Obamacare 2024 Rates for Travis County, Texas
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Obamacare is also known as the Affordable Care Act. This page gives you an overview of the rates for individual and family health insurance plans available from , the marketplace for Austin, TX.
The health insurance rates listed below are for calendar year 2024.
For information on subsidies to make your coverage affordable, you must take one of the following actions:
- Contact a licensed health insurance agent
- Complete an application at Healthcare.gov
- Contact the provider directly
Obamacare Providers, 133 Plans and 2024 Rates for Travis County, Texas
Below, you’ll find a summary of the 133 plans for Travis County, Texas and rates for each of these providers.‡ This chart is designed to give you a preview of your health insurance options.
Obamacare Rates and Providers for Other Years
2014 | 2015 | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 | 2022 | 2023 | 2024 |
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Moda Health, Inc.Local: 1-844-827-6571 | Toll Free: 1-844-827-6571 | TTY: 1-844-827-6571 |
Toc - Plan #1 Moda Health, Inc. | ||||||||||||||||||||
Gold
(EPO) Moda Select Gold 1000 ($0 Virtual Care) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-827-6571
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 |
$388.00 $440.00 $495.00 $692.00 $1,052.00 |
$684.00 $736.00 $791.00 $988.00 |
$980.00 $1,032.00 $1,087.00 $1,284.00 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$776.00 $880.00 $990.00 $1,384.00 $2,104.00 |
$1,072.00 $1,176.00 $1,286.00 $1,680.00 |
$1,368.00 $1,472.00 $1,582.00 $1,976.00 |
Toc - Plan #2 Moda Health, Inc. | ||||||||||||||||||||
Gold
(EPO) Moda Select Gold 1800 ($0 Virtual Care) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-827-6571
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 |
$389.00 $442.00 $497.00 $695.00 $1,056.00 |
$687.00 $740.00 $795.00 $993.00 |
$985.00 $1,038.00 $1,093.00 $1,291.00 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$778.00 $884.00 $994.00 $1,390.00 $2,112.00 |
$1,076.00 $1,182.00 $1,292.00 $1,688.00 |
$1,374.00 $1,480.00 $1,590.00 $1,986.00 |
Toc - Plan #3 Moda Health, Inc. | ||||||||||||||||||||
Silver
(EPO) Moda Select Silver 3500 ($0 Virtual Care) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-827-6571
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 |
$447.00 $508.00 $572.00 $799.00 $1,214.00 |
$789.00 $850.00 $914.00 $1,141.00 |
$1,131.00 $1,192.00 $1,256.00 $1,483.00 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$894.00 $1,016.00 $1,144.00 $1,598.00 $2,428.00 |
$1,236.00 $1,358.00 $1,486.00 $1,940.00 |
$1,578.00 $1,700.00 $1,828.00 $2,282.00 |
Toc - Plan #4 Moda Health, Inc. | ||||||||||||||||||||
Silver
(EPO) Moda Select Silver 4800 ($0 Virtual Care) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-827-6571
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 |
$445.00 $505.00 $569.00 $795.00 $1,208.00 |
$786.00 $846.00 $910.00 $1,136.00 |
$1,127.00 $1,187.00 $1,251.00 $1,477.00 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$890.00 $1,010.00 $1,138.00 $1,590.00 $2,416.00 |
$1,231.00 $1,351.00 $1,479.00 $1,931.00 |
$1,572.00 $1,692.00 $1,820.00 $2,272.00 |
Toc - Plan #5 Moda Health, Inc. | ||||||||||||||||||||
Silver
(EPO) Moda Select Silver 6400 ($0 Virtual Care) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-827-6571
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 |
$450.00 $510.00 $575.00 $803.00 $1,221.00 |
$794.00 $854.00 $919.00 $1,147.00 |
$1,138.00 $1,198.00 $1,263.00 $1,491.00 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$900.00 $1,020.00 $1,150.00 $1,606.00 $2,442.00 |
$1,244.00 $1,364.00 $1,494.00 $1,950.00 |
$1,588.00 $1,708.00 $1,838.00 $2,294.00 |
Toc - Plan #6 Moda Health, Inc. | ||||||||||||||||||||
Expanded Bronze
(EPO) Moda Select Bronze 8700 ($0 Virtual Care) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-827-6571
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 |
$285.00 $324.00 $365.00 $509.00 $774.00 |
$503.00 $542.00 $583.00 $727.00 |
$721.00 $760.00 $801.00 $945.00 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$570.00 $648.00 $730.00 $1,018.00 $1,548.00 |
$788.00 $866.00 $948.00 $1,236.00 |
$1,006.00 $1,084.00 $1,166.00 $1,454.00 |
Toc - Plan #7 Moda Health, Inc. | ||||||||||||||||||||
Expanded Bronze
(EPO) Moda Select Bronze HSA 7500 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-827-6571
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 |
$283.00 $322.00 $362.00 $506.00 $769.00 |
$500.00 $539.00 $579.00 $723.00 |
$717.00 $756.00 $796.00 $940.00 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$566.00 $644.00 $724.00 $1,012.00 $1,538.00 |
$783.00 $861.00 $941.00 $1,229.00 |
$1,000.00 $1,078.00 $1,158.00 $1,446.00 |
Toc - Plan #8 Moda Health, Inc. | ||||||||||||||||||||
Silver
(EPO) Moda Select Texas Standard Silver |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-827-6571
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 |
$450.00 $510.00 $575.00 $803.00 $1,221.00 |
$794.00 $854.00 $919.00 $1,147.00 |
$1,138.00 $1,198.00 $1,263.00 $1,491.00 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$900.00 $1,020.00 $1,150.00 $1,606.00 $2,442.00 |
$1,244.00 $1,364.00 $1,494.00 $1,950.00 |
$1,588.00 $1,708.00 $1,838.00 $2,294.00 |
Toc - Plan #9 Moda Health, Inc. | ||||||||||||||||||||
Gold
(EPO) Moda Select Texas Standard Gold |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-827-6571
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$391.00 $443.00 $499.00 $697.00 $1,060.00 |
$690.00 $742.00 $798.00 $996.00 |
$989.00 $1,041.00 $1,097.00 $1,295.00 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$782.00 $886.00 $998.00 $1,394.00 $2,120.00 |
$1,081.00 $1,185.00 $1,297.00 $1,693.00 |
$1,380.00 $1,484.00 $1,596.00 $1,992.00 |
Toc - Plan #10 Moda Health, Inc. | ||||||||||||||||||||
Expanded Bronze
(EPO) Moda Select Texas Standard Bronze |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-827-6571
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 |
$282.00 $320.00 $360.00 $503.00 $764.00 |
$497.00 $535.00 $575.00 $718.00 |
$712.00 $750.00 $790.00 $933.00 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$564.00 $640.00 $720.00 $1,006.00 $1,528.00 |
$779.00 $855.00 $935.00 $1,221.00 |
$994.00 $1,070.00 $1,150.00 $1,436.00 |
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Oscar Insurance CompanyLocal: 1-855-672-2755 | Toll Free: 1-855-672-2755 |
Toc - Plan #11 Oscar Insurance Company | ||||||||||||||||||||
Expanded Bronze
(EPO) Bronze Classic |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
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 |
$359.46 $407.98 $459.38 $641.98 $975.55 |
$634.44 $682.96 $734.36 $916.96 |
$909.42 $957.94 $1,009.34 $1,191.94 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$718.92 $815.96 $918.76 $1,283.96 $1,951.10 |
$993.90 $1,090.94 $1,193.74 $1,558.94 |
$1,268.88 $1,365.92 $1,468.72 $1,833.92 |
Toc - Plan #12 Oscar Insurance Company | ||||||||||||||||||||
Expanded Bronze
(EPO) Bronze Elite + PCP Saver Plus |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
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 |
$379.81 $431.07 $485.38 $678.32 $1,030.77 |
$670.35 $721.61 $775.92 $968.86 |
$960.89 $1,012.15 $1,066.46 $1,259.40 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$759.62 $862.14 $970.76 $1,356.64 $2,061.54 |
$1,050.16 $1,152.68 $1,261.30 $1,647.18 |
$1,340.70 $1,443.22 $1,551.84 $1,937.72 |
Toc - Plan #13 Oscar Insurance Company | ||||||||||||||||||||
Silver
(EPO) Silver Classic |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
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 |
$494.78 $561.57 $632.32 $883.67 $1,342.82 |
$873.28 $940.07 $1,010.82 $1,262.17 |
$1,251.78 $1,318.57 $1,389.32 $1,640.67 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$989.56 $1,123.14 $1,264.64 $1,767.34 $2,685.64 |
$1,368.06 $1,501.64 $1,643.14 $2,145.84 |
$1,746.56 $1,880.14 $2,021.64 $2,524.34 |
Toc - Plan #14 Oscar Insurance Company | ||||||||||||||||||||
Silver
(EPO) Silver Simple Specialist Saver |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
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 |
$489.47 $555.53 $625.52 $874.17 $1,328.38 |
$863.90 $929.96 $999.95 $1,248.60 |
$1,238.33 $1,304.39 $1,374.38 $1,623.03 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$978.94 $1,111.06 $1,251.04 $1,748.34 $2,656.76 |
$1,353.37 $1,485.49 $1,625.47 $2,122.77 |
$1,727.80 $1,859.92 $1,999.90 $2,497.20 |
Toc - Plan #15 Oscar Insurance Company | ||||||||||||||||||||
Expanded Bronze
(EPO) Bronze Elite + Specialist Saver Plus |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
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 |
$381.04 $432.47 $486.96 $680.52 $1,034.12 |
$672.53 $723.96 $778.45 $972.01 |
$964.02 $1,015.45 $1,069.94 $1,263.50 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$762.08 $864.94 $973.92 $1,361.04 $2,068.24 |
$1,053.57 $1,156.43 $1,265.41 $1,652.53 |
$1,345.06 $1,447.92 $1,556.90 $1,944.02 |
