Obamacare 2024 Rates for Walworth County, Wisconsin
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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 Williams Bay, WI.
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, 112 Plans and 2024 Rates for Walworth County, Wisconsin
Below, you’ll find a summary of the 112 plans for Walworth County, Wisconsin 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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QuartzLocal: 1-608-644-3430 | Toll Free: 1-800-362-3310 | TTY: 1-800-877-8973 |
Toc - Plan #1 Quartz | ||||||||||||||||||||
Gold
(HMO) QUARTZ ONE GOLD I402 MAINTENANCE VALUE TIER RX W/DENTAL |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$475.18 $539.32 $607.27 $848.66 $1,289.61 |
$838.69 $902.83 $970.78 $1,212.17 |
$1,202.20 $1,266.34 $1,334.29 $1,575.68 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$950.36 $1,078.64 $1,214.54 $1,697.32 $2,579.22 |
$1,313.87 $1,442.15 $1,578.05 $2,060.83 |
$1,677.38 $1,805.66 $1,941.56 $2,424.34 |
Toc - Plan #2 Quartz | ||||||||||||||||||||
Gold
(HMO) QUARTZ ONE GOLD I410 STANDARD W/DENTAL |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$478.88 $543.52 $612.00 $855.26 $1,299.66 |
$845.22 $909.86 $978.34 $1,221.60 |
$1,211.56 $1,276.20 $1,344.68 $1,587.94 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$957.76 $1,087.04 $1,224.00 $1,710.52 $2,599.32 |
$1,324.10 $1,453.38 $1,590.34 $2,076.86 |
$1,690.44 $1,819.72 $1,956.68 $2,443.20 |
Toc - Plan #3 Quartz | ||||||||||||||||||||
Silver
(HMO) QUARTZ ONE SILVER I308 VALUE TIER RX W/DENTAL |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$506.21 $574.54 $646.93 $904.08 $1,373.84 |
$893.46 $961.79 $1,034.18 $1,291.33 |
$1,280.71 $1,349.04 $1,421.43 $1,678.58 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$1,012.42 $1,149.08 $1,293.86 $1,808.16 $2,747.68 |
$1,399.67 $1,536.33 $1,681.11 $2,195.41 |
$1,786.92 $1,923.58 $2,068.36 $2,582.66 |
Toc - Plan #4 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I204 VALUE TIER RX W/DENTAL |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$376.64 $427.48 $481.34 $672.67 $1,022.18 |
$664.76 $715.60 $769.46 $960.79 |
$952.88 $1,003.72 $1,057.58 $1,248.91 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$753.28 $854.96 $962.68 $1,345.34 $2,044.36 |
$1,041.40 $1,143.08 $1,250.80 $1,633.46 |
$1,329.52 $1,431.20 $1,538.92 $1,921.58 |
Toc - Plan #5 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I205 VALUE TIER RX W/DENTAL |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$366.57 $416.05 $468.46 $654.68 $994.84 |
$646.99 $696.47 $748.88 $935.10 |
$927.41 $976.89 $1,029.30 $1,215.52 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$733.14 $832.10 $936.92 $1,309.36 $1,989.68 |
$1,013.56 $1,112.52 $1,217.34 $1,589.78 |
$1,293.98 $1,392.94 $1,497.76 $1,870.20 |
Toc - Plan #6 Quartz | ||||||||||||||||||||
Silver
(HMO) QUARTZ ONE SILVER I320 VALUE TIER RX W/DENTAL |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$518.25 $588.21 $662.32 $925.59 $1,406.52 |
$914.71 $984.67 $1,058.78 $1,322.05 |
$1,311.17 $1,381.13 $1,455.24 $1,718.51 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$1,036.50 $1,176.42 $1,324.64 $1,851.18 $2,813.04 |
$1,432.96 $1,572.88 $1,721.10 $2,247.64 |
$1,829.42 $1,969.34 $2,117.56 $2,644.10 |
Toc - Plan #7 Quartz | ||||||||||||||||||||
Gold
(HMO) QUARTZ ONE GOLD I420 VALUE TIER RX |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$435.40 $494.17 $556.43 $777.61 $1,181.66 |
$768.48 $827.25 $889.51 $1,110.69 |
$1,101.56 $1,160.33 $1,222.59 $1,443.77 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$870.80 $988.34 $1,112.86 $1,555.22 $2,363.32 |
$1,203.88 $1,321.42 $1,445.94 $1,888.30 |
$1,536.96 $1,654.50 $1,779.02 $2,221.38 |
Toc - Plan #8 Quartz | ||||||||||||||||||||
Gold
(HMO) QUARTZ ONE GOLD I402 MAINTENANCE VALUE TIER RX |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$452.53 $513.61 $578.32 $808.20 $1,228.14 |
$798.71 $859.79 $924.50 $1,154.38 |
$1,144.89 $1,205.97 $1,270.68 $1,500.56 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$905.06 $1,027.22 $1,156.64 $1,616.40 $2,456.28 |
$1,251.24 $1,373.40 $1,502.82 $1,962.58 |
$1,597.42 $1,719.58 $1,849.00 $2,308.76 |
Toc - Plan #9 Quartz | ||||||||||||||||||||
Gold
(HMO) QUARTZ ONE GOLD I410 STANDARD |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$456.05 $517.61 $582.82 $814.50 $1,237.71 |
$804.92 $866.48 $931.69 $1,163.37 |
$1,153.79 $1,215.35 $1,280.56 $1,512.24 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$912.10 $1,035.22 $1,165.64 $1,629.00 $2,475.42 |
$1,260.97 $1,384.09 $1,514.51 $1,977.87 |
$1,609.84 $1,732.96 $1,863.38 $2,326.74 |
Toc - Plan #10 Quartz | ||||||||||||||||||||
Silver
(HMO) QUARTZ ONE SILVER I308 VALUE TIER RX |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$482.08 $547.15 $616.09 $860.98 $1,308.35 |
$850.87 $915.94 $984.88 $1,229.77 |
$1,219.66 $1,284.73 $1,353.67 $1,598.56 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$964.16 $1,094.30 $1,232.18 $1,721.96 $2,616.70 |
$1,332.95 $1,463.09 $1,600.97 $2,090.75 |
$1,701.74 $1,831.88 $1,969.76 $2,459.54 |
Toc - Plan #11 Quartz | ||||||||||||||||||||
Silver
(HMO) QUARTZ ONE SILVER I309 STANDARD |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$469.22 $532.56 $599.66 $838.02 $1,273.45 |
$828.17 $891.51 $958.61 $1,196.97 |
$1,187.12 $1,250.46 $1,317.56 $1,555.92 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$938.44 $1,065.12 $1,199.32 $1,676.04 $2,546.90 |
$1,297.39 $1,424.07 $1,558.27 $2,034.99 |
$1,656.34 $1,783.02 $1,917.22 $2,393.94 |
Toc - Plan #12 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I204 VALUE TIER RX |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$358.69 $407.10 $458.39 $640.60 $973.46 |
$633.08 $681.49 $732.78 $914.99 |
$907.47 $955.88 $1,007.17 $1,189.38 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$717.38 $814.20 $916.78 $1,281.20 $1,946.92 |
$991.77 $1,088.59 $1,191.17 $1,555.59 |
$1,266.16 $1,362.98 $1,465.56 $1,829.98 |
Toc - Plan #13 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I205 VALUE TIER RX |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$349.09 $396.21 $446.13 $623.47 $947.42 |
$616.14 $663.26 $713.18 $890.52 |
$883.19 $930.31 $980.23 $1,157.57 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$698.18 $792.42 $892.26 $1,246.94 $1,894.84 |
$965.23 $1,059.47 $1,159.31 $1,513.99 |
$1,232.28 $1,326.52 $1,426.36 $1,781.04 |
Toc - Plan #14 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I206 STANDARD |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$333.18 $378.15 $425.79 $595.04 $904.23 |
$588.06 $633.03 $680.67 $849.92 |
