Obamacare 2023 Rates for Jackson 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 |
$484.96 $550.42 $619.77 $866.12 $1,316.16 |
$855.95 $921.41 $990.76 $1,237.11 |
$1,226.94 $1,292.40 $1,361.75 $1,608.10 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$969.92 $1,100.84 $1,239.54 $1,732.24 $2,632.32 |
$1,340.91 $1,471.83 $1,610.53 $2,103.23 |
$1,711.90 $1,842.82 $1,981.52 $2,474.22 |
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 |
$508.81 $577.49 $650.25 $908.72 $1,380.89 |
$898.05 $966.73 $1,039.49 $1,297.96 |
$1,287.29 $1,355.97 $1,428.73 $1,687.20 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$1,017.62 $1,154.98 $1,300.50 $1,817.44 $2,761.78 |
$1,406.86 $1,544.22 $1,689.74 $2,206.68 |
$1,796.10 $1,933.46 $2,078.98 $2,595.92 |
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 |
$532.90 $604.84 $681.04 $951.75 $1,446.28 |
$940.56 $1,012.50 $1,088.70 $1,359.41 |
$1,348.22 $1,420.16 $1,496.36 $1,767.07 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$1,065.80 $1,209.68 $1,362.08 $1,903.50 $2,892.56 |
$1,473.46 $1,617.34 $1,769.74 $2,311.16 |
$1,881.12 $2,025.00 $2,177.40 $2,718.82 |
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 |
$360.69 $409.38 $460.95 $644.18 $978.89 |
$636.61 $685.30 $736.87 $920.10 |
$912.53 $961.22 $1,012.79 $1,196.02 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$721.38 $818.76 $921.90 $1,288.36 $1,957.78 |
$997.30 $1,094.68 $1,197.82 $1,564.28 |
$1,273.22 $1,370.60 $1,473.74 $1,840.20 |
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 |
$364.26 $413.43 $465.51 $650.56 $988.58 |
$642.91 $692.08 $744.16 $929.21 |
$921.56 $970.73 $1,022.81 $1,207.86 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$728.52 $826.86 $931.02 $1,301.12 $1,977.16 |
$1,007.17 $1,105.51 $1,209.67 $1,579.77 |
$1,285.82 $1,384.16 $1,488.32 $1,858.42 |
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 |
$381.82 $433.36 $487.96 $681.92 $1,036.24 |
$673.91 $725.45 $780.05 $974.01 |
$966.00 $1,017.54 $1,072.14 $1,266.10 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$763.64 $866.72 $975.92 $1,363.84 $2,072.48 |
$1,055.73 $1,158.81 $1,268.01 $1,655.93 |
$1,347.82 $1,450.90 $1,560.10 $1,948.02 |
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 |
$377.92 $428.93 $482.97 $674.95 $1,025.65 |
$667.02 $718.03 $772.07 $964.05 |
$956.12 $1,007.13 $1,061.17 $1,253.15 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$755.84 $857.86 $965.94 $1,349.90 $2,051.30 |
$1,044.94 $1,146.96 $1,255.04 $1,639.00 |
$1,334.04 $1,436.06 $1,544.14 $1,928.10 |
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 |
$393.47 $446.59 $502.85 $702.74 $1,067.87 |
$694.47 $747.59 $803.85 $1,003.74 |
$995.47 $1,048.59 $1,104.85 $1,304.74 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$786.94 $893.18 $1,005.70 $1,405.48 $2,135.74 |
$1,087.94 $1,194.18 $1,306.70 $1,706.48 |
$1,388.94 $1,495.18 $1,607.70 $2,007.48 |
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 |
$493.28 $559.87 $630.41 $881.00 $1,338.76 |
$870.64 $937.23 $1,007.77 $1,258.36 |
$1,248.00 $1,314.59 $1,385.13 $1,635.72 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$986.56 $1,119.74 $1,260.82 $1,762.00 $2,677.52 |
$1,363.92 $1,497.10 $1,638.18 $2,139.36 |
$1,741.28 $1,874.46 $2,015.54 $2,516.72 |
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 |
$431.70 $489.98 $551.71 $771.01 $1,171.62 |
$761.95 $820.23 $881.96 $1,101.26 |
$1,092.20 $1,150.48 $1,212.21 $1,431.51 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$863.40 $979.96 $1,103.42 $1,542.02 $2,343.24 |
$1,193.65 $1,310.21 $1,433.67 $1,872.27 |
$1,523.90 $1,640.46 $1,763.92 $2,202.52 |
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 |
$440.27 $499.70 $562.65 $786.31 $1,194.87 |
$777.07 $836.50 $899.45 $1,123.11 |
$1,113.87 $1,173.30 $1,236.25 $1,459.91 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$880.54 $999.40 $1,125.30 $1,572.62 $2,389.74 |
$1,217.34 $1,336.20 $1,462.10 $1,909.42 |
$1,554.14 $1,673.00 $1,798.90 $2,246.22 |
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 |
$463.80 $526.41 $592.74 $828.34 $1,258.75 |
$818.61 $881.22 $947.55 $1,183.15 |
$1,173.42 $1,236.03 $1,302.36 $1,537.96 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$927.60 $1,052.82 $1,185.48 $1,656.68 $2,517.50 |
$1,282.41 $1,407.63 $1,540.29 $2,011.49 |
$1,637.22 $1,762.44 $1,895.10 $2,366.30 |
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 |
