The health insurance rates listed below are for calendar year 2018.
2018 Rates and Providers
(click here for 2014)
(click here for 2015)
(click here for 2016)
(click here for 2017)
This page gives you an overview of the rates for individual and family health insurance plans available from HealthCare.gov, the marketplace for Reedsburg, WI.
Obamacare Providers, Plans and 2018 Rates for Sauk County
Sauk County is in “Rating Area 15” of Wisconsin.
Currently, there are 70 plans offered in Rating Area 15.
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 for:
- 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 Reedsburg, WI area accept this insurance coverage as within the plan's "network".
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Unity Health Plans Insurance CorporationLocal: 1-608-644-3430 | Toll Free: 1-800-362-3310 TTY: 1-608-643-1421 |
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Plan: (HMO) Prime Gold First $500 with DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$3,500
: Family:
$7,000 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 |
$491.98 $558.39 $628.75 $878.67 $1,335.23 |
$983.96 $1,116.78 $1,257.50 $1,757.34 $2,670.46 |
$1,360.32 $1,493.14 $1,633.86 $2,133.70 |
$1,736.68 $1,869.50 $2,010.22 $2,510.06 |
$2,113.04 $2,245.86 $2,386.58 $2,886.42 |
$868.34 $934.75 $1,005.11 $1,255.03 |
$1,244.70 $1,311.11 $1,381.47 $1,631.39 |
$1,621.06 $1,687.47 $1,757.83 $2,007.75 |
$376.36 |
Plan: (HMO) Prime Gold Healthy You - PCP Copay $30 with DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$2,900
: Family:
$5,800 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 |
$453.52 $514.74 $579.59 $809.98 $1,230.84 |
$907.04 $1,029.48 $1,159.18 $1,619.96 $2,461.68 |
$1,253.98 $1,376.42 $1,506.12 $1,966.90 |
$1,600.92 $1,723.36 $1,853.06 $2,313.84 |
$1,947.86 $2,070.30 $2,200.00 $2,660.78 |
$800.46 $861.68 $926.53 $1,156.92 |
$1,147.40 $1,208.62 $1,273.47 $1,503.86 |
$1,494.34 $1,555.56 $1,620.41 $1,850.80 |
$346.94 |
Plan: (HMO) Prime Silver 5000 Value - PCP Copay $35 with DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
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 |
$443.73 $503.62 $567.08 $792.49 $1,204.26 |
$887.46 $1,007.24 $1,134.16 $1,584.98 $2,408.52 |
$1,226.91 $1,346.69 $1,473.61 $1,924.43 |
$1,566.36 $1,686.14 $1,813.06 $2,263.88 |
$1,905.81 $2,025.59 $2,152.51 $2,603.33 |
$783.18 $843.07 $906.53 $1,131.94 |
$1,122.63 $1,182.52 $1,245.98 $1,471.39 |
$1,462.08 $1,521.97 $1,585.43 $1,810.84 |
$339.45 |
Plan: (HMO) Prime Silver 7100 Value - PCP Copay $75 with DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$7,100
: Family:
$14,200 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 |
$434.83 $493.53 $555.71 $776.60 $1,180.12 |
$869.66 $987.06 $1,111.42 $1,553.20 $2,360.24 |
$1,202.30 $1,319.70 $1,444.06 $1,885.84 |
$1,534.94 $1,652.34 $1,776.70 $2,218.48 |
$1,867.58 $1,984.98 $2,109.34 $2,551.12 |
$767.47 $826.17 $888.35 $1,109.24 |
$1,100.11 $1,158.81 $1,220.99 $1,441.88 |
$1,432.75 $1,491.45 $1,553.63 $1,774.52 |
$332.64 |
Plan: (HMO) Prime Bronze Deductible $6500 with DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$6,500
: Family:
$13,000 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 |
$340.16 $386.08 $434.72 $607.52 $923.18 |
$680.32 $772.16 $869.44 $1,215.04 $1,846.36 |
$940.54 $1,032.38 $1,129.66 $1,475.26 |
$1,200.76 $1,292.60 $1,389.88 $1,735.48 |
$1,460.98 $1,552.82 $1,650.10 $1,995.70 |
$600.38 $646.30 $694.94 $867.74 |
$860.60 $906.52 $955.16 $1,127.96 |
$1,120.82 $1,166.74 $1,215.38 $1,388.18 |
$260.22 |
Plan: (HMO) Prime Gold Maintenance - PCP Copay $20 with DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$1,700
: Family:
$3,400 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 |
$484.74 $550.17 $619.49 $865.73 $1,315.56 |
$969.48 $1,100.34 $1,238.98 $1,731.46 $2,631.12 |
$1,340.30 $1,471.16 $1,609.80 $2,102.28 |
$1,711.12 $1,841.98 $1,980.62 $2,473.10 |
$2,081.94 $2,212.80 $2,351.44 $2,843.92 |
$855.56 $920.99 $990.31 $1,236.55 |
$1,226.38 $1,291.81 $1,361.13 $1,607.37 |
$1,597.20 $1,662.63 $1,731.95 $1,978.19 |
$370.82 |
Plan: (HMO) Prime Gold Healthy You - PCP Copay $30Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$2,900
: Family:
$5,800 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 |
$435.30 $494.06 $556.31 $777.44 $1,181.39 |
$870.60 $988.12 $1,112.62 $1,554.88 $2,362.78 |
$1,203.60 $1,321.12 $1,445.62 $1,887.88 |
$1,536.60 $1,654.12 $1,778.62 $2,220.88 |
$1,869.60 $1,987.12 $2,111.62 $2,553.88 |
$768.30 $827.06 $889.31 $1,110.44 |
$1,101.30 $1,160.06 $1,222.31 $1,443.44 |
$1,434.30 $1,493.06 $1,555.31 $1,776.44 |
$333.00 |
Plan: (HMO) Prime Silver 5000 Value - PCP Copay $35Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
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 |
$425.90 $483.39 $544.29 $760.65 $1,155.88 |
$851.80 $966.78 $1,088.58 $1,521.30 $2,311.76 |
$1,177.61 $1,292.59 $1,414.39 $1,847.11 |
