Providers for Zip Code 85032

Obamacare 2015 Marketplace Rates For Maricopa County, Arizona

Wednesday, November 26th, 2014

Click for Phoenix, Arizona Forecast

The health insurance rates listed below are for calendar year 2015.

2015 Rates and Providers

(click here for 2014)

This page gives you an overview of the rates for individual and family health insurance plans available from HealthCare.gov, the marketplace for Maricopa County, Arizona.

Obamacare Providers, Plans and 2015 Rates for Maricopa County

Maricopa County is in “Rating Area 4” of Arizona.

Currently, there are 10 providers offering 119 plans to Rating Area 4.

Below, you’ll find a summary of plans and rates for each of these providers. This chart is designed to give you a preview of your health insurance options. For detailed information, including deductible amounts, annual limits on out-of-pocket costs, and possible subsidies, you must complete an application at HealthCare.gov or contact the provider directly.

The table below shows premiums for the following scenarios for:

  • Individual
  • Couple
  • Couple with 1 2 or 3 children
  • Individual with 1 2 or 3 children
  • A child alone

Each scenario is covered for age

  • Age 21, 30, 40, 50
  • Age 60 (Individual and Couple only)

For each plan, there are links that go to the insurance provider's website in a new window. You can find links to:

  • a summary of plan benefits and costs,
  • a plan brochure, and
  • a "Provider Directory" -- where you can find out which doctors and hospitals in the Phoenix, AZ area accept this insurance coverage as within the plan's "network".

Humana, Inc.

Local: 1-877-720-4854 | Toll Free: 1-877-720-4854

TTY: 1-800-325-2028

Plan: (HMO) Humana Basic 6600/Phoenix HMOx

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana, Inc.)

Deductible: Individual: $6,600 : Family: $13,200
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Catastrophic 21
30
40
50
60
$144.99
$164.56
$185.30
$258.95
$393.50
$289.98
$329.12
$370.60
$517.90
$787.00
$382.05
$421.19
$462.67
$609.97
$474.12
$513.26
$554.74
$702.04
$566.19
$605.33
$646.81
$794.11
$237.06
$256.63
$277.37
$351.02
$329.13
$348.70
$369.44
$443.09
$421.20
$440.77
$461.51
$535.16
$92.07

Plan: (HMO) Humana Bronze 6300/Phoenix HMOx

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana, Inc.)

Deductible: Individual: $6,300 : Family: $12,600
Out of Pocket Maximum per year: Individual: $6,300 : Family: $12,600

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$176.17
$199.95
$225.15
$314.64
$478.13
$352.34
$399.90
$450.30
$629.28
$956.26
$464.21
$511.77
$562.17
$741.15
$576.08
$623.64
$674.04
$853.02
$687.95
$735.51
$785.91
$964.89
$288.04
$311.82
$337.02
$426.51
$399.91
$423.69
$448.89
$538.38
$511.78
$535.56
$560.76
$650.25
$111.87

Plan: (HMO) Humana Silver 4600/Phoenix HMOx

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana, Inc.)

Deductible: Individual: $4,600 : Family: $9,200
Out of Pocket Maximum per year: Individual: $6,300 : Family: $12,600

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$207.67
$235.71
$265.40
$370.90
$563.62
$415.34
$471.42
$530.80
$741.80
$1127.24
$547.21
$603.29
$662.67
$873.67
$679.08
$735.16
$794.54
$1005.54
$810.95
$867.03
$926.41
$1137.41
$339.54
$367.58
$397.27
$502.77
$471.41
$499.45
$529.14
$634.64
$603.28
$631.32
$661.01
$766.51
$131.87

Plan: (HMO) Humana Gold 2500/Phoenix HMOx

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana, Inc.)

Deductible: Individual: $2,500 : Family: $5,000
Out of Pocket Maximum per year: Individual: $3,500 : Family: $7,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$251.54
$285.50
$321.47
$449.25
$682.68
$503.08
$571.00
$642.94
$898.50
$1365.36
$662.81
$730.73
$802.67
$1058.23
$822.54
$890.46
$962.40
$1217.96
$982.27
$1050.19
$1122.13
$1377.69
$411.27
$445.23
$481.20
$608.98
$571.00
$604.96
$640.93
$768.71
$730.73
$764.69
$800.66
$928.44
$159.73

Plan: (HMO) Humana Platinum 1000/Phoenix HMOx

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana, Inc.)