Toc - Plan #16 Oscar Insurance Company | ||||||||||||||||||||
Expanded Bronze
(EPO) Bronze Classic 4700 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
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 |
$365.63 $414.98 $467.26 $653.00 $992.29 |
$645.33 $694.68 $746.96 $932.70 |
$925.03 $974.38 $1,026.66 $1,212.40 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$731.26 $829.96 $934.52 $1,306.00 $1,984.58 |
$1,010.96 $1,109.66 $1,214.22 $1,585.70 |
$1,290.66 $1,389.36 $1,493.92 $1,865.40 |
Toc - Plan #17 Oscar Insurance Company | ||||||||||||||||||||
Silver
(EPO) Silver Simple PCP Saver |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
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 |
$487.59 $553.40 $623.12 $870.81 $1,323.29 |
$860.59 $926.40 $996.12 $1,243.81 |
$1,233.59 $1,299.40 $1,369.12 $1,616.81 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$975.18 $1,106.80 $1,246.24 $1,741.62 $2,646.58 |
$1,348.18 $1,479.80 $1,619.24 $2,114.62 |
$1,721.18 $1,852.80 $1,992.24 $2,487.62 |
Toc - Plan #18 Oscar Insurance Company | ||||||||||||||||||||
Silver
(EPO) Silver Elite Saver Plus |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
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 |
$514.08 $583.47 $656.99 $918.14 $1,395.20 |
$907.35 $976.74 $1,050.26 $1,311.41 |
$1,300.62 $1,370.01 $1,443.53 $1,704.68 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$1,028.16 $1,166.94 $1,313.98 $1,836.28 $2,790.40 |
$1,421.43 $1,560.21 $1,707.25 $2,229.55 |
$1,814.70 $1,953.48 $2,100.52 $2,622.82 |
Toc - Plan #19 Oscar Insurance Company | ||||||||||||||||||||
Expanded Bronze
(EPO) Bronze Classic Standard |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$358.82 $407.25 $458.56 $640.84 $973.82 |
$633.31 $681.74 $733.05 $915.33 |
$907.80 $956.23 $1,007.54 $1,189.82 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$717.64 $814.50 $917.12 $1,281.68 $1,947.64 |
$992.13 $1,088.99 $1,191.61 $1,556.17 |
$1,266.62 $1,363.48 $1,466.10 $1,830.66 |
Toc - Plan #20 Oscar Insurance Company | ||||||||||||||||||||
Silver
(EPO) Silver Classic Standard |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
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 |
$481.95 $547.00 $615.92 $860.74 $1,307.98 |
$850.63 $915.68 $984.60 $1,229.42 |
$1,219.31 $1,284.36 $1,353.28 $1,598.10 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$963.90 $1,094.00 $1,231.84 $1,721.48 $2,615.96 |
$1,332.58 $1,462.68 $1,600.52 $2,090.16 |
$1,701.26 $1,831.36 $1,969.20 $2,458.84 |
Toc - Plan #21 Oscar Insurance Company | ||||||||||||||||||||
Gold
(EPO) Gold Classic Standard |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
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 |
$414.87 $470.87 $530.19 $740.94 $1,125.93 |
$732.24 $788.24 $847.56 $1,058.31 |
$1,049.61 $1,105.61 $1,164.93 $1,375.68 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$829.74 $941.74 $1,060.38 $1,481.88 $2,251.86 |
$1,147.11 $1,259.11 $1,377.75 $1,799.25 |
$1,464.48 $1,576.48 $1,695.12 $2,116.62 |
Toc - Plan #22 Oscar Insurance Company | ||||||||||||||||||||
Gold
(EPO) Gold Classic |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$428.04 $485.81 $547.02 $764.45 $1,161.66 |
$755.48 $813.25 $874.46 $1,091.89 |
$1,082.92 $1,140.69 $1,201.90 $1,419.33 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$856.08 $971.62 $1,094.04 $1,528.90 $2,323.32 |
$1,183.52 $1,299.06 $1,421.48 $1,856.34 |
$1,510.96 $1,626.50 $1,748.92 $2,183.78 |
Toc - Plan #23 Oscar Insurance Company | ||||||||||||||||||||
Gold
(EPO) Gold Elite |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$442.43 $502.15 $565.42 $790.17 $1,200.74 |
$780.88 $840.60 $903.87 $1,128.62 |
$1,119.33 $1,179.05 $1,242.32 $1,467.07 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$884.86 $1,004.30 $1,130.84 $1,580.34 $2,401.48 |
$1,223.31 $1,342.75 $1,469.29 $1,918.79 |
$1,561.76 $1,681.20 $1,807.74 $2,257.24 |
ADVERTISEMENT
Ambetter from Superior HealthPlanLocal: 1-877-687-1196 | Toll Free: 1-877-687-1196 | TTY: 1-800-735-2989 |
Toc - Plan #24 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Silver
(EPO) Complete Silver |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$550.10 $624.35 $703.01 $982.46 $1,492.94 |
$970.92 $1,045.17 $1,123.83 $1,403.28 |
$1,391.74 $1,465.99 $1,544.65 $1,824.10 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,100.20 $1,248.70 $1,406.02 $1,964.92 $2,985.88 |
$1,521.02 $1,669.52 $1,826.84 $2,385.74 |
$1,941.84 $2,090.34 $2,247.66 $2,806.56 |
Toc - Plan #25 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Gold
(EPO) Complete Gold |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$498.61 $565.91 $637.21 $890.50 $1,353.19 |
$880.04 $947.34 $1,018.64 $1,271.93 |
$1,261.47 $1,328.77 $1,400.07 $1,653.36 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$997.22 $1,131.82 $1,274.42 $1,781.00 $2,706.38 |
$1,378.65 $1,513.25 $1,655.85 $2,162.43 |
$1,760.08 $1,894.68 $2,037.28 $2,543.86 |
Toc - Plan #26 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Silver
(EPO) Clear Silver |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$541.21 $614.26 $691.66 $966.59 $1,468.82 |
$955.23 $1,028.28 $1,105.68 $1,380.61 |
$1,369.25 $1,442.30 $1,519.70 $1,794.63 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,082.42 $1,228.52 $1,383.32 $1,933.18 $2,937.64 |
$1,496.44 $1,642.54 $1,797.34 $2,347.20 |
$1,910.46 $2,056.56 $2,211.36 $2,761.22 |
Toc - Plan #27 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Silver
(EPO) Focused Silver |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$544.55 $618.05 $695.92 $972.55 $1,477.89 |
$961.12 $1,034.62 $1,112.49 $1,389.12 |
$1,377.69 $1,451.19 $1,529.06 $1,805.69 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,089.10 $1,236.10 $1,391.84 $1,945.10 $2,955.78 |
$1,505.67 $1,652.67 $1,808.41 $2,361.67 |
$1,922.24 $2,069.24 $2,224.98 $2,778.24 |
Toc - Plan #28 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Gold
(EPO) Everyday Gold |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$485.79 $551.36 $620.83 $867.60 $1,318.40 |
$857.41 $922.98 $992.45 $1,239.22 |
$1,229.03 $1,294.60 $1,364.07 $1,610.84 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$971.58 $1,102.72 $1,241.66 $1,735.20 $2,636.80 |
$1,343.20 $1,474.34 $1,613.28 $2,106.82 |
$1,714.82 $1,845.96 $1,984.90 $2,478.44 |
Toc - Plan #29 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Gold
(EPO) Clear Gold |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$481.80 $546.83 $615.73 $860.48 $1,307.59 |
$850.37 $915.40 $984.30 $1,229.05 |
$1,218.94 $1,283.97 $1,352.87 $1,597.62 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$963.60 $1,093.66 $1,231.46 $1,720.96 $2,615.18 |
$1,332.17 $1,462.23 $1,600.03 $2,089.53 |
$1,700.74 $1,830.80 $1,968.60 $2,458.10 |
Toc - Plan #30 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Silver
(EPO) Standard Silver |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$538.63 $611.33 $688.35 $961.97 $1,461.81 |
$950.67 $1,023.37 $1,100.39 $1,374.01 |
$1,362.71 $1,435.41 $1,512.43 $1,786.05 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,077.26 $1,222.66 $1,376.70 $1,923.94 $2,923.62 |
$1,489.30 $1,634.70 $1,788.74 $2,335.98 |
$1,901.34 $2,046.74 $2,200.78 $2,748.02 |
Toc - Plan #31 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Gold
(EPO) Standard Gold |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$487.40 $553.19 $622.89 $870.49 $1,322.79 |
$860.26 $926.05 $995.75 $1,243.35 |
$1,233.12 $1,298.91 $1,368.61 $1,616.21 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$974.80 $1,106.38 $1,245.78 $1,740.98 $2,645.58 |
$1,347.66 $1,479.24 $1,618.64 $2,113.84 |
$1,720.52 $1,852.10 $1,991.50 $2,486.70 |
Toc - Plan #32 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Gold
(EPO) Complete Gold + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$517.95 $587.86 $661.93 $925.04 $1,405.69 |
$914.18 $984.09 $1,058.16 $1,321.27 |
$1,310.41 $1,380.32 $1,454.39 $1,717.50 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,035.90 $1,175.72 $1,323.86 $1,850.08 $2,811.38 |
$1,432.13 $1,571.95 $1,720.09 $2,246.31 |
$1,828.36 $1,968.18 $2,116.32 $2,642.54 |
Toc - Plan #33 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Silver
(EPO) Complete Silver + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$571.44 $648.57 $730.29 $1,020.58 $1,550.86 |
$1,008.58 $1,085.71 $1,167.43 $1,457.72 |
$1,445.72 $1,522.85 $1,604.57 $1,894.86 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,142.88 $1,297.14 $1,460.58 $2,041.16 $3,101.72 |
$1,580.02 $1,734.28 $1,897.72 $2,478.30 |
$2,017.16 $2,171.42 $2,334.86 $2,915.44 |
Toc - Plan #34 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Silver
(EPO) Standard Silver + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$559.52 $635.05 $715.06 $999.29 $1,518.52 |
$987.55 $1,063.08 $1,143.09 $1,427.32 |
$1,415.58 $1,491.11 $1,571.12 $1,855.35 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,119.04 $1,270.10 $1,430.12 $1,998.58 $3,037.04 |
$1,547.07 $1,698.13 $1,858.15 $2,426.61 |
$1,975.10 $2,126.16 $2,286.18 $2,854.64 |
