Obamacare 2023 Rates for Dodge County
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QuartzLocal: 1-608-644-3430 | Toll Free: 1-800-362-3310 | TTY: 1-800-877-8973 |
Toc - Plan #1 Quartz | ||||||||||||||||||||
Silver
(HMO) QUARTZ ONE SILVER I303 with Dental & Vision |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$512.03 $581.15 $654.37 $914.49 $1,389.65 |
$903.73 $972.85 $1,046.07 $1,306.19 |
$1,295.43 $1,364.55 $1,437.77 $1,697.89 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$1,024.06 $1,162.30 $1,308.74 $1,828.98 $2,779.30 |
$1,415.76 $1,554.00 $1,700.44 $2,220.68 |
$1,807.46 $1,945.70 $2,092.14 $2,612.38 |
Toc - Plan #2 Quartz | ||||||||||||||||||||
Silver
(HMO) QUARTZ ONE SILVER I308 with Dental & Vision |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$537.22 $609.74 $686.56 $959.46 $1,458.00 |
$948.19 $1,020.71 $1,097.53 $1,370.43 |
$1,359.16 $1,431.68 $1,508.50 $1,781.40 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$1,074.44 $1,219.48 $1,373.12 $1,918.92 $2,916.00 |
$1,485.41 $1,630.45 $1,784.09 $2,329.89 |
$1,896.38 $2,041.42 $2,195.06 $2,740.86 |
Toc - Plan #3 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One Silver I309 Standard with Dental & Vision |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$562.65 $638.61 $719.07 $1,004.89 $1,527.03 |
$993.08 $1,069.04 $1,149.50 $1,435.32 |
$1,423.51 $1,499.47 $1,579.93 $1,865.75 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$1,125.30 $1,277.22 $1,438.14 $2,009.78 $3,054.06 |
$1,555.73 $1,707.65 $1,868.57 $2,440.21 |
$1,986.16 $2,138.08 $2,299.00 $2,870.64 |
Toc - Plan #4 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I201 with Dental & Vision |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$380.83 $432.23 $486.69 $680.15 $1,033.55 |
$672.16 $723.56 $778.02 $971.48 |
$963.49 $1,014.89 $1,069.35 $1,262.81 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$761.66 $864.46 $973.38 $1,360.30 $2,067.10 |
$1,052.99 $1,155.79 $1,264.71 $1,651.63 |
$1,344.32 $1,447.12 $1,556.04 $1,942.96 |
Toc - Plan #5 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I202 with Dental & Vision |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$384.60 $436.51 $491.51 $686.88 $1,043.78 |
$678.81 $730.72 $785.72 $981.09 |
$973.02 $1,024.93 $1,079.93 $1,275.30 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$769.20 $873.02 $983.02 $1,373.76 $2,087.56 |
$1,063.41 $1,167.23 $1,277.23 $1,667.97 |
$1,357.62 $1,461.44 $1,571.44 $1,962.18 |
Toc - Plan #6 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I204 with Dental & Vision |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$403.14 $457.56 $515.20 $719.99 $1,094.10 |
$711.54 $765.96 $823.60 $1,028.39 |
$1,019.94 $1,074.36 $1,132.00 $1,336.79 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$806.28 $915.12 $1,030.40 $1,439.98 $2,188.20 |
$1,114.68 $1,223.52 $1,338.80 $1,748.38 |
$1,423.08 $1,531.92 $1,647.20 $2,056.78 |
Toc - Plan #7 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I205 with Dental & Vision |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$399.02 $452.88 $509.94 $712.64 $1,082.92 |
$704.26 $758.12 $815.18 $1,017.88 |
$1,009.50 $1,063.36 $1,120.42 $1,323.12 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$798.04 $905.76 $1,019.88 $1,425.28 $2,165.84 |
$1,103.28 $1,211.00 $1,325.12 $1,730.52 |
$1,408.52 $1,516.24 $1,630.36 $2,035.76 |
Toc - Plan #8 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One Bronze I206 Standard with Dental & Vision |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$415.44 $471.52 $530.93 $741.97 $1,127.50 |
$733.25 $789.33 $848.74 $1,059.78 |
$1,051.06 $1,107.14 $1,166.55 $1,377.59 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$830.88 $943.04 $1,061.86 $1,483.94 $2,255.00 |
$1,148.69 $1,260.85 $1,379.67 $1,801.75 |
$1,466.50 $1,578.66 $1,697.48 $2,119.56 |
Toc - Plan #9 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I407 Maintenance with Dental & Vision |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$520.83 $591.13 $665.61 $930.19 $1,413.51 |
$919.26 $989.56 $1,064.04 $1,328.62 |
$1,317.69 $1,387.99 $1,462.47 $1,727.05 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$1,041.66 $1,182.26 $1,331.22 $1,860.38 $2,827.02 |
$1,440.09 $1,580.69 $1,729.65 $2,258.81 |
$1,838.52 $1,979.12 $2,128.08 $2,657.24 |
Toc - Plan #10 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I406 with Dental & Vision |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$455.81 $517.33 $582.51 $814.06 $1,237.05 |
$804.50 $866.02 $931.20 $1,162.75 |
$1,153.19 $1,214.71 $1,279.89 $1,511.44 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$911.62 $1,034.66 $1,165.02 $1,628.12 $2,474.10 |
$1,260.31 $1,383.35 $1,513.71 $1,976.81 |
$1,609.00 $1,732.04 $1,862.40 $2,325.50 |
Toc - Plan #11 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I409 with Dental & Vision |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$464.85 $527.60 $594.07 $830.21 $1,261.59 |
$820.46 $883.21 $949.68 $1,185.82 |
$1,176.07 $1,238.82 $1,305.29 $1,541.43 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$929.70 $1,055.20 $1,188.14 $1,660.42 $2,523.18 |
$1,285.31 $1,410.81 $1,543.75 $2,016.03 |
$1,640.92 $1,766.42 $1,899.36 $2,371.64 |
Toc - Plan #12 Quartz | ||||||||||||||||||||
Silver
(HMO) Tiered Choice Plus Silver I305 with Dental & Vision |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$489.70 $555.81 $625.83 $874.60 $1,329.04 |
$864.32 $930.43 $1,000.45 $1,249.22 |
$1,238.94 $1,305.05 $1,375.07 $1,623.84 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$979.40 $1,111.62 $1,251.66 $1,749.20 $2,658.08 |
$1,354.02 $1,486.24 $1,626.28 $2,123.82 |
$1,728.64 $1,860.86 $2,000.90 $2,498.44 |
Toc - Plan #13 Quartz | ||||||||||||||||||||
Gold
(HMO) Quartz One Gold I410 Standard with Dental & Vision |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$513.96 $583.34 $656.84 $917.93 $1,394.88 |
$907.14 $976.52 $1,050.02 $1,311.11 |
$1,300.32 $1,369.70 $1,443.20 $1,704.29 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$1,027.92 $1,166.68 $1,313.68 $1,835.86 $2,789.76 |
$1,421.10 $1,559.86 $1,706.86 $2,229.04 |
$1,814.28 $1,953.04 $2,100.04 $2,622.22 |
Toc - Plan #14 Quartz | ||||||||||||||||||||
Silver
(HMO) QUARTZ ONE SILVER I303 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$489.33 $555.39 $625.36 $873.94 $1,328.04 |
$863.67 $929.73 $999.70 $1,248.28 |
$1,238.01 $1,304.07 $1,374.04 $1,622.62 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$978.66 $1,110.78 $1,250.72 $1,747.88 $2,656.08 |
$1,353.00 $1,485.12 $1,625.06 $2,122.22 |
$1,727.34 $1,859.46 $1,999.40 $2,496.56 |
Toc - Plan #15 Quartz | ||||||||||||||||||||
Silver
(HMO) QUARTZ ONE SILVER I308 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$513.40 $582.70 $656.12 $916.93 $1,393.36 |
$906.15 $975.45 $1,048.87 $1,309.68 |
$1,298.90 $1,368.20 $1,441.62 $1,702.43 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$1,026.80 $1,165.40 $1,312.24 $1,833.86 $2,786.72 |
$1,419.55 $1,558.15 $1,704.99 $2,226.61 |
$1,812.30 $1,950.90 $2,097.74 $2,619.36 |
Toc - Plan #16 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One Silver I309 Standard |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$537.71 $610.29 $687.19 $960.34 $1,459.33 |
$949.05 $1,021.63 $1,098.53 $1,371.68 |
$1,360.39 $1,432.97 $1,509.87 $1,783.02 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$1,075.42 $1,220.58 $1,374.38 $1,920.68 $2,918.66 |
$1,486.76 $1,631.92 $1,785.72 $2,332.02 |
$1,898.10 $2,043.26 $2,197.06 $2,743.36 |
Toc - Plan #17 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I201 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$363.94 $413.07 $465.11 $649.99 $987.73 |
$642.35 $691.48 $743.52 $928.40 |
$920.76 $969.89 $1,021.93 $1,206.81 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$727.88 $826.14 $930.22 $1,299.98 $1,975.46 |
$1,006.29 $1,104.55 $1,208.63 $1,578.39 |
$1,284.70 $1,382.96 $1,487.04 $1,856.80 |
Toc - Plan #18 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I202 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$367.55 $417.16 $469.72 $656.43 $997.50 |
$648.72 $698.33 $750.89 $937.60 |
$929.89 $979.50 $1,032.06 $1,218.77 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$735.10 $834.32 $939.44 $1,312.86 $1,995.00 |
$1,016.27 $1,115.49 $1,220.61 $1,594.03 |
$1,297.44 $1,396.66 $1,501.78 $1,875.20 |
Toc - Plan #19 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I204 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$385.26 $437.27 $492.36 $688.07 $1,045.59 |
$679.98 $731.99 $787.08 $982.79 |
$974.70 $1,026.71 $1,081.80 $1,277.51 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$770.52 $874.54 $984.72 $1,376.14 $2,091.18 |
$1,065.24 $1,169.26 $1,279.44 $1,670.86 |
$1,359.96 $1,463.98 $1,574.16 $1,965.58 |
Toc - Plan #20 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I205 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$381.33 $432.80 $487.33 $681.04 $1,034.91 |
$673.04 $724.51 $779.04 $972.75 |
