Obamacare 2024 Rates for Lee County, Florida

Obamacare is also known as the Affordable Care Act. This page gives you an overview of the rates for individual and family health insurance plans available from , the marketplace for Captiva, FL.

The health insurance rates listed below are for calendar year 2024.

For information on subsidies to make your coverage affordable, you must take one of the following actions:

Contact a licensed health insurance agent
Complete an application at Healthcare.gov
Contact the provider directly

Obamacare Providers, 122 Plans and 2024 Rates for Lee County, Florida

Below, you’ll find a summary of the 122 plans for Lee County, Florida and rates for each of these providers.‡ This chart is designed to give you a preview of your health insurance options.

Obamacare Rates and Providers for Other Years

2014 | 2015 | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 | 2022 | 2023 | 2024 |

Florida Blue (BlueCross BlueShield FL)

Local: 1-800-352-2583 | Toll Free: 1-800-352-2583 | TTY: 1-800-955-8771

Toc - Plan #1 Florida Blue (BlueCross BlueShield FL)

Bronze

(EPO) BlueSelect Bronze 24L01-01 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$6,150 $12,300 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$391.48
$444.33
$500.31
$699.18
$1,062.48

$690.96
$743.81
$799.79
$998.66

$990.44
$1,043.29
$1,099.27
$1,298.14

$1,289.92
$1,342.77
$1,398.75
$1,597.62

$299.48

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$782.96
$888.66
$1,000.62
$1,398.36
$2,124.96

$1,082.44
$1,188.14
$1,300.10
$1,697.84

$1,381.92
$1,487.62
$1,599.58
$1,997.32

$1,681.40
$1,787.10
$1,899.06
$2,296.80

$299.48

Toc - Plan #2 Florida Blue (BlueCross BlueShield FL)

Silver

(EPO) BlueSelect Silver 1456 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$2,800 $5,600 Annual Deductible

$7,150 $14,300 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$531.17
$602.88
$678.84
$948.67
$1,441.60

$937.52
$1,009.23
$1,085.19
$1,355.02

$1,343.87
$1,415.58
$1,491.54
$1,761.37

$1,750.22
$1,821.93
$1,897.89
$2,167.72

$406.35

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,062.34
$1,205.76
$1,357.68
$1,897.34
$2,883.20

$1,468.69
$1,612.11
$1,764.03
$2,303.69

$1,875.04
$2,018.46
$2,170.38
$2,710.04

$2,281.39
$2,424.81
$2,576.73
$3,116.39

$406.35

Toc - Plan #3 Florida Blue (BlueCross BlueShield FL)

Platinum

(EPO) BlueSelect Platinum 1451 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$1,000 $2,000 Annual Deductible

$4,000 $8,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$697.23
$791.36
$891.06
$1,245.25
$1,892.28

$1,230.61
$1,324.74
$1,424.44
$1,778.63

$1,763.99
$1,858.12
$1,957.82
$2,312.01

$2,297.37
$2,391.50
$2,491.20
$2,845.39

$533.38

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,394.46
$1,582.72
$1,782.12
$2,490.50
$3,784.56

$1,927.84
$2,116.10
$2,315.50
$3,023.88

$2,461.22
$2,649.48
$2,848.88
$3,557.26

$2,994.60
$3,182.86
$3,382.26
$4,090.64

$533.38

Toc - Plan #4 Florida Blue (BlueCross BlueShield FL)

Expanded Bronze

(EPO) BlueSelect Bronze 1449 ($0 Virtual Visits / 3 PCP Visits for $0 then $40 / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$6,500 $13,000 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$418.38
$474.86
$534.69
$747.23
$1,135.48

$738.44
$794.92
$854.75
$1,067.29

$1,058.50
$1,114.98
$1,174.81
$1,387.35

$1,378.56
$1,435.04
$1,494.87
$1,707.41

$320.06

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$836.76
$949.72
$1,069.38
$1,494.46
$2,270.96

$1,156.82
$1,269.78
$1,389.44
$1,814.52

$1,476.88
$1,589.84
$1,709.50
$2,134.58

$1,796.94
$1,909.90
$2,029.56
$2,454.64

$320.06

Toc - Plan #5 Florida Blue (BlueCross BlueShield FL)

Platinum

(EPO) BlueSelect Platinum 1457 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$2,000 $4,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$724.46
$822.26
$925.86
$1,293.89
$1,966.18

$1,278.67
$1,376.47
$1,480.07
$1,848.10

$1,832.88
$1,930.68
$2,034.28
$2,402.31

$2,387.09
$2,484.89
$2,588.49
$2,956.52

$554.21

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,448.92
$1,644.52
$1,851.72
$2,587.78
$3,932.36

$2,003.13
$2,198.73
$2,405.93
$3,141.99

$2,557.34
$2,752.94
$2,960.14
$3,696.20

$3,111.55
$3,307.15
$3,514.35
$4,250.41

$554.21

Toc - Plan #6 Florida Blue (BlueCross BlueShield FL)

Silver

(EPO) BlueSelect Silver 1443 ($0 Virtual Visits / $0 Labs / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$6,000 $12,000 Annual Deductible

$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$497.20
$564.32
$635.42
$888.00
$1,349.40

$877.56
$944.68
$1,015.78
$1,268.36

$1,257.92
$1,325.04
$1,396.14
$1,648.72

$1,638.28
$1,705.40
$1,776.50
$2,029.08

$380.36

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$994.40
$1,128.64
$1,270.84
$1,776.00
$2,698.80

$1,374.76
$1,509.00
$1,651.20
$2,156.36

$1,755.12
$1,889.36
$2,031.56
$2,536.72

$2,135.48
$2,269.72
$2,411.92
$2,917.08

$380.36

Toc - Plan #7 Florida Blue (BlueCross BlueShield FL)

Gold

(EPO) BlueSelect Gold 1535 ($0 Virtual Visits / $20 PCP Visit / $15 Generic Meds / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$6,250 $12,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$599.13
$680.01
$765.69
$1,070.05
$1,626.04

$1,057.46
$1,138.34
$1,224.02
$1,528.38

$1,515.79
$1,596.67
$1,682.35
$1,986.71

$1,974.12
$2,055.00
$2,140.68
$2,445.04

$458.33

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,198.26
$1,360.02
$1,531.38
$2,140.10
$3,252.08

$1,656.59
$1,818.35
$1,989.71
$2,598.43

$2,114.92
$2,276.68
$2,448.04
$3,056.76

$2,573.25
$2,735.01
$2,906.37
$3,515.09

$458.33

Toc - Plan #8 Florida Blue (BlueCross BlueShield FL)

Expanded Bronze

(EPO) BlueSelect Bronze (HSA) 1735 (Rewards $$$ / $4 Condition Care Rx)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$7,050 $14,100 Annual Deductible

$7,050 $14,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$407.41
$462.41
$520.67
$727.63
$1,105.71

$719.08
$774.08
$832.34
$1,039.30

$1,030.75
$1,085.75
$1,144.01
$1,350.97

$1,342.42
$1,397.42
$1,455.68
$1,662.64

$311.67

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$814.82
$924.82
$1,041.34
$1,455.26
$2,211.42

$1,126.49
$1,236.49
$1,353.01
$1,766.93

$1,438.16
$1,548.16
$1,664.68
$2,078.60

$1,749.83
$1,859.83
$1,976.35
$2,390.27

$311.67

Toc - Plan #9 Florida Blue (BlueCross BlueShield FL)

Gold

(EPO) BlueSelect Gold 1835 ($0 Virtual Visits / $20 Labs / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$1,500 $3,000 Annual Deductible

$5,900 $11,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$581.80
$660.34
$743.54
$1,039.09
$1,579.01

$1,026.88
$1,105.42
$1,188.62
$1,484.17

$1,471.96
$1,550.50
$1,633.70
$1,929.25

$1,917.04
$1,995.58
$2,078.78
$2,374.33

$445.08

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,163.60
$1,320.68
$1,487.08
$2,078.18
$3,158.02

$1,608.68
$1,765.76
$1,932.16
$2,523.26

$2,053.76
$2,210.84
$2,377.24
$2,968.34

$2,498.84
$2,655.92
$2,822.32
$3,413.42

$445.08

Toc - Plan #10 Florida Blue (BlueCross BlueShield FL)

Expanded Bronze

(EPO) BlueSelect Bronze 2139 ($0 Virtual Visits / $50 PCP Visit / $30 Generic Meds / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$438.15
$497.30
$559.96
$782.54
$1,189.14

$773.33
$832.48
$895.14
$1,117.72

$1,108.51
$1,167.66
$1,230.32
$1,452.90

$1,443.69
$1,502.84
$1,565.50
$1,788.08

$335.18

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$876.30
$994.60
$1,119.92
$1,565.08
$2,378.28

$1,211.48
$1,329.78
$1,455.10
$1,900.26

$1,546.66
$1,664.96
$1,790.28
$2,235.44

$1,881.84
$2,000.14
$2,125.46
$2,570.62

$335.18

Toc - Plan #11 Florida Blue (BlueCross BlueShield FL)

Expanded Bronze

(EPO) BlueSelect Bronze 2342S (Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$410.71
$466.16
$524.89
$733.53
$1,114.67

$724.90
$780.35
$839.08
$1,047.72

$1,039.09
$1,094.54
$1,153.27
$1,361.91

$1,353.28
$1,408.73
$1,467.46
$1,676.10

$314.19

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$821.42
$932.32
$1,049.78
$1,467.06
$2,229.34

$1,135.61
$1,246.51
$1,363.97
$1,781.25

$1,449.80
$1,560.70
$1,678.16
$2,095.44

$1,763.99
$1,874.89
$1,992.35
$2,409.63

$314.19

Toc - Plan #12 Florida Blue (BlueCross BlueShield FL)

Silver

(EPO) BlueSelect Silver 2343S ($40 PCP Visits / Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$5,900 $11,800 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$516.48
$586.20
$660.06
$922.43
$1,401.73

$911.59
$981.31
$1,055.17
$1,317.54

$1,306.70
$1,376.42
$1,450.28
$1,712.65

$1,701.81
$1,771.53
$1,845.39
$2,107.76

$395.11

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,032.96
$1,172.40
$1,320.12
$1,844.86
$2,803.46

$1,428.07
$1,567.51
$1,715.23
$2,239.97

$1,823.18
$1,962.62
$2,110.34
$2,635.08

$2,218.29
$2,357.73
$2,505.45
$3,030.19

$395.11

Toc - Plan #13 Florida Blue (BlueCross BlueShield FL)

Gold

(EPO) BlueSelect Gold 2344S ($30 PCP Visits / Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$1,500 $3,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$567.20
$643.77
$724.88
$1,013.02
$1,539.38

$1,001.11
$1,077.68
$1,158.79
$1,446.93

$1,435.02
$1,511.59
$1,592.70
$1,880.84

$1,868.93
$1,945.50
$2,026.61
$2,314.75

$433.91

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,134.40
$1,287.54
$1,449.76
$2,026.04
$3,078.76

$1,568.31
$1,721.45
$1,883.67
$2,459.95

$2,002.22
$2,155.36
$2,317.58
$2,893.86

$2,436.13
$2,589.27
$2,751.49
$3,327.77

$433.91

Toc - Plan #14 Florida Blue (BlueCross BlueShield FL)

Platinum

(EPO) BlueSelect Platinum 2345S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$3,200 $6,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$720.46
$817.72
$920.75
$1,286.74
$1,955.33

$1,271.61
$1,368.87
$1,471.90
$1,837.89

$1,822.76
$1,920.02
$2,023.05
$2,389.04

$2,373.91
$2,471.17
$2,574.20
$2,940.19

$551.15

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,440.92
$1,635.44
$1,841.50
$2,573.48
$3,910.66

$1,992.07
$2,186.59
$2,392.65
$3,124.63

$2,543.22
$2,737.74
$2,943.80
$3,675.78

$3,094.37
$3,288.89
$3,494.95
$4,226.93

$551.15

Toc - Plan #15 Florida Blue (BlueCross BlueShield FL)

Silver

(PPO) BlueOptions Silver 24J01-03 ($0 Virtual Visits / $0 Labs / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$6,000 $12,000 Annual Deductible

$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$780.19
$885.52
$997.08
$1,393.42
$2,117.44

$1,377.04
$1,482.37
$1,593.93
$1,990.27

$1,973.89
$2,079.22
$2,190.78
$2,587.12

$2,570.74
$2,676.07
$2,787.63
$3,183.97

$596.85

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,560.38
$1,771.04
$1,994.16
$2,786.84
$4,234.88

$2,157.23
$2,367.89
$2,591.01
$3,383.69

$2,754.08
$2,964.74
$3,187.86
$3,980.54

$3,350.93
$3,561.59
$3,784.71
$4,577.39

$596.85

Toc - Plan #16 Florida Blue (BlueCross BlueShield FL)

Expanded Bronze

(PPO) BlueOptions Bronze 24J01-04 ($0 Virtual Visits / 3 PCP Visits for $0 then $40 / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$6,500 $13,000 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$557.64
$632.92
$712.66
$995.95
$1,513.43

$984.23
$1,059.51
$1,139.25
$1,422.54

$1,410.82
$1,486.10
$1,565.84
$1,849.13

$1,837.41
$1,912.69
$1,992.43
$2,275.72

$426.59

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,115.28
$1,265.84
$1,425.32
$1,991.90
$3,026.86

$1,541.87
$1,692.43
$1,851.91
$2,418.49

$1,968.46
$2,119.02
$2,278.50
$2,845.08

$2,395.05
$2,545.61
$2,705.09
$3,271.67

$426.59

Toc - Plan #17 Florida Blue (BlueCross BlueShield FL)

Platinum

(PPO) BlueOptions Platinum 24J01-05 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$1,000 $2,000 Annual Deductible

$4,000 $8,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$1,052.73
$1,194.85
$1,345.39
$1,880.18
$2,857.11

$1,858.07
$2,000.19
$2,150.73
$2,685.52

$2,663.41
$2,805.53
$2,956.07
$3,490.86

$3,468.75
$3,610.87
$3,761.41
$4,296.20

$805.34

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$2,105.46
$2,389.70
$2,690.78
$3,760.36
$5,714.22

