Obamacare Providers, Plans and 2017 Rates for Stark County
The health insurance rates listed below are for calendar year 2017.
2017 Rates and Providers
(click here for 2014)
(click here for 2015)
(click here for 2016)
This page gives you an overview of the rates for individual and family health insurance plans available from HealthCare.gov, the marketplace for Canton, OH.
Currently, there are 97 plans offered in Stark County.
Below, you’ll find a summary of plans and rates for each of these providers.‡ This chart is designed to give you a preview of your health insurance options. For detailed information on available subsidies to make your coverage affordable, you must complete an application at HealthCare.gov or contact the provider directly.
The table below shows premiums for the following scenarios:
- Individual
- Couple
- Couple with 1 2 or 3 children
- Individual with 1 2 or 3 children
- A child alone
Each scenario is covered for age
- Age 21, 30, 40, 50
- Age 60 (Individual and Couple only)
For each plan, there are links that go to the insurance provider's website in a new window. You can find links to:
- a summary of plan benefits and costs,
- a plan brochure, and
- a "Provider Directory" -- where you can find out which doctors and hospitals in the Canton, OH area accept this insurance coverage as within the plan's "network".
‡Source: HealthCare.gov has released sample rates for all counties in those states served by HealthCare.gov. We have integrated that data into our tables and provide you that information for Stark County here.
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CareSourceLocal: 1-800-479-9502 | Toll Free: 1-800-479-9502 TTY: 1-800-750-0750 |
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Plan: (HMO) CareSource GoldSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-479-9502 - Provider Directory for This Plan: (CareSource)
Deductible: Individual:
$1,000
: Family:
$2,000 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$266.91 $302.94 $341.11 $476.70 $724.39 |
$533.82 $605.88 $682.22 $953.40 $1448.78 |
$703.31 $775.37 $851.71 $1122.89 |
$872.80 $944.86 $1021.20 $1292.38 |
$1042.29 $1114.35 $1190.69 $1461.87 |
$436.40 $472.43 $510.60 $646.19 |
$605.89 $641.92 $680.09 $815.68 |
$775.38 $811.41 $849.58 $985.17 |
$169.49 |
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AultCare Insurance CompanyLocal: 1-330-363-6360 | Toll Free: 1-800-344-8858 TTY: 1-330-363-2393 |
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Plan: (PPO) AultCare Gold 750 No Pediatric DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)
Deductible: Individual:
$750
: Family:
$1,500 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$435.76 $494.59 $556.90 $778.26 $1182.65 |
$871.52 $989.18 $1113.80 $1556.52 $2365.30 |
$1148.23 $1265.89 $1390.51 $1833.23 |
$1424.94 $1542.60 $1667.22 $2109.94 |
$1701.65 $1819.31 $1943.93 $2386.65 |
$712.47 $771.30 $833.61 $1054.97 |
$989.18 $1048.01 $1110.32 $1331.68 |
$1265.89 $1324.72 $1387.03 $1608.39 |
$276.71 |
Plan: (PPO) AultCare Gold 350 No Pediatric DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)
Deductible: Individual:
$350
: Family:
$700 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$452.03 $513.06 $577.70 $807.33 $1226.82 |
$904.06 $1026.12 $1155.40 $1614.66 $2453.64 |
$1191.10 $1313.16 $1442.44 $1901.70 |
$1478.14 $1600.20 $1729.48 $2188.74 |
$1765.18 $1887.24 $2016.52 $2475.78 |
$739.07 $800.10 $864.74 $1094.37 |
$1026.11 $1087.14 $1151.78 $1381.41 |
$1313.15 $1374.18 $1438.82 $1668.45 |
$287.04 |
Plan: (PPO) AultCare Gold 750Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)
Deductible: Individual:
$750
: Family:
$1,500 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$442.56 $502.30 $565.59 $790.41 $1201.10 |
$885.12 $1004.60 $1131.18 $1580.82 $2402.20 |
$1166.14 $1285.62 $1412.20 $1861.84 |
$1447.16 $1566.64 $1693.22 $2142.86 |
$1728.18 $1847.66 $1974.24 $2423.88 |
$723.58 $783.32 $846.61 $1071.43 |
$1004.60 $1064.34 $1127.63 $1352.45 |
$1285.62 $1345.36 $1408.65 $1633.47 |
$281.02 |
Plan: (PPO) AultCare Gold 350Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)
Deductible: Individual:
$350
: Family:
$700 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$459.43 $521.45 $587.15 $820.53 $1246.88 |
$918.86 $1042.90 $1174.30 $1641.06 $2493.76 |
$1210.59 $1334.63 $1466.03 $1932.79 |
$1502.32 $1626.36 $1757.76 $2224.52 |
$1794.05 $1918.09 $2049.49 $2516.25 |
$751.16 $813.18 $878.88 $1112.26 |
$1042.89 $1104.91 $1170.61 $1403.99 |
$1334.62 $1396.64 $1462.34 $1695.72 |
$291.73 |
Plan: (PPO) AultCare Bronze 6000 No Pediatric DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)
Deductible: Individual:
$6,000
: Family:
$12,000 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$256.35 $290.95 $327.61 $457.83 $695.72 |
$512.70 $581.90 $655.22 $915.66 $1391.44 |
$675.48 $744.68 $818.00 $1078.44 |
$838.26 $907.46 $980.78 $1241.22 |
$1001.04 $1070.24 $1143.56 $1404.00 |
$419.13 $453.73 $490.39 $620.61 |
$581.91 $616.51 $653.17 $783.39 |
$744.69 $779.29 $815.95 $946.17 |
$162.78 |
Plan: (PPO) AultCare Bronze 5000 No Pediatric DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)
Deductible: Individual:
$5,000
: Family:
$10,000 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$264.76 $300.50 $338.36 $472.85 $718.55 |
$529.52 $601.00 $676.72 $945.70 $1437.10 |
$697.64 $769.12 $844.84 $1113.82 |
$865.76 $937.24 $1012.96 $1281.94 |
$1033.88 $1105.36 $1181.08 $1450.06 |
$432.88 $468.62 $506.48 $640.97 |
$601.00 $636.74 $674.60 $809.09 |
$769.12 $804.86 $842.72 $977.21 |
$168.12 |
Plan: (PPO) AultCare Silver 5000 No Pediatric DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)
Deductible: Individual:
$5,000
: Family:
$10,000 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$323.62 $367.31 $413.59 $577.99 $878.31 |
$647.24 $734.62 $827.18 $1155.98 $1756.62 |
$852.74 $940.12 $1032.68 $1361.48 |
$1058.24 $1145.62 $1238.18 $1566.98 |
$1263.74 $1351.12 $1443.68 $1772.48 |
$529.12 $572.81 $619.09 $783.49 |
$734.62 $778.31 $824.59 $988.99 |
$940.12 $983.81 $1030.09 $1194.49 |
$205.50 |
Plan: (PPO) AultCare Silver 3000 No Pediatric DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)
Deductible: Individual:
$3,000
: Family:
$6,000 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$350.87 $398.24 $448.42 $626.66 $952.27 |
$701.74 $796.48 $896.84 $1253.32 $1904.54 |
$924.54 $1019.28 $1119.64 $1476.12 |
$1147.34 $1242.08 $1342.44 $1698.92 |
$1370.14 $1464.88 $1565.24 $1921.72 |
$573.67 $621.04 $671.22 $849.46 |
$796.47 $843.84 $894.02 $1072.26 |
$1019.27 $1066.64 $1116.82 $1295.06 |
$222.80 |
Plan: (PPO) AultCare Silver 2500 No Pediatric DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)
Deductible: Individual:
$2,500
: Family:
$5,000 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$355.48 $403.47 $454.31 $634.89 $964.78 |
