Obamacare 2023 Rates for Fond Du Lac County
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Obamacare > Rates > Wisconsin > Fond Du Lac 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 | ||||||||||||||||||||
Silver
(HMO) QUARTZ ONE SILVER I303 with Dental & Vision |
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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 |
$512.03 $581.15 $654.37 $914.49 $1,389.65 |
$903.73 $972.85 $1,046.07 $1,306.19 |
$1,295.43 $1,364.55 $1,437.77 $1,697.89 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$1,024.06 $1,162.30 $1,308.74 $1,828.98 $2,779.30 |
$1,415.76 $1,554.00 $1,700.44 $2,220.68 |
$1,807.46 $1,945.70 $2,092.14 $2,612.38 |
Toc - Plan #2 Quartz | ||||||||||||||||||||
Silver
(HMO) QUARTZ ONE SILVER I308 with Dental & Vision |
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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 |
$537.22 $609.74 $686.56 $959.46 $1,458.00 |
$948.19 $1,020.71 $1,097.53 $1,370.43 |
$1,359.16 $1,431.68 $1,508.50 $1,781.40 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$1,074.44 $1,219.48 $1,373.12 $1,918.92 $2,916.00 |
$1,485.41 $1,630.45 $1,784.09 $2,329.89 |
$1,896.38 $2,041.42 $2,195.06 $2,740.86 |
Toc - Plan #3 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One Silver I309 Standard with Dental & Vision |
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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 |
$562.65 $638.61 $719.07 $1,004.89 $1,527.03 |
$993.08 $1,069.04 $1,149.50 $1,435.32 |
$1,423.51 $1,499.47 $1,579.93 $1,865.75 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$1,125.30 $1,277.22 $1,438.14 $2,009.78 $3,054.06 |
$1,555.73 $1,707.65 $1,868.57 $2,440.21 |
$1,986.16 $2,138.08 $2,299.00 $2,870.64 |
Toc - Plan #4 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I201 with Dental & Vision |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$380.83 $432.23 $486.69 $680.15 $1,033.55 |
$672.16 $723.56 $778.02 $971.48 |
$963.49 $1,014.89 $1,069.35 $1,262.81 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$761.66 $864.46 $973.38 $1,360.30 $2,067.10 |
$1,052.99 $1,155.79 $1,264.71 $1,651.63 |
$1,344.32 $1,447.12 $1,556.04 $1,942.96 |
Toc - Plan #5 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I202 with Dental & Vision |
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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 |
$384.60 $436.51 $491.51 $686.88 $1,043.78 |
$678.81 $730.72 $785.72 $981.09 |
$973.02 $1,024.93 $1,079.93 $1,275.30 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$769.20 $873.02 $983.02 $1,373.76 $2,087.56 |
$1,063.41 $1,167.23 $1,277.23 $1,667.97 |
$1,357.62 $1,461.44 $1,571.44 $1,962.18 |
Toc - Plan #6 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I204 with Dental & Vision |
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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 |
$403.14 $457.56 $515.20 $719.99 $1,094.10 |
$711.54 $765.96 $823.60 $1,028.39 |
$1,019.94 $1,074.36 $1,132.00 $1,336.79 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$806.28 $915.12 $1,030.40 $1,439.98 $2,188.20 |
$1,114.68 $1,223.52 $1,338.80 $1,748.38 |
$1,423.08 $1,531.92 $1,647.20 $2,056.78 |
Toc - Plan #7 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I205 with Dental & Vision |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$399.02 $452.88 $509.94 $712.64 $1,082.92 |
$704.26 $758.12 $815.18 $1,017.88 |
$1,009.50 $1,063.36 $1,120.42 $1,323.12 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$798.04 $905.76 $1,019.88 $1,425.28 $2,165.84 |
$1,103.28 $1,211.00 $1,325.12 $1,730.52 |
$1,408.52 $1,516.24 $1,630.36 $2,035.76 |
Toc - Plan #8 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One Bronze I206 Standard with Dental & Vision |
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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 |
$415.44 $471.52 $530.93 $741.97 $1,127.50 |
$733.25 $789.33 $848.74 $1,059.78 |
$1,051.06 $1,107.14 $1,166.55 $1,377.59 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$830.88 $943.04 $1,061.86 $1,483.94 $2,255.00 |
$1,148.69 $1,260.85 $1,379.67 $1,801.75 |
$1,466.50 $1,578.66 $1,697.48 $2,119.56 |
Toc - Plan #9 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I407 Maintenance with Dental & Vision |
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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 |
$520.83 $591.13 $665.61 $930.19 $1,413.51 |
$919.26 $989.56 $1,064.04 $1,328.62 |
$1,317.69 $1,387.99 $1,462.47 $1,727.05 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$1,041.66 $1,182.26 $1,331.22 $1,860.38 $2,827.02 |
$1,440.09 $1,580.69 $1,729.65 $2,258.81 |
$1,838.52 $1,979.12 $2,128.08 $2,657.24 |
Toc - Plan #10 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I406 with Dental & Vision |
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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 |
$455.81 $517.33 $582.51 $814.06 $1,237.05 |
$804.50 $866.02 $931.20 $1,162.75 |
$1,153.19 $1,214.71 $1,279.89 $1,511.44 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$911.62 $1,034.66 $1,165.02 $1,628.12 $2,474.10 |
$1,260.31 $1,383.35 $1,513.71 $1,976.81 |
$1,609.00 $1,732.04 $1,862.40 $2,325.50 |
Toc - Plan #11 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I409 with Dental & Vision |
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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 |
$464.85 $527.60 $594.07 $830.21 $1,261.59 |
$820.46 $883.21 $949.68 $1,185.82 |
$1,176.07 $1,238.82 $1,305.29 $1,541.43 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$929.70 $1,055.20 $1,188.14 $1,660.42 $2,523.18 |
$1,285.31 $1,410.81 $1,543.75 $2,016.03 |
$1,640.92 $1,766.42 $1,899.36 $2,371.64 |
Toc - Plan #12 Quartz | ||||||||||||||||||||
Silver
(HMO) Tiered Choice Plus Silver I305 with Dental & Vision |
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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 |
$489.70 $555.81 $625.83 $874.60 $1,329.04 |
$864.32 $930.43 $1,000.45 $1,249.22 |
$1,238.94 $1,305.05 $1,375.07 $1,623.84 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$979.40 $1,111.62 $1,251.66 $1,749.20 $2,658.08 |
$1,354.02 $1,486.24 $1,626.28 $2,123.82 |
$1,728.64 $1,860.86 $2,000.90 $2,498.44 |
Toc - Plan #13 Quartz | ||||||||||||||||||||
Gold
(HMO) Quartz One Gold I410 Standard with Dental & Vision |
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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 |
$513.96 $583.34 $656.84 $917.93 $1,394.88 |
$907.14 $976.52 $1,050.02 $1,311.11 |
$1,300.32 $1,369.70 $1,443.20 $1,704.29 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$1,027.92 $1,166.68 $1,313.68 $1,835.86 $2,789.76 |
$1,421.10 $1,559.86 $1,706.86 $2,229.04 |
$1,814.28 $1,953.04 $2,100.04 $2,622.22 |
Toc - Plan #14 Quartz | ||||||||||||||||||||
Silver
(HMO) QUARTZ ONE SILVER I303 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$489.33 $555.39 $625.36 $873.94 $1,328.04 |
$863.67 $929.73 $999.70 $1,248.28 |
$1,238.01 $1,304.07 $1,374.04 $1,622.62 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$978.66 $1,110.78 $1,250.72 $1,747.88 $2,656.08 |