$964.75 $1,016.22 $1,070.75 $1,264.46 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$762.66 $865.60 $974.66 $1,362.08 $2,069.82 |
$1,054.37 $1,157.31 $1,266.37 $1,653.79 |
$1,346.08 $1,449.02 $1,558.08 $1,945.50 |
Toc - Plan #21 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One Bronze I206 Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$397.03 $450.62 $507.39 $709.08 $1,077.51 |
$700.75 $754.34 $811.11 $1,012.80 |
$1,004.47 $1,058.06 $1,114.83 $1,316.52 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$794.06 $901.24 $1,014.78 $1,418.16 $2,155.02 |
$1,097.78 $1,204.96 $1,318.50 $1,721.88 |
$1,401.50 $1,508.68 $1,622.22 $2,025.60 |
Toc - Plan #22 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I407 Maintenance |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$497.74 $564.93 $636.10 $888.95 $1,350.85 |
$878.51 $945.70 $1,016.87 $1,269.72 |
$1,259.28 $1,326.47 $1,397.64 $1,650.49 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$995.48 $1,129.86 $1,272.20 $1,777.90 $2,701.70 |
$1,376.25 $1,510.63 $1,652.97 $2,158.67 |
$1,757.02 $1,891.40 $2,033.74 $2,539.44 |
Toc - Plan #23 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I406 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$435.60 $494.40 $556.69 $777.97 $1,182.20 |
$768.83 $827.63 $889.92 $1,111.20 |
$1,102.06 $1,160.86 $1,223.15 $1,444.43 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$871.20 $988.80 $1,113.38 $1,555.94 $2,364.40 |
$1,204.43 $1,322.03 $1,446.61 $1,889.17 |
$1,537.66 $1,655.26 $1,779.84 $2,222.40 |
Toc - Plan #24 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I409 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$444.24 $504.21 $567.73 $793.40 $1,205.66 |
$784.08 $844.05 $907.57 $1,133.24 |
$1,123.92 $1,183.89 $1,247.41 $1,473.08 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$888.48 $1,008.42 $1,135.46 $1,586.80 $2,411.32 |
$1,228.32 $1,348.26 $1,475.30 $1,926.64 |
$1,568.16 $1,688.10 $1,815.14 $2,266.48 |
Toc - Plan #25 Quartz | ||||||||||||||||||||
Silver
(HMO) Tiered Choice Plus Silver I305 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$467.99 $531.16 $598.08 $835.82 $1,270.11 |
$826.00 $889.17 $956.09 $1,193.83 |
$1,184.01 $1,247.18 $1,314.10 $1,551.84 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$935.98 $1,062.32 $1,196.16 $1,671.64 $2,540.22 |
$1,293.99 $1,420.33 $1,554.17 $2,029.65 |
$1,652.00 $1,778.34 $1,912.18 $2,387.66 |
Toc - Plan #26 Quartz | ||||||||||||||||||||
Gold
(HMO) Quartz One Gold I410 Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$491.17 $557.48 $627.72 $877.23 $1,333.03 |
$866.91 $933.22 $1,003.46 $1,252.97 |
$1,242.65 $1,308.96 $1,379.20 $1,628.71 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$982.34 $1,114.96 $1,255.44 $1,754.46 $2,666.06 |
$1,358.08 $1,490.70 $1,631.18 $2,130.20 |
$1,733.82 $1,866.44 $2,006.92 $2,505.94 |
Toc - Plan #27 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I408 HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$461.19 $523.44 $589.39 $823.67 $1,251.65 |
$814.00 $876.25 $942.20 $1,176.48 |
$1,166.81 $1,229.06 $1,295.01 $1,529.29 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$922.38 $1,046.88 $1,178.78 $1,647.34 $2,503.30 |
$1,275.19 $1,399.69 $1,531.59 $2,000.15 |
$1,628.00 $1,752.50 $1,884.40 $2,352.96 |
Toc - Plan #28 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I203 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$382.47 $434.09 $488.79 $683.08 $1,038.00 |
$675.05 $726.67 $781.37 $975.66 |
$967.63 $1,019.25 $1,073.95 $1,268.24 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$764.94 $868.18 $977.58 $1,366.16 $2,076.00 |
$1,057.52 $1,160.76 $1,270.16 $1,658.74 |
$1,350.10 $1,453.34 $1,562.74 $1,951.32 |
Toc - Plan #29 Quartz | ||||||||||||||||||||
Catastrophic
(HMO) QUARTZ ONE CATASTROPHIC I101 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$281.95 $320.00 $360.32 $503.55 $765.19 |
$497.64 $535.69 $576.01 $719.24 |
$713.33 $751.38 $791.70 $934.93 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$563.90 $640.00 $720.64 $1,007.10 $1,530.38 |
$779.59 $855.69 $936.33 $1,222.79 |
$995.28 $1,071.38 $1,152.02 $1,438.48 |
Toc - Plan #30 Quartz | ||||||||||||||||||||
Silver
(HMO) Tiered Choice Plus Silver I310 HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$514.65 $584.12 $657.71 $919.15 $1,396.74 |
$908.35 $977.82 $1,051.41 $1,312.85 |
$1,302.05 $1,371.52 $1,445.11 $1,706.55 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,029.30 $1,168.24 $1,315.42 $1,838.30 $2,793.48 |
$1,423.00 $1,561.94 $1,709.12 $2,232.00 |
$1,816.70 $1,955.64 $2,102.82 $2,625.70 |
Toc - Plan #31 Quartz | ||||||||||||||||||||
Silver
(HMO) Tiered Choice Plus Silver I311 HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$504.51 $572.61 $644.75 $901.04 $1,369.22 |
$890.45 $958.55 $1,030.69 $1,286.98 |
$1,276.39 $1,344.49 $1,416.63 $1,672.92 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,009.02 $1,145.22 $1,289.50 $1,802.08 $2,738.44 |
$1,394.96 $1,531.16 $1,675.44 $2,188.02 |
$1,780.90 $1,917.10 $2,061.38 $2,573.96 |
Toc - Plan #32 Quartz | ||||||||||||||||||||
Silver
(HMO) QUARTZ ONE SILVER I303 with Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$495.02 $561.84 $632.63 $884.09 $1,343.46 |
$873.70 $940.52 $1,011.31 $1,262.77 |
$1,252.38 $1,319.20 $1,389.99 $1,641.45 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$990.04 $1,123.68 $1,265.26 $1,768.18 $2,686.92 |
$1,368.72 $1,502.36 $1,643.94 $2,146.86 |
$1,747.40 $1,881.04 $2,022.62 $2,525.54 |
Toc - Plan #33 Quartz | ||||||||||||||||||||
Silver
(HMO) QUARTZ ONE SILVER I308 with Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$519.36 $589.47 $663.74 $927.58 $1,409.54 |
$916.67 $986.78 $1,061.05 $1,324.89 |
$1,313.98 $1,384.09 $1,458.36 $1,722.20 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,038.72 $1,178.94 $1,327.48 $1,855.16 $2,819.08 |
$1,436.03 $1,576.25 $1,724.79 $2,252.47 |
$1,833.34 $1,973.56 $2,122.10 $2,649.78 |
Toc - Plan #34 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One Silver I309 Standard with Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$543.96 $617.38 $695.17 $971.49 $1,476.28 |
$960.08 $1,033.50 $1,111.29 $1,387.61 |
$1,376.20 $1,449.62 $1,527.41 $1,803.73 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,087.92 $1,234.76 $1,390.34 $1,942.98 $2,952.56 |
$1,504.04 $1,650.88 $1,806.46 $2,359.10 |
$1,920.16 $2,067.00 $2,222.58 $2,775.22 |
Toc - Plan #35 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I201 with Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$368.17 $417.87 $470.52 $657.55 $999.20 |
$649.82 $699.52 $752.17 $939.20 |
$931.47 $981.17 $1,033.82 $1,220.85 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$736.34 $835.74 $941.04 $1,315.10 $1,998.40 |
$1,017.99 $1,117.39 $1,222.69 $1,596.75 |
$1,299.64 $1,399.04 $1,504.34 $1,878.40 |
Toc - Plan #36 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I202 with Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$371.81 $422.00 $475.17 $664.05 $1,009.09 |
$656.24 $706.43 $759.60 $948.48 |
$940.67 $990.86 $1,044.03 $1,232.91 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$743.62 $844.00 $950.34 $1,328.10 $2,018.18 |
$1,028.05 $1,128.43 $1,234.77 $1,612.53 |
$1,312.48 $1,412.86 $1,519.20 $1,896.96 |
Toc - Plan #37 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I204 with Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$389.74 $442.35 $498.08 $696.07 $1,057.74 |
$687.89 $740.50 $796.23 $994.22 |
$986.04 $1,038.65 $1,094.38 $1,292.37 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$779.48 $884.70 $996.16 $1,392.14 $2,115.48 |
$1,077.63 $1,182.85 $1,294.31 $1,690.29 |
$1,375.78 $1,481.00 $1,592.46 $1,988.44 |
Toc - Plan #38 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I205 with Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$385.76 $437.83 $492.99 $688.95 $1,046.93 |
$680.86 $732.93 $788.09 $984.05 |
$975.96 $1,028.03 $1,083.19 $1,279.15 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$771.52 $875.66 $985.98 $1,377.90 $2,093.86 |
$1,066.62 $1,170.76 $1,281.08 $1,673.00 |
$1,361.72 $1,465.86 $1,576.18 $1,968.10 |
Toc - Plan #39 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One Bronze I206 Standard with Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$401.64 $455.85 $513.29 $717.31 $1,090.03 |
$708.89 $763.10 $820.54 $1,024.56 |
$1,016.14 $1,070.35 $1,127.79 $1,331.81 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$803.28 $911.70 $1,026.58 $1,434.62 $2,180.06 |
$1,110.53 $1,218.95 $1,333.83 $1,741.87 |
$1,417.78 $1,526.20 $1,641.08 $2,049.12 |
Toc - Plan #40 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I203 with Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$386.91 $439.14 $494.46 $691.01 $1,050.06 |
$682.89 $735.12 $790.44 $986.99 |
$978.87 $1,031.10 $1,086.42 $1,282.97 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$773.82 $878.28 $988.92 $1,382.02 $2,100.12 |
$1,069.80 $1,174.26 $1,284.90 $1,678.00 |
$1,365.78 $1,470.24 $1,580.88 $1,973.98 |