$2,910.80
$3,195.04
$3,496.12
$4,565.70

$3,716.14
$4,000.38
$4,301.46
$5,371.04

$4,521.48
$4,805.72
$5,106.80
$6,176.38

$805.34

Toc - Plan #18 Florida Blue (BlueCross BlueShield FL)

Bronze

(PPO) BlueOptions Bronze 24J01-06 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$6,150 $12,300 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$521.72
$592.15
$666.76
$931.79
$1,415.95

$920.84
$991.27
$1,065.88
$1,330.91

$1,319.96
$1,390.39
$1,465.00
$1,730.03

$1,719.08
$1,789.51
$1,864.12
$2,129.15

$399.12

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,043.44
$1,184.30
$1,333.52
$1,863.58
$2,831.90

$1,442.56
$1,583.42
$1,732.64
$2,262.70

$1,841.68
$1,982.54
$2,131.76
$2,661.82

$2,240.80
$2,381.66
$2,530.88
$3,060.94

$399.12

Toc - Plan #19 Florida Blue (BlueCross BlueShield FL)

Silver

(PPO) BlueOptions Silver 24J01-07 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$2,800 $5,600 Annual Deductible

$7,150 $14,300 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$834.59
$947.26
$1,066.61
$1,490.58
$2,265.08

$1,473.05
$1,585.72
$1,705.07
$2,129.04

$2,111.51
$2,224.18
$2,343.53
$2,767.50

$2,749.97
$2,862.64
$2,981.99
$3,405.96

$638.46

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,669.18
$1,894.52
$2,133.22
$2,981.16
$4,530.16

$2,307.64
$2,532.98
$2,771.68
$3,619.62

$2,946.10
$3,171.44
$3,410.14
$4,258.08

$3,584.56
$3,809.90
$4,048.60
$4,896.54

$638.46

Toc - Plan #20 Florida Blue (BlueCross BlueShield FL)

Platinum

(PPO) BlueOptions Platinum 24J01-08 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$2,000 $4,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$1,094.95
$1,242.77
$1,399.35
$1,955.58
$2,971.69

$1,932.59
$2,080.41
$2,236.99
$2,793.22

$2,770.23
$2,918.05
$3,074.63
$3,630.86

$3,607.87
$3,755.69
$3,912.27
$4,468.50

$837.64

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$2,189.90
$2,485.54
$2,798.70
$3,911.16
$5,943.38

$3,027.54
$3,323.18
$3,636.34
$4,748.80

$3,865.18
$4,160.82
$4,473.98
$5,586.44

$4,702.82
$4,998.46
$5,311.62
$6,424.08

$837.64

Toc - Plan #21 Florida Blue (BlueCross BlueShield FL)

Gold

(PPO) BlueOptions Gold 24J01-09 ($0 Virtual Visits / $20 PCP Visits / $15 Generic Meds / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$6,250 $12,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$898.42
$1,019.71
$1,148.18
$1,604.58
$2,438.31

$1,585.71
$1,707.00
$1,835.47
$2,291.87

$2,273.00
$2,394.29
$2,522.76
$2,979.16

$2,960.29
$3,081.58
$3,210.05
$3,666.45

$687.29

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,796.84
$2,039.42
$2,296.36
$3,209.16
$4,876.62

$2,484.13
$2,726.71
$2,983.65
$3,896.45

$3,171.42
$3,414.00
$3,670.94
$4,583.74

$3,858.71
$4,101.29
$4,358.23
$5,271.03

$687.29

Toc - Plan #22 Florida Blue (BlueCross BlueShield FL)

Expanded Bronze

(PPO) BlueOptions Bronze (HSA) 24J01-10 (Rewards $$$ / $4 Condition Care Rx)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$7,050 $14,100 Annual Deductible

$7,050 $14,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$542.42
$615.65
$693.21
$968.76
$1,472.13

$957.37
$1,030.60
$1,108.16
$1,383.71

$1,372.32
$1,445.55
$1,523.11
$1,798.66

$1,787.27
$1,860.50
$1,938.06
$2,213.61

$414.95

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,084.84
$1,231.30
$1,386.42
$1,937.52
$2,944.26

$1,499.79
$1,646.25
$1,801.37
$2,352.47

$1,914.74
$2,061.20
$2,216.32
$2,767.42

$2,329.69
$2,476.15
$2,631.27
$3,182.37

$414.95

Toc - Plan #23 Florida Blue (BlueCross BlueShield FL)

Gold

(PPO) BlueOptions Gold 24J01-12 ($0 Virtual Visits / $20 Labs / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$1,500 $3,000 Annual Deductible

$5,900 $11,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$871.87
$989.57
$1,114.25
$1,557.16
$2,366.26

$1,538.85
$1,656.55
$1,781.23
$2,224.14

$2,205.83
$2,323.53
$2,448.21
$2,891.12

$2,872.81
$2,990.51
$3,115.19
$3,558.10

$666.98

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,743.74
$1,979.14
$2,228.50
$3,114.32
$4,732.52

$2,410.72
$2,646.12
$2,895.48
$3,781.30

$3,077.70
$3,313.10
$3,562.46
$4,448.28

$3,744.68
$3,980.08
$4,229.44
$5,115.26

$666.98

Toc - Plan #24 Florida Blue (BlueCross BlueShield FL)

Expanded Bronze

(PPO) BlueOptions Bronze 24J01-17 ($0 Virtual Visits / $50 PCP Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$583.88
$662.70
$746.20
$1,042.81
$1,584.65

$1,030.55
$1,109.37
$1,192.87
$1,489.48

$1,477.22
$1,556.04
$1,639.54
$1,936.15

$1,923.89
$2,002.71
$2,086.21
$2,382.82

$446.67

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,167.76
$1,325.40
$1,492.40
$2,085.62
$3,169.30

$1,614.43
$1,772.07
$1,939.07
$2,532.29

$2,061.10
$2,218.74
$2,385.74
$2,978.96

$2,507.77
$2,665.41
$2,832.41
$3,425.63

$446.67

Toc - Plan #25 Florida Blue (BlueCross BlueShield FL)

Expanded Bronze

(PPO) BlueOptions Bronze 24J01-18S (Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$546.60
$620.39
$698.55
$976.23
$1,483.47

$964.75
$1,038.54
$1,116.70
$1,394.38

$1,382.90
$1,456.69
$1,534.85
$1,812.53

$1,801.05
$1,874.84
$1,953.00
$2,230.68

$418.15

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,093.20
$1,240.78
$1,397.10
$1,952.46
$2,966.94

$1,511.35
$1,658.93
$1,815.25
$2,370.61

$1,929.50
$2,077.08
$2,233.40
$2,788.76

$2,347.65
$2,495.23
$2,651.55
$3,206.91

$418.15

Toc - Plan #26 Florida Blue (BlueCross BlueShield FL)

Silver

(PPO) BlueOptions Silver 24J01-19S ($40 PCP Visits / Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$5,900 $11,800 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$810.84
$920.30
$1,036.25
$1,448.16
$2,200.62

$1,431.13
$1,540.59
$1,656.54
$2,068.45

$2,051.42
$2,160.88
$2,276.83
$2,688.74

$2,671.71
$2,781.17
$2,897.12
$3,309.03

$620.29

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,621.68
$1,840.60
$2,072.50
$2,896.32
$4,401.24

$2,241.97
$2,460.89
$2,692.79
$3,516.61

$2,862.26
$3,081.18
$3,313.08
$4,136.90

$3,482.55
$3,701.47
$3,933.37
$4,757.19

$620.29

Toc - Plan #27 Florida Blue (BlueCross BlueShield FL)

Gold

(PPO) BlueOptions Gold 24J01-20S ($30 PCP Visits / Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$1,500 $3,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$850.34
$965.14
$1,086.73
$1,518.71
$2,307.82

$1,500.85
$1,615.65
$1,737.24
$2,169.22

$2,151.36
$2,266.16
$2,387.75
$2,819.73

$2,801.87
$2,916.67
$3,038.26
$3,470.24

$650.51

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,700.68
$1,930.28
$2,173.46
$3,037.42
$4,615.64

$2,351.19
$2,580.79
$2,823.97
$3,687.93

$3,001.70
$3,231.30
$3,474.48
$4,338.44

$3,652.21
$3,881.81
$4,124.99
$4,988.95

$650.51

Toc - Plan #28 Florida Blue (BlueCross BlueShield FL)

Platinum

(PPO) BlueOptions Platinum 24J01-21S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$3,200 $6,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$1,088.11
$1,235.00
$1,390.60
$1,943.36
$2,953.13

$1,920.51
$2,067.40
$2,223.00
$2,775.76

$2,752.91
$2,899.80
$3,055.40
$3,608.16

$3,585.31
$3,732.20
$3,887.80
$4,440.56

$832.40

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$2,176.22
$2,470.00
$2,781.20
$3,886.72
$5,906.26

$3,008.62
$3,302.40
$3,613.60
$4,719.12

$3,841.02
$4,134.80
$4,446.00
$5,551.52

$4,673.42
$4,967.20
$5,278.40
$6,383.92

$832.40

Aetna CVS Health

Local: 1-877-336-3915 | Toll Free: 1-877-336-3915

Toc - Plan #29 Aetna CVS Health

Silver

(HMO) Silver S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family

$5,900 $11,800 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$442.54
$502.28
$565.56
$790.36
$1,201.03

$781.08
$840.82
$904.10
$1,128.90

$1,119.62
$1,179.36
$1,242.64
$1,467.44

$1,458.16
$1,517.90
$1,581.18
$1,805.98

$338.54

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$885.08
$1,004.56
$1,131.12
$1,580.72
$2,402.06

$1,223.62
$1,343.10
$1,469.66
$1,919.26

$1,562.16
$1,681.64
$1,808.20
$2,257.80

$1,900.70
$2,020.18
$2,146.74
$2,596.34

$338.54

Toc - Plan #30 Aetna CVS Health

Expanded Bronze

(HMO) Bronze S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$353.38
$401.09
$451.62
$631.14
$959.07

$623.72
$671.43
$721.96
$901.48

$894.06
$941.77
$992.30
$1,171.82

$1,164.40
$1,212.11
$1,262.64
$1,442.16

$270.34

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$706.76
$802.18
$903.24
$1,262.28
$1,918.14

$977.10
$1,072.52
$1,173.58
$1,532.62

$1,247.44
$1,342.86
$1,443.92
$1,802.96

$1,517.78
$1,613.20
$1,714.26
$2,073.30

$270.34

Toc - Plan #31 Aetna CVS Health

Silver

(HMO) Silver 5: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family

$8,395 $16,790 Annual Deductible

$8,885 $17,770 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$442.25
$501.95
$565.19
$789.85
$1,200.25

$780.57
$840.27
$903.51
$1,128.17

$1,118.89
$1,178.59
$1,241.83
$1,466.49

$1,457.21
$1,516.91
$1,580.15
$1,804.81

$338.32

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$884.50
$1,003.90
$1,130.38
$1,579.70
$2,400.50

$1,222.82
$1,342.22
$1,468.70
$1,918.02

$1,561.14
$1,680.54
$1,807.02
$2,256.34

$1,899.46
$2,018.86
$2,145.34
$2,594.66

$338.32

Toc - Plan #32 Aetna CVS Health

Gold

(HMO) Gold S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family

$1,500 $3,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$472.98
$536.84
$604.47
$844.75
$1,283.67

$834.81
$898.67
$966.30
$1,206.58

$1,196.64
$1,260.50
$1,328.13
$1,568.41

$1,558.47
$1,622.33
$1,689.96
$1,930.24

$361.83

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$945.96
$1,073.68
$1,208.94
$1,689.50
$2,567.34

$1,307.79
$1,435.51
$1,570.77
$2,051.33

$1,669.62
$1,797.34
$1,932.60
$2,413.16

$2,031.45
$2,159.17
$2,294.43
$2,774.99

$361.83

Toc - Plan #33 Aetna CVS Health

Silver

(HMO) Silver 6: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family

$7,795 $15,590 Annual Deductible

$8,445 $16,890 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$451.57
$512.53
$577.11
$806.50
$1,225.55

$797.02
$857.98
$922.56
$1,151.95

$1,142.47
$1,203.43
$1,268.01
$1,497.40

$1,487.92
$1,548.88
$1,613.46
$1,842.85

$345.45

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$903.14
$1,025.06
$1,154.22
$1,613.00
$2,451.10

$1,248.59
$1,370.51
$1,499.67
$1,958.45

$1,594.04
$1,715.96
$1,845.12
$2,303.90

$1,939.49
$2,061.41
$2,190.57
$2,649.35

$345.45

Toc - Plan #34 Aetna CVS Health

Expanded Bronze

(HMO) Bronze 4: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$389.17
$441.71
$497.36
$695.05
$1,056.20

$686.89
$739.43
$795.08
$992.77

$984.61
$1,037.15
$1,092.80
$1,290.49

$1,282.33
$1,334.87
$1,390.52
$1,588.21

$297.72

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$778.34
$883.42
$994.72
$1,390.10
$2,112.40

$1,076.06
$1,181.14
$1,292.44
$1,687.82

$1,373.78
$1,478.86
$1,590.16
$1,985.54

$1,671.50
$1,776.58
$1,887.88
$2,283.26

$297.72

Toc - Plan #35 Aetna CVS Health

Gold

(HMO) Gold 3: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family

$795 $1,590 Annual Deductible

$9,195 $18,390 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$471.08
$534.68
$602.04
$841.35
$1,278.52

$831.46
$895.06
$962.42
$1,201.73

$1,191.84
$1,255.44
$1,322.80
$1,562.11

$1,552.22
$1,615.82
$1,683.18
$1,922.49

$360.38

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$942.16
$1,069.36
$1,204.08
$1,682.70
$2,557.04

$1,302.54
$1,429.74
$1,564.46
$2,043.08

$1,662.92
$1,790.12
$1,924.84
$2,403.46

$2,023.30
$2,150.50
$2,285.22
$2,763.84

$360.38

Toc - Plan #36 Aetna CVS Health

Gold

(HMO) Gold 4: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family

$3,500 $7,000 Annual Deductible

$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$477.36
$541.80
$610.07
$852.56
$1,295.55