$1,503.42 $1,618.40 $1,740.20 $2,172.92 |
$1,829.23 $1,944.21 $2,066.01 $2,498.73 |
$751.71 $809.20 $870.10 $1,086.46 |
$1,077.52 $1,135.01 $1,195.91 $1,412.27 |
$1,403.33 $1,460.82 $1,521.72 $1,738.08 |
$325.81 |
Plan: (HMO) Prime Silver 7100 Value - PCP Copay $75Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$7,100
: Family:
$14,200 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 |
$417.36 $473.70 $533.38 $745.40 $1,132.71 |
$834.72 $947.40 $1,066.76 $1,490.80 $2,265.42 |
$1,154.00 $1,266.68 $1,386.04 $1,810.08 |
$1,473.28 $1,585.96 $1,705.32 $2,129.36 |
$1,792.56 $1,905.24 $2,024.60 $2,448.64 |
$736.64 $792.98 $852.66 $1,064.68 |
$1,055.92 $1,112.26 $1,171.94 $1,383.96 |
$1,375.20 $1,431.54 $1,491.22 $1,703.24 |
$319.28 |
Plan: (HMO) Prime Gold First $500Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$3,500
: Family:
$7,000 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 |
$472.22 $535.96 $603.49 $843.37 $1,281.58 |
$944.44 $1,071.92 $1,206.98 $1,686.74 $2,563.16 |
$1,305.68 $1,433.16 $1,568.22 $2,047.98 |
$1,666.92 $1,794.40 $1,929.46 $2,409.22 |
$2,028.16 $2,155.64 $2,290.70 $2,770.46 |
$833.46 $897.20 $964.73 $1,204.61 |
$1,194.70 $1,258.44 $1,325.97 $1,565.85 |
$1,555.94 $1,619.68 $1,687.21 $1,927.09 |
$361.24 |
Plan: (HMO) Prime Gold Standard - PCP Copay $20Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$1,400
: Family:
$2,800 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 |
$473.75 $537.71 $605.45 $846.12 $1,285.76 |
$947.50 $1,075.42 $1,210.90 $1,692.24 $2,571.52 |
$1,309.92 $1,437.84 $1,573.32 $2,054.66 |
$1,672.34 $1,800.26 $1,935.74 $2,417.08 |
$2,034.76 $2,162.68 $2,298.16 $2,779.50 |
$836.17 $900.13 $967.87 $1,208.54 |
$1,198.59 $1,262.55 $1,330.29 $1,570.96 |
$1,561.01 $1,624.97 $1,692.71 $1,933.38 |
$362.42 |
Plan: (HMO) Prime Silver Standard - PCP Copay $30Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$3,500
: Family:
$7,000 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 |
$424.56 $481.87 $542.59 $758.26 $1,152.25 |
$849.12 $963.74 $1,085.18 $1,516.52 $2,304.50 |
$1,173.91 $1,288.53 $1,409.97 $1,841.31 |
$1,498.70 $1,613.32 $1,734.76 $2,166.10 |
$1,823.49 $1,938.11 $2,059.55 $2,490.89 |
$749.35 $806.66 $867.38 $1,083.05 |
$1,074.14 $1,131.45 $1,192.17 $1,407.84 |
$1,398.93 $1,456.24 $1,516.96 $1,732.63 |
$324.79 |
Plan: (HMO) Prime Bronze Standard - PCP Copay $35Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$6,650
: Family:
$13,300 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 |
Expanded Bronze | 21 30 40 50 60 |
$333.72 $378.76 $426.48 $596.01 $905.69 |
$667.44 $757.52 $852.96 $1,192.02 $1,811.38 |
$922.73 $1,012.81 $1,108.25 $1,447.31 |
$1,178.02 $1,268.10 $1,363.54 $1,702.60 |
$1,433.31 $1,523.39 $1,618.83 $1,957.89 |
$589.01 $634.05 $681.77 $851.30 |
$844.30 $889.34 $937.06 $1,106.59 |
$1,099.59 $1,144.63 $1,192.35 $1,361.88 |
$255.29 |
Plan: (HMO) Prime Bronze Deductible $6500Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$6,500
: Family:
$13,000 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 |
$326.49 $370.56 $417.25 $583.11 $886.09 |
$652.98 $741.12 $834.50 $1,166.22 $1,772.18 |
$902.74 $990.88 $1,084.26 $1,415.98 |
$1,152.50 $1,240.64 $1,334.02 $1,665.74 |
$1,402.26 $1,490.40 $1,583.78 $1,915.50 |
$576.25 $620.32 $667.01 $832.87 |
$826.01 $870.08 $916.77 $1,082.63 |
$1,075.77 $1,119.84 $1,166.53 $1,332.39 |
$249.76 |
Plan: (HMO) Prime Gold Maintenance - PCP Copay $20Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$1,700
: Family:
$3,400 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 |
$465.26 $528.07 $594.60 $830.95 $1,262.71 |
$930.52 $1,056.14 $1,189.20 $1,661.90 $2,525.42 |
$1,286.44 $1,412.06 $1,545.12 $2,017.82 |
$1,642.36 $1,767.98 $1,901.04 $2,373.74 |
$1,998.28 $2,123.90 $2,256.96 $2,729.66 |
$821.18 $883.99 $950.52 $1,186.87 |
$1,177.10 $1,239.91 $1,306.44 $1,542.79 |
$1,533.02 $1,595.83 $1,662.36 $1,898.71 |
$355.92 |
Plan: (HMO) Prime Gold HSA $1800Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$1,800
: Family:
$3,600 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 |
$468.61 $531.86 $598.87 $836.92 $1,271.78 |
$937.22 $1,063.72 $1,197.74 $1,673.84 $2,543.56 |
$1,295.70 $1,422.20 $1,556.22 $2,032.32 |
$1,654.18 $1,780.68 $1,914.70 $2,390.80 |
$2,012.66 $2,139.16 $2,273.18 $2,749.28 |
$827.09 $890.34 $957.35 $1,195.40 |
$1,185.57 $1,248.82 $1,315.83 $1,553.88 |
$1,544.05 $1,607.30 $1,674.31 $1,912.36 |
$358.48 |
Plan: (HMO) Prime Silver HSA $3000Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
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 |
$432.58 $490.97 $552.83 $772.58 $1,174.01 |
$865.16 $981.94 $1,105.66 $1,545.16 $2,348.02 |
$1,196.08 $1,312.86 $1,436.58 $1,876.08 |
$1,527.00 $1,643.78 $1,767.50 $2,207.00 |
$1,857.92 $1,974.70 $2,098.42 $2,537.92 |
$763.50 $821.89 $883.75 $1,103.50 |
$1,094.42 $1,152.81 $1,214.67 $1,434.42 |
$1,425.34 $1,483.73 $1,545.59 $1,765.34 |
$330.92 |