$842.94 $887.91 $935.55 $1,104.80 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$666.36 $756.30 $851.58 $1,190.08 $1,808.46 |
$921.24 $1,011.18 $1,106.46 $1,444.96 |
$1,176.12 $1,266.06 $1,361.34 $1,699.84 |
Toc - Plan #15 Quartz | ||||||||||||||||||||
Silver
(HMO) QUARTZ ONE SILVER I320 VALUE TIER RX |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$493.55 $560.17 $630.75 $881.47 $1,339.48 |
$871.11 $937.73 $1,008.31 $1,259.03 |
$1,248.67 $1,315.29 $1,385.87 $1,636.59 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$987.10 $1,120.34 $1,261.50 $1,762.94 $2,678.96 |
$1,364.66 $1,497.90 $1,639.06 $2,140.50 |
$1,742.22 $1,875.46 $2,016.62 $2,518.06 |
Toc - Plan #16 Quartz | ||||||||||||||||||||
Gold
(HMO) QUARTZ ONE GOLD I401 VALUE TIER RX |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$428.81 $486.70 $548.02 $765.85 $1,163.78 |
$756.85 $814.74 $876.06 $1,093.89 |
$1,084.89 $1,142.78 $1,204.10 $1,421.93 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$857.62 $973.40 $1,096.04 $1,531.70 $2,327.56 |
$1,185.66 $1,301.44 $1,424.08 $1,859.74 |
$1,513.70 $1,629.48 $1,752.12 $2,187.78 |
Toc - Plan #17 Quartz | ||||||||||||||||||||
Silver
(HMO) QUARTZ ONE SILVER I303 VALUE TIER RX |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$458.61 $520.52 $586.10 $819.07 $1,244.66 |
$809.45 $871.36 $936.94 $1,169.91 |
$1,160.29 $1,222.20 $1,287.78 $1,520.75 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$917.22 $1,041.04 $1,172.20 $1,638.14 $2,489.32 |
$1,268.06 $1,391.88 $1,523.04 $1,988.98 |
$1,618.90 $1,742.72 $1,873.88 $2,339.82 |
Toc - Plan #18 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I201 VALUE TIER RX |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$313.96 $356.34 $401.23 $560.72 $852.07 |
$554.14 $596.52 $641.41 $800.90 |
$794.32 $836.70 $881.59 $1,041.08 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$627.92 $712.68 $802.46 $1,121.44 $1,704.14 |
$868.10 $952.86 $1,042.64 $1,361.62 |
$1,108.28 $1,193.04 $1,282.82 $1,601.80 |
Toc - Plan #19 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I203 HSA |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$341.23 $387.29 $436.09 $609.43 $926.09 |
$602.27 $648.33 $697.13 $870.47 |
$863.31 $909.37 $958.17 $1,131.51 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$682.46 $774.58 $872.18 $1,218.86 $1,852.18 |
$943.50 $1,035.62 $1,133.22 $1,479.90 |
$1,204.54 $1,296.66 $1,394.26 $1,740.94 |
Toc - Plan #20 Quartz | ||||||||||||||||||||
Catastrophic
(HMO) QUARTZ ONE CATASTROPHIC I101 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$247.75 $281.19 $316.62 $442.47 $672.38 |
$437.28 $470.72 $506.15 $632.00 |
$626.81 $660.25 $695.68 $821.53 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$495.50 $562.38 $633.24 $884.94 $1,344.76 |
$685.03 $751.91 $822.77 $1,074.47 |
$874.56 $941.44 $1,012.30 $1,264.00 |
Toc - Plan #21 Quartz | ||||||||||||||||||||
Silver
(HMO) QUARTZ ONE SILVER I304 HSA |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$486.41 $552.07 $621.63 $868.72 $1,320.10 |
$858.51 $924.17 $993.73 $1,240.82 |
$1,230.61 $1,296.27 $1,365.83 $1,612.92 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$972.82 $1,104.14 $1,243.26 $1,737.44 $2,640.20 |
$1,344.92 $1,476.24 $1,615.36 $2,109.54 |
$1,717.02 $1,848.34 $1,987.46 $2,481.64 |
Toc - Plan #22 Quartz | ||||||||||||||||||||
Gold
(HMO) QUARTZ ONE GOLD I403 HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$446.25 $506.49 $570.31 $797.00 $1,211.12 |
$787.63 $847.87 $911.69 $1,138.38 |
$1,129.01 $1,189.25 $1,253.07 $1,479.76 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$892.50 $1,012.98 $1,140.62 $1,594.00 $2,422.24 |
$1,233.88 $1,354.36 $1,482.00 $1,935.38 |
$1,575.26 $1,695.74 $1,823.38 $2,276.76 |
ADVERTISEMENT
Dean Health PlanLocal: 1-800-279-1302 | Toll Free: 1-800-279-1302 | TTY: 1-800-279-1302 |
Toc - Plan #23 Dean Health Plan | ||||||||||||||||||||
Catastrophic
(HMO) Dean Catastrophic Safety Net |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$202.67 $230.04 $259.02 $361.98 $550.06 |
$357.72 $385.09 $414.07 $517.03 |
$512.77 $540.14 $569.12 $672.08 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$405.34 $460.08 $518.04 $723.96 $1,100.12 |
$560.39 $615.13 $673.09 $879.01 |
$715.44 $770.18 $828.14 $1,034.06 |
Toc - Plan #24 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Dean Silver Copay Plus 4800X (Free Virtual Visits) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$423.22 $480.35 $540.87 $755.86 $1,148.61 |
$746.98 $804.11 $864.63 $1,079.62 |
$1,070.74 $1,127.87 $1,188.39 $1,403.38 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$846.44 $960.70 $1,081.74 $1,511.72 $2,297.22 |
$1,170.20 $1,284.46 $1,405.50 $1,835.48 |
$1,493.96 $1,608.22 $1,729.26 $2,159.24 |
Toc - Plan #25 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Dean Silver HSA-E HDHP 3550X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$424.55 $481.87 $542.58 $758.25 $1,152.23 |
$749.33 $806.65 $867.36 $1,083.03 |
$1,074.11 $1,131.43 $1,192.14 $1,407.81 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$849.10 $963.74 $1,085.16 $1,516.50 $2,304.46 |
$1,173.88 $1,288.52 $1,409.94 $1,841.28 |
$1,498.66 $1,613.30 $1,734.72 $2,166.06 |
Toc - Plan #26 Dean Health Plan | ||||||||||||||||||||
Gold
(HMO) Dean Gold Copay Plus 1500X (Free Virtual Visits) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$447.60 $508.03 $572.03 $799.41 $1,214.79 |
$790.01 $850.44 $914.44 $1,141.82 |
$1,132.42 $1,192.85 $1,256.85 $1,484.23 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$895.20 $1,016.06 $1,144.06 $1,598.82 $2,429.58 |
$1,237.61 $1,358.47 $1,486.47 $1,941.23 |
$1,580.02 $1,700.88 $1,828.88 $2,283.64 |
Toc - Plan #27 Dean Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) Dean Bronze HSA-E HDHP 7450X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$295.50 $335.39 $377.65 $527.76 $801.98 |
$521.56 $561.45 $603.71 $753.82 |
$747.62 $787.51 $829.77 $979.88 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$591.00 $670.78 $755.30 $1,055.52 $1,603.96 |
$817.06 $896.84 $981.36 $1,281.58 |
$1,043.12 $1,122.90 $1,207.42 $1,507.64 |
Toc - Plan #28 Dean Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) Dean Bronze Copay Plus 9400X (Free Virtual Visits) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$280.40 $318.25 $358.35 $500.79 $761.00 |
$494.90 $532.75 $572.85 $715.29 |
$709.40 $747.25 $787.35 $929.79 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$560.80 $636.50 $716.70 $1,001.58 $1,522.00 |
$775.30 $851.00 $931.20 $1,216.08 |
$989.80 $1,065.50 $1,145.70 $1,430.58 |
Toc - Plan #29 Dean Health Plan | ||||||||||||||||||||
Gold
(HMO) Dean Gold HSA HDHP 2000X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$399.41 $453.33 $510.45 $713.35 $1,084.00 |