$842.54
$906.98
$975.25
$1,217.74

$1,207.72
$1,272.16
$1,340.43
$1,582.92

$1,572.90
$1,637.34
$1,705.61
$1,948.10

$365.18

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$954.72
$1,083.60
$1,220.14
$1,705.12
$2,591.10

$1,319.90
$1,448.78
$1,585.32
$2,070.30

$1,685.08
$1,813.96
$1,950.50
$2,435.48

$2,050.26
$2,179.14
$2,315.68
$2,800.66

$365.18

Toc - Plan #37 Aetna CVS Health

Silver

(HMO) Silver 7: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family

$7,795 $15,590 Annual Deductible

$8,845 $17,690 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$451.78
$512.77
$577.37
$806.87
$1,226.12

$797.39
$858.38
$922.98
$1,152.48

$1,143.00
$1,203.99
$1,268.59
$1,498.09

$1,488.61
$1,549.60
$1,614.20
$1,843.70

$345.61

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$903.56
$1,025.54
$1,154.74
$1,613.74
$2,452.24

$1,249.17
$1,371.15
$1,500.35
$1,959.35

$1,594.78
$1,716.76
$1,845.96
$2,304.96

$1,940.39
$2,062.37
$2,191.57
$2,650.57

$345.61

AvMed

Local: 1-800-477-8768 | Toll Free:

Toc - Plan #38 AvMed

Gold

(HMO) AvMed Entrust Gold 125 (2024)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family

$2,000 $4,000 Annual Deductible

$4,700 $9,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$668.34
$758.56
$854.13
$1,193.65
$1,813.87

$1,179.62
$1,269.84
$1,365.41
$1,704.93

$1,690.90
$1,781.12
$1,876.69
$2,216.21

$2,202.18
$2,292.40
$2,387.97
$2,727.49

$511.28

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,336.68
$1,517.12
$1,708.26
$2,387.30
$3,627.74

$1,847.96
$2,028.40
$2,219.54
$2,898.58

$2,359.24
$2,539.68
$2,730.82
$3,409.86

$2,870.52
$3,050.96
$3,242.10
$3,921.14

$511.28

Toc - Plan #39 AvMed

Silver

(HMO) AvMed Entrust Silver 300 (2024)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family

$3,000 $6,000 Annual Deductible

$7,650 $15,300 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$642.04
$728.72
$820.53
$1,146.69
$1,742.51

$1,133.20
$1,219.88
$1,311.69
$1,637.85

$1,624.36
$1,711.04
$1,802.85
$2,129.01

$2,115.52
$2,202.20
$2,294.01
$2,620.17

$491.16

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,284.08
$1,457.44
$1,641.06
$2,293.38
$3,485.02

$1,775.24
$1,948.60
$2,132.22
$2,784.54

$2,266.40
$2,439.76
$2,623.38
$3,275.70

$2,757.56
$2,930.92
$3,114.54
$3,766.86

$491.16

Toc - Plan #40 AvMed

Silver

(HMO) AvMed Entrust Silver 350 (2024)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family

$3,500 $7,000 Annual Deductible

$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$619.89
$703.58
$792.22
$1,107.13
$1,682.39

$1,094.11
$1,177.80
$1,266.44
$1,581.35

$1,568.33
$1,652.02
$1,740.66
$2,055.57

$2,042.55
$2,126.24
$2,214.88
$2,529.79

$474.22

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,239.78
$1,407.16
$1,584.44
$2,214.26
$3,364.78

$1,714.00
$1,881.38
$2,058.66
$2,688.48

$2,188.22
$2,355.60
$2,532.88
$3,162.70

$2,662.44
$2,829.82
$3,007.10
$3,636.92

$474.22

Toc - Plan #41 AvMed

Silver

(HMO) AvMed Entrust Silver 500 (2024)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family

$5,500 $11,000 Annual Deductible

$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$613.45
$696.27
$784.00
$1,095.63
$1,664.92

$1,082.74
$1,165.56
$1,253.29
$1,564.92

$1,552.03
$1,634.85
$1,722.58
$2,034.21

$2,021.32
$2,104.14
$2,191.87
$2,503.50

$469.29

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,226.90
$1,392.54
$1,568.00
$2,191.26
$3,329.84

$1,696.19
$1,861.83
$2,037.29
$2,660.55

$2,165.48
$2,331.12
$2,506.58
$3,129.84

$2,634.77
$2,800.41
$2,975.87
$3,599.13

$469.29

Toc - Plan #42 AvMed

Silver

(HMO) AvMed Entrust Silver 550 (2024)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family

$6,500 $13,000 Annual Deductible

$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$607.73
$689.78
$776.68
$1,085.41
$1,649.39

$1,072.65
$1,154.70
$1,241.60
$1,550.33

$1,537.57
$1,619.62
$1,706.52
$2,015.25

$2,002.49
$2,084.54
$2,171.44
$2,480.17

$464.92

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,215.46
$1,379.56
$1,553.36
$2,170.82
$3,298.78

$1,680.38
$1,844.48
$2,018.28
$2,635.74

$2,145.30
$2,309.40
$2,483.20
$3,100.66

$2,610.22
$2,774.32
$2,948.12
$3,565.58

$464.92

Toc - Plan #43 AvMed

Expanded Bronze

(HMO) AvMed Entrust Bronze 600 (2024)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family

$6,500 $13,000 Annual Deductible

$8,500 $17,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$507.70
$576.24
$648.85
$906.76
$1,377.91

$896.09
$964.63
$1,037.24
$1,295.15

$1,284.48
$1,353.02
$1,425.63
$1,683.54

$1,672.87
$1,741.41
$1,814.02
$2,071.93

$388.39

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,015.40
$1,152.48
$1,297.70
$1,813.52
$2,755.82

$1,403.79
$1,540.87
$1,686.09
$2,201.91

$1,792.18
$1,929.26
$2,074.48
$2,590.30

$2,180.57
$2,317.65
$2,462.87
$2,978.69

$388.39

Toc - Plan #44 AvMed

Expanded Bronze

(HMO) AvMed Entrust Bronze 650 (2024)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family

$8,750 $17,500 Annual Deductible

$8,750 $17,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$477.85
$542.35
$610.69
$853.43
$1,296.87

$843.40
$907.90
$976.24
$1,218.98

$1,208.95
$1,273.45
$1,341.79
$1,584.53

$1,574.50
$1,639.00
$1,707.34
$1,950.08

$365.55

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$955.70
$1,084.70
$1,221.38
$1,706.86
$2,593.74

$1,321.25
$1,450.25
$1,586.93
$2,072.41

$1,686.80
$1,815.80
$1,952.48
$2,437.96

$2,052.35
$2,181.35
$2,318.03
$2,803.51

$365.55

Toc - Plan #45 AvMed

Gold

(HMO) AvMed Entrust Gold Standard (2024)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family

$1,500 $3,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$697.99
$792.22
$892.03
$1,246.61
$1,894.35

$1,231.95
$1,326.18
$1,425.99
$1,780.57

$1,765.91
$1,860.14
$1,959.95
$2,314.53

$2,299.87
$2,394.10
$2,493.91
$2,848.49

$533.96

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,395.98
$1,584.44
$1,784.06
$2,493.22
$3,788.70

$1,929.94
$2,118.40
$2,318.02
$3,027.18

$2,463.90
$2,652.36
$2,851.98
$3,561.14

$2,997.86
$3,186.32
$3,385.94
$4,095.10

$533.96

Toc - Plan #46 AvMed

Silver

(HMO) AvMed Entrust Silver Standard (2024)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family

$5,900 $11,800 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$595.01
$675.34
$760.42
$1,062.69
$1,614.86

$1,050.19
$1,130.52
$1,215.60
$1,517.87

$1,505.37
$1,585.70
$1,670.78
$1,973.05

$1,960.55
$2,040.88
$2,125.96
$2,428.23

$455.18

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,190.02
$1,350.68
$1,520.84
$2,125.38
$3,229.72

$1,645.20
$1,805.86
$1,976.02
$2,580.56

$2,100.38
$2,261.04
$2,431.20
$3,035.74

$2,555.56
$2,716.22
$2,886.38
$3,490.92

$455.18

Toc - Plan #47 AvMed

Expanded Bronze

(HMO) AvMed Entrust Expanded Bronze Standard (2024)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$487.77
$553.62
$623.37
$871.16
$1,323.82

$860.92
$926.77
$996.52
$1,244.31

$1,234.07
$1,299.92
$1,369.67
$1,617.46

$1,607.22
$1,673.07
$1,742.82
$1,990.61

$373.15

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$975.54
$1,107.24
$1,246.74
$1,742.32
$2,647.64

$1,348.69
$1,480.39
$1,619.89
$2,115.47

$1,721.84
$1,853.54
$1,993.04
$2,488.62

$2,094.99
$2,226.69
$2,366.19
$2,861.77

$373.15

Toc - Plan #48 AvMed

Gold

(HMO) AvMed Entrust Gold 125 Dental+Vision (2024)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family

$2,000 $4,000 Annual Deductible

$4,700 $9,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$674.75
$765.84
$862.33
$1,205.10
$1,831.27

$1,190.93
$1,282.02
$1,378.51
$1,721.28

$1,707.11
$1,798.20
$1,894.69
$2,237.46

$2,223.29
$2,314.38
$2,410.87
$2,753.64

$516.18

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,349.50
$1,531.68
$1,724.66
$2,410.20
$3,662.54

$1,865.68
$2,047.86
$2,240.84
$2,926.38

$2,381.86
$2,564.04
$2,757.02
$3,442.56

$2,898.04
$3,080.22
$3,273.20
$3,958.74

$516.18

Toc - Plan #49 AvMed

Silver

(HMO) AvMed Entrust Silver 300 Dental+Vision (2024)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family

$3,000 $6,000 Annual Deductible

$7,650 $15,300 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$648.46
$736.00
$828.73
$1,158.14
$1,759.91

$1,144.53
$1,232.07
$1,324.80
$1,654.21

$1,640.60
$1,728.14
$1,820.87
$2,150.28

$2,136.67
$2,224.21
$2,316.94
$2,646.35

$496.07

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,296.92
$1,472.00
$1,657.46
$2,316.28
$3,519.82

$1,792.99
$1,968.07
$2,153.53
$2,812.35

$2,289.06
$2,464.14
$2,649.60
$3,308.42

$2,785.13
$2,960.21
$3,145.67
$3,804.49

$496.07

Toc - Plan #50 AvMed

Silver

(HMO) AvMed Entrust Silver 350 Dental+Vision (2024)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family

$3,500 $7,000 Annual Deductible

$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$626.31
$710.86
$800.42
$1,118.58
$1,699.80

$1,105.43
$1,189.98
$1,279.54
$1,597.70

$1,584.55
$1,669.10
$1,758.66
$2,076.82

$2,063.67
$2,148.22
$2,237.78
$2,555.94

$479.12

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,252.62
$1,421.72
$1,600.84
$2,237.16
$3,399.60

$1,731.74
$1,900.84
$2,079.96
$2,716.28

$2,210.86
$2,379.96
$2,559.08
$3,195.40

$2,689.98
$2,859.08
$3,038.20
$3,674.52

$479.12

Toc - Plan #51 AvMed

Silver

(HMO) AvMed Entrust Silver 500 Dental+Vision (2024)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family

$5,500 $11,000 Annual Deductible

$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$619.87
$703.55
$792.19
$1,107.08
$1,682.32

$1,094.07
$1,177.75
$1,266.39
$1,581.28

$1,568.27
$1,651.95
$1,740.59
$2,055.48

$2,042.47
$2,126.15
$2,214.79
$2,529.68

$474.20

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,239.74
$1,407.10
$1,584.38
$2,214.16
$3,364.64

$1,713.94
$1,881.30
$2,058.58
$2,688.36

$2,188.14
$2,355.50
$2,532.78
$3,162.56

$2,662.34
$2,829.70
$3,006.98
$3,636.76

$474.20

Toc - Plan #52 AvMed

Silver

(HMO) AvMed Entrust Silver 550 Dental+Vision (2024)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family

$6,500 $13,000 Annual Deductible

$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$614.15
$697.06
$784.88
$1,096.87
$1,666.80

$1,083.97
$1,166.88
$1,254.70
$1,566.69

$1,553.79
$1,636.70
$1,724.52
$2,036.51

$2,023.61
$2,106.52
$2,194.34
$2,506.33

$469.82

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,228.30
$1,394.12
$1,569.76
$2,193.74
$3,333.60

$1,698.12
$1,863.94
$2,039.58
$2,663.56

$2,167.94
$2,333.76
$2,509.40
$3,133.38

$2,637.76
$2,803.58
$2,979.22
$3,603.20

$469.82

Toc - Plan #53 AvMed

Expanded Bronze

(HMO) AvMed Entrust Bronze 625 Dental+Vision (2024)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$609.71
$692.02
$779.21
$1,088.94
$1,654.75

$1,076.14
$1,158.45
$1,245.64
$1,555.37

$1,542.57
$1,624.88
$1,712.07
$2,021.80

$2,009.00
$2,091.31
$2,178.50
$2,488.23

$466.43

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,219.42
$1,384.04
$1,558.42
$2,177.88
$3,309.50

$1,685.85
$1,850.47
$2,024.85
$2,644.31

$2,152.28
$2,316.90
$2,491.28
$3,110.74

$2,618.71
$2,783.33
$2,957.71
$3,577.17

$466.43

Ambetter from Sunshine Health

Local: 1-877-687-1169 | Toll Free: 1-877-687-1169 | TTY: 1-800-955-8770

Toc - Plan #54 Ambetter from Sunshine Health

Gold

(EPO) Complete Gold

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$1,450 $2,900 Annual Deductible

$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$481.12
$546.06
$614.86
$859.27
$1,305.74

$849.17
$914.11
$982.91
$1,227.32

$1,217.22
$1,282.16
$1,350.96
$1,595.37

$1,585.27
$1,650.21
$1,719.01
$1,963.42

$368.05

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$962.24
$1,092.12
$1,229.72
$1,718.54
$2,611.48

