The health insurance rates listed below are for calendar year 2019.
2019 Rates and Providers
(click here for 2014)
(click here for 2015)
(click here for 2016)
(click here for 2017)
(click here for 2018)
This page gives you an overview of the rates for individual and family health insurance plans available from HealthCare.gov, the marketplace for Verona, WI.
Obamacare Providers, Plans and 2019 Rates for Dane County
Dane County is in “Rating Area 2” of Wisconsin.
Currently, there are 60 plans offered in Rating Area 2.
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 Verona, 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: 1-800-877-8973 |
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Plan: (HMO) Prime Silver 5000 - Copay $50/$100 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 |
$405.68 $460.44 $518.45 $724.53 $1,101.00 |
$811.36 $920.88 $1,036.90 $1,449.06 $2,202.00 |
$1,121.70 $1,231.22 $1,347.24 $1,759.40 |
$1,432.04 $1,541.56 $1,657.58 $2,069.74 |
$1,742.38 $1,851.90 $1,967.92 $2,380.08 |
$716.02 $770.78 $828.79 $1,034.87 |
$1,026.36 $1,081.12 $1,139.13 $1,345.21 |
$1,336.70 $1,391.46 $1,449.47 $1,655.55 |
$370.38 |
Plan: (HMO) Prime Silver 7900 - Copay $80/$160 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:
$7,900
: Family:
$15,800 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 |
Silver | 21 30 40 50 60 |
$392.46 $445.44 $501.56 $700.93 $1,065.13 |
$784.92 $890.88 $1,003.12 $1,401.86 $2,130.26 |
$1,085.15 $1,191.11 $1,303.35 $1,702.09 |
$1,385.38 $1,491.34 $1,603.58 $2,002.32 |
$1,685.61 $1,791.57 $1,903.81 $2,302.55 |
$692.69 $745.67 $801.79 $1,001.16 |
$992.92 $1,045.90 $1,102.02 $1,301.39 |
$1,293.15 $1,346.13 $1,402.25 $1,601.62 |
$358.31 |
Plan: (HMO) Prime Gold Maintenance - Copay $40/$90 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:
$1,500
: Family:
$3,000 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 |
$343.03 $389.33 $438.39 $612.65 $930.97 |
$686.06 $778.66 $876.78 $1,225.30 $1,861.94 |
$948.48 $1,041.08 $1,139.20 $1,487.72 |
$1,210.90 $1,303.50 $1,401.62 $1,750.14 |
$1,473.32 $1,565.92 $1,664.04 $2,012.56 |
$605.45 $651.75 $700.81 $875.07 |
$867.87 $914.17 $963.23 $1,137.49 |
$1,130.29 $1,176.59 $1,225.65 $1,399.91 |
$313.18 |
Plan: (HMO) Prime Gold 2000 - Copay $30/$70 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:
$2,000
: Family:
$4,000 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 |
$334.74 $379.92 $427.79 $597.83 $908.46 |
$669.48 $759.84 $855.58 $1,195.66 $1,816.92 |
$925.55 $1,015.91 $1,111.65 $1,451.73 |
$1,181.62 $1,271.98 $1,367.72 $1,707.80 |
$1,437.69 $1,528.05 $1,623.79 $1,963.87 |
$590.81 $635.99 $683.86 $853.90 |
$846.88 $892.06 $939.93 $1,109.97 |
$1,102.95 $1,148.13 $1,196.00 $1,366.04 |
$305.61 |
Plan: (HMO) Prime Silver 4000 - Copay $45/$90 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:
$4,000
: Family:
$8,000 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 |
$410.18 $465.55 $524.21 $732.58 $1,113.22 |
$820.36 $931.10 $1,048.42 $1,465.16 $2,226.44 |
$1,134.15 $1,244.89 $1,362.21 $1,778.95 |
$1,447.94 $1,558.68 $1,676.00 $2,092.74 |
$1,761.73 $1,872.47 $1,989.79 $2,406.53 |
$723.97 $779.34 $838.00 $1,046.37 |
$1,037.76 $1,093.13 $1,151.79 $1,360.16 |
$1,351.55 $1,406.92 $1,465.58 $1,673.95 |
$374.49 |
Plan: (HMO) Prime Bronze 7500 - Copay $80/$160 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:
$7,500
: Family:
$15,000 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 |
Expanded Bronze | 21 30 40 50 60 |
$254.31 $288.63 $325.00 $454.19 $690.18 |
$508.62 $577.26 $650.00 $908.38 $1,380.36 |
$703.16 $771.80 $844.54 $1,102.92 |