Toc - Plan #35 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Gold
(EPO) Standard Gold + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$506.31 $574.65 $647.06 $904.26 $1,374.11 |
$893.63 $961.97 $1,034.38 $1,291.58 |
$1,280.95 $1,349.29 $1,421.70 $1,678.90 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,012.62 $1,149.30 $1,294.12 $1,808.52 $2,748.22 |
$1,399.94 $1,536.62 $1,681.44 $2,195.84 |
$1,787.26 $1,923.94 $2,068.76 $2,583.16 |
Toc - Plan #36 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Silver
(EPO) Focused Silver + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$565.68 $642.03 $722.92 $1,010.28 $1,535.22 |
$998.42 $1,074.77 $1,155.66 $1,443.02 |
$1,431.16 $1,507.51 $1,588.40 $1,875.76 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,131.36 $1,284.06 $1,445.84 $2,020.56 $3,070.44 |
$1,564.10 $1,716.80 $1,878.58 $2,453.30 |
$1,996.84 $2,149.54 $2,311.32 $2,886.04 |
Toc - Plan #37 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Gold
(EPO) Everyday Gold + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$504.63 $572.75 $644.91 $901.26 $1,369.55 |
$890.67 $958.79 $1,030.95 $1,287.30 |
$1,276.71 $1,344.83 $1,416.99 $1,673.34 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,009.26 $1,145.50 $1,289.82 $1,802.52 $2,739.10 |
$1,395.30 $1,531.54 $1,675.86 $2,188.56 |
$1,781.34 $1,917.58 $2,061.90 $2,574.60 |
Toc - Plan #38 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Silver
(EPO) Clear Silver + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$562.21 $638.10 $718.49 $1,004.09 $1,525.81 |
$992.29 $1,068.18 $1,148.57 $1,434.17 |
$1,422.37 $1,498.26 $1,578.65 $1,864.25 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,124.42 $1,276.20 $1,436.98 $2,008.18 $3,051.62 |
$1,554.50 $1,706.28 $1,867.06 $2,438.26 |
$1,984.58 $2,136.36 $2,297.14 $2,868.34 |
Toc - Plan #39 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Gold
(EPO) Clear Gold + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$500.49 $568.05 $639.62 $893.87 $1,358.31 |
$883.36 $950.92 $1,022.49 $1,276.74 |
$1,266.23 $1,333.79 $1,405.36 $1,659.61 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,000.98 $1,136.10 $1,279.24 $1,787.74 $2,716.62 |
$1,383.85 $1,518.97 $1,662.11 $2,170.61 |
$1,766.72 $1,901.84 $2,044.98 $2,553.48 |
ADVERTISEMENT
Blue Cross and Blue Shield of TexasLocal: 1-888-697-0683 | Toll Free: 1-888-697-0683 | TTY: 1-800-735-2989 |
Toc - Plan #40 Blue Cross and Blue Shield of Texas | ||||||||||||||||||||
Gold
(HMO) Blue Advantage Gold HMO? 206 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-697-0683
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$441.58 $501.20 $564.34 $788.67 $1,198.46 |
$779.39 $839.01 $902.15 $1,126.48 |
$1,117.20 $1,176.82 $1,239.96 $1,464.29 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$883.16 $1,002.40 $1,128.68 $1,577.34 $2,396.92 |
$1,220.97 $1,340.21 $1,466.49 $1,915.15 |
$1,558.78 $1,678.02 $1,804.30 $2,252.96 |
Toc - Plan #41 Blue Cross and Blue Shield of Texas | ||||||||||||||||||||
Catastrophic
(HMO) Blue Advantage Security HMO? 200 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-697-0683
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$327.09 $371.25 $418.02 $584.18 $887.72 |
$577.31 $621.47 $668.24 $834.40 |
$827.53 $871.69 $918.46 $1,084.62 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$654.18 $742.50 $836.04 $1,168.36 $1,775.44 |
$904.40 $992.72 $1,086.26 $1,418.58 |
$1,154.62 $1,242.94 $1,336.48 $1,668.80 |
Toc - Plan #42 Blue Cross and Blue Shield of Texas | ||||||||||||||||||||
Silver
(HMO) Blue Advantage Silver HMO? 205 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-697-0683
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$524.36 $595.15 $670.13 $936.51 $1,423.12 |
$925.50 $996.29 $1,071.27 $1,337.65 |
$1,326.64 $1,397.43 $1,472.41 $1,738.79 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,048.72 $1,190.30 $1,340.26 $1,873.02 $2,846.24 |
$1,449.86 $1,591.44 $1,741.40 $2,274.16 |
$1,851.00 $1,992.58 $2,142.54 $2,675.30 |
Toc - Plan #43 Blue Cross and Blue Shield of Texas | ||||||||||||||||||||
Expanded Bronze
(HMO) Blue Advantage Bronze HMO? 204 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-697-0683
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$366.27 $415.72 $468.09 $654.16 $994.06 |
$646.47 $695.92 $748.29 $934.36 |
$926.67 $976.12 $1,028.49 $1,214.56 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$732.54 $831.44 $936.18 $1,308.32 $1,988.12 |
$1,012.74 $1,111.64 $1,216.38 $1,588.52 |
$1,292.94 $1,391.84 $1,496.58 $1,868.72 |
Toc - Plan #44 Blue Cross and Blue Shield of Texas | ||||||||||||||||||||
Expanded Bronze
(HMO) Blue Advantage Bronze HMO? 302 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-697-0683
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$379.11 $430.29 $484.50 $677.09 $1,028.90 |
$669.13 $720.31 $774.52 $967.11 |
$959.15 $1,010.33 $1,064.54 $1,257.13 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$758.22 $860.58 $969.00 $1,354.18 $2,057.80 |
$1,048.24 $1,150.60 $1,259.02 $1,644.20 |
$1,338.26 $1,440.62 $1,549.04 $1,934.22 |
Toc - Plan #45 Blue Cross and Blue Shield of Texas | ||||||||||||||||||||
Bronze
(HMO) Blue Advantage Bronze HMO? 301 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-697-0683
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$360.81 $409.52 $461.12 $644.41 $979.25 |
$636.83 $685.54 $737.14 $920.43 |
$912.85 $961.56 $1,013.16 $1,196.45 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$721.62 $819.04 $922.24 $1,288.82 $1,958.50 |
$997.64 $1,095.06 $1,198.26 $1,564.84 |
$1,273.66 $1,371.08 $1,474.28 $1,840.86 |
Toc - Plan #46 Blue Cross and Blue Shield of Texas | ||||||||||||||||||||
Gold
(HMO) Blue Advantage Gold HMO? 603 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-697-0683
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$455.97 $517.53 $582.73 $814.36 $1,237.50 |
$804.79 $866.35 $931.55 $1,163.18 |
$1,153.61 $1,215.17 $1,280.37 $1,512.00 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$911.94 $1,035.06 $1,165.46 $1,628.72 $2,475.00 |
$1,260.76 $1,383.88 $1,514.28 $1,977.54 |
$1,609.58 $1,732.70 $1,863.10 $2,326.36 |
Toc - Plan #47 Blue Cross and Blue Shield of Texas | ||||||||||||||||||||
Gold
(HMO) Blue Advantage Gold HMO? 706 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-697-0683
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$452.96 $514.11 $578.88 $808.98 $1,229.33 |
$799.47 $860.62 $925.39 $1,155.49 |
$1,145.98 $1,207.13 $1,271.90 $1,502.00 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$905.92 $1,028.22 $1,157.76 $1,617.96 $2,458.66 |
$1,252.43 $1,374.73 $1,504.27 $1,964.47 |
$1,598.94 $1,721.24 $1,850.78 $2,310.98 |
Toc - Plan #48 Blue Cross and Blue Shield of Texas | ||||||||||||||||||||
Silver
(HMO) Blue Advantage Silver HMO? 705 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-697-0683
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$524.41 $595.21 $670.20 $936.60 $1,423.25 |
$925.59 $996.39 $1,071.38 $1,337.78 |
$1,326.77 $1,397.57 $1,472.56 $1,738.96 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,048.82 $1,190.42 $1,340.40 $1,873.20 $2,846.50 |
$1,450.00 $1,591.60 $1,741.58 $2,274.38 |
$1,851.18 $1,992.78 $2,142.76 $2,675.56 |
Toc - Plan #49 Blue Cross and Blue Shield of Texas | ||||||||||||||||||||
Expanded Bronze
(HMO) Blue Advantage Bronze HMO? 707 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-697-0683
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$365.03 $414.31 $466.51 $651.94 $990.69 |
$644.28 $693.56 $745.76 $931.19 |
$923.53 $972.81 $1,025.01 $1,210.44 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$730.06 $828.62 $933.02 $1,303.88 $1,981.38 |
$1,009.31 $1,107.87 $1,212.27 $1,583.13 |
$1,288.56 $1,387.12 $1,491.52 $1,862.38 |
Toc - Plan #50 Blue Cross and Blue Shield of Texas | ||||||||||||||||||||
Expanded Bronze
(HMO) MyBlue Health Bronze? 402 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-697-0683
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$291.93 $331.34 $373.08 $521.38 $792.29 |
$515.25 $554.66 $596.40 $744.70 |
$738.57 $777.98 $819.72 $968.02 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$583.86 $662.68 $746.16 $1,042.76 $1,584.58 |
$807.18 $886.00 $969.48 $1,266.08 |
$1,030.50 $1,109.32 $1,192.80 $1,489.40 |
Toc - Plan #51 Blue Cross and Blue Shield of Texas | ||||||||||||||||||||
Gold
(HMO) MyBlue Health Gold? 403 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-697-0683
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$354.41 $402.26 $452.94 $632.98 $961.88 |
$625.54 $673.39 $724.07 $904.11 |
$896.67 $944.52 $995.20 $1,175.24 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$708.82 $804.52 $905.88 $1,265.96 $1,923.76 |
$979.95 $1,075.65 $1,177.01 $1,537.09 |
$1,251.08 $1,346.78 $1,448.14 $1,808.22 |
Toc - Plan #52 Blue Cross and Blue Shield of Texas | ||||||||||||||||||||
Silver
(HMO) MyBlue Health Silver? 405 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-697-0683
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$427.26 $484.94 $546.04 $763.09 $1,159.59 |
$754.11 $811.79 $872.89 $1,089.94 |