Deductible: Individual: $1,000 : Family: $2,000
Out of Pocket Maximum per year: Individual: $1,500 : Family: $3,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Platinum 21
30
40
50
60
$296.13
$336.11
$378.45
$528.89
$803.70
$592.26
$672.22
$756.90
$1057.78
$1607.40
$780.30
$860.26
$944.94
$1245.82
$968.34
$1048.30
$1132.98
$1433.86
$1156.38
$1236.34
$1321.02
$1621.90
$484.17
$524.15
$566.49
$716.93
$672.21
$712.19
$754.53
$904.97
$860.25
$900.23
$942.57
$1093.01
$188.04

Health Net

Local: 1-877-288-9085 | Toll Free: 1-877-288-9085

TTY: 1-888-926-5180

Plan: (PPO) PPO Platinum $15/$30/$1000 with Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-288-9085 - Provider Directory for This Plan: (Health Net)

Deductible: Individual: $1,000 : Family: $2,000
Out of Pocket Maximum per year: Individual: $1,500 : Family: $3,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Platinum 21
30
40
50
60
$273.85
$310.82
$349.98
$489.10
$743.23
$547.70
$621.64
$699.96
$978.20
$1486.46
$721.59
$795.53
$873.85
$1152.09
$895.48
$969.42
$1047.74
$1325.98
$1069.37
$1143.31
$1221.63
$1499.87
$447.74
$484.71
$523.87
$662.99
$621.63
$658.60
$697.76
$836.88
$795.52
$832.49
$871.65
$1010.77
$173.89

Plan: (PPO) PPO Platinum $15/$30/$750 with Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-288-9085 - Provider Directory for This Plan: (Health Net)

Deductible: Individual: $750 : Family: $1,500
Out of Pocket Maximum per year: Individual: $1,250 : Family: $2,500

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Platinum 21
30
40
50
60
$269.07
$305.39
$343.87
$480.55
$730.25
$538.14
$610.78
$687.74
$961.10
$1460.50
$709.00
$781.64
$858.60
$1131.96
$879.86
$952.50
$1029.46
$1302.82
$1050.72
$1123.36
$1200.32
$1473.68
$439.93
$476.25
$514.73
$651.41
$610.79
$647.11
$685.59
$822.27
$781.65
$817.97
$856.45
$993.13
$170.86

Plan: (PPO) PPO Platinum $15/$30/$500 with Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-288-9085 - Provider Directory for This Plan: (Health Net)

Deductible: Individual: $500 : Family: $1,000
Out of Pocket Maximum per year: Individual: $1,750 : Family: $3,500

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Platinum 21
30
40
50
60
$263.39
$298.94
$336.61
$470.41
$714.83
$526.78
$597.88
$673.22
$940.82
$1429.66
$694.03
$765.13
$840.47
$1108.07
$861.28
$932.38
$1007.72
$1275.32
$1028.53
$1099.63
$1174.97
$1442.57
$430.64
$466.19
$503.86
$637.66
$597.89
$633.44
$671.11
$804.91
$765.14
$800.69
$838.36
$972.16
$167.25

Plan: (PPO) PPO Gold $25/$50/$2500 with Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-288-9085 - Provider Directory for This Plan: (Health Net)

Deductible: Individual: $2,500 : Family: $5,000
Out of Pocket Maximum per year: Individual: $4,000 : Family: $8,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$234.39
$266.03
$299.55
$418.62
$636.13
$468.78
$532.06
$599.10
$837.24
$1272.26
$617.62
$680.90
$747.94
$986.08
$766.46
$829.74
$896.78
$1134.92
$915.30
$978.58
$1045.62
$1283.76
$383.23
$414.87
$448.39
$567.46
$532.07
$563.71
$597.23
$716.30
$680.91
$712.55
$746.07
$865.14
$148.84

Plan: (PPO) PPO Gold $25/$50/$1500 with Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-288-9085 - Provider Directory for This Plan: (Health Net)

Deductible: Individual: $1,500 : Family: $3,000
Out of Pocket Maximum per year: Individual: $4,000 : Family: $8,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$236.78
$268.74
$302.60
$422.89
$642.62
$473.56
$537.48
$605.20
$845.78
$1285.24
$623.91
$687.83
$755.55
$996.13
$774.26
$838.18
$905.90
$1146.48
$924.61
$988.53
$1056.25
$1296.83
$387.13
$419.09
$452.95
$573.24
$537.48
$569.44
$603.30
$723.59
$687.83
$719.79
$753.65
$873.94
$150.35

Plan: (PPO) PPO Gold $25/$50/$500 with Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-288-9085 - Provider Directory for This Plan: (Health Net)