$704.96 $758.88 $816.00 $1,018.90 |
$1,010.51 $1,064.43 $1,121.55 $1,324.45 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$798.82 $906.66 $1,020.90 $1,426.70 $2,168.00 |
$1,104.37 $1,212.21 $1,326.45 $1,732.25 |
$1,409.92 $1,517.76 $1,632.00 $2,037.80 |
Toc - Plan #30 Dean Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) Dean Bronze Copay PCP 8000X (Free Virtual Visits) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$274.53 $311.59 $350.85 $490.31 $745.08 |
$484.55 $521.61 $560.87 $700.33 |
$694.57 $731.63 $770.89 $910.35 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$549.06 $623.18 $701.70 $980.62 $1,490.16 |
$759.08 $833.20 $911.72 $1,190.64 |
$969.10 $1,043.22 $1,121.74 $1,400.66 |
Toc - Plan #31 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Dean Silver Copay PCP 4500X (Free Virtual Visits) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$401.90 $456.16 $513.63 $717.80 $1,090.76 |
$709.36 $763.62 $821.09 $1,025.26 |
$1,016.82 $1,071.08 $1,128.55 $1,332.72 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$803.80 $912.32 $1,027.26 $1,435.60 $2,181.52 |
$1,111.26 $1,219.78 $1,334.72 $1,743.06 |
$1,418.72 $1,527.24 $1,642.18 $2,050.52 |
Toc - Plan #32 Dean Health Plan | ||||||||||||||||||||
Gold
(HMO) Dean Gold Copay PCP 3000X (Free Virtual Visits) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$403.64 $458.13 $515.85 $720.89 $1,095.47 |
$712.42 $766.91 $824.63 $1,029.67 |
$1,021.20 $1,075.69 $1,133.41 $1,338.45 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$807.28 $916.26 $1,031.70 $1,441.78 $2,190.94 |
$1,116.06 $1,225.04 $1,340.48 $1,750.56 |
$1,424.84 $1,533.82 $1,649.26 $2,059.34 |
Toc - Plan #33 Dean Health Plan | ||||||||||||||||||||
Gold
(HMO) Dean Gold Standard 1500X (Free Virtual Visits) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$415.22 $471.27 $530.65 $741.58 $1,126.90 |
$732.86 $788.91 $848.29 $1,059.22 |
$1,050.50 $1,106.55 $1,165.93 $1,376.86 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$830.44 $942.54 $1,061.30 $1,483.16 $2,253.80 |
$1,148.08 $1,260.18 $1,378.94 $1,800.80 |
$1,465.72 $1,577.82 $1,696.58 $2,118.44 |
Toc - Plan #34 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Dean Silver Standard 5900X (Free Virtual Visits) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$405.23 $459.94 $517.89 $723.75 $1,099.81 |
$715.23 $769.94 $827.89 $1,033.75 |
$1,025.23 $1,079.94 $1,137.89 $1,343.75 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$810.46 $919.88 $1,035.78 $1,447.50 $2,199.62 |
$1,120.46 $1,229.88 $1,345.78 $1,757.50 |
$1,430.46 $1,539.88 $1,655.78 $2,067.50 |
Toc - Plan #35 Dean Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) Dean Bronze Standard 7500X (Free Virtual Visits) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$284.48 $322.89 $363.57 $508.09 $772.09 |
$502.11 $540.52 $581.20 $725.72 |
$719.74 $758.15 $798.83 $943.35 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$568.96 $645.78 $727.14 $1,016.18 $1,544.18 |
$786.59 $863.41 $944.77 $1,233.81 |
$1,004.22 $1,081.04 $1,162.40 $1,451.44 |
Toc - Plan #36 Dean Health Plan | ||||||||||||||||||||
Bronze
(HMO) Dean Bronze Standard 9100X (Free Virtual Visits) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$252.42 $286.50 $322.59 $450.82 $685.06 |
$445.52 $479.60 $515.69 $643.92 |
$638.62 $672.70 $708.79 $837.02 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$504.84 $573.00 $645.18 $901.64 $1,370.12 |
$697.94 $766.10 $838.28 $1,094.74 |
$891.04 $959.20 $1,031.38 $1,287.84 |
ADVERTISEMENT
Molina HealthcareLocal: 1-888-560-2043 | Toll Free: 1-888-560-2043 |
Toc - Plan #37 Molina Healthcare | ||||||||||||||||||||
Gold
(HMO) Gold 1 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$505.61 $573.86 $646.16 $903.01 $1,372.22 |
$892.40 $960.65 $1,032.95 $1,289.80 |
$1,279.19 $1,347.44 $1,419.74 $1,676.59 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,011.22 $1,147.72 $1,292.32 $1,806.02 $2,744.44 |
$1,398.01 $1,534.51 $1,679.11 $2,192.81 |
$1,784.80 $1,921.30 $2,065.90 $2,579.60 |
Toc - Plan #38 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Silver 1 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$429.25 $487.20 $548.59 $766.65 $1,165.00 |
$757.63 $815.58 $876.97 $1,095.03 |
$1,086.01 $1,143.96 $1,205.35 $1,423.41 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$858.50 $974.40 $1,097.18 $1,533.30 $2,330.00 |
$1,186.88 $1,302.78 $1,425.56 $1,861.68 |
$1,515.26 $1,631.16 $1,753.94 $2,190.06 |
Toc - Plan #39 Molina Healthcare | ||||||||||||||||||||
Gold
(HMO) Gold 8 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$521.90 $592.36 $666.99 $932.12 $1,416.44 |
$921.16 $991.62 $1,066.25 $1,331.38 |
$1,320.42 $1,390.88 $1,465.51 $1,730.64 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,043.80 $1,184.72 $1,333.98 $1,864.24 $2,832.88 |
$1,443.06 $1,583.98 $1,733.24 $2,263.50 |
$1,842.32 $1,983.24 $2,132.50 $2,662.76 |
Toc - Plan #40 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Silver 8 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$419.16 $475.75 $535.69 $748.63 $1,137.61 |
$739.82 $796.41 $856.35 $1,069.29 |
$1,060.48 $1,117.07 $1,177.01 $1,389.95 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$838.32 $951.50 $1,071.38 $1,497.26 $2,275.22 |
$1,158.98 $1,272.16 $1,392.04 $1,817.92 |
$1,479.64 $1,592.82 $1,712.70 $2,138.58 |
Toc - Plan #41 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Silver 12 with First 4 Primary Care Visits Free |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$422.60 $479.65 $540.09 $754.77 $1,146.94 |
$745.89 $802.94 $863.38 $1,078.06 |
$1,069.18 $1,126.23 $1,186.67 $1,401.35 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$845.20 $959.30 $1,080.18 $1,509.54 $2,293.88 |
$1,168.49 $1,282.59 $1,403.47 $1,832.83 |
$1,491.78 $1,605.88 $1,726.76 $2,156.12 |
Toc - Plan #42 Molina Healthcare | ||||||||||||||||||||
Gold
(HMO) Gold 1 with Adult Vision Services |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$508.50 $577.15 $649.86 $908.18 $1,380.07 |
$897.50 $966.15 $1,038.86 $1,297.18 |
$1,286.50 $1,355.15 $1,427.86 $1,686.18 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,017.00 $1,154.30 $1,299.72 $1,816.36 $2,760.14 |
$1,406.00 $1,543.30 $1,688.72 $2,205.36 |
$1,795.00 $1,932.30 $2,077.72 $2,594.36 |
Toc - Plan #43 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Silver 1 with Adult Vision Services |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$431.87 $490.18 $551.93 $771.33 $1,172.11 |
$762.25 $820.56 $882.31 $1,101.71 |
$1,092.63 $1,150.94 $1,212.69 $1,432.09 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$863.74 $980.36 $1,103.86 $1,542.66 $2,344.22 |