Plan: (HMO) Prime Bronze HSA $6550Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
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 |
$333.25 $378.23 $425.88 $595.17 $904.42 |
$666.50 $756.46 $851.76 $1,190.34 $1,808.84 |
$921.43 $1,011.39 $1,106.69 $1,445.27 |
$1,176.36 $1,266.32 $1,361.62 $1,700.20 |
$1,431.29 $1,521.25 $1,616.55 $1,955.13 |
$588.18 $633.16 $680.81 $850.10 |
$843.11 $888.09 $935.74 $1,105.03 |
$1,098.04 $1,143.02 $1,190.67 $1,359.96 |
$254.93 |
Plan: (HMO) Prime CatastrophicSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$7,350
: Family:
$14,700 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 |
Catastrophic | 21 30 40 50 60 |
$238.35 $270.52 $304.61 $425.69 $646.87 |
$476.70 $541.04 $609.22 $851.38 $1,293.74 |
$659.03 $723.37 $791.55 $1,033.71 |
$841.36 $905.70 $973.88 $1,216.04 |
$1,023.69 $1,088.03 $1,156.21 $1,398.37 |
$420.68 $452.85 $486.94 $608.02 |
$603.01 $635.18 $669.27 $790.35 |
$785.34 $817.51 $851.60 $972.68 |
|
Plan: (HMO) Prime Bronze HSA $5000Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
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 |
$337.19 $382.71 $430.93 $602.22 $915.13 |
$674.38 $765.42 $861.86 $1,204.44 $1,830.26 |
$932.33 $1,023.37 $1,119.81 $1,462.39 |
$1,190.28 $1,281.32 $1,377.76 $1,720.34 |
$1,448.23 $1,539.27 $1,635.71 $1,978.29 |
$595.14 $640.66 $688.88 $860.17 |
$853.09 $898.61 $946.83 $1,118.12 |
$1,111.04 $1,156.56 $1,204.78 $1,376.07 |
$257.95 |
Plan: (HMO) Prime Bronze Standard HSA $6000Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
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 |
Expanded Bronze | 21 30 40 50 60 |
$340.67 $386.66 $435.37 $608.43 $924.57 |
$681.34 $773.32 $870.74 $1,216.86 $1,849.14 |
$941.95 $1,033.93 $1,131.35 $1,477.47 |
$1,202.56 $1,294.54 $1,391.96 $1,738.08 |
$1,463.17 $1,555.15 $1,652.57 $1,998.69 |
$601.28 $647.27 $695.98 $869.04 |
$861.89 $907.88 $956.59 $1,129.65 |
$1,122.50 $1,168.49 $1,217.20 $1,390.26 |
$260.61 |
ADVERTISEMENT
|
||||||||||
Group Health Cooperative of South Central WisconsinLocal: 1-608-828-4831 | Toll Free: 1-855-344-2729 |
||||||||||
Plan: (HMO) Select Platinum 500 Ded/1000 MOOPSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: ( Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$500
: Family:
$1,000 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 |
Platinum | 21 30 40 50 60 |
$425.66 $483.12 $543.99 $760.23 $1,155.24 |
$851.32 $966.24 $1,087.98 $1,520.46 $2,310.48 |
$1,176.95 $1,291.87 $1,413.61 $1,846.09 |
$1,502.58 $1,617.50 $1,739.24 $2,171.72 |
$1,828.21 $1,943.13 $2,064.87 $2,497.35 |
$751.29 $808.75 $869.62 $1,085.86 |
$1,076.92 $1,134.38 $1,195.25 $1,411.49 |
$1,402.55 $1,460.01 $1,520.88 $1,737.12 |
$325.63 |
ADVERTISEMENT
|
||||||||||
Unity Health Plans Insurance CorporationLocal: 1-608-644-3430 | Toll Free: 1-800-362-3310 TTY: 1-608-643-1421 |
||||||||||
Plan: (HMO) Prime Silver HSA $5050Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$5,050
: Family:
$10,100 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 |
$435.25 $494.01 $556.25 $777.35 $1,181.27 |
$870.50 $988.02 $1,112.50 $1,554.70 $2,362.54 |
$1,203.47 $1,320.99 $1,445.47 $1,887.67 |
$1,536.44 $1,653.96 $1,778.44 $2,220.64 |
$1,869.41 $1,986.93 $2,111.41 $2,553.61 |
$768.22 $826.98 $889.22 $1,110.32 |
$1,101.19 $1,159.95 $1,222.19 $1,443.29 |
$1,434.16 $1,492.92 $1,555.16 $1,776.26 |
$332.97 |
ADVERTISEMENT
|
||||||||||
Dean Health PlanLocal: 1-608-828-1302 | Toll Free: 1-800-279-1302 TTY: 1-608-827-4086 |
||||||||||
Plan: (HMO) Dean Catastrophic Safety NetSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$7,350
: Family:
$14,700 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 |
Catastrophic | 21 30 40 50 60 |
$183.02 $207.72 $233.90 $326.87 $496.71 |
$366.04 $415.44 $467.80 $653.74 $993.42 |
$506.05 $555.45 $607.81 $793.75 |
$646.06 $695.46 $747.82 $933.76 |
$786.07 $835.47 $887.83 $1,073.77 |
$323.03 $347.73 $373.91 $466.88 |
$463.04 $487.74 $513.92 $606.89 |
$603.05 $627.75 $653.93 $746.90 |
$140.01 |
Plan: (HMO) Dean Silver Copay Plus 3250XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$3,250
: Family:
$6,500 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 |
$359.70 $408.26 $459.69 $642.42 $976.22 |
$719.40 $816.52 $919.38 $1,284.84 $1,952.44 |
$994.57 $1,091.69 $1,194.55 $1,560.01 |
$1,269.74 $1,366.86 $1,469.72 $1,835.18 |
$1,544.91 $1,642.03 $1,744.89 $2,110.35 |
$634.87 $683.43 $734.86 $917.59 |
$910.04 $958.60 $1,010.03 $1,192.76 |
$1,185.21 $1,233.77 $1,285.20 $1,467.93 |
$275.17 |
Plan: (HMO) Dean Silver Classic 4750XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$4,750
: Family:
$9,500 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 |
$360.59 $409.27 $460.83 $644.01 $978.64 |
$721.18 $818.54 $921.66 $1,288.02 $1,957.28 |
$997.03 $1,094.39 $1,197.51 $1,563.87 |
$1,272.88 $1,370.24 $1,473.36 $1,839.72 |
$1,548.73 $1,646.09 $1,749.21 $2,115.57 |
$636.44 $685.12 $736.68 $919.86 |
$912.29 $960.97 $1,012.53 $1,195.71 |