$1,353.00 $1,485.12 $1,625.06 $2,122.22 |
$1,727.34 $1,859.46 $1,999.40 $2,496.56 |
Toc - Plan #15 Quartz | ||||||||||||||||||||
Silver
(HMO) QUARTZ ONE SILVER I308 |
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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 |
$513.40 $582.70 $656.12 $916.93 $1,393.36 |
$906.15 $975.45 $1,048.87 $1,309.68 |
$1,298.90 $1,368.20 $1,441.62 $1,702.43 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$1,026.80 $1,165.40 $1,312.24 $1,833.86 $2,786.72 |
$1,419.55 $1,558.15 $1,704.99 $2,226.61 |
$1,812.30 $1,950.90 $2,097.74 $2,619.36 |
Toc - Plan #16 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One Silver I309 Standard |
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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 |
$537.71 $610.29 $687.19 $960.34 $1,459.33 |
$949.05 $1,021.63 $1,098.53 $1,371.68 |
$1,360.39 $1,432.97 $1,509.87 $1,783.02 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$1,075.42 $1,220.58 $1,374.38 $1,920.68 $2,918.66 |
$1,486.76 $1,631.92 $1,785.72 $2,332.02 |
$1,898.10 $2,043.26 $2,197.06 $2,743.36 |
Toc - Plan #17 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I201 |
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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 |
$363.94 $413.07 $465.11 $649.99 $987.73 |
$642.35 $691.48 $743.52 $928.40 |
$920.76 $969.89 $1,021.93 $1,206.81 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$727.88 $826.14 $930.22 $1,299.98 $1,975.46 |
$1,006.29 $1,104.55 $1,208.63 $1,578.39 |
$1,284.70 $1,382.96 $1,487.04 $1,856.80 |
Toc - Plan #18 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I202 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$367.55 $417.16 $469.72 $656.43 $997.50 |
$648.72 $698.33 $750.89 $937.60 |
$929.89 $979.50 $1,032.06 $1,218.77 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$735.10 $834.32 $939.44 $1,312.86 $1,995.00 |
$1,016.27 $1,115.49 $1,220.61 $1,594.03 |
$1,297.44 $1,396.66 $1,501.78 $1,875.20 |
Toc - Plan #19 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I204 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$385.26 $437.27 $492.36 $688.07 $1,045.59 |
$679.98 $731.99 $787.08 $982.79 |
$974.70 $1,026.71 $1,081.80 $1,277.51 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$770.52 $874.54 $984.72 $1,376.14 $2,091.18 |
$1,065.24 $1,169.26 $1,279.44 $1,670.86 |
$1,359.96 $1,463.98 $1,574.16 $1,965.58 |
Toc - Plan #20 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I205 |
||||||||||||||||||||
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 |
$381.33 $432.80 $487.33 $681.04 $1,034.91 |
$673.04 $724.51 $779.04 $972.75 |
$964.75 $1,016.22 $1,070.75 $1,264.46 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$762.66 $865.60 $974.66 $1,362.08 $2,069.82 |
$1,054.37 $1,157.31 $1,266.37 $1,653.79 |
$1,346.08 $1,449.02 $1,558.08 $1,945.50 |
Toc - Plan #21 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One Bronze I206 Standard |
||||||||||||||||||||
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 |
$397.03 $450.62 $507.39 $709.08 $1,077.51 |
$700.75 $754.34 $811.11 $1,012.80 |
$1,004.47 $1,058.06 $1,114.83 $1,316.52 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$794.06 $901.24 $1,014.78 $1,418.16 $2,155.02 |
$1,097.78 $1,204.96 $1,318.50 $1,721.88 |
$1,401.50 $1,508.68 $1,622.22 $2,025.60 |
Toc - Plan #22 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I407 Maintenance |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$497.74 $564.93 $636.10 $888.95 $1,350.85 |
$878.51 $945.70 $1,016.87 $1,269.72 |
$1,259.28 $1,326.47 $1,397.64 $1,650.49 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$995.48 $1,129.86 $1,272.20 $1,777.90 $2,701.70 |
$1,376.25 $1,510.63 $1,652.97 $2,158.67 |
$1,757.02 $1,891.40 $2,033.74 $2,539.44 |
Toc - Plan #23 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 |
$435.60 $494.40 $556.69 $777.97 $1,182.20 |
$768.83 $827.63 $889.92 $1,111.20 |
$1,102.06 $1,160.86 $1,223.15 $1,444.43 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$871.20 $988.80 $1,113.38 $1,555.94 $2,364.40 |
$1,204.43 $1,322.03 $1,446.61 $1,889.17 |
$1,537.66 $1,655.26 $1,779.84 $2,222.40 |
Toc - Plan #24 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 |
$444.24 $504.21 $567.73 $793.40 $1,205.66 |
$784.08 $844.05 $907.57 $1,133.24 |
$1,123.92 $1,183.89 $1,247.41 $1,473.08 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$888.48 $1,008.42 $1,135.46 $1,586.80 $2,411.32 |
$1,228.32 $1,348.26 $1,475.30 $1,926.64 |
$1,568.16 $1,688.10 $1,815.14 $2,266.48 |
Toc - Plan #25 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 |
$467.99 $531.16 $598.08 $835.82 $1,270.11 |
$826.00 $889.17 $956.09 $1,193.83 |
$1,184.01 $1,247.18 $1,314.10 $1,551.84 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$935.98 $1,062.32 $1,196.16 $1,671.64 $2,540.22 |
$1,293.99 $1,420.33 $1,554.17 $2,029.65 |
$1,652.00 $1,778.34 $1,912.18 $2,387.66 |
Toc - Plan #26 Quartz | ||||||||||||||||||||
Gold
(HMO) Quartz One Gold I410 Standard |
||||||||||||||||||||
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 |
$491.17 $557.48 $627.72 $877.23 $1,333.03 |
$866.91 $933.22 $1,003.46 $1,252.97 |
$1,242.65 $1,308.96 $1,379.20 $1,628.71 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$982.34 $1,114.96 $1,255.44 $1,754.46 $2,666.06 |
$1,358.08 $1,490.70 $1,631.18 $2,130.20 |
$1,733.82 $1,866.44 $2,006.92 $2,505.94 |
Toc - Plan #27 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I408 HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$461.19 $523.44 $589.39 $823.67 $1,251.65 |
$814.00 $876.25 $942.20 $1,176.48 |
$1,166.81 $1,229.06 $1,295.01 $1,529.29 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$922.38 $1,046.88 $1,178.78 $1,647.34 $2,503.30 |
$1,275.19 $1,399.69 $1,531.59 $2,000.15 |
$1,628.00 $1,752.50 $1,884.40 $2,352.96 |
Toc - Plan #28 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I203 |
||||||||||||||||||||
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 |
$382.47 $434.09 $488.79 $683.08 $1,038.00 |
$675.05 $726.67 $781.37 $975.66 |
$967.63 $1,019.25 $1,073.95 $1,268.24 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$764.94 $868.18 $977.58 $1,366.16 $2,076.00 |
$1,057.52 $1,160.76 $1,270.16 $1,658.74 |
$1,350.10 $1,453.34 $1,562.74 $1,951.32 |
Toc - Plan #29 Quartz | ||||||||||||||||||||
Catastrophic
(HMO) QUARTZ ONE CATASTROPHIC I101 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$281.95 $320.00 $360.32 $503.55 $765.19 |
$497.64 $535.69 $576.01 $719.24 |
$713.33 $751.38 $791.70 $934.93 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$563.90 $640.00 $720.64 $1,007.10 $1,530.38 |
$779.59 $855.69 $936.33 $1,222.79 |
$995.28 $1,071.38 $1,152.02 $1,438.48 |
Toc - Plan #30 Quartz | ||||||||||||||||||||
Silver
(HMO) Tiered Choice Plus Silver I310 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 |
$514.65 $584.12 $657.71 $919.15 $1,396.74 |
$908.35 $977.82 $1,051.41 $1,312.85 |
$1,302.05 $1,371.52 $1,445.11 $1,706.55 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,029.30 $1,168.24 $1,315.42 $1,838.30 $2,793.48 |
$1,423.00 $1,561.94 $1,709.12 $2,232.00 |
