Wisconsin Obamacare 2021 Rates

Obamacare > Rates > Wisconsin

ADVERTISEMENT

ADVERTISEMENT

Together with CCHP

Local: 1-844-201-4672 | Toll Free: 1-844-201-4672 | TTY: 1-844-531-4856

Toc - Plan #1 Together with CCHP
Expanded Bronze

(EPO) Together Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-201-4672

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$256,76
$291,42
$328,13
$458,56
$696,83
$453,18
$487,84
$524,55
$654,98
$649,60
$684,26
$720,97
$851,40
$846,02
$880,68
$917,39
$1 047,82
$196,42
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$513,52
$582,84
$656,26
$917,12
$1 393,66
$709,94
$779,26
$852,68
$1 113,54
$906,36
$975,68
$1 049,10
$1 309,96
$1 102,78
$1 172,10
$1 245,52
$1 506,38
$196,42
Toc - Plan #2 Together with CCHP
Silver

(EPO) Together Standard Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-201-4672

Annual Out of Pocket Expenses:

Individual Family
$4,000 $8,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$352,21
$399,75
$450,11
$629,03
$955,87
$621,64
$669,18
$719,54
$898,46
$891,07
$938,61
$988,97
$1 167,89
$1 160,50
$1 208,04
$1 258,40
$1 437,32
$269,43
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$704,42
$799,50
$900,22
$1 258,06
$1 911,74
$973,85
$1 068,93
$1 169,65
$1 527,49
$1 243,28
$1 338,36
$1 439,08
$1 796,92
$1 512,71
$1 607,79
$1 708,51
$2 066,35
$269,43
Toc - Plan #3 Together with CCHP
Silver

(EPO) Together Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-201-4672

Annual Out of Pocket Expenses:

Individual Family
$5,400 $10,800 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$311,71
$353,78
$398,35
$556,69
$845,95
$550,16
$592,23
$636,80
$795,14
$788,61
$830,68
$875,25
$1 033,59
$1 027,06
$1 069,13
$1 113,70
$1 272,04
$238,45
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$623,42
$707,56
$796,70
$1 113,38
$1 691,90
$861,87
$946,01
$1 035,15
$1 351,83
$1 100,32
$1 184,46
$1 273,60
$1 590,28
$1 338,77
$1 422,91
$1 512,05
$1 828,73
$238,45
Toc - Plan #4 Together with CCHP
Gold

(EPO) Together Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-201-4672

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$6,500 $13,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$368,76
$418,54
$471,27
$658,60
$1 000,80
$650,86
$700,64
$753,37
$940,70
$932,96
$982,74
$1 035,47
$1 222,80
$1 215,06
$1 264,84
$1 317,57
$1 504,90
$282,10
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$737,52
$837,08
$942,54
$1 317,20
$2 001,60
$1 019,62
$1 119,18
$1 224,64
$1 599,30
$1 301,72
$1 401,28
$1 506,74
$1 881,40
$1 583,82
$1 683,38
$1 788,84
$2 163,50
$282,10
Toc - Plan #5 Together with CCHP
Expanded Bronze

(EPO) Together Bronze HDHP

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-201-4672

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$277,54
$315,00
$354,69
$495,68
$753,23
$489,85
$527,31
$567,00
$707,99
$702,16
$739,62
$779,31
$920,30
$914,47
$951,93
$991,62
$1 132,61
$212,31
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$555,08
$630,00
$709,38
$991,36
$1 506,46
$767,39
$842,31
$921,69
$1 203,67
$979,70
$1 054,62
$1 134,00
$1 415,98
$1 192,01
$1 266,93
$1 346,31
$1 628,29
$212,31
Toc - Plan #6 Together with CCHP
Silver

(EPO) Together Silver Select

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-201-4672

Annual Out of Pocket Expenses:

Individual Family
$3,250 $6,500 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$339,18
$384,96
$433,46
$605,76
$920,51
$598,64
$644,42
$692,92
$865,22
$858,10
$903,88
$952,38
$1 124,68
$1 117,56
$1 163,34
$1 211,84
$1 384,14
$259,46
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$678,36
$769,92
$866,92
$1 211,52
$1 841,02
$937,82
$1 029,38
$1 126,38
$1 470,98
$1 197,28
$1 288,84
$1 385,84
$1 730,44
$1 456,74
$1 548,30
$1 645,30
$1 989,90
$259,46
Toc - Plan #7 Together with CCHP
Catastrophic

(EPO) Together Catastrophic

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-201-4672

Annual Out of Pocket Expenses:

Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$216,26
$245,45
$276,37
$386,23
$586,91
$381,69
$410,88
$441,80
$551,66
$547,12
$576,31
$607,23
$717,09
$712,55
$741,74
$772,66
$882,52
$165,43
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$432,52
$490,90
$552,74
$772,46
$1 173,82
$597,95
$656,33
$718,17
$937,89
$763,38
$821,76
$883,60
$1 103,32
$928,81
$987,19
$1 049,03
$1 268,75
$165,43

ADVERTISEMENT

Molina Healthcare

Local: 1-888-560-2043 | Toll Free: 1-888-560-2043

Toc - Plan #8 Molina Healthcare
Gold

(HMO) Confident Care Gold 1

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-560-2043

Annual Out of Pocket Expenses:

Individual Family
$2,925 $5,850 Annual Deductible
$6,500 $13,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$394,14
$447,35
$503,71
$703,94
$1 069,70
$695,66
$748,87
$805,23
$1 005,46
$997,18
$1 050,39
$1 106,75
$1 306,98
$1 298,70
$1 351,91
$1 408,27
$1 608,50
$301,52
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$788,28
$894,70
$1 007,42
$1 407,88
$2 139,40
$1 089,80
$1 196,22
$1 308,94
$1 709,40
$1 391,32
$1 497,74
$1 610,46
$2 010,92
$1 692,84
$1 799,26
$1 911,98
$2 312,44
$301,52
Toc - Plan #9 Molina Healthcare
Silver

(HMO) Constant Care Silver 1

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-560-2043

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$8,500 $17,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$347,41
$394,31
$444,00
$620,48
$942,88
$613,18
$660,08
$709,77
$886,25
$878,95
$925,85
$975,54
$1 152,02
$1 144,72
$1 191,62
$1 241,31
$1 417,79
$265,77
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$694,82
$788,62
$888,00
$1 240,96
$1 885,76
$960,59
$1 054,39
$1 153,77
$1 506,73
$1 226,36
$1 320,16
$1 419,54
$1 772,50
$1 492,13
$1 585,93
$1 685,31
$2 038,27
$265,77
Toc - Plan #10 Molina Healthcare
Bronze

(HMO) Core Care Bronze 1

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-560-2043

Annual Out of Pocket Expenses:

Individual Family
$6,100 $12,200 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$275,36
$312,53
$351,91
$491,79
$747,33
$486,01
$523,18
$562,56
$702,44
$696,66
$733,83
$773,21
$913,09
$907,31
$944,48
$983,86
$1 123,74
$210,65
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$550,72
$625,06
$703,82
$983,58
$1 494,66
$761,37
$835,71
$914,47
$1 194,23
$972,02
$1 046,36
$1 125,12
$1 404,88
$1 182,67
$1 257,01
$1 335,77
$1 615,53
$210,65
Toc - Plan #11 Molina Healthcare
Silver

(HMO) Constant Care Silver 4

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-560-2043

Annual Out of Pocket Expenses:

Individual Family
$7,450 $14,900 Annual Deductible
$7,450 $14,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$343,74
$390,15
$439,30
$613,92
$932,92
$606,70
$653,11
$702,26
$876,88
$869,66
$916,07
$965,22
$1 139,84
$1 132,62
$1 179,03
$1 228,18
$1 402,80
$262,96
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$687,48
$780,30
$878,60
$1 227,84
$1 865,84
$950,44
$1 043,26
$1 141,56
$1 490,80
$1 213,40
$1 306,22
$1 404,52
$1 753,76
$1 476,36
$1 569,18
$1 667,48
$2 016,72
$262,96
Toc - Plan #12 Molina Healthcare
Expanded Bronze

(HMO) Core Care Bronze 4

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-560-2043

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$288,44
$327,38
$368,63
$515,15
$782,82
$509,10
$548,04
$589,29
$735,81
$729,76
$768,70
$809,95
$956,47
$950,42
$989,36
$1 030,61
$1 177,13
$220,66
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$576,88
$654,76
$737,26
$1 030,30
$1 565,64
$797,54
$875,42
$957,92
$1 250,96
$1 018,20
$1 096,08
$1 178,58
$1 471,62
$1 238,86
$1 316,74
$1 399,24
$1 692,28
$220,66
Toc - Plan #13 Molina Healthcare
Expanded Bronze

(HMO) Core Care Bronze 5

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-560-2043

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$280,44
$318,30
$358,41
$500,87
$761,13
$494,98
$532,84
$572,95
$715,41
$709,52
$747,38
$787,49
$929,95
$924,06
$961,92
$1 002,03
$1 144,49
$214,54
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$560,88
$636,60
$716,82
$1 001,74
$1 522,26
$775,42
$851,14
$931,36
$1 216,28
$989,96
$1 065,68
$1 145,90
$1 430,82
$1 204,50
$1 280,22
$1 360,44
$1 645,36
$214,54
Toc - Plan #14 Molina Healthcare
Gold

(HMO) Confident Care Gold 1 + Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-560-2043

Annual Out of Pocket Expenses:

Individual Family
$2,925 $5,850 Annual Deductible
$6,500 $13,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$397,26
$450,89
$507,70
$709,51
$1 078,16
$701,16
$754,79
$811,60
$1 013,41
$1 005,06
$1 058,69
$1 115,50
$1 317,31
$1 308,96
$1 362,59
$1 419,40
$1 621,21
$303,90
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$794,52
$901,78
$1 015,40
$1 419,02
$2 156,32
$1 098,42
$1 205,68
$1 319,30
$1 722,92
$1 402,32
$1 509,58
$1 623,20
$2 026,82
$1 706,22
$1 813,48
$1 927,10
$2 330,72
$303,90
Toc - Plan #15 Molina Healthcare
Silver

(HMO) Constant Care Silver 1 + Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-560-2043

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$8,500 $17,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$350,53
$397,85
$447,98
$626,05
$951,34
$618,69
$666,01
$716,14
$894,21
$886,85
$934,17
$984,30
$1 162,37
$1 155,01
$1 202,33
$1 252,46
$1 430,53
$268,16
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$701,06
$795,70
$895,96
$1 252,10
$1 902,68
$969,22
$1 063,86
$1 164,12
$1 520,26
$1 237,38
$1 332,02
$1 432,28
$1 788,42
$1 505,54
$1 600,18
$1 700,44
$2 056,58
$268,16
Toc - Plan #16 Molina Healthcare
Bronze

(HMO) Core Care Bronze 1 + Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-560-2043

Annual Out of Pocket Expenses:

Individual Family
$6,100 $12,200 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$278,48
$316,07
$355,90
$497,36
$755,79
$491,52
$529,11
$568,94
$710,40
$704,56
$742,15
$781,98
$923,44
$917,60
$955,19
$995,02
$1 136,48
$213,04
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$556,96
$632,14
$711,80
$994,72
$1 511,58
$770,00
$845,18
$924,84
$1 207,76
$983,04
$1 058,22
$1 137,88
$1 420,80
$1 196,08
$1 271,26
$1 350,92
$1 633,84
$213,04
Toc - Plan #17 Molina Healthcare
Silver

(HMO) Constant Care Silver 2

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-560-2043

Annual Out of Pocket Expenses:

Individual Family
$5,200 $10,400 Annual Deductible
$8,150 $16,300 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$347,04
$393,89
$443,52
$619,81
$941,86
$612,53
$659,38
$709,01
$885,30
$878,02
$924,87
$974,50
$1 150,79
$1 143,51
$1 190,36
$1 239,99
$1 416,28
$265,49
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$694,08
$787,78
$887,04
$1 239,62
$1 883,72
$959,57
$1 053,27
$1 152,53
$1 505,11
$1 225,06
$1 318,76
$1 418,02
$1 770,60
$1 490,55
$1 584,25
$1 683,51
$2 036,09
$265,49
Toc - Plan #18 Molina Healthcare
Bronze

(HMO) Core Care Bronze 2

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-560-2043

Annual Out of Pocket Expenses:

Individual Family
$8,000 $16,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$272,93
$309,77
$348,80
$487,45
$740,73
$481,72
$518,56
$557,59
$696,24
$690,51
$727,35
$766,38
$905,03
$899,30
$936,14
$975,17
$1 113,82
$208,79
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$545,86
$619,54
$697,60
$974,90
$1 481,46
$754,65
$828,33
$906,39
$1 183,69
$963,44
$1 037,12
$1 115,18
$1 392,48
$1 172,23
$1 245,91
$1 323,97
$1 601,27
$208,79

ADVERTISEMENT

Anthem Blue Cross and Blue Shield

Local: 1-855-748-1813 | Toll Free: 1-855-748-1813

Toc - Plan #19 Anthem Blue Cross and Blue Shield
Bronze

(HMO) Anthem Bronze Pathway X 0 for HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1813

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$283,75
$322,06
$362,63
$506,78
$770,10
$500,82
$539,13
$579,70
$723,85
$717,89
$756,20
$796,77
$940,92
$934,96
$973,27
$1 013,84
$1 157,99
$217,07
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$567,50
$644,12
$725,26
$1 013,56
$1 540,20
$784,57
$861,19
$942,33
$1 230,63
$1 001,64
$1 078,26
$1 159,40
$1 447,70
$1 218,71
$1 295,33
$1 376,47
$1 664,77
$217,07
Toc - Plan #20 Anthem Blue Cross and Blue Shield
Bronze

(HMO) Anthem Bronze Pathway X 5000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1813

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$280,71
$318,61
$358,75
$501,35
$761,85
$495,45
$533,35
$573,49
$716,09
$710,19
$748,09
$788,23
$930,83
$924,93
$962,83
$1 002,97
$1 145,57
$214,74
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$561,42
$637,22
$717,50
$1 002,70
$1 523,70
$776,16
$851,96
$932,24
$1 217,44
$990,90
$1 066,70
$1 146,98
$1 432,18
$1 205,64
$1 281,44
$1 361,72
$1 646,92
$214,74
Toc - Plan #21 Anthem Blue Cross and Blue Shield
Bronze

(HMO) Anthem Bronze Pathway X 6550

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1813

Annual Out of Pocket Expenses:

Individual Family
$6,550 $13,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$271,71
$308,39
$347,25
$485,27
$737,42
$479,57
$516,25
$555,11
$693,13
$687,43
$724,11
$762,97
$900,99
$895,29
$931,97
$970,83
$1 108,85
$207,86
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$543,42
$616,78
$694,50
$970,54
$1 474,84
$751,28
$824,64
$902,36
$1 178,40
$959,14
$1 032,50
$1 110,22
$1 386,26
$1 167,00
$1 240,36
$1 318,08
$1 594,12
$207,86
Toc - Plan #22 Anthem Blue Cross and Blue Shield
Bronze

(HMO) Anthem Bronze Pathway X 8550

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1813

Annual Out of Pocket Expenses:

Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$269,04
$305,36
$343,83
$480,51
$730,17
$474,86
$511,18
$549,65
$686,33
$680,68
$717,00
$755,47
$892,15
$886,50
$922,82
$961,29
$1 097,97
$205,82
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$538,08
$610,72
$687,66
$961,02
$1 460,34
$743,90
$816,54
$893,48
$1 166,84
$949,72
$1 022,36
$1 099,30
$1 372,66
$1 155,54
$1 228,18
$1 305,12
$1 578,48
$205,82
Toc - Plan #23 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Pathway X 4000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1813

Annual Out of Pocket Expenses:

Individual Family
$4,000 $8,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$347,69
$394,63
$444,35
$620,97
$943,63
$613,67
$660,61
$710,33
$886,95
$879,65
$926,59
$976,31
$1 152,93
$1 145,63
$1 192,57
$1 242,29
$1 418,91
$265,98
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$695,38
$789,26
$888,70
$1 241,94
$1 887,26
$961,36
$1 055,24
$1 154,68
$1 507,92
$1 227,34
$1 321,22
$1 420,66
$1 773,90
$1 493,32
$1 587,20
$1 686,64
$2 039,88
$265,98
Toc - Plan #24 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Pathway X 4750

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1813

Annual Out of Pocket Expenses:

Individual Family
$4,750 $9,500 Annual Deductible
$7,250 $14,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$348,58
$395,64
$445,49
$622,56
$946,05
$615,24
$662,30
$712,15
$889,22
$881,90
$928,96
$978,81
$1 155,88
$1 148,56
$1 195,62
$1 245,47
$1 422,54
$266,66
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$697,16
$791,28
$890,98
$1 245,12
$1 892,10
$963,82
$1 057,94
$1 157,64
$1 511,78
$1 230,48
$1 324,60
$1 424,30
$1 778,44
$1 497,14
$1 591,26
$1 690,96
$2 045,10
$266,66
Toc - Plan #25 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Pathway X 6550

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1813

Annual Out of Pocket Expenses:

Individual Family
$6,550 $13,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$332,22
$377,07
$424,58
$593,34
$901,65
$586,37
$631,22
$678,73
$847,49
$840,52
$885,37
$932,88
$1 101,64
$1 094,67
$1 139,52
$1 187,03
$1 355,79
$254,15
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$664,44
$754,14
$849,16
$1 186,68
$1 803,30
$918,59
$1 008,29
$1 103,31
$1 440,83
$1 172,74
$1 262,44
$1 357,46
$1 694,98
$1 426,89
$1 516,59
$1 611,61
$1 949,13
$254,15
Toc - Plan #26 Anthem Blue Cross and Blue Shield
Gold

(HMO) Anthem Gold Pathway X 2700

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1813

Annual Out of Pocket Expenses:

Individual Family
$2,700 $5,400 Annual Deductible
$5,350 $10,700 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$398,67
$452,49
$509,50
$712,02
$1 081,99
$703,65
$757,47
$814,48
$1 017,00
$1 008,63
$1 062,45
$1 119,46
$1 321,98
$1 313,61
$1 367,43
$1 424,44
$1 626,96
$304,98
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$797,34
$904,98
$1 019,00
$1 424,04
$2 163,98
$1 102,32
$1 209,96
$1 323,98
$1 729,02
$1 407,30
$1 514,94
$1 628,96
$2 034,00
$1 712,28
$1 819,92
$1 933,94
$2 338,98
$304,98

ADVERTISEMENT

Network Health

Local: 1-920-720-1400x1400 | Toll Free: 1-855-275-1400 | TTY: 1-800-947-3529

Toc - Plan #27 Network Health
Expanded Bronze

(HMO) Prestige Bronze 20 HDHP + Dental + Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-275-1400

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$366,63
$416,12
$468,55
$654,80
$995,03
$647,10
$696,59
$749,02
$935,27
$927,57
$977,06
$1 029,49
$1 215,74
$1 208,04
$1 257,53
$1 309,96
$1 496,21
$280,47
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$733,26
$832,24
$937,10
$1 309,60
$1 990,06
$1 013,73
$1 112,71
$1 217,57
$1 590,07
$1 294,20
$1 393,18
$1 498,04
$1 870,54
$1 574,67
$1 673,65
$1 778,51
$2 151,01
$280,47
Toc - Plan #28 Network Health
Silver

(HMO) Prestige Silver 20 HDHP + Dental + Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-275-1400

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$565,88
$642,28
$723,20
$1 010,67
$1 535,80
$998,78
$1 075,18
$1 156,10
$1 443,57
$1 431,68
$1 508,08
$1 589,00
$1 876,47
$1 864,58
$1 940,98
$2 021,90
$2 309,37
$432,90
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1 131,76
$1 284,56
$1 446,40
$2 021,34
$3 071,60
$1 564,66
$1 717,46
$1 879,30
$2 454,24
$1 997,56
$2 150,36
$2 312,20
$2 887,14
$2 430,46
$2 583,26
$2 745,10
$3 320,04
$432,90
Toc - Plan #29 Network Health
Expanded Bronze

(HMO) Prestige Bronze Essential + Dental + Vision + Fitness + 3 Free PCP Visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-275-1400

Annual Out of Pocket Expenses:

Individual Family
$7,750 $15,500 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$352,81
$400,44
$450,90
$630,12
$957,53
$622,71
$670,34
$720,80
$900,02
$892,61
$940,24
$990,70
$1 169,92
$1 162,51
$1 210,14
$1 260,60
$1 439,82
$269,90
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$705,62
$800,88
$901,80
$1 260,24
$1 915,06
$975,52
$1 070,78
$1 171,70
$1 530,14
$1 245,42
$1 340,68
$1 441,60
$1 800,04
$1 515,32
$1 610,58
$1 711,50
$2 069,94
$269,90
Toc - Plan #30 Network Health
Silver

(HMO) Prestige Silver Essential + Dental + Vision + Fitness + 3 Free PCP Visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-275-1400

Annual Out of Pocket Expenses:

Individual Family
$4,000 $8,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$540,00
$612,90
$690,12
$964,44
$1 465,56
$953,10
$1 026,00
$1 103,22
$1 377,54
$1 366,20
$1 439,10
$1 516,32
$1 790,64
$1 779,30
$1 852,20
$1 929,42
$2 203,74
$413,10
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1 080,00
$1 225,80
$1 380,24
$1 928,88
$2 931,12
$1 493,10
$1 638,90
$1 793,34
$2 341,98
$1 906,20
$2 052,00
$2 206,44
$2 755,08
$2 319,30
$2 465,10
$2 619,54
$3 168,18
$413,10
Toc - Plan #31 Network Health
Gold

(HMO) Prestige Gold Essential + Dental + Vision + Fitness + 3 Free PCP Visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-275-1400

Annual Out of Pocket Expenses:

Individual Family
$1,750 $3,500 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$535,22
$607,48
$684,01
$955,90
$1 452,58
$944,67
$1 016,93
$1 093,46
$1 365,35
$1 354,12
$1 426,38
$1 502,91
$1 774,80
$1 763,57
$1 835,83
$1 912,36
$2 184,25
$409,45
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1 070,44
$1 214,96
$1 368,02
$1 911,80
$2 905,16
$1 479,89
$1 624,41
$1 777,47
$2 321,25
$1 889,34
$2 033,86
$2 186,92
$2 730,70
$2 298,79
$2 443,31
$2 596,37
$3 140,15
$409,45
Toc - Plan #32 Network Health
Expanded Bronze

(HMO) Prestige Bronze 0 + Dental + Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-275-1400

Annual Out of Pocket Expenses:

Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$328,04
$372,32
$419,23
$585,87
$890,28
$578,99
$623,27
$670,18
$836,82
$829,94
$874,22
$921,13
$1 087,77
$1 080,89
$1 125,17
$1 172,08
$1 338,72
$250,95
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$656,08
$744,64
$838,46
$1 171,74
$1 780,56
$907,03
$995,59
$1 089,41
$1 422,69
$1 157,98
$1 246,54
$1 340,36
$1 673,64
$1 408,93
$1 497,49
$1 591,31
$1 924,59
$250,95
Toc - Plan #33 Network Health
Gold

(HMO) Prestige Gold 50 + Dental + Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-275-1400

Annual Out of Pocket Expenses:

Individual Family
$1,000 $2,000 Annual Deductible
$4,300 $8,600 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$551,96
$626,47
$705,40
$985,80
$1 498,01
$974,21
$1 048,72
$1 127,65
$1 408,05
$1 396,46
$1 470,97
$1 549,90
$1 830,30
$1 818,71
$1 893,22
$1 972,15
$2 252,55
$422,25
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1 103,92
$1 252,94
$1 410,80
$1 971,60
$2 996,02
$1 526,17
$1 675,19
$1 833,05
$2 393,85
$1 948,42
$2 097,44
$2 255,30
$2 816,10
$2 370,67
$2 519,69
$2 677,55
$3 238,35
$422,25
Toc - Plan #34 Network Health
Gold

(HMO) Prestige Gold 0 HDHP + Dental + Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-275-1400

Annual Out of Pocket Expenses:

Individual Family
$2,800 $5,600 Annual Deductible
$5,000 $10,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$559,28
$634,78
$714,76
$998,87
$1 517,88
$987,13
$1 062,63
$1 142,61
$1 426,72
$1 414,98
$1 490,48
$1 570,46
$1 854,57
$1 842,83
$1 918,33
$1 998,31
$2 282,42
$427,85
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1 118,56
$1 269,56
$1 429,52
$1 997,74
$3 035,76
$1 546,41
$1 697,41
$1 857,37
$2 425,59
$1 974,26
$2 125,26
$2 285,22
$2 853,44
$2 402,11
$2 553,11
$2 713,07
$3 281,29
$427,85

ADVERTISEMENT

Arise Health Plan

Local: 1-920-490-6900 | Toll Free: 1-800-332-6249 | TTY: 1-888-332-0144

Toc - Plan #35 Arise Health Plan
Bronze

(HMO) WPS HMO Bronze $8,550 | Select Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-332-6249

Annual Out of Pocket Expenses:

Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$297,75
$337,95
$380,52
$531,78
$808,09
$525,53
$565,73
$608,30
$759,56
$753,31
$793,51
$836,08
$987,34
$981,09
$1 021,29
$1 063,86
$1 215,12
$227,78
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$595,50
$675,90
$761,04
$1 063,56
$1 616,18
$823,28
$903,68
$988,82
$1 291,34
$1 051,06
$1 131,46
$1 216,60
$1 519,12
$1 278,84
$1 359,24
$1 444,38
$1 746,90
$227,78
Toc - Plan #36 Arise Health Plan
Expanded Bronze

(HMO) WPS HMO Bronze $6,500 with 3 Free PCP Visits | Select Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-332-6249

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$309,16
$350,90
$395,11
$552,16
$839,06
$545,67
$587,41
$631,62
$788,67
$782,18
$823,92
$868,13
$1 025,18
$1 018,69
$1 060,43
$1 104,64
$1 261,69
$236,51
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$618,32
$701,80
$790,22
$1 104,32
$1 678,12
$854,83
$938,31
$1 026,73
$1 340,83
$1 091,34
$1 174,82
$1 263,24
$1 577,34
$1 327,85
$1 411,33
$1 499,75
$1 813,85
$236,51
Toc - Plan #37 Arise Health Plan
Expanded Bronze

(HMO) WPS HMO Bronze $7,200 | Select Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-332-6249

Annual Out of Pocket Expenses:

Individual Family
$7,200 $14,400 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$302,91
$343,80
$387,12
$541,00
$822,10
$534,64
$575,53
$618,85
$772,73
$766,37
$807,26
$850,58
$1 004,46
$998,10
$1 038,99
$1 082,31
$1 236,19
$231,73
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$605,82
$687,60
$774,24
$1 082,00
$1 644,20
$837,55
$919,33
$1 005,97
$1 313,73
$1 069,28
$1 151,06
$1 237,70
$1 545,46
$1 301,01
$1 382,79
$1 469,43
$1 777,19
$231,73
Toc - Plan #38 Arise Health Plan
Silver

(HMO) WPS HMO Silver $7,500 | Select Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-332-6249