$1,080.96 $1,138.64 $1,199.74 $1,416.79 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$854.52 $969.88 $1,092.08 $1,526.18 $2,319.18 |
$1,181.37 $1,296.73 $1,418.93 $1,853.03 |
$1,508.22 $1,623.58 $1,745.78 $2,179.88 |
Toc - Plan #53 Blue Cross and Blue Shield of Texas | ||||||||||||||||||||
Expanded Bronze
(HMO) MyBlue Health Bronze? 806 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-697-0683
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$294.42 $334.17 $376.27 $525.83 $799.06 |
$519.65 $559.40 $601.50 $751.06 |
$744.88 $784.63 $826.73 $976.29 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$588.84 $668.34 $752.54 $1,051.66 $1,598.12 |
$814.07 $893.57 $977.77 $1,276.89 |
$1,039.30 $1,118.80 $1,203.00 $1,502.12 |
Toc - Plan #54 Blue Cross and Blue Shield of Texas | ||||||||||||||||||||
Gold
(HMO) MyBlue Health Gold? 808 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-697-0683
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$368.86 $418.66 $471.40 $658.79 $1,001.09 |
$651.04 $700.84 $753.58 $940.97 |
$933.22 $983.02 $1,035.76 $1,223.15 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$737.72 $837.32 $942.80 $1,317.58 $2,002.18 |
$1,019.90 $1,119.50 $1,224.98 $1,599.76 |
$1,302.08 $1,401.68 $1,507.16 $1,881.94 |
Toc - Plan #55 Blue Cross and Blue Shield of Texas | ||||||||||||||||||||
Silver
(HMO) MyBlue Health Silver? 807 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-697-0683
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$425.33 $482.74 $543.57 $759.63 $1,154.33 |
$750.70 $808.11 $868.94 $1,085.00 |
$1,076.07 $1,133.48 $1,194.31 $1,410.37 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$850.66 $965.48 $1,087.14 $1,519.26 $2,308.66 |
$1,176.03 $1,290.85 $1,412.51 $1,844.63 |
$1,501.40 $1,616.22 $1,737.88 $2,170.00 |
Toc - Plan #56 Blue Cross and Blue Shield of Texas | ||||||||||||||||||||
Silver
(HMO) Blue Advantage Silver HMO? 801 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-697-0683
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$522.19 $592.68 $667.35 $932.62 $1,417.21 |
$921.66 $992.15 $1,066.82 $1,332.09 |
$1,321.13 $1,391.62 $1,466.29 $1,731.56 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,044.38 $1,185.36 $1,334.70 $1,865.24 $2,834.42 |
$1,443.85 $1,584.83 $1,734.17 $2,264.71 |
$1,843.32 $1,984.30 $2,133.64 $2,664.18 |
Toc - Plan #57 Blue Cross and Blue Shield of Texas | ||||||||||||||||||||
Expanded Bronze
(POS) Blue Advantage Plus Bronze? 303 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-697-0683
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$417.78 $474.19 $533.93 $746.16 $1,133.87 |
$737.39 $793.80 $853.54 $1,065.77 |
$1,057.00 $1,113.41 $1,173.15 $1,385.38 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$835.56 $948.38 $1,067.86 $1,492.32 $2,267.74 |
$1,155.17 $1,267.99 $1,387.47 $1,811.93 |
$1,474.78 $1,587.60 $1,707.08 $2,131.54 |
Toc - Plan #58 Blue Cross and Blue Shield of Texas | ||||||||||||||||||||
Bronze
(POS) Blue Advantage Plus Bronze? 305 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-697-0683
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$396.07 $449.54 $506.18 $707.38 $1,074.93 |
$699.06 $752.53 $809.17 $1,010.37 |
$1,002.05 $1,055.52 $1,112.16 $1,313.36 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$792.14 $899.08 $1,012.36 $1,414.76 $2,149.86 |
$1,095.13 $1,202.07 $1,315.35 $1,717.75 |
$1,398.12 $1,505.06 $1,618.34 $2,020.74 |
Toc - Plan #59 Blue Cross and Blue Shield of Texas | ||||||||||||||||||||
Expanded Bronze
(POS) Blue Advantage Plus Bronze? 707 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-697-0683
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$406.52 $461.40 $519.53 $726.04 $1,103.30 |
$717.51 $772.39 $830.52 $1,037.03 |
$1,028.50 $1,083.38 $1,141.51 $1,348.02 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$813.04 $922.80 $1,039.06 $1,452.08 $2,206.60 |
$1,124.03 $1,233.79 $1,350.05 $1,763.07 |
$1,435.02 $1,544.78 $1,661.04 $2,074.06 |
Toc - Plan #60 Blue Cross and Blue Shield of Texas | ||||||||||||||||||||
Gold
(POS) Blue Advantage Plus Gold? 203 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-697-0683
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$500.50 $568.07 $639.64 $893.90 $1,358.37 |
$883.39 $950.96 $1,022.53 $1,276.79 |
$1,266.28 $1,333.85 $1,405.42 $1,659.68 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,001.00 $1,136.14 $1,279.28 $1,787.80 $2,716.74 |
$1,383.89 $1,519.03 $1,662.17 $2,170.69 |
$1,766.78 $1,901.92 $2,045.06 $2,553.58 |
Toc - Plan #61 Blue Cross and Blue Shield of Texas | ||||||||||||||||||||
Gold
(POS) Blue Advantage Plus Gold? 706 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-697-0683
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$504.22 $572.28 $644.39 $900.53 $1,368.44 |
$889.94 $958.00 $1,030.11 $1,286.25 |
$1,275.66 $1,343.72 $1,415.83 $1,671.97 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,008.44 $1,144.56 $1,288.78 $1,801.06 $2,736.88 |
$1,394.16 $1,530.28 $1,674.50 $2,186.78 |
$1,779.88 $1,916.00 $2,060.22 $2,572.50 |
Toc - Plan #62 Blue Cross and Blue Shield of Texas | ||||||||||||||||||||
Silver
(POS) Blue Advantage Plus Silver? 202 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-697-0683
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$590.11 $669.78 $754.16 $1,053.94 $1,601.56 |
$1,041.54 $1,121.21 $1,205.59 $1,505.37 |
$1,492.97 $1,572.64 $1,657.02 $1,956.80 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,180.22 $1,339.56 $1,508.32 $2,107.88 $3,203.12 |
$1,631.65 $1,790.99 $1,959.75 $2,559.31 |
$2,083.08 $2,242.42 $2,411.18 $3,010.74 |
Toc - Plan #63 Blue Cross and Blue Shield of Texas | ||||||||||||||||||||
Silver
(POS) Blue Advantage Plus Silver? 605 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-697-0683
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$598.52 $679.32 $764.90 $1,068.95 $1,624.37 |
$1,056.39 $1,137.19 $1,222.77 $1,526.82 |
$1,514.26 $1,595.06 $1,680.64 $1,984.69 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,197.04 $1,358.64 $1,529.80 $2,137.90 $3,248.74 |
$1,654.91 $1,816.51 $1,987.67 $2,595.77 |
$2,112.78 $2,274.38 $2,445.54 $3,053.64 |
Toc - Plan #64 Blue Cross and Blue Shield of Texas | ||||||||||||||||||||
Silver
(POS) Blue Advantage Plus Silver? 705 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-697-0683
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$583.78 $662.58 $746.06 $1,042.62 $1,584.37 |
$1,030.37 $1,109.17 $1,192.65 $1,489.21 |
$1,476.96 $1,555.76 $1,639.24 $1,935.80 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,167.56 $1,325.16 $1,492.12 $2,085.24 $3,168.74 |
$1,614.15 $1,771.75 $1,938.71 $2,531.83 |
$2,060.74 $2,218.34 $2,385.30 $2,978.42 |
Toc - Plan #65 Blue Cross and Blue Shield of Texas | ||||||||||||||||||||
Gold
(POS) Blue Advantage Plus Gold? 803 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-697-0683
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$491.87 $558.28 $628.61 $878.48 $1,334.94 |
$868.15 $934.56 $1,004.89 $1,254.76 |
$1,244.43 $1,310.84 $1,381.17 $1,631.04 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$983.74 $1,116.56 $1,257.22 $1,756.96 $2,669.88 |
$1,360.02 $1,492.84 $1,633.50 $2,133.24 |
$1,736.30 $1,869.12 $2,009.78 $2,509.52 |
ADVERTISEMENT
Imperial Insurance Companies, Inc.Local: 1-626-838-5100x8 | Toll Free: 1-800-595-0619 | TTY: 1-800-595-0619 |
Toc - Plan #66 Imperial Insurance Companies, Inc. | ||||||||||||||||||||
Gold
(HMO) Imperial Preferred Gold Zero |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-595-0619
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$480.80 $545.71 $614.47 $858.72 $1,304.90 |
$848.62 $913.53 $982.29 $1,226.54 |
$1,216.44 $1,281.35 $1,350.11 $1,594.36 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$961.60 $1,091.42 $1,228.94 $1,717.44 $2,609.80 |
$1,329.42 $1,459.24 $1,596.76 $2,085.26 |
$1,697.24 $1,827.06 $1,964.58 $2,453.08 |
Toc - Plan #67 Imperial Insurance Companies, Inc. | ||||||||||||||||||||
Expanded Bronze
(HMO) Imperial Standard Bronze |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-595-0619
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$332.92 $377.86 $425.47 $594.59 $903.54 |
$587.60 $632.54 $680.15 $849.27 |
$842.28 $887.22 $934.83 $1,103.95 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$665.84 $755.72 $850.94 $1,189.18 $1,807.08 |
$920.52 $1,010.40 $1,105.62 $1,443.86 |
$1,175.20 $1,265.08 $1,360.30 $1,698.54 |
Toc - Plan #68 Imperial Insurance Companies, Inc. | ||||||||||||||||||||
Silver
(HMO) Imperial Standard Silver |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-595-0619
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$494.97 $561.79 $632.57 $884.02 $1,343.35 |
$873.62 $940.44 $1,011.22 $1,262.67 |
$1,252.27 $1,319.09 $1,389.87 $1,641.32 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$989.94 $1,123.58 $1,265.14 $1,768.04 $2,686.70 |
$1,368.59 $1,502.23 $1,643.79 $2,146.69 |
$1,747.24 $1,880.88 $2,022.44 $2,525.34 |
Toc - Plan #69 Imperial Insurance Companies, Inc. | ||||||||||||||||||||
Gold