$897.70 $966.34 $1,039.08 $1,297.46 |
$1,092.24 $1,160.88 $1,233.62 $1,492.00 |
$448.85 $483.17 $519.54 $648.73 |
$643.39 $677.71 $714.08 $843.27 |
$837.93 $872.25 $908.62 $1,037.81 |
$232.18 |
Plan: (HMO) Prime Bronze 7900 - Copay $50/$100 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:
$7,900
: Family:
$15,800 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 |
Bronze | 21 30 40 50 60 |
$247.90 $281.37 $316.81 $442.75 $672.80 |
$495.80 $562.74 $633.62 $885.50 $1,345.60 |
$685.44 $752.38 $823.26 $1,075.14 |
$875.08 $942.02 $1,012.90 $1,264.78 |
$1,064.72 $1,131.66 $1,202.54 $1,454.42 |
$437.54 $471.01 $506.45 $632.39 |
$627.18 $660.65 $696.09 $822.03 |
$816.82 $850.29 $885.73 $1,011.67 |
$226.33 |
Plan: (HMO) Prime Silver 5000 - Copay $50/$100Summary 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 |
$386.49 $438.66 $493.93 $690.27 $1,048.93 |
$772.98 $877.32 $987.86 $1,380.54 $2,097.86 |
$1,068.64 $1,172.98 $1,283.52 $1,676.20 |
$1,364.30 $1,468.64 $1,579.18 $1,971.86 |
$1,659.96 $1,764.30 $1,874.84 $2,267.52 |
$682.15 $734.32 $789.59 $985.93 |
$977.81 $1,029.98 $1,085.25 $1,281.59 |
$1,273.47 $1,325.64 $1,380.91 $1,577.25 |
$352.86 |
Plan: (HMO) Prime Silver 7900 - Copay $80/$160Summary 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:
$7,900
: Family:
$15,800 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 |
Silver | 21 30 40 50 60 |
$373.90 $424.37 $477.84 $667.78 $1,014.76 |
$747.80 $848.74 $955.68 $1,335.56 $2,029.52 |
$1,033.83 $1,134.77 $1,241.71 $1,621.59 |
$1,319.86 $1,420.80 $1,527.74 $1,907.62 |
$1,605.89 $1,706.83 $1,813.77 $2,193.65 |
$659.93 $710.40 $763.87 $953.81 |
$945.96 $996.43 $1,049.90 $1,239.84 |
$1,231.99 $1,282.46 $1,335.93 $1,525.87 |
$341.37 |
Plan: (HMO) Prime Gold Maintenance - Copay $40/$90Summary 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:
$1,500
: Family:
$3,000 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 |
$326.81 $370.92 $417.65 $583.67 $886.94 |
$653.62 $741.84 $835.30 $1,167.34 $1,773.88 |
$903.62 $991.84 $1,085.30 $1,417.34 |
$1,153.62 $1,241.84 $1,335.30 $1,667.34 |
$1,403.62 $1,491.84 $1,585.30 $1,917.34 |
$576.81 $620.92 $667.65 $833.67 |
$826.81 $870.92 $917.65 $1,083.67 |
$1,076.81 $1,120.92 $1,167.65 $1,333.67 |
$298.37 |
Plan: (HMO) Prime Gold 2000 - Copay $30/$70Summary 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:
$2,000
: Family:
$4,000 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 |
$318.91 $361.95 $407.56 $569.56 $865.50 |
$637.82 $723.90 $815.12 $1,139.12 $1,731.00 |
$881.78 $967.86 $1,059.08 $1,383.08 |
$1,125.74 $1,211.82 $1,303.04 $1,627.04 |
$1,369.70 $1,455.78 $1,547.00 $1,871.00 |
$562.87 $605.91 $651.52 $813.52 |
$806.83 $849.87 $895.48 $1,057.48 |
$1,050.79 $1,093.83 $1,139.44 $1,301.44 |
$291.16 |
Plan: (HMO) Prime Silver 4000 - Copay $45/$90Summary 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:
$4,000
: Family:
$8,000 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 |
$390.78 $443.53 $499.41 $697.93 $1,060.57 |
$781.56 $887.06 $998.82 $1,395.86 $2,121.14 |
$1,080.51 $1,186.01 $1,297.77 $1,694.81 |
$1,379.46 $1,484.96 $1,596.72 $1,993.76 |
$1,678.41 $1,783.91 $1,895.67 $2,292.71 |
$689.73 $742.48 $798.36 $996.88 |
$988.68 $1,041.43 $1,097.31 $1,295.83 |
$1,287.63 $1,340.38 $1,396.26 $1,594.78 |
$356.78 |
Plan: (HMO) Prime Bronze 7500 - Copay $80/$160Summary 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:
$7,500
: Family:
$15,000 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 |
Expanded Bronze | 21 30 40 50 60 |
$242.28 $274.98 $309.63 $432.71 $657.54 |
$484.56 $549.96 $619.26 $865.42 $1,315.08 |
$669.90 $735.30 $804.60 $1,050.76 |
