Obamacare 2024 Rates for Martin County, Florida

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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 Stuart, 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, 96 Plans and 2024 Rates for Martin County, Florida

Below, you’ll find a summary of the 96 plans for Martin 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 |

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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 		$384.05
$435.90
$490.82
$685.91
$1,042.31 		$677.85
$729.70
$784.62
$979.71 		$971.65
$1,023.50
$1,078.42
$1,273.51 		$1,265.45
$1,317.30
$1,372.22
$1,567.31 		$293.80
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$768.10
$871.80
$981.64
$1,371.82
$2,084.62 		$1,061.90
$1,165.60
$1,275.44
$1,665.62 		$1,355.70
$1,459.40
$1,569.24
$1,959.42 		$1,649.50
$1,753.20
$1,863.04
$2,253.22 		$293.80
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 		$521.09
$591.44
$665.95
$930.67
$1,414.24 		$919.72
$990.07
$1,064.58
$1,329.30 		$1,318.35
$1,388.70
$1,463.21
$1,727.93 		$1,716.98
$1,787.33
$1,861.84
$2,126.56 		$398.63
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,042.18
$1,182.88
$1,331.90
$1,861.34
$2,828.48 		$1,440.81
$1,581.51
$1,730.53
$2,259.97 		$1,839.44
$1,980.14
$2,129.16
$2,658.60 		$2,238.07
$2,378.77
$2,527.79
$3,057.23 		$398.63
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 		$683.99
$776.33
$874.14
$1,221.61
$1,856.35 		$1,207.24
$1,299.58
$1,397.39
$1,744.86 		$1,730.49
$1,822.83
$1,920.64
$2,268.11 		$2,253.74
$2,346.08
$2,443.89
$2,791.36 		$523.25
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,367.98
$1,552.66
$1,748.28
$2,443.22
$3,712.70 		$1,891.23
$2,075.91
$2,271.53
$2,966.47 		$2,414.48
$2,599.16
$2,794.78
$3,489.72 		$2,937.73
$3,122.41
$3,318.03
$4,012.97 		$523.25
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 		$410.44
$465.85
$524.54
$733.05
$1,113.93 		$724.43
$779.84
$838.53
$1,047.04 		$1,038.42
$1,093.83
$1,152.52
$1,361.03 		$1,352.41
$1,407.82
$1,466.51
$1,675.02 		$313.99
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$820.88
$931.70
$1,049.08
$1,466.10
$2,227.86 		$1,134.87
$1,245.69
$1,363.07
$1,780.09 		$1,448.86
$1,559.68
$1,677.06
$2,094.08 		$1,762.85
$1,873.67
$1,991.05
$2,408.07 		$313.99
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 		$710.71
$806.66
$908.29
$1,269.33
$1,928.87 		$1,254.40
$1,350.35
$1,451.98
$1,813.02 		$1,798.09
$1,894.04
$1,995.67
$2,356.71 		$2,341.78
$2,437.73
$2,539.36
$2,900.40 		$543.69
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,421.42
$1,613.32
$1,816.58
$2,538.66
$3,857.74 		$1,965.11
$2,157.01
$2,360.27
$3,082.35 		$2,508.80
$2,700.70
$2,903.96
$3,626.04 		$3,052.49
$3,244.39
$3,447.65
$4,169.73 		$543.69
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 		$487.76
$553.61
$623.36
$871.14
$1,323.78 		$860.90
$926.75
$996.50
$1,244.28 		$1,234.04
$1,299.89
$1,369.64
$1,617.42 		$1,607.18
$1,673.03
$1,742.78
$1,990.56 		$373.14
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$975.52
$1,107.22
$1,246.72
$1,742.28
$2,647.56 		$1,348.66
$1,480.36
$1,619.86
$2,115.42 		$1,721.80
$1,853.50
$1,993.00
$2,488.56 		$2,094.94
$2,226.64
$2,366.14
$2,861.70 		$373.14
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 		$587.76
$667.11
$751.16
$1,049.74
$1,595.18 		$1,037.40
$1,116.75
$1,200.80
$1,499.38 		$1,487.04
$1,566.39
$1,650.44
$1,949.02 		$1,936.68
$2,016.03
$2,100.08
$2,398.66 		$449.64
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,175.52
$1,334.22
$1,502.32
$2,099.48
$3,190.36 		$1,625.16
$1,783.86
$1,951.96
$2,549.12 		$2,074.80
$2,233.50
$2,401.60
$2,998.76 		$2,524.44
$2,683.14
$2,851.24
$3,448.40 		$449.64
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 		$399.68
$453.64
$510.79
$713.83
$1,084.73 		$705.44
$759.40
$816.55
$1,019.59 		$1,011.20
$1,065.16
$1,122.31
$1,325.35 		$1,316.96
$1,370.92
$1,428.07
$1,631.11 		$305.76
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$799.36
$907.28
$1,021.58
$1,427.66
$2,169.46 		$1,105.12
$1,213.04
$1,327.34
$1,733.42 		$1,410.88
$1,518.80
$1,633.10
$2,039.18 		$1,716.64
$1,824.56
$1,938.86
$2,344.94 		$305.76
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 		$570.75
$647.80
$729.42
$1,019.36
$1,549.02 		$1,007.37
$1,084.42
$1,166.04
$1,455.98 		$1,443.99
$1,521.04
$1,602.66
$1,892.60 		$1,880.61
$1,957.66
$2,039.28
$2,329.22 		$436.62
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,141.50
$1,295.60
$1,458.84
$2,038.72
$3,098.04 		$1,578.12
$1,732.22
$1,895.46
$2,475.34 		$2,014.74
$2,168.84
$2,332.08
$2,911.96 		$2,451.36
$2,605.46
$2,768.70
$3,348.58 		$436.62
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 		$429.84
$487.87
$549.34
$767.69
$1,166.59 		$758.67
$816.70
$878.17
$1,096.52 		$1,087.50
$1,145.53
$1,207.00
$1,425.35 		$1,416.33
$1,474.36
$1,535.83
$1,754.18 		$328.83
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$859.68
$975.74
$1,098.68
$1,535.38
$2,333.18 		$1,188.51
$1,304.57
$1,427.51
$1,864.21 		$1,517.34
$1,633.40
$1,756.34
$2,193.04 		$1,846.17
$1,962.23
$2,085.17
$2,521.87 		$328.83
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 		$402.92
$457.31
$514.93
$719.62
$1,093.52 		$711.15
$765.54
$823.16
$1,027.85 		$1,019.38
$1,073.77
$1,131.39
$1,336.08 		$1,327.61
$1,382.00
$1,439.62
$1,644.31 		$308.23
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$805.84
$914.62
$1,029.86
$1,439.24
$2,187.04 		$1,114.07
$1,222.85
$1,338.09
$1,747.47 		$1,422.30
$1,531.08
$1,646.32
$2,055.70 		$1,730.53
$1,839.31
$1,954.55
$2,363.93 		$308.23
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 		$506.68
$575.08
$647.54
$904.93
$1,375.13 		$894.29
$962.69
$1,035.15
$1,292.54 		$1,281.90
$1,350.30
$1,422.76
$1,680.15 		$1,669.51
$1,737.91
$1,810.37
$2,067.76 		$387.61
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,013.36
$1,150.16
$1,295.08
$1,809.86
$2,750.26 		$1,400.97
$1,537.77
$1,682.69
$2,197.47 		$1,788.58
$1,925.38
$2,070.30
$2,585.08 		$2,176.19
$2,312.99
$2,457.91
$2,972.69 		$387.61
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 		$556.44
$631.56
$711.13
$993.80
$1,510.18 		$982.12
$1,057.24
$1,136.81
$1,419.48 		$1,407.80
$1,482.92
$1,562.49
$1,845.16 		$1,833.48
$1,908.60
$1,988.17
$2,270.84 		$425.68
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,112.88
$1,263.12
$1,422.26
$1,987.60
$3,020.36 		$1,538.56
$1,688.80
$1,847.94
$2,413.28 		$1,964.24
$2,114.48
$2,273.62
$2,838.96 		$2,389.92
$2,540.16
$2,699.30
$3,264.64 		$425.68
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 		$706.78
$802.20
$903.26
$1,262.31
$1,918.20 		$1,247.47
$1,342.89
$1,443.95
$1,803.00 		$1,788.16
$1,883.58
$1,984.64
$2,343.69 		$2,328.85
$2,424.27
$2,525.33
$2,884.38 		$540.69
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,413.56
$1,604.40