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$400,27
$454,31
$511,55
$714,88
$1 086,33
$706,48
$760,52
$817,76
$1 021,09
$1 012,69
$1 066,73
$1 123,97
$1 327,30
$1 318,90
$1 372,94
$1 430,18
$1 633,51
$306,21
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$800,54
$908,62
$1 023,10
$1 429,76
$2 172,66
$1 106,75
$1 214,83
$1 329,31
$1 735,97
$1 412,96
$1 521,04
$1 635,52
$2 042,18
$1 719,17
$1 827,25
$1 941,73
$2 348,39
$306,21
Toc - Plan #39 Arise Health Plan
Silver

(HMO) WPS HMO Silver $4,500 | Select Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-332-6249

Annual Out of Pocket Expenses:

Individual Family
$4,500 $9,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$401,22
$455,38
$512,76
$716,58
$1 088,91
$708,15
$762,31
$819,69
$1 023,51
$1 015,08
$1 069,24
$1 126,62
$1 330,44
$1 322,01
$1 376,17
$1 433,55
$1 637,37
$306,93
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$802,44
$910,76
$1 025,52
$1 433,16
$2 177,82
$1 109,37
$1 217,69
$1 332,45
$1 740,09
$1 416,30
$1 524,62
$1 639,38
$2 047,02
$1 723,23
$1 831,55
$1 946,31
$2 353,95
$306,93
Toc - Plan #40 Arise Health Plan
Silver

(HMO) WPS HMO Silver $5,000 with 3 Free PCP Visits | Select Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-332-6249

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$417,35
$473,69
$533,37
$745,39
$1 132,69
$736,62
$792,96
$852,64
$1 064,66
$1 055,89
$1 112,23
$1 171,91
$1 383,93
$1 375,16
$1 431,50
$1 491,18
$1 703,20
$319,27
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$834,70
$947,38
$1 066,74
$1 490,78
$2 265,38
$1 153,97
$1 266,65
$1 386,01
$1 810,05
$1 473,24
$1 585,92
$1 705,28
$2 129,32
$1 792,51
$1 905,19
$2 024,55
$2 448,59
$319,27
Toc - Plan #41 Arise Health Plan
Gold

(HMO) WPS HMO Gold $2,500 | Select Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-332-6249

Annual Out of Pocket Expenses:

Individual Family
$2,500 $5,000 Annual Deductible
$5,000 $10,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$552,84
$627,47
$706,53
$987,37
$1 500,41
$975,76
$1 050,39
$1 129,45
$1 410,29
$1 398,68
$1 473,31
$1 552,37
$1 833,21
$1 821,60
$1 896,23
$1 975,29
$2 256,13
$422,92
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1 105,68
$1 254,94
$1 413,06
$1 974,74
$3 000,82
$1 528,60
$1 677,86
$1 835,98
$2 397,66
$1 951,52
$2 100,78
$2 258,90
$2 820,58
$2 374,44
$2 523,70
$2 681,82
$3 243,50
$422,92
Toc - Plan #42 Arise Health Plan
Catastrophic

(HMO) WPS HMO Catastrophic $8,550 with 3 Free PCP Visits | Select Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-332-6249

Annual Out of Pocket Expenses:

Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$258,85
$293,79
$330,81
$462,31
$702,52
$456,87
$491,81
$528,83
$660,33
$654,89
$689,83
$726,85
$858,35
$852,91
$887,85
$924,87
$1 056,37
$198,02
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$517,70
$587,58
$661,62
$924,62
$1 405,04
$715,72
$785,60
$859,64
$1 122,64
$913,74
$983,62
$1 057,66
$1 320,66
$1 111,76
$1 181,64
$1 255,68
$1 518,68
$198,02
Toc - Plan #43 Arise Health Plan
Expanded Bronze

(HMO) WPS HMO HDHP Bronze $7,000 | Select Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-332-6249

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$309,54
$351,33
$395,59
$552,84
$840,09
$546,34
$588,13
$632,39
$789,64
$783,14
$824,93
$869,19
$1 026,44
$1 019,94
$1 061,73
$1 105,99
$1 263,24
$236,80
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$619,08
$702,66
$791,18
$1 105,68
$1 680,18
$855,88
$939,46
$1 027,98
$1 342,48
$1 092,68
$1 176,26
$1 264,78
$1 579,28
$1 329,48
$1 413,06
$1 501,58
$1 816,08
$236,80
Toc - Plan #44 Arise Health Plan
Expanded Bronze

(HMO) WPS HMO HDHP Bronze $6,830 | Select Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-332-6249

Annual Out of Pocket Expenses:

Individual Family
$6,830 $13,660 Annual Deductible
$6,830 $13,660 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$315,85
$358,49
$403,66
$564,11
$857,22
$557,48
$600,12
$645,29
$805,74
$799,11
$841,75
$886,92
$1 047,37
$1 040,74
$1 083,38
$1 128,55
$1 289,00
$241,63
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$631,70
$716,98
$807,32
$1 128,22
$1 714,44
$873,33
$958,61
$1 048,95
$1 369,85
$1 114,96
$1 200,24
$1 290,58
$1 611,48
$1 356,59
$1 441,87
$1 532,21
$1 853,11
$241,63
Toc - Plan #45 Arise Health Plan
Expanded Bronze

(HMO) WPS HMO HDHP Bronze $6,000 | Select Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-332-6249

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$310,18
$352,05
$396,41
$553,98
$841,83
$547,47
$589,34
$633,70
$791,27
$784,76
$826,63
$870,99
$1 028,56
$1 022,05
$1 063,92
$1 108,28
$1 265,85
$237,29
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$620,36
$704,10
$792,82
$1 107,96
$1 683,66
$857,65
$941,39
$1 030,11
$1 345,25
$1 094,94
$1 178,68
$1 267,40
$1 582,54
$1 332,23
$1 415,97
$1 504,69
$1 819,83
$237,29
Toc - Plan #46 Arise Health Plan
Silver