$1,188.14 $1,236.82 $1,288.38 $1,471.56 |
$275.85 |
Plan: (HMO) Dean Silver Value Copay 5000XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean Health Plan)
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 |
$376.40 $427.22 $481.04 $672.25 $1,021.55 |
$752.80 $854.44 $962.08 $1,344.50 $2,043.10 |
$1,040.75 $1,142.39 $1,250.03 $1,632.45 |
$1,328.70 $1,430.34 $1,537.98 $1,920.40 |
$1,616.65 $1,718.29 $1,825.93 $2,208.35 |
$664.35 $715.17 $768.99 $960.20 |
$952.30 $1,003.12 $1,056.94 $1,248.15 |
$1,240.25 $1,291.07 $1,344.89 $1,536.10 |
$287.95 |
Plan: (HMO) Dean Gold Value Copay 3500XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean 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 |
Gold | 21 30 40 50 60 |
$317.89 $360.80 $406.26 $567.75 $862.75 |
$635.78 $721.60 $812.52 $1,135.50 $1,725.50 |
$878.96 $964.78 $1,055.70 $1,378.68 |
$1,122.14 $1,207.96 $1,298.88 $1,621.86 |
$1,365.32 $1,451.14 $1,542.06 $1,865.04 |
$561.07 $603.98 $649.44 $810.93 |
$804.25 $847.16 $892.62 $1,054.11 |
$1,047.43 $1,090.34 $1,135.80 $1,297.29 |
$243.18 |
Plan: (HMO) Dean Bronze Value Copay 7350XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$7,350
: Family:
$14,700 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 |
$265.65 $301.51 $339.50 $474.45 $720.97 |
$531.30 $603.02 $679.00 $948.90 $1,441.94 |
$734.52 $806.24 $882.22 $1,152.12 |
$937.74 $1,009.46 $1,085.44 $1,355.34 |
$1,140.96 $1,212.68 $1,288.66 $1,558.56 |
$468.87 $504.73 $542.72 $677.67 |
$672.09 $707.95 $745.94 $880.89 |
$875.31 $911.17 $949.16 $1,084.11 |
$203.22 |
Plan: (HMO) Dean Silver HSA-E 3500XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean 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 |
$379.72 $430.99 $485.29 $678.19 $1,030.57 |
$759.44 $861.98 $970.58 $1,356.38 $2,061.14 |
$1,049.93 $1,152.47 $1,261.07 $1,646.87 |
$1,340.42 $1,442.96 $1,551.56 $1,937.36 |
$1,630.91 $1,733.45 $1,842.05 $2,227.85 |
$670.21 $721.48 $775.78 $968.68 |
$960.70 $1,011.97 $1,066.27 $1,259.17 |
$1,251.19 $1,302.46 $1,356.76 $1,549.66 |
$290.49 |
Plan: (HMO) Dean Gold Copay Plus 1500XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$1,500
: Family:
$3,000 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 |
$326.32 $370.37 $417.03 $582.80 $885.62 |
$652.64 $740.74 $834.06 $1,165.60 $1,771.24 |
$902.27 $990.37 $1,083.69 $1,415.23 |
$1,151.90 $1,240.00 $1,333.32 $1,664.86 |
$1,401.53 $1,489.63 $1,582.95 $1,914.49 |
$575.95 $620.00 $666.66 $832.43 |
$825.58 $869.63 $916.29 $1,082.06 |
$1,075.21 $1,119.26 $1,165.92 $1,331.69 |
$249.63 |
Plan: (HMO) Dean Bronze HSA-E 6550XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean Health Plan)
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 |
$254.02 $288.31 $324.64 $453.68 $689.41 |
$508.04 $576.62 $649.28 $907.36 $1,378.82 |
$702.37 $770.95 $843.61 $1,101.69 |
$896.70 $965.28 $1,037.94 $1,296.02 |
$1,091.03 $1,159.61 $1,232.27 $1,490.35 |
$448.35 $482.64 $518.97 $648.01 |
$642.68 $676.97 $713.30 $842.34 |
$837.01 $871.30 $907.63 $1,036.67 |
$194.33 |
Plan: (EPO) Dean Focus Network Silver Value Copay 5000XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean Health Plan)
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 |
$346.16 $392.89 $442.39 $618.24 $939.48 |
$692.32 $785.78 $884.78 $1,236.48 $1,878.96 |
$957.13 $1,050.59 $1,149.59 $1,501.29 |
$1,221.94 $1,315.40 $1,414.40 $1,766.10 |
$1,486.75 $1,580.21 $1,679.21 $2,030.91 |
$610.97 $657.70 $707.20 $883.05 |
$875.78 $922.51 $972.01 $1,147.86 |
$1,140.59 $1,187.32 $1,236.82 $1,412.67 |
$264.81 |
Plan: (EPO) Dean Focus Network Bronze Value Copay 7350XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$7,350
: Family:
$14,700 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 |
$242.67 $275.43 $310.13 $433.41 $658.60 |
$485.34 $550.86 $620.26 $866.82 $1,317.20 |
$670.98 $736.50 $805.90 $1,052.46 |
$856.62 $922.14 $991.54 $1,238.10 |
$1,042.26 $1,107.78 $1,177.18 $1,423.74 |
$428.31 $461.07 $495.77 $619.05 |
$613.95 $646.71 $681.41 $804.69 |
$799.59 $832.35 $867.05 $990.33 |
$185.64 |
Plan: (EPO) Dean Focus Network Silver HSA-E 3500XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean 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 |
$327.82 $372.08 $418.96 $585.49 $889.72 |
$655.64 $744.16 $837.92 $1,170.98 $1,779.44 |
$906.43 $994.95 $1,088.71 $1,421.77 |
$1,157.22 $1,245.74 $1,339.50 $1,672.56 |
$1,408.01 $1,496.53 $1,590.29 $1,923.35 |
$578.61 $622.87 $669.75 $836.28 |
$829.40 $873.66 $920.54 $1,087.07 |
$1,080.19 $1,124.45 $1,171.33 $1,337.86 |
$250.79 |
Plan: (EPO) Dean Focus Network Bronze HSA-E 6550XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean Health Plan)
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 |
$232.15 $263.49 $296.68 $414.62 $630.05 |
$464.30 $526.98 $593.36 $829.24 $1,260.10 |
$641.89 $704.57 $770.95 $1,006.83 |
$819.48 $882.16 $948.54 $1,184.42 |
$997.07 $1,059.75 $1,126.13 $1,362.01 |
$409.74 $441.08 $474.27 $592.21 |