$855.24 $920.64 $989.94 $1,236.10 |
$1,040.58 $1,105.98 $1,175.28 $1,421.44 |
$427.62 $460.32 $494.97 $618.05 |
$612.96 $645.66 $680.31 $803.39 |
$798.30 $831.00 $865.65 $988.73 |
$221.20 |
Plan: (HMO) Prime Bronze 7900 - Copay $50/$100Summary 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:
$7,900
: Family:
$15,800 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 |
Bronze | 21 30 40 50 60 |
$236.18 $268.06 $301.83 $421.81 $640.98 |
$472.36 $536.12 $603.66 $843.62 $1,281.96 |
$653.03 $716.79 $784.33 $1,024.29 |
$833.70 $897.46 $965.00 $1,204.96 |
$1,014.37 $1,078.13 $1,145.67 $1,385.63 |
$416.85 $448.73 $482.50 $602.48 |
$597.52 $629.40 $663.17 $783.15 |
$778.19 $810.07 $843.84 $963.82 |
$215.63 |
Plan: (HMO) Prime Gold HSA 2000Summary 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:
$2,000
: Family:
$4,000 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 |
$334.01 $379.10 $426.86 $596.53 $906.49 |
$668.02 $758.20 $853.72 $1,193.06 $1,812.98 |
$923.53 $1,013.71 $1,109.23 $1,448.57 |
$1,179.04 $1,269.22 $1,364.74 $1,704.08 |
$1,434.55 $1,524.73 $1,620.25 $1,959.59 |
$589.52 $634.61 $682.37 $852.04 |
$845.03 $890.12 $937.88 $1,107.55 |
$1,100.54 $1,145.63 $1,193.39 $1,363.06 |
$304.95 |
Plan: (HMO) Prime Bronze HSA 6750Summary 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:
$6,750
: Family:
$13,500 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 |
Bronze | 21 30 40 50 60 |
$246.83 $280.15 $315.45 $440.83 $669.89 |
$493.66 $560.30 $630.90 $881.66 $1,339.78 |
$682.48 $749.12 $819.72 $1,070.48 |
$871.30 $937.94 $1,008.54 $1,259.30 |
$1,060.12 $1,126.76 $1,197.36 $1,448.12 |
$435.65 $468.97 $504.27 $629.65 |
$624.47 $657.79 $693.09 $818.47 |
$813.29 $846.61 $881.91 $1,007.29 |
$225.35 |
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:
$7,900
: Family:
$15,800 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 |
Catastrophic | 21 30 40 50 60 |
$183.26 $208.00 $234.20 $327.30 $497.36 |
$366.52 $416.00 $468.40 $654.60 $994.72 |
$506.71 $556.19 $608.59 $794.79 |
$646.90 $696.38 $748.78 $934.98 |
$787.09 $836.57 $888.97 $1,075.17 |
$323.45 $348.19 $374.39 $467.49 |
$463.64 $488.38 $514.58 $607.68 |
$603.83 $628.57 $654.77 $747.87 |
$167.31 |
Plan: (HMO) Prime Silver HSA 5250Summary 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:
$5,250
: Family:
$10,500 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 |
Silver | 21 30 40 50 60 |
$400.07 $454.07 $511.28 $714.51 $1,085.77 |
$800.14 $908.14 $1,022.56 $1,429.02 $2,171.54 |
$1,106.19 $1,214.19 $1,328.61 $1,735.07 |
$1,412.24 $1,520.24 $1,634.66 $2,041.12 |
$1,718.29 $1,826.29 $1,940.71 $2,347.17 |
$706.12 $760.12 $817.33 $1,020.56 |
$1,012.17 $1,066.17 $1,123.38 $1,326.61 |
$1,318.22 $1,372.22 $1,429.43 $1,632.66 |
$365.26 |
Plan: (HMO) Prime Gold 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: |
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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 |
$337.56 $383.13 $431.40 $602.88 $916.13 |
$675.12 $766.26 $862.80 $1,205.76 $1,832.26 |
$933.35 $1,024.49 $1,121.03 $1,463.99 |
$1,191.58 $1,282.72 $1,379.26 $1,722.22 |
$1,449.81 $1,540.95 $1,637.49 $1,980.45 |
$595.79 $641.36 $689.63 $861.11 |
$854.02 $899.59 $947.86 $1,119.34 |
$1,112.25 $1,157.82 $1,206.09 $1,377.57 |
$308.19 |
ADVERTISEMENT
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Dean Health PlanLocal: 1-608-828-1302 | Toll Free: 1-800-279-1302 TTY: 1-608-827-4086 |
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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:
$7,900
: Family:
$15,800 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 |