(HMO) Imperial Standard Gold |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-595-0619
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$453.00 $514.16 $578.93 $809.06 $1,229.44 |
$799.55 $860.71 $925.48 $1,155.61 |
$1,146.10 $1,207.26 $1,272.03 $1,502.16 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$906.00 $1,028.32 $1,157.86 $1,618.12 $2,458.88 |
$1,252.55 $1,374.87 $1,504.41 $1,964.67 |
$1,599.10 $1,721.42 $1,850.96 $2,311.22 |
Toc - Plan #70 Imperial Insurance Companies, Inc. | ||||||||||||||||||||
Bronze
(HMO) Imperial Preferred Bronze |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-595-0619
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$336.59 $382.03 $430.16 $601.15 $913.50 |
$594.08 $639.52 $687.65 $858.64 |
$851.57 $897.01 $945.14 $1,116.13 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$673.18 $764.06 $860.32 $1,202.30 $1,827.00 |
$930.67 $1,021.55 $1,117.81 $1,459.79 |
$1,188.16 $1,279.04 $1,375.30 $1,717.28 |
Toc - Plan #71 Imperial Insurance Companies, Inc. | ||||||||||||||||||||
Silver
(HMO) Imperial Preferred Silver |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-595-0619
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$500.37 $567.92 $639.48 $893.67 $1,358.01 |
$883.16 $950.71 $1,022.27 $1,276.46 |
$1,265.95 $1,333.50 $1,405.06 $1,659.25 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,000.74 $1,135.84 $1,278.96 $1,787.34 $2,716.02 |
$1,383.53 $1,518.63 $1,661.75 $2,170.13 |
$1,766.32 $1,901.42 $2,044.54 $2,552.92 |
Toc - Plan #72 Imperial Insurance Companies, Inc. | ||||||||||||||||||||
Gold
(HMO) Imperial Preferred Gold |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-595-0619
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$461.24 $523.50 $589.46 $823.77 $1,251.80 |
$814.09 $876.35 $942.31 $1,176.62 |
$1,166.94 $1,229.20 $1,295.16 $1,529.47 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$922.48 $1,047.00 $1,178.92 $1,647.54 $2,503.60 |
$1,275.33 $1,399.85 $1,531.77 $2,000.39 |
$1,628.18 $1,752.70 $1,884.62 $2,353.24 |
ADVERTISEMENT
UnitedHealthcareLocal: 1-866-811-2704 | Toll Free: 1-866-811-2704 | TTY: 1-866-811-2704 |
Toc - Plan #73 UnitedHealthcare | ||||||||||||||||||||
Silver
(HMO) UHC Silver Virtual First (Unlimited $0 App-based Care, $3 Tier 2 Rx, $0 Insulin) (Disponible en espanol) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-866-811-2704
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$422.70 $479.76 $540.21 $754.94 $1,147.21 |
$746.07 $803.13 $863.58 $1,078.31 |
$1,069.44 $1,126.50 $1,186.95 $1,401.68 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$845.40 $959.52 $1,080.42 $1,509.88 $2,294.42 |
$1,168.77 $1,282.89 $1,403.79 $1,833.25 |
$1,492.14 $1,606.26 $1,727.16 $2,156.62 |
Toc - Plan #74 UnitedHealthcare | ||||||||||||||||||||
Expanded Bronze
(HMO) UHC Bronze Value ($0 Virtual Urgent Care + $0 PCP Visits, $3 Tier 2 Rx, $0 Insulin) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-866-811-2704
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$297.66 $337.84 $380.40 $531.61 $807.84 |
$525.37 $565.55 $608.11 $759.32 |
$753.08 $793.26 $835.82 $987.03 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$595.32 $675.68 $760.80 $1,063.22 $1,615.68 |
$823.03 $903.39 $988.51 $1,290.93 |
$1,050.74 $1,131.10 $1,216.22 $1,518.64 |
Toc - Plan #75 UnitedHealthcare | ||||||||||||||||||||
Expanded Bronze
(HMO) UHC Bronze Virtual First (Unlimited $0 App-based Care, $3 Tier 2 Rx, $0 Insulin) (Disponible en espanol) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-866-811-2704
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$301.47 $342.17 $385.28 $538.43 $818.19 |
$532.10 $572.80 $615.91 $769.06 |
$762.73 $803.43 $846.54 $999.69 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$602.94 $684.34 $770.56 $1,076.86 $1,636.38 |
$833.57 $914.97 $1,001.19 $1,307.49 |
$1,064.20 $1,145.60 $1,231.82 $1,538.12 |
Toc - Plan #76 UnitedHealthcare | ||||||||||||||||||||
Gold
(HMO) UHC Gold Standard $0 Indiv Ded ($0 Virtual Urgent Care + $0 PCP Visits, $3 Tier 2 Rx, $0 Insulin) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-866-811-2704
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$370.01 $419.96 $472.87 $660.83 $1,004.20 |
$653.07 $703.02 $755.93 $943.89 |
$936.13 $986.08 $1,038.99 $1,226.95 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$740.02 $839.92 $945.74 $1,321.66 $2,008.40 |
$1,023.08 $1,122.98 $1,228.80 $1,604.72 |
$1,306.14 $1,406.04 $1,511.86 $1,887.78 |
Toc - Plan #77 UnitedHealthcare | ||||||||||||||||||||
Expanded Bronze
(HMO) UHC Bronze Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-866-811-2704
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$302.14 $342.93 $386.14 $539.63 $820.01 |
$533.28 $574.07 $617.28 $770.77 |
$764.42 $805.21 $848.42 $1,001.91 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$604.28 $685.86 $772.28 $1,079.26 $1,640.02 |
$835.42 $917.00 $1,003.42 $1,310.40 |
$1,066.56 $1,148.14 $1,234.56 $1,541.54 |
Toc - Plan #78 UnitedHealthcare | ||||||||||||||||||||
Silver
(HMO) UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care + $0 PCP Visits, $5 Tier 2 Rx, $0 Insulin) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-866-811-2704
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$439.49 $498.83 $561.67 $784.94 $1,192.79 |
$775.70 $835.04 $897.88 $1,121.15 |
$1,111.91 $1,171.25 $1,234.09 $1,457.36 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$878.98 $997.66 $1,123.34 $1,569.88 $2,385.58 |
$1,215.19 $1,333.87 $1,459.55 $1,906.09 |
$1,551.40 $1,670.08 $1,795.76 $2,242.30 |
Toc - Plan #79 UnitedHealthcare | ||||||||||||||||||||
Silver
(HMO) UHC Silver Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-866-811-2704
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$422.61 $479.66 $540.10 $754.79 $1,146.97 |
$745.91 $802.96 $863.40 $1,078.09 |
$1,069.21 $1,126.26 $1,186.70 $1,401.39 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$845.22 $959.32 $1,080.20 $1,509.58 $2,293.94 |
$1,168.52 $1,282.62 $1,403.50 $1,832.88 |
$1,491.82 $1,605.92 $1,726.80 $2,156.18 |
Toc - Plan #80 UnitedHealthcare | ||||||||||||||||||||
Gold
(HMO) UHC Gold Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-866-811-2704
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$382.79 $434.46 $489.20 $683.66 $1,038.88 |
$675.62 $727.29 $782.03 $976.49 |
$968.45 $1,020.12 $1,074.86 $1,269.32 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$765.58 $868.92 $978.40 $1,367.32 $2,077.76 |
$1,058.41 $1,161.75 $1,271.23 $1,660.15 |
$1,351.24 $1,454.58 $1,564.06 $1,952.98 |
Toc - Plan #81 UnitedHealthcare | ||||||||||||||||||||
Silver
(HMO) UHC Silver Value ($0 Virtual Urgent Care + $0 PCP Visits, $3 Tier 2 Rx, $0 Insulin) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-866-811-2704
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$411.61 $467.18 $526.04 $735.14 $1,117.12 |
$726.49 $782.06 $840.92 $1,050.02 |
$1,041.37 $1,096.94 $1,155.80 $1,364.90 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$823.22 $934.36 $1,052.08 $1,470.28 $2,234.24 |
$1,138.10 $1,249.24 $1,366.96 $1,785.16 |
$1,452.98 $1,564.12 $1,681.84 $2,100.04 |
Toc - Plan #82 UnitedHealthcare | ||||||||||||||||||||
Silver
(HMO) UHC Silver Advantage ($0 Virtual Urgent Care + $0 PCP Visits, $3 Tier 2 Rx, $0 Insulin) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-866-811-2704
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$418.89 $475.43 $535.34 $748.13 $1,136.85 |
$739.34 $795.88 $855.79 $1,068.58 |
$1,059.79 $1,116.33 $1,176.24 $1,389.03 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$837.78 $950.86 $1,070.68 $1,496.26 $2,273.70 |
$1,158.23 $1,271.31 $1,391.13 $1,816.71 |
$1,478.68 $1,591.76 $1,711.58 $2,137.16 |
Toc - Plan #83 UnitedHealthcare | ||||||||||||||||||||
Gold
(HMO) UHC Gold Value ($0 Virtual Urgent Care + $0 PCP Visits, $1 Tier 2 Rx, $0 Insulin) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-866-811-2704
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$360.97 $409.70 $461.32 $644.69 $979.67 |
$637.11 $685.84 $737.46 $920.83 |
$913.25 $961.98 $1,013.60 $1,196.97 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$721.94 $819.40 $922.64 $1,289.38 $1,959.34 |
$998.08 $1,095.54 $1,198.78 $1,565.52 |
$1,274.22 $1,371.68 $1,474.92 $1,841.66 |
Toc - Plan #84 UnitedHealthcare | ||||||||||||||||||||
Gold
(HMO) UHC Gold Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, $0 Insulin) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-866-811-2704
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$373.26 $423.65 $477.03 $666.64 $1,013.03 |
$658.80 $709.19 $762.57 $952.18 |
$944.34 $994.73 $1,048.11 $1,237.72 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$746.52 $847.30 $954.06 $1,333.28 $2,026.06 |
$1,032.06 $1,132.84 $1,239.60 $1,618.82 |
$1,317.60 $1,418.38 $1,525.14 $1,904.36 |
Toc - Plan #85 UnitedHealthcare | ||||||||||||||||||||
Gold
(HMO) UHC Gold Virtual First (Unlimited $0 App-based Care, $3 Tier 2 Rx, $0 Insulin) (Disponible en espanol) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-866-811-2704
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$370.92 $420.99 $474.03 $662.46 $1,006.67 |