Toc - Plan #41 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I407 Maintenance with Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$503.52 $571.49 $643.49 $899.28 $1,366.54 |
$888.71 $956.68 $1,028.68 $1,284.47 |
$1,273.90 $1,341.87 $1,413.87 $1,669.66 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,007.04 $1,142.98 $1,286.98 $1,798.56 $2,733.08 |
$1,392.23 $1,528.17 $1,672.17 $2,183.75 |
$1,777.42 $1,913.36 $2,057.36 $2,568.94 |
Toc - Plan #42 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I406 with Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$440.66 $500.14 $563.15 $787.01 $1,195.93 |
$777.76 $837.24 $900.25 $1,124.11 |
$1,114.86 $1,174.34 $1,237.35 $1,461.21 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$881.32 $1,000.28 $1,126.30 $1,574.02 $2,391.86 |
$1,218.42 $1,337.38 $1,463.40 $1,911.12 |
$1,555.52 $1,674.48 $1,800.50 $2,248.22 |
Toc - Plan #43 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I409 with Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$449.40 $510.06 $574.33 $802.62 $1,219.66 |
$793.19 $853.85 $918.12 $1,146.41 |
$1,136.98 $1,197.64 $1,261.91 $1,490.20 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$898.80 $1,020.12 $1,148.66 $1,605.24 $2,439.32 |
$1,242.59 $1,363.91 $1,492.45 $1,949.03 |
$1,586.38 $1,707.70 $1,836.24 $2,292.82 |
Toc - Plan #44 Quartz | ||||||||||||||||||||
Silver
(HMO) Tiered Choice Plus Silver I305 with Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$473.43 $537.33 $605.03 $845.53 $1,284.87 |
$835.60 $899.50 $967.20 $1,207.70 |
$1,197.77 $1,261.67 $1,329.37 $1,569.87 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$946.86 $1,074.66 $1,210.06 $1,691.06 $2,569.74 |
$1,309.03 $1,436.83 $1,572.23 $2,053.23 |
$1,671.20 $1,799.00 $1,934.40 $2,415.40 |
Toc - Plan #45 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I408 HSA with Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$466.55 $529.52 $596.24 $833.24 $1,266.19 |
$823.45 $886.42 $953.14 $1,190.14 |
$1,180.35 $1,243.32 $1,310.04 $1,547.04 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$933.10 $1,059.04 $1,192.48 $1,666.48 $2,532.38 |
$1,290.00 $1,415.94 $1,549.38 $2,023.38 |
$1,646.90 $1,772.84 $1,906.28 $2,380.28 |
Toc - Plan #46 Quartz | ||||||||||||||||||||
Silver
(HMO) Tiered Choice Plus Silver I310 HSA with Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$520.63 $590.91 $665.35 $929.83 $1,412.97 |
$918.91 $989.19 $1,063.63 $1,328.11 |
$1,317.19 $1,387.47 $1,461.91 $1,726.39 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,041.26 $1,181.82 $1,330.70 $1,859.66 $2,825.94 |
$1,439.54 $1,580.10 $1,728.98 $2,257.94 |
$1,837.82 $1,978.38 $2,127.26 $2,656.22 |
Toc - Plan #47 Quartz | ||||||||||||||||||||
Silver
(HMO) Tiered Choice Plus Silver I311 HSA with Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$510.37 $579.26 $652.24 $911.51 $1,385.12 |
$900.80 $969.69 $1,042.67 $1,301.94 |
$1,291.23 $1,360.12 $1,433.10 $1,692.37 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,020.74 $1,158.52 $1,304.48 $1,823.02 $2,770.24 |
$1,411.17 $1,548.95 $1,694.91 $2,213.45 |
$1,801.60 $1,939.38 $2,085.34 $2,603.88 |
Toc - Plan #48 Quartz | ||||||||||||||||||||
Gold
(HMO) Quartz One Gold I410 Standard with Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$496.88 $563.95 $635.01 $887.42 $1,348.52 |
$876.99 $944.06 $1,015.12 $1,267.53 |
$1,257.10 $1,324.17 $1,395.23 $1,647.64 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$993.76 $1,127.90 $1,270.02 $1,774.84 $2,697.04 |
$1,373.87 $1,508.01 $1,650.13 $2,154.95 |
$1,753.98 $1,888.12 $2,030.24 $2,535.06 |
ADVERTISEMENT
Security Health PlanLocal: 1-715-221-9258x19258 | Toll Free: 1-844-293-9624 | TTY: 1-877-727-2232 |
Toc - Plan #49 Security Health Plan | ||||||||||||||||||||
Gold
(HMO) Enrich $3,500 - 30% |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$354.80 $402.69 $453.43 $633.66 $962.91 |
$626.22 $674.11 $724.85 $905.08 |
$897.64 $945.53 $996.27 $1,176.50 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$709.60 $805.38 $906.86 $1,267.32 $1,925.82 |
$981.02 $1,076.80 $1,178.28 $1,538.74 |
$1,252.44 $1,348.22 $1,449.70 $1,810.16 |
Toc - Plan #50 Security Health Plan | ||||||||||||||||||||
Silver
(HMO) Enrich $4,100 HDHP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$430.92 $489.08 $550.70 $769.60 $1,169.48 |
$760.56 $818.72 $880.34 $1,099.24 |
$1,090.20 $1,148.36 $1,209.98 $1,428.88 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$861.84 $978.16 $1,101.40 $1,539.20 $2,338.96 |
$1,191.48 $1,307.80 $1,431.04 $1,868.84 |
$1,521.12 $1,637.44 $1,760.68 $2,198.48 |
Toc - Plan #51 Security Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) Enrich $6,200 HDHP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$293.73 $333.38 $375.38 $524.59 $797.17 |
$518.43 $558.08 $600.08 $749.29 |
$743.13 $782.78 $824.78 $973.99 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$587.46 $666.76 $750.76 $1,049.18 $1,594.34 |
$812.16 $891.46 $975.46 $1,273.88 |
$1,036.86 $1,116.16 $1,200.16 $1,498.58 |
Toc - Plan #52 Security Health Plan | ||||||||||||||||||||
Bronze
(HMO) Enrich $9,100 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$253.02 $287.17 $323.35 $451.88 $686.68 |
$446.57 $480.72 $516.90 $645.43 |
$640.12 $674.27 $710.45 $838.98 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$506.04 $574.34 $646.70 $903.76 $1,373.36 |
$699.59 $767.89 $840.25 $1,097.31 |
$893.14 $961.44 $1,033.80 $1,290.86 |
Toc - Plan #53 Security Health Plan | ||||||||||||||||||||
Catastrophic
(HMO) Enrich Protection |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$173.10 $196.45 $221.20 $309.13 $469.76 |
$305.51 $328.86 $353.61 $441.54 |
$437.92 $461.27 $486.02 $573.95 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$346.20 $392.90 $442.40 $618.26 $939.52 |
$478.61 $525.31 $574.81 $750.67 |
$611.02 $657.72 $707.22 $883.08 |
Toc - Plan #54 Security Health Plan | ||||||||||||||||||||
Gold
(HMO) Enrich $2,000 - 25% |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$376.71 $427.55 $481.42 $672.78 $1,022.36 |
$664.88 $715.72 $769.59 $960.95 |
$953.05 $1,003.89 $1,057.76 $1,249.12 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$753.42 $855.10 $962.84 $1,345.56 $2,044.72 |
$1,041.59 $1,143.27 $1,251.01 $1,633.73 |
$1,329.76 $1,431.44 $1,539.18 $1,921.90 |
Toc - Plan #55 Security Health Plan | ||||||||||||||||||||
Silver
(HMO) Enrich $5,800 - 40% |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$373.46 $423.87 $477.27 $666.99 $1,013.55 |
$659.15 $709.56 $762.96 $952.68 |
$944.84 $995.25 $1,048.65 $1,238.37 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$746.92 $847.74 $954.54 $1,333.98 $2,027.10 |
$1,032.61 $1,133.43 $1,240.23 $1,619.67 |
$1,318.30 $1,419.12 $1,525.92 $1,905.36 |
Toc - Plan #56 Security Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) Enrich $7,500 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$258.59 $293.49 $330.47 $461.83 $701.79 |
$456.40 $491.30 $528.28 $659.64 |
$654.21 $689.11 $726.09 $857.45 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$517.18 $586.98 $660.94 $923.66 $1,403.58 |
$714.99 $784.79 $858.75 $1,121.47 |
$912.80 $982.60 $1,056.56 $1,319.28 |
Toc - Plan #57 Security Health Plan | ||||||||||||||||||||
Gold
(HMO) Premier $2,000 - 25% |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$508.99 $577.69 $650.48 $909.04 $1,381.37 |
$898.36 $967.06 $1,039.85 $1,298.41 |
$1,287.73 $1,356.43 $1,429.22 $1,687.78 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,017.98 $1,155.38 $1,300.96 $1,818.08 $2,762.74 |
$1,407.35 $1,544.75 $1,690.33 $2,207.45 |
$1,796.72 $1,934.12 $2,079.70 $2,596.82 |
Toc - Plan #58 Security Health Plan | ||||||||||||||||||||
Gold
(HMO) Premier $3,500 - 30% |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$479.39 $544.10 $612.65 $856.18 $1,301.05 |
$846.12 $910.83 $979.38 $1,222.91 |
$1,212.85 $1,277.56 $1,346.11 $1,589.64 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$958.78 $1,088.20 $1,225.30 $1,712.36 $2,602.10 |
$1,325.51 $1,454.93 $1,592.03 $2,079.09 |
$1,692.24 $1,821.66 $1,958.76 $2,445.82 |
Toc - Plan #59 Security Health Plan | ||||||||||||||||||||
Silver
(HMO) Premier $5,800 - 40% |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$504.61 $572.72 $644.87 $901.21 $1,369.47 |
$890.63 $958.74 $1,030.89 $1,287.23 |
$1,276.65 $1,344.76 $1,416.91 $1,673.25 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,009.22 $1,145.44 $1,289.74 $1,802.42 $2,738.94 |
$1,395.24 $1,531.46 $1,675.76 $2,188.44 |
$1,781.26 $1,917.48 $2,061.78 $2,574.46 |
Toc - Plan #60 Security Health Plan | ||||||||||||||||||||
Silver
(HMO) Premier $4,100 HDHP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$582.24 $660.83 $744.08 $1,039.86 $1,580.16 |
$1,027.64 $1,106.23 $1,189.48 $1,485.26 |
$1,473.04 $1,551.63 $1,634.88 $1,930.66 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,164.48 $1,321.66 $1,488.16 $2,079.72 $3,160.32 |
$1,609.88 $1,767.06 $1,933.56 $2,525.12 |
$2,055.28 $2,212.46 $2,378.96 $2,970.52 |
Toc - Plan #61 Security Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) Premier $6,200 HDHP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$396.88 $450.45 $507.20 $708.81 $1,077.11 |