$1,806.52
$2,524.62
$3,836.40 		$1,954.25
$2,145.09
$2,347.21
$3,065.31 		$2,494.94
$2,685.78
$2,887.90
$3,606.00 		$3,035.63
$3,226.47
$3,428.59
$4,146.69 		$540.69
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 		$765.38
$868.71
$978.16
$1,366.97
$2,077.24 		$1,350.90
$1,454.23
$1,563.68
$1,952.49 		$1,936.42
$2,039.75
$2,149.20
$2,538.01 		$2,521.94
$2,625.27
$2,734.72
$3,123.53 		$585.52
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,530.76
$1,737.42
$1,956.32
$2,733.94
$4,154.48 		$2,116.28
$2,322.94
$2,541.84
$3,319.46 		$2,701.80
$2,908.46
$3,127.36
$3,904.98 		$3,287.32
$3,493.98
$3,712.88
$4,490.50 		$585.52
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 		$547.05
$620.90
$699.13
$977.03
$1,484.69 		$965.54
$1,039.39
$1,117.62
$1,395.52 		$1,384.03
$1,457.88
$1,536.11
$1,814.01 		$1,802.52
$1,876.37
$1,954.60
$2,232.50 		$418.49
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,094.10
$1,241.80
$1,398.26
$1,954.06
$2,969.38 		$1,512.59
$1,660.29
$1,816.75
$2,372.55 		$1,931.08
$2,078.78
$2,235.24
$2,791.04 		$2,349.57
$2,497.27
$2,653.73
$3,209.53 		$418.49
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 		$1,032.75
$1,172.17
$1,319.85
$1,844.49
$2,802.88 		$1,822.80
$1,962.22
$2,109.90
$2,634.54 		$2,612.85
$2,752.27
$2,899.95
$3,424.59 		$3,402.90
$3,542.32
$3,690.00
$4,214.64 		$790.05
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$2,065.50
$2,344.34
$2,639.70
$3,688.98
$5,605.76 		$2,855.55
$3,134.39
$3,429.75
$4,479.03 		$3,645.60
$3,924.44
$4,219.80
$5,269.08 		$4,435.65
$4,714.49
$5,009.85
$6,059.13 		$790.05
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 		$511.81
$580.90
$654.09
$914.09
$1,389.05 		$903.34
$972.43
$1,045.62
$1,305.62 		$1,294.87
$1,363.96
$1,437.15
$1,697.15 		$1,686.40
$1,755.49
$1,828.68
$2,088.68 		$391.53
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,023.62
$1,161.80
$1,308.18
$1,828.18
$2,778.10 		$1,415.15
$1,553.33
$1,699.71
$2,219.71 		$1,806.68
$1,944.86
$2,091.24
$2,611.24 		$2,198.21
$2,336.39
$2,482.77
$3,002.77 		$391.53
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 		$818.74
$929.27
$1,046.35
$1,462.27
$2,222.06 		$1,445.08
$1,555.61
$1,672.69
$2,088.61 		$2,071.42
$2,181.95
$2,299.03
$2,714.95 		$2,697.76
$2,808.29
$2,925.37
$3,341.29 		$626.34
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,637.48
$1,858.54
$2,092.70
$2,924.54
$4,444.12 		$2,263.82
$2,484.88
$2,719.04
$3,550.88 		$2,890.16
$3,111.22
$3,345.38
$4,177.22 		$3,516.50
$3,737.56
$3,971.72
$4,803.56 		$626.34
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 		$1,074.17
$1,219.18
$1,372.79
$1,918.47
$2,915.30 		$1,895.91
$2,040.92
$2,194.53
$2,740.21 		$2,717.65
$2,862.66
$3,016.27
$3,561.95 		$3,539.39
$3,684.40
$3,838.01
$4,383.69 		$821.74
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$2,148.34
$2,438.36
$2,745.58
$3,836.94
$5,830.60 		$2,970.08
$3,260.10
$3,567.32
$4,658.68 		$3,791.82
$4,081.84
$4,389.06
$5,480.42 		$4,613.56
$4,903.58
$5,210.80
$6,302.16 		$821.74
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 		$881.36
$1,000.34
$1,126.38
$1,574.11
$2,392.01 		$1,555.60
$1,674.58
$1,800.62
$2,248.35 		$2,229.84
$2,348.82
$2,474.86
$2,922.59 		$2,904.08
$3,023.06
$3,149.10
$3,596.83 		$674.24
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,762.72
$2,000.68
$2,252.76
$3,148.22
$4,784.02 		$2,436.96
$2,674.92
$2,927.00
$3,822.46 		$3,111.20
$3,349.16
$3,601.24
$4,496.70 		$3,785.44
$4,023.40
$4,275.48
$5,170.94 		$674.24
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 		$532.12
$603.96
$680.05
$950.37
$1,444.17 		$939.19
$1,011.03
$1,087.12
$1,357.44 		$1,346.26
$1,418.10
$1,494.19
$1,764.51 		$1,753.33
$1,825.17
$1,901.26
$2,171.58 		$407.07
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,064.24
$1,207.92
$1,360.10
$1,900.74
$2,888.34 		$1,471.31
$1,614.99
$1,767.17
$2,307.81 		$1,878.38
$2,022.06
$2,174.24
$2,714.88 		$2,285.45
$2,429.13
$2,581.31
$3,121.95 		$407.07
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 		$855.32
$970.79
$1,093.10
$1,527.60
$2,321.34 		$1,509.64
$1,625.11
$1,747.42
$2,181.92 		$2,163.96
$2,279.43
$2,401.74
$2,836.24 		$2,818.28
$2,933.75
$3,056.06
$3,490.56 		$654.32
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,710.64
$1,941.58
$2,186.20
$3,055.20
$4,642.68 		$2,364.96
$2,595.90
$2,840.52
$3,709.52 		$3,019.28
$3,250.22
$3,494.84
$4,363.84 		$3,673.60
$3,904.54
$4,149.16
$5,018.16 		$654.32
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 		$572.80
$650.13
$732.04
$1,023.02
$1,554.58 		$1,010.99
$1,088.32
$1,170.23
$1,461.21 		$1,449.18
$1,526.51
$1,608.42
$1,899.40 		$1,887.37
$1,964.70
$2,046.61
$2,337.59 		$438.19
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,145.60
$1,300.26
$1,464.08
$2,046.04
$3,109.16 		$1,583.79
$1,738.45
$1,902.27
$2,484.23 		$2,021.98
$2,176.64
$2,340.46
$2,922.42 		$2,460.17
$2,614.83
$2,778.65
$3,360.61 		$438.19
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 		$536.22
$608.61
$685.29
$957.69
$1,455.30 		$946.43
$1,018.82
$1,095.50
$1,367.90 		$1,356.64
$1,429.03
$1,505.71
$1,778.11 		$1,766.85
$1,839.24
$1,915.92
$2,188.32 		$410.21
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,072.44
$1,217.22
$1,370.58
$1,915.38
$2,910.60 		$1,482.65
$1,627.43
$1,780.79
$2,325.59 		$1,892.86
$2,037.64
$2,191.00
$2,735.80 		$2,303.07
$2,447.85
$2,601.21
$3,146.01 		$410.21
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 		$795.45
$902.84
$1,016.59
$1,420.67
$2,158.85 		$1,403.97
$1,511.36
$1,625.11
$2,029.19 		$2,012.49
$2,119.88
$2,233.63
$2,637.71 		$2,621.01
$2,728.40
$2,842.15
$3,246.23 		$608.52
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,590.90
$1,805.68
$2,033.18
$2,841.34
$4,317.70 		$2,199.42
$2,414.20
$2,641.70
$3,449.86 		$2,807.94
$3,022.72
$3,250.22
$4,058.38 		$3,416.46
$3,631.24
$3,858.74
$4,666.90 		$608.52
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 		$834.19
$946.81
$1,066.09
$1,489.86
$2,263.99 		$1,472.35
$1,584.97
$1,704.25
$2,128.02 		$2,110.51
$2,223.13
$2,342.41
$2,766.18 		$2,748.67
$2,861.29
$2,980.57
$3,404.34 		$638.16
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,668.38
$1,893.62
$2,132.18
$2,979.72
$4,527.98 		$2,306.54
$2,531.78
$2,770.34
$3,617.88 		$2,944.70
$3,169.94
$3,408.50
$4,256.04 		$3,582.86
$3,808.10
$4,046.66
$4,894.20 		$638.16
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 		$1,067.45
$1,211.56
$1,364.20
$1,906.47
$2,897.06 		$1,884.05
$2,028.16
$2,180.80
$2,723.07 		$2,700.65
$2,844.76
$2,997.40
$3,539.67 		$3,517.25
$3,661.36
$3,814.00
$4,356.27 		$816.60
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$2,134.90
$2,423.12
$2,728.40
$3,812.94
$5,794.12 		$2,951.50
$3,239.72
$3,545.00
$4,629.54 		$3,768.10
$4,056.32
$4,361.60
$5,446.14 		$4,584.70
$4,872.92
$5,178.20
$6,262.74 		$816.60