(HMO) WPS HMO HDHP Silver $2,800 | Select Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-332-6249

Annual Out of Pocket Expenses:

Individual Family
$2,800 $5,600 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$411,36
$466,89
$525,72
$734,69
$1 116,43
$726,05
$781,58
$840,41
$1 049,38
$1 040,74
$1 096,27
$1 155,10
$1 364,07
$1 355,43
$1 410,96
$1 469,79
$1 678,76
$314,69
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$822,72
$933,78
$1 051,44
$1 469,38
$2 232,86
$1 137,41
$1 248,47
$1 366,13
$1 784,07
$1 452,10
$1 563,16
$1 680,82
$2 098,76
$1 766,79
$1 877,85
$1 995,51
$2 413,45
$314,69
Toc - Plan #47 Arise Health Plan
Silver

(HMO) WPS HMO HDHP Silver $4,500 | Select Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-332-6249

Annual Out of Pocket Expenses:

Individual Family
$4,500 $9,000 Annual Deductible
$4,500 $9,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$410,40
$465,80
$524,49
$732,97
$1 113,83
$724,36
$779,76
$838,45
$1 046,93
$1 038,32
$1 093,72
$1 152,41
$1 360,89
$1 352,28
$1 407,68
$1 466,37
$1 674,85
$313,96
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$820,80
$931,60
$1 048,98
$1 465,94
$2 227,66
$1 134,76
$1 245,56
$1 362,94
$1 779,90
$1 448,72
$1 559,52
$1 676,90
$2 093,86
$1 762,68
$1 873,48
$1 990,86
$2 407,82
$313,96
Toc - Plan #48 Arise Health Plan
Silver

(HMO) WPS HMO HDHP Silver $5,500 | Select Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-332-6249

Annual Out of Pocket Expenses:

Individual Family
$5,500 $11,000 Annual Deductible
$5,500 $11,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$389,68
$442,29
$498,01
$695,97
$1 057,59
$687,79
$740,40
$796,12
$994,08
$985,90
$1 038,51
$1 094,23
$1 292,19
$1 284,01
$1 336,62
$1 392,34
$1 590,30
$298,11
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$779,36
$884,58
$996,02
$1 391,94
$2 115,18
$1 077,47
$1 182,69
$1 294,13
$1 690,05
$1 375,58
$1 480,80
$1 592,24
$1 988,16
$1 673,69
$1 778,91
$1 890,35
$2 286,27
$298,11
Toc - Plan #49 Arise Health Plan
Bronze

(POS) WPS POS Bronze $8,550 | Select Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-332-6249

Annual Out of Pocket Expenses:

Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$318,47
$361,46
$407,00
$568,79
$864,33
$562,10
$605,09
$650,63
$812,42
$805,73
$848,72
$894,26
$1 056,05
$1 049,36
$1 092,35
$1 137,89
$1 299,68
$243,63
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$636,94
$722,92
$814,00
$1 137,58
$1 728,66
$880,57
$966,55
$1 057,63
$1 381,21
$1 124,20
$1 210,18
$1 301,26
$1 624,84
$1 367,83
$1 453,81
$1 544,89
$1 868,47
$243,63
Toc - Plan #50 Arise Health Plan
Expanded Bronze

(POS) WPS POS HDHP Bronze $6,000 | Select Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-332-6249

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$331,72
$376,50
$423,94
$592,45
$900,29
$585,49
$630,27
$677,71
$846,22
$839,26
$884,04
$931,48
$1 099,99
$1 093,03
$1 137,81
$1 185,25
$1 353,76
$253,77
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$663,44
$753,00
$847,88
$1 184,90
$1 800,58
$917,21
$1 006,77
$1 101,65
$1 438,67
$1 170,98
$1 260,54
$1 355,42
$1 692,44
$1 424,75
$1 514,31
$1 609,19
$1 946,21
$253,77

ADVERTISEMENT

Common Ground Healthcare Cooperative

Local: 1-877-514-2442 | Toll Free: 1-877-514-2442 | TTY: 1-844-472-2442

Toc - Plan #51 Common Ground Healthcare Cooperative
Gold

(EPO) Envision - Gold 1800/80

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-514-2442

Annual Out of Pocket Expenses:

Individual Family
$1,800 $3,600 Annual Deductible
$6,500 $13,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$413,89
$469,75
$528,94
$739,18
$1 123,26
$730,51
$786,37
$845,56
$1 055,80
$1 047,13
$1 102,99
$1 162,18
$1 372,42
$1 363,75
$1 419,61
$1 478,80
$1 689,04
$316,62
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$827,78
$939,50
$1 057,88
$1 478,36
$2 246,52
$1 144,40
$1 256,12
$1 374,50
$1 794,98
$1 461,02
$1 572,74
$1 691,12
$2 111,60
$1 777,64
$1 889,36
$2 007,74
$2 428,22
$316,62
Toc - Plan #52 Common Ground Healthcare Cooperative
Gold

(EPO) Envision - Gold 2000/80

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-514-2442

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$389,13
$441,66
$497,30
$694,98
$1 056,08
$686,81
$739,34
$794,98
$992,66
$984,49
$1 037,02
$1 092,66
$1 290,34
$1 282,17
$1 334,70
$1 390,34
$1 588,02
$297,68
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$778,26
$883,32
$994,60
$1 389,96
$2 112,16
$1 075,94
$1 181,00
$1 292,28
$1 687,64
$1 373,62
$1 478,68
$1 589,96
$1 985,32
$1 671,30
$1 776,36
$1 887,64
$2 283,00
$297,68
Toc - Plan #53 Common Ground Healthcare Cooperative
Silver