$1,816.70 $1,955.64 $2,102.82 $2,625.70 |
Toc - Plan #31 Quartz | ||||||||||||||||||||
Silver
(HMO) Tiered Choice Plus Silver I311 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 |
$504.51 $572.61 $644.75 $901.04 $1,369.22 |
$890.45 $958.55 $1,030.69 $1,286.98 |
$1,276.39 $1,344.49 $1,416.63 $1,672.92 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,009.02 $1,145.22 $1,289.50 $1,802.08 $2,738.44 |
$1,394.96 $1,531.16 $1,675.44 $2,188.02 |
$1,780.90 $1,917.10 $2,061.38 $2,573.96 |
Toc - Plan #32 Quartz | ||||||||||||||||||||
Silver
(HMO) QUARTZ ONE SILVER I303 with Vision |
||||||||||||||||||||
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 |
$495.02 $561.84 $632.63 $884.09 $1,343.46 |
$873.70 $940.52 $1,011.31 $1,262.77 |
$1,252.38 $1,319.20 $1,389.99 $1,641.45 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$990.04 $1,123.68 $1,265.26 $1,768.18 $2,686.92 |
$1,368.72 $1,502.36 $1,643.94 $2,146.86 |
$1,747.40 $1,881.04 $2,022.62 $2,525.54 |
Toc - Plan #33 Quartz | ||||||||||||||||||||
Silver
(HMO) QUARTZ ONE SILVER I308 with Vision |
||||||||||||||||||||
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 |
$519.36 $589.47 $663.74 $927.58 $1,409.54 |
$916.67 $986.78 $1,061.05 $1,324.89 |
$1,313.98 $1,384.09 $1,458.36 $1,722.20 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,038.72 $1,178.94 $1,327.48 $1,855.16 $2,819.08 |
$1,436.03 $1,576.25 $1,724.79 $2,252.47 |
$1,833.34 $1,973.56 $2,122.10 $2,649.78 |
Toc - Plan #34 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One Silver I309 Standard with Vision |
||||||||||||||||||||
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 |
$543.96 $617.38 $695.17 $971.49 $1,476.28 |
$960.08 $1,033.50 $1,111.29 $1,387.61 |
$1,376.20 $1,449.62 $1,527.41 $1,803.73 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,087.92 $1,234.76 $1,390.34 $1,942.98 $2,952.56 |
$1,504.04 $1,650.88 $1,806.46 $2,359.10 |
$1,920.16 $2,067.00 $2,222.58 $2,775.22 |
Toc - Plan #35 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I201 with Vision |
||||||||||||||||||||
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 |
$368.17 $417.87 $470.52 $657.55 $999.20 |
$649.82 $699.52 $752.17 $939.20 |
$931.47 $981.17 $1,033.82 $1,220.85 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$736.34 $835.74 $941.04 $1,315.10 $1,998.40 |
$1,017.99 $1,117.39 $1,222.69 $1,596.75 |
$1,299.64 $1,399.04 $1,504.34 $1,878.40 |
Toc - Plan #36 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I202 with Vision |
||||||||||||||||||||
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 |
$371.81 $422.00 $475.17 $664.05 $1,009.09 |
$656.24 $706.43 $759.60 $948.48 |
$940.67 $990.86 $1,044.03 $1,232.91 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$743.62 $844.00 $950.34 $1,328.10 $2,018.18 |
$1,028.05 $1,128.43 $1,234.77 $1,612.53 |
$1,312.48 $1,412.86 $1,519.20 $1,896.96 |
Toc - Plan #37 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I204 with Vision |
||||||||||||||||||||
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 |
$389.74 $442.35 $498.08 $696.07 $1,057.74 |
$687.89 $740.50 $796.23 $994.22 |
$986.04 $1,038.65 $1,094.38 $1,292.37 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$779.48 $884.70 $996.16 $1,392.14 $2,115.48 |
$1,077.63 $1,182.85 $1,294.31 $1,690.29 |
$1,375.78 $1,481.00 $1,592.46 $1,988.44 |
Toc - Plan #38 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I205 with Vision |
||||||||||||||||||||
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 |
$385.76 $437.83 $492.99 $688.95 $1,046.93 |
$680.86 $732.93 $788.09 $984.05 |
$975.96 $1,028.03 $1,083.19 $1,279.15 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$771.52 $875.66 $985.98 $1,377.90 $2,093.86 |
$1,066.62 $1,170.76 $1,281.08 $1,673.00 |
$1,361.72 $1,465.86 $1,576.18 $1,968.10 |
Toc - Plan #39 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One Bronze I206 Standard with Vision |
||||||||||||||||||||
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 |
$401.64 $455.85 $513.29 $717.31 $1,090.03 |
$708.89 $763.10 $820.54 $1,024.56 |
$1,016.14 $1,070.35 $1,127.79 $1,331.81 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$803.28 $911.70 $1,026.58 $1,434.62 $2,180.06 |
$1,110.53 $1,218.95 $1,333.83 $1,741.87 |
$1,417.78 $1,526.20 $1,641.08 $2,049.12 |
Toc - Plan #40 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I203 with Vision |
||||||||||||||||||||
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 |
$386.91 $439.14 $494.46 $691.01 $1,050.06 |
$682.89 $735.12 $790.44 $986.99 |
$978.87 $1,031.10 $1,086.42 $1,282.97 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$773.82 $878.28 $988.92 $1,382.02 $2,100.12 |
$1,069.80 $1,174.26 $1,284.90 $1,678.00 |
$1,365.78 $1,470.24 $1,580.88 $1,973.98 |
Toc - Plan #41 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I407 Maintenance with Vision |
||||||||||||||||||||
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 |
$503.52 $571.49 $643.49 $899.28 $1,366.54 |
$888.71 $956.68 $1,028.68 $1,284.47 |
$1,273.90 $1,341.87 $1,413.87 $1,669.66 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,007.04 $1,142.98 $1,286.98 $1,798.56 $2,733.08 |
$1,392.23 $1,528.17 $1,672.17 $2,183.75 |
$1,777.42 $1,913.36 $2,057.36 $2,568.94 |
Toc - Plan #42 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I406 with Vision |
||||||||||||||||||||
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 |
$440.66 $500.14 $563.15 $787.01 $1,195.93 |
$777.76 $837.24 $900.25 $1,124.11 |
$1,114.86 $1,174.34 $1,237.35 $1,461.21 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$881.32 $1,000.28 $1,126.30 $1,574.02 $2,391.86 |
$1,218.42 $1,337.38 $1,463.40 $1,911.12 |
$1,555.52 $1,674.48 $1,800.50 $2,248.22 |
Toc - Plan #43 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I409 with Vision |
||||||||||||||||||||
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 |
$449.40 $510.06 $574.33 $802.62 $1,219.66 |
$793.19 $853.85 $918.12 $1,146.41 |
$1,136.98 $1,197.64 $1,261.91 $1,490.20 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$898.80 $1,020.12 $1,148.66 $1,605.24 $2,439.32 |
$1,242.59 $1,363.91 $1,492.45 $1,949.03 |
$1,586.38 $1,707.70 $1,836.24 $2,292.82 |
Toc - Plan #44 Quartz | ||||||||||||||||||||
Silver
(HMO) Tiered Choice Plus Silver I305 with Vision |
||||||||||||||||||||
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 |
$473.43 $537.33 $605.03 $845.53 $1,284.87 |
$835.60 $899.50 $967.20 $1,207.70 |
$1,197.77 $1,261.67 $1,329.37 $1,569.87 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$946.86 $1,074.66 $1,210.06 $1,691.06 $2,569.74 |
$1,309.03 $1,436.83 $1,572.23 $2,053.23 |
$1,671.20 $1,799.00 $1,934.40 $2,415.40 |
Toc - Plan #45 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I408 HSA with Vision |
||||||||||||||||||||
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 |
$466.55 $529.52 $596.24 $833.24 $1,266.19 |
$823.45 $886.42 $953.14 $1,190.14 |
$1,180.35 $1,243.32 $1,310.04 $1,547.04 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$933.10 $1,059.04 $1,192.48 $1,666.48 $2,532.38 |
$1,290.00 $1,415.94 $1,549.38 $2,023.38 |
$1,646.90 $1,772.84 $1,906.28 $2,380.28 |