ADVERTISEMENT

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 		$410.75
$466.20
$524.94
$733.60
$1,114.78 		$724.98
$780.43
$839.17
$1,047.83 		$1,039.21
$1,094.66
$1,153.40
$1,362.06 		$1,353.44
$1,408.89
$1,467.63
$1,676.29 		$314.23
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$821.50
$932.40
$1,049.88
$1,467.20
$2,229.56 		$1,135.73
$1,246.63
$1,364.11
$1,781.43 		$1,449.96
$1,560.86
$1,678.34
$2,095.66 		$1,764.19
$1,875.09
$1,992.57
$2,409.89 		$314.23
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 		$328.00
$372.28
$419.19
$585.81
$890.20 		$578.92
$623.20
$670.11
$836.73 		$829.84
$874.12
$921.03
$1,087.65 		$1,080.76
$1,125.04
$1,171.95
$1,338.57 		$250.92
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$656.00
$744.56
$838.38
$1,171.62
$1,780.40 		$906.92
$995.48
$1,089.30
$1,422.54 		$1,157.84
$1,246.40
$1,340.22
$1,673.46 		$1,408.76
$1,497.32
$1,591.14
$1,924.38 		$250.92
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 		$410.49
$465.90
$524.60
$733.12
$1,114.05 		$724.51
$779.92
$838.62
$1,047.14 		$1,038.53
$1,093.94
$1,152.64
$1,361.16 		$1,352.55
$1,407.96
$1,466.66
$1,675.18 		$314.02
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$820.98
$931.80
$1,049.20
$1,466.24
$2,228.10 		$1,135.00
$1,245.82
$1,363.22
$1,780.26 		$1,449.02
$1,559.84
$1,677.24
$2,094.28 		$1,763.04
$1,873.86
$1,991.26
$2,408.30 		$314.02
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 		$439.02
$498.28
$561.06
$784.08
$1,191.48 		$774.87
$834.13
$896.91
$1,119.93 		$1,110.72
$1,169.98
$1,232.76
$1,455.78 		$1,446.57
$1,505.83
$1,568.61
$1,791.63 		$335.85
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$878.04
$996.56
$1,122.12
$1,568.16
$2,382.96 		$1,213.89
$1,332.41
$1,457.97
$1,904.01 		$1,549.74
$1,668.26
$1,793.82
$2,239.86 		$1,885.59
$2,004.11
$2,129.67
$2,575.71 		$335.85
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 		$419.14
$475.72
$535.66
$748.58
$1,137.54 		$739.78
$796.36
$856.30
$1,069.22 		$1,060.42
$1,117.00
$1,176.94
$1,389.86 		$1,381.06
$1,437.64
$1,497.58
$1,710.50 		$320.64
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$838.28
$951.44
$1,071.32
$1,497.16
$2,275.08 		$1,158.92
$1,272.08
$1,391.96
$1,817.80 		$1,479.56
$1,592.72
$1,712.60
$2,138.44 		$1,800.20
$1,913.36
$2,033.24
$2,459.08 		$320.64
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 		$361.22
$409.98
$461.64
$645.14
$980.34 		$637.55
$686.31
$737.97
$921.47 		$913.88
$962.64
$1,014.30
$1,197.80 		$1,190.21
$1,238.97
$1,290.63
$1,474.13 		$276.33
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$722.44
$819.96
$923.28
$1,290.28
$1,960.68 		$998.77
$1,096.29
$1,199.61
$1,566.61 		$1,275.10
$1,372.62
$1,475.94
$1,842.94 		$1,551.43
$1,648.95
$1,752.27
$2,119.27 		$276.33
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 		$437.25
$496.28
$558.81
$780.93
$1,186.70 		$771.75
$830.78
$893.31
$1,115.43 		$1,106.25
$1,165.28
$1,227.81
$1,449.93 		$1,440.75
$1,499.78
$1,562.31
$1,784.43 		$334.50
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$874.50
$992.56
$1,117.62
$1,561.86
$2,373.40 		$1,209.00
$1,327.06
$1,452.12
$1,896.36 		$1,543.50
$1,661.56
$1,786.62
$2,230.86 		$1,878.00
$1,996.06
$2,121.12
$2,565.36 		$334.50
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 		$443.08
$502.89
$566.25
$791.33
$1,202.51 		$782.04
$841.85
$905.21
$1,130.29 		$1,121.00
$1,180.81
$1,244.17
$1,469.25 		$1,459.96
$1,519.77
$1,583.13
$1,808.21 		$338.96
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$886.16
$1,005.78
$1,132.50
$1,582.66
$2,405.02 		$1,225.12
$1,344.74
$1,471.46
$1,921.62 		$1,564.08
$1,683.70
$1,810.42
$2,260.58 		$1,903.04
$2,022.66
$2,149.38
$2,599.54 		$338.96
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 		$419.33
$475.94
$535.91
$748.93
$1,138.06 		$740.12
$796.73
$856.70
$1,069.72 		$1,060.91
$1,117.52
$1,177.49
$1,390.51 		$1,381.70
$1,438.31
$1,498.28
$1,711.30 		$320.79
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$838.66
$951.88
$1,071.82
$1,497.86
$2,276.12 		$1,159.45
$1,272.67
$1,392.61
$1,818.65 		$1,480.24
$1,593.46
$1,713.40
$2,139.44 		$1,801.03
$1,914.25
$2,034.19
$2,460.23 		$320.79

ADVERTISEMENT

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 #38 Florida Blue HMO (a BlueCross BlueShield FL company)
Expanded Bronze

(HMO) myBlue Bronze 1601 ($0 Virtual Visits / 3 PCP Visits for $0 then $45 / 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 		$378.95
$430.11
$484.30
$676.80
$1,028.47 		$668.85
$720.01
$774.20
$966.70 		$958.75
$1,009.91
$1,064.10
$1,256.60 		$1,248.65
$1,299.81
$1,354.00
$1,546.50 		$289.90
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$757.90
$860.22
$968.60
$1,353.60
$2,056.94 		$1,047.80
$1,150.12
$1,258.50
$1,643.50 		$1,337.70
$1,440.02
$1,548.40
$1,933.40 		$1,627.60
$1,729.92
$1,838.30
$2,223.30 		$289.90
Toc - Plan #39 Florida Blue HMO (a BlueCross BlueShield FL company)
Gold

(HMO) myBlue Gold 1605 ($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 		$513.57
$582.90
$656.34
$917.24
$1,393.83 		$906.45
$975.78
$1,049.22
$1,310.12 		$1,299.33
$1,368.66
$1,442.10
$1,703.00 		$1,692.21
$1,761.54
$1,834.98
$2,095.88 		$392.88
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,027.14
$1,165.80
$1,312.68
$1,834.48
$2,787.66 		$1,420.02
$1,558.68
$1,705.56
$2,227.36 		$1,812.90
$1,951.56
$2,098.44
$2,620.24 		$2,205.78
$2,344.44
$2,491.32
$3,013.12 		$392.88
Toc - Plan #40 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver

(HMO) myBlue Silver 2017 ($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
$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 		$439.25
$498.55
$561.36
$784.50
$1,192.12 		$775.28
$834.58
$897.39
$1,120.53 		$1,111.31
$1,170.61
$1,233.42
$1,456.56 		$1,447.34
$1,506.64
$1,569.45
$1,792.59 		$336.03
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$878.50
$997.10
$1,122.72
$1,569.00
$2,384.24 		$1,214.53
$1,333.13
$1,458.75
$1,905.03 		$1,550.56
$1,669.16
$1,794.78
$2,241.06 		$1,886.59
$2,005.19
$2,130.81
$2,577.09 		$336.03
Toc - Plan #41 Florida Blue HMO (a BlueCross BlueShield FL company)
Expanded Bronze

(HMO) myBlue Bronze 2129 ($0 Virtual Visits / $35 PCP Visit / $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 		$398.84
$452.68
$509.72
$712.33
$1,082.45 		$703.95
$757.79
$814.83
$1,017.44 		$1,009.06
$1,062.90
$1,119.94
$1,322.55 		$1,314.17
$1,368.01
$1,425.05
$1,627.66 		$305.11
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$797.68
$905.36
$1,019.44
$1,424.66
$2,164.90 		$1,102.79
$1,210.47
$1,324.55
$1,729.77 		$1,407.90
$1,515.58
$1,629.66
$2,034.88 		$1,713.01
$1,820.69
$1,934.77
$2,339.99 		$305.11
Toc - Plan #42 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver

(HMO) myBlue Silver 2237 ($0 Virtual Visits / $60 PCP Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$4,100 $8,200 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 		$416.64
$472.89
$532.47
$744.12
$1,130.76 		$735.37
$791.62
$851.20
$1,062.85 		$1,054.10
$1,110.35
$1,169.93
$1,381.58 		$1,372.83
$1,429.08
$1,488.66
$1,700.31 		$318.73
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$833.28
$945.78
$1,064.94
$1,488.24
$2,261.52 		$1,152.01
$1,264.51
$1,383.67
$1,806.97 		$1,470.74
$1,583.24
$1,702.40
$2,125.70 		$1,789.47
$1,901.97
$2,021.13
$2,444.43 		$318.73
Toc - Plan #43 Florida Blue HMO (a BlueCross BlueShield FL company)
Expanded Bronze

(HMO) myBlue Bronze 2219 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$1,650 $3,300 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 		$371.00
$421.09
$474.14
$662.61
$1,006.89 		$654.82
$704.91
$757.96
$946.43 		$938.64
$988.73
$1,041.78
$1,230.25 		$1,222.46
$1,272.55
$1,325.60
$1,514.07 		$283.82
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$742.00
$842.18
$948.28
$1,325.22
$2,013.78 		$1,025.82
$1,126.00
$1,232.10
$1,609.04 		$1,309.64
$1,409.82
$1,515.92
$1,892.86 		$1,593.46
$1,693.64
$1,799.74
$2,176.68 		$283.82
Toc - Plan #44 Florida Blue HMO (a BlueCross BlueShield FL company)
Expanded Bronze

(HMO) myBlue Bronze 2312S (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 		$359.26
$407.76
$459.13
$641.64
$975.03 		$634.09
$682.59
$733.96
$916.47 		$908.92
$957.42
$1,008.79
$1,191.30 		$1,183.75
$1,232.25
$1,283.62
$1,466.13 		$274.83
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$718.52
$815.52
$918.26
$1,283.28
$1,950.06 		$993.35
$1,090.35
$1,193.09
$1,558.11 		$1,268.18
$1,365.18
$1,467.92
$1,832.94 		$1,543.01
$1,640.01
$1,742.75
$2,107.77 		$274.83
Toc - Plan #45 Florida Blue HMO (a BlueCross BlueShield FL company)
Expanded Bronze

(HMO) myBlue Bronze 2329 ($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 		$389.55
$442.14
$497.84
$695.74
$1,057.24 		$687.56
$740.15
$795.85
$993.75 		$985.57
$1,038.16
$1,093.86
$1,291.76 		$1,283.58
$1,336.17
$1,391.87
$1,589.77 		$298.01
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$779.10
$884.28
$995.68
$1,391.48
$2,114.48 		$1,077.11
$1,182.29
$1,293.69
$1,689.49 		$1,375.12
$1,480.30
$1,591.70
$1,987.50 		$1,673.13
$1,778.31
$1,889.71
$2,285.51 		$298.01
Toc - Plan #46 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver

(HMO) myBlue Silver 24M06-50 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$5,500 $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 		$444.12
$504.08
$567.59
$793.20
$1,205.34 		$783.87
$843.83
$907.34
$1,132.95 		$1,123.62
$1,183.58
$1,247.09
$1,472.70 		$1,463.37
$1,523.33
$1,586.84
$1,812.45 		$339.75
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$888.24
$1,008.16
$1,135.18
$1,586.40
$2,410.68 		$1,227.99
$1,347.91
$1,474.93
$1,926.15 		$1,567.74
$1,687.66
$1,814.68
$2,265.90 		$1,907.49
$2,027.41
$2,154.43
$2,605.65 		$339.75
Toc - Plan #47 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver

(HMO) myBlue Silver 2313S ($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 		$439.68
$499.04
$561.91
$785.27
$1,193.29 		$776.04
$835.40
$898.27
$1,121.63 		$1,112.40
$1,171.76
$1,234.63
$1,457.99 		$1,448.76
$1,508.12
$1,570.99
$1,794.35 		$336.36
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$879.36
$998.08
$1,123.82
$1,570.54
$2,386.58 		$1,215.72
$1,334.44
$1,460.18
$1,906.90 		$1,552.08
$1,670.80
$1,796.54
$2,243.26 		$1,888.44
$2,007.16
$2,132.90
$2,579.62 		$336.36
Toc - Plan #48 Florida Blue HMO (a BlueCross BlueShield FL company)
Gold

(HMO) myBlue Gold 2314S ($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 		$506.36
$574.72
$647.13
$904.36
$1,374.26 		$893.73
$962.09
$1,034.50
$1,291.73 		$1,281.10
$1,349.46
$1,421.87
$1,679.10 		$1,668.47
$1,736.83
$1,809.24
$2,066.47 		$387.37
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,012.72
$1,149.44
$1,294.26
$1,808.72
$2,748.52 		$1,400.09
$1,536.81
$1,681.63
$2,196.09 		$1,787.46
$1,924.18
$2,069.00
$2,583.46 		$2,174.83
$2,311.55
$2,456.37
$2,970.83 		$387.37
Toc - Plan #49 Florida Blue HMO (a BlueCross BlueShield FL company)
Gold

(HMO) myBlue Gold 24M05-74 ($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 		$532.26
$604.12
$680.23
$950.62
$1,444.55 		$939.44
$1,011.30
$1,087.41
$1,357.80 		$1,346.62
$1,418.48
$1,494.59
$1,764.98 		$1,753.80
$1,825.66
$1,901.77
$2,172.16 		$407.18
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,064.52
$1,208.24
$1,360.46
$1,901.24
$2,889.10 		$1,471.70
$1,615.42
$1,767.64
$2,308.42 		$1,878.88
$2,022.60
$2,174.82
$2,715.60 		$2,286.06
$2,429.78
$2,582.00
$3,122.78 		$407.18
Toc - Plan #50 Florida Blue HMO (a BlueCross BlueShield FL company)
Platinum

(HMO) myBlue Platinum 24M05-75 ($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 		$652.72
$740.84
$834.18
$1,165.76
$1,771.48 		$1,152.05
$1,240.17
$1,333.51
$1,665.09 		$1,651.38
$1,739.50
$1,832.84
$2,164.42 		$2,150.71
$2,238.83
$2,332.17
$2,663.75 		$499.33
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,305.44
$1,481.68
$1,668.36
$2,331.52
$3,542.96 		$1,804.77
$1,981.01
$2,167.69
$2,830.85 		$2,304.10
$2,480.34
$2,667.02
$3,330.18 		$2,803.43
$2,979.67
$3,166.35
$3,829.51 		$499.33
Toc - Plan #51 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver

(HMO) myBlue Silver 24M06-76 ($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
$9,200 $18,400 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 		$408.26
$463.38
$521.76
$729.15
$1,108.02 		$720.58
$775.70
$834.08
$1,041.47 		$1,032.90
$1,088.02
$1,146.40
$1,353.79 		$1,345.22
$1,400.34
$1,458.72
$1,666.11 		$312.32
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$816.52
$926.76
$1,043.52
$1,458.30
$2,216.04 		$1,128.84
$1,239.08
$1,355.84
$1,770.62 		$1,441.16
$1,551.40
$1,668.16
$2,082.94 		$1,753.48
$1,863.72
$1,980.48
$2,395.26 		$312.32
Toc - Plan #52 Florida Blue HMO (a BlueCross BlueShield FL company)
Platinum

(HMO) myBlue Platinum 24M05-00S ($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 		$650.01
$737.76
$830.71
$1,160.92
$1,764.13 		$1,147.27
$1,235.02
$1,327.97
$1,658.18 		$1,644.53
$1,732.28
$1,825.23
$2,155.44 		$2,141.79
$2,229.54
$2,322.49
$2,652.70 		$497.26
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,300.02
$1,475.52
$1,661.42
$2,321.84
$3,528.26 		$1,797.28
$1,972.78
$2,158.68
$2,819.10 		$2,294.54
$2,470.04
$2,655.94
$3,316.36 		$2,791.80
$2,967.30
$3,153.20
$3,813.62 		$497.26
Toc - Plan #53 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver

(HMO) myBlue Silver 2237D ($0 Virtual Visits / $60 PCP Visits / Adult Dental / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$4,100 $8,200 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 		$424.97
$482.34
$543.11
$759.00
$1,153.37 		$750.07
$807.44
$868.21
$1,084.10 		$1,075.17
$1,132.54
$1,193.31
$1,409.20 		$1,400.27
$1,457.64
$1,518.41
$1,734.30 		$325.10
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$849.94
$964.68
$1,086.22
$1,518.00
$2,306.74 		$1,175.04
$1,289.78
$1,411.32
$1,843.10 		$1,500.14
$1,614.88
$1,736.42
$2,168.20 		$1,825.24
$1,939.98
$2,061.52
$2,493.30 		$325.10
Toc - Plan #54 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver

(HMO) myBlue Silver 24M06-76D ($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
$9,200 $18,400 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 		$416.64
$472.89
$532.47
$744.12
$1,130.76 		$735.37
$791.62
$851.20
$1,062.85 		$1,054.10
$1,110.35
$1,169.93
$1,381.58 		$1,372.83
$1,429.08
$1,488.66
$1,700.31 		$318.73
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$833.28
$945.78
$1,064.94
$1,488.24
$2,261.52 		$1,152.01
$1,264.51
$1,383.67
$1,806.97 		$1,470.74
$1,583.24
$1,702.40
$2,125.70 		$1,789.47
$1,901.97
$2,021.13
$2,444.43 		$318.73
Toc - Plan #55 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 		$487.15
$552.92
$622.58
$870.05
$1,322.13 		$859.82
$925.59
$995.25
$1,242.72 		$1,232.49
$1,298.26
$1,367.92
$1,615.39 		$1,605.16
$1,670.93
$1,740.59
$1,988.06 		$372.67
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$974.30
$1,105.84
$1,245.16
$1,740.10
$2,644.26 		$1,346.97
$1,478.51
$1,617.83
$2,112.77 		$1,719.64
$1,851.18
$1,990.50
$2,485.44 		$2,092.31
$2,223.85
$2,363.17
$2,858.11 		$372.67
Toc - Plan #56 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 		$411.04
$466.53
$525.31
$734.12
$1,115.56 		$725.49
$780.98
$839.76
$1,048.57 		$1,039.94
$1,095.43
$1,154.21
$1,363.02 		$1,354.39
$1,409.88
$1,468.66
$1,677.47 		$314.45
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$822.08
$933.06
$1,050.62
$1,468.24
$2,231.12 		$1,136.53
$1,247.51
$1,365.07
$1,782.69 		$1,450.98
$1,561.96
$1,679.52
$2,097.14 		$1,765.43
$1,876.41
$1,993.97
$2,411.59 		$314.45
Toc - Plan #57 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 		$665.79
$755.67
$850.88
$1,189.10
$1,806.95 		$1,175.12
$1,265.00
$1,360.21
$1,698.43 		$1,684.45
$1,774.33
$1,869.54
$2,207.76 		$2,193.78
$2,283.66
$2,378.87
$2,717.09 		$509.33
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,331.58
$1,511.34
$1,701.76
$2,378.20
$3,613.90 		$1,840.91
$2,020.67
$2,211.09
$2,887.53 		$2,350.24
$2,530.00
$2,720.42
$3,396.86 		$2,859.57
$3,039.33
$3,229.75
$3,906.19 		$509.33
Toc - Plan #58 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 		$374.52
$425.08
$478.64
$668.89
$1,016.45 		$661.03
$711.59
$765.15
$955.40 		$947.54
$998.10
$1,051.66
$1,241.91 		$1,234.05
$1,284.61
$1,338.17
$1,528.42 		$286.51
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$749.04
$850.16
$957.28
$1,337.78
$2,032.90 		$1,035.55
$1,136.67
$1,243.79
$1,624.29 		$1,322.06
$1,423.18
$1,530.30
$1,910.80 		$1,608.57
$1,709.69
$1,816.81
$2,197.31 		$286.51
Toc - Plan #59 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 		$536.17
$608.55
$685.23
$957.60
$1,455.17 		$946.34
$1,018.72
$1,095.40
$1,367.77 		$1,356.51
$1,428.89
$1,505.57
$1,777.94 		$1,766.68
$1,839.06
$1,915.74
$2,188.11 		$410.17
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,072.34
$1,217.10
$1,370.46
$1,915.20
$2,910.34 		$1,482.51
$1,627.27
$1,780.63
$2,325.37 		$1,892.68
$2,037.44
$2,190.80
$2,735.54 		$2,302.85
$2,447.61
$2,600.97
$3,145.71 		$410.17
Toc - Plan #60 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 		$700.15
$794.67
$894.79
$1,250.47
$1,900.21 		$1,235.76
$1,330.28
$1,430.40
$1,786.08 		$1,771.37
$1,865.89
$1,966.01
$2,321.69 		$2,306.98
$2,401.50
$2,501.62
$2,857.30 		$535.61
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,400.30
$1,589.34
$1,789.58
$2,500.94
$3,800.42 		$1,935.91
$2,124.95
$2,325.19
$3,036.55 		$2,471.52
$2,660.56
$2,860.80
$3,572.16 		$3,007.13
$3,196.17
$3,396.41
$4,107.77 		$535.61
Toc - Plan #61 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 		$605.69
$687.46
$774.07
$1,081.76
$1,643.84 		$1,069.04
$1,150.81
$1,237.42
$1,545.11 		$1,532.39
$1,614.16
$1,700.77
$2,008.46 		$1,995.74
$2,077.51
$2,164.12
$2,471.81 		$463.35
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,211.38
$1,374.92
$1,548.14
$2,163.52
$3,287.68 		$1,674.73
$1,838.27
$2,011.49
$2,626.87 		$2,138.08
$2,301.62
$2,474.84
$3,090.22 		$2,601.43
$2,764.97
$2,938.19
$3,553.57 		$463.35
Toc - Plan #62 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 		$393.61
$446.75
$503.03
$702.99
$1,068.26 		$694.72
$747.86
$804.14
$1,004.10 		$995.83
$1,048.97
$1,105.25
$1,305.21 		$1,296.94
$1,350.08
$1,406.36
$1,606.32 		$301.11
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$787.22
$893.50
$1,006.06
$1,405.98
$2,136.52 		$1,088.33
$1,194.61
$1,307.17
$1,707.09 		$1,389.44
$1,495.72
$1,608.28
$2,008.20 		$1,690.55
$1,796.83
$1,909.39
$2,309.31 		$301.11
Toc - Plan #63 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 		$581.06
$659.50
$742.59
$1,037.77
$1,577.00 		$1,025.57
$1,104.01
$1,187.10
$1,482.28 		$1,470.08
$1,548.52
$1,631.61
$1,926.79 		$1,914.59
$1,993.03
$2,076.12
$2,371.30 		$444.51
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,162.12
$1,319.00
$1,485.18
$2,075.54
$3,154.00 		$1,606.63
$1,763.51
$1,929.69
$2,520.05 		$2,051.14
$2,208.02
$2,374.20
$2,964.56 		$2,495.65
$2,652.53
$2,818.71
$3,409.07 		$444.51
Toc - Plan #64 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 		$438.56
$497.77
$560.48
$783.27
$1,190.25 		$774.06
$833.27
$895.98
$1,118.77 		$1,109.56
$1,168.77
$1,231.48
$1,454.27 		$1,445.06
$1,504.27
$1,566.98
$1,789.77 		$335.50
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$877.12
$995.54
$1,120.96
$1,566.54
$2,380.50 		$1,212.62
$1,331.04
$1,456.46
$1,902.04 		$1,548.12
$1,666.54
$1,791.96
$2,237.54 		$1,883.62
$2,002.04
$2,127.46
$2,573.04 		$335.50
Toc - Plan #65 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 		$400.45
$454.51
$511.78
$715.20
$1,086.82 		$706.79
$760.85
$818.12
$1,021.54 		$1,013.13
$1,067.19
$1,124.46
$1,327.88 		$1,319.47
$1,373.53
$1,430.80
$1,634.22 		$306.34
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$800.90
$909.02
$1,023.56
$1,430.40
$2,173.64 		$1,107.24
$1,215.36
$1,329.90
$1,736.74 		$1,413.58
$1,521.70
$1,636.24
$2,043.08 		$1,719.92
$1,828.04
$1,942.58
$2,349.42 		$306.34
Toc - Plan #66 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 		$515.90
$585.55
$659.32
$921.40
$1,400.15 		$910.56
$980.21
$1,053.98
$1,316.06 		$1,305.22
$1,374.87
$1,448.64
$1,710.72 		$1,699.88
$1,769.53
$1,843.30
$2,105.38 		$394.66
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,031.80
$1,171.10
$1,318.64
$1,842.80
$2,800.30 		$1,426.46
$1,565.76
$1,713.30
$2,237.46 		$1,821.12
$1,960.42
$2,107.96
$2,632.12 		$2,215.78
$2,355.08
$2,502.62
$3,026.78 		$394.66
Toc - Plan #67 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 		$563.14
$639.16
$719.69
$1,005.77
$1,528.36 		$993.94
$1,069.96
$1,150.49
$1,436.57 		$1,424.74
$1,500.76
$1,581.29
$1,867.37 		$1,855.54
$1,931.56
$2,012.09
$2,298.17 		$430.80
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,126.28
$1,278.32
$1,439.38
$2,011.54
$3,056.72 		$1,557.08
$1,709.12
$1,870.18
$2,442.34 		$1,987.88
$2,139.92
$2,300.98
$2,873.14 		$2,418.68
$2,570.72
$2,731.78
$3,303.94 		$430.80
Toc - Plan #68 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 		$697.93
$792.15
$891.95
$1,246.50
$1,894.18 		$1,231.85
$1,326.07
$1,425.87
$1,780.42 		$1,765.77
$1,859.99
$1,959.79
$2,314.34 		$2,299.69
$2,393.91
$2,493.71
$2,848.26 		$533.92
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,395.86
$1,584.30
$1,783.90
$2,493.00
$3,788.36 		$1,929.78
$2,118.22
$2,317.82
$3,026.92 		$2,463.70
$2,652.14
$2,851.74
$3,560.84 		$2,997.62
$3,186.06
$3,385.66
$4,094.76 		$533.92