(EPO) Envision - Silver 4000/75

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-514-2442

Annual Out of Pocket Expenses:

Individual Family
$4,000 $8,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$380,58
$431,95
$486,37
$679,71
$1 032,88
$671,72
$723,09
$777,51
$970,85
$962,86
$1 014,23
$1 068,65
$1 261,99
$1 254,00
$1 305,37
$1 359,79
$1 553,13
$291,14
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$761,16
$863,90
$972,74
$1 359,42
$2 065,76
$1 052,30
$1 155,04
$1 263,88
$1 650,56
$1 343,44
$1 446,18
$1 555,02
$1 941,70
$1 634,58
$1 737,32
$1 846,16
$2 232,84
$291,14
Toc - Plan #54 Common Ground Healthcare Cooperative
Silver

(EPO) Envision - Silver 3000/75/Copay40

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-514-2442

Annual Out of Pocket Expenses:

Individual Family
$3,000 $6,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$398,02
$451,74
$508,66
$710,84
$1 080,20
$702,50
$756,22
$813,14
$1 015,32
$1 006,98
$1 060,70
$1 117,62
$1 319,80
$1 311,46
$1 365,18
$1 422,10
$1 624,28
$304,48
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$796,04
$903,48
$1 017,32
$1 421,68
$2 160,40
$1 100,52
$1 207,96
$1 321,80
$1 726,16
$1 405,00
$1 512,44
$1 626,28
$2 030,64
$1 709,48
$1 816,92
$1 930,76
$2 335,12
$304,48
Toc - Plan #55 Common Ground Healthcare Cooperative
Catastrophic

(EPO) Envision - Catastrophic 8550/100

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-514-2442

Annual Out of Pocket Expenses:

Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$188,35
$213,77
$240,70
$336,38
$511,16
$332,43
$357,85
$384,78
$480,46
$476,51
$501,93
$528,86
$624,54
$620,59
$646,01
$672,94
$768,62
$144,08
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$376,70
$427,54
$481,40
$672,76
$1 022,32
$520,78
$571,62
$625,48
$816,84
$664,86
$715,70
$769,56
$960,92
$808,94
$859,78
$913,64
$1 105,00
$144,08
Toc - Plan #56 Common Ground Healthcare Cooperative
Expanded Bronze

(EPO) Envision - Bronze 8550/100

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-514-2442

Annual Out of Pocket Expenses:

Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$264,98
$300,75
$338,64
$473,25
$719,14
$467,69
$503,46
$541,35
$675,96
$670,40
$706,17
$744,06
$878,67
$873,11
$908,88
$946,77
$1 081,38
$202,71
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$529,96
$601,50
$677,28
$946,50
$1 438,28
$732,67
$804,21
$879,99
$1 149,21
$935,38
$1 006,92
$1 082,70
$1 351,92
$1 138,09
$1 209,63
$1 285,41
$1 554,63
$202,71
Toc - Plan #57 Common Ground Healthcare Cooperative
Expanded Bronze

(EPO) Envision - Bronze 8150/ 100

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-514-2442

Annual Out of Pocket Expenses:

Individual Family
$8,150 $16,300 Annual Deductible
$8,150 $16,300 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$282,26
$320,36
$360,72
$504,10
$766,03
$498,18
$536,28
$576,64
$720,02
$714,10
$752,20
$792,56
$935,94
$930,02
$968,12
$1 008,48
$1 151,86
$215,92
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$564,52
$640,72
$721,44
$1 008,20
$1 532,06
$780,44
$856,64
$937,36
$1 224,12
$996,36
$1 072,56
$1 153,28
$1 440,04
$1 212,28
$1 288,48
$1 369,20
$1 655,96
$215,92
Toc - Plan #58 Common Ground Healthcare Cooperative
Expanded Bronze

(EPO) Envision - HSA Bronze 7000/100

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-514-2442

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$279,98
$317,76
$357,80
$500,02
$759,83
$494,15
$531,93
$571,97
$714,19
$708,32
$746,10
$786,14
$928,36
$922,49
$960,27
$1 000,31
$1 142,53
$214,17
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$559,96
$635,52
$715,60
$1 000,04
$1 519,66
$774,13
$849,69
$929,77
$1 214,21
$988,30
$1 063,86
$1 143,94
$1 428,38
$1 202,47
$1 278,03
$1 358,11
$1 642,55
$214,17
Toc - Plan #59 Common Ground Healthcare Cooperative
Silver

(EPO) Envision - Silver 7000/75

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-514-2442

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$316,43
$359,14
$404,39
$565,13
$858,77
$558,49
$601,20
$646,45
$807,19
$800,55
$843,26
$888,51
$1 049,25
$1 042,61
$1 085,32
$1 130,57
$1 291,31
$242,06
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$632,86
$718,28
$808,78
$1 130,26
$1 717,54
$874,92
$960,34
$1 050,84
$1 372,32
$1 116,98
$1 202,40
$1 292,90
$1 614,38
$1 359,04
$1 444,46
$1 534,96
$1 856,44
$242,06

‡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 Milwaukee County here.

Milwaukee County is in “Rating Area 1” of Wisconsin.

Currently, there are 59 plans offered in Rating Area 1.

Top

2021 Obamacare Plans for Milwaukee County, WI

Plan Browser: 59 Plans
scroll down for more
Speak with a Health Insurance Expert 800-943-6832Ads by +HealthNetwork