$1,194.12 $1,310.74 $1,434.24 $1,873.04 |
$1,524.50 $1,641.12 $1,764.62 $2,203.42 |
ADVERTISEMENT
MercyCare Health PlansLocal: 1-800-895-2421 | Toll Free: 1-800-895-2421 |
Toc - Plan #44 MercyCare Health Plans | ||||||||||||||||||||
Silver
(HMO) MercyCare HMO Silver Option A |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-895-2421
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$354.73 $402.62 $453.35 $633.55 $962.74 |
$626.10 $673.99 $724.72 $904.92 |
$897.47 $945.36 $996.09 $1,176.29 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$709.46 $805.24 $906.70 $1,267.10 $1,925.48 |
$980.83 $1,076.61 $1,178.07 $1,538.47 |
$1,252.20 $1,347.98 $1,449.44 $1,809.84 |
Toc - Plan #45 MercyCare Health Plans | ||||||||||||||||||||
Gold
(HMO) MercyCare HMO Gold Option B |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-895-2421
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$369.39 $419.26 $472.08 $659.73 $1,002.51 |
$651.97 $701.84 $754.66 $942.31 |
$934.55 $984.42 $1,037.24 $1,224.89 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$738.78 $838.52 $944.16 $1,319.46 $2,005.02 |
$1,021.36 $1,121.10 $1,226.74 $1,602.04 |
$1,303.94 $1,403.68 $1,509.32 $1,884.62 |
Toc - Plan #46 MercyCare Health Plans | ||||||||||||||||||||
Silver
(HMO) MercyCare HMO Silver Option B |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-895-2421
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$359.40 $407.91 $459.31 $641.88 $975.39 |
$634.34 $682.85 $734.25 $916.82 |
$909.28 $957.79 $1,009.19 $1,191.76 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$718.80 $815.82 $918.62 $1,283.76 $1,950.78 |
$993.74 $1,090.76 $1,193.56 $1,558.70 |
$1,268.68 $1,365.70 $1,468.50 $1,833.64 |
Toc - Plan #47 MercyCare Health Plans | ||||||||||||||||||||
Gold
(HMO) MercyCare HMO Gold Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-895-2421
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$360.69 $409.38 $460.95 $644.18 $978.89 |
$636.62 $685.31 $736.88 $920.11 |
$912.55 $961.24 $1,012.81 $1,196.04 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$721.38 $818.76 $921.90 $1,288.36 $1,957.78 |
$997.31 $1,094.69 $1,197.83 $1,564.29 |
$1,273.24 $1,370.62 $1,473.76 $1,840.22 |
Toc - Plan #48 MercyCare Health Plans | ||||||||||||||||||||
Silver
(HMO) MercyCare HMO Silver Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-895-2421
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$354.89 $402.80 $453.54 $633.83 $963.16 |
$626.38 $674.29 $725.03 $905.32 |
$897.87 $945.78 $996.52 $1,176.81 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$709.78 $805.60 $907.08 $1,267.66 $1,926.32 |
$981.27 $1,077.09 $1,178.57 $1,539.15 |
$1,252.76 $1,348.58 $1,450.06 $1,810.64 |
Toc - Plan #49 MercyCare Health Plans | ||||||||||||||||||||
Expanded Bronze
(HMO) MercyCare HMO Bronze Standard Expanded |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-895-2421
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$278.11 $315.66 $355.43 $496.70 $754.79 |
$490.87 $528.42 $568.19 $709.46 |
$703.63 $741.18 $780.95 $922.22 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$556.22 $631.32 $710.86 $993.40 $1,509.58 |
$768.98 $844.08 $923.62 $1,206.16 |
$981.74 $1,056.84 $1,136.38 $1,418.92 |
Toc - Plan #50 MercyCare Health Plans | ||||||||||||||||||||
Bronze
(HMO) MercyCare HMO Bronze Option B |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-895-2421
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$255.06 $289.49 $325.96 $455.53 $692.22 |
$450.18 $484.61 $521.08 $650.65 |
$645.30 $679.73 $716.20 $845.77 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$510.12 $578.98 $651.92 $911.06 $1,384.44 |
$705.24 $774.10 $847.04 $1,106.18 |
$900.36 $969.22 $1,042.16 $1,301.30 |
ADVERTISEMENT
Anthem Blue Cross and Blue ShieldLocal: 1-855-748-1813 | Toll Free: 1-855-748-1813 |
Toc - Plan #51 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(HMO) Anthem Bronze Blue Priority/Lean 0% for HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$287.06 $325.81 $366.86 $512.69 $779.08 |
$506.66 $545.41 $586.46 $732.29 |
$726.26 $765.01 $806.06 $951.89 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$574.12 $651.62 $733.72 $1,025.38 $1,558.16 |
$793.72 $871.22 $953.32 $1,244.98 |
$1,013.32 $1,090.82 $1,172.92 $1,464.58 |
Toc - Plan #52 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(HMO) Anthem Silver Blue Priority/Lean 4000 (3 Free PCP Visits + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$357.25 $405.48 $456.57 $638.05 $969.58 |
$630.55 $678.78 $729.87 $911.35 |
$903.85 $952.08 $1,003.17 $1,184.65 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$714.50 $810.96 $913.14 $1,276.10 $1,939.16 |
$987.80 $1,084.26 $1,186.44 $1,549.40 |
$1,261.10 $1,357.56 $1,459.74 $1,822.70 |
Toc - Plan #53 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Bronze
(HMO) Anthem Bronze Blue Priority/Lean 9450 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$273.65 $310.59 $349.72 $488.74 $742.69 |
$482.99 $519.93 $559.06 $698.08 |
$692.33 $729.27 $768.40 $907.42 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$547.30 $621.18 $699.44 $977.48 $1,485.38 |
$756.64 $830.52 $908.78 $1,186.82 |
$965.98 $1,039.86 $1,118.12 $1,396.16 |
Toc - Plan #54 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Gold
(HMO) Anthem Gold Blue Priority/Lean 1000 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$382.28 $433.89 $488.55 $682.75 $1,037.51 |
$674.72 $726.33 $780.99 $975.19 |
$967.16 $1,018.77 $1,073.43 $1,267.63 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$764.56 $867.78 $977.10 $1,365.50 $2,075.02 |
$1,057.00 $1,160.22 $1,269.54 $1,657.94 |
$1,349.44 $1,452.66 $1,561.98 $1,950.38 |
Toc - Plan #55 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(HMO) Anthem Bronze Blue Priority/Lean 0 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$292.72 $332.24 $374.10 $522.80 $794.44 |
$516.65 $556.17 $598.03 $746.73 |
$740.58 $780.10 $821.96 $970.66 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$585.44 $664.48 $748.20 $1,045.60 $1,588.88 |
$809.37 $888.41 $972.13 $1,269.53 |
$1,033.30 $1,112.34 $1,196.06 $1,493.46 |
Toc - Plan #56 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(HMO) Anthem Silver Blue Priority/Lean 5300 (3 Free PCP Visits + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$349.09 $396.22 $446.14 $623.47 $947.43 |
$616.14 $663.27 $713.19 $890.52 |
$883.19 $930.32 $980.24 $1,157.57 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$698.18 $792.44 $892.28 $1,246.94 $1,894.86 |
$965.23 $1,059.49 $1,159.33 $1,513.99 |
$1,232.28 $1,326.54 $1,426.38 $1,781.04 |