$1,330.29
$1,460.17
$1,597.77
$2,086.59

$1,698.34
$1,828.22
$1,965.82
$2,454.64

$2,066.39
$2,196.27
$2,333.87
$2,822.69

$368.05

Toc - Plan #55 Ambetter from Sunshine Health

Expanded Bronze

(EPO) Choice Bronze HSA

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$7,250 $14,500 Annual Deductible

$7,250 $14,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$397.43
$451.07
$507.91
$709.80
$1,078.61

$701.46
$755.10
$811.94
$1,013.83

$1,005.49
$1,059.13
$1,115.97
$1,317.86

$1,309.52
$1,363.16
$1,420.00
$1,621.89

$304.03

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$794.86
$902.14
$1,015.82
$1,419.60
$2,157.22

$1,098.89
$1,206.17
$1,319.85
$1,723.63

$1,402.92
$1,510.20
$1,623.88
$2,027.66

$1,706.95
$1,814.23
$1,927.91
$2,331.69

$304.03

Toc - Plan #56 Ambetter from Sunshine Health

Silver

(EPO) Everyday Silver

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$6,500 $13,000 Annual Deductible

$8,400 $16,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$501.62
$569.33
$641.06
$895.88
$1,361.37

$885.35
$953.06
$1,024.79
$1,279.61

$1,269.08
$1,336.79
$1,408.52
$1,663.34

$1,652.81
$1,720.52
$1,792.25
$2,047.07

$383.73

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,003.24
$1,138.66
$1,282.12
$1,791.76
$2,722.74

$1,386.97
$1,522.39
$1,665.85
$2,175.49

$1,770.70
$1,906.12
$2,049.58
$2,559.22

$2,154.43
$2,289.85
$2,433.31
$2,942.95

$383.73

Toc - Plan #57 Ambetter from Sunshine Health

Expanded Bronze

(EPO) Everyday Bronze

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$8,450 $16,900 Annual Deductible

$9,250 $18,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$392.03
$444.94
$501.00
$700.15
$1,063.94

$691.92
$744.83
$800.89
$1,000.04

$991.81
$1,044.72
$1,100.78
$1,299.93

$1,291.70
$1,344.61
$1,400.67
$1,599.82

$299.89

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$784.06
$889.88
$1,002.00
$1,400.30
$2,127.88

$1,083.95
$1,189.77
$1,301.89
$1,700.19

$1,383.84
$1,489.66
$1,601.78
$2,000.08

$1,683.73
$1,789.55
$1,901.67
$2,299.97

$299.89

Toc - Plan #58 Ambetter from Sunshine Health

Expanded Bronze

(EPO) Elite Bronze

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$9,250 $18,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$450.11
$510.86
$575.23
$803.88
$1,221.57

$794.44
$855.19
$919.56
$1,148.21

$1,138.77
$1,199.52
$1,263.89
$1,492.54

$1,483.10
$1,543.85
$1,608.22
$1,836.87

$344.33

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$900.22
$1,021.72
$1,150.46
$1,607.76
$2,443.14

$1,244.55
$1,366.05
$1,494.79
$1,952.09

$1,588.88
$1,710.38
$1,839.12
$2,296.42

$1,933.21
$2,054.71
$2,183.45
$2,640.75

$344.33

Toc - Plan #59 Ambetter from Sunshine Health

Silver

(EPO) Clear Silver

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$5,400 $10,800 Annual Deductible

$5,400 $10,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$488.52
$554.46
$624.32
$872.49
$1,325.83

$862.23
$928.17
$998.03
$1,246.20

$1,235.94
$1,301.88
$1,371.74
$1,619.91

$1,609.65
$1,675.59
$1,745.45
$1,993.62

$373.71

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$977.04
$1,108.92
$1,248.64
$1,744.98
$2,651.66

$1,350.75
$1,482.63
$1,622.35
$2,118.69

$1,724.46
$1,856.34
$1,996.06
$2,492.40

$2,098.17
$2,230.05
$2,369.77
$2,866.11

$373.71

Toc - Plan #60 Ambetter from Sunshine Health

Silver

(EPO) Focused Silver

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$6,300 $12,600 Annual Deductible

$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$497.24
$564.35
$635.46
$888.05
$1,349.48

$877.62
$944.73
$1,015.84
$1,268.43

$1,258.00
$1,325.11
$1,396.22
$1,648.81

$1,638.38
$1,705.49
$1,776.60
$2,029.19

$380.38

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$994.48
$1,128.70
$1,270.92
$1,776.10
$2,698.96

$1,374.86
$1,509.08
$1,651.30
$2,156.48

$1,755.24
$1,889.46
$2,031.68
$2,536.86

$2,135.62
$2,269.84
$2,412.06
$2,917.24

$380.38

Toc - Plan #61 Ambetter from Sunshine Health

Gold

(EPO) Everyday Gold

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$750 $1,500 Annual Deductible

$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$459.90
$521.97
$587.74
$821.36
$1,248.13

$811.71
$873.78
$939.55
$1,173.17

$1,163.52
$1,225.59
$1,291.36
$1,524.98

$1,515.33
$1,577.40
$1,643.17
$1,876.79

$351.81

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$919.80
$1,043.94
$1,175.48
$1,642.72
$2,496.26

$1,271.61
$1,395.75
$1,527.29
$1,994.53

$1,623.42
$1,747.56
$1,879.10
$2,346.34

$1,975.23
$2,099.37
$2,230.91
$2,698.15

$351.81

Toc - Plan #62 Ambetter from Sunshine Health

Gold

(EPO) Elite Gold

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$5,500 $11,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$529.03
$600.44
$676.09
$944.83
$1,435.76

$933.73
$1,005.14
$1,080.79
$1,349.53

$1,338.43
$1,409.84
$1,485.49
$1,754.23

$1,743.13
$1,814.54
$1,890.19
$2,158.93

$404.70

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,058.06
$1,200.88
$1,352.18
$1,889.66
$2,871.52

$1,462.76
$1,605.58
$1,756.88
$2,294.36

$1,867.46
$2,010.28
$2,161.58
$2,699.06

$2,272.16
$2,414.98
$2,566.28
$3,103.76

$404.70

Toc - Plan #63 Ambetter from Sunshine Health

Expanded Bronze

(EPO) Standard Expanded Bronze

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$384.43
$436.32
$491.29
$686.58
$1,043.33

$678.51
$730.40
$785.37
$980.66

$972.59
$1,024.48
$1,079.45
$1,274.74

$1,266.67
$1,318.56
$1,373.53
$1,568.82

$294.08

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$768.86
$872.64
$982.58
$1,373.16
$2,086.66

$1,062.94
$1,166.72
$1,276.66
$1,667.24

$1,357.02
$1,460.80
$1,570.74
$1,961.32

$1,651.10
$1,754.88
$1,864.82
$2,255.40

$294.08

Toc - Plan #64 Ambetter from Sunshine Health

Silver

(EPO) Standard Silver

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$5,900 $11,800 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$486.87
$552.58
$622.21
$869.53
$1,321.33

$859.32
$925.03
$994.66
$1,241.98

$1,231.77
$1,297.48
$1,367.11
$1,614.43

$1,604.22
$1,669.93
$1,739.56
$1,986.88

$372.45

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$973.74
$1,105.16
$1,244.42
$1,739.06
$2,642.66

$1,346.19
$1,477.61
$1,616.87
$2,111.51

$1,718.64
$1,850.06
$1,989.32
$2,483.96

$2,091.09
$2,222.51
$2,361.77
$2,856.41

$372.45

Toc - Plan #65 Ambetter from Sunshine Health

Gold

(EPO) Standard Gold

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$1,500 $3,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$457.12
$518.82
$584.19
$816.40
$1,240.60

$806.81
$868.51
$933.88
$1,166.09

$1,156.50
$1,218.20
$1,283.57
$1,515.78

$1,506.19
$1,567.89
$1,633.26
$1,865.47

$349.69

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$914.24
$1,037.64
$1,168.38
$1,632.80
$2,481.20

$1,263.93
$1,387.33
$1,518.07
$1,982.49

$1,613.62
$1,737.02
$1,867.76
$2,332.18

$1,963.31
$2,086.71
$2,217.45
$2,681.87

$349.69

Toc - Plan #66 Ambetter from Sunshine Health

Silver

(EPO) Everyday Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$6,500 $13,000 Annual Deductible

$8,400 $16,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$518.88
$588.92
$663.12
$926.71
$1,408.22

$915.82
$985.86
$1,060.06
$1,323.65

$1,312.76
$1,382.80
$1,457.00
$1,720.59

$1,709.70
$1,779.74
$1,853.94
$2,117.53

$396.94

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,037.76
$1,177.84
$1,326.24
$1,853.42
$2,816.44

$1,434.70
$1,574.78
$1,723.18
$2,250.36

$1,831.64
$1,971.72
$2,120.12
$2,647.30

$2,228.58
$2,368.66
$2,517.06
$3,044.24

$396.94

Toc - Plan #67 Ambetter from Sunshine Health

Expanded Bronze

(EPO) Choice Bronze HSA + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$7,250 $14,500 Annual Deductible

$7,250 $14,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$411.11
$466.60
$525.39
$734.23
$1,115.73

$725.60
$781.09
$839.88
$1,048.72

$1,040.09
$1,095.58
$1,154.37
$1,363.21

$1,354.58
$1,410.07
$1,468.86
$1,677.70

$314.49

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$822.22
$933.20
$1,050.78
$1,468.46
$2,231.46

$1,136.71
$1,247.69
$1,365.27
$1,782.95

$1,451.20
$1,562.18
$1,679.76
$2,097.44

$1,765.69
$1,876.67
$1,994.25
$2,411.93

$314.49

Toc - Plan #68 Ambetter from Sunshine Health

Gold

(EPO) Complete Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$1,450 $2,900 Annual Deductible

$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$497.68
$564.86
$636.02
$888.84
$1,350.68

$878.40
$945.58
$1,016.74
$1,269.56

$1,259.12
$1,326.30
$1,397.46
$1,650.28

$1,639.84
$1,707.02
$1,778.18
$2,031.00

$380.72

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$995.36
$1,129.72
$1,272.04
$1,777.68
$2,701.36

$1,376.08
$1,510.44
$1,652.76
$2,158.40

$1,756.80
$1,891.16
$2,033.48
$2,539.12

$2,137.52
$2,271.88
$2,414.20
$2,919.84

$380.72

Toc - Plan #69 Ambetter from Sunshine Health

Silver

(EPO) Clear Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$5,400 $10,800 Annual Deductible

$5,400 $10,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$505.34
$573.55
$645.81
$902.51
$1,371.46

$891.92
$960.13
$1,032.39
$1,289.09

$1,278.50
$1,346.71
$1,418.97
$1,675.67

$1,665.08
$1,733.29
$1,805.55
$2,062.25

$386.58

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,010.68
$1,147.10
$1,291.62
$1,805.02
$2,742.92

$1,397.26
$1,533.68
$1,678.20
$2,191.60

$1,783.84
$1,920.26
$2,064.78
$2,578.18

$2,170.42
$2,306.84
$2,451.36
$2,964.76

$386.58

Toc - Plan #70 Ambetter from Sunshine Health

Gold

(EPO) Elite Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$5,500 $11,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$547.24
$621.10
$699.36
$977.35
$1,485.18

$965.87
$1,039.73
$1,117.99
$1,395.98

$1,384.50
$1,458.36
$1,536.62
$1,814.61

$1,803.13
$1,876.99
$1,955.25
$2,233.24

$418.63

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,094.48
$1,242.20
$1,398.72
$1,954.70
$2,970.36

$1,513.11
$1,660.83
$1,817.35
$2,373.33

$1,931.74
$2,079.46
$2,235.98
$2,791.96

$2,350.37
$2,498.09
$2,654.61
$3,210.59

$418.63

Toc - Plan #71 Ambetter from Sunshine Health

Expanded Bronze

(EPO) Standard Expanded Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$397.66
$451.34
$508.20
$710.21
$1,079.23

$701.87
$755.55
$812.41
$1,014.42

$1,006.08
$1,059.76
$1,116.62
$1,318.63

$1,310.29
$1,363.97
$1,420.83
$1,622.84

$304.21

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$795.32
$902.68
$1,016.40
$1,420.42
$2,158.46

$1,099.53
$1,206.89
$1,320.61
$1,724.63

$1,403.74
$1,511.10
$1,624.82
$2,028.84

$1,707.95
$1,815.31
$1,929.03
$2,333.05

$304.21

Toc - Plan #72 Ambetter from Sunshine Health

Silver

(EPO) Standard Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$5,900 $11,800 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$503.62
$571.60
$643.62
$899.46
$1,366.81

$888.89
$956.87
$1,028.89
$1,284.73

$1,274.16
$1,342.14
$1,414.16
$1,670.00

$1,659.43
$1,727.41
$1,799.43
$2,055.27

$385.27

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,007.24
$1,143.20
$1,287.24
$1,798.92
$2,733.62

$1,392.51
$1,528.47
$1,672.51
$2,184.19

$1,777.78
$1,913.74
$2,057.78
$2,569.46

$2,163.05
$2,299.01
$2,443.05
$2,954.73

$385.27

Toc - Plan #73 Ambetter from Sunshine Health

Gold

(EPO) Standard Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$1,500 $3,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$472.85
$536.68
$604.29
$844.50
$1,283.30

$834.58
$898.41
$966.02
$1,206.23

$1,196.31
$1,260.14
$1,327.75
$1,567.96

$1,558.04
$1,621.87
$1,689.48
$1,929.69

$361.73

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$945.70
$1,073.36
$1,208.58
$1,689.00
$2,566.60

$1,307.43
$1,435.09
$1,570.31
$2,050.73

$1,669.16
$1,796.82
$1,932.04
$2,412.46

$2,030.89
$2,158.55
$2,293.77
$2,774.19

$361.73

Toc - Plan #74 Ambetter from Sunshine Health

Expanded Bronze

(EPO) Everyday Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$8,450 $16,900 Annual Deductible

$9,250 $18,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$405.52
$460.25
$518.24
$724.24
$1,100.56