Catastrophic | 21 30 40 50 60 |
$151.88 $172.38 $194.10 $271.25 $412.19 |
$303.76 $344.76 $388.20 $542.50 $824.38 |
$419.95 $460.95 $504.39 $658.69 |
$536.14 $577.14 $620.58 $774.88 |
$652.33 $693.33 $736.77 $891.07 |
$268.07 $288.57 $310.29 $387.44 |
$384.26 $404.76 $426.48 $503.63 |
$500.45 $520.95 $542.67 $619.82 |
$138.66 |
Plan: (HMO) Dean Silver Copay Plus 3600XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$3,600
: Family:
$7,200 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 |
$332.68 $377.59 $425.17 $594.17 $902.90 |
$665.36 $755.18 $850.34 $1,188.34 $1,805.80 |
$919.86 $1,009.68 $1,104.84 $1,442.84 |
$1,174.36 $1,264.18 $1,359.34 $1,697.34 |
$1,428.86 $1,518.68 $1,613.84 $1,951.84 |
$587.18 $632.09 $679.67 $848.67 |
$841.68 $886.59 $934.17 $1,103.17 |
$1,096.18 $1,141.09 $1,188.67 $1,357.67 |
$303.74 |
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 |
$323.18 $366.81 $413.03 $577.21 $877.12 |
$646.36 $733.62 $826.06 $1,154.42 $1,754.24 |
$893.60 $980.86 $1,073.30 $1,401.66 |
$1,140.84 $1,228.10 $1,320.54 $1,648.90 |
$1,388.08 $1,475.34 $1,567.78 $1,896.14 |
$570.42 $614.05 $660.27 $824.45 |
$817.66 $861.29 $907.51 $1,071.69 |
$1,064.90 $1,108.53 $1,154.75 $1,318.93 |
$295.07 |
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 |
$329.43 $373.91 $421.02 $588.37 $894.09 |
$658.86 $747.82 $842.04 $1,176.74 $1,788.18 |
$910.88 $999.84 $1,094.06 $1,428.76 |
$1,162.90 $1,251.86 $1,346.08 $1,680.78 |
$1,414.92 $1,503.88 $1,598.10 $1,932.80 |
$581.45 $625.93 $673.04 $840.39 |
$833.47 $877.95 $925.06 $1,092.41 |
$1,085.49 $1,129.97 $1,177.08 $1,344.43 |
$300.77 |
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 |
$314.75 $357.24 $402.25 $562.15 $854.24 |
$629.50 $714.48 $804.50 $1,124.30 $1,708.48 |
$870.29 $955.27 $1,045.29 $1,365.09 |
$1,111.08 $1,196.06 $1,286.08 $1,605.88 |
$1,351.87 $1,436.85 $1,526.87 $1,846.67 |
$555.54 $598.03 $643.04 $802.94 |
$796.33 $838.82 $883.83 $1,043.73 |
$1,037.12 $1,079.61 $1,124.62 $1,284.52 |
$287.37 |
Plan: (HMO) Dean Bronze Value Copay 7800XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$7,800
: Family:
$15,600 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 |
$220.35 $250.10 $281.61 $393.55 $598.03 |
$440.70 $500.20 $563.22 $787.10 $1,196.06 |
$609.27 $668.77 $731.79 $955.67 |
$777.84 $837.34 $900.36 $1,124.24 |
$946.41 $1,005.91 $1,068.93 $1,292.81 |
$388.92 $418.67 $450.18 $562.12 |
$557.49 $587.24 $618.75 $730.69 |
$726.06 $755.81 $787.32 $899.26 |
$201.18 |
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 |
$316.96 $359.75 $405.08 $566.10 $860.24 |
$633.92 $719.50 $810.16 $1,132.20 $1,720.48 |
$876.40 $961.98 $1,052.64 $1,374.68 |
$1,118.88 $1,204.46 $1,295.12 $1,617.16 |
$1,361.36 $1,446.94 $1,537.60 $1,859.64 |
$559.44 $602.23 $647.56 $808.58 |
$801.92 $844.71 $890.04 $1,051.06 |
$1,044.40 $1,087.19 $1,132.52 $1,293.54 |
$289.39 |
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 |
$327.25 $371.43 $418.23 $584.47 $888.16 |
$654.50 $742.86 $836.46 $1,168.94 $1,776.32 |
$904.85 $993.21 $1,086.81 $1,419.29 |
$1,155.20 $1,243.56 $1,337.16 $1,669.64 |
$1,405.55 $1,493.91 $1,587.51 $1,919.99 |
$577.60 $621.78 $668.58 $834.82 |
$827.95 $872.13 $918.93 $1,085.17 |
$1,078.30 $1,122.48 $1,169.28 $1,335.52 |
$298.78 |
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 |
$217.43 $246.78 $277.88 $388.33 $590.11 |
$434.86 $493.56 $555.76 $776.66 $1,180.22 |
$601.19 $659.89 $722.09 $942.99 |
$767.52 $826.22 $888.42 $1,109.32 |
$933.85 $992.55 $1,054.75 $1,275.65 |
$383.76 $413.11 $444.21 $554.66 |
$550.09 $579.44 $610.54 $720.99 |
$716.42 $745.77 $776.87 $887.32 |
$198.51 |