ADVERTISEMENT

Oscar Insurance Company of Florida

Local: 1-855-672-2755 | Toll Free: 1-855-672-2755

Toc - Plan #69 Oscar Insurance Company of Florida
Expanded Bronze

(EPO) Bronze Elite + PCP Saver Plus

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

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 		$375.70
$426.41
$480.14
$670.99
$1,019.63 		$663.11
$713.82
$767.55
$958.40 		$950.52
$1,001.23
$1,054.96
$1,245.81 		$1,237.93
$1,288.64
$1,342.37
$1,533.22 		$287.41
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$751.40
$852.82
$960.28
$1,341.98
$2,039.26 		$1,038.81
$1,140.23
$1,247.69
$1,629.39 		$1,326.22
$1,427.64
$1,535.10
$1,916.80 		$1,613.63
$1,715.05
$1,822.51
$2,204.21 		$287.41
Toc - Plan #70 Oscar Insurance Company of Florida
Silver

(EPO) Silver Classic

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$5,400 $10,800 Annual Deductible
$8,650 $17,300 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 		$414.03
$469.91
$529.11
$739.43
$1,123.64 		$730.75
$786.63
$845.83
$1,056.15 		$1,047.47
$1,103.35
$1,162.55
$1,372.87 		$1,364.19
$1,420.07
$1,479.27
$1,689.59 		$316.72
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$828.06
$939.82
$1,058.22
$1,478.86
$2,247.28 		$1,144.78
$1,256.54
$1,374.94
$1,795.58 		$1,461.50
$1,573.26
$1,691.66
$2,112.30 		$1,778.22
$1,889.98
$2,008.38
$2,429.02 		$316.72
Toc - Plan #71 Oscar Insurance Company of Florida
Catastrophic

(EPO) Secure

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$9,450 $18,900 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 		$250.34
$284.12
$319.92
$447.09
$679.40 		$441.84
$475.62
$511.42
$638.59 		$633.34
$667.12
$702.92
$830.09 		$824.84
$858.62
$894.42
$1,021.59 		$191.50
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$500.68
$568.24
$639.84
$894.18
$1,358.80 		$692.18
$759.74
$831.34
$1,085.68 		$883.68
$951.24
$1,022.84
$1,277.18 		$1,075.18
$1,142.74
$1,214.34
$1,468.68 		$191.50
Toc - Plan #72 Oscar Insurance Company of Florida
Expanded Bronze

(EPO) Bronze Elite + Specialist Saver Plus

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

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 		$377.98
$428.99
$483.04
$675.05
$1,025.81 		$667.13
$718.14
$772.19
$964.20 		$956.28
$1,007.29
$1,061.34
$1,253.35 		$1,245.43
$1,296.44
$1,350.49
$1,542.50 		$289.15
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$755.96
$857.98
$966.08
$1,350.10
$2,051.62 		$1,045.11
$1,147.13
$1,255.23
$1,639.25 		$1,334.26
$1,436.28
$1,544.38
$1,928.40 		$1,623.41
$1,725.43
$1,833.53
$2,217.55 		$289.15
Toc - Plan #73 Oscar Insurance Company of Florida
Gold

(EPO) Gold Classic

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$439.44
$498.76
$561.60
$784.83
$1,192.62 		$775.61
$834.93
$897.77
$1,121.00 		$1,111.78
$1,171.10
$1,233.94
$1,457.17 		$1,447.95
$1,507.27
$1,570.11
$1,793.34 		$336.17
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$878.88
$997.52
$1,123.20
$1,569.66
$2,385.24 		$1,215.05
$1,333.69
$1,459.37
$1,905.83 		$1,551.22
$1,669.86
$1,795.54
$2,242.00 		$1,887.39
$2,006.03
$2,131.71
$2,578.17 		$336.17
Toc - Plan #74 Oscar Insurance Company of Florida
Silver

(EPO) Silver Simple

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$4,500 $9,000 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 		$412.96
$468.70
$527.75
$737.53
$1,120.74 		$728.87
$784.61
$843.66
$1,053.44 		$1,044.78
$1,100.52
$1,159.57
$1,369.35 		$1,360.69
$1,416.43
$1,475.48
$1,685.26 		$315.91
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$825.92
$937.40
$1,055.50
$1,475.06
$2,241.48 		$1,141.83
$1,253.31
$1,371.41
$1,790.97 		$1,457.74
$1,569.22
$1,687.32
$2,106.88 		$1,773.65
$1,885.13
$2,003.23
$2,422.79 		$315.91
Toc - Plan #75 Oscar Insurance Company of Florida
Silver