Deductible: Individual: $500 : Family: $1,000
Out of Pocket Maximum per year: Individual: $3,500 : Family: $7,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$244.85
$277.91
$312.92
$437.30
$664.52
$489.70
$555.82
$625.84
$874.60
$1329.04
$645.18
$711.30
$781.32
$1030.08
$800.66
$866.78
$936.80
$1185.56
$956.14
$1022.26
$1092.28
$1341.04
$400.33
$433.39
$468.40
$592.78
$555.81
$588.87
$623.88
$748.26
$711.29
$744.35
$779.36
$903.74
$155.48

Plan: (PPO) PPO Platinum $15/$30/$1000 without Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-288-9085 - Provider Directory for This Plan: (Health Net)

Deductible: Individual: $1,000 : Family: $2,000
Out of Pocket Maximum per year: Individual: $1,500 : Family: $3,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Platinum 21
30
40
50
60
$269.43
$305.80
$344.33
$481.20
$731.23
$538.86
$611.60
$688.66
$962.40
$1462.46
$709.95
$782.69
$859.75
$1133.49
$881.04
$953.78
$1030.84
$1304.58
$1052.13
$1124.87
$1201.93
$1475.67
$440.52
$476.89
$515.42
$652.29
$611.61
$647.98
$686.51
$823.38
$782.70
$819.07
$857.60
$994.47
$171.09

Plan: (PPO) PPO Platinum $15/$30/$750 without Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-288-9085 - Provider Directory for This Plan: (Health Net)

Deductible: Individual: $750 : Family: $1,500
Out of Pocket Maximum per year: Individual: $1,250 : Family: $2,500

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Platinum 21
30
40
50
60
$264.72
$300.46
$338.32
$472.79
$718.46
$529.44
$600.92
$676.64
$945.58
$1436.92
$697.54
$769.02
$844.74
$1113.68
$865.64
$937.12
$1012.84
$1281.78
$1033.74
$1105.22
$1180.94
$1449.88
$432.82
$468.56
$506.42
$640.89
$600.92
$636.66
$674.52
$808.99
$769.02
$804.76
$842.62
$977.09
$168.10

Plan: (PPO) PPO Platinum $15/$30/$500 without Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-288-9085 - Provider Directory for This Plan: (Health Net)

Deductible: Individual: $500 : Family: $1,000
Out of Pocket Maximum per year: Individual: $1,750 : Family: $3,500

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Platinum 21
30
40
50
60
$259.13
$294.12
$331.17
$462.81
$703.29
$518.26
$588.24
$662.34
$925.62
$1406.58
$682.81
$752.79
$826.89
$1090.17
$847.36
$917.34
$991.44
$1254.72
$1011.91
$1081.89
$1155.99
$1419.27
$423.68
$458.67
$495.72
$627.36
$588.23
$623.22
$660.27
$791.91
$752.78
$787.77
$824.82
$956.46
$164.55

Plan: (PPO) PPO Gold $25/$50/$2500 without Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-288-9085 - Provider Directory for This Plan: (Health Net)

Deductible: Individual: $2,500 : Family: $5,000
Out of Pocket Maximum per year: Individual: $4,000 : Family: $8,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$230.60
$261.73
$294.71
$411.86
$625.86
$461.20
$523.46
$589.42
$823.72
$1251.72
$607.63
$669.89
$735.85
$970.15
$754.06
$816.32
$882.28
$1116.58
$900.49
$962.75
$1028.71
$1263.01
$377.03
$408.16
$441.14
$558.29
$523.46
$554.59
$587.57
$704.72
$669.89
$701.02
$734.00
$851.15
$146.43

Plan: (PPO) PPO Gold $25/$50/$1500 without Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-288-9085 - Provider Directory for This Plan: (Health Net)

Deductible: Individual: $1,500 : Family: $3,000
Out of Pocket Maximum per year: Individual: $4,000 : Family: $8,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$232.96
$264.40
$297.72
$416.06
$632.24
$465.92
$528.80
$595.44
$832.12
$1264.48
$613.85
$676.73
$743.37
$980.05
$761.78
$824.66
$891.30
$1127.98
$909.71
$972.59
$1039.23
$1275.91
$380.89
$412.33
$445.65
$563.99
$528.82
$560.26
$593.58
$711.92
$676.75
$708.19
$741.51
$859.85
$147.93

Plan: (PPO) PPO Gold $25/$50/$500 without Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-288-9085 - Provider Directory for This Plan: (Health Net)