$710.96 $806.94 $908.62 $1269.78 $1929.56 |
$936.69 $1032.67 $1134.35 $1495.51 |
$1162.42 $1258.40 $1360.08 $1721.24 |
$1388.15 $1484.13 $1585.81 $1946.97 |
$581.21 $629.20 $680.04 $860.62 |
$806.94 $854.93 $905.77 $1086.35 |
$1032.67 $1080.66 $1131.50 $1312.08 |
$225.73 |
Plan: (PPO) AultCare Gold 1200 No Pediatric DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)
Deductible: Individual:
$1,200
: Family:
$2,400 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$437.03 $496.02 $558.52 $780.53 $1186.09 |
$874.06 $992.04 $1117.04 $1561.06 $2372.18 |
$1151.57 $1269.55 $1394.55 $1838.57 |
$1429.08 $1547.06 $1672.06 $2116.08 |
$1706.59 $1824.57 $1949.57 $2393.59 |
$714.54 $773.53 $836.03 $1058.04 |
$992.05 $1051.04 $1113.54 $1335.55 |
$1269.56 $1328.55 $1391.05 $1613.06 |
$277.51 |
Plan: (PPO) AultCare Catastrophic SelectSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)
Deductible: Individual:
$7,150
: Family:
$14,300 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Catastrophic | 21 30 40 50 60 |
$160.44 $182.10 $205.04 $286.55 $435.44 |
$320.88 $364.20 $410.08 $573.10 $870.88 |
$422.76 $466.08 $511.96 $674.98 |
$524.64 $567.96 $613.84 $776.86 |
$626.52 $669.84 $715.72 $878.74 |
$262.32 $283.98 $306.92 $388.43 |
$364.20 $385.86 $408.80 $490.31 |
$466.08 $487.74 $510.68 $592.19 |
$101.88 |
Plan: (PPO) AultCare Bronze 6000 SelectSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)
Deductible: Individual:
$6,000
: Family:
$12,000 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$221.56 $251.47 $283.16 $395.71 $601.32 |
$443.12 $502.94 $566.32 $791.42 $1202.64 |
$583.81 $643.63 $707.01 $932.11 |
$724.50 $784.32 $847.70 $1072.80 |
$865.19 $925.01 $988.39 $1213.49 |
$362.25 $392.16 $423.85 $536.40 |
$502.94 $532.85 $564.54 $677.09 |
$643.63 $673.54 $705.23 $817.78 |
$140.69 |
Plan: (PPO) AultCare Bronze 5000 SelectSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)
Deductible: Individual:
$5,000
: Family:
$10,000 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$229.22 $260.17 $292.95 $409.39 $622.11 |
$458.44 $520.34 $585.90 $818.78 $1244.22 |
$604.00 $665.90 $731.46 $964.34 |
$749.56 $811.46 $877.02 $1109.90 |
$895.12 $957.02 $1022.58 $1255.46 |
$374.78 $405.73 $438.51 $554.95 |
$520.34 $551.29 $584.07 $700.51 |
$665.90 $696.85 $729.63 $846.07 |
$145.56 |
Plan: (PPO) AultCare Silver 5000 SelectSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)
Deductible: Individual:
$5,000
: Family:
$10,000 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$279.98 $317.77 $357.81 $500.04 $759.85 |
$559.96 $635.54 $715.62 $1000.08 $1519.70 |
$737.74 $813.32 $893.40 $1177.86 |
$915.52 $991.10 $1071.18 $1355.64 |
$1093.30 $1168.88 $1248.96 $1533.42 |
$457.76 $495.55 $535.59 $677.82 |
$635.54 $673.33 $713.37 $855.60 |
$813.32 $851.11 $891.15 $1033.38 |
$177.78 |
Plan: (PPO) AultCare Silver 3000 SelectSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)
Deductible: Individual:
$3,000
: Family:
$6,000 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$303.41 $344.38 $387.76 $541.90 $823.47 |
$606.82 $688.76 $775.52 $1083.80 $1646.94 |
$799.49 $881.43 $968.19 $1276.47 |
$992.16 $1074.10 $1160.86 $1469.14 |
$1184.83 $1266.77 $1353.53 $1661.81 |
$496.08 $537.05 $580.43 $734.57 |
$688.75 $729.72 $773.10 $927.24 |
$881.42 $922.39 $965.77 $1119.91 |
$192.67 |
Plan: (PPO) AultCare Silver 2500 SelectSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)
Deductible: Individual:
$2,500
: Family:
$5,000 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$307.03 $348.47 $392.38 $548.35 $833.27 |
$614.06 $696.94 $784.76 $1096.70 $1666.54 |
$809.02 $891.90 $979.72 $1291.66 |
$1003.98 $1086.86 $1174.68 $1486.62 |
$1198.94 $1281.82 $1369.64 $1681.58 |
$501.99 $543.43 $587.34 $743.31 |
$696.95 $738.39 $782.30 $938.27 |
$891.91 $933.35 $977.26 $1133.23 |
$194.96 |
Plan: (PPO) AultCare Gold 1200 SelectSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)
Deductible: Individual:
$1,200
: Family:
$2,400 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$376.90 $427.78 $481.68 $673.14 $1022.90 |
$753.80 $855.56 $963.36 $1346.28 $2045.80 |
$993.13 $1094.89 $1202.69 $1585.61 |
$1232.46 $1334.22 $1442.02 $1824.94 |
$1471.79 $1573.55 $1681.35 $2064.27 |
$616.23 $667.11 $721.01 $912.47 |
$855.56 $906.44 $960.34 $1151.80 |
$1094.89 $1145.77 $1199.67 $1391.13 |
$239.33 |
Plan: (PPO) AultCare Gold 750 SelectSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)
Deductible: Individual:
$750
: Family:
$1,500 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$376.17 $426.96 $480.75 $671.85 $1020.94 |
$752.34 $853.92 $961.50 $1343.70 $2041.88 |
$991.21 $1092.79 $1200.37 $1582.57 |
$1230.08 $1331.66 $1439.24 $1821.44 |
$1468.95 $1570.53 $1678.11 $2060.31 |
$615.04 $665.83 $719.62 $910.72 |
$853.91 $904.70 $958.49 $1149.59 |
$1092.78 $1143.57 $1197.36 $1388.46 |
$238.87 |
Plan: (PPO) AultCare Gold 350 SelectSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)
Deductible: Individual:
$350
: Family:
$700 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$390.51 $443.23 $499.07 $697.45 $1059.85 |
$781.02 $886.46 $998.14 $1394.90 $2119.70 |
$1028.99 $1134.43 $1246.11 $1642.87 |
$1276.96 $1382.40 $1494.08 $1890.84 |
$1524.93 $1630.37 $1742.05 $2138.81 |
$638.48 $691.20 $747.04 $945.42 |
$886.45 $939.17 $995.01 $1193.39 |
$1134.42 $1187.14 $1242.98 $1441.36 |
$247.97 |
Plan: (PPO) AultCare CatastrophicSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)
Deductible: Individual:
$7,150
: Family:
$14,300 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Catastrophic | 21 30 40 50 60 |
$188.75 $214.24 $241.23 $337.12 $512.28 |
$377.50 $428.48 $482.46 $674.24 $1024.56 |
$497.36 $548.34 $602.32 $794.10 |
$617.22 $668.20 $722.18 $913.96 |
$737.08 $788.06 $842.04 $1033.82 |
$308.61 $334.10 $361.09 $456.98 |
$428.47 $453.96 $480.95 $576.84 |
$548.33 $573.82 $600.81 $696.70 |
$119.86 |
Plan: (PPO) AultCare Bronze 6000Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)
Deductible: Individual:
$6,000
: Family:
$12,000 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$260.66 $295.85 $333.12 $465.54 $707.43 |
$521.32 $591.70 $666.24 $931.08 $1414.86 |
$686.84 $757.22 $831.76 $1096.60 |
$852.36 $922.74 $997.28 $1262.12 |
$1017.88 $1088.26 $1162.80 $1427.64 |
$426.18 $461.37 $498.64 $631.06 |
$591.70 $626.89 $664.16 $796.58 |
$757.22 $792.41 $829.68 $962.10 |
$165.52 |
Plan: (PPO) AultCare Bronze 5000Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)
Deductible: Individual:
$5,000
: Family:
$10,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$269.67 $306.08 $344.64 $481.63 $731.89 |
$539.34 $612.16 $689.28 $963.26 $1463.78 |
$710.58 $783.40 $860.52 $1134.50 |
$881.82 $954.64 $1031.76 $1305.74 |
$1053.06 $1125.88 $1203.00 $1476.98 |
$440.91 $477.32 $515.88 $652.87 |