$486.78 $552.49 $622.10 $869.38 $1,321.11 |
$859.16 $924.87 $994.48 $1,241.76 |
$1,231.54 $1,297.25 $1,366.86 $1,614.14 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$973.56 $1,104.98 $1,244.20 $1,738.76 $2,642.22 |
$1,345.94 $1,477.36 $1,616.58 $2,111.14 |
$1,718.32 $1,849.74 $1,988.96 $2,483.52 |
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 |
$463.46 $526.02 $592.29 $827.72 $1,257.81 |
$818.00 $880.56 $946.83 $1,182.26 |
$1,172.54 $1,235.10 $1,301.37 $1,536.80 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$926.92 $1,052.04 $1,184.58 $1,655.44 $2,515.62 |
$1,281.46 $1,406.58 $1,539.12 $2,009.98 |
$1,636.00 $1,761.12 $1,893.66 $2,364.52 |
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 |
$486.25 $551.89 $621.42 $868.43 $1,319.67 |
$858.23 $923.87 $993.40 $1,240.41 |
$1,230.21 $1,295.85 $1,365.38 $1,612.39 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$972.50 $1,103.78 $1,242.84 $1,736.86 $2,639.34 |
$1,344.48 $1,475.76 $1,614.82 $2,108.84 |
$1,716.46 $1,847.74 $1,986.80 $2,480.82 |
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 |
$509.27 $578.02 $650.84 $909.55 $1,382.15 |
$898.86 $967.61 $1,040.43 $1,299.14 |
$1,288.45 $1,357.20 $1,430.02 $1,688.73 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$1,018.54 $1,156.04 $1,301.68 $1,819.10 $2,764.30 |
$1,408.13 $1,545.63 $1,691.27 $2,208.69 |
$1,797.72 $1,935.22 $2,080.86 $2,598.28 |
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 |
$344.70 $391.23 $440.52 $615.62 $935.49 |
$608.39 $654.92 $704.21 $879.31 |
$872.08 $918.61 $967.90 $1,143.00 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$689.40 $782.46 $881.04 $1,231.24 $1,870.98 |
$953.09 $1,046.15 $1,144.73 $1,494.93 |
$1,216.78 $1,309.84 $1,408.42 $1,758.62 |
Toc - Plan #18 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I202 |
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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 |
$348.11 $395.10 $444.88 $621.71 $944.75 |
$614.41 $661.40 $711.18 $888.01 |
$880.71 $927.70 $977.48 $1,154.31 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$696.22 $790.20 $889.76 $1,243.42 $1,889.50 |
$962.52 $1,056.50 $1,156.06 $1,509.72 |
$1,228.82 $1,322.80 $1,422.36 $1,776.02 |
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 |
$364.89 $414.14 $466.32 $651.68 $990.30 |
$644.03 $693.28 $745.46 $930.82 |
$923.17 $972.42 $1,024.60 $1,209.96 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$729.78 $828.28 $932.64 $1,303.36 $1,980.60 |
$1,008.92 $1,107.42 $1,211.78 $1,582.50 |
$1,288.06 $1,386.56 $1,490.92 $1,861.64 |
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 |
$361.16 $409.91 $461.56 $645.02 $980.18 |
$637.44 $686.19 $737.84 $921.30 |
$913.72 $962.47 $1,014.12 $1,197.58 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$722.32 $819.82 $923.12 $1,290.04 $1,960.36 |
$998.60 $1,096.10 $1,199.40 $1,566.32 |
$1,274.88 $1,372.38 $1,475.68 $1,842.60 |
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 |
$376.03 $426.79 $480.56 $671.58 $1,020.53 |
$663.69 $714.45 $768.22 $959.24 |
$951.35 $1,002.11 $1,055.88 $1,246.90 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$752.06 $853.58 $961.12 $1,343.16 $2,041.06 |
$1,039.72 $1,141.24 $1,248.78 $1,630.82 |
$1,327.38 $1,428.90 $1,536.44 $1,918.48 |
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 |
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21 30 40 50 60 |
$471.41 $535.05 $602.46 $841.94 $1,279.41 |
$832.04 $895.68 $963.09 $1,202.57 |
$1,192.67 $1,256.31 $1,323.72 $1,563.20 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$942.82 $1,070.10 $1,204.92 $1,683.88 $2,558.82 |
$1,303.45 $1,430.73 $1,565.55 $2,044.51 |
$1,664.08 $1,791.36 $1,926.18 $2,405.14 |
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 |
$412.56 $468.25 $527.25 $736.83 $1,119.68 |
$728.17 $783.86 $842.86 $1,052.44 |
$1,043.78 $1,099.47 $1,158.47 $1,368.05 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$825.12 $936.50 $1,054.50 $1,473.66 $2,239.36 |
$1,140.73 $1,252.11 $1,370.11 $1,789.27 |
$1,456.34 $1,567.72 $1,685.72 $2,104.88 |
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 |
$420.75 $477.54 $537.71 $751.45 $1,141.90 |
$742.62 $799.41 $859.58 $1,073.32 |
$1,064.49 $1,121.28 $1,181.45 $1,395.19 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$841.50 $955.08 $1,075.42 $1,502.90 $2,283.80 |
$1,163.37 $1,276.95 $1,397.29 $1,824.77 |