Toc - Plan #57 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(HMO) Anthem Bronze Blue Priority/Lean 7500/50% Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$287.32 $326.11 $367.19 $513.15 $779.79 |
$507.12 $545.91 $586.99 $732.95 |
$726.92 $765.71 $806.79 $952.75 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$574.64 $652.22 $734.38 $1,026.30 $1,559.58 |
$794.44 $872.02 $954.18 $1,246.10 |
$1,014.24 $1,091.82 $1,173.98 $1,465.90 |
Toc - Plan #58 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(HMO) Anthem Bronze Blue Priority/Lean 5000 (3 Free PCP Visits + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$288.17 $327.07 $368.28 $514.67 $782.09 |
$508.62 $547.52 $588.73 $735.12 |
$729.07 $767.97 $809.18 $955.57 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$576.34 $654.14 $736.56 $1,029.34 $1,564.18 |
$796.79 $874.59 $957.01 $1,249.79 |
$1,017.24 $1,095.04 $1,177.46 $1,470.24 |
Toc - Plan #59 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(HMO) Anthem Silver Blue Priority/Lean 4100 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$357.45 $405.71 $456.82 $638.41 $970.12 |
$630.90 $679.16 $730.27 $911.86 |
$904.35 $952.61 $1,003.72 $1,185.31 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$714.90 $811.42 $913.64 $1,276.82 $1,940.24 |
$988.35 $1,084.87 $1,187.09 $1,550.27 |
$1,261.80 $1,358.32 $1,460.54 $1,823.72 |
Toc - Plan #60 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Gold
(HMO) Anthem Gold Blue Priority/Lean 1500/25% Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$389.44 $442.01 $497.70 $695.54 $1,056.94 |
$687.36 $739.93 $795.62 $993.46 |
$985.28 $1,037.85 $1,093.54 $1,291.38 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$778.88 $884.02 $995.40 $1,391.08 $2,113.88 |
$1,076.80 $1,181.94 $1,293.32 $1,689.00 |
$1,374.72 $1,479.86 $1,591.24 $1,986.92 |
Toc - Plan #61 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(HMO) Anthem Silver Blue Priority/Lean 5900/40% Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$348.77 $395.85 $445.73 $622.90 $946.56 |
$615.58 $662.66 $712.54 $889.71 |
$882.39 $929.47 $979.35 $1,156.52 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$697.54 $791.70 $891.46 $1,245.80 $1,893.12 |
$964.35 $1,058.51 $1,158.27 $1,512.61 |
$1,231.16 $1,325.32 $1,425.08 $1,779.42 |
Toc - Plan #62 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(POS) Anthem Bronze Blue Preferred/Broad 0 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$314.58 $357.05 $402.03 $561.84 $853.77 |
$555.23 $597.70 $642.68 $802.49 |
$795.88 $838.35 $883.33 $1,043.14 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$629.16 $714.10 $804.06 $1,123.68 $1,707.54 |
$869.81 $954.75 $1,044.71 $1,364.33 |
$1,110.46 $1,195.40 $1,285.36 $1,604.98 |
Toc - Plan #63 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(POS) Anthem Silver Blue Preferred/Broad 4100 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$372.36 $422.63 $475.88 $665.03 $1,010.59 |
$657.22 $707.49 $760.74 $949.89 |
$942.08 $992.35 $1,045.60 $1,234.75 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$744.72 $845.26 $951.76 $1,330.06 $2,021.18 |
$1,029.58 $1,130.12 $1,236.62 $1,614.92 |
$1,314.44 $1,414.98 $1,521.48 $1,899.78 |
Toc - Plan #64 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Bronze
(POS) Anthem Bronze Blue Preferred/Broad 9450 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$285.06 $323.54 $364.31 $509.12 $773.65 |
$503.13 $541.61 $582.38 $727.19 |
$721.20 $759.68 $800.45 $945.26 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$570.12 $647.08 $728.62 $1,018.24 $1,547.30 |
$788.19 $865.15 $946.69 $1,236.31 |
$1,006.26 $1,083.22 $1,164.76 $1,454.38 |
Toc - Plan #65 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(POS) Anthem Bronze Blue Preferred/Broad 0% for HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$299.03 $339.40 $382.16 $534.07 $811.57 |
$527.79 $568.16 $610.92 $762.83 |
$756.55 $796.92 $839.68 $991.59 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$598.06 $678.80 $764.32 $1,068.14 $1,623.14 |
$826.82 $907.56 $993.08 $1,296.90 |
$1,055.58 $1,136.32 $1,221.84 $1,525.66 |
Toc - Plan #66 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(POS) Anthem Bronze Blue Preferred/Broad 5000 (3 Free PCP Visits + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$300.17 $340.69 $383.62 $536.10 $814.66 |
$529.80 $570.32 $613.25 $765.73 |
$759.43 $799.95 $842.88 $995.36 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$600.34 $681.38 $767.24 $1,072.20 $1,629.32 |
$829.97 $911.01 $996.87 $1,301.83 |
$1,059.60 $1,140.64 $1,226.50 $1,531.46 |
Toc - Plan #67 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(POS) Anthem Silver Blue Preferred/Broad 5300 (3 Free PCP Visits + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$363.61 $412.70 $464.69 $649.41 $986.84 |
$641.77 $690.86 $742.85 $927.57 |
$919.93 $969.02 $1,021.01 $1,205.73 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$727.22 $825.40 $929.38 $1,298.82 $1,973.68 |
$1,005.38 $1,103.56 $1,207.54 $1,576.98 |
$1,283.54 $1,381.72 $1,485.70 $1,855.14 |
Toc - Plan #68 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Gold
(POS) Anthem Gold Blue Preferred/Broad 1000 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$398.18 $451.93 $508.87 $711.15 $1,080.66 |
$702.79 $756.54 $813.48 $1,015.76 |
$1,007.40 $1,061.15 $1,118.09 $1,320.37 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$796.36 $903.86 $1,017.74 $1,422.30 $2,161.32 |
$1,100.97 $1,208.47 $1,322.35 $1,726.91 |
$1,405.58 $1,513.08 $1,626.96 $2,031.52 |
Toc - Plan #69 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(POS) Anthem Bronze Blue Preferred/Broad 7500/50% Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$299.29 $339.69 $382.49 $534.53 $812.27 |
$528.25 $568.65 $611.45 $763.49 |
$757.21 $797.61 $840.41 $992.45 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$598.58 $679.38 $764.98 $1,069.06 $1,624.54 |
$827.54 $908.34 $993.94 $1,298.02 |
$1,056.50 $1,137.30 $1,222.90 $1,526.98 |
Toc - Plan #70 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(POS) Anthem Silver Blue Preferred/Broad 5900/40% Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$363.32 $412.37 $464.32 $648.89 $986.05 |
$641.26 $690.31 $742.26 $926.83 |
$919.20 $968.25 $1,020.20 $1,204.77 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$726.64 $824.74 $928.64 $1,297.78 $1,972.10 |
$1,004.58 $1,102.68 $1,206.58 $1,575.72 |
$1,282.52 $1,380.62 $1,484.52 $1,853.66 |
Toc - Plan #71 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Gold
(POS) Anthem Gold Blue Preferred/Broad 1500/25% Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$405.66 $460.42 $518.43 $724.51 $1,100.96 |
$715.99 $770.75 $828.76 $1,034.84 |