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 |
$299.80 $340.27 $383.14 $535.44 $813.65 |
$599.60 $680.54 $766.28 $1,070.88 $1,627.30 |
$828.94 $909.88 $995.62 $1,300.22 |
$1,058.28 $1,139.22 $1,224.96 $1,529.56 |
$1,287.62 $1,368.56 $1,454.30 $1,758.90 |
$529.14 $569.61 $612.48 $764.78 |
$758.48 $798.95 $841.82 $994.12 |
$987.82 $1,028.29 $1,071.16 $1,223.46 |
$273.71 |
Plan: (EPO) Dean Focus Network Bronze Value Copay 7800XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$7,800
: Family:
$15,600 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 |
$198.90 $225.75 $254.19 $355.24 $539.81 |
$397.80 $451.50 $508.38 $710.48 $1,079.62 |
$549.96 $603.66 $660.54 $862.64 |
$702.12 $755.82 $812.70 $1,014.80 |
$854.28 $907.98 $964.86 $1,166.96 |
$351.06 $377.91 $406.35 $507.40 |
$503.22 $530.07 $558.51 $659.56 |
$655.38 $682.23 $710.67 $811.72 |
$181.60 |
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 |
$287.95 $326.83 $368.00 $514.28 $781.50 |
$575.90 $653.66 $736.00 $1,028.56 $1,563.00 |
$796.18 $873.94 $956.28 $1,248.84 |
$1,016.46 $1,094.22 $1,176.56 $1,469.12 |
$1,236.74 $1,314.50 $1,396.84 $1,689.40 |
$508.23 $547.11 $588.28 $734.56 |
$728.51 $767.39 $808.56 $954.84 |
$948.79 $987.67 $1,028.84 $1,175.12 |
$262.90 |
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 |
$196.31 $222.81 $250.88 $350.60 $532.78 |
$392.62 $445.62 $501.76 $701.20 $1,065.56 |
$542.79 $595.79 $651.93 $851.37 |
$692.96 $745.96 $802.10 $1,001.54 |
$843.13 $896.13 $952.27 $1,151.71 |
$346.48 $372.98 $401.05 $500.77 |
$496.65 $523.15 $551.22 $650.94 |
$646.82 $673.32 $701.39 $801.11 |
$179.23 |
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 |
$283.07 $321.28 $361.76 $505.56 $768.24 |
$566.14 $642.56 $723.52 $1,011.12 $1,536.48 |
$782.69 $859.11 $940.07 $1,227.67 |
$999.24 $1,075.66 $1,156.62 $1,444.22 |
$1,215.79 $1,292.21 $1,373.17 $1,660.77 |
$499.62 $537.83 $578.31 $722.11 |
$716.17 $754.38 $794.86 $938.66 |
$932.72 $970.93 $1,011.41 $1,155.21 |
$258.44 |
ADVERTISEMENT
|
||||||||||
Group Health Cooperative of South Central WisconsinLocal: 1-608-828-4831 | Toll Free: 1-855-344-2729 TTY: 1-608-828-4815 |
||||||||||
Plan: (HMO) Platinum 500 Ded/1500 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 |
$453.73 $514.98 $579.87 $810.36 $1,231.42 |
$907.46 $1,029.96 $1,159.74 $1,620.72 $2,462.84 |
$1,254.56 $1,377.06 $1,506.84 $1,967.82 |
$1,601.66 $1,724.16 $1,853.94 $2,314.92 |
$1,948.76 $2,071.26 $2,201.04 $2,662.02 |
$800.83 $862.08 $926.97 $1,157.46 |
$1,147.93 $1,209.18 $1,274.07 $1,504.56 |
$1,495.03 $1,556.28 $1,621.17 $1,851.66 |
$414.26 |
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 |
$398.08 $451.82 $508.74 $710.96 $1,080.37 |
$796.16 $903.64 $1,017.48 $1,421.92 $2,160.74 |
$1,100.69 $1,208.17 $1,322.01 $1,726.45 |
$1,405.22 $1,512.70 $1,626.54 $2,030.98 |
$1,709.75 $1,817.23 $1,931.07 $2,335.51 |
$702.61 $756.35 $813.27 $1,015.49 |
$1,007.14 $1,060.88 $1,117.80 $1,320.02 |
$1,311.67 $1,365.41 $1,422.33 $1,624.55 |
$363.45 |
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 |
$435.36 $494.13 $556.38 $777.54 $1,181.55 |
$870.72 $988.26 $1,112.76 $1,555.08 $2,363.10 |
$1,203.77 $1,321.31 $1,445.81 $1,888.13 |
$1,536.82 $1,654.36 $1,778.86 $2,221.18 |
$1,869.87 $1,987.41 $2,111.91 $2,554.23 |
$768.41 $827.18 $889.43 $1,110.59 |
$1,101.46 $1,160.23 $1,222.48 $1,443.64 |
$1,434.51 $1,493.28 $1,555.53 $1,776.69 |
$397.48 |
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 |
$310.06 $351.92 $396.26 $553.77 $841.50 |
$620.12 $703.84 $792.52 $1,107.54 $1,683.00 |
$857.32 $941.04 $1,029.72 $1,344.74 |
$1,094.52 $1,178.24 $1,266.92 $1,581.94 |