$1,485.24 $1,598.82 $1,719.16 $2,146.64 |
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 |
$443.24 $503.07 $566.46 $791.62 $1,202.94 |
$782.32 $842.15 $905.54 $1,130.70 |
$1,121.40 $1,181.23 $1,244.62 $1,469.78 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$886.48 $1,006.14 $1,132.92 $1,583.24 $2,405.88 |
$1,225.56 $1,345.22 $1,472.00 $1,922.32 |
$1,564.64 $1,684.30 $1,811.08 $2,261.40 |
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 |
$465.20 $528.00 $594.52 $830.84 $1,262.54 |
$821.07 $883.87 $950.39 $1,186.71 |
$1,176.94 $1,239.74 $1,306.26 $1,542.58 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$930.40 $1,056.00 $1,189.04 $1,661.68 $2,525.08 |
$1,286.27 $1,411.87 $1,544.91 $2,017.55 |
$1,642.14 $1,767.74 $1,900.78 $2,373.42 |
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 |
$436.80 $495.76 $558.22 $780.11 $1,185.46 |
$770.95 $829.91 $892.37 $1,114.26 |
$1,105.10 $1,164.06 $1,226.52 $1,448.41 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$873.60 $991.52 $1,116.44 $1,560.22 $2,370.92 |
$1,207.75 $1,325.67 $1,450.59 $1,894.37 |
$1,541.90 $1,659.82 $1,784.74 $2,228.52 |
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 |
$362.24 $411.14 $462.94 $646.95 $983.11 |
$639.35 $688.25 $740.05 $924.06 |
$916.46 $965.36 $1,017.16 $1,201.17 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$724.48 $822.28 $925.88 $1,293.90 $1,966.22 |
$1,001.59 $1,099.39 $1,202.99 $1,571.01 |
$1,278.70 $1,376.50 $1,480.10 $1,848.12 |
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 |
$267.04 $303.08 $341.27 $476.92 $724.73 |
$471.32 $507.36 $545.55 $681.20 |
$675.60 $711.64 $749.83 $885.48 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$534.08 $606.16 $682.54 $953.84 $1,449.46 |
$738.36 $810.44 $886.82 $1,158.12 |
$942.64 $1,014.72 $1,091.10 $1,362.40 |
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 |
$487.43 $553.23 $622.93 $870.54 $1,322.88 |
$860.31 $926.11 $995.81 $1,243.42 |
$1,233.19 $1,298.99 $1,368.69 $1,616.30 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$974.86 $1,106.46 $1,245.86 $1,741.08 $2,645.76 |
$1,347.74 $1,479.34 $1,618.74 $2,113.96 |
$1,720.62 $1,852.22 $1,991.62 $2,486.84 |
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 |
$477.83 $542.33 $610.66 $853.39 $1,296.81 |
$843.36 $907.86 $976.19 $1,218.92 |
$1,208.89 $1,273.39 $1,341.72 $1,584.45 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$955.66 $1,084.66 $1,221.32 $1,706.78 $2,593.62 |
$1,321.19 $1,450.19 $1,586.85 $2,072.31 |
$1,686.72 $1,815.72 $1,952.38 $2,437.84 |
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 |
$468.84 $532.13 $599.17 $837.34 $1,272.42 |
$827.50 $890.79 $957.83 $1,196.00 |
$1,186.16 $1,249.45 $1,316.49 $1,554.66 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$937.68 $1,064.26 $1,198.34 $1,674.68 $2,544.84 |
$1,296.34 $1,422.92 $1,557.00 $2,033.34 |
$1,655.00 $1,781.58 $1,915.66 $2,392.00 |
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 |
$491.90 $558.30 $628.64 $878.52 $1,335.00 |
$868.20 $934.60 $1,004.94 $1,254.82 |
$1,244.50 $1,310.90 $1,381.24 $1,631.12 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$983.80 $1,116.60 $1,257.28 $1,757.04 $2,670.00 |
$1,360.10 $1,492.90 $1,633.58 $2,133.34 |
$1,736.40 $1,869.20 $2,009.88 $2,509.64 |
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 |
$515.19 $584.73 $658.40 $920.12 $1,398.21 |
$909.31 $978.85 $1,052.52 $1,314.24 |
$1,303.43 $1,372.97 $1,446.64 $1,708.36 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,030.38 $1,169.46 $1,316.80 $1,840.24 $2,796.42 |
$1,424.50 $1,563.58 $1,710.92 $2,234.36 |
$1,818.62 $1,957.70 $2,105.04 $2,628.48 |
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 |
$348.70 $395.77 $445.63 $622.77 $946.36 |
$615.45 $662.52 $712.38 $889.52 |
$882.20 $929.27 $979.13 $1,156.27 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$697.40 $791.54 $891.26 $1,245.54 $1,892.72 |
$964.15 $1,058.29 $1,158.01 $1,512.29 |
$1,230.90 $1,325.04 $1,424.76 $1,779.04 |
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 |
$352.15 $399.69 $450.04 $628.93 $955.73 |
$621.54 $669.08 $719.43 $898.32 |
$890.93 $938.47 $988.82 $1,167.71 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$704.30 $799.38 $900.08 $1,257.86 $1,911.46 |
$973.69 $1,068.77 $1,169.47 $1,527.25 |
$1,243.08 $1,338.16 $1,438.86 $1,796.64 |
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 |