$654.67 $704.74 $757.78 $946.21 |
$938.42 $988.49 $1,041.53 $1,229.96 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$741.84 $841.98 $948.06 $1,324.92 $2,013.34 |
$1,025.59 $1,125.73 $1,231.81 $1,608.67 |
$1,309.34 $1,409.48 $1,515.56 $1,892.42 |
Toc - Plan #86 UnitedHealthcare | ||||||||||||||||||||
Expanded Bronze
(HMO) UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Insulin) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-866-811-2704
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$318.58 $361.59 $407.15 $568.99 $864.64 |
$562.30 $605.31 $650.87 $812.71 |
$806.02 $849.03 $894.59 $1,056.43 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$637.16 $723.18 $814.30 $1,137.98 $1,729.28 |
$880.88 $966.90 $1,058.02 $1,381.70 |
$1,124.60 $1,210.62 $1,301.74 $1,625.42 |
Toc - Plan #87 UnitedHealthcare | ||||||||||||||||||||
Expanded Bronze
(HMO) UHC Bronze Value HSA |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-866-811-2704
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$298.59 $338.90 $381.60 $533.28 $810.37 |
$527.01 $567.32 $610.02 $761.70 |
$755.43 $795.74 $838.44 $990.12 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$597.18 $677.80 $763.20 $1,066.56 $1,620.74 |
$825.60 $906.22 $991.62 $1,294.98 |
$1,054.02 $1,134.64 $1,220.04 $1,523.40 |
Toc - Plan #88 UnitedHealthcare | ||||||||||||||||||||
Silver
(HMO) UHC Silver Advantage+ ($0 Virtual Urgent Care + $0 PCP Visits, $3 Tier 2 Rx, $0 Insulin, Dental + Vision) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-866-811-2704
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$437.51 $496.58 $559.14 $781.39 $1,187.41 |
$772.21 $831.28 $893.84 $1,116.09 |
$1,106.91 $1,165.98 $1,228.54 $1,450.79 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$875.02 $993.16 $1,118.28 $1,562.78 $2,374.82 |
$1,209.72 $1,327.86 $1,452.98 $1,897.48 |
$1,544.42 $1,662.56 $1,787.68 $2,232.18 |
Toc - Plan #89 UnitedHealthcare | ||||||||||||||||||||
Gold
(HMO) UHC Gold Advantage+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, $0 Insulin, Dental + Vision) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-866-811-2704
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$391.89 $444.79 $500.83 $699.91 $1,063.58 |
$691.68 $744.58 $800.62 $999.70 |
$991.47 $1,044.37 $1,100.41 $1,299.49 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$783.78 $889.58 $1,001.66 $1,399.82 $2,127.16 |
$1,083.57 $1,189.37 $1,301.45 $1,699.61 |
$1,383.36 $1,489.16 $1,601.24 $1,999.40 |
ADVERTISEMENT
Baylor Scott and White Health PlanLocal: 1-844-633-5325 | Toll Free: 1-844-633-5325 | TTY: 1-800-735-2989 |
Toc - Plan #90 Baylor Scott and White Health Plan | ||||||||||||||||||||
Gold
(HMO) BSW Elite Gold HMO 001 (CMS Standardized Plan with $0 Pediatric PCP copay) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-633-5325
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$396.48 $450.01 $506.70 $708.11 $1,076.05 |
$699.79 $753.32 $810.01 $1,011.42 |
$1,003.10 $1,056.63 $1,113.32 $1,314.73 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$792.96 $900.02 $1,013.40 $1,416.22 $2,152.10 |
$1,096.27 $1,203.33 $1,316.71 $1,719.53 |
$1,399.58 $1,506.64 $1,620.02 $2,022.84 |
Toc - Plan #91 Baylor Scott and White Health Plan | ||||||||||||||||||||
Silver
(HMO) BSW Prime Silver HMO 003 (CMS Standardized Plan with $0 Pediatric PCP copay) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-633-5325
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$391.82 $444.71 $500.74 $699.78 $1,063.39 |
$691.56 $744.45 $800.48 $999.52 |
$991.30 $1,044.19 $1,100.22 $1,299.26 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$783.64 $889.42 $1,001.48 $1,399.56 $2,126.78 |
$1,083.38 $1,189.16 $1,301.22 $1,699.30 |
$1,383.12 $1,488.90 $1,600.96 $1,999.04 |
Toc - Plan #92 Baylor Scott and White Health Plan | ||||||||||||||||||||
Gold
(HMO) BSW Elite Gold HMO 004 (Two free PCP visits, $0 Pediatric PCP visits) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-633-5325
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$384.82 $436.77 $491.80 $687.29 $1,044.40 |
$679.21 $731.16 $786.19 $981.68 |
$973.60 $1,025.55 $1,080.58 $1,276.07 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$769.64 $873.54 $983.60 $1,374.58 $2,088.80 |
$1,064.03 $1,167.93 $1,277.99 $1,668.97 |
$1,358.42 $1,462.32 $1,572.38 $1,963.36 |
Toc - Plan #93 Baylor Scott and White Health Plan | ||||||||||||||||||||
Silver
(HMO) BSW Prime Silver HMO 005 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-633-5325
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$398.72 $452.55 $509.56 $712.11 $1,082.13 |
$703.74 $757.57 $814.58 $1,017.13 |
$1,008.76 $1,062.59 $1,119.60 $1,322.15 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$797.44 $905.10 $1,019.12 $1,424.22 $2,164.26 |
$1,102.46 $1,210.12 $1,324.14 $1,729.24 |
$1,407.48 $1,515.14 $1,629.16 $2,034.26 |
Toc - Plan #94 Baylor Scott and White Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) BSW Savers Bronze HMO H S A 006 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-633-5325
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$327.48 $371.70 $418.53 $584.89 $888.79 |
$578.01 $622.23 $669.06 $835.42 |
$828.54 $872.76 $919.59 $1,085.95 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$654.96 $743.40 $837.06 $1,169.78 $1,777.58 |
$905.49 $993.93 $1,087.59 $1,420.31 |
$1,156.02 $1,244.46 $1,338.12 $1,670.84 |
Toc - Plan #95 Baylor Scott and White Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) BSW Vital Bronze HMO 007 (CMS Standardized Plan with $0 Pediatric PCP copay) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-633-5325
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$308.31 $349.93 $394.02 $550.64 $836.76 |
$544.17 $585.79 $629.88 $786.50 |
$780.03 $821.65 $865.74 $1,022.36 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$616.62 $699.86 $788.04 $1,101.28 $1,673.52 |
$852.48 $935.72 $1,023.90 $1,337.14 |
$1,088.34 $1,171.58 $1,259.76 $1,573.00 |
Toc - Plan #96 Baylor Scott and White Health Plan | ||||||||||||||||||||
Silver
(HMO) BSW Prime Silver HMO 008 (Two free PCP visits, $0 Pediatric PCP visit) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-633-5325
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$384.72 $436.66 $491.68 $687.12 $1,044.14 |
$679.03 $730.97 $785.99 $981.43 |
$973.34 $1,025.28 $1,080.30 $1,275.74 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$769.44 $873.32 $983.36 $1,374.24 $2,088.28 |
$1,063.75 $1,167.63 $1,277.67 $1,668.55 |
$1,358.06 $1,461.94 $1,571.98 $1,962.86 |
Toc - Plan #97 Baylor Scott and White Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) BSW Vital Bronze HMO 009 (One free PCP visit, $0 Pediatric PCP visit) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-633-5325
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$317.78 $360.68 $406.13 $567.56 $862.46 |
$560.88 $603.78 $649.23 $810.66 |
$803.98 $846.88 $892.33 $1,053.76 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$635.56 $721.36 $812.26 $1,135.12 $1,724.92 |
$878.66 $964.46 $1,055.36 $1,378.22 |
$1,121.76 $1,207.56 $1,298.46 $1,621.32 |
Toc - Plan #98 Baylor Scott and White Health Plan | ||||||||||||||||||||
Gold
(HMO) BSW Elite Gold HMO 012 ($0 PCP unlimited visits) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-633-5325
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$381.65 $433.17 $487.74 $681.62 $1,035.79 |
$673.61 $725.13 $779.70 $973.58 |
$965.57 $1,017.09 $1,071.66 $1,265.54 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$763.30 $866.34 $975.48 $1,363.24 $2,071.58 |
$1,055.26 $1,158.30 $1,267.44 $1,655.20 |
$1,347.22 $1,450.26 $1,559.40 $1,947.16 |
ADVERTISEMENT
US Health and LifeLocal: 1-833-600-1311 | Toll Free: |
Toc - Plan #99 US Health and Life | ||||||||||||||||||||
Expanded Bronze
(EPO) Ascension Personalized Care Balanced Bronze |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone:
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$289.62 $328.72 $370.14 $517.26 $786.03 |
$511.18 $550.28 $591.70 $738.82 |
$732.74 $771.84 $813.26 $960.38 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$579.24 $657.44 $740.28 $1,034.52 $1,572.06 |
$800.80 $879.00 $961.84 $1,256.08 |
$1,022.36 $1,100.56 $1,183.40 $1,477.64 |
Toc - Plan #100 US Health and Life | ||||||||||||||||||||
Expanded Bronze
(EPO) Ascension Personalized Care No Medical Deductible Bronze |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone:
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$303.00 $343.90 $387.23 $541.16 $822.34 |
$534.79 $575.69 $619.02 $772.95 |
$766.58 $807.48 $850.81 $1,004.74 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$606.00 $687.80 $774.46 $1,082.32 $1,644.68 |
$837.79 $919.59 $1,006.25 $1,314.11 |
$1,069.58 $1,151.38 $1,238.04 $1,545.90 |
Toc - Plan #101 US Health and Life | ||||||||||||||||||||
Silver
(EPO) Ascension Personalized Care No Deductible Silver |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone:
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$459.88 $521.97 $587.73 $821.35 $1,248.13 |