$587.33 $618.67 $651.86 $769.80 |
$764.92 $796.26 $829.45 $947.39 |
$177.59 |
Plan: (EPO) Dean Focus Network Gold Value Copay 3500XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean 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 |
Gold | 21 30 40 50 60 |
$289.92 $329.06 $370.52 $517.80 $786.85 |
$579.84 $658.12 $741.04 $1,035.60 $1,573.70 |
$801.63 $879.91 $962.83 $1,257.39 |
$1,023.42 $1,101.70 $1,184.62 $1,479.18 |
$1,245.21 $1,323.49 $1,406.41 $1,700.97 |
$511.71 $550.85 $592.31 $739.59 |
$733.50 $772.64 $814.10 $961.38 |
$955.29 $994.43 $1,035.89 $1,183.17 |
$221.79 |
ADVERTISEMENT
|
||||||||||
Group Health Cooperative of South Central WisconsinLocal: 1-608-828-4831 | Toll Free: 1-855-344-2729 |
||||||||||
Plan: (HMO) Platinum 500 Ded/1000 MOOPSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: ( Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$500
: Family:
$1,000 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 |
Platinum | 21 30 40 50 60 |
$468.19 $531.40 $598.35 $836.19 $1,270.66 |
$936.38 $1,062.80 $1,196.70 $1,672.38 $2,541.32 |
$1,294.55 $1,420.97 $1,554.87 $2,030.55 |
$1,652.72 $1,779.14 $1,913.04 $2,388.72 |
$2,010.89 $2,137.31 $2,271.21 $2,746.89 |
$826.36 $889.57 $956.52 $1,194.36 |
$1,184.53 $1,247.74 $1,314.69 $1,552.53 |
$1,542.70 $1,605.91 $1,672.86 $1,910.70 |
$358.17 |
Plan: (HMO) Gold 1000 Ded/4000 MOOPSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: ( Group Health Cooperative of South Central Wisconsin)
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 |
$402.82 $457.20 $514.80 $719.43 $1,093.23 |
$805.64 $914.40 $1,029.60 $1,438.86 $2,186.46 |
$1,113.80 $1,222.56 $1,337.76 $1,747.02 |
$1,421.96 $1,530.72 $1,645.92 $2,055.18 |
$1,730.12 $1,838.88 $1,954.08 $2,363.34 |
$710.98 $765.36 $822.96 $1,027.59 |
$1,019.14 $1,073.52 $1,131.12 $1,335.75 |
$1,327.30 $1,381.68 $1,439.28 $1,643.91 |
$308.16 |
Plan: (HMO) Gold 2000 Ded/2000 MOOP HSASummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: ( Group Health Cooperative of South Central Wisconsin)
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 |
Gold | 21 30 40 50 60 |
$398.39 $452.17 $509.14 $711.51 $1,081.21 |
$796.78 $904.34 $1,018.28 $1,423.02 $2,162.42 |
$1,101.55 $1,209.11 $1,323.05 $1,727.79 |
$1,406.32 $1,513.88 $1,627.82 $2,032.56 |
$1,711.09 $1,818.65 $1,932.59 $2,337.33 |
$703.16 $756.94 $813.91 $1,016.28 |
$1,007.93 $1,061.71 $1,118.68 $1,321.05 |
$1,312.70 $1,366.48 $1,423.45 $1,625.82 |
$304.77 |
Plan: (HMO) Silver 2000 Ded/6000 MOOPSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: ( Group Health Cooperative of South Central Wisconsin)
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 |
$439.22 $498.52 $561.32 $784.45 $1,192.04 |
$878.44 $997.04 $1,122.64 $1,568.90 $2,384.08 |
$1,214.45 $1,333.05 $1,458.65 $1,904.91 |
$1,550.46 $1,669.06 $1,794.66 $2,240.92 |
$1,886.47 $2,005.07 $2,130.67 $2,576.93 |
$775.23 $834.53 $897.33 $1,120.46 |
$1,111.24 $1,170.54 $1,233.34 $1,456.47 |
$1,447.25 $1,506.55 $1,569.35 $1,792.48 |
$336.01 |
Plan: (HMO) Bronze 4000 Ded/7350 MOOPSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: ( Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$4,000
: Family:
$8,000 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 |
Expanded Bronze | 21 30 40 50 60 |
$315.29 $357.85 $402.94 $563.10 $855.68 |
$630.58 $715.70 $805.88 $1,126.20 $1,711.36 |
$871.78 $956.90 $1,047.08 $1,367.40 |
$1,112.98 $1,198.10 $1,288.28 $1,608.60 |
$1,354.18 $1,439.30 $1,529.48 $1,849.80 |
$556.49 $599.05 $644.14 $804.30 |
$797.69 $840.25 $885.34 $1,045.50 |
$1,038.89 $1,081.45 $1,126.54 $1,286.70 |
$241.20 |
Plan: (HMO) Select Gold 1000 Ded/4000 MOOPSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: ( Group Health Cooperative of South Central Wisconsin)
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 |
$366.22 $415.66 $468.03 $654.06 $993.91 |
$732.44 $831.32 $936.06 $1,308.12 $1,987.82 |
$1,012.60 $1,111.48 $1,216.22 $1,588.28 |
$1,292.76 $1,391.64 $1,496.38 $1,868.44 |
$1,572.92 $1,671.80 $1,776.54 $2,148.60 |
$646.38 $695.82 $748.19 $934.22 |
$926.54 $975.98 $1,028.35 $1,214.38 |
$1,206.70 $1,256.14 $1,308.51 $1,494.54 |
$280.16 |
Plan: (HMO) Select Gold 2000 Ded/2000 MOOP HSASummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: ( Group Health Cooperative of South Central Wisconsin)
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 |
Gold | 21 30 40 50 60 |
$362.21 $411.11 $462.90 $646.91 $983.03 |
$724.42 $822.22 $925.80 $1,293.82 $1,966.06 |
$1,001.51 $1,099.31 $1,202.89 $1,570.91 |
$1,278.60 $1,376.40 $1,479.98 $1,848.00 |
$1,555.69 $1,653.49 $1,757.07 $2,125.09 |
$639.30 $688.20 $739.99 $924.00 |
$916.39 $965.29 $1,017.08 $1,201.09 |
$1,193.48 $1,242.38 $1,294.17 $1,478.18 |
$277.09 |
Plan: (HMO) Select Silver 2000 Ded/6000 MOOPSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: ( Group Health Cooperative of South Central Wisconsin)
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 |