$369.13 $418.96 $471.74 $659.25 $1,001.80 |
$651.51 $701.34 $754.12 $941.63 |
$933.89 $983.72 $1,036.50 $1,224.01 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$738.26 $837.92 $943.48 $1,318.50 $2,003.60 |
$1,020.64 $1,120.30 $1,225.86 $1,600.88 |
$1,303.02 $1,402.68 $1,508.24 $1,883.26 |
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 |
$365.36 $414.67 $466.92 $652.52 $991.56 |
$644.85 $694.16 $746.41 $932.01 |
$924.34 $973.65 $1,025.90 $1,211.50 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$730.72 $829.34 $933.84 $1,305.04 $1,983.12 |
$1,010.21 $1,108.83 $1,213.33 $1,584.53 |
$1,289.70 $1,388.32 $1,492.82 $1,864.02 |
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 |
$380.40 $431.74 $486.14 $679.38 $1,032.38 |
$671.40 $722.74 $777.14 $970.38 |
$962.40 $1,013.74 $1,068.14 $1,261.38 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$760.80 $863.48 $972.28 $1,358.76 $2,064.76 |
$1,051.80 $1,154.48 $1,263.28 $1,649.76 |
$1,342.80 $1,445.48 $1,554.28 $1,940.76 |
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 |
$366.45 $415.91 $468.31 $654.47 $994.53 |
$646.78 $696.24 $748.64 $934.80 |
$927.11 $976.57 $1,028.97 $1,215.13 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$732.90 $831.82 $936.62 $1,308.94 $1,989.06 |
$1,013.23 $1,112.15 $1,216.95 $1,589.27 |
$1,293.56 $1,392.48 $1,497.28 $1,869.60 |
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 |
$476.89 $541.27 $609.46 $851.72 $1,294.27 |
$841.71 $906.09 $974.28 $1,216.54 |
$1,206.53 $1,270.91 $1,339.10 $1,581.36 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$953.78 $1,082.54 $1,218.92 $1,703.44 $2,588.54 |
$1,318.60 $1,447.36 $1,583.74 $2,068.26 |
$1,683.42 $1,812.18 $1,948.56 $2,433.08 |
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 |
$417.35 $473.69 $533.37 $745.39 $1,132.69 |
$736.62 $792.96 $852.64 $1,064.66 |
$1,055.89 $1,112.23 $1,171.91 $1,383.93 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$834.70 $947.38 $1,066.74 $1,490.78 $2,265.38 |
$1,153.97 $1,266.65 $1,386.01 $1,810.05 |
$1,473.24 $1,585.92 $1,705.28 $2,129.32 |
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 |
$425.63 $483.09 $543.96 $760.18 $1,155.16 |
$751.24 $808.70 $869.57 $1,085.79 |
$1,076.85 $1,134.31 $1,195.18 $1,411.40 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$851.26 $966.18 $1,087.92 $1,520.36 $2,310.32 |
$1,176.87 $1,291.79 $1,413.53 $1,845.97 |
$1,502.48 $1,617.40 $1,739.14 $2,171.58 |
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 |
$448.39 $508.92 $573.04 $800.81 $1,216.92 |
$791.40 $851.93 $916.05 $1,143.82 |
$1,134.41 $1,194.94 $1,259.06 $1,486.83 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$896.78 $1,017.84 $1,146.08 $1,601.62 $2,433.84 |
$1,239.79 $1,360.85 $1,489.09 $1,944.63 |
$1,582.80 $1,703.86 $1,832.10 $2,287.64 |
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 |
$441.87 $501.52 $564.71 $789.18 $1,199.23 |
$779.90 $839.55 $902.74 $1,127.21 |
$1,117.93 $1,177.58 $1,240.77 $1,465.24 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$883.74 $1,003.04 $1,129.42 $1,578.36 $2,398.46 |
$1,221.77 $1,341.07 $1,467.45 $1,916.39 |
$1,559.80 $1,679.10 $1,805.48 $2,254.42 |
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 |
$493.09 $559.66 $630.17 $880.66 $1,338.24 |
$870.30 $936.87 $1,007.38 $1,257.87 |
$1,247.51 $1,314.08 $1,384.59 $1,635.08 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$986.18 $1,119.32 $1,260.34 $1,761.32 $2,676.48 |
$1,363.39 $1,496.53 $1,637.55 $2,138.53 |
$1,740.60 $1,873.74 $2,014.76 $2,515.74 |
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 |
$483.38 $548.63 $617.75 $863.30 $1,311.87 |
$853.16 $918.41 $987.53 $1,233.08 |
$1,222.94 $1,288.19 $1,357.31 $1,602.86 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$966.76 $1,097.26 $1,235.50 $1,726.60 $2,623.74 |
$1,336.54 $1,467.04 $1,605.28 $2,096.38 |
$1,706.32 $1,836.82 $1,975.06 $2,466.16 |
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 |
$470.60 $534.13 $601.42 $840.49 $1,277.20 |
$830.61 $894.14 $961.43 $1,200.50 |
$1,190.62 $1,254.15 $1,321.44 $1,560.51 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$941.20 $1,068.26 $1,202.84 $1,680.98 $2,554.40 |
$1,301.21 $1,428.27 $1,562.85 $2,040.99 |
$1,661.22 $1,788.28 $1,922.86 $2,401.00 |
ADVERTISEMENT
Security Health PlanLocal: 1-715-221-9258x19258 | Toll Free: 1-844-293-9624 | TTY: 1-877-727-2232 |