$1,026.32 $1,081.08 $1,139.09 $1,345.17 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$811.32 $920.84 $1,036.86 $1,449.02 $2,201.92 |
$1,121.65 $1,231.17 $1,347.19 $1,759.35 |
$1,431.98 $1,541.50 $1,657.52 $2,069.68 |
Toc - Plan #72 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(POS) Anthem Silver Blue Preferred/Broad 4000 (3 Free PCP Visits + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$372.15 $422.39 $475.61 $664.66 $1,010.02 |
$656.84 $707.08 $760.30 $949.35 |
$941.53 $991.77 $1,044.99 $1,234.04 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$744.30 $844.78 $951.22 $1,329.32 $2,020.04 |
$1,028.99 $1,129.47 $1,235.91 $1,614.01 |
$1,313.68 $1,414.16 $1,520.60 $1,898.70 |
ADVERTISEMENT
UnitedHealthcareLocal: 1-866-569-3468 | Toll Free: 1-866-569-3468 | TTY: 1-866-569-3468 |
Toc - Plan #73 UnitedHealthcare | ||||||||||||||||||||
Expanded Bronze
(HMO) UHC Bronze Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-866-569-3468
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$288.77 $327.76 $369.05 $515.75 $783.73 |
$509.68 $548.67 $589.96 $736.66 |
$730.59 $769.58 $810.87 $957.57 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$577.54 $655.52 $738.10 $1,031.50 $1,567.46 |
$798.45 $876.43 $959.01 $1,252.41 |
$1,019.36 $1,097.34 $1,179.92 $1,473.32 |
Toc - Plan #74 UnitedHealthcare | ||||||||||||||||||||
Expanded Bronze
(HMO) UHC Bronze Value HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-866-569-3468
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$281.51 $319.52 $359.77 $502.78 $764.03 |
$496.87 $534.88 $575.13 $718.14 |
$712.23 $750.24 $790.49 $933.50 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$563.02 $639.04 $719.54 $1,005.56 $1,528.06 |
$778.38 $854.40 $934.90 $1,220.92 |
$993.74 $1,069.76 $1,150.26 $1,436.28 |
Toc - Plan #75 UnitedHealthcare | ||||||||||||||||||||
Expanded Bronze
(HMO) UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-866-569-3468
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$297.86 $338.07 $380.67 $531.98 $808.39 |
$525.72 $565.93 $608.53 $759.84 |
$753.58 $793.79 $836.39 $987.70 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$595.72 $676.14 $761.34 $1,063.96 $1,616.78 |
$823.58 $904.00 $989.20 $1,291.82 |
$1,051.44 $1,131.86 $1,217.06 $1,519.68 |
Toc - Plan #76 UnitedHealthcare | ||||||||||||||||||||
Silver
(HMO) UHC Silver Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-866-569-3468
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$360.28 $408.92 $460.44 $643.46 $977.80 |
$635.89 $684.53 $736.05 $919.07 |
$911.50 $960.14 $1,011.66 $1,194.68 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$720.56 $817.84 $920.88 $1,286.92 $1,955.60 |
$996.17 $1,093.45 $1,196.49 $1,562.53 |
$1,271.78 $1,369.06 $1,472.10 $1,838.14 |
Toc - Plan #77 UnitedHealthcare | ||||||||||||||||||||
Silver
(HMO) UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care + $0 PCP Visits, $5 Tier 2 Rx) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-866-569-3468
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$362.26 $411.16 $462.96 $646.99 $983.16 |
$639.39 $688.29 $740.09 $924.12 |
$916.52 $965.42 $1,017.22 $1,201.25 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$724.52 $822.32 $925.92 $1,293.98 $1,966.32 |
$1,001.65 $1,099.45 $1,203.05 $1,571.11 |
$1,278.78 $1,376.58 $1,480.18 $1,848.24 |
Toc - Plan #78 UnitedHealthcare | ||||||||||||||||||||
Silver
(HMO) UHC Silver Value ($0 Virtual Urgent Care, $3 Tier 2 Rx) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-866-569-3468
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$358.46 $406.86 $458.12 $640.22 $972.87 |
$632.68 $681.08 $732.34 $914.44 |
$906.90 $955.30 $1,006.56 $1,188.66 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$716.92 $813.72 $916.24 $1,280.44 $1,945.74 |
$991.14 $1,087.94 $1,190.46 $1,554.66 |
$1,265.36 $1,362.16 $1,464.68 $1,828.88 |
Toc - Plan #79 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: 1-866-569-3468
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$358.31 $406.68 $457.92 $639.94 $972.45 |
$632.42 $680.79 $732.03 $914.05 |
$906.53 $954.90 $1,006.14 $1,188.16 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$716.62 $813.36 $915.84 $1,279.88 $1,944.90 |
$990.73 $1,087.47 $1,189.95 $1,553.99 |
$1,264.84 $1,361.58 $1,464.06 $1,828.10 |
Toc - Plan #80 UnitedHealthcare | ||||||||||||||||||||
Gold
(HMO) UHC Gold Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-866-569-3468
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$401.44 $455.63 $513.03 $716.96 $1,089.50 |
$708.54 $762.73 $820.13 $1,024.06 |
$1,015.64 $1,069.83 $1,127.23 $1,331.16 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$802.88 $911.26 $1,026.06 $1,433.92 $2,179.00 |
$1,109.98 $1,218.36 $1,333.16 $1,741.02 |
$1,417.08 $1,525.46 $1,640.26 $2,048.12 |
Toc - Plan #81 UnitedHealthcare | ||||||||||||||||||||
Gold
(HMO) UHC Gold Value ($0 Virtual Urgent Care, $3 Tier 2 Rx) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-866-569-3468
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$388.46 $440.90 $496.46 $693.79 $1,054.29 |
$685.63 $738.07 $793.63 $990.96 |
$982.80 $1,035.24 $1,090.80 $1,288.13 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$776.92 $881.80 $992.92 $1,387.58 $2,108.58 |
$1,074.09 $1,178.97 $1,290.09 $1,684.75 |
$1,371.26 $1,476.14 $1,587.26 $1,981.92 |
Toc - Plan #82 UnitedHealthcare | ||||||||||||||||||||
Gold
(HMO) UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care + $0 PCP Visits, $3 Tier 2 Rx) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-866-569-3468
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$403.78 $458.30 $516.04 $721.16 $1,095.87 |
$712.68 $767.20 $824.94 $1,030.06 |
$1,021.58 $1,076.10 $1,133.84 $1,338.96 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$807.56 $916.60 $1,032.08 $1,442.32 $2,191.74 |
$1,116.46 $1,225.50 $1,340.98 $1,751.22 |
$1,425.36 $1,534.40 $1,649.88 $2,060.12 |
Toc - Plan #83 UnitedHealthcare | ||||||||||||||||||||
Silver
(HMO) UHC Silver Advantage+ ($0 Virtual Urgent Care + $0 PCP Visits, $3 Tier 2 Rx, Dental + Vision) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-866-569-3468
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$372.33 $422.60 $475.84 $664.99 $1,010.52 |
$657.17 $707.44 $760.68 $949.83 |
$942.01 $992.28 $1,045.52 $1,234.67 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$744.66 $845.20 $951.68 $1,329.98 $2,021.04 |
$1,029.50 $1,130.04 $1,236.52 $1,614.82 |
$1,314.34 $1,414.88 $1,521.36 $1,899.66 |
Toc - Plan #84 UnitedHealthcare | ||||||||||||||||||||
Gold
(HMO) UHC Gold Advantage+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-866-569-3468
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$410.48 $465.89 $524.59 $733.12 $1,114.04 |