$399.31 $453.22 $510.32 $713.16 $1,083.72 |
$798.62 $906.44 $1,020.64 $1,426.32 $2,167.44 |
$1,104.09 $1,211.91 $1,326.11 $1,731.79 |
$1,409.56 $1,517.38 $1,631.58 $2,037.26 |
$1,715.03 $1,822.85 $1,937.05 $2,342.73 |
$704.78 $758.69 $815.79 $1,018.63 |
$1,010.25 $1,064.16 $1,121.26 $1,324.10 |
$1,315.72 $1,369.63 $1,426.73 $1,629.57 |
$305.47 |
Plan: (HMO) Select Bronze 4000 Ded/7350 MOOPSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: ( Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$4,000
: Family:
$8,000 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 |
Expanded Bronze | 21 30 40 50 60 |
$286.67 $325.36 $366.36 $511.98 $778.00 |
$573.34 $650.72 $732.72 $1,023.96 $1,556.00 |
$792.64 $870.02 $952.02 $1,243.26 |
$1,011.94 $1,089.32 $1,171.32 $1,462.56 |
$1,231.24 $1,308.62 $1,390.62 $1,681.86 |
$505.97 $544.66 $585.66 $731.28 |
$725.27 $763.96 $804.96 $950.58 |
$944.57 $983.26 $1,024.26 $1,169.88 |
$219.30 |
Plan: (HMO) Bronze 6550 Ded/6550 MOOP HSASummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: ( Group Health Cooperative of South Central Wisconsin)
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 |
$301.27 $341.94 $385.02 $538.06 $817.63 |
$602.54 $683.88 $770.04 $1,076.12 $1,635.26 |
$833.01 $914.35 $1,000.51 $1,306.59 |
$1,063.48 $1,144.82 $1,230.98 $1,537.06 |
$1,293.95 $1,375.29 $1,461.45 $1,767.53 |
$531.74 $572.41 $615.49 $768.53 |
$762.21 $802.88 $845.96 $999.00 |
$992.68 $1,033.35 $1,076.43 $1,229.47 |
$230.47 |
Plan: (HMO) Select Bronze 6550 Ded/6550 MOOP HSASummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: ( Group Health Cooperative of South Central Wisconsin)
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 |
$273.91 $310.89 $350.06 $489.21 $743.39 |
$547.82 $621.78 $700.12 $978.42 $1,486.78 |
$757.36 $831.32 $909.66 $1,187.96 |
$966.90 $1,040.86 $1,119.20 $1,397.50 |
$1,176.44 $1,250.40 $1,328.74 $1,607.04 |
$483.45 $520.43 $559.60 $698.75 |
$692.99 $729.97 $769.14 $908.29 |
$902.53 $939.51 $978.68 $1,117.83 |
$209.54 |
Plan: (HMO) Gold 2500 Ded/6500 MOOPSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: ( Group Health Cooperative of South Central Wisconsin)
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 |
Gold | 21 30 40 50 60 |
$368.88 $418.67 $471.42 $658.81 $1,001.12 |
$737.76 $837.34 $942.84 $1,317.62 $2,002.24 |
$1,019.95 $1,119.53 $1,225.03 $1,599.81 |
$1,302.14 $1,401.72 $1,507.22 $1,882.00 |
$1,584.33 $1,683.91 $1,789.41 $2,164.19 |
$651.07 $700.86 $753.61 $941.00 |
$933.26 $983.05 $1,035.80 $1,223.19 |
$1,215.45 $1,265.24 $1,317.99 $1,505.38 |
$282.19 |
Plan: (HMO) Select Gold 2500 Ded/6500 MOOPSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: ( Group Health Cooperative of South Central Wisconsin)
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 |
Gold | 21 30 40 50 60 |
$335.36 $380.63 $428.59 $598.95 $910.16 |
$670.72 $761.26 $857.18 $1,197.90 $1,820.32 |
$927.27 $1,017.81 $1,113.73 $1,454.45 |
$1,183.82 $1,274.36 $1,370.28 $1,711.00 |
$1,440.37 $1,530.91 $1,626.83 $1,967.55 |
$591.91 $637.18 $685.14 $855.50 |
$848.46 $893.73 $941.69 $1,112.05 |
$1,105.01 $1,150.28 $1,198.24 $1,368.60 |
$256.55 |
Plan: (HMO) Platinum No Ded/3000X MOOPSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: ( Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$0
: Family:
$0 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 |
Platinum | 21 30 40 50 60 |
$465.26 $528.07 $594.61 $830.96 $1,262.72 |
$930.52 $1,056.14 $1,189.22 $1,661.92 $2,525.44 |
$1,286.45 $1,412.07 $1,545.15 $2,017.85 |
$1,642.38 $1,768.00 $1,901.08 $2,373.78 |
$1,998.31 $2,123.93 $2,257.01 $2,729.71 |
$821.19 $884.00 $950.54 $1,186.89 |
$1,177.12 $1,239.93 $1,306.47 $1,542.82 |
$1,533.05 $1,595.86 $1,662.40 $1,898.75 |
$355.93 |
Plan: (HMO) Platinum 500 Ded/3000X MOOPSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: ( Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$500
: Family:
$1,000 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 |
Platinum | 21 30 40 50 60 |
$454.63 $516.01 $581.02 $811.97 $1,233.86 |
$909.26 $1,032.02 $1,162.04 $1,623.94 $2,467.72 |
$1,257.05 $1,379.81 $1,509.83 $1,971.73 |
$1,604.84 $1,727.60 $1,857.62 $2,319.52 |
$1,952.63 $2,075.39 $2,205.41 $2,667.31 |
$802.42 $863.80 $928.81 $1,159.76 |
$1,150.21 $1,211.59 $1,276.60 $1,507.55 |
$1,498.00 $1,559.38 $1,624.39 $1,855.34 |
$347.79 |
Plan: (HMO) Gold 1500 Ded/5200X MOOPSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: ( Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$1,500
: Family:
$3,000 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 |
$418.11 $474.55 $534.34 $746.74 $1,134.74 |
$836.22 $949.10 $1,068.68 $1,493.48 $2,269.48 |
$1,156.08 $1,268.96 $1,388.54 $1,813.34 |
$1,475.94 $1,588.82 $1,708.40 $2,133.20 |
$1,795.80 $1,908.68 $2,028.26 $2,453.06 |
$737.97 $794.41 $854.20 $1,066.60 |
$1,057.83 $1,114.27 $1,174.06 $1,386.46 |
$1,377.69 $1,434.13 $1,493.92 $1,706.32 |
$319.86 |