(EPO) Silver Elite

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 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 		$421.44
$478.32
$538.59
$752.68
$1,143.76 		$743.83
$800.71
$860.98
$1,075.07 		$1,066.22
$1,123.10
$1,183.37
$1,397.46 		$1,388.61
$1,445.49
$1,505.76
$1,719.85 		$322.39
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$842.88
$956.64
$1,077.18
$1,505.36
$2,287.52 		$1,165.27
$1,279.03
$1,399.57
$1,827.75 		$1,487.66
$1,601.42
$1,721.96
$2,150.14 		$1,810.05
$1,923.81
$2,044.35
$2,472.53 		$322.39
Toc - Plan #76 Oscar Insurance Company of Florida
Expanded Bronze

(EPO) Bronze Classic 4700

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$4,700 $9,400 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 		$340.10
$386.00
$434.63
$607.39
$922.99 		$600.27
$646.17
$694.80
$867.56 		$860.44
$906.34
$954.97
$1,127.73 		$1,120.61
$1,166.51
$1,215.14
$1,387.90 		$260.17
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$680.20
$772.00
$869.26
$1,214.78
$1,845.98 		$940.37
$1,032.17
$1,129.43
$1,474.95 		$1,200.54
$1,292.34
$1,389.60
$1,735.12 		$1,460.71
$1,552.51
$1,649.77
$1,995.29 		$260.17
Toc - Plan #77 Oscar Insurance Company of Florida
Silver

(EPO) Silver Simple PCP Saver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$5,500 $11,000 Annual Deductible
$8,900 $17,800 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 		$409.95
$465.28
$523.90
$732.15
$1,112.58 		$723.55
$778.88
$837.50
$1,045.75 		$1,037.15
$1,092.48
$1,151.10
$1,359.35 		$1,350.75
$1,406.08
$1,464.70
$1,672.95 		$313.60
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$819.90
$930.56
$1,047.80
$1,464.30
$2,225.16 		$1,133.50
$1,244.16
$1,361.40
$1,777.90 		$1,447.10
$1,557.76
$1,675.00
$2,091.50 		$1,760.70
$1,871.36
$1,988.60
$2,405.10 		$313.60
Toc - Plan #78 Oscar Insurance Company of Florida
Gold

(EPO) Gold Elite Saver Plus

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$0 $0 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 		$479.81
$544.57
$613.19
$856.92
$1,302.18 		$846.86
$911.62
$980.24
$1,223.97 		$1,213.91
$1,278.67
$1,347.29
$1,591.02 		$1,580.96
$1,645.72
$1,714.34
$1,958.07 		$367.05
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$959.62
$1,089.14
$1,226.38
$1,713.84
$2,604.36 		$1,326.67
$1,456.19
$1,593.43
$2,080.89 		$1,693.72
$1,823.24
$1,960.48
$2,447.94 		$2,060.77
$2,190.29
$2,327.53
$2,814.99 		$367.05
Toc - Plan #79 Oscar Insurance Company of Florida
Gold

(EPO) Gold Elite

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$500 $1,000 Annual Deductible
$5,500 $11,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$455.60
$517.09
$582.24
$813.68
$1,236.47 		$804.13
$865.62
$930.77
$1,162.21 		$1,152.66
$1,214.15
$1,279.30
$1,510.74 		$1,501.19
$1,562.68
$1,627.83
$1,859.27 		$348.53
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$911.20
$1,034.18
$1,164.48
$1,627.36
$2,472.94 		$1,259.73
$1,382.71
$1,513.01
$1,975.89 		$1,608.26
$1,731.24
$1,861.54
$2,324.42 		$1,956.79
$2,079.77
$2,210.07
$2,672.95 		$348.53
Toc - Plan #80 Oscar Insurance Company of Florida
Expanded Bronze

(EPO) Bronze Elite Saver Plus

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

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 		$368.98
$418.78
$471.55
$658.99
$1,001.39 		$651.24
$701.04
$753.81
$941.25 		$933.50
$983.30
$1,036.07
$1,223.51 		$1,215.76
$1,265.56
$1,318.33
$1,505.77 		$282.26
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$737.96
$837.56
$943.10
$1,317.98
$2,002.78 		$1,020.22
$1,119.82
$1,225.36
$1,600.24 		$1,302.48
$1,402.08
$1,507.62
$1,882.50 		$1,584.74
$1,684.34
$1,789.88
$2,164.76 		$282.26
Toc - Plan #81 Oscar Insurance Company of Florida
Expanded Bronze

(EPO) Bronze Classic Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

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 		$337.08
$382.58
$430.78
$602.01
$914.82 		$594.94
$640.44
$688.64
$859.87 		$852.80
$898.30
$946.50
$1,117.73 		$1,110.66
$1,156.16
$1,204.36
$1,375.59 		$257.86
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$674.16
$765.16
$861.56
$1,204.02
$1,829.64 		$932.02
$1,023.02
$1,119.42
$1,461.88 		$1,189.88
$1,280.88
$1,377.28
$1,719.74 		$1,447.74
$1,538.74
$1,635.14
$1,977.60 		$257.86
Toc - Plan #82 Oscar Insurance Company of Florida
Silver

(EPO) Silver Classic Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

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 		$410.80
$466.24
$524.98
$733.66
$1,114.87 		$725.05
$780.49
$839.23
$1,047.91 		$1,039.30
$1,094.74
$1,153.48
$1,362.16 		$1,353.55
$1,408.99
$1,467.73
$1,676.41 		$314.25
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$821.60
$932.48
$1,049.96
$1,467.32
$2,229.74 		$1,135.85
$1,246.73
$1,364.21
$1,781.57 		$1,450.10
$1,560.98
$1,678.46
$2,095.82 		$1,764.35
$1,875.23
$1,992.71
$2,410.07 		$314.25
Toc - Plan #83 Oscar Insurance Company of Florida
Gold

(EPO) Gold Classic Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

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 		$424.75
$482.07
$542.81
$758.58
$1,152.73 		$749.67
$806.99
$867.73
$1,083.50 		$1,074.59
$1,131.91
$1,192.65
$1,408.42 		$1,399.51
$1,456.83
$1,517.57
$1,733.34 		$324.92
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$849.50
$964.14
$1,085.62
$1,517.16
$2,305.46 		$1,174.42
$1,289.06
$1,410.54
$1,842.08 		$1,499.34
$1,613.98
$1,735.46
$2,167.00 		$1,824.26
$1,938.90
$2,060.38
$2,491.92 		$324.92

ADVERTISEMENT

Cigna Healthcare

Local: 1-877-900-1237 | Toll Free: 1-877-900-1237 | TTY: 1-800-676-3777
Toc - Plan #84 Cigna Healthcare
Expanded Bronze

(EPO) Connect Bronze 8500 Indiv Med Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family
$8,500 $17,000 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 		$300.22
$340.75
$383.68
$536.19
$814.79 		$529.89
$570.42
$613.35
$765.86 		$759.56
$800.09
$843.02
$995.53 		$989.23
$1,029.76
$1,072.69
$1,225.20 		$229.67
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$600.44
$681.50
$767.36
$1,072.38
$1,629.58 		$830.11
$911.17
$997.03
$1,302.05 		$1,059.78
$1,140.84
$1,226.70
$1,531.72 		$1,289.45
$1,370.51
$1,456.37
$1,761.39 		$229.67
Toc - Plan #85 Cigna Healthcare
Silver

(EPO) Connect Silver 4000 Indiv Med Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family
$4,000 $8,000 Annual Deductible
$9,200 $18,400 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 		$404.71
$459.35
$517.22
$722.81
$1,098.38 		$714.31
$768.95
$826.82
$1,032.41 		$1,023.91
$1,078.55
$1,136.42
$1,342.01 		$1,333.51
$1,388.15
$1,446.02
$1,651.61 		$309.60
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$809.42
$918.70
$1,034.44
$1,445.62
$2,196.76 		$1,119.02
$1,228.30
$1,344.04
$1,755.22 		$1,428.62
$1,537.90
$1,653.64
$2,064.82 		$1,738.22
$1,847.50
$1,963.24
$2,374.42 		$309.60
Toc - Plan #86 Cigna Healthcare
Silver