$811.69 $873.78 $939.54 $1,173.16 |
$1,163.50 $1,225.59 $1,291.35 $1,524.97 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$919.76 $1,043.94 $1,175.46 $1,642.70 $2,496.26 |
$1,271.57 $1,395.75 $1,527.27 $1,994.51 |
$1,623.38 $1,747.56 $1,879.08 $2,346.32 |
Toc - Plan #102 US Health and Life | ||||||||||||||||||||
Silver
(EPO) Ascension Personalized Care Low Premium Silver |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone:
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$437.87 $496.98 $559.59 $782.03 $1,188.37 |
$772.84 $831.95 $894.56 $1,117.00 |
$1,107.81 $1,166.92 $1,229.53 $1,451.97 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$875.74 $993.96 $1,119.18 $1,564.06 $2,376.74 |
$1,210.71 $1,328.93 $1,454.15 $1,899.03 |
$1,545.68 $1,663.90 $1,789.12 $2,234.00 |
Toc - Plan #103 US Health and Life | ||||||||||||||||||||
Expanded Bronze
(EPO) Ascension Personalized Care Standard Expanded Bronze |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone:
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$294.55 $334.31 $376.44 $526.07 $799.41 |
$519.88 $559.64 $601.77 $751.40 |
$745.21 $784.97 $827.10 $976.73 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$589.10 $668.62 $752.88 $1,052.14 $1,598.82 |
$814.43 $893.95 $978.21 $1,277.47 |
$1,039.76 $1,119.28 $1,203.54 $1,502.80 |
Toc - Plan #104 US Health and Life | ||||||||||||||||||||
Silver
(EPO) Ascension Personalized Care Standard Silver |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone:
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$439.53 $498.86 $561.71 $784.99 $1,192.87 |
$775.77 $835.10 $897.95 $1,121.23 |
$1,112.01 $1,171.34 $1,234.19 $1,457.47 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$879.06 $997.72 $1,123.42 $1,569.98 $2,385.74 |
$1,215.30 $1,333.96 $1,459.66 $1,906.22 |
$1,551.54 $1,670.20 $1,795.90 $2,242.46 |
Toc - Plan #105 US Health and Life | ||||||||||||||||||||
Gold
(EPO) Ascension Personalized Care Standard Gold |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone:
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$391.04 $443.83 $499.75 $698.40 $1,061.28 |
$690.19 $742.98 $798.90 $997.55 |
$989.34 $1,042.13 $1,098.05 $1,296.70 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$782.08 $887.66 $999.50 $1,396.80 $2,122.56 |
$1,081.23 $1,186.81 $1,298.65 $1,695.95 |
$1,380.38 $1,485.96 $1,597.80 $1,995.10 |
ADVERTISEMENT
Aetna CVS HealthLocal: 1-877-336-3915 | Toll Free: 1-877-336-3915 |
Toc - Plan #106 Aetna CVS Health | ||||||||||||||||||||
Silver
(HMO) Silver 1: Aetna network of doctors & hospitals + $0 walk-in clinic + $0 Virtual Care options 24/7 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-336-3915
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$440.41 $499.87 $562.85 $786.58 $1,195.27 |
$777.33 $836.79 $899.77 $1,123.50 |
$1,114.25 $1,173.71 $1,236.69 $1,460.42 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$880.82 $999.74 $1,125.70 $1,573.16 $2,390.54 |
$1,217.74 $1,336.66 $1,462.62 $1,910.08 |
$1,554.66 $1,673.58 $1,799.54 $2,247.00 |
Toc - Plan #107 Aetna CVS Health | ||||||||||||||||||||
Gold
(HMO) Gold S: Aetna network of doctors & hospitals + $0 walk-in clinic + $0 Virtual Care options 24/7 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-336-3915
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$395.67 $449.08 $505.66 $706.65 $1,073.83 |
$698.36 $751.77 $808.35 $1,009.34 |
$1,001.05 $1,054.46 $1,111.04 $1,312.03 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$791.34 $898.16 $1,011.32 $1,413.30 $2,147.66 |
$1,094.03 $1,200.85 $1,314.01 $1,715.99 |
$1,396.72 $1,503.54 $1,616.70 $2,018.68 |
Toc - Plan #108 Aetna CVS Health | ||||||||||||||||||||
Silver
(HMO) Silver S: Aetna network of doctors & hospitals + $0 walk-in clinic + $0 Virtual Care options 24/7 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-336-3915
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$427.30 $484.98 $546.09 $763.15 $1,159.68 |
$754.18 $811.86 $872.97 $1,090.03 |
$1,081.06 $1,138.74 $1,199.85 $1,416.91 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$854.60 $969.96 $1,092.18 $1,526.30 $2,319.36 |
$1,181.48 $1,296.84 $1,419.06 $1,853.18 |
$1,508.36 $1,623.72 $1,745.94 $2,180.06 |
Toc - Plan #109 Aetna CVS Health | ||||||||||||||||||||
Gold
(HMO) Gold 3: Aetna network of doctors & hospitals + $0 walk-in clinic + $0 Virtual Care options 24/7 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-336-3915
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$394.40 $447.65 $504.04 $704.40 $1,070.40 |
$696.12 $749.37 $805.76 $1,006.12 |
$997.84 $1,051.09 $1,107.48 $1,307.84 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$788.80 $895.30 $1,008.08 $1,408.80 $2,140.80 |
$1,090.52 $1,197.02 $1,309.80 $1,710.52 |
$1,392.24 $1,498.74 $1,611.52 $2,012.24 |
Toc - Plan #110 Aetna CVS Health | ||||||||||||||||||||
Gold
(HMO) Gold 4: Aetna network of doctors & hospitals + $0 walk-in clinic + $0 Virtual Care options 24/7 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-336-3915
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$399.89 $453.87 $511.05 $714.19 $1,085.28 |
$705.80 $759.78 $816.96 $1,020.10 |
$1,011.71 $1,065.69 $1,122.87 $1,326.01 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$799.78 $907.74 $1,022.10 $1,428.38 $2,170.56 |
$1,105.69 $1,213.65 $1,328.01 $1,734.29 |
$1,411.60 $1,519.56 $1,633.92 $2,040.20 |
Toc - Plan #111 Aetna CVS Health | ||||||||||||||||||||
Silver
(HMO) Silver 5: Aetna network of doctors & hospitals + $0 walk-in clinic + $0 Virtual Care options 24/7 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-336-3915
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$426.80 $484.42 $545.45 $762.27 $1,158.33 |
$753.31 $810.93 $871.96 $1,088.78 |
$1,079.82 $1,137.44 $1,198.47 $1,415.29 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$853.60 $968.84 $1,090.90 $1,524.54 $2,316.66 |
$1,180.11 $1,295.35 $1,417.41 $1,851.05 |
$1,506.62 $1,621.86 $1,743.92 $2,177.56 |
Toc - Plan #112 Aetna CVS Health | ||||||||||||||||||||
Silver
(HMO) Silver 6: Aetna network of doctors & hospitals + $0 walk-in clinic + $0 Virtual Care options 24/7 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-336-3915
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$436.20 $495.09 $557.46 $779.05 $1,183.84 |
$769.89 $828.78 $891.15 $1,112.74 |
$1,103.58 $1,162.47 $1,224.84 $1,446.43 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$872.40 $990.18 $1,114.92 $1,558.10 $2,367.68 |
$1,206.09 $1,323.87 $1,448.61 $1,891.79 |
$1,539.78 $1,657.56 $1,782.30 $2,225.48 |
Toc - Plan #113 Aetna CVS Health | ||||||||||||||||||||
Silver
(HMO) Silver 7: Aetna network of doctors & hospitals + $0 walk-in clinic + $0 Virtual Care options 24/7 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-336-3915
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$436.70 $495.65 $558.10 $779.94 $1,185.19 |
$770.77 $829.72 $892.17 $1,114.01 |
$1,104.84 $1,163.79 $1,226.24 $1,448.08 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$873.40 $991.30 $1,116.20 $1,559.88 $2,370.38 |
$1,207.47 $1,325.37 $1,450.27 $1,893.95 |
$1,541.54 $1,659.44 $1,784.34 $2,228.02 |
ADVERTISEMENT
Sendero Health Plans, Local NonprofitLocal: 1-844-800-4693 | Toll Free: 1-844-800-4693 | TTY: 1-800-855-2880 |
Toc - Plan #114 Sendero Health Plans, Local Nonprofit | ||||||||||||||||||||
Silver
(HMO) Sendero Health Original Silver / $20 PCP / $10 Gen Rx |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-800-4693
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$425.03 $482.41 $543.19 $759.10 $1,153.53 |
$750.18 $807.56 $868.34 $1,084.25 |
$1,075.33 $1,132.71 $1,193.49 $1,409.40 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$850.06 $964.82 $1,086.38 $1,518.20 $2,307.06 |
$1,175.21 $1,289.97 $1,411.53 $1,843.35 |
$1,500.36 $1,615.12 $1,736.68 $2,168.50 |
Toc - Plan #115 Sendero Health Plans, Local Nonprofit | ||||||||||||||||||||
Gold
(HMO) Sendero Health Real Gold / $350 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-800-4693
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$392.56 $445.55 $501.69 $701.10 $1,065.39 |
$692.86 $745.85 $801.99 $1,001.40 |
$993.16 $1,046.15 $1,102.29 $1,301.70 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$785.12 $891.10 $1,003.38 $1,402.20 $2,130.78 |
$1,085.42 $1,191.40 $1,303.68 $1,702.50 |
$1,385.72 $1,491.70 $1,603.98 $2,002.80 |
Toc - Plan #116 Sendero Health Plans, Local Nonprofit | ||||||||||||||||||||
Expanded Bronze
(HMO) Sendero Health Ideal Bronze / $25 PCP / $11 Gen Rx |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-800-4693
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$283.97 $322.30 $362.91 $507.17 $770.69 |
$501.21 $539.54 $580.15 $724.41 |
$718.45 $756.78 $797.39 $941.65 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$567.94 $644.60 $725.82 $1,014.34 $1,541.38 |
$785.18 $861.84 $943.06 $1,231.58 |
$1,002.42 $1,079.08 $1,160.30 $1,448.82 |
Toc - Plan #117 Sendero Health Plans, Local Nonprofit | ||||||||||||||||||||
Bronze
(HMO) Sendero Health Reliable Bronze High Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-800-4693