Toc - Plan #46 Quartz | ||||||||||||||||||||
Silver
(HMO) Tiered Choice Plus Silver I310 HSA with Vision |
||||||||||||||||||||
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 |
$520.63 $590.91 $665.35 $929.83 $1,412.97 |
$918.91 $989.19 $1,063.63 $1,328.11 |
$1,317.19 $1,387.47 $1,461.91 $1,726.39 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,041.26 $1,181.82 $1,330.70 $1,859.66 $2,825.94 |
$1,439.54 $1,580.10 $1,728.98 $2,257.94 |
$1,837.82 $1,978.38 $2,127.26 $2,656.22 |
Toc - Plan #47 Quartz | ||||||||||||||||||||
Silver
(HMO) Tiered Choice Plus Silver I311 HSA with Vision |
||||||||||||||||||||
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 |
$510.37 $579.26 $652.24 $911.51 $1,385.12 |
$900.80 $969.69 $1,042.67 $1,301.94 |
$1,291.23 $1,360.12 $1,433.10 $1,692.37 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,020.74 $1,158.52 $1,304.48 $1,823.02 $2,770.24 |
$1,411.17 $1,548.95 $1,694.91 $2,213.45 |
$1,801.60 $1,939.38 $2,085.34 $2,603.88 |
Toc - Plan #48 Quartz | ||||||||||||||||||||
Gold
(HMO) Quartz One Gold I410 Standard with Vision |
||||||||||||||||||||
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 |
$496.88 $563.95 $635.01 $887.42 $1,348.52 |
$876.99 $944.06 $1,015.12 $1,267.53 |
$1,257.10 $1,324.17 $1,395.23 $1,647.64 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$993.76 $1,127.90 $1,270.02 $1,774.84 $2,697.04 |
$1,373.87 $1,508.01 $1,650.13 $2,154.95 |
$1,753.98 $1,888.12 $2,030.24 $2,535.06 |
ADVERTISEMENT
Dean Health PlanLocal: 1-800-279-1302 | Toll Free: 1-800-279-1302 | TTY: 1-800-279-1302 |
Toc - Plan #49 Dean Health Plan | ||||||||||||||||||||
Gold
(HMO) Dean Gold Copay Plus 1500X (Free Virtual Visits & Transportation) |
||||||||||||||||||||
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 |
$388.39 $440.82 $496.36 $693.66 $1,054.09 |
$685.51 $737.94 $793.48 $990.78 |
$982.63 $1,035.06 $1,090.60 $1,287.90 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$776.78 $881.64 $992.72 $1,387.32 $2,108.18 |
$1,073.90 $1,178.76 $1,289.84 $1,684.44 |
$1,371.02 $1,475.88 $1,586.96 $1,981.56 |
Toc - Plan #50 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Dean Silver Copay Plus 4800X (Free Virtual Visits & Transportation) |
||||||||||||||||||||
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 |
$387.34 $439.63 $495.02 $691.79 $1,051.25 |
$683.66 $735.95 $791.34 $988.11 |
$979.98 $1,032.27 $1,087.66 $1,284.43 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$774.68 $879.26 $990.04 $1,383.58 $2,102.50 |
$1,071.00 $1,175.58 $1,286.36 $1,679.90 |
$1,367.32 $1,471.90 $1,582.68 $1,976.22 |
Toc - Plan #51 Dean Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) Dean Bronze Copay Plus 9050X (Free Virtual Visits & Transportation) |
||||||||||||||||||||
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 |
$256.09 $290.66 $327.28 $457.37 $695.02 |
$452.00 $486.57 $523.19 $653.28 |
$647.91 $682.48 $719.10 $849.19 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$512.18 $581.32 $654.56 $914.74 $1,390.04 |
$708.09 $777.23 $850.47 $1,110.65 |
$904.00 $973.14 $1,046.38 $1,306.56 |
Toc - Plan #52 Dean Health Plan | ||||||||||||||||||||
Gold
(HMO) Dean Gold Value Copay 4000X (Free Virtual Visits & Transportation) |
||||||||||||||||||||
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 |
$369.10 $418.92 $471.70 $659.20 $1,001.73 |
$651.46 $701.28 $754.06 $941.56 |
$933.82 $983.64 $1,036.42 $1,223.92 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$738.20 $837.84 $943.40 $1,318.40 $2,003.46 |
$1,020.56 $1,120.20 $1,225.76 $1,600.76 |
$1,302.92 $1,402.56 $1,508.12 $1,883.12 |
Toc - Plan #53 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Dean Silver Value Copay 4100X (Free Virtual Visits & Transportation) |
||||||||||||||||||||
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 |
$384.34 $436.23 $491.19 $686.44 $1,043.11 |
$678.36 $730.25 $785.21 $980.46 |
$972.38 $1,024.27 $1,079.23 $1,274.48 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$768.68 $872.46 $982.38 $1,372.88 $2,086.22 |
$1,062.70 $1,166.48 $1,276.40 $1,666.90 |
$1,356.72 $1,460.50 $1,570.42 $1,960.92 |
Toc - Plan #54 Dean Health Plan | ||||||||||||||||||||
Bronze
(HMO) Dean Bronze Value Copay 9050X (Free Virtual Visits & Transportation) |
||||||||||||||||||||
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 |
$244.58 $277.59 $312.57 $436.81 $663.78 |
$431.68 $464.69 $499.67 $623.91 |
$618.78 $651.79 $686.77 $811.01 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$489.16 $555.18 $625.14 $873.62 $1,327.56 |
$676.26 $742.28 $812.24 $1,060.72 |
$863.36 $929.38 $999.34 $1,247.82 |
Toc - Plan #55 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Dean Silver HSA-E HDHP 3550X (Free Transportation) |
||||||||||||||||||||
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 |
$368.64 $418.41 $471.12 $658.39 $1,000.49 |
$650.65 $700.42 $753.13 $940.40 |
$932.66 $982.43 $1,035.14 $1,222.41 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$737.28 $836.82 $942.24 $1,316.78 $2,000.98 |
$1,019.29 $1,118.83 $1,224.25 $1,598.79 |
$1,301.30 $1,400.84 $1,506.26 $1,880.80 |
Toc - Plan #56 Dean Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) Dean Bronze HSA-E HDHP 7000X (Free Transportation) |
||||||||||||||||||||
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 |
$263.28 $298.82 $336.47 $470.21 $714.53 |
$464.69 $500.23 $537.88 $671.62 |
$666.10 $701.64 $739.29 $873.03 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$526.56 $597.64 $672.94 $940.42 $1,429.06 |
$727.97 $799.05 $874.35 $1,141.83 |
$929.38 $1,000.46 $1,075.76 $1,343.24 |
Toc - Plan #57 Dean Health Plan | ||||||||||||||||||||
Catastrophic
(HMO) Dean Catastrophic Safety Net (Free Transportation) |
||||||||||||||||||||
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 |
$196.60 $223.14 $251.26 $351.13 $533.58 |
$347.00 $373.54 $401.66 $501.53 |
$497.40 $523.94 $552.06 $651.93 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$393.20 $446.28 $502.52 $702.26 $1,067.16 |
$543.60 $596.68 $652.92 $852.66 |
$694.00 $747.08 $803.32 $1,003.06 |
Toc - Plan #58 Dean Health Plan | ||||||||||||||||||||
Gold
(HMO) Dean Gold HSA HDHP 2000X (Free Transportation) |
||||||||||||||||||||
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 |
$346.45 $393.22 $442.77 $618.76 $940.27 |
$611.49 $658.26 $707.81 $883.80 |
$876.53 $923.30 $972.85 $1,148.84 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$692.90 $786.44 $885.54 $1,237.52 $1,880.54 |
$957.94 $1,051.48 $1,150.58 $1,502.56 |
$1,222.98 $1,316.52 $1,415.62 $1,767.60 |
Toc - Plan #59 Dean Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) Dean Bronze Copay PCP 8000X (Free Virtual Visits & Transportation) |
||||||||||||||||||||
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 |
$245.48 $278.62 $313.73 $438.43 $666.24 |
$433.27 $466.41 $501.52 $626.22 |
$621.06 $654.20 $689.31 $814.01 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$490.96 $557.24 $627.46 $876.86 $1,332.48 |
$678.75 $745.03 $815.25 $1,064.65 |
$866.54 $932.82 $1,003.04 $1,252.44 |
Toc - Plan #60 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Dean Silver Copay PCP 4500X (Free Virtual Visits & Transportation) |