$612.15 $648.56 $687.12 $824.11 |
$783.39 $819.80 $858.36 $995.35 |
$171.24 |
Plan: (PPO) AultCare Silver 5000Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)
Deductible: Individual:
$5,000
: Family:
$10,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$329.38 $373.85 $420.95 $588.28 $893.94 |
$658.76 $747.70 $841.90 $1176.56 $1787.88 |
$867.92 $956.86 $1051.06 $1385.72 |
$1077.08 $1166.02 $1260.22 $1594.88 |
$1286.24 $1375.18 $1469.38 $1804.04 |
$538.54 $583.01 $630.11 $797.44 |
$747.70 $792.17 $839.27 $1006.60 |
$956.86 $1001.33 $1048.43 $1215.76 |
$209.16 |
Plan: (PPO) AultCare Silver 3000Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)
Deductible: Individual:
$3,000
: Family:
$6,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$356.96 $405.15 $456.19 $637.53 $968.78 |
$713.92 $810.30 $912.38 $1275.06 $1937.56 |
$940.59 $1036.97 $1139.05 $1501.73 |
$1167.26 $1263.64 $1365.72 $1728.40 |
$1393.93 $1490.31 $1592.39 $1955.07 |
$583.63 $631.82 $682.86 $864.20 |
$810.30 $858.49 $909.53 $1090.87 |
$1036.97 $1085.16 $1136.20 $1317.54 |
$226.67 |
Plan: (PPO) AultCare Silver 2500Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)
Deductible: Individual:
$2,500
: Family:
$5,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$361.21 $409.97 $461.62 $645.12 $980.32 |
$722.42 $819.94 $923.24 $1290.24 $1960.64 |
$951.79 $1049.31 $1152.61 $1519.61 |
$1181.16 $1278.68 $1381.98 $1748.98 |
$1410.53 $1508.05 $1611.35 $1978.35 |
$590.58 $639.34 $690.99 $874.49 |
$819.95 $868.71 $920.36 $1103.86 |
$1049.32 $1098.08 $1149.73 $1333.23 |
$229.37 |
Plan: (PPO) AultCare Gold 1200Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)
Deductible: Individual:
$1,200
: Family:
$2,400 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$443.41 $503.27 $566.68 $791.93 $1203.41 |
$886.82 $1006.54 $1133.36 $1583.86 $2406.82 |
$1168.39 $1288.11 $1414.93 $1865.43 |
$1449.96 $1569.68 $1696.50 $2147.00 |
$1731.53 $1851.25 $1978.07 $2428.57 |
$724.98 $784.84 $848.25 $1073.50 |
$1006.55 $1066.41 $1129.82 $1355.07 |
$1288.12 $1347.98 $1411.39 $1636.64 |
$281.57 |
Plan: (PPO) AultCare Catastrophic No Pediatric DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)
Deductible: Individual:
$7,150
: Family:
$14,300 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Catastrophic | 21 30 40 50 60 |
$185.80 $210.89 $237.46 $331.85 $504.27 |
$371.60 $421.78 $474.92 $663.70 $1008.54 |
$489.59 $539.77 $592.91 $781.69 |
$607.58 $657.76 $710.90 $899.68 |
$725.57 $775.75 $828.89 $1017.67 |
$303.79 $328.88 $355.45 $449.84 |
$421.78 $446.87 $473.44 $567.83 |
$539.77 $564.86 $591.43 $685.82 |
$117.99 |
Plan: (PPO) AultCare Gold 350 Select No Pediatric DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)
Deductible: Individual:
$350
: Family:
$700 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$384.23 $436.10 $491.04 $686.23 $1042.79 |
$768.46 $872.20 $982.08 $1372.46 $2085.58 |
$1012.44 $1116.18 $1226.06 $1616.44 |
$1256.42 $1360.16 $1470.04 $1860.42 |
$1500.40 $1604.14 $1714.02 $2104.40 |
$628.21 $680.08 $735.02 $930.21 |
$872.19 $924.06 $979.00 $1174.19 |
$1116.17 $1168.04 $1222.98 $1418.17 |
$243.98 |
Plan: (PPO) AultCare Gold 750 Select No Pediatric DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)
Deductible: Individual:
$750
: Family:
$1,500 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$370.39 $420.40 $473.36 $661.52 $1005.25 |
$740.78 $840.80 $946.72 $1323.04 $2010.50 |
$975.98 $1076.00 $1181.92 $1558.24 |
$1211.18 $1311.20 $1417.12 $1793.44 |
$1446.38 $1546.40 $1652.32 $2028.64 |
$605.59 $655.60 $708.56 $896.72 |
$840.79 $890.80 $943.76 $1131.92 |
$1075.99 $1126.00 $1178.96 $1367.12 |
$235.20 |
Plan: (PPO) AultCare Gold 1200 Select No Pediatric DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)
Deductible: Individual:
$1,200
: Family:
$2,400 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$371.47 $421.62 $474.74 $663.45 $1008.18 |
$742.94 $843.24 $949.48 $1326.90 $2016.36 |
$978.82 $1079.12 $1185.36 $1562.78 |
$1214.70 $1315.00 $1421.24 $1798.66 |
$1450.58 $1550.88 $1657.12 $2034.54 |
$607.35 $657.50 $710.62 $899.33 |
$843.23 $893.38 $946.50 $1135.21 |
$1079.11 $1129.26 $1182.38 $1371.09 |
$235.88 |
Plan: (PPO) AultCare Silver 2500 Select No Pediatric DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)
Deductible: Individual:
$2,500
: Family:
$5,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$302.16 $342.95 $386.16 $539.66 $820.07 |
$604.32 $685.90 $772.32 $1079.32 $1640.14 |
$796.19 $877.77 $964.19 $1271.19 |
$988.06 $1069.64 $1156.06 $1463.06 |
$1179.93 $1261.51 $1347.93 $1654.93 |
$494.03 $534.82 $578.03 $731.53 |
$685.90 $726.69 $769.90 $923.40 |
$877.77 $918.56 $961.77 $1115.27 |
$191.87 |
Plan: (PPO) AultCare Bronze 6600Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)
Deductible: Individual:
$6,550
: Family:
$13,100 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$260.07 $295.18 $332.38 $464.49 $705.84 |
$520.14 $590.36 $664.76 $928.98 $1411.68 |
$685.29 $755.51 $829.91 $1094.13 |
$850.44 $920.66 $995.06 $1259.28 |
$1015.59 $1085.81 $1160.21 $1424.43 |
$425.22 $460.33 $497.53 $629.64 |
$590.37 $625.48 $662.68 $794.79 |
$755.52 $790.63 $827.83 $959.94 |
$165.15 |
Plan: (PPO) AultCare Silver 3000 Select No Pediatric DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)
Deductible: Individual:
$3,000
: Family:
$6,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$298.24 $338.51 $381.15 $532.66 $809.43 |
$596.48 $677.02 $762.30 $1065.32 $1618.86 |
$785.86 $866.40 $951.68 $1254.70 |
$975.24 $1055.78 $1141.06 $1444.08 |
$1164.62 $1245.16 $1330.44 $1633.46 |
$487.62 $527.89 $570.53 $722.04 |
$677.00 $717.27 $759.91 $911.42 |
$866.38 $906.65 $949.29 $1100.80 |
$189.38 |
Plan: (PPO) AultCare Silver 5000 Select No Pediatric DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)
Deductible: Individual:
$5,000
: Family:
$10,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$275.08 $312.21 $351.55 $491.29 $746.56 |
$550.16 $624.42 $703.10 $982.58 $1493.12 |
$724.84 $799.10 $877.78 $1157.26 |
$899.52 $973.78 $1052.46 $1331.94 |
$1074.20 $1148.46 $1227.14 $1506.62 |
$449.76 $486.89 $526.23 $665.97 |
$624.44 $661.57 $700.91 $840.65 |
$799.12 $836.25 $875.59 $1015.33 |
$174.68 |
Plan: (PPO) AultCare Bronze 5000 Select No Pediatric DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)
Deductible: Individual:
$5,000
: Family:
$10,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$225.04 $255.42 $287.60 $401.93 $610.77 |
$450.08 $510.84 $575.20 $803.86 $1221.54 |
$592.98 $653.74 $718.10 $946.76 |
$735.88 $796.64 $861.00 $1089.66 |
$878.78 $939.54 $1003.90 $1232.56 |
$367.94 $398.32 $430.50 $544.83 |
$510.84 $541.22 $573.40 $687.73 |
$653.74 $684.12 $716.30 $830.63 |
$142.90 |
Plan: (PPO) AultCare Bronze 6000 Select No Pediatric DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)