Toc - Plan #49 Security Health Plan | ||||||||||||||||||||
Catastrophic
(EPO) Select Protection |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$231.10 $262.29 $295.34 $412.73 $627.18 |
$407.89 $439.08 $472.13 $589.52 |
$584.68 $615.87 $648.92 $766.31 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$462.20 $524.58 $590.68 $825.46 $1,254.36 |
$638.99 $701.37 $767.47 $1,002.25 |
$815.78 $878.16 $944.26 $1,179.04 |
Toc - Plan #50 Security Health Plan | ||||||||||||||||||||
Bronze
(EPO) Select $9,100 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$337.81 $383.41 $431.71 $603.32 $916.80 |
$596.23 $641.83 $690.13 $861.74 |
$854.65 $900.25 $948.55 $1,120.16 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$675.62 $766.82 $863.42 $1,206.64 $1,833.60 |
$934.04 $1,025.24 $1,121.84 $1,465.06 |
$1,192.46 $1,283.66 $1,380.26 $1,723.48 |
Toc - Plan #51 Security Health Plan | ||||||||||||||||||||
Silver
(EPO) Select $4,100 HDHP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$575.33 $652.98 $735.25 $1,027.52 $1,561.41 |
$1,015.45 $1,093.10 $1,175.37 $1,467.64 |
$1,455.57 $1,533.22 $1,615.49 $1,907.76 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,150.66 $1,305.96 $1,470.50 $2,055.04 $3,122.82 |
$1,590.78 $1,746.08 $1,910.62 $2,495.16 |
$2,030.90 $2,186.20 $2,350.74 $2,935.28 |
Toc - Plan #52 Security Health Plan | ||||||||||||||||||||
Expanded Bronze
(EPO) Select $6,200 HDHP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$392.17 $445.10 $501.18 $700.40 $1,064.32 |
$692.17 $745.10 $801.18 $1,000.40 |
$992.17 $1,045.10 $1,101.18 $1,300.40 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$784.34 $890.20 $1,002.36 $1,400.80 $2,128.64 |
$1,084.34 $1,190.20 $1,302.36 $1,700.80 |
$1,384.34 $1,490.20 $1,602.36 $2,000.80 |
Toc - Plan #53 Security Health Plan | ||||||||||||||||||||
Gold
(EPO) Select $3,500 - 30% |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$473.70 $537.64 $605.38 $846.02 $1,285.61 |
$836.08 $900.02 $967.76 $1,208.40 |
$1,198.46 $1,262.40 $1,330.14 $1,570.78 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$947.40 $1,075.28 $1,210.76 $1,692.04 $2,571.22 |
$1,309.78 $1,437.66 $1,573.14 $2,054.42 |
$1,672.16 $1,800.04 $1,935.52 $2,416.80 |
Toc - Plan #54 Security Health Plan | ||||||||||||||||||||
Gold
(EPO) Select $2,000 - 25% |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$502.95 $570.84 $642.76 $898.25 $1,364.98 |
$887.70 $955.59 $1,027.51 $1,283.00 |
$1,272.45 $1,340.34 $1,412.26 $1,667.75 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,005.90 $1,141.68 $1,285.52 $1,796.50 $2,729.96 |
$1,390.65 $1,526.43 $1,670.27 $2,181.25 |
$1,775.40 $1,911.18 $2,055.02 $2,566.00 |
Toc - Plan #55 Security Health Plan | ||||||||||||||||||||
Silver
(EPO) Select $5,800 - 40% |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$498.62 $565.92 $637.22 $890.51 $1,353.22 |
$880.05 $947.35 $1,018.65 $1,271.94 |
$1,261.48 $1,328.78 $1,400.08 $1,653.37 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$997.24 $1,131.84 $1,274.44 $1,781.02 $2,706.44 |
$1,378.67 $1,513.27 $1,655.87 $2,162.45 |
$1,760.10 $1,894.70 $2,037.30 $2,543.88 |
Toc - Plan #56 Security Health Plan | ||||||||||||||||||||
Expanded Bronze
(EPO) Select $7,500 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$345.25 $391.85 $441.22 $616.60 $936.98 |
$609.36 $655.96 $705.33 $880.71 |
$873.47 $920.07 $969.44 $1,144.82 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$690.50 $783.70 $882.44 $1,233.20 $1,873.96 |
$954.61 $1,047.81 $1,146.55 $1,497.31 |
$1,218.72 $1,311.92 $1,410.66 $1,761.42 |
Toc - Plan #57 Security Health Plan | ||||||||||||||||||||
Gold
(HMO) Premier $2,000 - 25% |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$578.64 $656.75 $739.49 $1,033.43 $1,570.40 |
$1,021.29 $1,099.40 $1,182.14 $1,476.08 |
$1,463.94 $1,542.05 $1,624.79 $1,918.73 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,157.28 $1,313.50 $1,478.98 $2,066.86 $3,140.80 |
$1,599.93 $1,756.15 $1,921.63 $2,509.51 |
$2,042.58 $2,198.80 $2,364.28 $2,952.16 |
Toc - Plan #58 Security Health Plan | ||||||||||||||||||||
Gold
(HMO) Premier $3,500 - 30% |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$544.99 $618.56 $696.49 $973.34 $1,479.08 |
$961.90 $1,035.47 $1,113.40 $1,390.25 |
$1,378.81 $1,452.38 $1,530.31 $1,807.16 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,089.98 $1,237.12 $1,392.98 $1,946.68 $2,958.16 |