$1,331.72 $1,415.44 $1,504.12 $1,819.14 |
$547.26 $589.12 $633.46 $790.97 |
$784.46 $826.32 $870.66 $1,028.17 |
$1,021.66 $1,063.52 $1,107.86 $1,265.37 |
$283.09 |
Plan: (HMO) Select Platinum 500 Ded/1500 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 |
$412.52 $468.21 $527.20 $736.76 $1,119.57 |
$825.04 $936.42 $1,054.40 $1,473.52 $2,239.14 |
$1,140.62 $1,252.00 $1,369.98 $1,789.10 |
$1,456.20 $1,567.58 $1,685.56 $2,104.68 |
$1,771.78 $1,883.16 $2,001.14 $2,420.26 |
$728.10 $783.79 $842.78 $1,052.34 |
$1,043.68 $1,099.37 $1,158.36 $1,367.92 |
$1,359.26 $1,414.95 $1,473.94 $1,683.50 |
$376.63 |
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 |
$361.97 $410.84 $462.60 $646.48 $982.38 |
$723.94 $821.68 $925.20 $1,292.96 $1,964.76 |
$1,000.85 $1,098.59 $1,202.11 $1,569.87 |
$1,277.76 $1,375.50 $1,479.02 $1,846.78 |
$1,554.67 $1,652.41 $1,755.93 $2,123.69 |
$638.88 $687.75 $739.51 $923.39 |
$915.79 $964.66 $1,016.42 $1,200.30 |
$1,192.70 $1,241.57 $1,293.33 $1,477.21 |
$330.48 |
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 |
$395.85 $449.29 $505.89 $706.98 $1,074.32 |
$791.70 $898.58 $1,011.78 $1,413.96 $2,148.64 |
$1,094.52 $1,201.40 $1,314.60 $1,716.78 |
$1,397.34 $1,504.22 $1,617.42 $2,019.60 |
$1,700.16 $1,807.04 $1,920.24 $2,322.42 |
$698.67 $752.11 $808.71 $1,009.80 |
$1,001.49 $1,054.93 $1,111.53 $1,312.62 |
$1,304.31 $1,357.75 $1,414.35 $1,615.44 |
$361.41 |
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 |
$281.90 $319.95 $360.26 $503.46 $765.06 |
$563.80 $639.90 $720.52 $1,006.92 $1,530.12 |
$779.45 $855.55 $936.17 $1,222.57 |
$995.10 $1,071.20 $1,151.82 $1,438.22 |
$1,210.75 $1,286.85 $1,367.47 $1,653.87 |
$497.55 $535.60 $575.91 $719.11 |
$713.20 $751.25 $791.56 $934.76 |
$928.85 $966.90 $1,007.21 $1,150.41 |
$257.37 |
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 |
$302.84 $343.72 $387.03 $540.87 $821.90 |
$605.68 $687.44 $774.06 $1,081.74 $1,643.80 |
$837.35 $919.11 $1,005.73 $1,313.41 |
$1,069.02 $1,150.78 $1,237.40 $1,545.08 |
$1,300.69 $1,382.45 $1,469.07 $1,776.75 |
$534.51 $575.39 $618.70 $772.54 |
$766.18 $807.06 $850.37 $1,004.21 |
$997.85 $1,038.73 $1,082.04 $1,235.88 |
$276.49 |
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 |
$275.36 $312.53 $351.90 $491.78 $747.31 |
$550.72 $625.06 $703.80 $983.56 $1,494.62 |
$761.37 $835.71 $914.45 $1,194.21 |
$972.02 $1,046.36 $1,125.10 $1,404.86 |
$1,182.67 $1,257.01 $1,335.75 $1,615.51 |
$486.01 $523.18 $562.55 $702.43 |
$696.66 $733.83 $773.20 $913.08 |
$907.31 $944.48 $983.85 $1,123.73 |
$251.40 |
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 |
$369.50 $419.38 $472.21 $659.92 $1,002.80 |
$739.00 $838.76 $944.42 $1,319.84 $2,005.60 |
$1,021.67 $1,121.43 $1,227.09 $1,602.51 |
$1,304.34 $1,404.10 $1,509.76 $1,885.18 |
$1,587.01 $1,686.77 $1,792.43 $2,167.85 |
$652.17 $702.05 $754.88 $942.59 |
$934.84 $984.72 $1,037.55 $1,225.26 |
$1,217.51 $1,267.39 $1,320.22 $1,507.93 |
$337.35 |
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 |
$335.96 $381.31 $429.36 $600.02 $911.79 |
$671.92 $762.62 $858.72 $1,200.04 $1,823.58 |
$928.93 $1,019.63 $1,115.73 $1,457.05 |
$1,185.94 $1,276.64 $1,372.74 $1,714.06 |
$1,442.95 $1,533.65 $1,629.75 $1,971.07 |
$592.97 $638.32 $686.37 $857.03 |
$849.98 $895.33 $943.38 $1,114.04 |
$1,106.99 $1,152.34 $1,200.39 $1,371.05 |
$306.73 |
Plan: (HMO) Select Gold Simple Choice 1400 Ded/5000 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:
$1,400
: 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 |
$358.12 $406.46 $457.67 $639.59 $971.92 |
$716.24 $812.92 $915.34 $1,279.18 $1,943.84 |
$990.20 $1,086.88 $1,189.30 $1,553.14 |