$700.49 $754.06 $810.81 $1,012.42 |
$1,004.10 $1,057.67 $1,114.42 $1,316.03 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$793.76 $900.90 $1,014.40 $1,417.62 $2,154.22 |
$1,097.37 $1,204.51 $1,318.01 $1,721.23 |
$1,400.98 $1,508.12 $1,621.62 $2,024.84 |
Toc - Plan #62 Security Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) Premier $7,500 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$349.40 $396.55 $446.51 $624.00 $948.23 |
$616.68 $663.83 $713.79 $891.28 |
$883.96 $931.11 $981.07 $1,158.56 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$698.80 $793.10 $893.02 $1,248.00 $1,896.46 |
$966.08 $1,060.38 $1,160.30 $1,515.28 |
$1,233.36 $1,327.66 $1,427.58 $1,782.56 |
Toc - Plan #63 Security Health Plan | ||||||||||||||||||||
Bronze
(HMO) Premier $9,100 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$341.87 $388.01 $436.90 $610.56 $927.81 |
$603.39 $649.53 $698.42 $872.08 |
$864.91 $911.05 $959.94 $1,133.60 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$683.74 $776.02 $873.80 $1,221.12 $1,855.62 |
$945.26 $1,037.54 $1,135.32 $1,482.64 |
$1,206.78 $1,299.06 $1,396.84 $1,744.16 |
Toc - Plan #64 Security Health Plan | ||||||||||||||||||||
Catastrophic
(HMO) Premier Protection |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$233.88 $265.44 $298.88 $417.69 $634.72 |
$412.79 $444.35 $477.79 $596.60 |
$591.70 $623.26 $656.70 $775.51 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$467.76 $530.88 $597.76 $835.38 $1,269.44 |
$646.67 $709.79 $776.67 $1,014.29 |
$825.58 $888.70 $955.58 $1,193.20 |
ADVERTISEMENT
Dean Health PlanLocal: 1-800-279-1302 | Toll Free: 1-800-279-1302 | TTY: 1-800-279-1302 |
Toc - Plan #65 Dean Health Plan | ||||||||||||||||||||
Catastrophic
(HMO) Dean Catastrophic Safety Net (Free Transportation) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$212.62 $241.32 $271.72 $379.73 $577.04 |
$375.27 $403.97 $434.37 $542.38 |
$537.92 $566.62 $597.02 $705.03 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$425.24 $482.64 $543.44 $759.46 $1,154.08 |
$587.89 $645.29 $706.09 $922.11 |
$750.54 $807.94 $868.74 $1,084.76 |
Toc - Plan #66 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Dean Silver Copay Plus 4800X (Free Virtual Visits & Transportation) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$419.72 $476.38 $536.40 $749.62 $1,139.12 |
$740.81 $797.47 $857.49 $1,070.71 |
$1,061.90 $1,118.56 $1,178.58 $1,391.80 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$839.44 $952.76 $1,072.80 $1,499.24 $2,278.24 |
$1,160.53 $1,273.85 $1,393.89 $1,820.33 |
$1,481.62 $1,594.94 $1,714.98 $2,141.42 |
Toc - Plan #67 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Dean Silver Value Copay 4100X (Free Virtual Visits & Transportation) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$416.48 $472.70 $532.26 $743.83 $1,130.31 |
$735.08 $791.30 $850.86 $1,062.43 |
$1,053.68 $1,109.90 $1,169.46 $1,381.03 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$832.96 $945.40 $1,064.52 $1,487.66 $2,260.62 |
$1,151.56 $1,264.00 $1,383.12 $1,806.26 |
$1,470.16 $1,582.60 $1,701.72 $2,124.86 |
Toc - Plan #68 Dean Health Plan | ||||||||||||||||||||
Gold
(HMO) Dean Gold Value Copay 4000X (Free Virtual Visits & Transportation) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$399.90 $453.89 $511.08 $714.23 $1,085.34 |
$705.83 $759.82 $817.01 $1,020.16 |
$1,011.76 $1,065.75 $1,122.94 $1,326.09 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$799.80 $907.78 $1,022.16 $1,428.46 $2,170.68 |
$1,105.73 $1,213.71 $1,328.09 $1,734.39 |
$1,411.66 $1,519.64 $1,634.02 $2,040.32 |
Toc - Plan #69 Dean Health Plan | ||||||||||||||||||||
Bronze
(HMO) Dean Bronze Value Copay 9050X (Free Virtual Visits & Transportation) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$264.74 $300.48 $338.34 $472.83 $718.51 |
$467.27 $503.01 $540.87 $675.36 |
$669.80 $705.54 $743.40 $877.89 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$529.48 $600.96 $676.68 $945.66 $1,437.02 |
$732.01 $803.49 $879.21 $1,148.19 |
$934.54 $1,006.02 $1,081.74 $1,350.72 |
Toc - Plan #70 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Dean Silver HSA-E HDHP 3550X (Free Transportation) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$399.41 $453.34 $510.45 $713.35 $1,084.01 |
$704.96 $758.89 $816.00 $1,018.90 |
$1,010.51 $1,064.44 $1,121.55 $1,324.45 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$798.82 $906.68 $1,020.90 $1,426.70 $2,168.02 |
$1,104.37 $1,212.23 $1,326.45 $1,732.25 |
$1,409.92 $1,517.78 $1,632.00 $2,037.80 |
Toc - Plan #71 Dean Health Plan | ||||||||||||||||||||
Gold
(HMO) Dean Gold Copay Plus 1500X (Free Virtual Visits & Transportation) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$420.87 $477.69 $537.87 $751.68 $1,142.25 |
$742.84 $799.66 $859.84 $1,073.65 |
$1,064.81 $1,121.63 $1,181.81 $1,395.62 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$841.74 $955.38 $1,075.74 $1,503.36 $2,284.50 |
$1,163.71 $1,277.35 $1,397.71 $1,825.33 |
$1,485.68 $1,599.32 $1,719.68 $2,147.30 |
Toc - Plan #72 Dean Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) Dean Bronze HSA-E HDHP 7000X (Free Transportation) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$285.01 $323.49 $364.25 $509.03 $773.52 |
$503.04 $541.52 $582.28 $727.06 |
$721.07 $759.55 $800.31 $945.09 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$570.02 $646.98 $728.50 $1,018.06 $1,547.04 |
$788.05 $865.01 $946.53 $1,236.09 |
$1,006.08 $1,083.04 $1,164.56 $1,454.12 |
Toc - Plan #73 Dean Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) Dean Bronze Copay Plus 9050X (Free Virtual Visits & Transportation) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$277.20 $314.62 $354.26 $495.07 $752.31 |
$489.26 $526.68 $566.32 $707.13 |
$701.32 $738.74 $778.38 $919.19 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$554.40 $629.24 $708.52 $990.14 $1,504.62 |
$766.46 $841.30 $920.58 $1,202.20 |
$978.52 $1,053.36 $1,132.64 $1,414.26 |
Toc - Plan #74 Dean Health Plan | ||||||||||||||||||||
Gold
(HMO) Dean Gold Copay Elite 1500X (Free Virtual Visits & Transportation) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$397.98 $451.71 $508.62 $710.80 $1,080.13 |
$702.44 $756.17 $813.08 $1,015.26 |
$1,006.90 $1,060.63 $1,117.54 $1,319.72 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$795.96 $903.42 $1,017.24 $1,421.60 $2,160.26 |
$1,100.42 $1,207.88 $1,321.70 $1,726.06 |
$1,404.88 $1,512.34 $1,626.16 $2,030.52 |
Toc - Plan #75 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Dean Silver Copay Elite 4800X (Free Virtual Visits & Transportation) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$356.88 $405.06 $456.10 $637.40 $968.58 |
$629.90 $678.08 $729.12 $910.42 |
$902.92 $951.10 $1,002.14 $1,183.44 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$713.76 $810.12 $912.20 $1,274.80 $1,937.16 |
$986.78 $1,083.14 $1,185.22 $1,547.82 |
$1,259.80 $1,356.16 $1,458.24 $1,820.84 |
Toc - Plan #76 Dean Health Plan | ||||||||||||||||||||
Gold
(HMO) Dean Gold HSA HDHP 2000X (Free Transportation) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$375.31 $425.97 $479.64 $670.30 $1,018.58 |
$662.42 $713.08 $766.75 $957.41 |
$949.53 $1,000.19 $1,053.86 $1,244.52 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$750.62 $851.94 $959.28 $1,340.60 $2,037.16 |
$1,037.73 $1,139.05 $1,246.39 $1,627.71 |
$1,324.84 $1,426.16 $1,533.50 $1,914.82 |
Toc - Plan #77 Dean Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) Dean Bronze Copay PCP 8000X (Free Virtual Visits & Transportation) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$265.72 $301.59 $339.59 $474.57 $721.16 |
$468.99 $504.86 $542.86 $677.84 |
$672.26 $708.13 $746.13 $881.11 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$531.44 $603.18 $679.18 $949.14 $1,442.32 |
$734.71 $806.45 $882.45 $1,152.41 |
$937.98 $1,009.72 $1,085.72 $1,355.68 |
Toc - Plan #78 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Dean Silver Copay PCP 4500X (Free Virtual Visits & Transportation) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$389.82 $442.45 $498.19 $696.22 $1,057.97 |
$688.03 $740.66 $796.40 $994.43 |
$986.24 $1,038.87 $1,094.61 $1,292.64 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$779.64 $884.90 $996.38 $1,392.44 $2,115.94 |
$1,077.85 $1,183.11 $1,294.59 $1,690.65 |
$1,376.06 $1,481.32 $1,592.80 $1,988.86 |
Toc - Plan #79 Dean Health Plan | ||||||||||||||||||||
Gold
(HMO) Dean Gold Copay PCP 2000X (Free Virtual Visits & Transportation) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$386.89 $439.12 $494.44 $690.98 $1,050.02 |
$682.86 $735.09 $790.41 $986.95 |
$978.83 $1,031.06 $1,086.38 $1,282.92 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$773.78 $878.24 $988.88 $1,381.96 $2,100.04 |
$1,069.75 $1,174.21 $1,284.85 $1,677.93 |
$1,365.72 $1,470.18 $1,580.82 $1,973.90 |
Toc - Plan #80 Dean Health Plan | ||||||||||||||||||||
Gold