Deductible: Individual:
$6,000
: Family:
$12,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$217.89 $247.31 $278.47 $389.16 $591.36 |
$435.78 $494.62 $556.94 $778.32 $1182.72 |
$574.14 $632.98 $695.30 $916.68 |
$712.50 $771.34 $833.66 $1055.04 |
$850.86 $909.70 $972.02 $1193.40 |
$356.25 $385.67 $416.83 $527.52 |
$494.61 $524.03 $555.19 $665.88 |
$632.97 $662.39 $693.55 $804.24 |
$138.36 |
Plan: (PPO) AultCare Catastrophic Select No Pediatric DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)
Deductible: Individual:
$7,150
: Family:
$14,300 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Catastrophic | 21 30 40 50 60 |
$157.93 $179.26 $201.84 $282.07 $428.63 |
$315.86 $358.52 $403.68 $564.14 $857.26 |
$416.15 $458.81 $503.97 $664.43 |
$516.44 $559.10 $604.26 $764.72 |
$616.73 $659.39 $704.55 $865.01 |
$258.22 $279.55 $302.13 $382.36 |
$358.51 $379.84 $402.42 $482.65 |
$458.80 $480.13 $502.71 $582.94 |
$100.29 |
Plan: (PPO) AultCare Silver 6850Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)
Deductible: Individual:
$6,850
: Family:
$13,700 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$289.96 $329.11 $370.57 $517.88 $786.96 |
$579.92 $658.22 $741.14 $1035.76 $1573.92 |
$764.05 $842.35 $925.27 $1219.89 |
$948.18 $1026.48 $1109.40 $1404.02 |
$1132.31 $1210.61 $1293.53 $1588.15 |
$474.09 $513.24 $554.70 $702.01 |
$658.22 $697.37 $738.83 $886.14 |
$842.35 $881.50 $922.96 $1070.27 |
$184.13 |
Plan: (PPO) AultCare Silver 6850 SelectSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)
Deductible: Individual:
$6,850
: Family:
$13,700 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$246.47 $279.74 $314.99 $440.19 $668.92 |
$492.94 $559.48 $629.98 $880.38 $1337.84 |
$649.45 $715.99 $786.49 $1036.89 |
$805.96 $872.50 $943.00 $1193.40 |
$962.47 $1029.01 $1099.51 $1349.91 |
$402.98 $436.25 $471.50 $596.70 |
$559.49 $592.76 $628.01 $753.21 |
$716.00 $749.27 $784.52 $909.72 |
$156.51 |
Plan: (PPO) AultCare Silver 6850 No Pediatric DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)
Deductible: Individual:
$6,850
: Family:
$13,700 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$285.33 $323.85 $364.66 $509.60 $774.39 |
$570.66 $647.70 $729.32 $1019.20 $1548.78 |
$751.85 $828.89 $910.51 $1200.39 |
$933.04 $1010.08 $1091.70 $1381.58 |
$1114.23 $1191.27 $1272.89 $1562.77 |
$466.52 $505.04 $545.85 $690.79 |
$647.71 $686.23 $727.04 $871.98 |
$828.90 $867.42 $908.23 $1053.17 |
$181.19 |
Plan: (PPO) AultCare Silver 6850 Select No Pediatric DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)
Deductible: Individual:
$6,850
: Family:
$13,700 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$242.53 $275.28 $309.96 $433.16 $658.23 |
$485.06 $550.56 $619.92 $866.32 $1316.46 |
$639.07 $704.57 $773.93 $1020.33 |
$793.08 $858.58 $927.94 $1174.34 |
$947.09 $1012.59 $1081.95 $1328.35 |
$396.54 $429.29 $463.97 $587.17 |
$550.55 $583.30 $617.98 $741.18 |
$704.56 $737.31 $771.99 $895.19 |
$154.01 |
Plan: (PPO) AultCare Bronze 6600 SelectSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)
Deductible: Individual:
$6,550
: Family:
$13,100 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$221.06 $250.91 $282.52 $394.82 $599.97 |
$442.12 $501.82 $565.04 $789.64 $1199.94 |
$582.50 $642.20 $705.42 $930.02 |
$722.88 $782.58 $845.80 $1070.40 |
$863.26 $922.96 $986.18 $1210.78 |
$361.44 $391.29 $422.90 $535.20 |
$501.82 $531.67 $563.28 $675.58 |
$642.20 $672.05 $703.66 $815.96 |
$140.38 |
Plan: (PPO) AultCare Bronze 6600 No Pediatric DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)
Deductible: Individual:
$6,550
: Family:
$13,100 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$255.97 $290.53 $327.13 $457.16 $694.71 |
$511.94 $581.06 $654.26 $914.32 $1389.42 |
$674.48 $743.60 $816.80 $1076.86 |
$837.02 $906.14 $979.34 $1239.40 |
$999.56 $1068.68 $1141.88 $1401.94 |
$418.51 $453.07 $489.67 $619.70 |
$581.05 $615.61 $652.21 $782.24 |
$743.59 $778.15 $814.75 $944.78 |
$162.54 |
Plan: (PPO) AultCare Bronze 6600 Select No Pediatric DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)
Deductible: Individual:
$6,550
: Family:
$13,100 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$217.58 $246.95 $278.06 $388.59 $590.50 |
$435.16 $493.90 $556.12 $777.18 $1181.00 |
$573.32 $632.06 $694.28 $915.34 |
$711.48 $770.22 $832.44 $1053.50 |
$849.64 $908.38 $970.60 $1191.66 |
$355.74 $385.11 $416.22 $526.75 |
$493.90 $523.27 $554.38 $664.91 |
$632.06 $661.43 $692.54 $803.07 |
$138.16 |
Plan: (PPO) AultCare Bronze Standard Select No Pediatric DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)
Deductible: Individual:
$6,650
: Family:
$13,300 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$217.34 $246.68 $277.76 $388.17 $589.86 |
$434.68 $493.36 $555.52 $776.34 $1179.72 |
$572.69 $631.37 $693.53 $914.35 |
$710.70 $769.38 $831.54 $1052.36 |
$848.71 $907.39 $969.55 $1190.37 |
$355.35 $384.69 $415.77 $526.18 |
$493.36 $522.70 $553.78 $664.19 |
$631.37 $660.71 $691.79 $802.20 |
$138.01 |
ADVERTISEMENT
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||||||||||
Community Insurance Company(Anthem BCBS)Local: 1-855-748-1808 | Toll Free: 1-855-748-1808 |
||||||||||
Plan: (PPO) Anthem Catastrophic Pathway X PPO 7150Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS))
Deductible: Individual:
$7,150
: Family:
$14,300 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Catastrophic | 21 30 40 50 60 |
$182.58 $207.23 $233.34 $326.09 $495.52 |
$365.16 $414.46 $466.68 $652.18 $991.04 |
$481.10 $530.40 $582.62 $768.12 |
$597.04 $646.34 $698.56 $884.06 |
$712.98 $762.28 $814.50 $1000.00 |
$298.52 $323.17 $349.28 $442.03 |
$414.46 $439.11 $465.22 $557.97 |
$530.40 $555.05 $581.16 $673.91 |
$115.94 |
Plan: (PPO) Anthem Bronze Pathway X PPO 0 for HSASummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS))
Deductible: Individual:
$6,550
: Family:
$13,100 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$227.57 $258.29 $290.83 $406.44 $617.62 |
$455.14 $516.58 $581.66 $812.88 $1235.24 |
$599.65 $661.09 $726.17 $957.39 |
$744.16 $805.60 $870.68 $1101.90 |
$888.67 $950.11 $1015.19 $1246.41 |
$372.08 $402.80 $435.34 $550.95 |
$516.59 $547.31 $579.85 $695.46 |
$661.10 $691.82 $724.36 $839.97 |
$144.51 |
Plan: (PPO) Anthem Bronze Pathway X PPO 5150Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS))
Deductible: Individual:
$5,150
: Family:
$10,300 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$227.25 $257.93 $290.43 $405.87 $616.76 |
$454.50 $515.86 $580.86 $811.74 $1233.52 |
$598.80 $660.16 $725.16 $956.04 |
$743.10 $804.46 $869.46 $1100.34 |
$887.40 $948.76 $1013.76 $1244.64 |
$371.55 $402.23 $434.73 $550.17 |
$515.85 $546.53 $579.03 $694.47 |
$660.15 $690.83 $723.33 $838.77 |
$144.30 |