$1,506.89 $1,654.03 $1,809.89 $2,363.59 |
$1,923.80 $2,070.94 $2,226.80 $2,780.50 |
Toc - Plan #59 Security Health Plan | ||||||||||||||||||||
Silver
(HMO) Premier $5,800 - 40% |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$573.66 $651.09 $733.12 $1,024.53 $1,556.87 |
$1,012.50 $1,089.93 $1,171.96 $1,463.37 |
$1,451.34 $1,528.77 $1,610.80 $1,902.21 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,147.32 $1,302.18 $1,466.24 $2,049.06 $3,113.74 |
$1,586.16 $1,741.02 $1,905.08 $2,487.90 |
$2,025.00 $2,179.86 $2,343.92 $2,926.74 |
Toc - Plan #60 Security Health Plan | ||||||||||||||||||||
Silver
(HMO) Premier $4,100 HDHP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$661.91 $751.26 $845.91 $1,182.15 $1,796.39 |
$1,168.26 $1,257.61 $1,352.26 $1,688.50 |
$1,674.61 $1,763.96 $1,858.61 $2,194.85 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,323.82 $1,502.52 $1,691.82 $2,364.30 $3,592.78 |
$1,830.17 $2,008.87 $2,198.17 $2,870.65 |
$2,336.52 $2,515.22 $2,704.52 $3,377.00 |
Toc - Plan #61 Security Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) Premier $6,200 HDHP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$451.19 $512.09 $576.61 $805.81 $1,224.50 |
$796.34 $857.24 $921.76 $1,150.96 |
$1,141.49 $1,202.39 $1,266.91 $1,496.11 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$902.38 $1,024.18 $1,153.22 $1,611.62 $2,449.00 |
$1,247.53 $1,369.33 $1,498.37 $1,956.77 |
$1,592.68 $1,714.48 $1,843.52 $2,301.92 |
Toc - Plan #62 Security Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) Premier $7,500 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$397.21 $450.82 $507.62 $709.39 $1,077.99 |
$701.06 $754.67 $811.47 $1,013.24 |
$1,004.91 $1,058.52 $1,115.32 $1,317.09 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$794.42 $901.64 $1,015.24 $1,418.78 $2,155.98 |
$1,098.27 $1,205.49 $1,319.09 $1,722.63 |
$1,402.12 $1,509.34 $1,622.94 $2,026.48 |
Toc - Plan #63 Security Health Plan | ||||||||||||||||||||
Bronze
(HMO) Premier $9,100 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$388.65 $441.11 $496.69 $694.12 $1,054.78 |
$685.96 $738.42 $794.00 $991.43 |
$983.27 $1,035.73 $1,091.31 $1,288.74 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$777.30 $882.22 $993.38 $1,388.24 $2,109.56 |
$1,074.61 $1,179.53 $1,290.69 $1,685.55 |
$1,371.92 $1,476.84 $1,588.00 $1,982.86 |
Toc - Plan #64 Security Health Plan | ||||||||||||||||||||
Catastrophic
(HMO) Premier Protection |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$265.88 $301.76 $339.78 $474.84 $721.57 |
$469.27 $505.15 $543.17 $678.23 |
$672.66 $708.54 $746.56 $881.62 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$531.76 $603.52 $679.56 $949.68 $1,443.14 |
$735.15 $806.91 $882.95 $1,153.07 |
$938.54 $1,010.30 $1,086.34 $1,356.46 |
ADVERTISEMENT
MedicaLocal: 1-888-592-8211 | Toll Free: 1-888-592-8211 | TTY: 1-800-947-3529 |
Toc - Plan #65 Medica | ||||||||||||||||||||
Gold
(EPO) Engage by Medica Gold Copay ($0 Virtual Care with Designated Providers + $0 Preferred Generic Drugs) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-592-8211
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$533.97 $606.05 $682.41 $953.66 $1,449.18 |
$942.45 $1,014.53 $1,090.89 $1,362.14 |
$1,350.93 $1,423.01 $1,499.37 $1,770.62 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,067.94 $1,212.10 $1,364.82 $1,907.32 $2,898.36 |
$1,476.42 $1,620.58 $1,773.30 $2,315.80 |
$1,884.90 $2,029.06 $2,181.78 $2,724.28 |
Toc - Plan #66 Medica | ||||||||||||||||||||
Expanded Bronze
(EPO) Engage by Medica Bronze Copay ($0 Virtual Care with Designated Providers) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-592-8211
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$408.09 $463.17 $521.53 $728.83 $1,107.53 |
$720.27 $775.35 $833.71 $1,041.01 |
$1,032.45 $1,087.53 $1,145.89 $1,353.19 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$816.18 $926.34 $1,043.06 $1,457.66 $2,215.06 |
$1,128.36 $1,238.52 $1,355.24 $1,769.84 |
$1,440.54 $1,550.70 $1,667.42 $2,082.02 |
Toc - Plan #67 Medica | ||||||||||||||||||||
Expanded Bronze
(EPO) Engage by Medica Bronze HSA ($0 Virtual Care after Deductible with Designated Providers) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-592-8211
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$464.83 $527.57 $594.04 $830.17 $1,261.53 |
$820.42 $883.16 $949.63 $1,185.76 |