||||||||||||||||||||
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 |
$359.82 $408.39 $459.84 $642.63 $976.54 |
$635.08 $683.65 $735.10 $917.89 |
$910.34 $958.91 $1,010.36 $1,193.15 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$719.64 $816.78 $919.68 $1,285.26 $1,953.08 |
$994.90 $1,092.04 $1,194.94 $1,560.52 |
$1,270.16 $1,367.30 $1,470.20 $1,835.78 |
Toc - Plan #61 Dean Health Plan | ||||||||||||||||||||
Gold
(HMO) Dean Gold Copay PCP 2000X (Free Virtual Visits & Transportation) |
||||||||||||||||||||
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 |
$357.09 $405.30 $456.37 $637.77 $969.15 |
$630.27 $678.48 $729.55 $910.95 |
$903.45 $951.66 $1,002.73 $1,184.13 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$714.18 $810.60 $912.74 $1,275.54 $1,938.30 |
$987.36 $1,083.78 $1,185.92 $1,548.72 |
$1,260.54 $1,356.96 $1,459.10 $1,821.90 |
Toc - Plan #62 Dean Health Plan | ||||||||||||||||||||
Gold
(HMO) Dean Gold Standard 2000X (Free Virtual Visits & Transportation) |
||||||||||||||||||||
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 |
$372.13 $422.37 $475.58 $664.63 $1,009.96 |
$656.81 $707.05 $760.26 $949.31 |
$941.49 $991.73 $1,044.94 $1,233.99 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$744.26 $844.74 $951.16 $1,329.26 $2,019.92 |
$1,028.94 $1,129.42 $1,235.84 $1,613.94 |
$1,313.62 $1,414.10 $1,520.52 $1,898.62 |
Toc - Plan #63 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Dean Silver Standard 5800X (Free Virtual Visits & Transportation) |
||||||||||||||||||||
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 |
$369.76 $419.68 $472.55 $660.39 $1,003.52 |
$652.63 $702.55 $755.42 $943.26 |
$935.50 $985.42 $1,038.29 $1,226.13 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$739.52 $839.36 $945.10 $1,320.78 $2,007.04 |
$1,022.39 $1,122.23 $1,227.97 $1,603.65 |
$1,305.26 $1,405.10 $1,510.84 $1,886.52 |
Toc - Plan #64 Dean Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) Dean Bronze Standard 7500X (Free Virtual Visits & Transportation) |
||||||||||||||||||||
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 |
$252.77 $286.90 $323.05 $451.45 $686.03 |
$446.14 $480.27 $516.42 $644.82 |
$639.51 $673.64 $709.79 $838.19 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$505.54 $573.80 $646.10 $902.90 $1,372.06 |
$698.91 $767.17 $839.47 $1,096.27 |
$892.28 $960.54 $1,032.84 $1,289.64 |
Toc - Plan #65 Dean Health Plan | ||||||||||||||||||||
Bronze
(HMO) Dean Bronze Standard 9100X (Free Virtual Visits & Transportation) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$226.08 $256.61 $288.94 $403.79 $613.59 |
$399.03 $429.56 $461.89 $576.74 |
$571.98 $602.51 $634.84 $749.69 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$452.16 $513.22 $577.88 $807.58 $1,227.18 |
$625.11 $686.17 $750.83 $980.53 |
$798.06 $859.12 $923.78 $1,153.48 |
ADVERTISEMENT
Molina HealthcareLocal: 1-888-560-2043 | Toll Free: 1-888-560-2043 |
Toc - Plan #66 Molina Healthcare | ||||||||||||||||||||
Gold
(HMO) Confident Care Gold 1 |
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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 |
$449.08 $509.71 $573.93 $802.06 $1,218.81 |
$792.63 $853.26 $917.48 $1,145.61 |
$1,136.18 $1,196.81 $1,261.03 $1,489.16 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$898.16 $1,019.42 $1,147.86 $1,604.12 $2,437.62 |
$1,241.71 $1,362.97 $1,491.41 $1,947.67 |
$1,585.26 $1,706.52 $1,834.96 $2,291.22 |
Toc - Plan #67 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Constant Care Silver 1 |
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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 |
$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 #68 Molina Healthcare | ||||||||||||||||||||
Gold
(HMO) Confident Care Gold 8 |
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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 |
$458.76 $520.69 $586.29 $819.34 $1,245.06 |
$809.71 $871.64 $937.24 $1,170.29 |
$1,160.66 $1,222.59 $1,288.19 $1,521.24 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$917.52 $1,041.38 $1,172.58 $1,638.68 $2,490.12 |
$1,268.47 $1,392.33 $1,523.53 $1,989.63 |
$1,619.42 $1,743.28 $1,874.48 $2,340.58 |
Toc - Plan #69 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Constant Care Silver 8 |
||||||||||||||||||||
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 |
$387.69 $440.03 $495.47 $692.42 $1,052.19 |
$684.27 $736.61 $792.05 $989.00 |
$980.85 $1,033.19 $1,088.63 $1,285.58 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$775.38 $880.06 $990.94 $1,384.84 $2,104.38 |
$1,071.96 $1,176.64 $1,287.52 $1,681.42 |
$1,368.54 $1,473.22 $1,584.10 $1,978.00 |
Toc - Plan #70 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 |
$453.33 $514.52 $579.35 $809.64 $1,230.33 |
$800.12 $861.31 $926.14 $1,156.43 |
$1,146.91 $1,208.10 $1,272.93 $1,503.22 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$906.66 $1,029.04 $1,158.70 $1,619.28 $2,460.66 |
$1,253.45 $1,375.83 $1,505.49 $1,966.07 |
$1,600.24 $1,722.62 $1,852.28 $2,312.86 |
Toc - Plan #71 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 |
$387.27 $439.55 $494.93 $691.66 $1,051.05 |
$683.53 $735.81 $791.19 $987.92 |
$979.79 $1,032.07 $1,087.45 $1,284.18 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$774.54 $879.10 $989.86 $1,383.32 $2,102.10 |
$1,070.80 $1,175.36 $1,286.12 $1,679.58 |
$1,367.06 $1,471.62 $1,582.38 $1,975.84 |
ADVERTISEMENT
Anthem Blue Cross and Blue ShieldLocal: 1-855-748-1813 | Toll Free: 1-855-748-1813 |
Toc - Plan #72 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(HMO) Anthem Bronze Blue Preferred/Broad 0 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$337.56 $383.13 $431.40 $602.88 $916.14 |
$595.79 $641.36 $689.63 $861.11 |
$854.02 $899.59 $947.86 $1,119.34 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$675.12 $766.26 $862.80 $1,205.76 $1,832.28 |
$933.35 $1,024.49 $1,121.03 $1,463.99 |
$1,191.58 $1,282.72 $1,379.26 $1,722.22 |
Toc - Plan #73 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(HMO) Anthem Bronze Blue Preferred/Broad 5000 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$327.30 $371.49 $418.29 $584.56 $888.29 |
$577.68 $621.87 $668.67 $834.94 |
$828.06 $872.25 $919.05 $1,085.32 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$654.60 $742.98 $836.58 $1,169.12 $1,776.58 |
$904.98 $993.36 $1,086.96 $1,419.50 |
$1,155.36 $1,243.74 $1,337.34 $1,669.88 |
Toc - Plan #74 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(HMO) Anthem Bronze Blue Preferred/Broad 6550 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$321.43 $364.82 $410.79 $574.07 $872.36 |
$567.32 $610.71 $656.68 $819.96 |
$813.21 $856.60 $902.57 $1,065.85 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$642.86 $729.64 $821.58 $1,148.14 $1,744.72 |
$888.75 $975.53 $1,067.47 $1,394.03 |
$1,134.64 $1,221.42 $1,313.36 $1,639.92 |
Toc - Plan #75 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Bronze
(HMO) Anthem Bronze Blue Preferred/Broad 9100 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$304.67 $345.80 $389.37 $544.14 $826.87 |
$537.74 $578.87 $622.44 $777.21 |