$724.50 $779.91 $838.61 $1,047.14 |
$1,038.52 $1,093.93 $1,152.63 $1,361.16 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$820.96 $931.78 $1,049.18 $1,466.24 $2,228.08 |
$1,134.98 $1,245.80 $1,363.20 $1,780.26 |
$1,449.00 $1,559.82 $1,677.22 $2,094.28 |
ADVERTISEMENT
Common Ground Healthcare CooperativeLocal: 1-877-514-2442 | Toll Free: 1-877-514-2442 | TTY: 1-844-472-2442 |
Toc - Plan #85 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Copay Bronze $0 Ded / $2250 Rx Ded - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$328.52 $372.86 $419.84 $586.73 $891.59 |
$579.83 $624.17 $671.15 $838.04 |
$831.14 $875.48 $922.46 $1,089.35 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$657.04 $745.72 $839.68 $1,173.46 $1,783.18 |
$908.35 $997.03 $1,090.99 $1,424.77 |
$1,159.66 $1,248.34 $1,342.30 $1,676.08 |
Toc - Plan #86 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Copay Gold $0 Ded - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$513.16 $582.42 $655.80 $916.48 $1,392.68 |
$905.72 $974.98 $1,048.36 $1,309.04 |
$1,298.28 $1,367.54 $1,440.92 $1,701.60 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,026.32 $1,164.84 $1,311.60 $1,832.96 $2,785.36 |
$1,418.88 $1,557.40 $1,704.16 $2,225.52 |
$1,811.44 $1,949.96 $2,096.72 $2,618.08 |
Toc - Plan #87 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Gold $3000 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$446.96 $507.28 $571.20 $798.25 $1,213.01 |
$788.87 $849.19 $913.11 $1,140.16 |
$1,130.78 $1,191.10 $1,255.02 $1,482.07 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$893.92 $1,014.56 $1,142.40 $1,596.50 $2,426.02 |
$1,235.83 $1,356.47 $1,484.31 $1,938.41 |
$1,577.74 $1,698.38 $1,826.22 $2,280.32 |
Toc - Plan #88 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Gold $1800 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$484.29 $549.65 $618.90 $864.92 $1,314.32 |
$854.76 $920.12 $989.37 $1,235.39 |
$1,225.23 $1,290.59 $1,359.84 $1,605.86 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$968.58 $1,099.30 $1,237.80 $1,729.84 $2,628.64 |
$1,339.05 $1,469.77 $1,608.27 $2,100.31 |
$1,709.52 $1,840.24 $1,978.74 $2,470.78 |
Toc - Plan #89 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Silver $4000 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$440.97 $500.49 $563.55 $787.55 $1,196.76 |
$778.30 $837.82 $900.88 $1,124.88 |
$1,115.63 $1,175.15 $1,238.21 $1,462.21 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$881.94 $1,000.98 $1,127.10 $1,575.10 $2,393.52 |
$1,219.27 $1,338.31 $1,464.43 $1,912.43 |
$1,556.60 $1,675.64 $1,801.76 $2,249.76 |
Toc - Plan #90 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Silver $5000 Ded / $5000 Rx Ded - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$373.74 $424.18 $477.62 $667.48 $1,014.30 |
$659.64 $710.08 $763.52 $953.38 |
$945.54 $995.98 $1,049.42 $1,239.28 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$747.48 $848.36 $955.24 $1,334.96 $2,028.60 |
$1,033.38 $1,134.26 $1,241.14 $1,620.86 |
$1,319.28 $1,420.16 $1,527.04 $1,906.76 |
Toc - Plan #91 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Catastrophic
(EPO) CGHC Catastrophic $9450 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$211.32 $239.84 $270.06 $377.40 $573.50 |
$372.97 $401.49 $431.71 $539.05 |
$534.62 $563.14 $593.36 $700.70 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$422.64 $479.68 $540.12 $754.80 $1,147.00 |
$584.29 $641.33 $701.77 $916.45 |
$745.94 $802.98 $863.42 $1,078.10 |
Toc - Plan #92 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Bronze $9450 ($35 PCP Copay) - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$313.94 $356.31 $401.21 $560.68 $852.01 |
$554.10 $596.47 $641.37 $800.84 |
$794.26 $836.63 $881.53 $1,041.00 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$627.88 $712.62 $802.42 $1,121.36 $1,704.02 |
$868.04 $952.78 $1,042.58 $1,361.52 |
$1,108.20 $1,192.94 $1,282.74 $1,601.68 |
Toc - Plan #93 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC HSA Bronze $7500 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$327.21 $371.37 $418.16 $584.38 $888.02 |
$577.52 $621.68 $668.47 $834.69 |
$827.83 $871.99 $918.78 $1,085.00 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$654.42 $742.74 $836.32 $1,168.76 $1,776.04 |
$904.73 $993.05 $1,086.63 $1,419.07 |
$1,155.04 $1,243.36 $1,336.94 $1,669.38 |
Toc - Plan #94 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC HSA Gold $3200 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$510.82 $579.77 $652.81 $912.31 $1,386.34 |
$901.59 $970.54 $1,043.58 $1,303.08 |
$1,292.36 $1,361.31 $1,434.35 $1,693.85 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,021.64 $1,159.54 $1,305.62 $1,824.62 $2,772.68 |
$1,412.41 $1,550.31 $1,696.39 $2,215.39 |
$1,803.18 $1,941.08 $2,087.16 $2,606.16 |
Toc - Plan #95 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC HSA Silver $3200 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$464.09 $526.73 $593.10 $828.85 $1,259.52 |
$819.11 $881.75 $948.12 $1,183.87 |
$1,174.13 $1,236.77 $1,303.14 $1,538.89 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$928.18 $1,053.46 $1,186.20 $1,657.70 $2,519.04 |
$1,283.20 $1,408.48 $1,541.22 $2,012.72 |
$1,638.22 $1,763.50 $1,896.24 $2,367.74 |
Toc - Plan #96 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Bronze
(EPO) CGHC Bronze $6000 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$322.30 $365.80 $411.88 $575.60 $874.69 |
$568.85 $612.35 $658.43 $822.15 |
$815.40 $858.90 $904.98 $1,068.70 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$644.60 $731.60 $823.76 $1,151.20 $1,749.38 |
$891.15 $978.15 $1,070.31 $1,397.75 |
$1,137.70 $1,224.70 $1,316.86 $1,644.30 |
Toc - Plan #97 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Bronze Standard $7500 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$317.84 $360.74 $406.19 $567.65 $862.60 |
$560.98 $603.88 $649.33 $810.79 |
$804.12 $847.02 $892.47 $1,053.93 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$635.68 $721.48 $812.38 $1,135.30 $1,725.20 |
$878.82 $964.62 $1,055.52 $1,378.44 |
$1,121.96 $1,207.76 $1,298.66 $1,621.58 |
Toc - Plan #98 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Silver Standard $5900 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$391.63 $444.48 $500.48 $699.42 $1,062.84 |
$691.22 $744.07 $800.07 $999.01 |
$990.81 $1,043.66 $1,099.66 $1,298.60 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$783.26 $888.96 $1,000.96 $1,398.84 $2,125.68 |
$1,082.85 $1,188.55 $1,300.55 $1,698.43 |
$1,382.44 $1,488.14 $1,600.14 $1,998.02 |
Toc - Plan #99 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Gold Standard $1500 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$459.66 $521.70 $587.43 $820.94 $1,247.49 |