$715.74
$770.47
$828.46
$1,034.46

$1,025.96
$1,080.69
$1,138.68
$1,344.68

$1,336.18
$1,390.91
$1,448.90
$1,654.90

$310.22

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$811.04
$920.50
$1,036.48
$1,448.48
$2,201.12

$1,121.26
$1,230.72
$1,346.70
$1,758.70

$1,431.48
$1,540.94
$1,656.92
$2,068.92

$1,741.70
$1,851.16
$1,967.14
$2,379.14

$310.22

Toc - Plan #75 Ambetter from Sunshine Health

Expanded Bronze

(EPO) Elite Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$9,250 $18,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$465.60
$528.45
$595.03
$831.55
$1,263.62

$821.78
$884.63
$951.21
$1,187.73

$1,177.96
$1,240.81
$1,307.39
$1,543.91

$1,534.14
$1,596.99
$1,663.57
$1,900.09

$356.18

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$931.20
$1,056.90
$1,190.06
$1,663.10
$2,527.24

$1,287.38
$1,413.08
$1,546.24
$2,019.28

$1,643.56
$1,769.26
$1,902.42
$2,375.46

$1,999.74
$2,125.44
$2,258.60
$2,731.64

$356.18

Toc - Plan #76 Ambetter from Sunshine Health

Silver

(EPO) Focused Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$6,300 $12,600 Annual Deductible

$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$514.35
$583.78
$657.33
$918.61
$1,395.92

$907.82
$977.25
$1,050.80
$1,312.08

$1,301.29
$1,370.72
$1,444.27
$1,705.55

$1,694.76
$1,764.19
$1,837.74
$2,099.02

$393.47

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,028.70
$1,167.56
$1,314.66
$1,837.22
$2,791.84

$1,422.17
$1,561.03
$1,708.13
$2,230.69

$1,815.64
$1,954.50
$2,101.60
$2,624.16

$2,209.11
$2,347.97
$2,495.07
$3,017.63

$393.47

Toc - Plan #77 Ambetter from Sunshine Health

Gold

(EPO) Everyday Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$750 $1,500 Annual Deductible

$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$475.72
$539.94
$607.96
$849.63
$1,291.09

$839.64
$903.86
$971.88
$1,213.55

$1,203.56
$1,267.78
$1,335.80
$1,577.47

$1,567.48
$1,631.70
$1,699.72
$1,941.39

$363.92

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$951.44
$1,079.88
$1,215.92
$1,699.26
$2,582.18

$1,315.36
$1,443.80
$1,579.84
$2,063.18

$1,679.28
$1,807.72
$1,943.76
$2,427.10

$2,043.20
$2,171.64
$2,307.68
$2,791.02

$363.92

Florida Blue HMO (a BlueCross BlueShield FL company)

Local: 1-800-352-2583 | Toll Free: 1-800-352-2583 | TTY: 1-800-955-8771

Toc - Plan #78 Florida Blue HMO (a BlueCross BlueShield FL company)

Silver

(HMO) myBlue Silver 2010 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$5,000 $10,000 Annual Deductible

$7,700 $15,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$442.09
$501.77
$564.99
$789.57
$1,199.83

$780.29
$839.97
$903.19
$1,127.77

$1,118.49
$1,178.17
$1,241.39
$1,465.97

$1,456.69
$1,516.37
$1,579.59
$1,804.17

$338.20

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$884.18
$1,003.54
$1,129.98
$1,579.14
$2,399.66

$1,222.38
$1,341.74
$1,468.18
$1,917.34

$1,560.58
$1,679.94
$1,806.38
$2,255.54

$1,898.78
$2,018.14
$2,144.58
$2,593.74

$338.20

Toc - Plan #79 Florida Blue HMO (a BlueCross BlueShield FL company)

Gold

(HMO) myBlue Gold 2011 ($0 Virtual Visits / $0 Labs / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$940 $1,880 Annual Deductible

$4,700 $9,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$537.59
$610.16
$687.04
$960.14
$1,459.02

$948.85
$1,021.42
$1,098.30
$1,371.40

$1,360.11
$1,432.68
$1,509.56
$1,782.66

$1,771.37
$1,843.94
$1,920.82
$2,193.92

$411.26

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,075.18
$1,220.32
$1,374.08
$1,920.28
$2,918.04

$1,486.44
$1,631.58
$1,785.34
$2,331.54

$1,897.70
$2,042.84
$2,196.60
$2,742.80

$2,308.96
$2,454.10
$2,607.86
$3,154.06

$411.26

Toc - Plan #80 Florida Blue HMO (a BlueCross BlueShield FL company)

Expanded Bronze

(HMO) myBlue Bronze 2013 ($0 Virtual Visits / 3 PCP Visits for $0 then $30 / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$6,000 $12,000 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$401.15
$455.31
$512.67
$716.45
$1,088.72

$708.03
$762.19
$819.55
$1,023.33

$1,014.91
$1,069.07
$1,126.43
$1,330.21

$1,321.79
$1,375.95
$1,433.31
$1,637.09

$306.88

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$802.30
$910.62
$1,025.34
$1,432.90
$2,177.44

$1,109.18
$1,217.50
$1,332.22
$1,739.78

$1,416.06
$1,524.38
$1,639.10
$2,046.66

$1,722.94
$1,831.26
$1,945.98
$2,353.54

$306.88

Toc - Plan #81 Florida Blue HMO (a BlueCross BlueShield FL company)

Platinum

(HMO) myBlue Platinum 2015 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$2,000 $4,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$697.20
$791.32
$891.02
$1,245.20
$1,892.20

$1,230.56
$1,324.68
$1,424.38
$1,778.56

$1,763.92
$1,858.04
$1,957.74
$2,311.92

$2,297.28
$2,391.40
$2,491.10
$2,845.28

$533.36

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,394.40
$1,582.64
$1,782.04
$2,490.40
$3,784.40

$1,927.76
$2,116.00
$2,315.40
$3,023.76

$2,461.12
$2,649.36
$2,848.76
$3,557.12

$2,994.48
$3,182.72
$3,382.12
$4,090.48

$533.36

Toc - Plan #82 Florida Blue HMO (a BlueCross BlueShield FL company)

Gold

(HMO) myBlue Gold 2016 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$5,950 $11,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$569.18
$646.02
$727.41
$1,016.56
$1,544.75

$1,004.60
$1,081.44
$1,162.83
$1,451.98

$1,440.02
$1,516.86
$1,598.25
$1,887.40

$1,875.44
$1,952.28
$2,033.67
$2,322.82

$435.42

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,138.36
$1,292.04
$1,454.82
$2,033.12
$3,089.50

$1,573.78
$1,727.46
$1,890.24
$2,468.54

$2,009.20
$2,162.88
$2,325.66
$2,903.96

$2,444.62
$2,598.30
$2,761.08
$3,339.38

$435.42

Toc - Plan #83 Florida Blue HMO (a BlueCross BlueShield FL company)

Expanded Bronze

(HMO) myBlue Bronze 2149 ($0 Virtual Visits / $35 PCP Visits / $75 Specialist Visits / $30 Generic Meds / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$421.65
$478.57
$538.87
$753.07
$1,144.36

$744.21
$801.13
$861.43
$1,075.63

$1,066.77
$1,123.69
$1,183.99
$1,398.19

$1,389.33
$1,446.25
$1,506.55
$1,720.75

$322.56

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$843.30
$957.14
$1,077.74
$1,506.14
$2,288.72

$1,165.86
$1,279.70
$1,400.30
$1,828.70

$1,488.42
$1,602.26
$1,722.86
$2,151.26

$1,810.98
$1,924.82
$2,045.42
$2,473.82

$322.56

Toc - Plan #84 Florida Blue HMO (a BlueCross BlueShield FL company)

Expanded Bronze

(HMO) myBlue Bronze 2349 ($0 Virtual Visits / Multilingual Available /Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$409.30
$464.56
$523.09
$731.01
$1,110.84

$722.41
$777.67
$836.20
$1,044.12

$1,035.52
$1,090.78
$1,149.31
$1,357.23

$1,348.63
$1,403.89
$1,462.42
$1,670.34

$313.11

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$818.60
$929.12
$1,046.18
$1,462.02
$2,221.68

$1,131.71
$1,242.23
$1,359.29
$1,775.13

$1,444.82
$1,555.34
$1,672.40
$2,088.24

$1,757.93
$1,868.45
$1,985.51
$2,401.35

$313.11

Toc - Plan #85 Florida Blue HMO (a BlueCross BlueShield FL company)

Silver

(HMO) myBlue Silver 2204 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$4,750 $9,500 Annual Deductible

$7,800 $15,600 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$456.36
$517.97
$583.23
$815.06
$1,238.56

$805.48
$867.09
$932.35
$1,164.18

$1,154.60
$1,216.21
$1,281.47
$1,513.30

$1,503.72
$1,565.33
$1,630.59
$1,862.42

$349.12

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$912.72
$1,035.94
$1,166.46
$1,630.12
$2,477.12

$1,261.84
$1,385.06
$1,515.58
$1,979.24

$1,610.96
$1,734.18
$1,864.70
$2,328.36

$1,960.08
$2,083.30
$2,213.82
$2,677.48

$349.12

Toc - Plan #86 Florida Blue HMO (a BlueCross BlueShield FL company)

Expanded Bronze

(HMO) myBlue Bronze 2286 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$1,700 $3,400 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$391.75
$444.64
$500.66
$699.67
$1,063.21

$691.44
$744.33
$800.35
$999.36

$991.13
$1,044.02
$1,100.04
$1,299.05

$1,290.82
$1,343.71
$1,399.73
$1,598.74

$299.69

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$783.50
$889.28
$1,001.32
$1,399.34
$2,126.42

$1,083.19
$1,188.97
$1,301.01
$1,699.03

$1,382.88
$1,488.66
$1,600.70
$1,998.72

$1,682.57
$1,788.35
$1,900.39
$2,298.41

$299.69

Toc - Plan #87 Florida Blue HMO (a BlueCross BlueShield FL company)

Expanded Bronze

(HMO) myBlue Bronze 2322S (Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$379.83
$431.11
$485.42
$678.38
$1,030.86

$670.40
$721.68
$775.99
$968.95

$960.97
$1,012.25
$1,066.56
$1,259.52

$1,251.54
$1,302.82
$1,357.13
$1,550.09

$290.57

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$759.66
$862.22
$970.84
$1,356.76
$2,061.72

$1,050.23
$1,152.79
$1,261.41
$1,647.33

$1,340.80
$1,443.36
$1,551.98
$1,937.90

$1,631.37
$1,733.93
$1,842.55
$2,228.47

$290.57

Toc - Plan #88 Florida Blue HMO (a BlueCross BlueShield FL company)

Silver

(HMO) myBlue Silver 2323S ($40 PCP Visits / Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$5,900 $11,800 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$464.07
$526.72
$593.08
$828.83
$1,259.49

$819.08
$881.73
$948.09
$1,183.84

$1,174.09
$1,236.74
$1,303.10
$1,538.85

$1,529.10
$1,591.75
$1,658.11
$1,893.86

$355.01

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$928.14
$1,053.44
$1,186.16
$1,657.66
$2,518.98

$1,283.15
$1,408.45
$1,541.17
$2,012.67

$1,638.16
$1,763.46
$1,896.18
$2,367.68

$1,993.17
$2,118.47
$2,251.19
$2,722.69

$355.01

Toc - Plan #89 Florida Blue HMO (a BlueCross BlueShield FL company)

Gold

(HMO) myBlue Gold 2325S ($30 PCP Visits / $60 Specialist Visits / Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$1,500 $3,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$530.04
$601.60
$677.39
$946.65
$1,438.53

$935.52
$1,007.08
$1,082.87
$1,352.13

$1,341.00
$1,412.56
$1,488.35
$1,757.61

$1,746.48
$1,818.04
$1,893.83
$2,163.09

$405.48

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,060.08
$1,203.20
$1,354.78
$1,893.30
$2,877.06

$1,465.56
$1,608.68
$1,760.26
$2,298.78

$1,871.04
$2,014.16
$2,165.74
$2,704.26

$2,276.52
$2,419.64
$2,571.22
$3,109.74

$405.48

Toc - Plan #90 Florida Blue HMO (a BlueCross BlueShield FL company)

Platinum

(HMO) myBlue Platinum 2324S ($0 Deductible / $10 PCP Visits / Multilingual Available / Rewards $$$ )

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$3,200 $6,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$689.43
$782.50
$881.09
$1,231.32
$1,871.11

$1,216.84
$1,309.91
$1,408.50
$1,758.73

$1,744.25
$1,837.32
$1,935.91
$2,286.14

$2,271.66
$2,364.73
$2,463.32
$2,813.55

$527.41

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,378.86
$1,565.00
$1,762.18
$2,462.64
$3,742.22

$1,906.27
$2,092.41
$2,289.59
$2,990.05

$2,433.68
$2,619.82
$2,817.00
$3,517.46

$2,961.09
$3,147.23
$3,344.41
$4,044.87

$527.41

Toc - Plan #91 Florida Blue HMO (a BlueCross BlueShield FL company)

Silver

(HMO) myBlue Silver 24M02-78 ($0 Virtual Visits / $10 Labs / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$7,600 $15,200 Annual Deductible

$9,300 $18,600 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$426.68
$484.28
$545.30
$762.05
$1,158.01

$753.09
$810.69
$871.71
$1,088.46

$1,079.50
$1,137.10
$1,198.12
$1,414.87

$1,405.91
$1,463.51
$1,524.53
$1,741.28

$326.41

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$853.36
$968.56
$1,090.60
$1,524.10
$2,316.02

$1,179.77
$1,294.97
$1,417.01
$1,850.51

$1,506.18
$1,621.38
$1,743.42
$2,176.92

$1,832.59
$1,947.79
$2,069.83
$2,503.33

$326.41

Toc - Plan #92 Florida Blue HMO (a BlueCross BlueShield FL company)

Silver

(HMO) myBlue Silver 24M02-78D ($0 Virtual Visits / Adult Dental / $10 Labs / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$7,600 $15,200 Annual Deductible

$9,300 $18,600 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$435.82
$494.66
$556.98
$778.37
$1,182.82