$1,176.01 $1,238.75 $1,305.22 $1,541.35 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$929.66 $1,055.14 $1,188.08 $1,660.34 $2,523.06 |
$1,285.25 $1,410.73 $1,543.67 $2,015.93 |
$1,640.84 $1,766.32 $1,899.26 $2,371.52 |
Toc - Plan #68 Medica | ||||||||||||||||||||
Catastrophic
(EPO) Engage by Medica Catastrophic ($0 Virtual Care with Designated Providers) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-592-8211
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$260.69 $295.87 $333.15 $465.57 $707.48 |
$460.11 $495.29 $532.57 $664.99 |
$659.53 $694.71 $731.99 $864.41 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$521.38 $591.74 $666.30 $931.14 $1,414.96 |
$720.80 $791.16 $865.72 $1,130.56 |
$920.22 $990.58 $1,065.14 $1,329.98 |
Toc - Plan #69 Medica | ||||||||||||||||||||
Silver
(EPO) Engage by Medica Silver Share ($0 Virtual Care with Designated Providers + $5 Preferred Generic Drugs) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-592-8211
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$533.76 $605.80 $682.13 $953.27 $1,448.59 |
$942.08 $1,014.12 $1,090.45 $1,361.59 |
$1,350.40 $1,422.44 $1,498.77 $1,769.91 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,067.52 $1,211.60 $1,364.26 $1,906.54 $2,897.18 |
$1,475.84 $1,619.92 $1,772.58 $2,314.86 |
$1,884.16 $2,028.24 $2,180.90 $2,723.18 |
Toc - Plan #70 Medica | ||||||||||||||||||||
Expanded Bronze
(EPO) Engage by Medica Bronze Share Plus ($0 Virtual Care with Designated Providers) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-592-8211
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$418.54 $475.03 $534.88 $747.50 $1,135.89 |
$738.72 $795.21 $855.06 $1,067.68 |
$1,058.90 $1,115.39 $1,175.24 $1,387.86 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$837.08 $950.06 $1,069.76 $1,495.00 $2,271.78 |
$1,157.26 $1,270.24 $1,389.94 $1,815.18 |
$1,477.44 $1,590.42 $1,710.12 $2,135.36 |
Toc - Plan #71 Medica | ||||||||||||||||||||
Gold
(EPO) Engage by Medica Gold Standard ($0 Virtual Care with Designated Providers) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-592-8211
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$533.16 $605.13 $681.37 $952.21 $1,446.98 |
$941.02 $1,012.99 $1,089.23 $1,360.07 |
$1,348.88 $1,420.85 $1,497.09 $1,767.93 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,066.32 $1,210.26 $1,362.74 $1,904.42 $2,893.96 |
$1,474.18 $1,618.12 $1,770.60 $2,312.28 |
$1,882.04 $2,025.98 $2,178.46 $2,720.14 |
Toc - Plan #72 Medica | ||||||||||||||||||||
Silver
(EPO) Engage by Medica Silver Standard ($0 Virtual Care with Designated Providers) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-592-8211
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$514.48 $583.93 $657.50 $918.85 $1,396.28 |
$908.05 $977.50 $1,051.07 $1,312.42 |
$1,301.62 $1,371.07 $1,444.64 $1,705.99 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,028.96 $1,167.86 $1,315.00 $1,837.70 $2,792.56 |
$1,422.53 $1,561.43 $1,708.57 $2,231.27 |
$1,816.10 $1,955.00 $2,102.14 $2,624.84 |
Toc - Plan #73 Medica | ||||||||||||||||||||
Bronze
(EPO) Engage by Medica Bronze Standard ($0 Virtual Care with Designated Providers) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-592-8211
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$398.24 $451.99 $508.93 $711.23 $1,080.79 |
$702.88 $756.63 $813.57 $1,015.87 |
$1,007.52 $1,061.27 $1,118.21 $1,320.51 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$796.48 $903.98 $1,017.86 $1,422.46 $2,161.58 |
$1,101.12 $1,208.62 $1,322.50 $1,727.10 |
$1,405.76 $1,513.26 $1,627.14 $2,031.74 |
ADVERTISEMENT
Anthem Blue Cross and Blue ShieldLocal: 1-855-748-1813 | Toll Free: 1-855-748-1813 |
Toc - Plan #74 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 |
$441.87 $501.52 $564.71 $789.18 $1,199.24 |
$779.90 $839.55 $902.74 $1,127.21 |
$1,117.93 $1,177.58 $1,240.77 $1,465.24 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$883.74 $1,003.04 $1,129.42 $1,578.36 $2,398.48 |
$1,221.77 $1,341.07 $1,467.45 $1,916.39 |
$1,559.80 $1,679.10 $1,805.48 $2,254.42 |
Toc - Plan #75 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 |
$428.43 $486.27 $547.53 $765.18 $1,162.76 |
$756.18 $814.02 $875.28 $1,092.93 |
$1,083.93 $1,141.77 $1,203.03 $1,420.68 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$856.86 $972.54 $1,095.06 $1,530.36 $2,325.52 |
$1,184.61 $1,300.29 $1,422.81 $1,858.11 |
