $702.18 $755.03 $942.77 |
$935.02 $984.90 $1,037.75 $1,225.49 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$739.16 $838.92 $944.62 $1,320.10 $2,006.02 |
$1,021.88 $1,121.64 $1,227.34 $1,602.82 |
$1,304.60 $1,404.36 $1,510.06 $1,885.54 |
Toc - Plan #73 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Value 1 Gold $3600 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$358.92 $407.36 $458.68 $641.01 $974.07 |
$633.48 $681.92 $733.24 $915.57 |
$908.04 $956.48 $1,007.80 $1,190.13 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$717.84 $814.72 $917.36 $1,282.02 $1,948.14 |
$992.40 $1,089.28 $1,191.92 $1,556.58 |
$1,266.96 $1,363.84 $1,466.48 $1,831.14 |
Toc - Plan #74 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Value Plus Silver $4000 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$358.19 $406.54 $457.76 $639.72 $972.11 |
$632.20 $680.55 $731.77 $913.73 |
$906.21 $954.56 $1,005.78 $1,187.74 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$716.38 $813.08 $915.52 $1,279.44 $1,944.22 |
$990.39 $1,087.09 $1,189.53 $1,553.45 |
$1,264.40 $1,361.10 $1,463.54 $1,827.46 |
Toc - Plan #75 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Value Premier Silver $3000 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$372.96 $423.30 $476.64 $666.10 $1,012.20 |
$658.27 $708.61 $761.95 $951.41 |
$943.58 $993.92 $1,047.26 $1,236.72 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$745.92 $846.60 $953.28 $1,332.20 $2,024.40 |
$1,031.23 $1,131.91 $1,238.59 $1,617.51 |
$1,316.54 $1,417.22 $1,523.90 $1,902.82 |
Toc - Plan #76 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Value 1 Silver $7500 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$305.06 $346.23 $389.85 $544.82 $827.90 |
$538.42 $579.59 $623.21 $778.18 |
$771.78 $812.95 $856.57 $1,011.54 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$610.12 $692.46 $779.70 $1,089.64 $1,655.80 |
$843.48 $925.82 $1,013.06 $1,323.00 |
$1,076.84 $1,159.18 $1,246.42 $1,556.36 |
Toc - Plan #77 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Value 2 Silver $6500 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$305.13 $346.31 $389.94 $544.94 $828.09 |
$538.55 $579.73 $623.36 $778.36 |
$771.97 $813.15 $856.78 $1,011.78 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$610.26 $692.62 $779.88 $1,089.88 $1,656.18 |
$843.68 $926.04 $1,013.30 $1,323.30 |
$1,077.10 $1,159.46 $1,246.72 $1,556.72 |
Toc - Plan #78 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Bronze
(EPO) CGHC Value 1 Bronze $8700 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$260.41 $295.55 $332.79 $465.07 $706.72 |
$459.62 $494.76 $532.00 $664.28 |
$658.83 $693.97 $731.21 $863.49 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$520.82 $591.10 $665.58 $930.14 $1,413.44 |
$720.03 $790.31 $864.79 $1,129.35 |
$919.24 $989.52 $1,064.00 $1,328.56 |
Toc - Plan #79 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Value Plus Bronze $8700 Deductible ($35 PCP Copay+ Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$262.13 $297.51 $334.99 $468.15 $711.40 |
$462.65 $498.03 $535.51 $668.67 |
$663.17 $698.55 $736.03 $869.19 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$524.26 $595.02 $669.98 $936.30 $1,422.80 |
$724.78 $795.54 $870.50 $1,136.82 |
$925.30 $996.06 $1,071.02 $1,337.34 |
Toc - Plan #80 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Value Premier Bronze $8150 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$270.30 $306.78 $345.43 $482.74 $733.57 |
$477.07 $513.55 $552.20 $689.51 |
$683.84 $720.32 $758.97 $896.28 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$540.60 $613.56 $690.86 $965.48 $1,467.14 |
$747.37 $820.33 $897.63 $1,172.25 |
$954.14 $1,027.10 $1,104.40 $1,379.02 |
Toc - Plan #81 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Value 2 Bronze $6000 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$267.90 $304.06 $342.37 $478.46 $727.07 |
$472.84 $509.00 $547.31 $683.40 |
$677.78 $713.94 $752.25 $888.34 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$535.80 $608.12 $684.74 $956.92 $1,454.14 |
$740.74 $813.06 $889.68 $1,161.86 |
$945.68 $1,018.00 $1,094.62 $1,366.80 |
Toc - Plan #82 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC HSA Bronze $7000 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$272.10 $308.83 $347.73 $485.96 $738.46 |
$480.25 $516.98 $555.88 $694.11 |
$688.40 $725.13 $764.03 $902.26 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$544.20 $617.66 $695.46 $971.92 $1,476.92 |
$752.35 $825.81 $903.61 $1,180.07 |
$960.50 $1,033.96 $1,111.76 $1,388.22 |
Toc - Plan #83 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC HSA Silver $3000 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$411.75 $467.33 $526.21 $735.37 $1,117.47 |
$726.73 $782.31 $841.19 $1,050.35 |
$1,041.71 $1,097.29 $1,156.17 $1,365.33 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$823.50 $934.66 $1,052.42 $1,470.74 $2,234.94 |
$1,138.48 $1,249.64 $1,367.40 $1,785.72 |
$1,453.46 $1,564.62 $1,682.38 $2,100.70 |
Toc - Plan #84 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC HSA Gold $2800 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$423.22 $480.35 $540.87 $755.86 $1,148.60 |
$746.98 $804.11 $864.63 $1,079.62 |
$1,070.74 $1,127.87 $1,188.39 $1,403.38 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$846.44 $960.70 $1,081.74 $1,511.72 $2,297.20 |
$1,170.20 $1,284.46 $1,405.50 $1,835.48 |
$1,493.96 $1,608.22 $1,729.26 $2,159.24 |
Toc - Plan #85 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Solutions Bronze $0 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$277.53 $314.99 $354.68 $495.66 $753.20 |
$489.84 $527.30 $566.99 $707.97 |
$702.15 $739.61 $779.30 $920.28 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$555.06 $629.98 $709.36 $991.32 $1,506.40 |
$767.37 $842.29 $921.67 $1,203.63 |
$979.68 $1,054.60 $1,133.98 $1,415.94 |
Toc - Plan #86 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Solutions Silver $0 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$397.04 $450.63 $507.41 $709.10 $1,077.55 |
$700.77 $754.36 $811.14 $1,012.83 |
$1,004.50 $1,058.09 $1,114.87 $1,316.56 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$794.08 $901.26 $1,014.82 $1,418.20 $2,155.10 |
$1,097.81 $1,204.99 $1,318.55 $1,721.93 |
$1,401.54 $1,508.72 $1,622.28 $2,025.66 |
Toc - Plan #87 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Solutions Gold $0 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$421.40 $478.28 $538.54 $752.60 $1,143.66 |
$743.76 $800.64 $860.90 $1,074.96 |
$1,066.12 $1,123.00 $1,183.26 $1,397.32 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$842.80 $956.56 $1,077.08 $1,505.20 $2,287.32 |
$1,165.16 $1,278.92 $1,399.44 $1,827.56 |
$1,487.52 $1,601.28 $1,721.80 $2,149.92 |
‡Source: HealthCare.gov has released sample rates for all counties in the 36 states served by HealthCare.gov. We have integrated that data into our tables and provide you that information for Waupaca County here.
Waupaca County is in “Rating Area 10” of Wisconsin.
Currently, there are 87 plans offered in Rating Area 10.