(EPO) Connect Silver 5000 Indiv Med Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 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 		$401.48
$455.68
$513.10
$717.05
$1,089.63 		$708.62
$762.82
$820.24
$1,024.19 		$1,015.76
$1,069.96
$1,127.38
$1,331.33 		$1,322.90
$1,377.10
$1,434.52
$1,638.47 		$307.14
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$802.96
$911.36
$1,026.20
$1,434.10
$2,179.26 		$1,110.10
$1,218.50
$1,333.34
$1,741.24 		$1,417.24
$1,525.64
$1,640.48
$2,048.38 		$1,724.38
$1,832.78
$1,947.62
$2,355.52 		$307.14
Toc - Plan #87 Cigna Healthcare
Silver

(EPO) Connect Silver 9100 Indiv Med Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family
$9,100 $18,200 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 		$409.44
$464.71
$523.26
$731.26
$1,111.22 		$722.66
$777.93
$836.48
$1,044.48 		$1,035.88
$1,091.15
$1,149.70
$1,357.70 		$1,349.10
$1,404.37
$1,462.92
$1,670.92 		$313.22
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$818.88
$929.42
$1,046.52
$1,462.52
$2,222.44 		$1,132.10
$1,242.64
$1,359.74
$1,775.74 		$1,445.32
$1,555.86
$1,672.96
$2,088.96 		$1,758.54
$1,869.08
$1,986.18
$2,402.18 		$313.22
Toc - Plan #88 Cigna Healthcare
Gold

(EPO) Connect Gold 2500 Indiv Med Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family
$2,500 $5,000 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 		$416.91
$473.19
$532.81
$744.60
$1,131.49 		$735.85
$792.13
$851.75
$1,063.54 		$1,054.79
$1,111.07
$1,170.69
$1,382.48 		$1,373.73
$1,430.01
$1,489.63
$1,701.42 		$318.94
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$833.82
$946.38
$1,065.62
$1,489.20
$2,262.98 		$1,152.76
$1,265.32
$1,384.56
$1,808.14 		$1,471.70
$1,584.26
$1,703.50
$2,127.08 		$1,790.64
$1,903.20
$2,022.44
$2,446.02 		$318.94
Toc - Plan #89 Cigna Healthcare
Expanded Bronze

(EPO) Connect Bronze 6500 Indiv Med Deductible Enhanced Diabetes Care

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-900-1237

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 		$300.26
$340.80
$383.73
$536.27
$814.91 		$529.96
$570.50
$613.43
$765.97 		$759.66
$800.20
$843.13
$995.67 		$989.36
$1,029.90
$1,072.83
$1,225.37 		$229.70
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$600.52
$681.60
$767.46
$1,072.54
$1,629.82 		$830.22
$911.30
$997.16
$1,302.24 		$1,059.92
$1,141.00
$1,226.86
$1,531.94 		$1,289.62
$1,370.70
$1,456.56
$1,761.64 		$229.70
Toc - Plan #90 Cigna Healthcare
Silver

(EPO) Connect Silver 3000 Indiv Med Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family
$3,000 $6,000 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 		$400.60
$454.68
$511.97
$715.47
$1,087.23 		$707.06
$761.14
$818.43
$1,021.93 		$1,013.52
$1,067.60
$1,124.89
$1,328.39 		$1,319.98
$1,374.06
$1,431.35
$1,634.85 		$306.46
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$801.20
$909.36
$1,023.94
$1,430.94
$2,174.46 		$1,107.66
$1,215.82
$1,330.40
$1,737.40 		$1,414.12
$1,522.28
$1,636.86
$2,043.86 		$1,720.58
$1,828.74
$1,943.32
$2,350.32 		$306.46
Toc - Plan #91 Cigna Healthcare
Gold

(EPO) Connect Gold 500 Indiv Med Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family
$500 $1,000 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 		$434.50
$493.16
$555.29
$776.02
$1,179.24 		$766.89
$825.55
$887.68
$1,108.41 		$1,099.28
$1,157.94
$1,220.07
$1,440.80 		$1,431.67
$1,490.33
$1,552.46
$1,773.19 		$332.39
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$869.00
$986.32
$1,110.58
$1,552.04
$2,358.48 		$1,201.39
$1,318.71
$1,442.97
$1,884.43 		$1,533.78
$1,651.10
$1,775.36
$2,216.82 		$1,866.17
$1,983.49
$2,107.75
$2,549.21 		$332.39
Toc - Plan #92 Cigna Healthcare
Gold

(EPO) Connect Gold CMS Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-900-1237

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 		$421.51
$478.41
$538.69
$752.81
$1,143.97 		$743.96
$800.86
$861.14
$1,075.26 		$1,066.41
$1,123.31
$1,183.59
$1,397.71 		$1,388.86
$1,445.76
$1,506.04
$1,720.16 		$322.45
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$843.02
$956.82
$1,077.38
$1,505.62
$2,287.94 		$1,165.47
$1,279.27
$1,399.83
$1,828.07 		$1,487.92
$1,601.72
$1,722.28
$2,150.52 		$1,810.37
$1,924.17
$2,044.73
$2,472.97 		$322.45
Toc - Plan #93 Cigna Healthcare
Silver

(EPO) Connect Silver CMS Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-900-1237

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 		$403.96
$458.49
$516.26
$721.47
$1,096.35 		$712.99
$767.52
$825.29
$1,030.50 		$1,022.02
$1,076.55
$1,134.32
$1,339.53 		$1,331.05
$1,385.58
$1,443.35
$1,648.56 		$309.03
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$807.92
$916.98
$1,032.52
$1,442.94
$2,192.70 		$1,116.95
$1,226.01
$1,341.55
$1,751.97 		$1,425.98
$1,535.04
$1,650.58
$2,061.00 		$1,735.01
$1,844.07
$1,959.61
$2,370.03 		$309.03
Toc - Plan #94 Cigna Healthcare
Expanded Bronze

(EPO) Connect Bronze CMS Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-900-1237

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 		$301.72
$342.45
$385.60
$538.87
$818.87 		$532.54
$573.27
$616.42
$769.69 		$763.36
$804.09
$847.24
$1,000.51 		$994.18
$1,034.91
$1,078.06
$1,231.33 		$230.82
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$603.44
$684.90
$771.20
$1,077.74
$1,637.74 		$834.26
$915.72
$1,002.02
$1,308.56 		$1,065.08
$1,146.54
$1,232.84
$1,539.38 		$1,295.90
$1,377.36
$1,463.66
$1,770.20 		$230.82
Toc - Plan #95 Cigna Healthcare
Expanded Bronze

(EPO) Connect Bronze 0 Indiv Med Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-900-1237

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 		$330.10
$374.66
$421.87
$589.56
$895.89 		$582.63
$627.19
$674.40
$842.09 		$835.16
$879.72
$926.93
$1,094.62 		$1,087.69
$1,132.25
$1,179.46
$1,347.15 		$252.53
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$660.20
$749.32
$843.74
$1,179.12
$1,791.78 		$912.73
$1,001.85
$1,096.27
$1,431.65 		$1,165.26
$1,254.38
$1,348.80
$1,684.18 		$1,417.79
$1,506.91
$1,601.33
$1,936.71 		$252.53
Toc - Plan #96 Cigna Healthcare
Expanded Bronze

(EPO) Connect Bronze 5500 Indiv Med Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family
$5,500 $11,000 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 		$304.95
$346.12
$389.72
$544.64
$827.63 		$538.23
$579.40
$623.00
$777.92 		$771.51
$812.68
$856.28
$1,011.20 		$1,004.79
$1,045.96
$1,089.56
$1,244.48 		$233.28
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$609.90
$692.24
$779.44
$1,089.28
$1,655.26 		$843.18
$925.52
$1,012.72
$1,322.56 		$1,076.46
$1,158.80
$1,246.00
$1,555.84 		$1,309.74
$1,392.08
$1,479.28
$1,789.12 		$233.28

‡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 Martin County here.

Martin County is in “Rating Area 42” of Florida.

Currently, there are 96 plans offered in Rating Area 42.

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2024 Obamacare Plans for Martin County, FL

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