(HMO) Dean Gold Standard 2000X (Free Virtual Visits & Transportation) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$403.22 $457.65 $515.31 $720.15 $1,094.33 |
$711.68 $766.11 $823.77 $1,028.61 |
$1,020.14 $1,074.57 $1,132.23 $1,337.07 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$806.44 $915.30 $1,030.62 $1,440.30 $2,188.66 |
$1,114.90 $1,223.76 $1,339.08 $1,748.76 |
$1,423.36 $1,532.22 $1,647.54 $2,057.22 |
Toc - Plan #81 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Dean Silver Standard 5800X (Free Virtual Visits & Transportation) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$400.64 $454.72 $512.01 $715.54 $1,087.33 |
$707.13 $761.21 $818.50 $1,022.03 |
$1,013.62 $1,067.70 $1,124.99 $1,328.52 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$801.28 $909.44 $1,024.02 $1,431.08 $2,174.66 |
$1,107.77 $1,215.93 $1,330.51 $1,737.57 |
$1,414.26 $1,522.42 $1,637.00 $2,044.06 |
Toc - Plan #82 Dean Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) Dean Bronze Standard 7500X (Free Virtual Visits & Transportation) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$273.60 $310.54 $349.66 $488.66 $742.56 |
$482.91 $519.85 $558.97 $697.97 |
$692.22 $729.16 $768.28 $907.28 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$547.20 $621.08 $699.32 $977.32 $1,485.12 |
$756.51 $830.39 $908.63 $1,186.63 |
$965.82 $1,039.70 $1,117.94 $1,395.94 |
Toc - Plan #83 Dean Health Plan | ||||||||||||||||||||
Bronze
(HMO) Dean Bronze Standard 9100X (Free Virtual Visits & Transportation) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$244.64 $277.67 $312.66 $436.94 $663.97 |
$431.79 $464.82 $499.81 $624.09 |
$618.94 $651.97 $686.96 $811.24 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$489.28 $555.34 $625.32 $873.88 $1,327.94 |
$676.43 $742.49 $812.47 $1,061.03 |
$863.58 $929.64 $999.62 $1,248.18 |
ADVERTISEMENT
Molina HealthcareLocal: 1-888-560-2043 | Toll Free: 1-888-560-2043 |
Toc - Plan #84 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$449.08 $509.71 $573.93 $802.06 $1,218.81 |
$792.63 $853.26 $917.48 $1,145.61 |
$1,136.18 $1,196.81 $1,261.03 $1,489.16 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$898.16 $1,019.42 $1,147.86 $1,604.12 $2,437.62 |
$1,241.71 $1,362.97 $1,491.41 $1,947.67 |
$1,585.26 $1,706.52 $1,834.96 $2,291.22 |
Toc - Plan #85 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$376.98 $427.87 $481.78 $673.28 $1,023.12 |
$665.37 $716.26 $770.17 $961.67 |
$953.76 $1,004.65 $1,058.56 $1,250.06 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$753.96 $855.74 $963.56 $1,346.56 $2,046.24 |
$1,042.35 $1,144.13 $1,251.95 $1,634.95 |
$1,330.74 $1,432.52 $1,540.34 $1,923.34 |
Toc - Plan #86 Molina Healthcare | ||||||||||||||||||||
Gold
(HMO) Confident Care Gold 8 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$458.76 $520.69 $586.29 $819.34 $1,245.06 |
$809.71 $871.64 $937.24 $1,170.29 |
$1,160.66 $1,222.59 $1,288.19 $1,521.24 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$917.52 $1,041.38 $1,172.58 $1,638.68 $2,490.12 |
$1,268.47 $1,392.33 $1,523.53 $1,989.63 |
$1,619.42 $1,743.28 $1,874.48 $2,340.58 |
Toc - Plan #87 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Constant Care Silver 8 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$387.69 $440.03 $495.47 $692.42 $1,052.19 |
$684.27 $736.61 $792.05 $989.00 |
$980.85 $1,033.19 $1,088.63 $1,285.58 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$775.38 $880.06 $990.94 $1,384.84 $2,104.38 |
$1,071.96 $1,176.64 $1,287.52 $1,681.42 |
$1,368.54 $1,473.22 $1,584.10 $1,978.00 |
Toc - Plan #88 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$453.33 $514.52 $579.35 $809.64 $1,230.33 |
$800.12 $861.31 $926.14 $1,156.43 |
$1,146.91 $1,208.10 $1,272.93 $1,503.22 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$906.66 $1,029.04 $1,158.70 $1,619.28 $2,460.66 |
$1,253.45 $1,375.83 $1,505.49 $1,966.07 |
$1,600.24 $1,722.62 $1,852.28 $2,312.86 |
Toc - Plan #89 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Constant Care Silver 1 + Vision |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$387.27 $439.55 $494.93 $691.66 $1,051.05 |
$683.53 $735.81 $791.19 $987.92 |
$979.79 $1,032.07 $1,087.45 $1,284.18 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$774.54 $879.10 $989.86 $1,383.32 $2,102.10 |
$1,070.80 $1,175.36 $1,286.12 $1,679.58 |
$1,367.06 $1,471.62 $1,582.38 $1,975.84 |
ADVERTISEMENT
Anthem Blue Cross and Blue ShieldLocal: 1-855-748-1813 | Toll Free: 1-855-748-1813 |
Toc - Plan #90 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(HMO) Anthem Bronze Blue Preferred/Broad 0 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$337.56 $383.13 $431.40 $602.88 $916.14 |
$595.79 $641.36 $689.63 $861.11 |
$854.02 $899.59 $947.86 $1,119.34 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$675.12 $766.26 $862.80 $1,205.76 $1,832.28 |
$933.35 $1,024.49 $1,121.03 $1,463.99 |
$1,191.58 $1,282.72 $1,379.26 $1,722.22 |
Toc - Plan #91 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(HMO) Anthem Bronze Blue Preferred/Broad 5000 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$327.30 $371.49 $418.29 $584.56 $888.29 |
$577.68 $621.87 $668.67 $834.94 |
$828.06 $872.25 $919.05 $1,085.32 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$654.60 $742.98 $836.58 $1,169.12 $1,776.58 |
$904.98 $993.36 $1,086.96 $1,419.50 |
$1,155.36 $1,243.74 $1,337.34 $1,669.88 |
Toc - Plan #92 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(HMO) Anthem Bronze Blue Preferred/Broad 6550 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$321.43 $364.82 $410.79 $574.07 $872.36 |
$567.32 $610.71 $656.68 $819.96 |
$813.21 $856.60 $902.57 $1,065.85 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$642.86 $729.64 $821.58 $1,148.14 $1,744.72 |
$888.75 $975.53 $1,067.47 $1,394.03 |
$1,134.64 $1,221.42 $1,313.36 $1,639.92 |
Toc - Plan #93 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Bronze
(HMO) Anthem Bronze Blue Preferred/Broad 9100 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$304.67 $345.80 $389.37 $544.14 $826.87 |
$537.74 $578.87 $622.44 $777.21 |
$770.81 $811.94 $855.51 $1,010.28 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$609.34 $691.60 $778.74 $1,088.28 $1,653.74 |
$842.41 $924.67 $1,011.81 $1,321.35 |
$1,075.48 $1,157.74 $1,244.88 $1,554.42 |
Toc - Plan #94 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(HMO) Anthem Bronze Blue Preferred/Broad 0% for HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$320.77 $364.07 $409.94 $572.90 $870.57 |
$566.16 $609.46 $655.33 $818.29 |
$811.55 $854.85 $900.72 $1,063.68 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$641.54 $728.14 $819.88 $1,145.80 $1,741.14 |
$886.93 $973.53 $1,065.27 $1,391.19 |
$1,132.32 $1,218.92 $1,310.66 $1,636.58 |
Toc - Plan #95 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Gold
(HMO) Anthem Gold Blue Preferred/Broad 1000 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$416.09 $472.26 $531.76 $743.14 $1,129.27 |
$734.40 $790.57 $850.07 $1,061.45 |
$1,052.71 $1,108.88 $1,168.38 $1,379.76 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$832.18 $944.52 $1,063.52 $1,486.28 $2,258.54 |
$1,150.49 $1,262.83 $1,381.83 $1,804.59 |
$1,468.80 $1,581.14 $1,700.14 $2,122.90 |
Toc - Plan #96 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(HMO) Anthem Silver Blue Preferred/Broad 4000 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$401.73 $455.96 $513.41 $717.49 $1,090.30 |
$709.05 $763.28 $820.73 $1,024.81 |
$1,016.37 $1,070.60 $1,128.05 $1,332.13 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$803.46 $911.92 $1,026.82 $1,434.98 $2,180.60 |
$1,110.78 $1,219.24 $1,334.14 $1,742.30 |
$1,418.10 $1,526.56 $1,641.46 $2,049.62 |
Toc - Plan #97 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(HMO) Anthem Silver Blue Preferred/Broad 4100 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$406.56 $461.45 $519.58 $726.12 $1,103.40 |
$717.58 $772.47 $830.60 $1,037.14 |
$1,028.60 $1,083.49 $1,141.62 $1,348.16 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$813.12 $922.90 $1,039.16 $1,452.24 $2,206.80 |
$1,124.14 $1,233.92 $1,350.18 $1,763.26 |
$1,435.16 $1,544.94 $1,661.20 $2,074.28 |
Toc - Plan #98 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(HMO) Anthem Silver Blue Preferred/Broad 5300 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$399.37 $453.28 $510.39 $713.27 $1,083.89 |
$704.89 $758.80 $815.91 $1,018.79 |
$1,010.41 $1,064.32 $1,121.43 $1,324.31 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$798.74 $906.56 $1,020.78 $1,426.54 $2,167.78 |
$1,104.26 $1,212.08 $1,326.30 $1,732.06 |
$1,409.78 $1,517.60 $1,631.82 $2,037.58 |
Toc - Plan #99 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Bronze
(HMO) Anthem Bronze Blue Preferred/Broad 9100/0% Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$305.11 $346.30 $389.93 $544.93 $828.07 |
$538.52 $579.71 $623.34 $778.34 |
$771.93 $813.12 $856.75 $1,011.75 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$610.22 $692.60 $779.86 $1,089.86 $1,656.14 |
$843.63 $926.01 $1,013.27 $1,323.27 |