Plan: (PPO) Anthem Bronze Pathway X PPO 6800Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS))
Deductible: Individual:
$6,800
: Family:
$13,600 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$229.62 $260.62 $293.45 $410.10 $623.19 |
$459.24 $521.24 $586.90 $820.20 $1246.38 |
$605.05 $667.05 $732.71 $966.01 |
$750.86 $812.86 $878.52 $1111.82 |
$896.67 $958.67 $1024.33 $1257.63 |
$375.43 $406.43 $439.26 $555.91 |
$521.24 $552.24 $585.07 $701.72 |
$667.05 $698.05 $730.88 $847.53 |
$145.81 |
Plan: (PPO) Anthem Silver Pathway X PPO 3000Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS))
Deductible: Individual:
$3,000
: Family:
$6,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$270.41 $306.92 $345.58 $482.95 $733.89 |
$540.82 $613.84 $691.16 $965.90 $1467.78 |
$712.53 $785.55 $862.87 $1137.61 |
$884.24 $957.26 $1034.58 $1309.32 |
$1055.95 $1128.97 $1206.29 $1481.03 |
$442.12 $478.63 $517.29 $654.66 |
$613.83 $650.34 $689.00 $826.37 |
$785.54 $822.05 $860.71 $998.08 |
$171.71 |
Plan: (PPO) Anthem Silver Pathway X PPO 10 for HSASummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS))
Deductible: Individual:
$2,700
: Family:
$5,400 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$273.39 $310.30 $349.39 $488.27 $741.98 |
$546.78 $620.60 $698.78 $976.54 $1483.96 |
$720.38 $794.20 $872.38 $1150.14 |
$893.98 $967.80 $1045.98 $1323.74 |
$1067.58 $1141.40 $1219.58 $1497.34 |
$446.99 $483.90 $522.99 $661.87 |
$620.59 $657.50 $696.59 $835.47 |
$794.19 $831.10 $870.19 $1009.07 |
$173.60 |
Plan: (PPO) Anthem Bronze Pathway X PPO 5850Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS))
Deductible: Individual:
$5,850
: Family:
$11,700 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$221.99 $251.96 $283.70 $396.47 $602.48 |
$443.98 $503.92 $567.40 $792.94 $1204.96 |
$584.94 $644.88 $708.36 $933.90 |
$725.90 $785.84 $849.32 $1074.86 |
$866.86 $926.80 $990.28 $1215.82 |
$362.95 $392.92 $424.66 $537.43 |
$503.91 $533.88 $565.62 $678.39 |
$644.87 $674.84 $706.58 $819.35 |
$140.96 |
Plan: (PPO) Anthem Silver Pathway X PPO 4050Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS))
Deductible: Individual:
$4,050
: Family:
$8,100 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$272.60 $309.40 $348.38 $486.86 $739.84 |
$545.20 $618.80 $696.76 $973.72 $1479.68 |
$718.30 $791.90 $869.86 $1146.82 |
$891.40 $965.00 $1042.96 $1319.92 |
$1064.50 $1138.10 $1216.06 $1493.02 |
$445.70 $482.50 $521.48 $659.96 |
$618.80 $655.60 $694.58 $833.06 |
$791.90 $828.70 $867.68 $1006.16 |
$173.10 |
Plan: (PPO) Anthem Silver Pathway X PPO 2000Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS))
Deductible: Individual:
$2,000
: Family:
$4,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$280.28 $318.12 $358.20 $500.58 $760.68 |
$560.56 $636.24 $716.40 $1001.16 $1521.36 |
$738.54 $814.22 $894.38 $1179.14 |
$916.52 $992.20 $1072.36 $1357.12 |
$1094.50 $1170.18 $1250.34 $1535.10 |
$458.26 $496.10 $536.18 $678.56 |
$636.24 $674.08 $714.16 $856.54 |
$814.22 $852.06 $892.14 $1034.52 |
$177.98 |
Plan: (PPO) Anthem Silver Pathway X PPO 2500Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS))
Deductible: Individual:
$2,500
: Family:
$5,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$278.60 $316.21 $356.05 $497.58 $756.12 |
$557.20 $632.42 $712.10 $995.16 $1512.24 |
$734.11 $809.33 $889.01 $1172.07 |
$911.02 $986.24 $1065.92 $1348.98 |
$1087.93 $1163.15 $1242.83 $1525.89 |
$455.51 $493.12 $532.96 $674.49 |
$632.42 $670.03 $709.87 $851.40 |
$809.33 $846.94 $886.78 $1028.31 |
$176.91 |
Plan: (PPO) Anthem Silver Pathway X PPO 3500Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS))
Deductible: Individual:
$3,500
: Family:
$7,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$271.81 $308.50 $347.37 $485.45 $737.69 |
$543.62 $617.00 $694.74 $970.90 $1475.38 |
$716.22 $789.60 $867.34 $1143.50 |
$888.82 $962.20 $1039.94 $1316.10 |
$1061.42 $1134.80 $1212.54 $1488.70 |
$444.41 $481.10 $519.97 $658.05 |
$617.01 $653.70 $692.57 $830.65 |
$789.61 $826.30 $865.17 $1003.25 |
$172.60 |
Plan: (HMO) Anthem Bronze Pathway X HMO 5000Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS))
Deductible: Individual:
$5,000
: Family:
$10,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$191.27 $217.09 $244.44 $341.61 $519.11 |
$382.54 $434.18 $488.88 $683.22 $1038.22 |
$504.00 $555.64 $610.34 $804.68 |
$625.46 $677.10 $731.80 $926.14 |
$746.92 $798.56 $853.26 $1047.60 |
$312.73 $338.55 $365.90 $463.07 |
$434.19 $460.01 $487.36 $584.53 |
$555.65 $581.47 $608.82 $705.99 |
$121.46 |
Plan: (HMO) Anthem Bronze Pathway X HMO 5200Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS))
Deductible: Individual:
$5,200
: Family:
$10,400 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$193.74 $219.89 $247.60 $346.02 $525.81 |
$387.48 $439.78 $495.20 $692.04 $1051.62 |
$510.50 $562.80 $618.22 $815.06 |
$633.52 $685.82 $741.24 $938.08 |
$756.54 $808.84 $864.26 $1061.10 |
$316.76 $342.91 $370.62 $469.04 |
$439.78 $465.93 $493.64 $592.06 |
$562.80 $588.95 $616.66 $715.08 |
$123.02 |
Plan: (HMO) Anthem Bronze Pathway X HMO 7150Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS))
Deductible: Individual:
$7,150
: Family:
$14,300 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$188.63 $214.10 $241.07 $336.89 $511.94 |
$377.26 $428.20 $482.14 $673.78 $1023.88 |
$497.04 $547.98 $601.92 $793.56 |
$616.82 $667.76 $721.70 $913.34 |
$736.60 $787.54 $841.48 $1033.12 |
$308.41 $333.88 $360.85 $456.67 |
$428.19 $453.66 $480.63 $576.45 |
$547.97 $573.44 $600.41 $696.23 |
$119.78 |
Plan: (HMO) Anthem Silver Pathway X HMO 4250Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS))
Deductible: Individual:
$4,250
: Family:
$8,500 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$226.70 $257.30 $289.72 $404.89 $615.26 |
$453.40 $514.60 $579.44 $809.78 $1230.52 |
$597.35 $658.55 $723.39 $953.73 |
$741.30 $802.50 $867.34 $1097.68 |
$885.25 $946.45 $1011.29 $1241.63 |
$370.65 $401.25 $433.67 $548.84 |
$514.60 $545.20 $577.62 $692.79 |
$658.55 $689.15 $721.57 $836.74 |
$143.95 |
Plan: (HMO) Anthem Silver Pathway X HMO 2850Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS))
Deductible: Individual:
$2,850
: Family:
$5,700 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$226.78 $257.40 $289.82 $405.03 $615.48 |
$453.56 $514.80 $579.64 $810.06 $1230.96 |
$597.57 $658.81 $723.65 $954.07 |
$741.58 $802.82 $867.66 $1098.08 |
$885.59 $946.83 $1011.67 $1242.09 |
$370.79 $401.41 $433.83 $549.04 |
$514.80 $545.42 $577.84 $693.05 |
$658.81 $689.43 $721.85 $837.06 |
$144.01 |
Plan: (HMO) Anthem Gold Pathway X HMO 1450Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS))
Deductible: Individual:
$1,450
: Family:
$4,350 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$289.83 $328.96 $370.40 $517.64 $786.60 |
$579.66 $657.92 $740.80 $1035.28 $1573.20 |