$811.29 $873.33 $939.06 $1,172.57 |
$1,162.92 $1,224.96 $1,290.69 $1,524.20 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$919.32 $1,043.40 $1,174.86 $1,641.88 $2,494.98 |
$1,270.95 $1,395.03 $1,526.49 $1,993.51 |
$1,622.58 $1,746.66 $1,878.12 $2,345.14 |
Toc - Plan #100 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Silver $5650 Ded / $6000 Rx Ded - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$373.61 $424.04 $477.46 $667.25 $1,013.96 |
$659.42 $709.85 $763.27 $953.06 |
$945.23 $995.66 $1,049.08 $1,238.87 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$747.22 $848.08 $954.92 $1,334.50 $2,027.92 |
$1,033.03 $1,133.89 $1,240.73 $1,620.31 |
$1,318.84 $1,419.70 $1,526.54 $1,906.12 |
Toc - Plan #101 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Gold $1800 - Envision Network (Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$487.38 $553.17 $622.86 $870.45 $1,322.73 |
$860.22 $926.01 $995.70 $1,243.29 |
$1,233.06 $1,298.85 $1,368.54 $1,616.13 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$974.76 $1,106.34 $1,245.72 $1,740.90 $2,645.46 |
$1,347.60 $1,479.18 $1,618.56 $2,113.74 |
$1,720.44 $1,852.02 $1,991.40 $2,486.58 |
Toc - Plan #102 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Gold $3000 - Envision Network (Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$450.02 $510.76 $575.12 $803.72 $1,221.33 |
$794.28 $855.02 $919.38 $1,147.98 |
$1,138.54 $1,199.28 $1,263.64 $1,492.24 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$900.04 $1,021.52 $1,150.24 $1,607.44 $2,442.66 |
$1,244.30 $1,365.78 $1,494.50 $1,951.70 |
$1,588.56 $1,710.04 $1,838.76 $2,295.96 |
Toc - Plan #103 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Silver $4000 - Envision Network (Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$444.04 $503.97 $567.47 $793.03 $1,205.09 |
$783.72 $843.65 $907.15 $1,132.71 |
$1,123.40 $1,183.33 $1,246.83 $1,472.39 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$888.08 $1,007.94 $1,134.94 $1,586.06 $2,410.18 |
$1,227.76 $1,347.62 $1,474.62 $1,925.74 |
$1,567.44 $1,687.30 $1,814.30 $2,265.42 |
Toc - Plan #104 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Silver $5650 Ded / $6000 Rx Ded - Envision Network (Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$376.64 $427.47 $481.33 $672.66 $1,022.17 |
$664.76 $715.59 $769.45 $960.78 |
$952.88 $1,003.71 $1,057.57 $1,248.90 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$753.28 $854.94 $962.66 $1,345.32 $2,044.34 |
$1,041.40 $1,143.06 $1,250.78 $1,633.44 |
$1,329.52 $1,431.18 $1,538.90 $1,921.56 |
Toc - Plan #105 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Silver $5000 Ded / $5000 Rx Ded - Envision Network (Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$376.77 $427.63 $481.50 $672.90 $1,022.53 |
$664.99 $715.85 $769.72 $961.12 |
$953.21 $1,004.07 $1,057.94 $1,249.34 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$753.54 $855.26 $963.00 $1,345.80 $2,045.06 |
$1,041.76 $1,143.48 $1,251.22 $1,634.02 |
$1,329.98 $1,431.70 $1,539.44 $1,922.24 |
Toc - Plan #106 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Bronze $9450 ($35 PCP Copay) - Envision Network (Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$316.94 $359.71 $405.03 $566.03 $860.14 |
$559.39 $602.16 $647.48 $808.48 |
$801.84 $844.61 $889.93 $1,050.93 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$633.88 $719.42 $810.06 $1,132.06 $1,720.28 |
$876.33 $961.87 $1,052.51 $1,374.51 |
$1,118.78 $1,204.32 $1,294.96 $1,616.96 |
Toc - Plan #107 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Bronze
(EPO) CGHC Bronze $6000 - Envision Network (Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$325.30 $369.21 $415.72 $580.97 $882.84 |
$574.15 $618.06 $664.57 $829.82 |
$823.00 $866.91 $913.42 $1,078.67 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$650.60 $738.42 $831.44 $1,161.94 $1,765.68 |
$899.45 $987.27 $1,080.29 $1,410.79 |
$1,148.30 $1,236.12 $1,329.14 $1,659.64 |
Toc - Plan #108 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC HSA Bronze $7500 - Envision Network (Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$330.21 $374.78 $422.00 $589.74 $896.17 |
$582.82 $627.39 $674.61 $842.35 |
$835.43 $880.00 $927.22 $1,094.96 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$660.42 $749.56 $844.00 $1,179.48 $1,792.34 |
$913.03 $1,002.17 $1,096.61 $1,432.09 |
$1,165.64 $1,254.78 $1,349.22 $1,684.70 |
Toc - Plan #109 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC HSA Silver $3200 - Envision Network (Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$467.17 $530.23 $597.03 $834.35 $1,267.87 |
$824.55 $887.61 $954.41 $1,191.73 |
$1,181.93 $1,244.99 $1,311.79 $1,549.11 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$934.34 $1,060.46 $1,194.06 $1,668.70 $2,535.74 |
$1,291.72 $1,417.84 $1,551.44 $2,026.08 |
$1,649.10 $1,775.22 $1,908.82 $2,383.46 |
Toc - Plan #110 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC HSA Gold $3200 - Envision Network (Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$513.92 $583.28 $656.77 $917.84 $1,394.74 |
$907.06 $976.42 $1,049.91 $1,310.98 |
$1,300.20 $1,369.56 $1,443.05 $1,704.12 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,027.84 $1,166.56 $1,313.54 $1,835.68 $2,789.48 |
$1,420.98 $1,559.70 $1,706.68 $2,228.82 |
$1,814.12 $1,952.84 $2,099.82 $2,621.96 |
Toc - Plan #111 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Copay Bronze $0 Ded / $2250 Rx Ded - Envision Network (Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$331.53 $376.27 $423.68 $592.09 $899.74 |
$585.14 $629.88 $677.29 $845.70 |
$838.75 $883.49 $930.90 $1,099.31 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$663.06 $752.54 $847.36 $1,184.18 $1,799.48 |
$916.67 $1,006.15 $1,100.97 $1,437.79 |
$1,170.28 $1,259.76 $1,354.58 $1,691.40 |
Toc - Plan #112 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Copay Gold $0 Ded - Envision Network (Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$516.26 $585.95 $659.77 $922.03 $1,401.11 |
$911.19 $980.88 $1,054.70 $1,316.96 |
$1,306.12 $1,375.81 $1,449.63 $1,711.89 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,032.52 $1,171.90 $1,319.54 $1,844.06 $2,802.22 |
$1,427.45 $1,566.83 $1,714.47 $2,238.99 |
$1,822.38 $1,961.76 $2,109.40 $2,633.92 |
‡Source: HealthCare.gov has released sample rates for all counties in the 36 states served by HealthCare.gov. We have integrated that data into our tables and provide you that information for Walworth County here.
Walworth County is in “Rating Area 14” of Wisconsin.
Currently, there are 112 plans offered in Rating Area 14.