$1,264.16 $1,360.84 $1,463.26 $1,827.10 |
$1,538.12 $1,634.80 $1,737.22 $2,101.06 |
$632.08 $680.42 $731.63 $913.55 |
$906.04 $954.38 $1,005.59 $1,187.51 |
$1,180.00 $1,228.34 $1,279.55 $1,461.47 |
$326.96 |
Plan: (HMO) Select Silver Simple Choice 4000X 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:
$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 |
$380.38 $431.74 $486.13 $679.36 $1,032.35 |
$760.76 $863.48 $972.26 $1,358.72 $2,064.70 |
$1,051.76 $1,154.48 $1,263.26 $1,649.72 |
$1,342.76 $1,445.48 $1,554.26 $1,940.72 |
$1,633.76 $1,736.48 $1,845.26 $2,231.72 |
$671.38 $722.74 $777.13 $970.36 |
$962.38 $1,013.74 $1,068.13 $1,261.36 |
$1,253.38 $1,304.74 $1,359.13 $1,552.36 |
$347.29 |
Plan: (HMO) Select Bronze Simple Choice 6650 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:
$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 |
$281.71 $319.74 $360.02 $503.12 $764.54 |
$563.42 $639.48 $720.04 $1,006.24 $1,529.08 |
$778.93 $854.99 $935.55 $1,221.75 |
$994.44 $1,070.50 $1,151.06 $1,437.26 |
$1,209.95 $1,286.01 $1,366.57 $1,652.77 |
$497.22 $535.25 $575.53 $718.63 |
$712.73 $750.76 $791.04 $934.14 |
$928.24 $966.27 $1,006.55 $1,149.65 |
$257.20 |
Plan: (HMO) Select Catastrophic 7900 Ded/7900 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:
$7,900
: Family:
$15,800 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 |
Catastrophic | 21 30 40 50 60 |
$207.38 $235.37 $265.03 $370.37 $562.82 |
$414.76 $470.74 $530.06 $740.74 $1,125.64 |
$573.41 $629.39 $688.71 $899.39 |
$732.06 $788.04 $847.36 $1,058.04 |
$890.71 $946.69 $1,006.01 $1,216.69 |
$366.03 $394.02 $423.68 $529.02 |
$524.68 $552.67 $582.33 $687.67 |
$683.33 $711.32 $740.98 $846.32 |
$189.34 |
Plan: (HMO) Gold Simple Choice 1400 Ded/5000 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:
$1,400
: 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 |
$393.88 $447.05 $503.38 $703.47 $1,068.99 |
$787.76 $894.10 $1,006.76 $1,406.94 $2,137.98 |
$1,089.08 $1,195.42 $1,308.08 $1,708.26 |
$1,390.40 $1,496.74 $1,609.40 $2,009.58 |
$1,691.72 $1,798.06 $1,910.72 $2,310.90 |
$695.20 $748.37 $804.70 $1,004.79 |
$996.52 $1,049.69 $1,106.02 $1,306.11 |
$1,297.84 $1,351.01 $1,407.34 $1,607.43 |
$359.61 |
Plan: (HMO) Silver Simple Choice 4000X 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:
$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 |
$418.34 $474.82 $534.64 $747.16 $1,135.37 |
$836.68 $949.64 $1,069.28 $1,494.32 $2,270.74 |
$1,156.71 $1,269.67 $1,389.31 $1,814.35 |
$1,476.74 $1,589.70 $1,709.34 $2,134.38 |
$1,796.77 $1,909.73 $2,029.37 $2,454.41 |
$738.37 $794.85 $854.67 $1,067.19 |
$1,058.40 $1,114.88 $1,174.70 $1,387.22 |
$1,378.43 $1,434.91 $1,494.73 $1,707.25 |
$381.95 |
Plan: (HMO) Bronze Simple Choice 6650 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:
$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 |
$309.80 $351.62 $395.92 $553.30 $840.78 |
$619.60 $703.24 $791.84 $1,106.60 $1,681.56 |
$856.60 $940.24 $1,028.84 $1,343.60 |
$1,093.60 $1,177.24 $1,265.84 $1,580.60 |
$1,330.60 $1,414.24 $1,502.84 $1,817.60 |
$546.80 $588.62 $632.92 $790.30 |
$783.80 $825.62 $869.92 $1,027.30 |
$1,020.80 $1,062.62 $1,106.92 $1,264.30 |
$282.85 |
Plan: (HMO) Platinum No Ded/2000 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 |
$459.74 $521.81 $587.55 $821.09 $1,247.73 |
$919.48 $1,043.62 $1,175.10 $1,642.18 $2,495.46 |
$1,271.18 $1,395.32 $1,526.80 $1,993.88 |
$1,622.88 $1,747.02 $1,878.50 $2,345.58 |
$1,974.58 $2,098.72 $2,230.20 $2,697.28 |
$811.44 $873.51 $939.25 $1,172.79 |
$1,163.14 $1,225.21 $1,290.95 $1,524.49 |
$1,514.84 $1,576.91 $1,642.65 $1,876.19 |
$419.74 |