$763.70 $841.96 $924.84 $1219.32 |
$947.74 $1026.00 $1108.88 $1403.36 |
$1131.78 $1210.04 $1292.92 $1587.40 |
$473.87 $513.00 $554.44 $701.68 |
$657.91 $697.04 $738.48 $885.72 |
$841.95 $881.08 $922.52 $1069.76 |
$184.04 |
Plan: (HMO) Anthem Silver Core Pathway X HMO 5300Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS))
Deductible: Individual:
$5,300
: Family:
$10,600 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$212.37 $241.04 $271.41 $379.29 $576.37 |
$424.74 $482.08 $542.82 $758.58 $1152.74 |
$559.59 $616.93 $677.67 $893.43 |
$694.44 $751.78 $812.52 $1028.28 |
$829.29 $886.63 $947.37 $1163.13 |
$347.22 $375.89 $406.26 $514.14 |
$482.07 $510.74 $541.11 $648.99 |
$616.92 $645.59 $675.96 $783.84 |
$134.85 |
Plan: (HMO) Anthem Bronze Pathway X HMO 0 for HSASummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS))
Deductible: Individual:
$6,550
: Family:
$13,100 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$195.09 $221.43 $249.33 $348.43 $529.47 |
$390.18 $442.86 $498.66 $696.86 $1058.94 |
$514.06 $566.74 $622.54 $820.74 |
$637.94 $690.62 $746.42 $944.62 |
$761.82 $814.50 $870.30 $1068.50 |
$318.97 $345.31 $373.21 $472.31 |
$442.85 $469.19 $497.09 $596.19 |
$566.73 $593.07 $620.97 $720.07 |
$123.88 |
Plan: (HMO) Anthem Silver Pathway X HMO 10 for HSASummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS))
Deductible: Individual:
$3,200
: Family:
$6,400 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$229.47 $260.45 $293.26 $409.83 $622.78 |
$458.94 $520.90 $586.52 $819.66 $1245.56 |
$604.65 $666.61 $732.23 $965.37 |
$750.36 $812.32 $877.94 $1111.08 |
$896.07 $958.03 $1023.65 $1256.79 |
$375.18 $406.16 $438.97 $555.54 |
$520.89 $551.87 $584.68 $701.25 |
$666.60 $697.58 $730.39 $846.96 |
$145.71 |
ADVERTISEMENT
|
||||||||||
Summa Insurance Company, Inc.Local: 1-330-996-8675 | Toll Free: 1-888-996-8675 TTY: 1-800-750-0750 |
||||||||||
Plan: (PPO) SummaCare Value with SCConnect Network and 3 Free PCP VisitsSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-996-8675 - Provider Directory for This Plan: (Summa Insurance Company, Inc.)
Deductible: Individual:
$7,150
: Family:
$14,300 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Catastrophic | 21 30 40 50 60 |
$162.11 $183.99 $207.17 $289.52 $439.95 |
$324.22 $367.98 $414.34 $579.04 $879.90 |
$427.16 $470.92 $517.28 $681.98 |
$530.10 $573.86 $620.22 $784.92 |
$633.04 $676.80 $723.16 $887.86 |
$265.05 $286.93 $310.11 $392.46 |
$367.99 $389.87 $413.05 $495.40 |
$470.93 $492.81 $515.99 $598.34 |
$102.94 |
ADVERTISEMENT
|
||||||||||
Community Insurance Company(Anthem BCBS)Local: 1-855-748-1808 | Toll Free: 1-855-748-1808 |
||||||||||
Plan: (HMO) Anthem Silver Pathway X HMO 3500Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS))
Deductible: Individual:
$3,500
: Family:
$7,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$231.84 $263.14 $296.29 $414.07 $629.21 |
$463.68 $526.28 $592.58 $828.14 $1258.42 |
$610.90 $673.50 $739.80 $975.36 |
$758.12 $820.72 $887.02 $1122.58 |
$905.34 $967.94 $1034.24 $1269.80 |
$379.06 $410.36 $443.51 $561.29 |
$526.28 $557.58 $590.73 $708.51 |
$673.50 $704.80 $737.95 $855.73 |
$147.22 |
ADVERTISEMENT
|
||||||||||
Buckeye Community Health PlanLocal: 1-877-687-1189 | Toll Free: 1-877-687-1189 TTY: 1-877-941-9236 |
||||||||||
Plan: (HMO) Ambetter Secure Care 1 (2017) with 3 Free PCP VisitsSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1189 - Provider Directory for This Plan: (Buckeye Community Health Plan)
Deductible: Individual:
$1,000
: Family:
$2,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$227.84 $258.58 $291.16 $406.90 $618.32 |
$455.68 $517.16 $582.32 $813.80 $1236.64 |
$600.35 $661.83 $726.99 $958.47 |
$745.02 $806.50 $871.66 $1103.14 |
$889.69 $951.17 $1016.33 $1247.81 |
$372.51 $403.25 $435.83 $551.57 |
$517.18 $547.92 $580.50 $696.24 |
$661.85 $692.59 $725.17 $840.91 |
$144.67 |
Plan: (HMO) Ambetter Balanced Care 1 (2017)Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1189 - Provider Directory for This Plan: (Buckeye Community Health Plan)
Deductible: Individual:
$5,500
: Family:
$11,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$167.07 $189.62 $213.50 $298.37 $453.41 |
$334.14 $379.24 $427.00 $596.74 $906.82 |
$440.22 $485.32 $533.08 $702.82 |
$546.30 $591.40 $639.16 $808.90 |
$652.38 $697.48 $745.24 $914.98 |
$273.15 $295.70 $319.58 $404.45 |
$379.23 $401.78 $425.66 $510.53 |
$485.31 $507.86 $531.74 $616.61 |
$106.08 |
Plan: (HMO) Ambetter Balanced Care 2 (2017)Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1189 - Provider Directory for This Plan: (Buckeye Community Health Plan)
Deductible: Individual:
$6,500
: Family:
$13,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$163.80 $185.90 $209.32 $292.52 $444.52 |
$327.60 $371.80 $418.64 $585.04 $889.04 |
$431.60 $475.80 $522.64 $689.04 |
$535.60 $579.80 $626.64 $793.04 |
$639.60 $683.80 $730.64 $897.04 |
$267.80 $289.90 $313.32 $396.52 |
$371.80 $393.90 $417.32 $500.52 |
$475.80 $497.90 $521.32 $604.52 |
$104.00 |
Plan: (HMO) Ambetter Balanced Care 10 (2017)Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1189 - Provider Directory for This Plan: (Buckeye Community Health Plan)
Deductible: Individual:
$4,500
: Family:
$9,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$177.55 $201.51 $226.90 $317.09 $481.85 |
$355.10 $403.02 $453.80 $634.18 $963.70 |
$467.84 $515.76 $566.54 $746.92 |
$580.58 $628.50 $679.28 $859.66 |
$693.32 $741.24 $792.02 $972.40 |
$290.29 $314.25 $339.64 $429.83 |
$403.03 $426.99 $452.38 $542.57 |
$515.77 $539.73 $565.12 $655.31 |
$112.74 |
Plan: (HMO) Ambetter Balanced Care 12 (2017)Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1189 - Provider Directory for This Plan: (Buckeye Community Health Plan)
Deductible: Individual:
$3,500
: Family:
$7,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$180.01 $204.30 $230.04 $321.48 $488.52 |
$360.02 $408.60 $460.08 $642.96 $977.04 |
$474.32 $522.90 $574.38 $757.26 |
$588.62 $637.20 $688.68 $871.56 |
$702.92 $751.50 $802.98 $985.86 |
$294.31 $318.60 $344.34 $435.78 |
$408.61 $432.90 $458.64 $550.08 |
$522.91 $547.20 $572.94 $664.38 |
$114.30 |
Plan: (HMO) Ambetter Balanced Care 1 (2017) + VisionSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1189 - Provider Directory for This Plan: (Buckeye Community Health Plan)
Deductible: Individual:
$5,500
: Family:
$11,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$170.60 $193.62 $218.01 $304.67 $462.97 |
$341.20 $387.24 $436.02 $609.34 $925.94 |
$449.52 $495.56 $544.34 $717.66 |
$557.84 $603.88 $652.66 $825.98 |
$666.16 $712.20 $760.98 $934.30 |
$278.92 $301.94 $326.33 $412.99 |
$387.24 $410.26 $434.65 $521.31 |
$495.56 $518.58 $542.97 $629.63 |
$108.32 |
Plan: (HMO) Ambetter Balanced Care 2 (2017) + VisionSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1189 - Provider Directory for This Plan: (Buckeye Community Health Plan)