Plan: (HMO) Gold 2500 Ded/7000X MOOPSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: ( Group Health Cooperative of South Central Wisconsin)
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 |
Gold | 21 30 40 50 60 |
$402.35 $456.67 $514.21 $718.60 $1,091.98 |
$804.70 $913.34 $1,028.42 $1,437.20 $2,183.96 |
$1,112.50 $1,221.14 $1,336.22 $1,745.00 |
$1,420.30 $1,528.94 $1,644.02 $2,052.80 |
$1,728.10 $1,836.74 $1,951.82 $2,360.60 |
$710.15 $764.47 $822.01 $1,026.40 |
$1,017.95 $1,072.27 $1,129.81 $1,334.20 |
$1,325.75 $1,380.07 $1,437.61 $1,642.00 |
$307.80 |
Plan: (HMO) Silver 4000 Ded/7350X MOOPSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: ( Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$4,000
: Family:
$8,000 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 |
$441.53 $501.14 $564.28 $788.57 $1,198.31 |
$883.06 $1,002.28 $1,128.56 $1,577.14 $2,396.62 |
$1,220.83 $1,340.05 $1,466.33 $1,914.91 |
$1,558.60 $1,677.82 $1,804.10 $2,252.68 |
$1,896.37 $2,015.59 $2,141.87 $2,590.45 |
$779.30 $838.91 $902.05 $1,126.34 |
$1,117.07 $1,176.68 $1,239.82 $1,464.11 |
$1,454.84 $1,514.45 $1,577.59 $1,801.88 |
$337.77 |
Plan: (HMO) Select Platinum No Ded/3000X MOOPSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: ( Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$0
: Family:
$0 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 |
Platinum | 21 30 40 50 60 |
$423.00 $480.11 $540.60 $755.48 $1,148.02 |
$846.00 $960.22 $1,081.20 $1,510.96 $2,296.04 |
$1,169.60 $1,283.82 $1,404.80 $1,834.56 |
$1,493.20 $1,607.42 $1,728.40 $2,158.16 |
$1,816.80 $1,931.02 $2,052.00 $2,481.76 |
$746.60 $803.71 $864.20 $1,079.08 |
$1,070.20 $1,127.31 $1,187.80 $1,402.68 |
$1,393.80 $1,450.91 $1,511.40 $1,726.28 |
$323.60 |
Plan: (HMO) Select Platinum 500 Ded/3000X MOOPSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: ( Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$500
: Family:
$1,000 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 |
Platinum | 21 30 40 50 60 |
$413.33 $469.13 $528.24 $738.21 $1,121.78 |
$826.66 $938.26 $1,056.48 $1,476.42 $2,243.56 |
$1,142.86 $1,254.46 $1,372.68 $1,792.62 |
$1,459.06 $1,570.66 $1,688.88 $2,108.82 |
$1,775.26 $1,886.86 $2,005.08 $2,425.02 |
$729.53 $785.33 $844.44 $1,054.41 |
$1,045.73 $1,101.53 $1,160.64 $1,370.61 |
$1,361.93 $1,417.73 $1,476.84 $1,686.81 |
$316.20 |
Plan: (HMO) Select Gold 1500 Ded/5200X MOOPSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: ( Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$1,500
: Family:
$3,000 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 |
$380.13 $431.44 $485.80 $678.90 $1,031.65 |
$760.26 $862.88 $971.60 $1,357.80 $2,063.30 |
$1,051.06 $1,153.68 $1,262.40 $1,648.60 |
$1,341.86 $1,444.48 $1,553.20 $1,939.40 |
$1,632.66 $1,735.28 $1,844.00 $2,230.20 |
$670.93 $722.24 $776.60 $969.70 |
$961.73 $1,013.04 $1,067.40 $1,260.50 |
$1,252.53 $1,303.84 $1,358.20 $1,551.30 |
$290.80 |
Plan: (HMO) Select Gold 2500 Ded/7000X MOOPSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: ( Group Health Cooperative of South Central Wisconsin)
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 |
Gold | 21 30 40 50 60 |
$365.83 $415.22 $467.53 $653.37 $992.86 |
$731.66 $830.44 $935.06 $1,306.74 $1,985.72 |
$1,011.52 $1,110.30 $1,214.92 $1,586.60 |
$1,291.38 $1,390.16 $1,494.78 $1,866.46 |
$1,571.24 $1,670.02 $1,774.64 $2,146.32 |
$645.69 $695.08 $747.39 $933.23 |
$925.55 $974.94 $1,027.25 $1,213.09 |
$1,205.41 $1,254.80 $1,307.11 $1,492.95 |
$279.86 |
Plan: (HMO) Select Silver 4000 Ded/7350X MOOPSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: ( Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$4,000
: Family:
$8,000 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 |
$401.43 $455.62 $513.03 $716.95 $1,089.47 |
$802.86 $911.24 $1,026.06 $1,433.90 $2,178.94 |
$1,109.95 $1,218.33 $1,333.15 $1,740.99 |
$1,417.04 $1,525.42 $1,640.24 $2,048.08 |
$1,724.13 $1,832.51 $1,947.33 $2,355.17 |
$708.52 $762.71 $820.12 $1,024.04 |
$1,015.61 $1,069.80 $1,127.21 $1,331.13 |
$1,322.70 $1,376.89 $1,434.30 $1,638.22 |
$307.09 |
Plan: (HMO) Select Gold Simple Choice PlanSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: ( Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$1,400
: Family:
$2,800 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 |
Gold | 21 30 40 50 60 |
$346.11 $392.83 $442.32 $618.15 $939.33 |
$692.22 $785.66 $884.64 $1,236.30 $1,878.66 |
$956.99 $1,050.43 $1,149.41 $1,501.07 |
$1,221.76 $1,315.20 $1,414.18 $1,765.84 |
$1,486.53 $1,579.97 $1,678.95 $2,030.61 |
$610.88 $657.60 $707.09 $882.92 |
$875.65 $922.37 $971.86 $1,147.69 |
$1,140.42 $1,187.14 $1,236.63 $1,412.46 |
$264.77 |
Plan: (HMO) Select Silver Simple Choice PlanSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: ( Group Health Cooperative of South Central Wisconsin)
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 |
$367.76 $417.41 $469.99 $656.81 $998.09 |