$769.22
$828.06
$890.38
$1,111.77

$1,102.62
$1,161.46
$1,223.78
$1,445.17

$1,436.02
$1,494.86
$1,557.18
$1,778.57

$333.40

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$871.64
$989.32
$1,113.96
$1,556.74
$2,365.64

$1,205.04
$1,322.72
$1,447.36
$1,890.14

$1,538.44
$1,656.12
$1,780.76
$2,223.54

$1,871.84
$1,989.52
$2,114.16
$2,556.94

$333.40

Toc - Plan #93 Florida Blue HMO (a BlueCross BlueShield FL company)

Silver

(POS) BlueCare Silver 24K01-02 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$6,000 $12,000 Annual Deductible

$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$531.23
$602.95
$678.91
$948.78
$1,441.76

$937.62
$1,009.34
$1,085.30
$1,355.17

$1,344.01
$1,415.73
$1,491.69
$1,761.56

$1,750.40
$1,822.12
$1,898.08
$2,167.95

$406.39

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,062.46
$1,205.90
$1,357.82
$1,897.56
$2,883.52

$1,468.85
$1,612.29
$1,764.21
$2,303.95

$1,875.24
$2,018.68
$2,170.60
$2,710.34

$2,281.63
$2,425.07
$2,576.99
$3,116.73

$406.39

Toc - Plan #94 Florida Blue HMO (a BlueCross BlueShield FL company)

Expanded Bronze

(POS) BlueCare Bronze 24K01-03 ($0 Virtual Visits / 3 PCP Visits for $0 then $40 / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$6,500 $13,000 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$448.23
$508.74
$572.84
$800.54
$1,216.50

$791.13
$851.64
$915.74
$1,143.44

$1,134.03
$1,194.54
$1,258.64
$1,486.34

$1,476.93
$1,537.44
$1,601.54
$1,829.24

$342.90

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$896.46
$1,017.48
$1,145.68
$1,601.08
$2,433.00

$1,239.36
$1,360.38
$1,488.58
$1,943.98

$1,582.26
$1,703.28
$1,831.48
$2,286.88

$1,925.16
$2,046.18
$2,174.38
$2,629.78

$342.90

Toc - Plan #95 Florida Blue HMO (a BlueCross BlueShield FL company)

Platinum

(POS) BlueCare Platinum 24K01-04 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$1,000 $2,000 Annual Deductible

$4,000 $8,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$726.03
$824.04
$927.87
$1,296.69
$1,970.45

$1,281.44
$1,379.45
$1,483.28
$1,852.10

$1,836.85
$1,934.86
$2,038.69
$2,407.51

$2,392.26
$2,490.27
$2,594.10
$2,962.92

$555.41

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,452.06
$1,648.08
$1,855.74
$2,593.38
$3,940.90

$2,007.47
$2,203.49
$2,411.15
$3,148.79

$2,562.88
$2,758.90
$2,966.56
$3,704.20

$3,118.29
$3,314.31
$3,521.97
$4,259.61

$555.41

Toc - Plan #96 Florida Blue HMO (a BlueCross BlueShield FL company)

Bronze

(POS) BlueCare Bronze 24K01-05 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$6,150 $12,300 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$408.40
$463.53
$521.94
$729.40
$1,108.40

$720.83
$775.96
$834.37
$1,041.83

$1,033.26
$1,088.39
$1,146.80
$1,354.26

$1,345.69
$1,400.82
$1,459.23
$1,666.69

$312.43

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$816.80
$927.06
$1,043.88
$1,458.80
$2,216.80

$1,129.23
$1,239.49
$1,356.31
$1,771.23

$1,441.66
$1,551.92
$1,668.74
$2,083.66

$1,754.09
$1,864.35
$1,981.17
$2,396.09

$312.43

Toc - Plan #97 Florida Blue HMO (a BlueCross BlueShield FL company)

Silver

(POS) BlueCare Silver 24K01-06 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$2,800 $5,600 Annual Deductible

$7,150 $14,300 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$584.67
$663.60
$747.21
$1,044.22
$1,586.79

$1,031.94
$1,110.87
$1,194.48
$1,491.49

$1,479.21
$1,558.14
$1,641.75
$1,938.76

$1,926.48
$2,005.41
$2,089.02
$2,386.03

$447.27

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,169.34
$1,327.20
$1,494.42
$2,088.44
$3,173.58

$1,616.61
$1,774.47
$1,941.69
$2,535.71

$2,063.88
$2,221.74
$2,388.96
$2,982.98

$2,511.15
$2,669.01
$2,836.23
$3,430.25

$447.27

Toc - Plan #98 Florida Blue HMO (a BlueCross BlueShield FL company)

Platinum

(POS) BlueCare Platinum 24K01-07 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$2,000 $4,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$763.49
$866.56
$975.74
$1,363.59
$2,072.11

$1,347.56
$1,450.63
$1,559.81
$1,947.66

$1,931.63
$2,034.70
$2,143.88
$2,531.73

$2,515.70
$2,618.77
$2,727.95
$3,115.80

$584.07

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,526.98
$1,733.12
$1,951.48
$2,727.18
$4,144.22

$2,111.05
$2,317.19
$2,535.55
$3,311.25

$2,695.12
$2,901.26
$3,119.62
$3,895.32

$3,279.19
$3,485.33
$3,703.69
$4,479.39

$584.07

Toc - Plan #99 Florida Blue HMO (a BlueCross BlueShield FL company)

Gold

(POS) BlueCare Gold 24K01-08 ($0 Virtual Visits / $20 PCP Visit / $15 Generic Meds / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$6,250 $12,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$660.49
$749.66
$844.11
$1,179.64
$1,792.57

$1,165.76
$1,254.93
$1,349.38
$1,684.91

$1,671.03
$1,760.20
$1,854.65
$2,190.18

$2,176.30
$2,265.47
$2,359.92
$2,695.45

$505.27

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,320.98
$1,499.32
$1,688.22
$2,359.28
$3,585.14

$1,826.25
$2,004.59
$2,193.49
$2,864.55

$2,331.52
$2,509.86
$2,698.76
$3,369.82

$2,836.79
$3,015.13
$3,204.03
$3,875.09

$505.27

Toc - Plan #100 Florida Blue HMO (a BlueCross BlueShield FL company)

Expanded Bronze

(POS) BlueCare Bronze (HSA) 24K01-09 (Rewards $$$ / $4 Condition Care Rx)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$7,050 $14,100 Annual Deductible

$7,050 $14,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$429.23
$487.18
$548.56
$766.60
$1,164.93

$757.59
$815.54
$876.92
$1,094.96

$1,085.95
$1,143.90
$1,205.28
$1,423.32

$1,414.31
$1,472.26
$1,533.64
$1,751.68

$328.36

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$858.46
$974.36
$1,097.12
$1,533.20
$2,329.86

$1,186.82
$1,302.72
$1,425.48
$1,861.56

$1,515.18
$1,631.08
$1,753.84
$2,189.92

$1,843.54
$1,959.44
$2,082.20
$2,518.28

$328.36

Toc - Plan #101 Florida Blue HMO (a BlueCross BlueShield FL company)

Gold

(POS) BlueCare Gold 24K01-10 ($0 Virtual Visits / $20 Labs / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$1,500 $3,000 Annual Deductible

$5,900 $11,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$633.63
$719.17
$809.78
$1,131.66
$1,719.67

$1,118.36
$1,203.90
$1,294.51
$1,616.39

$1,603.09
$1,688.63
$1,779.24
$2,101.12

$2,087.82
$2,173.36
$2,263.97
$2,585.85

$484.73

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,267.26
$1,438.34
$1,619.56
$2,263.32
$3,439.34

$1,751.99
$1,923.07
$2,104.29
$2,748.05

$2,236.72
$2,407.80
$2,589.02
$3,232.78

$2,721.45
$2,892.53
$3,073.75
$3,717.51

$484.73

Toc - Plan #102 Florida Blue HMO (a BlueCross BlueShield FL company)

Expanded Bronze

(POS) BlueCare Bronze 24K01-25 ($0 Virtual Visits / $50 PCP Visit / $30 Generic Meds / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$478.24
$542.80
$611.19
$854.14
$1,297.94

$844.09
$908.65
$977.04
$1,219.99

$1,209.94
$1,274.50
$1,342.89
$1,585.84

$1,575.79
$1,640.35
$1,708.74
$1,951.69

$365.85

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$956.48
$1,085.60
$1,222.38
$1,708.28
$2,595.88

$1,322.33
$1,451.45
$1,588.23
$2,074.13

$1,688.18
$1,817.30
$1,954.08
$2,439.98

$2,054.03
$2,183.15
$2,319.93
$2,805.83

$365.85

Toc - Plan #103 Florida Blue HMO (a BlueCross BlueShield FL company)

Expanded Bronze

(POS) BlueCare Bronze 24K01-31S (Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$436.68
$495.63
$558.08
$779.91
$1,185.15

$770.74
$829.69
$892.14
$1,113.97

$1,104.80
$1,163.75
$1,226.20
$1,448.03

$1,438.86
$1,497.81
$1,560.26
$1,782.09

$334.06

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$873.36
$991.26
$1,116.16
$1,559.82
$2,370.30

$1,207.42
$1,325.32
$1,450.22
$1,893.88

$1,541.48
$1,659.38
$1,784.28
$2,227.94

$1,875.54
$1,993.44
$2,118.34
$2,562.00

$334.06

Toc - Plan #104 Florida Blue HMO (a BlueCross BlueShield FL company)

Silver

(POS) BlueCare Silver 24K01-32S ($40 PCP Visits / Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$5,900 $11,800 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$562.58
$638.53
$718.98
$1,004.77
$1,526.84

$992.95
$1,068.90
$1,149.35
$1,435.14

$1,423.32
$1,499.27
$1,579.72
$1,865.51

$1,853.69
$1,929.64
$2,010.09
$2,295.88

$430.37

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,125.16
$1,277.06
$1,437.96
$2,009.54
$3,053.68

$1,555.53
$1,707.43
$1,868.33
$2,439.91

$1,985.90
$2,137.80
$2,298.70
$2,870.28

$2,416.27
$2,568.17
$2,729.07
$3,300.65

$430.37

Toc - Plan #105 Florida Blue HMO (a BlueCross BlueShield FL company)

Gold

(POS) BlueCare Gold 24K01-33S ($30 PCP Visit / Multilingual Available/ Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$1,500 $3,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$614.09
$696.99
$784.81
$1,096.76
$1,666.64

$1,083.87
$1,166.77
$1,254.59
$1,566.54

$1,553.65
$1,636.55
$1,724.37
$2,036.32

$2,023.43
$2,106.33
$2,194.15
$2,506.10

$469.78

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,228.18
$1,393.98
$1,569.62
$2,193.52
$3,333.28

$1,697.96
$1,863.76
$2,039.40
$2,663.30

$2,167.74
$2,333.54
$2,509.18
$3,133.08

$2,637.52
$2,803.32
$2,978.96
$3,602.86

$469.78

Toc - Plan #106 Florida Blue HMO (a BlueCross BlueShield FL company)

Platinum

(POS) BlueCare Platinum 24K01-34S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$3,200 $6,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$761.08
$863.83
$972.66
$1,359.29
$2,065.57

$1,343.31
$1,446.06
$1,554.89
$1,941.52

$1,925.54
$2,028.29
$2,137.12
$2,523.75

$2,507.77
$2,610.52
$2,719.35
$3,105.98

$582.23

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,522.16
$1,727.66
$1,945.32
$2,718.58
$4,131.14

$2,104.39
$2,309.89
$2,527.55
$3,300.81

$2,686.62
$2,892.12
$3,109.78
$3,883.04

$3,268.85
$3,474.35
$3,692.01
$4,465.27

$582.23

UnitedHealthcare

Local: 1-888-200-0405 | Toll Free: 1-888-200-0405 | TTY: 1-888-200-0405

Toc - Plan #107 UnitedHealthcare

Silver

(HMO) UHC Silver Virtual First (Unlimited $0 App-based Care, $3 Tier 2 Rx) (Disponible en espanol)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family

$3,900 $7,800 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$434.37
$493.01
$555.13
$775.79
$1,178.88

$766.66
$825.30
$887.42
$1,108.08

$1,098.95
$1,157.59
$1,219.71
$1,440.37

$1,431.24
$1,489.88
$1,552.00
$1,772.66

$332.29

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$868.74
$986.02
$1,110.26
$1,551.58
$2,357.76

$1,201.03
$1,318.31
$1,442.55
$1,883.87

$1,533.32
$1,650.60
$1,774.84
$2,216.16

$1,865.61
$1,982.89
$2,107.13
$2,548.45

$332.29

Toc - Plan #108 UnitedHealthcare

Expanded Bronze

(HMO) UHC Bronze Value ($0 Virtual Urgent Care + $0 PCP Visits, $3 Tier 2 Rx)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family

$8,250 $16,500 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$348.12
$395.11
$444.90
$621.74
$944.79

$614.43
$661.42
$711.21
$888.05

$880.74
$927.73
$977.52
$1,154.36

$1,147.05
$1,194.04
$1,243.83
$1,420.67

$266.31

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$696.24
$790.22
$889.80
$1,243.48
$1,889.58

$962.55
$1,056.53
$1,156.11
$1,509.79

$1,228.86
$1,322.84
$1,422.42
$1,776.10

$1,495.17
$1,589.15
$1,688.73
$2,042.41

$266.31

Toc - Plan #109 UnitedHealthcare

Expanded Bronze

(HMO) UHC Bronze Virtual First (Unlimited $0 App-based Care, $3 Tier 2 Rx) (Disponible en espanol)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family

$7,250 $14,500 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$348.65
$395.72
$445.58
$622.69
$946.24

$615.37
$662.44
$712.30
$889.41

$882.09
$929.16
$979.02
$1,156.13

$1,148.81
$1,195.88
$1,245.74
$1,422.85

$266.72

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$697.30
$791.44
$891.16
$1,245.38
$1,892.48

$964.02
$1,058.16
$1,157.88
$1,512.10

$1,230.74
$1,324.88
$1,424.60
$1,778.82

$1,497.46
$1,591.60
$1,691.32
$2,045.54

$266.72

Toc - Plan #110 UnitedHealthcare

Gold

(HMO) UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $3 Tier 2 Rx)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$7,750 $15,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$499.25
$566.65
$638.05
$891.67
$1,354.98