$770.81 $811.94 $855.51 $1,010.28 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$609.34 $691.60 $778.74 $1,088.28 $1,653.74 |
$842.41 $924.67 $1,011.81 $1,321.35 |
$1,075.48 $1,157.74 $1,244.88 $1,554.42 |
Toc - Plan #76 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(HMO) Anthem Bronze Blue Preferred/Broad 0% for HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$320.77 $364.07 $409.94 $572.90 $870.57 |
$566.16 $609.46 $655.33 $818.29 |
$811.55 $854.85 $900.72 $1,063.68 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$641.54 $728.14 $819.88 $1,145.80 $1,741.14 |
$886.93 $973.53 $1,065.27 $1,391.19 |
$1,132.32 $1,218.92 $1,310.66 $1,636.58 |
Toc - Plan #77 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Gold
(HMO) Anthem Gold Blue Preferred/Broad 1000 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$416.09 $472.26 $531.76 $743.14 $1,129.27 |
$734.40 $790.57 $850.07 $1,061.45 |
$1,052.71 $1,108.88 $1,168.38 $1,379.76 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$832.18 $944.52 $1,063.52 $1,486.28 $2,258.54 |
$1,150.49 $1,262.83 $1,381.83 $1,804.59 |
$1,468.80 $1,581.14 $1,700.14 $2,122.90 |
Toc - Plan #78 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(HMO) Anthem Silver Blue Preferred/Broad 4000 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$401.73 $455.96 $513.41 $717.49 $1,090.30 |
$709.05 $763.28 $820.73 $1,024.81 |
$1,016.37 $1,070.60 $1,128.05 $1,332.13 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$803.46 $911.92 $1,026.82 $1,434.98 $2,180.60 |
$1,110.78 $1,219.24 $1,334.14 $1,742.30 |
$1,418.10 $1,526.56 $1,641.46 $2,049.62 |
Toc - Plan #79 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(HMO) Anthem Silver Blue Preferred/Broad 4100 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$406.56 $461.45 $519.58 $726.12 $1,103.40 |
$717.58 $772.47 $830.60 $1,037.14 |
$1,028.60 $1,083.49 $1,141.62 $1,348.16 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$813.12 $922.90 $1,039.16 $1,452.24 $2,206.80 |
$1,124.14 $1,233.92 $1,350.18 $1,763.26 |
$1,435.16 $1,544.94 $1,661.20 $2,074.28 |
Toc - Plan #80 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(HMO) Anthem Silver Blue Preferred/Broad 5300 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$399.37 $453.28 $510.39 $713.27 $1,083.89 |
$704.89 $758.80 $815.91 $1,018.79 |
$1,010.41 $1,064.32 $1,121.43 $1,324.31 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$798.74 $906.56 $1,020.78 $1,426.54 $2,167.78 |
$1,104.26 $1,212.08 $1,326.30 $1,732.06 |
$1,409.78 $1,517.60 $1,631.82 $2,037.58 |
Toc - Plan #81 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Bronze
(HMO) Anthem Bronze Blue Preferred/Broad 9100/0% Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$305.11 $346.30 $389.93 $544.93 $828.07 |
$538.52 $579.71 $623.34 $778.34 |
$771.93 $813.12 $856.75 $1,011.75 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$610.22 $692.60 $779.86 $1,089.86 $1,656.14 |
$843.63 $926.01 $1,013.27 $1,323.27 |
$1,077.04 $1,159.42 $1,246.68 $1,556.68 |
Toc - Plan #82 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(HMO) Anthem Bronze Blue Preferred/Broad 7500/50% Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$331.63 $376.40 $423.82 $592.29 $900.04 |
$585.33 $630.10 $677.52 $845.99 |
$839.03 $883.80 $931.22 $1,099.69 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$663.26 $752.80 $847.64 $1,184.58 $1,800.08 |
$916.96 $1,006.50 $1,101.34 $1,438.28 |
$1,170.66 $1,260.20 $1,355.04 $1,691.98 |
Toc - Plan #83 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(HMO) Anthem Silver Blue Preferred/Broad 5800/40% Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$395.97 $449.43 $506.05 $707.20 $1,074.66 |
$698.89 $752.35 $808.97 $1,010.12 |
$1,001.81 $1,055.27 $1,111.89 $1,313.04 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$791.94 $898.86 $1,012.10 $1,414.40 $2,149.32 |
$1,094.86 $1,201.78 $1,315.02 $1,717.32 |
$1,397.78 $1,504.70 $1,617.94 $2,020.24 |
Toc - Plan #84 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Gold
(HMO) Anthem Gold Blue Preferred/Broad 2000/25% Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$416.39 $472.60 $532.15 $743.67 $1,130.08 |
$734.93 $791.14 $850.69 $1,062.21 |
$1,053.47 $1,109.68 $1,169.23 $1,380.75 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$832.78 $945.20 $1,064.30 $1,487.34 $2,260.16 |
$1,151.32 $1,263.74 $1,382.84 $1,805.88 |
$1,469.86 $1,582.28 $1,701.38 $2,124.42 |
ADVERTISEMENT
Common Ground Healthcare CooperativeLocal: 1-877-514-2442 | Toll Free: 1-877-514-2442 | TTY: 1-844-472-2442 |
Toc - Plan #85 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Copay Bronze $0 Ded - Envision Network |
||||||||||||||||||||
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 |
$283.96 $322.29 $362.89 $507.14 $770.65 |
$501.19 $539.52 $580.12 $724.37 |
$718.42 $756.75 $797.35 $941.60 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$567.92 $644.58 $725.78 $1,014.28 $1,541.30 |
$785.15 $861.81 $943.01 $1,231.51 |
$1,002.38 $1,079.04 $1,160.24 $1,448.74 |
Toc - Plan #86 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Copay Silver $0 Ded - Envision Network |
||||||||||||||||||||
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 |
$403.17 $457.58 $515.23 $720.04 $1,094.17 |
$711.58 $765.99 $823.64 $1,028.45 |
$1,019.99 $1,074.40 $1,132.05 $1,336.86 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$806.34 $915.16 $1,030.46 $1,440.08 $2,188.34 |
$1,114.75 $1,223.57 $1,338.87 $1,748.49 |
$1,423.16 $1,531.98 $1,647.28 $2,056.90 |
Toc - Plan #87 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Copay Gold $0 Ded - Envision Network |
||||||||||||||||||||
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 |
$434.51 $493.15 $555.29 $776.01 $1,179.22 |
$766.90 $825.54 $887.68 $1,108.40 |
$1,099.29 $1,157.93 $1,220.07 $1,440.79 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$869.02 $986.30 $1,110.58 $1,552.02 $2,358.44 |
$1,201.41 $1,318.69 $1,442.97 $1,884.41 |
$1,533.80 $1,651.08 $1,775.36 $2,216.80 |
Toc - Plan #88 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Gold $3000 - Envision Network |
||||||||||||||||||||
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 |
$374.80 $425.39 $478.98 $669.38 $1,017.18 |
$661.52 $712.11 $765.70 $956.10 |
$948.24 $998.83 $1,052.42 $1,242.82 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$749.60 $850.78 $957.96 $1,338.76 $2,034.36 |
$1,036.32 $1,137.50 $1,244.68 $1,625.48 |
$1,323.04 $1,424.22 $1,531.40 $1,912.20 |
Toc - Plan #89 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Gold $1800 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$410.52 $465.93 $524.63 $733.18 $1,114.13 |
$724.56 $779.97 $838.67 $1,047.22 |
$1,038.60 $1,094.01 $1,152.71 $1,361.26 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$821.04 $931.86 $1,049.26 $1,466.36 $2,228.26 |
$1,135.08 $1,245.90 $1,363.30 $1,780.40 |
$1,449.12 $1,559.94 $1,677.34 $2,094.44 |
Toc - Plan #90 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Silver $4000 - Envision Network |
||||||||||||||||||||
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 |
$369.84 $419.76 $472.65 $660.52 $1,003.73 |