$1,512.36 $1,628.04 $1,750.56 $2,185.86 |
Toc - Plan #76 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 |
$420.76 $477.56 $537.73 $751.48 $1,141.94 |
$742.64 $799.44 $859.61 $1,073.36 |
$1,064.52 $1,121.32 $1,181.49 $1,395.24 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$841.52 $955.12 $1,075.46 $1,502.96 $2,283.88 |
$1,163.40 $1,277.00 $1,397.34 $1,824.84 |
$1,485.28 $1,598.88 $1,719.22 $2,146.72 |
Toc - Plan #77 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 |
$398.82 $452.66 $509.69 $712.29 $1,082.40 |
$703.92 $757.76 $814.79 $1,017.39 |
$1,009.02 $1,062.86 $1,119.89 $1,322.49 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$797.64 $905.32 $1,019.38 $1,424.58 $2,164.80 |
$1,102.74 $1,210.42 $1,324.48 $1,729.68 |
$1,407.84 $1,515.52 $1,629.58 $2,034.78 |
Toc - Plan #78 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 |
$419.89 $476.58 $536.62 $749.92 $1,139.58 |
$741.11 $797.80 $857.84 $1,071.14 |
$1,062.33 $1,119.02 $1,179.06 $1,392.36 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$839.78 $953.16 $1,073.24 $1,499.84 $2,279.16 |
$1,161.00 $1,274.38 $1,394.46 $1,821.06 |
$1,482.22 $1,595.60 $1,715.68 $2,142.28 |
Toc - Plan #79 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 |
$544.67 $618.20 $696.09 $972.78 $1,478.23 |
$961.34 $1,034.87 $1,112.76 $1,389.45 |
$1,378.01 $1,451.54 $1,529.43 $1,806.12 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,089.34 $1,236.40 $1,392.18 $1,945.56 $2,956.46 |
$1,506.01 $1,653.07 $1,808.85 $2,362.23 |
$1,922.68 $2,069.74 $2,225.52 $2,778.90 |
Toc - Plan #80 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 |
$525.87 $596.86 $672.06 $939.20 $1,427.21 |
$928.16 $999.15 $1,074.35 $1,341.49 |
$1,330.45 $1,401.44 $1,476.64 $1,743.78 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,051.74 $1,193.72 $1,344.12 $1,878.40 $2,854.42 |
$1,454.03 $1,596.01 $1,746.41 $2,280.69 |
$1,856.32 $1,998.30 $2,148.70 $2,682.98 |
Toc - Plan #81 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 |
$532.19 $604.04 $680.14 $950.49 $1,444.36 |
$939.32 $1,011.17 $1,087.27 $1,357.62 |
$1,346.45 $1,418.30 $1,494.40 $1,764.75 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,064.38 $1,208.08 $1,360.28 $1,900.98 $2,888.72 |
$1,471.51 $1,615.21 $1,767.41 $2,308.11 |
$1,878.64 $2,022.34 $2,174.54 $2,715.24 |
Toc - Plan #82 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 |
$522.77 $593.34 $668.10 $933.67 $1,418.80 |
$922.69 $993.26 $1,068.02 $1,333.59 |
$1,322.61 $1,393.18 $1,467.94 $1,733.51 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,045.54 $1,186.68 $1,336.20 $1,867.34 $2,837.60 |
$1,445.46 $1,586.60 $1,736.12 $2,267.26 |
$1,845.38 $1,986.52 $2,136.04 $2,667.18 |
Toc - Plan #83 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 |
$399.39 $453.31 $510.42 $713.31 $1,083.94 |
$704.92 $758.84 $815.95 $1,018.84 |
$1,010.45 $1,064.37 $1,121.48 $1,324.37 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$798.78 $906.62 $1,020.84 $1,426.62 $2,167.88 |
$1,104.31 $1,212.15 $1,326.37 $1,732.15 |
$1,409.84 $1,517.68 $1,631.90 $2,037.68 |
Toc - Plan #84 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 |
$434.10 $492.70 $554.78 $775.30 $1,178.15 |
$766.19 $824.79 $886.87 $1,107.39 |
$1,098.28 $1,156.88 $1,218.96 $1,439.48 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$868.20 $985.40 $1,109.56 $1,550.60 $2,356.30 |
$1,200.29 $1,317.49 $1,441.65 $1,882.69 |
$1,532.38 $1,649.58 $1,773.74 $2,214.78 |
Toc - Plan #85 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 |
$518.33 $588.30 $662.43 $925.74 $1,406.75 |
$914.85 $984.82 $1,058.95 $1,322.26 |
$1,311.37 $1,381.34 $1,455.47 $1,718.78 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,036.66 $1,176.60 $1,324.86 $1,851.48 $2,813.50 |
$1,433.18 $1,573.12 $1,721.38 $2,248.00 |
$1,829.70 $1,969.64 $2,117.90 $2,644.52 |
Toc - Plan #86 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 |
$545.06 $618.64 $696.59 $973.48 $1,479.29 |
$962.03 $1,035.61 $1,113.56 $1,390.45 |
$1,379.00 $1,452.58 $1,530.53 $1,807.42 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,090.12 $1,237.28 $1,393.18 $1,946.96 $2,958.58 |
$1,507.09 $1,654.25 $1,810.15 $2,363.93 |
$1,924.06 $2,071.22 $2,227.12 $2,780.90 |
‡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 Jackson County here.
Jackson County is in “Rating Area 6” of Wisconsin.
Currently, there are 86 plans offered in Rating Area 6.