Deductible: Individual:
$6,500
: Family:
$13,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$167.25 $189.82 $213.73 $298.69 $453.89 |
$334.50 $379.64 $427.46 $597.38 $907.78 |
$440.70 $485.84 $533.66 $703.58 |
$546.90 $592.04 $639.86 $809.78 |
$653.10 $698.24 $746.06 $915.98 |
$273.45 $296.02 $319.93 $404.89 |
$379.65 $402.22 $426.13 $511.09 |
$485.85 $508.42 $532.33 $617.29 |
$106.20 |
Plan: (HMO) Ambetter Balanced Care 10 (2017) + VisionSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1189 - Provider Directory for This Plan: (Buckeye Community Health Plan)
Deductible: Individual:
$4,500
: Family:
$9,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$181.30 $205.76 $231.69 $323.78 $492.02 |
$362.60 $411.52 $463.38 $647.56 $984.04 |
$477.72 $526.64 $578.50 $762.68 |
$592.84 $641.76 $693.62 $877.80 |
$707.96 $756.88 $808.74 $992.92 |
$296.42 $320.88 $346.81 $438.90 |
$411.54 $436.00 $461.93 $554.02 |
$526.66 $551.12 $577.05 $669.14 |
$115.12 |
Plan: (HMO) Ambetter Balanced Care 1 (2017) + Vision + Adult DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1189 - Provider Directory for This Plan: (Buckeye Community Health Plan)
Deductible: Individual:
$5,500
: Family:
$11,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$177.55 $201.51 $226.90 $317.10 $481.86 |
$355.10 $403.02 $453.80 $634.20 $963.72 |
$467.84 $515.76 $566.54 $746.94 |
$580.58 $628.50 $679.28 $859.68 |
$693.32 $741.24 $792.02 $972.42 |
$290.29 $314.25 $339.64 $429.84 |
$403.03 $426.99 $452.38 $542.58 |
$515.77 $539.73 $565.12 $655.32 |
$112.74 |
Plan: (HMO) Ambetter Balanced Care 2 (2017) + Vision + Adult DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1189 - Provider Directory for This Plan: (Buckeye Community Health Plan)
Deductible: Individual:
$6,500
: Family:
$13,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$174.07 $197.56 $222.45 $310.88 $472.41 |
$348.14 $395.12 $444.90 $621.76 $944.82 |
$458.67 $505.65 $555.43 $732.29 |
$569.20 $616.18 $665.96 $842.82 |
$679.73 $726.71 $776.49 $953.35 |
$284.60 $308.09 $332.98 $421.41 |
$395.13 $418.62 $443.51 $531.94 |
$505.66 $529.15 $554.04 $642.47 |
$110.53 |
Plan: (HMO) Ambetter Balanced Care 10 (2017) + Vision + Adult DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1189 - Provider Directory for This Plan: (Buckeye Community Health Plan)
Deductible: Individual:
$4,500
: Family:
$9,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$188.69 $214.16 $241.14 $336.99 $512.09 |
$377.38 $428.32 $482.28 $673.98 $1024.18 |
$497.19 $548.13 $602.09 $793.79 |
$617.00 $667.94 $721.90 $913.60 |
$736.81 $787.75 $841.71 $1033.41 |
$308.50 $333.97 $360.95 $456.80 |
$428.31 $453.78 $480.76 $576.61 |
$548.12 $573.59 $600.57 $696.42 |
$119.81 |
ADVERTISEMENT
|
||||||||||
Summa Insurance Company, Inc.Local: 1-330-996-8675 | Toll Free: 1-888-996-8675 TTY: 1-800-750-0750 |
||||||||||
Plan: (PPO) SummaCare Silver 3000 with SCConnect Network and 3 Free PCP VisitsSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-996-8675 - Provider Directory for This Plan: (Summa Insurance Company, Inc.)
Deductible: Individual:
$3,000
: Family:
$6,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$232.67 $264.07 $297.34 $415.53 $631.44 |
$465.34 $528.14 $594.68 $831.06 $1262.88 |
$613.08 $675.88 $742.42 $978.80 |
$760.82 $823.62 $890.16 $1126.54 |
$908.56 $971.36 $1037.90 $1274.28 |
$380.41 $411.81 $445.08 $563.27 |
$528.15 $559.55 $592.82 $711.01 |
$675.89 $707.29 $740.56 $858.75 |
$147.74 |
Plan: (PPO) SummaCare Silver 5000 with SCConnect Network and 3 Free PCP VisitsSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-996-8675 - Provider Directory for This Plan: (Summa Insurance Company, Inc.)
Deductible: Individual:
$5,000
: Family:
$10,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$235.98 $267.82 $301.56 $421.43 $640.41 |
$471.96 $535.64 $603.12 $842.86 $1280.82 |
$621.80 $685.48 $752.96 $992.70 |
$771.64 $835.32 $902.80 $1142.54 |
$921.48 $985.16 $1052.64 $1292.38 |
$385.82 $417.66 $451.40 $571.27 |
$535.66 $567.50 $601.24 $721.11 |
$685.50 $717.34 $751.08 $870.95 |
$149.84 |
Plan: (PPO) SummaCare Gold 750 with SCConnect Network and 3 Free PCP VisitsSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-996-8675 - Provider Directory for This Plan: (Summa Insurance Company, Inc.)
Deductible: Individual:
$750
: Family:
$1,500 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$298.17 $338.42 $381.05 $532.52 $809.22 |
$596.34 $676.84 $762.10 $1065.04 $1618.44 |
$785.67 $866.17 $951.43 $1254.37 |
$975.00 $1055.50 $1140.76 $1443.70 |
$1164.33 $1244.83 $1330.09 $1633.03 |
$487.50 $527.75 $570.38 $721.85 |
$676.83 $717.08 $759.71 $911.18 |
$866.16 $906.41 $949.04 $1100.51 |
$189.33 |
Plan: (PPO) SummaCare Silver 3500 Standard with SCConnect NetworkSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-996-8675 - Provider Directory for This Plan: (Summa Insurance Company, Inc.)
Deductible: Individual:
$3,500
: Family:
$7,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$234.23 $265.83 $299.33 $418.31 $635.66 |
$468.46 $531.66 $598.66 $836.62 $1271.32 |
$617.19 $680.39 $747.39 $985.35 |
$765.92 $829.12 $896.12 $1134.08 |
$914.65 $977.85 $1044.85 $1282.81 |
$382.96 $414.56 $448.06 $567.04 |
$531.69 $563.29 $596.79 $715.77 |
$680.42 $712.02 $745.52 $864.50 |
$148.73 |
ADVERTISEMENT
|
||||||||||
Molina Healthcare of Ohio, Inc.Local: 1-888-296-7677 | Toll Free: 1-888-296-7677 |
||||||||||
Plan: (HMO) Molina Marketplace Gold PlanSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-296-7677 - Provider Directory for This Plan: (Molina Healthcare of Ohio, Inc.)
Deductible: Individual:
$1,025
: Family:
$2,050 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$264.70 $300.43 $338.29 $472.75 $718.40 |
$529.40 $600.86 $676.58 $945.50 $1436.80 |
$697.48 $768.94 $844.66 $1113.58 |
$865.56 $937.02 $1012.74 $1281.66 |
$1033.64 $1105.10 $1180.82 $1449.74 |
$432.78 $468.51 $506.37 $640.83 |
$600.86 $636.59 $674.45 $808.91 |
$768.94 $804.67 $842.53 $976.99 |
$168.08 |
Plan: (HMO) Molina Marketplace Silver PlanSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-296-7677 - Provider Directory for This Plan: (Molina Healthcare of Ohio, Inc.)
Deductible: Individual:
$2,400
: Family:
$4,800 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$207.96 $236.03 $265.77 $371.41 $564.40 |
$415.92 $472.06 $531.54 $742.82 $1128.80 |
$547.97 $604.11 $663.59 $874.87 |
$680.02 $736.16 $795.64 $1006.92 |
$812.07 $868.21 $927.69 $1138.97 |
$340.01 $368.08 $397.82 $503.46 |
$472.06 $500.13 $529.87 $635.51 |
$604.11 $632.18 $661.92 $767.56 |
$132.05 |
Plan: (HMO) Molina Marketplace Bronze PlanSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-296-7677 - Provider Directory for This Plan: (Molina Healthcare of Ohio, Inc.)