Deductible: Individual: $500 : Family: $1,000
Out of Pocket Maximum per year: Individual: $3,500 : Family: $7,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$240.90
$273.42
$307.87
$430.24
$653.80
$481.80
$546.84
$615.74
$860.48
$1307.60
$634.77
$699.81
$768.71
$1013.45
$787.74
$852.78
$921.68
$1166.42
$940.71
$1005.75
$1074.65
$1319.39
$393.87
$426.39
$460.84
$583.21
$546.84
$579.36
$613.81
$736.18
$699.81
$732.33
$766.78
$889.15
$152.97

Plan: (PPO) PPO Silver 30%/30%/$1500 with Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-288-9085 - Provider Directory for This Plan: (Health Net)

Deductible: Individual: $1,500 : Family: $3,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$203.89
$231.42
$260.58
$364.15
$553.37
$407.78
$462.84
$521.16
$728.30
$1106.74
$537.25
$592.31
$650.63
$857.77
$666.72
$721.78
$780.10
$987.24
$796.19
$851.25
$909.57
$1116.71
$333.36
$360.89
$390.05
$493.62
$462.83
$490.36
$519.52
$623.09
$592.30
$619.83
$648.99
$752.56
$129.47

Plan: (PPO) PPO Bronze 50%/50%/$5500 with Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-288-9085 - Provider Directory for This Plan: (Health Net)

Deductible: Individual: $5,500 : Family: $11,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$178.18
$202.24
$227.72
$318.23
$483.59
$356.36
$404.48
$455.44
$636.46
$967.18
$469.51
$517.63
$568.59
$749.61
$582.66
$630.78
$681.74
$862.76
$695.81
$743.93
$794.89
$975.91
$291.33
$315.39
$340.87
$431.38
$404.48
$428.54
$454.02
$544.53
$517.63
$541.69
$567.17
$657.68
$113.15

Plan: (PPO) PPO Silver 30%/30%/$1500 without Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-288-9085 - Provider Directory for This Plan: (Health Net)

Deductible: Individual: $1,500 : Family: $3,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$200.60
$227.68
$256.37
$358.27
$544.43
$401.20
$455.36
$512.74
$716.54
$1088.86
$528.58
$582.74
$640.12
$843.92
$655.96
$710.12
$767.50
$971.30
$783.34
$837.50
$894.88
$1098.68
$327.98
$355.06
$383.75
$485.65
$455.36
$482.44
$511.13
$613.03
$582.74
$609.82
$638.51
$740.41
$127.38

Plan: (PPO) PPO Bronze 50%/50%/$5500 without Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-288-9085 - Provider Directory for This Plan: (Health Net)

Deductible: Individual: $5,500 : Family: $11,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$175.31
$198.97
$224.04
$313.09
$475.78
$350.62
$397.94
$448.08
$626.18
$951.56
$461.94
$509.26
$559.40
$737.50
$573.26
$620.58
$670.72
$848.82
$684.58
$731.90
$782.04
$960.14
$286.63
$310.29
$335.36
$424.41
$397.95
$421.61
$446.68
$535.73
$509.27
$532.93
$558.00
$647.05
$111.32

Blue Cross Blue Shield of Arizona, Inc.

Local: 1-877-475-4771 | Toll Free: 1-877-475-4771

TTY: 1-602-864-4823

Plan: (PPO) AZ Blue EverydayHealth PPO 1000 - Statewide Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-475-4771 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $1,000 : Family: $2,000
Out of Pocket Maximum per year: Individual: $4,500 : Family: $9,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$309.90
$351.74
$396.05
$553.48
$841.07
$619.80
$703.48
$792.10
$1106.96
$1682.14
$816.59
$900.27
$988.89
$1303.75
$1013.38
$1097.06
$1185.68
$1500.54
$1210.17
$1293.85
$1382.47
$1697.33
$506.69
$548.53
$592.84
$750.27
$703.48
$745.32
$789.63
$947.06
$900.27
$942.11
$986.42
$1143.85
$196.79

Plan: (PPO) AZ Blue EverydayHealth PPO 3000 - Statewide Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-475-4771 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $3,000 : Family: $6,000
Out of Pocket Maximum per year: Individual: $4,500 : Family: $9,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$268.00
$304.18
$342.50
$478.64
$727.33
$536.00
$608.36
$685.00
$957.28
$1454.66
$706.18
$778.54
$855.18
$1127.46
$876.36
$948.72
$1025.36
$1297.64
$1046.54
$1118.90
$1195.54
$1467.82
$438.18
$474.36
$512.68
$648.82
$608.36
$644.54
$682.86
$819.00
$778.54
$814.72
$853.04
$989.18
$170.18