$735.52 $834.82 $939.98 $1,313.62 $1,996.18 |
$1,016.86 $1,116.16 $1,221.32 $1,594.96 |
$1,298.20 $1,397.50 $1,502.66 $1,876.30 |
$1,579.54 $1,678.84 $1,784.00 $2,157.64 |
$649.10 $698.75 $751.33 $938.15 |
$930.44 $980.09 $1,032.67 $1,219.49 |
$1,211.78 $1,261.43 $1,314.01 $1,500.83 |
$281.34 |
Plan: (HMO) Select Bronze Simple Choice PlanSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: ( Group Health Cooperative of South Central Wisconsin)
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 |
Expanded Bronze | 21 30 40 50 60 |
$279.27 $316.97 $356.90 $498.77 $757.93 |
$558.54 $633.94 $713.80 $997.54 $1,515.86 |
$772.18 $847.58 $927.44 $1,211.18 |
$985.82 $1,061.22 $1,141.08 $1,424.82 |
$1,199.46 $1,274.86 $1,354.72 $1,638.46 |
$492.91 $530.61 $570.54 $712.41 |
$706.55 $744.25 $784.18 $926.05 |
$920.19 $957.89 $997.82 $1,139.69 |
$213.64 |
Plan: (HMO) Catastrophic 7350 Ded/7350 MOOPSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: ( Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$7,350
: Family:
$14,700 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 |
Catastrophic | 21 30 40 50 60 |
$232.38 $263.76 $296.99 $415.03 $630.68 |
$464.76 $527.52 $593.98 $830.06 $1,261.36 |
$642.54 $705.30 $771.76 $1,007.84 |
$820.32 $883.08 $949.54 $1,185.62 |
$998.10 $1,060.86 $1,127.32 $1,363.40 |
$410.16 $441.54 $474.77 $592.81 |
$587.94 $619.32 $652.55 $770.59 |
$765.72 $797.10 $830.33 $948.37 |
$177.78 |
Plan: (HMO) Select Catastrophic 7350 Ded/7350 MOOPSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: ( Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$7,350
: Family:
$14,700 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 |
Catastrophic | 21 30 40 50 60 |
$211.27 $239.79 $270.01 $377.33 $573.39 |
$422.54 $479.58 $540.02 $754.66 $1,146.78 |
$584.16 $641.20 $701.64 $916.28 |
$745.78 $802.82 $863.26 $1,077.90 |
$907.40 $964.44 $1,024.88 $1,239.52 |
$372.89 $401.41 $431.63 $538.95 |
$534.51 $563.03 $593.25 $700.57 |
$696.13 $724.65 $754.87 $862.19 |
$161.62 |
Plan: (HMO) Select Bronze Simple Choice Plan HSASummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: ( Group Health Cooperative of South Central Wisconsin)
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 |
Expanded Bronze | 21 30 40 50 60 |
$281.58 $319.59 $359.86 $502.90 $764.20 |
$563.16 $639.18 $719.72 $1,005.80 $1,528.40 |
$778.57 $854.59 $935.13 $1,221.21 |
$993.98 $1,070.00 $1,150.54 $1,436.62 |
$1,209.39 $1,285.41 $1,365.95 $1,652.03 |
$496.99 $535.00 $575.27 $718.31 |
$712.40 $750.41 $790.68 $933.72 |
$927.81 $965.82 $1,006.09 $1,149.13 |
$215.41 |
Plan: (HMO) Gold Simple Choice PlanSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: ( Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$1,400
: Family:
$2,800 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 |
Gold | 21 30 40 50 60 |
$380.70 $432.10 $486.54 $679.93 $1,033.22 |
$761.40 $864.20 $973.08 $1,359.86 $2,066.44 |
$1,052.64 $1,155.44 $1,264.32 $1,651.10 |
$1,343.88 $1,446.68 $1,555.56 $1,942.34 |
$1,635.12 $1,737.92 $1,846.80 $2,233.58 |
$671.94 $723.34 $777.78 $971.17 |
$963.18 $1,014.58 $1,069.02 $1,262.41 |
$1,254.42 $1,305.82 $1,360.26 $1,553.65 |
$291.24 |
Plan: (HMO) Silver Simple Choice PlanSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: ( Group Health Cooperative of South Central Wisconsin)
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 |
$404.47 $459.08 $516.91 $722.38 $1,097.73 |
$808.94 $918.16 $1,033.82 $1,444.76 $2,195.46 |
$1,118.36 $1,227.58 $1,343.24 $1,754.18 |
$1,427.78 $1,537.00 $1,652.66 $2,063.60 |
$1,737.20 $1,846.42 $1,962.08 $2,373.02 |
$713.89 $768.50 $826.33 $1,031.80 |
$1,023.31 $1,077.92 $1,135.75 $1,341.22 |
$1,332.73 $1,387.34 $1,445.17 $1,650.64 |
$309.42 |
Plan: (HMO) Bronze Simple Choice PlanSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: ( Group Health Cooperative of South Central Wisconsin)
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 |
Expanded Bronze | 21 30 40 50 60 |
$307.16 $348.63 $392.55 $548.58 $833.62 |
$614.32 $697.26 $785.10 $1,097.16 $1,667.24 |
$849.30 $932.24 $1,020.08 $1,332.14 |
$1,084.28 $1,167.22 $1,255.06 $1,567.12 |
$1,319.26 $1,402.20 $1,490.04 $1,802.10 |
$542.14 $583.61 $627.53 $783.56 |
$777.12 $818.59 $862.51 $1,018.54 |
$1,012.10 $1,053.57 $1,097.49 $1,253.52 |
$234.98 |
Plan: (HMO) Bronze Simple Choice Plan HSASummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: ( Group Health Cooperative of South Central Wisconsin)
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 |
Expanded Bronze | 21 30 40 50 60 |
$309.70 $351.51 $395.80 $553.12 $840.52 |
$619.40 $703.02 $791.60 $1,106.24 $1,681.04 |
$856.32 $939.94 $1,028.52 $1,343.16 |
$1,093.24 $1,176.86 $1,265.44 $1,580.08 |
$1,330.16 $1,413.78 $1,502.36 $1,817.00 |
$546.62 $588.43 $632.72 $790.04 |
$783.54 $825.35 $869.64 $1,026.96 |
$1,020.46 $1,062.27 $1,106.56 $1,263.88 |
$236.92 |
‡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 Sauk County here.