$1,077.04 $1,159.42 $1,246.68 $1,556.68 |
Toc - Plan #100 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(HMO) Anthem Bronze Blue Preferred/Broad 7500/50% Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$331.63 $376.40 $423.82 $592.29 $900.04 |
$585.33 $630.10 $677.52 $845.99 |
$839.03 $883.80 $931.22 $1,099.69 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$663.26 $752.80 $847.64 $1,184.58 $1,800.08 |
$916.96 $1,006.50 $1,101.34 $1,438.28 |
$1,170.66 $1,260.20 $1,355.04 $1,691.98 |
Toc - Plan #101 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(HMO) Anthem Silver Blue Preferred/Broad 5800/40% Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$395.97 $449.43 $506.05 $707.20 $1,074.66 |
$698.89 $752.35 $808.97 $1,010.12 |
$1,001.81 $1,055.27 $1,111.89 $1,313.04 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$791.94 $898.86 $1,012.10 $1,414.40 $2,149.32 |
$1,094.86 $1,201.78 $1,315.02 $1,717.32 |
$1,397.78 $1,504.70 $1,617.94 $2,020.24 |
Toc - Plan #102 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Gold
(HMO) Anthem Gold Blue Preferred/Broad 2000/25% Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$416.39 $472.60 $532.15 $743.67 $1,130.08 |
$734.93 $791.14 $850.69 $1,062.21 |
$1,053.47 $1,109.68 $1,169.23 $1,380.75 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$832.78 $945.20 $1,064.30 $1,487.34 $2,260.16 |
$1,151.32 $1,263.74 $1,382.84 $1,805.88 |
$1,469.86 $1,582.28 $1,701.38 $2,124.42 |
ADVERTISEMENT
Common Ground Healthcare CooperativeLocal: 1-877-514-2442 | Toll Free: 1-877-514-2442 | TTY: 1-844-472-2442 |
Toc - Plan #103 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Copay Bronze $0 Ded - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$283.96 $322.29 $362.89 $507.14 $770.65 |
$501.19 $539.52 $580.12 $724.37 |
$718.42 $756.75 $797.35 $941.60 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$567.92 $644.58 $725.78 $1,014.28 $1,541.30 |
$785.15 $861.81 $943.01 $1,231.51 |
$1,002.38 $1,079.04 $1,160.24 $1,448.74 |
Toc - Plan #104 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Copay Silver $0 Ded - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$403.17 $457.58 $515.23 $720.04 $1,094.17 |
$711.58 $765.99 $823.64 $1,028.45 |
$1,019.99 $1,074.40 $1,132.05 $1,336.86 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$806.34 $915.16 $1,030.46 $1,440.08 $2,188.34 |
$1,114.75 $1,223.57 $1,338.87 $1,748.49 |
$1,423.16 $1,531.98 $1,647.28 $2,056.90 |
Toc - Plan #105 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Copay Gold $0 Ded - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$434.51 $493.15 $555.29 $776.01 $1,179.22 |
$766.90 $825.54 $887.68 $1,108.40 |
$1,099.29 $1,157.93 $1,220.07 $1,440.79 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$869.02 $986.30 $1,110.58 $1,552.02 $2,358.44 |
$1,201.41 $1,318.69 $1,442.97 $1,884.41 |
$1,533.80 $1,651.08 $1,775.36 $2,216.80 |
Toc - Plan #106 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Gold $3000 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$374.80 $425.39 $478.98 $669.38 $1,017.18 |
$661.52 $712.11 $765.70 $956.10 |
$948.24 $998.83 $1,052.42 $1,242.82 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$749.60 $850.78 $957.96 $1,338.76 $2,034.36 |
$1,036.32 $1,137.50 $1,244.68 $1,625.48 |
$1,323.04 $1,424.22 $1,531.40 $1,912.20 |
Toc - Plan #107 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Gold $1800 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$410.52 $465.93 $524.63 $733.18 $1,114.13 |
$724.56 $779.97 $838.67 $1,047.22 |
$1,038.60 $1,094.01 $1,152.71 $1,361.26 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$821.04 $931.86 $1,049.26 $1,466.36 $2,228.26 |
$1,135.08 $1,245.90 $1,363.30 $1,780.40 |
$1,449.12 $1,559.94 $1,677.34 $2,094.44 |
Toc - Plan #108 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Silver $4000 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$369.84 $419.76 $472.65 $660.52 $1,003.73 |
$652.76 $702.68 $755.57 $943.44 |
$935.68 $985.60 $1,038.49 $1,226.36 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$739.68 $839.52 $945.30 $1,321.04 $2,007.46 |
$1,022.60 $1,122.44 $1,228.22 $1,603.96 |
$1,305.52 $1,405.36 $1,511.14 $1,886.88 |
Toc - Plan #109 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Silver $5000 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$316.41 $359.11 $404.35 $565.08 $858.70 |
$558.45 $601.15 $646.39 $807.12 |
$800.49 $843.19 $888.43 $1,049.16 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$632.82 $718.22 $808.70 $1,130.16 $1,717.40 |
$874.86 $960.26 $1,050.74 $1,372.20 |
$1,116.90 $1,202.30 $1,292.78 $1,614.24 |
Toc - Plan #110 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Catastrophic
(EPO) CGHC Catastrophic $9100 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$186.10 $211.21 $237.83 $332.36 $505.05 |
$328.46 $353.57 $380.19 $474.72 |
$470.82 $495.93 $522.55 $617.08 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$372.20 $422.42 $475.66 $664.72 $1,010.10 |
$514.56 $564.78 $618.02 $807.08 |
$656.92 $707.14 $760.38 $949.44 |
Toc - Plan #111 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Bronze $9100 ($35 PCP Copay) - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$266.02 $301.92 $339.96 $475.09 $721.95 |
$469.52 $505.42 $543.46 $678.59 |
$673.02 $708.92 $746.96 $882.09 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$532.04 $603.84 $679.92 $950.18 $1,443.90 |
$735.54 $807.34 $883.42 $1,153.68 |
$939.04 $1,010.84 $1,086.92 $1,357.18 |
Toc - Plan #112 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Bronze $8150 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$276.09 $313.35 $352.83 $493.07 $749.27 |
$487.29 $524.55 $564.03 $704.27 |
$698.49 $735.75 $775.23 $915.47 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$552.18 $626.70 $705.66 $986.14 $1,498.54 |
$763.38 $837.90 $916.86 $1,197.34 |
$974.58 $1,049.10 $1,128.06 $1,408.54 |
Toc - Plan #113 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC HSA Bronze $7500 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$274.64 $311.70 $350.97 $490.48 $745.34 |
$484.73 $521.79 $561.06 $700.57 |
$694.82 $731.88 $771.15 $910.66 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$549.28 $623.40 $701.94 $980.96 $1,490.68 |
$759.37 $833.49 $912.03 $1,191.05 |
$969.46 $1,043.58 $1,122.12 $1,401.14 |
Toc - Plan #114 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC HSA Gold $3000 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$436.43 $495.34 $557.75 $779.45 $1,184.45 |
$770.29 $829.20 $891.61 $1,113.31 |
$1,104.15 $1,163.06 $1,225.47 $1,447.17 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$872.86 $990.68 $1,115.50 $1,558.90 $2,368.90 |
$1,206.72 $1,324.54 $1,449.36 $1,892.76 |
$1,540.58 $1,658.40 $1,783.22 $2,226.62 |
Toc - Plan #115 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC HSA Silver $3000 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$423.24 $480.36 $540.88 $755.88 $1,148.63 |
$747.01 $804.13 $864.65 $1,079.65 |
$1,070.78 $1,127.90 $1,188.42 $1,403.42 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$846.48 $960.72 $1,081.76 $1,511.76 $2,297.26 |
$1,170.25 $1,284.49 $1,405.53 $1,835.53 |
$1,494.02 $1,608.26 $1,729.30 $2,159.30 |
Toc - Plan #116 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Bronze
(EPO) CGHC Bronze $6000 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$272.65 $309.44 $348.43 $486.93 $739.93 |
$481.22 $518.01 $557.00 $695.50 |
$689.79 $726.58 $765.57 $904.07 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$545.30 $618.88 $696.86 $973.86 $1,479.86 |
$753.87 $827.45 $905.43 $1,182.43 |
$962.44 $1,036.02 $1,114.00 $1,391.00 |
Toc - Plan #117 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Bronze
(EPO) Bronze Standard Plan - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$264.09 $299.74 $337.50 $471.65 $716.72 |
$466.11 $501.76 $539.52 $673.67 |
$668.13 $703.78 $741.54 $875.69 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$528.18 $599.48 $675.00 $943.30 $1,433.44 |
$730.20 $801.50 $877.02 $1,145.32 |
$932.22 $1,003.52 $1,079.04 $1,347.34 |
Toc - Plan #118 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) Silver Standard Plan - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$319.59 $362.72 $408.42 $570.77 $867.34 |
$564.07 $607.20 $652.90 $815.25 |
$808.55 $851.68 $897.38 $1,059.73 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$639.18 $725.44 $816.84 $1,141.54 $1,734.68 |
$883.66 $969.92 $1,061.32 $1,386.02 |
$1,128.14 $1,214.40 $1,305.80 $1,630.50 |
Toc - Plan #119 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) Gold Standard Plan - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$382.09 $433.66 $488.30 $682.40 $1,036.97 |
$674.38 $725.95 $780.59 $974.69 |
$966.67 $1,018.24 $1,072.88 $1,266.98 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$764.18 $867.32 $976.60 $1,364.80 $2,073.94 |
$1,056.47 $1,159.61 $1,268.89 $1,657.09 |
$1,348.76 $1,451.90 $1,561.18 $1,949.38 |