Plan: (HMO) Select Platinum No Ded/2000 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 |
$418.00 $474.43 $534.21 $746.55 $1,134.45 |
$836.00 $948.86 $1,068.42 $1,493.10 $2,268.90 |
$1,155.77 $1,268.63 $1,388.19 $1,812.87 |
$1,475.54 $1,588.40 $1,707.96 $2,132.64 |
$1,795.31 $1,908.17 $2,027.73 $2,452.41 |
$737.77 $794.20 $853.98 $1,066.32 |
$1,057.54 $1,113.97 $1,173.75 $1,386.09 |
$1,377.31 $1,433.74 $1,493.52 $1,705.86 |
$381.64 |
Plan: (HMO) Bronze 7900 Ded/7900 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:
$7,900
: Family:
$15,800 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 |
Bronze | 21 30 40 50 60 |
$293.31 $332.91 $374.85 $523.85 $796.05 |
$586.62 $665.82 $749.70 $1,047.70 $1,592.10 |
$811.01 $890.21 $974.09 $1,272.09 |
$1,035.40 $1,114.60 $1,198.48 $1,496.48 |
$1,259.79 $1,338.99 $1,422.87 $1,720.87 |
$517.70 $557.30 $599.24 $748.24 |
$742.09 $781.69 $823.63 $972.63 |
$966.48 $1,006.08 $1,048.02 $1,197.02 |
$267.80 |
Plan: (HMO) Select Bronze 7900 Ded/7900 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:
$7,900
: Family:
$15,800 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 |
Bronze | 21 30 40 50 60 |
$266.70 $302.70 $340.84 $476.32 $723.81 |
$533.40 $605.40 $681.68 $952.64 $1,447.62 |
$737.42 $809.42 $885.70 $1,156.66 |
$941.44 $1,013.44 $1,089.72 $1,360.68 |
$1,145.46 $1,217.46 $1,293.74 $1,564.70 |
$470.72 $506.72 $544.86 $680.34 |
$674.74 $710.74 $748.88 $884.36 |
$878.76 $914.76 $952.90 $1,088.38 |
$243.50 |
Plan: (HMO) Silver 4900 Ded/7900 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:
$4,900
: Family:
$9,800 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 |
$424.20 $481.47 $542.13 $757.62 $1,151.28 |
$848.40 $962.94 $1,084.26 $1,515.24 $2,302.56 |
$1,172.92 $1,287.46 $1,408.78 $1,839.76 |
$1,497.44 $1,611.98 $1,733.30 $2,164.28 |
$1,821.96 $1,936.50 $2,057.82 $2,488.80 |
$748.72 $805.99 $866.65 $1,082.14 |
$1,073.24 $1,130.51 $1,191.17 $1,406.66 |
$1,397.76 $1,455.03 $1,515.69 $1,731.18 |
$387.30 |
Plan: (HMO) Select Silver 4900 Ded/7900 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:
$4,900
: Family:
$9,800 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 |
$385.68 $437.74 $492.89 $688.82 $1,046.72 |
$771.36 $875.48 $985.78 $1,377.64 $2,093.44 |
$1,066.40 $1,170.52 $1,280.82 $1,672.68 |
$1,361.44 $1,465.56 $1,575.86 $1,967.72 |
$1,656.48 $1,760.60 $1,870.90 $2,262.76 |
$680.72 $732.78 $787.93 $983.86 |
$975.76 $1,027.82 $1,082.97 $1,278.90 |
$1,270.80 $1,322.86 $1,378.01 $1,573.94 |
$352.12 |
Plan: (HMO) Silver 5250 Ded/5250 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:
$5,250
: Family:
$10,500 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 |
$422.16 $479.15 $539.52 $753.98 $1,145.74 |
$844.32 $958.30 $1,079.04 $1,507.96 $2,291.48 |
$1,167.27 $1,281.25 $1,401.99 $1,830.91 |
$1,490.22 $1,604.20 $1,724.94 $2,153.86 |
$1,813.17 $1,927.15 $2,047.89 $2,476.81 |
$745.11 $802.10 $862.47 $1,076.93 |
$1,068.06 $1,125.05 $1,185.42 $1,399.88 |
$1,391.01 $1,448.00 $1,508.37 $1,722.83 |
$385.43 |
Plan: (HMO) Select Silver 5250 Ded/5250 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:
$5,250
: Family:
$10,500 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 |
$383.82 $435.64 $490.53 $685.51 $1,041.69 |
$767.64 $871.28 $981.06 $1,371.02 $2,083.38 |
$1,061.27 $1,164.91 $1,274.69 $1,664.65 |
$1,354.90 $1,458.54 $1,568.32 $1,958.28 |
$1,648.53 $1,752.17 $1,861.95 $2,251.91 |
$677.45 $729.27 $784.16 $979.14 |
$971.08 $1,022.90 $1,077.79 $1,272.77 |
$1,264.71 $1,316.53 $1,371.42 $1,566.40 |
$350.43 |
‡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 Dane County here.