$652.76 $702.68 $755.57 $943.44 |
$935.68 $985.60 $1,038.49 $1,226.36 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$739.68 $839.52 $945.30 $1,321.04 $2,007.46 |
$1,022.60 $1,122.44 $1,228.22 $1,603.96 |
$1,305.52 $1,405.36 $1,511.14 $1,886.88 |
Toc - Plan #91 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Silver $5000 - Envision Network |
||||||||||||||||||||
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 |
$316.41 $359.11 $404.35 $565.08 $858.70 |
$558.45 $601.15 $646.39 $807.12 |
$800.49 $843.19 $888.43 $1,049.16 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$632.82 $718.22 $808.70 $1,130.16 $1,717.40 |
$874.86 $960.26 $1,050.74 $1,372.20 |
$1,116.90 $1,202.30 $1,292.78 $1,614.24 |
Toc - Plan #92 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Catastrophic
(EPO) CGHC Catastrophic $9100 - Envision Network |
||||||||||||||||||||
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 |
$186.10 $211.21 $237.83 $332.36 $505.05 |
$328.46 $353.57 $380.19 $474.72 |
$470.82 $495.93 $522.55 $617.08 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$372.20 $422.42 $475.66 $664.72 $1,010.10 |
$514.56 $564.78 $618.02 $807.08 |
$656.92 $707.14 $760.38 $949.44 |
Toc - Plan #93 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Bronze $9100 ($35 PCP Copay) - Envision Network |
||||||||||||||||||||
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 |
$266.02 $301.92 $339.96 $475.09 $721.95 |
$469.52 $505.42 $543.46 $678.59 |
$673.02 $708.92 $746.96 $882.09 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$532.04 $603.84 $679.92 $950.18 $1,443.90 |
$735.54 $807.34 $883.42 $1,153.68 |
$939.04 $1,010.84 $1,086.92 $1,357.18 |
Toc - Plan #94 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Bronze $8150 - Envision Network |
||||||||||||||||||||
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 |
$276.09 $313.35 $352.83 $493.07 $749.27 |
$487.29 $524.55 $564.03 $704.27 |
$698.49 $735.75 $775.23 $915.47 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$552.18 $626.70 $705.66 $986.14 $1,498.54 |
$763.38 $837.90 $916.86 $1,197.34 |
$974.58 $1,049.10 $1,128.06 $1,408.54 |
Toc - Plan #95 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC HSA Bronze $7500 - Envision Network |
||||||||||||||||||||
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 |
$274.64 $311.70 $350.97 $490.48 $745.34 |
$484.73 $521.79 $561.06 $700.57 |
$694.82 $731.88 $771.15 $910.66 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$549.28 $623.40 $701.94 $980.96 $1,490.68 |
$759.37 $833.49 $912.03 $1,191.05 |
$969.46 $1,043.58 $1,122.12 $1,401.14 |
Toc - Plan #96 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC HSA Gold $3000 - Envision Network |
||||||||||||||||||||
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 |
$436.43 $495.34 $557.75 $779.45 $1,184.45 |
$770.29 $829.20 $891.61 $1,113.31 |
$1,104.15 $1,163.06 $1,225.47 $1,447.17 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$872.86 $990.68 $1,115.50 $1,558.90 $2,368.90 |
$1,206.72 $1,324.54 $1,449.36 $1,892.76 |
$1,540.58 $1,658.40 $1,783.22 $2,226.62 |
Toc - Plan #97 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC HSA Silver $3000 - Envision Network |
||||||||||||||||||||
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 |
$423.24 $480.36 $540.88 $755.88 $1,148.63 |
$747.01 $804.13 $864.65 $1,079.65 |
$1,070.78 $1,127.90 $1,188.42 $1,403.42 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$846.48 $960.72 $1,081.76 $1,511.76 $2,297.26 |
$1,170.25 $1,284.49 $1,405.53 $1,835.53 |
$1,494.02 $1,608.26 $1,729.30 $2,159.30 |
Toc - Plan #98 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Bronze
(EPO) CGHC Bronze $6000 - Envision Network |
||||||||||||||||||||
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 |
$272.65 $309.44 $348.43 $486.93 $739.93 |
$481.22 $518.01 $557.00 $695.50 |
$689.79 $726.58 $765.57 $904.07 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$545.30 $618.88 $696.86 $973.86 $1,479.86 |
$753.87 $827.45 $905.43 $1,182.43 |
$962.44 $1,036.02 $1,114.00 $1,391.00 |
Toc - Plan #99 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Bronze
(EPO) Bronze Standard Plan - Envision Network |
||||||||||||||||||||
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 |
$264.09 $299.74 $337.50 $471.65 $716.72 |
$466.11 $501.76 $539.52 $673.67 |
$668.13 $703.78 $741.54 $875.69 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$528.18 $599.48 $675.00 $943.30 $1,433.44 |
$730.20 $801.50 $877.02 $1,145.32 |
$932.22 $1,003.52 $1,079.04 $1,347.34 |
Toc - Plan #100 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) Silver Standard Plan - Envision Network |
||||||||||||||||||||
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 |
$319.59 $362.72 $408.42 $570.77 $867.34 |
$564.07 $607.20 $652.90 $815.25 |
$808.55 $851.68 $897.38 $1,059.73 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$639.18 $725.44 $816.84 $1,141.54 $1,734.68 |
$883.66 $969.92 $1,061.32 $1,386.02 |
$1,128.14 $1,214.40 $1,305.80 $1,630.50 |
Toc - Plan #101 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) Gold Standard Plan - Envision Network |
||||||||||||||||||||
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 |
$382.09 $433.66 $488.30 $682.40 $1,036.97 |
$674.38 $725.95 $780.59 $974.69 |
$966.67 $1,018.24 $1,072.88 $1,266.98 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$764.18 $867.32 $976.60 $1,364.80 $2,073.94 |
$1,056.47 $1,159.61 $1,268.89 $1,657.09 |
$1,348.76 $1,451.90 $1,561.18 $1,949.38 |
Toc - Plan #102 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Silver $5650 - Envision Network |
||||||||||||||||||||
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 |
$316.20 $358.87 $404.09 $564.71 $858.13 |
$558.08 $600.75 $645.97 $806.59 |
$799.96 $842.63 $887.85 $1,048.47 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$632.40 $717.74 $808.18 $1,129.42 $1,716.26 |
$874.28 $959.62 $1,050.06 $1,371.30 |
$1,116.16 $1,201.50 $1,291.94 $1,613.18 |
Toc - Plan #103 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Gold $1800 - Envision Network (Vision Exam + Allergy Test) |
||||||||||||||||||||
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 |
$413.44 $469.25 $528.37 $738.39 $1,122.06 |
$729.72 $785.53 $844.65 $1,054.67 |
$1,046.00 $1,101.81 $1,160.93 $1,370.95 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$826.88 $938.50 $1,056.74 $1,476.78 $2,244.12 |
$1,143.16 $1,254.78 $1,373.02 $1,793.06 |
$1,459.44 $1,571.06 $1,689.30 $2,109.34 |
Toc - Plan #104 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Gold $2000 - Envision Network (Vision Exam + Allergy Test) |
||||||||||||||||||||
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 |
$384.62 $436.54 $491.54 $686.92 $1,043.84 |
$678.85 $730.77 $785.77 $981.15 |
$973.08 $1,025.00 $1,080.00 $1,275.38 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$769.24 $873.08 $983.08 $1,373.84 $2,087.68 |
$1,063.47 $1,167.31 $1,277.31 $1,668.07 |
$1,357.70 $1,461.54 $1,571.54 $1,962.30 |
Toc - Plan #105 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Gold $3000 - Envision Network (Vision Exam + Allergy Test) |