Toc - Plan #120 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Silver $5650 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$316.20 $358.87 $404.09 $564.71 $858.13 |
$558.08 $600.75 $645.97 $806.59 |
$799.96 $842.63 $887.85 $1,048.47 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$632.40 $717.74 $808.18 $1,129.42 $1,716.26 |
$874.28 $959.62 $1,050.06 $1,371.30 |
$1,116.16 $1,201.50 $1,291.94 $1,613.18 |
Toc - Plan #121 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Gold $1800 - Envision Network (Vision Exam + Allergy Test) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$413.44 $469.25 $528.37 $738.39 $1,122.06 |
$729.72 $785.53 $844.65 $1,054.67 |
$1,046.00 $1,101.81 $1,160.93 $1,370.95 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$826.88 $938.50 $1,056.74 $1,476.78 $2,244.12 |
$1,143.16 $1,254.78 $1,373.02 $1,793.06 |
$1,459.44 $1,571.06 $1,689.30 $2,109.34 |
Toc - Plan #122 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Gold $2000 - Envision Network (Vision Exam + Allergy Test) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$384.62 $436.54 $491.54 $686.92 $1,043.84 |
$678.85 $730.77 $785.77 $981.15 |
$973.08 $1,025.00 $1,080.00 $1,275.38 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$769.24 $873.08 $983.08 $1,373.84 $2,087.68 |
$1,063.47 $1,167.31 $1,277.31 $1,668.07 |
$1,357.70 $1,461.54 $1,571.54 $1,962.30 |
Toc - Plan #123 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Gold $3000 - Envision Network (Vision Exam + Allergy Test) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$377.69 $428.67 $482.68 $674.54 $1,025.03 |
$666.62 $717.60 $771.61 $963.47 |
$955.55 $1,006.53 $1,060.54 $1,252.40 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$755.38 $857.34 $965.36 $1,349.08 $2,050.06 |
$1,044.31 $1,146.27 $1,254.29 $1,638.01 |
$1,333.24 $1,435.20 $1,543.22 $1,926.94 |
Toc - Plan #124 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Silver $4000 - Envision Network (Vision Exam + Allergy Test) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$372.74 $423.04 $476.34 $665.69 $1,011.58 |
$657.87 $708.17 $761.47 $950.82 |
$943.00 $993.30 $1,046.60 $1,235.95 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$745.48 $846.08 $952.68 $1,331.38 $2,023.16 |
$1,030.61 $1,131.21 $1,237.81 $1,616.51 |
$1,315.74 $1,416.34 $1,522.94 $1,901.64 |
Toc - Plan #125 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Silver $5650 (Vision Exam + Allergy Test) - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$319.05 $362.11 $407.73 $569.81 $865.87 |
$563.12 $606.18 $651.80 $813.88 |
$807.19 $850.25 $895.87 $1,057.95 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$638.10 $724.22 $815.46 $1,139.62 $1,731.74 |
$882.17 $968.29 $1,059.53 $1,383.69 |
$1,126.24 $1,212.36 $1,303.60 $1,627.76 |
Toc - Plan #126 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Silver $5000 - Envision Network (Vision Exam + Allergy Test) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$319.26 $362.35 $408.00 $570.18 $866.44 |
$563.49 $606.58 $652.23 $814.41 |
$807.72 $850.81 $896.46 $1,058.64 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$638.52 $724.70 $816.00 $1,140.36 $1,732.88 |
$882.75 $968.93 $1,060.23 $1,384.59 |
$1,126.98 $1,213.16 $1,304.46 $1,628.82 |
Toc - Plan #127 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Bronze
(EPO) CGHC Bronze $9100 - Envision Network (Vision Exam + Allergy Test) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$266.92 $302.94 $341.11 $476.70 $724.39 |
$471.11 $507.13 $545.30 $680.89 |
$675.30 $711.32 $749.49 $885.08 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$533.84 $605.88 $682.22 $953.40 $1,448.78 |
$738.03 $810.07 $886.41 $1,157.59 |
$942.22 $1,014.26 $1,090.60 $1,361.78 |
Toc - Plan #128 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Bronze $9100 ($35 PCP Copay) - Envision Network (Vision Exam + Allergy Test) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$268.84 $305.13 $343.57 $480.14 $729.62 |
$474.50 $510.79 $549.23 $685.80 |
$680.16 $716.45 $754.89 $891.46 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$537.68 $610.26 $687.14 $960.28 $1,459.24 |
$743.34 $815.92 $892.80 $1,165.94 |
$949.00 $1,021.58 $1,098.46 $1,371.60 |
Toc - Plan #129 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Bronze $8150 - Envision Network (Vision Exam + Allergy Test) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$278.92 $316.56 $356.45 $498.14 $756.96 |
$492.29 $529.93 $569.82 $711.51 |
$705.66 $743.30 $783.19 $924.88 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$557.84 $633.12 $712.90 $996.28 $1,513.92 |
$771.21 $846.49 $926.27 $1,209.65 |
$984.58 $1,059.86 $1,139.64 $1,423.02 |
Toc - Plan #130 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Bronze
(EPO) CGHC Bronze $6000 - Envision Network (Vision Exam + Allergy Test) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$275.47 $312.65 $352.04 $491.97 $747.60 |
$486.20 $523.38 $562.77 $702.70 |
$696.93 $734.11 $773.50 $913.43 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$550.94 $625.30 $704.08 $983.94 $1,495.20 |
$761.67 $836.03 $914.81 $1,194.67 |
$972.40 $1,046.76 $1,125.54 $1,405.40 |
Toc - Plan #131 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC HSA Bronze $7500 - Envision Network (Vision Exam + Allergy Test) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$277.46 $314.91 $354.58 $495.53 $753.00 |
$489.71 $527.16 $566.83 $707.78 |
$701.96 $739.41 $779.08 $920.03 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$554.92 $629.82 $709.16 $991.06 $1,506.00 |
$767.17 $842.07 $921.41 $1,203.31 |
$979.42 $1,054.32 $1,133.66 $1,415.56 |
Toc - Plan #132 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC HSA Silver $3000 - Envision Network (Vision Exam + Allergy Test) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$426.16 $483.69 $544.63 $761.11 $1,156.58 |
$752.17 $809.70 $870.64 $1,087.12 |
$1,078.18 $1,135.71 $1,196.65 $1,413.13 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$852.32 $967.38 $1,089.26 $1,522.22 $2,313.16 |
$1,178.33 $1,293.39 $1,415.27 $1,848.23 |
$1,504.34 $1,619.40 $1,741.28 $2,174.24 |
Toc - Plan #133 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC HSA Gold $3000 - Envision Network (Vision Exam + Allergy Test) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$439.37 $498.67 $561.50 $784.70 $1,192.42 |
$775.48 $834.78 $897.61 $1,120.81 |
$1,111.59 $1,170.89 $1,233.72 $1,456.92 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$878.74 $997.34 $1,123.00 $1,569.40 $2,384.84 |
$1,214.85 $1,333.45 $1,459.11 $1,905.51 |
$1,550.96 $1,669.56 $1,795.22 $2,241.62 |
Toc - Plan #134 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Copay Bronze $0 Ded - Envision Network (Vision Exam + Allergy Test) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$286.80 $325.51 $366.52 $512.21 $778.35 |
$506.19 $544.90 $585.91 $731.60 |
$725.58 $764.29 $805.30 $950.99 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$573.60 $651.02 $733.04 $1,024.42 $1,556.70 |
$792.99 $870.41 $952.43 $1,243.81 |
$1,012.38 $1,089.80 $1,171.82 $1,463.20 |
Toc - Plan #135 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Copay Silver $0 Ded - Envision Network (Vision Exam + Allergy Test) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$406.08 $460.89 $518.95 $725.23 $1,102.06 |
$716.72 $771.53 $829.59 $1,035.87 |
$1,027.36 $1,082.17 $1,140.23 $1,346.51 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$812.16 $921.78 $1,037.90 $1,450.46 $2,204.12 |
$1,122.80 $1,232.42 $1,348.54 $1,761.10 |
$1,433.44 $1,543.06 $1,659.18 $2,071.74 |
Toc - Plan #136 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Copay Gold $0 Ded - Envision Network (Vision Exam + Allergy Test) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$437.44 $496.48 $559.03 $781.24 $1,187.17 |
$772.07 $831.11 $893.66 $1,115.87 |
$1,106.70 $1,165.74 $1,228.29 $1,450.50 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$874.88 $992.96 $1,118.06 $1,562.48 $2,374.34 |
$1,209.51 $1,327.59 $1,452.69 $1,897.11 |
$1,544.14 $1,662.22 $1,787.32 $2,231.74 |
ADVERTISEMENT
Group Health Cooperative-SCWLocal: 1-608-828-4831 | Toll Free: 1-855-344-2729 | TTY: 1-608-828-4815 |
Toc - Plan #137 Group Health Cooperative-SCW | ||||||||||||||||||||
Platinum
(HMO) Platinum 500 Ded/1500 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$442.35 $502.07 $565.32 $790.04 $1,200.53 |
$780.75 $840.47 $903.72 $1,128.44 |
$1,119.15 $1,178.87 $1,242.12 $1,466.84 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$884.70 $1,004.14 $1,130.64 $1,580.08 $2,401.06 |
$1,223.10 $1,342.54 $1,469.04 $1,918.48 |
$1,561.50 $1,680.94 $1,807.44 $2,256.88 |
Toc - Plan #138 Group Health Cooperative-SCW | ||||||||||||||||||||
Gold
(HMO) Gold 2600 Ded/2600 MOOP HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$368.82 $418.61 $471.36 $658.71 $1,000.98 |
$650.97 $700.76 $753.51 $940.86 |
$933.12 $982.91 $1,035.66 $1,223.01 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$737.64 $837.22 $942.72 $1,317.42 $2,001.96 |
$1,019.79 $1,119.37 $1,224.87 $1,599.57 |
$1,301.94 $1,401.52 $1,507.02 $1,881.72 |