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$272.21 $308.95 $347.88 $486.16 $738.76 |
$480.45 $517.19 $556.12 $694.40 |
$688.69 $725.43 $764.36 $902.64 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$544.42 $617.90 $695.76 $972.32 $1,477.52 |
$752.66 $826.14 $904.00 $1,180.56 |
$960.90 $1,034.38 $1,112.24 $1,388.80 |
Toc - Plan #118 Sendero Health Plans, Local Nonprofit | ||||||||||||||||||||
Expanded Bronze
(HMO) Sendero Health Preferred Bronze / $25 PCP / $75 Specialist / $22 Gen Rx |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-800-4693
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$291.20 $330.51 $372.15 $520.08 $790.31 |
$513.97 $553.28 $594.92 $742.85 |
$736.74 $776.05 $817.69 $965.62 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$582.40 $661.02 $744.30 $1,040.16 $1,580.62 |
$805.17 $883.79 $967.07 $1,262.93 |
$1,027.94 $1,106.56 $1,189.84 $1,485.70 |
Toc - Plan #119 Sendero Health Plans, Local Nonprofit | ||||||||||||||||||||
Silver
(HMO) Sendero Health Capital Silver / $40 PCP / $80 Specialist / $20 Gen Rx |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-800-4693
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$420.40 $477.15 $537.27 $750.83 $1,140.96 |
$742.00 $798.75 $858.87 $1,072.43 |
$1,063.60 $1,120.35 $1,180.47 $1,394.03 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$840.80 $954.30 $1,074.54 $1,501.66 $2,281.92 |
$1,162.40 $1,275.90 $1,396.14 $1,823.26 |
$1,484.00 $1,597.50 $1,717.74 $2,144.86 |
Toc - Plan #120 Sendero Health Plans, Local Nonprofit | ||||||||||||||||||||
Gold
(HMO) Sendero Health Hill Country Gold / $30 PCP / $60 Specialist / $15 Gen Rx |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-800-4693
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$390.88 $443.65 $499.54 $698.11 $1,060.84 |
$689.90 $742.67 $798.56 $997.13 |
$988.92 $1,041.69 $1,097.58 $1,296.15 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$781.76 $887.30 $999.08 $1,396.22 $2,121.68 |
$1,080.78 $1,186.32 $1,298.10 $1,695.24 |
$1,379.80 $1,485.34 $1,597.12 $1,994.26 |
Toc - Plan #121 Sendero Health Plans, Local Nonprofit | ||||||||||||||||||||
Expanded Bronze
(HMO) Sendero Health Quality Care Bronze High Deductible / $50 PCP / $25 Gen Rx / $100 Specialist |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-800-4693
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$288.31 $327.24 $368.47 $514.93 $782.48 |
$508.87 $547.80 $589.03 $735.49 |
$729.43 $768.36 $809.59 $956.05 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$576.62 $654.48 $736.94 $1,029.86 $1,564.96 |
$797.18 $875.04 $957.50 $1,250.42 |
$1,017.74 $1,095.60 $1,178.06 $1,470.98 |
Toc - Plan #122 Sendero Health Plans, Local Nonprofit | ||||||||||||||||||||
Silver
(HMO) Sendero Health Pure Silver / $30 PCP / $70 Specialist / $20 Gen Rx |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-800-4693
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$436.42 $495.33 $557.74 $779.44 $1,184.43 |
$770.28 $829.19 $891.60 $1,113.30 |
$1,104.14 $1,163.05 $1,225.46 $1,447.16 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$872.84 $990.66 $1,115.48 $1,558.88 $2,368.86 |
$1,206.70 $1,324.52 $1,449.34 $1,892.74 |
$1,540.56 $1,658.38 $1,783.20 $2,226.60 |
Toc - Plan #123 Sendero Health Plans, Local Nonprofit | ||||||||||||||||||||
Silver
(HMO) Sendero Health Austin512 Silver / $40 PCP / $75 Specialist / $15 Gen Rx / $0 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-800-4693
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$463.67 $526.27 $592.57 $828.12 $1,258.40 |
$818.38 $880.98 $947.28 $1,182.83 |
$1,173.09 $1,235.69 $1,301.99 $1,537.54 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$927.34 $1,052.54 $1,185.14 $1,656.24 $2,516.80 |
$1,282.05 $1,407.25 $1,539.85 $2,010.95 |
$1,636.76 $1,761.96 $1,894.56 $2,365.66 |
ADVERTISEMENT
Ambetter from Superior HealthPlanLocal: 1-877-687-1196 | Toll Free: 1-877-687-1196 | TTY: 1-800-735-2989 |
Toc - Plan #124 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Silver
(HMO) Ambetter Virtual Access Silver (Virtual PCP selection required) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$550.95 $625.32 $704.10 $983.98 $1,495.25 |
$972.42 $1,046.79 $1,125.57 $1,405.45 |
$1,393.89 $1,468.26 $1,547.04 $1,826.92 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,101.90 $1,250.64 $1,408.20 $1,967.96 $2,990.50 |
$1,523.37 $1,672.11 $1,829.67 $2,389.43 |
$1,944.84 $2,093.58 $2,251.14 $2,810.90 |
Toc - Plan #125 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Gold
(HMO) Ambetter Virtual Access Gold (Virtual PCP selection required) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$508.12 $576.70 $649.36 $907.48 $1,379.01 |
$896.82 $965.40 $1,038.06 $1,296.18 |
$1,285.52 $1,354.10 $1,426.76 $1,684.88 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,016.24 $1,153.40 $1,298.72 $1,814.96 $2,758.02 |
$1,404.94 $1,542.10 $1,687.42 $2,203.66 |
$1,793.64 $1,930.80 $2,076.12 $2,592.36 |
Toc - Plan #126 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Silver
(HMO) Standard Ambetter Virtual Access Silver (Virtual PCP selection required) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$550.25 $624.52 $703.20 $982.72 $1,493.35 |
$971.18 $1,045.45 $1,124.13 $1,403.65 |
$1,392.11 $1,466.38 $1,545.06 $1,824.58 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,100.50 $1,249.04 $1,406.40 $1,965.44 $2,986.70 |
$1,521.43 $1,669.97 $1,827.33 $2,386.37 |
$1,942.36 $2,090.90 $2,248.26 $2,807.30 |
Toc - Plan #127 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Gold
(HMO) Standard Ambetter Virtual Access Gold (Virtual PCP selection required) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$497.89 $565.09 $636.29 $889.22 $1,351.25 |
$878.77 $945.97 $1,017.17 $1,270.10 |
$1,259.65 $1,326.85 $1,398.05 $1,650.98 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$995.78 $1,130.18 $1,272.58 $1,778.44 $2,702.50 |
$1,376.66 $1,511.06 $1,653.46 $2,159.32 |
$1,757.54 $1,891.94 $2,034.34 $2,540.20 |
Toc - Plan #128 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Silver
(HMO) Complete VALUE Silver |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$477.01 $541.40 $609.61 $851.93 $1,294.59 |
$841.92 $906.31 $974.52 $1,216.84 |
$1,206.83 $1,271.22 $1,339.43 $1,581.75 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$954.02 $1,082.80 $1,219.22 $1,703.86 $2,589.18 |
$1,318.93 $1,447.71 $1,584.13 $2,068.77 |
$1,683.84 $1,812.62 $1,949.04 $2,433.68 |
Toc - Plan #129 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Silver
(HMO) Clear VALUE Silver |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$469.31 $532.65 $599.76 $838.16 $1,273.67 |
$828.32 $891.66 $958.77 $1,197.17 |
$1,187.33 $1,250.67 $1,317.78 $1,556.18 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$938.62 $1,065.30 $1,199.52 $1,676.32 $2,547.34 |
$1,297.63 $1,424.31 $1,558.53 $2,035.33 |
$1,656.64 $1,783.32 $1,917.54 $2,394.34 |
Toc - Plan #130 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Silver
(HMO) Focused VALUE Silver |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$472.20 $535.94 $603.46 $843.34 $1,281.53 |
$833.43 $897.17 $964.69 $1,204.57 |
$1,194.66 $1,258.40 $1,325.92 $1,565.80 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$944.40 $1,071.88 $1,206.92 $1,686.68 $2,563.06 |
$1,305.63 $1,433.11 $1,568.15 $2,047.91 |
$1,666.86 $1,794.34 $1,929.38 $2,409.14 |
Toc - Plan #131 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Gold
(HMO) Everyday VALUE Gold |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$421.25 $478.10 $538.34 $752.33 $1,143.24 |
$743.50 $800.35 $860.59 $1,074.58 |
$1,065.75 $1,122.60 $1,182.84 $1,396.83 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$842.50 $956.20 $1,076.68 $1,504.66 $2,286.48 |
$1,164.75 $1,278.45 $1,398.93 $1,826.91 |
$1,487.00 $1,600.70 $1,721.18 $2,149.16 |
Toc - Plan #132 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Silver
(HMO) Standard Silver VALUE |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$467.07 $530.11 $596.90 $834.16 $1,267.59 |
$824.37 $887.41 $954.20 $1,191.46 |
$1,181.67 $1,244.71 $1,311.50 $1,548.76 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$934.14 $1,060.22 $1,193.80 $1,668.32 $2,535.18 |
$1,291.44 $1,417.52 $1,551.10 $2,025.62 |
$1,648.74 $1,774.82 $1,908.40 $2,382.92 |
Toc - Plan #133 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Gold
(HMO) Standard Gold VALUE |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$422.65 $479.69 $540.13 $754.83 $1,147.04 |
$745.97 $803.01 $863.45 $1,078.15 |
$1,069.29 $1,126.33 $1,186.77 $1,401.47 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$845.30 $959.38 $1,080.26 $1,509.66 $2,294.08 |
$1,168.62 $1,282.70 $1,403.58 $1,832.98 |
$1,491.94 $1,606.02 $1,726.90 $2,156.30 |
‡Source: HealthCare.gov has released sample rates for all counties in the 36 states served by HealthCare.gov. We have integrated that data into our tables and provide you that information for Travis County here.
Travis County is in “Rating Area 3” of Texas.
Currently, there are 133 plans offered in Rating Area 3.