$881.18
$948.58
$1,019.98
$1,273.60

$1,263.11
$1,330.51
$1,401.91
$1,655.53

$1,645.04
$1,712.44
$1,783.84
$2,037.46

$381.93

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$998.50
$1,133.30
$1,276.10
$1,783.34
$2,709.96

$1,380.43
$1,515.23
$1,658.03
$2,165.27

$1,762.36
$1,897.16
$2,039.96
$2,547.20

$2,144.29
$2,279.09
$2,421.89
$2,929.13

$381.93

Toc - Plan #111 UnitedHealthcare

Gold

(HMO) UHC Gold Standard

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family

$1,500 $3,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$490.76
$557.01
$627.19
$876.50
$1,331.93

$866.19
$932.44
$1,002.62
$1,251.93

$1,241.62
$1,307.87
$1,378.05
$1,627.36

$1,617.05
$1,683.30
$1,753.48
$2,002.79

$375.43

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$981.52
$1,114.02
$1,254.38
$1,753.00
$2,663.86

$1,356.95
$1,489.45
$1,629.81
$2,128.43

$1,732.38
$1,864.88
$2,005.24
$2,503.86

$2,107.81
$2,240.31
$2,380.67
$2,879.29

$375.43

Toc - Plan #112 UnitedHealthcare

Silver

(HMO) UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$451.84
$512.84
$577.46
$806.99
$1,226.30

$797.50
$858.50
$923.12
$1,152.65

$1,143.16
$1,204.16
$1,268.78
$1,498.31

$1,488.82
$1,549.82
$1,614.44
$1,843.97

$345.66

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$903.68
$1,025.68
$1,154.92
$1,613.98
$2,452.60

$1,249.34
$1,371.34
$1,500.58
$1,959.64

$1,595.00
$1,717.00
$1,846.24
$2,305.30

$1,940.66
$2,062.66
$2,191.90
$2,650.96

$345.66

Toc - Plan #113 UnitedHealthcare

Silver

(HMO) UHC Silver Standard

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family

$5,900 $11,800 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$429.55
$487.54
$548.97
$767.18
$1,165.80

$758.16
$816.15
$877.58
$1,095.79

$1,086.77
$1,144.76
$1,206.19
$1,424.40

$1,415.38
$1,473.37
$1,534.80
$1,753.01

$328.61

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$859.10
$975.08
$1,097.94
$1,534.36
$2,331.60

$1,187.71
$1,303.69
$1,426.55
$1,862.97

$1,516.32
$1,632.30
$1,755.16
$2,191.58

$1,844.93
$1,960.91
$2,083.77
$2,520.19

$328.61

Toc - Plan #114 UnitedHealthcare

Bronze

(HMO) UHC Bronze Essential ($0 Virtual Urgent Care, $3 Tier 2 Rx)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family

$6,350 $12,700 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$343.01
$389.32
$438.37
$612.62
$930.94

$605.42
$651.73
$700.78
$875.03

$867.83
$914.14
$963.19
$1,137.44

$1,130.24
$1,176.55
$1,225.60
$1,399.85

$262.41

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$686.02
$778.64
$876.74
$1,225.24
$1,861.88

$948.43
$1,041.05
$1,139.15
$1,487.65

$1,210.84
$1,303.46
$1,401.56
$1,750.06

$1,473.25
$1,565.87
$1,663.97
$2,012.47

$262.41

Toc - Plan #115 UnitedHealthcare

Expanded Bronze

(HMO) UHC Bronze Standard

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$349.16
$396.30
$446.23
$623.61
$947.63

$616.27
$663.41
$713.34
$890.72

$883.38
$930.52
$980.45
$1,157.83

$1,150.49
$1,197.63
$1,247.56
$1,424.94

$267.11

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$698.32
$792.60
$892.46
$1,247.22
$1,895.26

$965.43
$1,059.71
$1,159.57
$1,514.33

$1,232.54
$1,326.82
$1,426.68
$1,781.44

$1,499.65
$1,593.93
$1,693.79
$2,048.55

$267.11

Toc - Plan #116 UnitedHealthcare

Expanded Bronze

(HMO) UHC Bronze Copay Focus $0 Indiv Med Ded

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$366.15
$415.58
$467.94
$653.94
$993.72

$646.25
$695.68
$748.04
$934.04

$926.35
$975.78
$1,028.14
$1,214.14

$1,206.45
$1,255.88
$1,308.24
$1,494.24

$280.10

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$732.30
$831.16
$935.88
$1,307.88
$1,987.44

$1,012.40
$1,111.26
$1,215.98
$1,587.98

$1,292.50
$1,391.36
$1,496.08
$1,868.08

$1,572.60
$1,671.46
$1,776.18
$2,148.18

$280.10

Toc - Plan #117 UnitedHealthcare

Silver

(HMO) UHC Silver Value ($0 Virtual Urgent Care, $3 Tier 2 Rx)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family

$3,500 $7,000 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$433.41
$491.93
$553.90
$774.08
$1,176.29

$764.97
$823.49
$885.46
$1,105.64

$1,096.53
$1,155.05
$1,217.02
$1,437.20

$1,428.09
$1,486.61
$1,548.58
$1,768.76

$331.56

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$866.82
$983.86
$1,107.80
$1,548.16
$2,352.58

$1,198.38
$1,315.42
$1,439.36
$1,879.72

$1,529.94
$1,646.98
$1,770.92
$2,211.28

$1,861.50
$1,978.54
$2,102.48
$2,542.84

$331.56

Toc - Plan #118 UnitedHealthcare

Silver

(HMO) UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, $0 Insulin)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family

$2,750 $5,500 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$438.31
$497.48
$560.16
$782.82
$1,189.57

$773.62
$832.79
$895.47
$1,118.13

$1,108.93
$1,168.10
$1,230.78
$1,453.44

$1,444.24
$1,503.41
$1,566.09
$1,788.75

$335.31

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$876.62
$994.96
$1,120.32
$1,565.64
$2,379.14

$1,211.93
$1,330.27
$1,455.63
$1,900.95

$1,547.24
$1,665.58
$1,790.94
$2,236.26

$1,882.55
$2,000.89
$2,126.25
$2,571.57

$335.31

Toc - Plan #119 UnitedHealthcare

Gold

(HMO) UHC Gold Value ($0 Virtual Urgent Care, $3 Tier 2 Rx)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family

$1,500 $3,000 Annual Deductible

$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$488.02
$553.90
$623.69
$871.60
$1,324.48

$861.35
$927.23
$997.02
$1,244.93

$1,234.68
$1,300.56
$1,370.35
$1,618.26

$1,608.01
$1,673.89
$1,743.68
$1,991.59

$373.33

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$976.04
$1,107.80
$1,247.38
$1,743.20
$2,648.96

$1,349.37
$1,481.13
$1,620.71
$2,116.53

$1,722.70
$1,854.46
$1,994.04
$2,489.86

$2,096.03
$2,227.79
$2,367.37
$2,863.19

$373.33

Toc - Plan #120 UnitedHealthcare

Gold

(HMO) UHC Gold Virtual First (Unlimited $0 App-based Care, $3 Tier 2 Rx) (Disponible en espanol)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family

$1,000 $2,000 Annual Deductible

$8,400 $16,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$489.33
$555.39
$625.37
$873.95
$1,328.05

$863.67
$929.73
$999.71
$1,248.29

$1,238.01
$1,304.07
$1,374.05
$1,622.63

$1,612.35
$1,678.41
$1,748.39
$1,996.97

$374.34

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$978.66
$1,110.78
$1,250.74
$1,747.90
$2,656.10

$1,353.00
$1,485.12
$1,625.08
$2,122.24

$1,727.34
$1,859.46
$1,999.42
$2,496.58

$2,101.68
$2,233.80
$2,373.76
$2,870.92

$374.34

Toc - Plan #121 UnitedHealthcare

Gold

(HMO) UHC Gold Advantage+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family

$500 $1,000 Annual Deductible

$7,750 $15,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$517.37
$587.21
$661.20
$924.02
$1,404.14

$913.16
$983.00
$1,056.99
$1,319.81

$1,308.95
$1,378.79
$1,452.78
$1,715.60

$1,704.74
$1,774.58
$1,848.57
$2,111.39

$395.79

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,034.74
$1,174.42
$1,322.40
$1,848.04
$2,808.28

$1,430.53
$1,570.21
$1,718.19
$2,243.83

$1,826.32
$1,966.00
$2,113.98
$2,639.62

$2,222.11
$2,361.79
$2,509.77
$3,035.41

$395.79

Toc - Plan #122 UnitedHealthcare

Silver

(HMO) UHC Silver Advantage+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, $0 Insulin)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family

$2,750 $5,500 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$457.57
$519.34
$584.77
$817.22
$1,241.84

$807.61
$869.38
$934.81
$1,167.26

$1,157.65
$1,219.42
$1,284.85
$1,517.30

$1,507.69
$1,569.46
$1,634.89
$1,867.34

$350.04

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$915.14
$1,038.68
$1,169.54
$1,634.44
$2,483.68

$1,265.18
$1,388.72
$1,519.58
$1,984.48

$1,615.22
$1,738.76
$1,869.62
$2,334.52

$1,965.26
$2,088.80
$2,219.66
$2,684.56

$350.04

‡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 Lee County here.

Lee County is in “Rating Area 35” of Florida.

Currently, there are 122 plans offered in Rating Area 35.

Top

2024 Obamacare Plans for Lee County, FL

Plan Browser: 122 Plans

Florida Blue (BlueCross BlueShield FL)

Local: 1-800-352-2583 | Toll Free: 1-800-352-2583 | TTY: 1-800-955-8771

1. Bronze BlueSelect Bronze 24L01-01 ($0 Virtual Visits / Rewards $$$)

2. Silver BlueSelect Silver 1456 ($0 Virtual Visits / Rewards $$$)

3. Platinum BlueSelect Platinum 1451 ($0 Virtual Visits / Rewards $$$)

4. Expanded Bronze BlueSelect Bronze 1449 ($0 Virtual Visits / 3 PCP Visits for $0 then $40 / Rewards $$$)

5. Platinum BlueSelect Platinum 1457 ($0 Virtual Visits / Rewards $$$)

6. Silver BlueSelect Silver 1443 ($0 Virtual Visits / $0 Labs / Rewards $$$)

7. Gold BlueSelect Gold 1535 ($0 Virtual Visits / $20 PCP Visit / $15 Generic Meds / Rewards $$$)

8. Expanded Bronze BlueSelect Bronze (HSA) 1735 (Rewards $$$ / $4 Condition Care Rx)

9. Gold BlueSelect Gold 1835 ($0 Virtual Visits / $20 Labs / Rewards $$$)

10. Expanded Bronze BlueSelect Bronze 2139 ($0 Virtual Visits / $50 PCP Visit / $30 Generic Meds / Rewards $$$)

11. Expanded Bronze BlueSelect Bronze 2342S (Multilingual Available / Rewards $$$)

12. Silver BlueSelect Silver 2343S ($40 PCP Visits / Multilingual Available / Rewards $$$)

13. Gold BlueSelect Gold 2344S ($30 PCP Visits / Multilingual Available / Rewards $$$)

14. Platinum BlueSelect Platinum 2345S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Multilingual Available / Rewards $$$)

15. Silver BlueOptions Silver 24J01-03 ($0 Virtual Visits / $0 Labs / Rewards $$$)

16. Expanded Bronze BlueOptions Bronze 24J01-04 ($0 Virtual Visits / 3 PCP Visits for $0 then $40 / Rewards $$$)

17. Platinum BlueOptions Platinum 24J01-05 ($0 Virtual Visits / Rewards $$$)

18. Bronze BlueOptions Bronze 24J01-06 ($0 Virtual Visits / Rewards $$$)

19. Silver BlueOptions Silver 24J01-07 ($0 Virtual Visits / Rewards $$$)

20. Platinum BlueOptions Platinum 24J01-08 ($0 Virtual Visits / Rewards $$$)

21. Gold BlueOptions Gold 24J01-09 ($0 Virtual Visits / $20 PCP Visits / $15 Generic Meds / Rewards $$$)

22. Expanded Bronze BlueOptions Bronze (HSA) 24J01-10 (Rewards $$$ / $4 Condition Care Rx)

23. Gold BlueOptions Gold 24J01-12 ($0 Virtual Visits / $20 Labs / Rewards $$$)

24. Expanded Bronze BlueOptions Bronze 24J01-17 ($0 Virtual Visits / $50 PCP Visits / Rewards $$$)

25. Expanded Bronze BlueOptions Bronze 24J01-18S (Multilingual Available / Rewards $$$)

26. Silver BlueOptions Silver 24J01-19S ($40 PCP Visits / Multilingual Available / Rewards $$$)

27. Gold BlueOptions Gold 24J01-20S ($30 PCP Visits / Multilingual Available / Rewards $$$)

28. Platinum BlueOptions Platinum 24J01-21S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Multilingual Available / Rewards $$$)

Aetna CVS Health

Local: 1-877-336-3915 | Toll Free: 1-877-336-3915

29. Silver Silver S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

30. Expanded Bronze Bronze S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

31. Silver Silver 5: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

32. Gold Gold S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

33. Silver Silver 6: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

34. Expanded Bronze Bronze 4: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

35. Gold Gold 3: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

36. Gold Gold 4: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

37. Silver Silver 7: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

AvMed

Local: 1-800-477-8768 | Toll Free:

38. Gold AvMed Entrust Gold 125 (2024)

39. Silver AvMed Entrust Silver 300 (2024)

40. Silver AvMed Entrust Silver 350 (2024)

41. Silver AvMed Entrust Silver 500 (2024)

42. Silver AvMed Entrust Silver 550 (2024)

43. Expanded Bronze AvMed Entrust Bronze 600 (2024)

44. Expanded Bronze AvMed Entrust Bronze 650 (2024)

45. Gold AvMed Entrust Gold Standard (2024)

46. Silver AvMed Entrust Silver Standard (2024)

47. Expanded Bronze AvMed Entrust Expanded Bronze Standard (2024)

48. Gold AvMed Entrust Gold 125 Dental+Vision (2024)

49. Silver AvMed Entrust Silver 300 Dental+Vision (2024)

50. Silver AvMed Entrust Silver 350 Dental+Vision (2024)

51. Silver AvMed Entrust Silver 500 Dental+Vision (2024)

52. Silver AvMed Entrust Silver 550 Dental+Vision (2024)

53. Expanded Bronze AvMed Entrust Bronze 625 Dental+Vision (2024)

Ambetter from Sunshine Health

Local: 1-877-687-1169 | Toll Free: 1-877-687-1169 | TTY: 1-800-955-8770

54. Gold Complete Gold

55. Expanded Bronze Choice Bronze HSA

56. Silver Everyday Silver

57. Expanded Bronze Everyday Bronze

58. Expanded Bronze Elite Bronze

59. Silver Clear Silver

60. Silver Focused Silver

61. Gold Everyday Gold

62. Gold Elite Gold

63. Expanded Bronze Standard Expanded Bronze

64. Silver Standard Silver

65. Gold Standard Gold

66. Silver Everyday Silver + Vision + Adult Dental

67. Expanded Bronze Choice Bronze HSA + Vision + Adult Dental

68. Gold Complete Gold + Vision + Adult Dental

69. Silver Clear Silver + Vision + Adult Dental

70. Gold Elite Gold + Vision + Adult Dental

71. Expanded Bronze Standard Expanded Bronze + Vision + Adult Dental

72. Silver Standard Silver + Vision + Adult Dental

73. Gold Standard Gold + Vision + Adult Dental

74. Expanded Bronze Everyday Bronze + Vision + Adult Dental

75. Expanded Bronze Elite Bronze + Vision + Adult Dental

76. Silver Focused Silver + Vision + Adult Dental

77. Gold Everyday Gold + Vision + Adult Dental

Florida Blue HMO (a BlueCross BlueShield FL company)

Local: 1-800-352-2583 | Toll Free: 1-800-352-2583 | TTY: 1-800-955-8771

78. Silver myBlue Silver 2010 ($0 Virtual Visits / Rewards $$$)

79. Gold myBlue Gold 2011 ($0 Virtual Visits / $0 Labs / Rewards $$$)

80. Expanded Bronze myBlue Bronze 2013 ($0 Virtual Visits / 3 PCP Visits for $0 then $30 / Rewards $$$)

81. Platinum myBlue Platinum 2015 ($0 Virtual Visits / Rewards $$$)

82. Gold myBlue Gold 2016 ($0 Virtual Visits / Rewards $$$)

83. Expanded Bronze myBlue Bronze 2149 ($0 Virtual Visits / $35 PCP Visits / $75 Specialist Visits / $30 Generic Meds / Rewards $$$)

84. Expanded Bronze myBlue Bronze 2349 ($0 Virtual Visits / Multilingual Available /Rewards $$$)

85. Silver myBlue Silver 2204 ($0 Virtual Visits / Rewards $$$)

86. Expanded Bronze myBlue Bronze 2286 ($0 Virtual Visits / Rewards $$$)

87. Expanded Bronze myBlue Bronze 2322S (Multilingual Available / Rewards $$$)

88. Silver myBlue Silver 2323S ($40 PCP Visits / Multilingual Available / Rewards $$$)

89. Gold myBlue Gold 2325S ($30 PCP Visits / $60 Specialist Visits / Multilingual Available / Rewards $$$)

90. Platinum myBlue Platinum 2324S ($0 Deductible / $10 PCP Visits / Multilingual Available / Rewards $$$ )

91. Silver myBlue Silver 24M02-78 ($0 Virtual Visits / $10 Labs / Rewards $$$)

92. Silver myBlue Silver 24M02-78D ($0 Virtual Visits / Adult Dental / $10 Labs / Rewards $$$)

93. Silver BlueCare Silver 24K01-02 ($0 Virtual Visits / Rewards $$$)

94. Expanded Bronze BlueCare Bronze 24K01-03 ($0 Virtual Visits / 3 PCP Visits for $0 then $40 / Rewards $$$)

95. Platinum BlueCare Platinum 24K01-04 ($0 Virtual Visits / Rewards $$$)

96. Bronze BlueCare Bronze 24K01-05 ($0 Virtual Visits / Rewards $$$)

97. Silver BlueCare Silver 24K01-06 ($0 Virtual Visits / Rewards $$$)

98. Platinum BlueCare Platinum 24K01-07 ($0 Virtual Visits / Rewards $$$)

99. Gold BlueCare Gold 24K01-08 ($0 Virtual Visits / $20 PCP Visit / $15 Generic Meds / Rewards $$$)

100. Expanded Bronze BlueCare Bronze (HSA) 24K01-09 (Rewards $$$ / $4 Condition Care Rx)

101. Gold BlueCare Gold 24K01-10 ($0 Virtual Visits / $20 Labs / Rewards $$$)

102. Expanded Bronze BlueCare Bronze 24K01-25 ($0 Virtual Visits / $50 PCP Visit / $30 Generic Meds / Rewards $$$)

103. Expanded Bronze BlueCare Bronze 24K01-31S (Multilingual Available / Rewards $$$)

104. Silver BlueCare Silver 24K01-32S ($40 PCP Visits / Multilingual Available / Rewards $$$)

105. Gold BlueCare Gold 24K01-33S ($30 PCP Visit / Multilingual Available/ Rewards $$$)

106. Platinum BlueCare Platinum 24K01-34S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Multilingual Available / Rewards $$$)

UnitedHealthcare

Local: 1-888-200-0405 | Toll Free: 1-888-200-0405 | TTY: 1-888-200-0405

107. Silver UHC Silver Virtual First (Unlimited $0 App-based Care, $3 Tier 2 Rx) (Disponible en espanol)

108. Expanded Bronze UHC Bronze Value ($0 Virtual Urgent Care + $0 PCP Visits, $3 Tier 2 Rx)

109. Expanded Bronze UHC Bronze Virtual First (Unlimited $0 App-based Care, $3 Tier 2 Rx) (Disponible en espanol)

110. Gold UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $3 Tier 2 Rx)

111. Gold UHC Gold Standard

112. Silver UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx)

113. Silver UHC Silver Standard

114. Bronze UHC Bronze Essential ($0 Virtual Urgent Care, $3 Tier 2 Rx)

115. Expanded Bronze UHC Bronze Standard

116. Expanded Bronze UHC Bronze Copay Focus $0 Indiv Med Ded

117. Silver UHC Silver Value ($0 Virtual Urgent Care, $3 Tier 2 Rx)

118. Silver UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, $0 Insulin)

119. Gold UHC Gold Value ($0 Virtual Urgent Care, $3 Tier 2 Rx)

120. Gold UHC Gold Virtual First (Unlimited $0 App-based Care, $3 Tier 2 Rx) (Disponible en espanol)

121. Gold UHC Gold Advantage+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision)

122. Silver UHC Silver Advantage+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, $0 Insulin)

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For information on subsidies to make your coverage affordable, you must take one of the following actions:

Obamacare Providers, 122 Plans and 2024 Rates for Lee County, Florida

Obamacare Rates and Providers for Other Years

How To Sign Up for Obamacare in Florida for 2024

Where's the Florida Health Care Exchange?

Florida Medicaid Expansion: Do I Qualify for Medicaid Under the ACA?

Florida Has Not Expanded Medicaid

The Medicaid Coverage Gap

Get Help Finding a Health Insurance Plan in Florida

Get Help From Florida's Health Insurance Exchange

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More Information

Florida Blue (BlueCross BlueShield FL)

(EPO) BlueSelect Bronze 24L01-01 ($0 Virtual Visits / Rewards $$$)

Annual Out of Pocket Expenses:

Individual Family $6,150 $12,300 Annual Deductible $9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

(EPO) BlueSelect Silver 1456 ($0 Virtual Visits / Rewards $$$)

Annual Out of Pocket Expenses:

Individual Family $2,800 $5,600 Annual Deductible $7,150 $14,300 Maximum Out of Pocket Per Year

Monthly Premiums:

(EPO) BlueSelect Platinum 1451 ($0 Virtual Visits / Rewards $$$)

Annual Out of Pocket Expenses:

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

Monthly Premiums:

(EPO) BlueSelect Bronze 1449 ($0 Virtual Visits / 3 PCP Visits for $0 then $40 / Rewards $$$)

Annual Out of Pocket Expenses:

Individual Family $6,500 $13,000 Annual Deductible $9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

(EPO) BlueSelect Platinum 1457 ($0 Virtual Visits / Rewards $$$)

Annual Out of Pocket Expenses:

Individual Family $0 $0 Annual Deductible $2,000 $4,000 Maximum Out of Pocket Per Year

Monthly Premiums:

(EPO) BlueSelect Silver 1443 ($0 Virtual Visits / $0 Labs / Rewards $$$)

Annual Out of Pocket Expenses:

Individual Family $6,000 $12,000 Annual Deductible $8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

(EPO) BlueSelect Gold 1535 ($0 Virtual Visits / $20 PCP Visit / $15 Generic Meds / Rewards $$$)

Annual Out of Pocket Expenses:

Individual Family $0 $0 Annual Deductible $6,250 $12,500 Maximum Out of Pocket Per Year

Monthly Premiums:

(EPO) BlueSelect Bronze (HSA) 1735 (Rewards $$$ / $4 Condition Care Rx)

Annual Out of Pocket Expenses:

Individual Family $7,050 $14,100 Annual Deductible $7,050 $14,100 Maximum Out of Pocket Per Year

Monthly Premiums:

(EPO) BlueSelect Gold 1835 ($0 Virtual Visits / $20 Labs / Rewards $$$)

Annual Out of Pocket Expenses:

Individual Family $1,500 $3,000 Annual Deductible $5,900 $11,800 Maximum Out of Pocket Per Year

Monthly Premiums:

(EPO) BlueSelect Bronze 2139 ($0 Virtual Visits / $50 PCP Visit / $30 Generic Meds / Rewards $$$)

Annual Out of Pocket Expenses:

Individual Family $0 $0 Annual Deductible $9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

(EPO) BlueSelect Bronze 2342S (Multilingual Available / Rewards $$$)

Annual Out of Pocket Expenses:

Individual Family $7,500 $15,000 Annual Deductible $9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

(EPO) BlueSelect Silver 2343S ($40 PCP Visits / Multilingual Available / Rewards $$$)

Annual Out of Pocket Expenses:

Individual Family $5,900 $11,800 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

(EPO) BlueSelect Gold 2344S ($30 PCP Visits / Multilingual Available / Rewards $$$)

Annual Out of Pocket Expenses:

Individual Family $1,500 $3,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

(EPO) BlueSelect Platinum 2345S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Multilingual Available / Rewards $$$)

Annual Out of Pocket Expenses:

Individual Family $0 $0 Annual Deductible $3,200 $6,400 Maximum Out of Pocket Per Year

Monthly Premiums:

(PPO) BlueOptions Silver 24J01-03 ($0 Virtual Visits / $0 Labs / Rewards $$$)

Annual Out of Pocket Expenses:

Individual Family $6,000 $12,000 Annual Deductible $8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

(PPO) BlueOptions Bronze 24J01-04 ($0 Virtual Visits / 3 PCP Visits for $0 then $40 / Rewards $$$)

Annual Out of Pocket Expenses:

Individual Family $6,500 $13,000 Annual Deductible $9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

(PPO) BlueOptions Platinum 24J01-05 ($0 Virtual Visits / Rewards $$$)

Annual Out of Pocket Expenses:

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

Individual Family

$6,150 $12,300 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Individual Family

$2,800 $5,600 Annual Deductible

$7,150 $14,300 Maximum Out of Pocket Per Year

Individual Family

$1,000 $2,000 Annual Deductible

$4,000 $8,000 Maximum Out of Pocket Per Year

Individual Family

$6,500 $13,000 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Individual Family

$0 $0 Annual Deductible

$2,000 $4,000 Maximum Out of Pocket Per Year

Individual Family

$6,000 $12,000 Annual Deductible

$8,000 $16,000 Maximum Out of Pocket Per Year

Individual Family

$0 $0 Annual Deductible

$6,250 $12,500 Maximum Out of Pocket Per Year

Individual Family

$7,050 $14,100 Annual Deductible

$7,050 $14,100 Maximum Out of Pocket Per Year

Individual Family

$1,500 $3,000 Annual Deductible

$5,900 $11,800 Maximum Out of Pocket Per Year

Individual Family

$0 $0 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Individual Family

$7,500 $15,000 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Individual Family

$5,900 $11,800 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Individual Family

$1,500 $3,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Individual Family

$0 $0 Annual Deductible

$3,200 $6,400 Maximum Out of Pocket Per Year

Individual Family

$6,000 $12,000 Annual Deductible

$8,000 $16,000 Maximum Out of Pocket Per Year

Individual Family

$6,500 $13,000 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Individual Family

$1,000 $2,000 Annual Deductible

$4,000 $8,000 Maximum Out of Pocket Per Year

Individual Family

$6,150 $12,300 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Individual Family

$2,800 $5,600 Annual Deductible

$7,150 $14,300 Maximum Out of Pocket Per Year

Individual Family

$0 $0 Annual Deductible

$2,000 $4,000 Maximum Out of Pocket Per Year

Individual Family

$0 $0 Annual Deductible

$6,250 $12,500 Maximum Out of Pocket Per Year

Individual Family

$7,050 $14,100 Annual Deductible

$7,050 $14,100 Maximum Out of Pocket Per Year

Individual Family

$1,500 $3,000 Annual Deductible

$5,900 $11,800 Maximum Out of Pocket Per Year

Individual Family

$0 $0 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Individual Family

$7,500 $15,000 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Individual Family

$5,900 $11,800 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Individual Family

$1,500 $3,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Individual Family

$0 $0 Annual Deductible

$3,200 $6,400 Maximum Out of Pocket Per Year

Individual Family

$5,900 $11,800 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Individual Family

$7,500 $15,000 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Individual Family

$8,395 $16,790 Annual Deductible

$8,885 $17,770 Maximum Out of Pocket Per Year

Individual Family

$1,500 $3,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year