Deductible: Individual:
$6,650
: Family:
$13,300 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$178.92 $203.07 $228.66 $319.55 $485.58 |
$357.84 $406.14 $457.32 $639.10 $971.16 |
$471.45 $519.75 $570.93 $752.71 |
$585.06 $633.36 $684.54 $866.32 |
$698.67 $746.97 $798.15 $979.93 |
$292.53 $316.68 $342.27 $433.16 |
$406.14 $430.29 $455.88 $546.77 |
$519.75 $543.90 $569.49 $660.38 |
$113.61 |
Plan: (HMO) Molina Marketplace Options Silver PlanSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-296-7677 - Provider Directory for This Plan: (Molina Healthcare of Ohio, Inc.)
Deductible: Individual:
$3,500
: Family:
$7,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$209.87 $238.21 $268.22 $374.83 $569.59 |
$419.74 $476.42 $536.44 $749.66 $1139.18 |
$553.01 $609.69 $669.71 $882.93 |
$686.28 $742.96 $802.98 $1016.20 |
$819.55 $876.23 $936.25 $1149.47 |
$343.14 $371.48 $401.49 $508.10 |
$476.41 $504.75 $534.76 $641.37 |
$609.68 $638.02 $668.03 $774.64 |
$133.27 |
Plan: (HMO) Molina Marketplace Options Bronze PlanSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-296-7677 - Provider Directory for This Plan: (Molina Healthcare of Ohio, Inc.)
Deductible: Individual:
$6,650
: Family:
$13,300 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$184.08 $208.93 $235.25 $328.77 $499.59 |
$368.16 $417.86 $470.50 $657.54 $999.18 |
$485.05 $534.75 $587.39 $774.43 |
$601.94 $651.64 $704.28 $891.32 |
$718.83 $768.53 $821.17 $1008.21 |
$300.97 $325.82 $352.14 $445.66 |
$417.86 $442.71 $469.03 $562.55 |
$534.75 $559.60 $585.92 $679.44 |
$116.89 |
ADVERTISEMENT
|
||||||||||
CareSourceLocal: 1-800-479-9502 | Toll Free: 1-800-479-9502 TTY: 1-800-750-0750 |
||||||||||
Plan: (HMO) CareSource SilverSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-479-9502 - Provider Directory for This Plan: (CareSource)
Deductible: Individual:
$3,300
: Family:
$6,600 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$220.84 $250.66 $282.24 $394.42 $599.36 |
$441.68 $501.32 $564.48 $788.84 $1198.72 |
$581.91 $641.55 $704.71 $929.07 |
$722.14 $781.78 $844.94 $1069.30 |
$862.37 $922.01 $985.17 $1209.53 |
$361.07 $390.89 $422.47 $534.65 |
$501.30 $531.12 $562.70 $674.88 |
$641.53 $671.35 $702.93 $815.11 |
$140.23 |
Plan: (HMO) CareSource BronzeSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-479-9502 - Provider Directory for This Plan: (CareSource)
Deductible: Individual:
$6,650
: Family:
$13,300 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$190.85 $216.61 $243.90 $340.85 $517.96 |
$381.70 $433.22 $487.80 $681.70 $1035.92 |
$502.89 $554.41 $608.99 $802.89 |
$624.08 $675.60 $730.18 $924.08 |
$745.27 $796.79 $851.37 $1045.27 |
$312.04 $337.80 $365.09 $462.04 |
$433.23 $458.99 $486.28 $583.23 |
$554.42 $580.18 $607.47 $704.42 |
$121.19 |
Plan: (HMO) CareSource Gold Dental and VisionSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-479-9502 - Provider Directory for This Plan: (CareSource)
Deductible: Individual:
$1,000
: Family:
$2,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$282.48 $320.61 $361.01 $504.51 $766.65 |
$564.96 $641.22 $722.02 $1009.02 $1533.30 |
$744.33 $820.59 $901.39 $1188.39 |
$923.70 $999.96 $1080.76 $1367.76 |
$1103.07 $1179.33 $1260.13 $1547.13 |
$461.85 $499.98 $540.38 $683.88 |
$641.22 $679.35 $719.75 $863.25 |
$820.59 $858.72 $899.12 $1042.62 |
$179.37 |
Plan: (HMO) CareSource Silver Dental and VisionSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-479-9502 - Provider Directory for This Plan: (CareSource)
Deductible: Individual:
$3,300
: Family:
$6,600 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$236.74 $268.69 $302.55 $422.81 $642.50 |
$473.48 $537.38 $605.10 $845.62 $1285.00 |
$623.81 $687.71 $755.43 $995.95 |
$774.14 $838.04 $905.76 $1146.28 |
$924.47 $988.37 $1056.09 $1296.61 |
$387.07 $419.02 $452.88 $573.14 |
$537.40 $569.35 $603.21 $723.47 |
$687.73 $719.68 $753.54 $873.80 |
$150.33 |
Plan: (HMO) CareSource Bronze Dental and VisionSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-479-9502 - Provider Directory for This Plan: (CareSource)
Deductible: Individual:
$6,650
: Family:
$13,300 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$206.83 $234.75 $264.33 $369.39 $561.33 |
$413.66 $469.50 $528.66 $738.78 $1122.66 |
$545.00 $600.84 $660.00 $870.12 |
$676.34 $732.18 $791.34 $1001.46 |
$807.68 $863.52 $922.68 $1132.80 |
$338.17 $366.09 $395.67 $500.73 |
$469.51 $497.43 $527.01 $632.07 |
$600.85 $628.77 $658.35 $763.41 |
$131.34 |
Plan: (HMO) CareSource Federal Simple Choice GoldSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-479-9502 - Provider Directory for This Plan: (CareSource)
Deductible: Individual:
$1,250
: Family:
$2,500 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$244.06 $277.00 $311.90 $435.88 $662.36 |
$488.12 $554.00 $623.80 $871.76 $1324.72 |
$643.09 $708.97 $778.77 $1026.73 |
$798.06 $863.94 $933.74 $1181.70 |
$953.03 $1018.91 $1088.71 $1336.67 |
$399.03 $431.97 $466.87 $590.85 |
$554.00 $586.94 $621.84 $745.82 |
$708.97 $741.91 $776.81 $900.79 |
$154.97 |
Plan: (HMO) CareSource Federal Simple Choice SilverSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-479-9502 - Provider Directory for This Plan: (CareSource)
Deductible: Individual:
$3,500
: Family:
$7,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$201.35 $228.52 $257.31 $359.60 $546.44 |
$402.70 $457.04 $514.62 $719.20 $1092.88 |
$530.55 $584.89 $642.47 $847.05 |
$658.40 $712.74 $770.32 $974.90 |
$786.25 $840.59 $898.17 $1102.75 |
$329.20 $356.37 $385.16 $487.45 |
$457.05 $484.22 $513.01 $615.30 |
$584.90 $612.07 $640.86 $743.15 |
$127.85 |
Plan: (HMO) CareSource Federal Simple Choice BronzeSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-479-9502 - Provider Directory for This Plan: (CareSource)
Deductible: Individual:
$6,650
: Family:
$13,300 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$177.12 $201.03 $226.36 $316.34 $480.70 |
$354.24 $402.06 $452.72 $632.68 $961.40 |
$466.71 $514.53 $565.19 $745.15 |
$579.18 $627.00 $677.66 $857.62 |
$691.65 $739.47 $790.13 $970.09 |
$289.59 $313.50 $338.83 $428.81 |
$402.06 $425.97 $451.30 $541.28 |
$514.53 $538.44 $563.77 $653.75 |
$112.47 |
Plan: (HMO) CareSource Low Premium SilverSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-479-9502 - Provider Directory for This Plan: (CareSource)
Deductible: Individual:
$6,150
: Family:
$12,300 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$189.19 $214.73 $241.78 $337.89 $513.46 |
$378.38 $429.46 $483.56 $675.78 $1026.92 |
$498.51 $549.59 $603.69 $795.91 |
$618.64 $669.72 $723.82 $916.04 |
$738.77 $789.85 $843.95 $1036.17 |
$309.32 $334.86 $361.91 $458.02 |
$429.45 $454.99 $482.04 $578.15 |
$549.58 $575.12 $602.17 $698.28 |
$120.13 |