Toc - Plan #139 Group Health Cooperative-SCW | ||||||||||||||||||||
Silver
(HMO) Silver 5400 Ded/5400 MOOP HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$431.83 $490.13 $551.88 $771.25 $1,171.99 |
$762.18 $820.48 $882.23 $1,101.60 |
$1,092.53 $1,150.83 $1,212.58 $1,431.95 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$863.66 $980.26 $1,103.76 $1,542.50 $2,343.98 |
$1,194.01 $1,310.61 $1,434.11 $1,872.85 |
$1,524.36 $1,640.96 $1,764.46 $2,203.20 |
Toc - Plan #140 Group Health Cooperative-SCW | ||||||||||||||||||||
Expanded Bronze
(HMO) Bronze 4000 Ded/8500 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$300.81 $341.42 $384.44 $537.24 $816.39 |
$530.93 $571.54 $614.56 $767.36 |
$761.05 $801.66 $844.68 $997.48 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$601.62 $682.84 $768.88 $1,074.48 $1,632.78 |
$831.74 $912.96 $999.00 $1,304.60 |
$1,061.86 $1,143.08 $1,229.12 $1,534.72 |
Toc - Plan #141 Group Health Cooperative-SCW | ||||||||||||||||||||
Expanded Bronze
(HMO) Bronze 7500 Ded/7500 MOOP HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$292.53 $332.02 $373.85 $522.45 $793.91 |
$516.31 $555.80 $597.63 $746.23 |
$740.09 $779.58 $821.41 $970.01 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$585.06 $664.04 $747.70 $1,044.90 $1,587.82 |
$808.84 $887.82 $971.48 $1,268.68 |
$1,032.62 $1,111.60 $1,195.26 $1,492.46 |
Toc - Plan #142 Group Health Cooperative-SCW | ||||||||||||||||||||
Gold
(HMO) Gold 2500 Ded/6500 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$369.03 $418.85 $471.62 $659.08 $1,001.53 |
$651.34 $701.16 $753.93 $941.39 |
$933.65 $983.47 $1,036.24 $1,223.70 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$738.06 $837.70 $943.24 $1,318.16 $2,003.06 |
$1,020.37 $1,120.01 $1,225.55 $1,600.47 |
$1,302.68 $1,402.32 $1,507.86 $1,882.78 |
Toc - Plan #143 Group Health Cooperative-SCW | ||||||||||||||||||||
Gold
(HMO) Gold 1800 Ded/5600 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$375.10 $425.74 $479.38 $669.93 $1,018.02 |
$662.06 $712.70 $766.34 $956.89 |
$949.02 $999.66 $1,053.30 $1,243.85 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$750.20 $851.48 $958.76 $1,339.86 $2,036.04 |
$1,037.16 $1,138.44 $1,245.72 $1,626.82 |
$1,324.12 $1,425.40 $1,532.68 $1,913.78 |
Toc - Plan #144 Group Health Cooperative-SCW | ||||||||||||||||||||
Expanded Bronze
(HMO) Bronze 6850 Ded/8200 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$309.35 $351.11 $395.35 $552.49 $839.57 |
$546.00 $587.76 $632.00 $789.14 |
$782.65 $824.41 $868.65 $1,025.79 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$618.70 $702.22 $790.70 $1,104.98 $1,679.14 |
$855.35 $938.87 $1,027.35 $1,341.63 |
$1,092.00 $1,175.52 $1,264.00 $1,578.28 |
Toc - Plan #145 Group Health Cooperative-SCW | ||||||||||||||||||||
Platinum
(HMO) Platinum No Ded/2200 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$441.96 $501.62 $564.82 $789.33 $1,199.46 |
$780.06 $839.72 $902.92 $1,127.43 |
$1,118.16 $1,177.82 $1,241.02 $1,465.53 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$883.92 $1,003.24 $1,129.64 $1,578.66 $2,398.92 |
$1,222.02 $1,341.34 $1,467.74 $1,916.76 |
$1,560.12 $1,679.44 $1,805.84 $2,254.86 |
Toc - Plan #146 Group Health Cooperative-SCW | ||||||||||||||||||||
Bronze
(HMO) Bronze 9050 Ded/9050 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$286.79 $325.50 $366.51 $512.20 $778.33 |
$506.18 $544.89 $585.90 $731.59 |
$725.57 $764.28 $805.29 $950.98 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$573.58 $651.00 $733.02 $1,024.40 $1,556.66 |
$792.97 $870.39 $952.41 $1,243.79 |
$1,012.36 $1,089.78 $1,171.80 $1,463.18 |
Toc - Plan #147 Group Health Cooperative-SCW | ||||||||||||||||||||
Silver
(HMO) Silver 4900 Ded/7900 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$434.81 $493.50 $555.68 $776.56 $1,180.06 |
$767.44 $826.13 $888.31 $1,109.19 |
$1,100.07 $1,158.76 $1,220.94 $1,441.82 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$869.62 $987.00 $1,111.36 $1,553.12 $2,360.12 |
$1,202.25 $1,319.63 $1,443.99 $1,885.75 |
$1,534.88 $1,652.26 $1,776.62 $2,218.38 |
Toc - Plan #148 Group Health Cooperative-SCW | ||||||||||||||||||||
Gold
(HMO) Gold 1500 Ded/8550 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$358.45 $406.84 $458.10 $640.19 $972.83 |
$632.67 $681.06 $732.32 $914.41 |
$906.89 $955.28 $1,006.54 $1,188.63 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$716.90 $813.68 $916.20 $1,280.38 $1,945.66 |
$991.12 $1,087.90 $1,190.42 $1,554.60 |
$1,265.34 $1,362.12 $1,464.64 $1,828.82 |
Toc - Plan #149 Group Health Cooperative-SCW | ||||||||||||||||||||
Catastrophic
(HMO) Catastrophic 9100 Ded/9100 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$234.80 $266.50 $300.08 $419.36 $637.25 |
$414.43 $446.13 $479.71 $598.99 |
$594.06 $625.76 $659.34 $778.62 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$469.60 $533.00 $600.16 $838.72 $1,274.50 |
$649.23 $712.63 $779.79 $1,018.35 |
$828.86 $892.26 $959.42 $1,197.98 |
Toc - Plan #150 Group Health Cooperative-SCW | ||||||||||||||||||||
Platinum
(HMO) Platinum 1000 Ded/4000 MOOP Primary Care Preferred |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$416.74 $472.99 $532.59 $744.29 $1,131.01 |
$735.54 $791.79 $851.39 $1,063.09 |
$1,054.34 $1,110.59 $1,170.19 $1,381.89 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$833.48 $945.98 $1,065.18 $1,488.58 $2,262.02 |
$1,152.28 $1,264.78 $1,383.98 $1,807.38 |
$1,471.08 $1,583.58 $1,702.78 $2,126.18 |
Toc - Plan #151 Group Health Cooperative-SCW | ||||||||||||||||||||
Gold
(HMO) Gold 4450 Ded/7450 MOOP Primary Care Preferred |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$354.42 $402.27 $452.95 $633.00 $961.90 |
$625.56 $673.41 $724.09 $904.14 |
$896.70 $944.55 $995.23 $1,175.28 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$708.84 $804.54 $905.90 $1,266.00 $1,923.80 |
$979.98 $1,075.68 $1,177.04 $1,537.14 |
$1,251.12 $1,346.82 $1,448.18 $1,808.28 |
Toc - Plan #152 Group Health Cooperative-SCW | ||||||||||||||||||||
Silver
(HMO) Silver 9050 Ded/9050 MOOP Primary Care Preferred |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$425.05 $482.43 $543.22 $759.14 $1,153.58 |
$750.22 $807.60 $868.39 $1,084.31 |
$1,075.39 $1,132.77 $1,193.56 $1,409.48 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$850.10 $964.86 $1,086.44 $1,518.28 $2,307.16 |
$1,175.27 $1,290.03 $1,411.61 $1,843.45 |
$1,500.44 $1,615.20 $1,736.78 $2,168.62 |
Toc - Plan #153 Group Health Cooperative-SCW | ||||||||||||||||||||
Platinum
(HMO) Platinum No Ded/3000 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$458.24 $520.11 $585.63 $818.42 $1,243.67 |
$808.80 $870.67 $936.19 $1,168.98 |
$1,159.36 $1,221.23 $1,286.75 $1,519.54 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$916.48 $1,040.22 $1,171.26 $1,636.84 $2,487.34 |
$1,267.04 $1,390.78 $1,521.82 $1,987.40 |
$1,617.60 $1,741.34 $1,872.38 $2,337.96 |
Toc - Plan #154 Group Health Cooperative-SCW | ||||||||||||||||||||
Gold
(HMO) Gold 2000 Ded/8700 MOOP |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$358.66 $407.07 $458.36 $640.56 $973.38 |
$633.03 $681.44 $732.73 $914.93 |
$907.40 $955.81 $1,007.10 $1,189.30 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$717.32 $814.14 $916.72 $1,281.12 $1,946.76 |
$991.69 $1,088.51 $1,191.09 $1,555.49 |
$1,266.06 $1,362.88 $1,465.46 $1,829.86 |
Toc - Plan #155 Group Health Cooperative-SCW | ||||||||||||||||||||
Silver
(HMO) Silver 5800 Ded/8900 MOOP |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$418.31 $474.78 $534.60 $747.10 $1,135.28 |
$738.32 $794.79 $854.61 $1,067.11 |
$1,058.33 $1,114.80 $1,174.62 $1,387.12 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$836.62 $949.56 $1,069.20 $1,494.20 $2,270.56 |
$1,156.63 $1,269.57 $1,389.21 $1,814.21 |
$1,476.64 $1,589.58 $1,709.22 $2,134.22 |
Toc - Plan #156 Group Health Cooperative-SCW | ||||||||||||||||||||
Expanded Bronze
(HMO) Bronze 7500 Ded/9000 MOOP |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$306.24 $347.58 $391.37 $546.94 $831.13 |
$540.51 $581.85 $625.64 $781.21 |
$774.78 $816.12 $859.91 $1,015.48 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$612.48 $695.16 $782.74 $1,093.88 $1,662.26 |
$846.75 $929.43 $1,017.01 $1,328.15 |
$1,081.02 $1,163.70 $1,251.28 $1,562.42 |
Toc - Plan #157 Group Health Cooperative-SCW | ||||||||||||||||||||
Bronze
(HMO) Bronze 9100 Ded/9100 MOOP |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$272.62 $309.43 $348.41 $486.90 $739.89 |
$481.18 $517.99 $556.97 $695.46 |
$689.74 $726.55 $765.53 $904.02 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$545.24 $618.86 $696.82 $973.80 $1,479.78 |
$753.80 $827.42 $905.38 $1,182.36 |
$962.36 $1,035.98 $1,113.94 $1,390.92 |
‡Source: HealthCare.gov has released sample rates for all counties in the 36 states served by HealthCare.gov. We have integrated that data into our tables and provide you that information for Dodge County here.
Dodge County is in “Rating Area 11” of Wisconsin.
Currently, there are 157 plans offered in Rating Area 11.