||||||||||||||||||||
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 |
$377.69 $428.67 $482.68 $674.54 $1,025.03 |
$666.62 $717.60 $771.61 $963.47 |
$955.55 $1,006.53 $1,060.54 $1,252.40 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$755.38 $857.34 $965.36 $1,349.08 $2,050.06 |
$1,044.31 $1,146.27 $1,254.29 $1,638.01 |
$1,333.24 $1,435.20 $1,543.22 $1,926.94 |
Toc - Plan #106 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Silver $4000 - Envision Network (Vision Exam + Allergy Test) |
||||||||||||||||||||
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 |
$372.74 $423.04 $476.34 $665.69 $1,011.58 |
$657.87 $708.17 $761.47 $950.82 |
$943.00 $993.30 $1,046.60 $1,235.95 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$745.48 $846.08 $952.68 $1,331.38 $2,023.16 |
$1,030.61 $1,131.21 $1,237.81 $1,616.51 |
$1,315.74 $1,416.34 $1,522.94 $1,901.64 |
Toc - Plan #107 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Silver $5650 (Vision Exam + Allergy Test) - Envision Network |
||||||||||||||||||||
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 |
$319.05 $362.11 $407.73 $569.81 $865.87 |
$563.12 $606.18 $651.80 $813.88 |
$807.19 $850.25 $895.87 $1,057.95 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$638.10 $724.22 $815.46 $1,139.62 $1,731.74 |
$882.17 $968.29 $1,059.53 $1,383.69 |
$1,126.24 $1,212.36 $1,303.60 $1,627.76 |
Toc - Plan #108 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Silver $5000 - Envision Network (Vision Exam + Allergy Test) |
||||||||||||||||||||
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 |
$319.26 $362.35 $408.00 $570.18 $866.44 |
$563.49 $606.58 $652.23 $814.41 |
$807.72 $850.81 $896.46 $1,058.64 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$638.52 $724.70 $816.00 $1,140.36 $1,732.88 |
$882.75 $968.93 $1,060.23 $1,384.59 |
$1,126.98 $1,213.16 $1,304.46 $1,628.82 |
Toc - Plan #109 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Bronze
(EPO) CGHC Bronze $9100 - Envision Network (Vision Exam + Allergy Test) |
||||||||||||||||||||
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 |
$266.92 $302.94 $341.11 $476.70 $724.39 |
$471.11 $507.13 $545.30 $680.89 |
$675.30 $711.32 $749.49 $885.08 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$533.84 $605.88 $682.22 $953.40 $1,448.78 |
$738.03 $810.07 $886.41 $1,157.59 |
$942.22 $1,014.26 $1,090.60 $1,361.78 |
Toc - Plan #110 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Bronze $9100 ($35 PCP Copay) - Envision Network (Vision Exam + Allergy Test) |
||||||||||||||||||||
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 |
$268.84 $305.13 $343.57 $480.14 $729.62 |
$474.50 $510.79 $549.23 $685.80 |
$680.16 $716.45 $754.89 $891.46 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$537.68 $610.26 $687.14 $960.28 $1,459.24 |
$743.34 $815.92 $892.80 $1,165.94 |
$949.00 $1,021.58 $1,098.46 $1,371.60 |
Toc - Plan #111 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Bronze $8150 - Envision Network (Vision Exam + Allergy Test) |
||||||||||||||||||||
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 |
$278.92 $316.56 $356.45 $498.14 $756.96 |
$492.29 $529.93 $569.82 $711.51 |
$705.66 $743.30 $783.19 $924.88 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$557.84 $633.12 $712.90 $996.28 $1,513.92 |
$771.21 $846.49 $926.27 $1,209.65 |
$984.58 $1,059.86 $1,139.64 $1,423.02 |
Toc - Plan #112 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Bronze
(EPO) CGHC Bronze $6000 - Envision Network (Vision Exam + Allergy Test) |
||||||||||||||||||||
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 |
$275.47 $312.65 $352.04 $491.97 $747.60 |
$486.20 $523.38 $562.77 $702.70 |
$696.93 $734.11 $773.50 $913.43 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$550.94 $625.30 $704.08 $983.94 $1,495.20 |
$761.67 $836.03 $914.81 $1,194.67 |
$972.40 $1,046.76 $1,125.54 $1,405.40 |
Toc - Plan #113 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC HSA Bronze $7500 - Envision Network (Vision Exam + Allergy Test) |
||||||||||||||||||||
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 |
$277.46 $314.91 $354.58 $495.53 $753.00 |
$489.71 $527.16 $566.83 $707.78 |
$701.96 $739.41 $779.08 $920.03 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$554.92 $629.82 $709.16 $991.06 $1,506.00 |
$767.17 $842.07 $921.41 $1,203.31 |
$979.42 $1,054.32 $1,133.66 $1,415.56 |
Toc - Plan #114 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC HSA Silver $3000 - Envision Network (Vision Exam + Allergy Test) |
||||||||||||||||||||
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 |
$426.16 $483.69 $544.63 $761.11 $1,156.58 |
$752.17 $809.70 $870.64 $1,087.12 |
$1,078.18 $1,135.71 $1,196.65 $1,413.13 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$852.32 $967.38 $1,089.26 $1,522.22 $2,313.16 |
$1,178.33 $1,293.39 $1,415.27 $1,848.23 |
$1,504.34 $1,619.40 $1,741.28 $2,174.24 |
Toc - Plan #115 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC HSA Gold $3000 - Envision Network (Vision Exam + Allergy Test) |
||||||||||||||||||||
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 |
$439.37 $498.67 $561.50 $784.70 $1,192.42 |
$775.48 $834.78 $897.61 $1,120.81 |
$1,111.59 $1,170.89 $1,233.72 $1,456.92 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$878.74 $997.34 $1,123.00 $1,569.40 $2,384.84 |
$1,214.85 $1,333.45 $1,459.11 $1,905.51 |
$1,550.96 $1,669.56 $1,795.22 $2,241.62 |
Toc - Plan #116 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Copay Bronze $0 Ded - Envision Network (Vision Exam + Allergy Test) |
||||||||||||||||||||
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 |
$286.80 $325.51 $366.52 $512.21 $778.35 |
$506.19 $544.90 $585.91 $731.60 |
$725.58 $764.29 $805.30 $950.99 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$573.60 $651.02 $733.04 $1,024.42 $1,556.70 |
$792.99 $870.41 $952.43 $1,243.81 |
$1,012.38 $1,089.80 $1,171.82 $1,463.20 |
Toc - Plan #117 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Copay Silver $0 Ded - Envision Network (Vision Exam + Allergy Test) |
||||||||||||||||||||
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 |
$406.08 $460.89 $518.95 $725.23 $1,102.06 |
$716.72 $771.53 $829.59 $1,035.87 |
$1,027.36 $1,082.17 $1,140.23 $1,346.51 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$812.16 $921.78 $1,037.90 $1,450.46 $2,204.12 |
$1,122.80 $1,232.42 $1,348.54 $1,761.10 |
$1,433.44 $1,543.06 $1,659.18 $2,071.74 |
Toc - Plan #118 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Copay Gold $0 Ded - Envision Network (Vision Exam + Allergy Test) |
||||||||||||||||||||
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 |
$437.44 $496.48 $559.03 $781.24 $1,187.17 |
$772.07 $831.11 $893.66 $1,115.87 |
$1,106.70 $1,165.74 $1,228.29 $1,450.50 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$874.88 $992.96 $1,118.06 $1,562.48 $2,374.34 |
$1,209.51 $1,327.59 $1,452.69 $1,897.11 |
$1,544.14 $1,662.22 $1,787.32 $2,231.74 |
‡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 Fond Du Lac County here.
Fond Du Lac County is in “Rating Area 11” of Wisconsin.
Currently, there are 118 plans offered in Rating Area 11.