Plan: (PPO) AZ Blue EverydayHealth PPO 4000 - Statewide Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-475-4771 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$244.24
$277.21
$312.14
$436.21
$662.86
$488.48
$554.42
$624.28
$872.42
$1325.72
$643.58
$709.52
$779.38
$1027.52
$798.68
$864.62
$934.48
$1182.62
$953.78
$1019.72
$1089.58
$1337.72
$399.34
$432.31
$467.24
$591.31
$554.44
$587.41
$622.34
$746.41
$709.54
$742.51
$777.44
$901.51
$155.10

Plan: (PPO) AZ Blue EverydayHealth PPO 6000 - Statewide Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-475-4771 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $6,000 : Family: $12,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$204.30
$231.88
$261.10
$364.88
$554.47
$408.60
$463.76
$522.20
$729.76
$1108.94
$538.33
$593.49
$651.93
$859.49
$668.06
$723.22
$781.66
$989.22
$797.79
$852.95
$911.39
$1118.95
$334.03
$361.61
$390.83
$494.61
$463.76
$491.34
$520.56
$624.34
$593.49
$621.07
$650.29
$754.07
$129.73

Plan: (PPO) AZ Blue Essential PPO 1500 - Statewide Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-475-4771 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $1,500 : Family: $3,000
Out of Pocket Maximum per year: Individual: $3,000 : Family: $6,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$296.67
$336.72
$379.14
$529.85
$805.16
$593.34
$673.44
$758.28
$1059.70
$1610.32
$781.73
$861.83
$946.67
$1248.09
$970.12
$1050.22
$1135.06
$1436.48
$1158.51
$1238.61
$1323.45
$1624.87
$485.06
$525.11
$567.53
$718.24
$673.45
$713.50
$755.92
$906.63
$861.84
$901.89
$944.31
$1095.02
$188.39

Plan: (PPO) AZ Blue Essential PPO 4000 - Statewide Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-475-4771 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$228.74
$259.61
$292.32
$408.52
$620.78
$457.48
$519.22
$584.64
$817.04
$1241.56
$602.73
$664.47
$729.89
$962.29
$747.98
$809.72
$875.14
$1107.54
$893.23
$954.97
$1020.39
$1252.79
$373.99
$404.86
$437.57
$553.77
$519.24
$550.11
$582.82
$699.02
$664.49
$695.36
$728.07
$844.27
$145.25

Plan: (PPO) AZ Blue Essential PPO 6000 - Statewide Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-475-4771 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $6,000 : Family: $12,000
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$194.81
$221.10
$248.96
$347.92
$528.69
$389.62
$442.20
$497.92
$695.84
$1057.38
$513.32
$565.90
$621.62
$819.54
$637.02
$689.60
$745.32
$943.24
$760.72
$813.30
$869.02
$1066.94
$318.51
$344.80
$372.66
$471.62
$442.21
$468.50
$496.36
$595.32
$565.91
$592.20
$620.06
$719.02
$123.70

Plan: (PPO) AZ Blue Portfolio HSA PPO 1500 - Statewide Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-475-4771 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $1,500 : Family: $3,000
Out of Pocket Maximum per year: Individual: $3,000 : Family: $6,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$284.29
$322.67
$363.33
$507.74
$771.57
$568.58
$645.34
$726.66
$1015.48
$1543.14
$749.11
$825.87
$907.19
$1196.01
$929.64
$1006.40
$1087.72
$1376.54
$1110.17
$1186.93
$1268.25
$1557.07
$464.82
$503.20
$543.86
$688.27
$645.35
$683.73
$724.39
$868.80
$825.88
$864.26
$904.92
$1049.33
$180.53

Plan: (PPO) AZ Blue Portfolio HSA PPO 3500 - Statewide Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-475-4771 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $3,500 : Family: $7,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$227.12
$257.78
$290.26
$405.63
$616.39
$454.24
$515.56
$580.52
$811.26
$1232.78
$598.46
$659.78
$724.74
$955.48
$742.68
$804.00
$868.96
$1099.70
$886.90
$948.22
$1013.18
$1243.92
$371.34
$402.00
$434.48
$549.85
$515.56
$546.22
$578.70
$694.07
$659.78
$690.44
$722.92
$838.29
$144.22

Plan: (PPO) AZ Blue Portfolio HSA PPO 5500 - Statewide Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-475-4771 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $5,500 : Family: $11,000
Out of Pocket Maximum per year: Individual: $5,500 : Family: $11,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$183.14
$207.87
$234.06
$327.09
$497.04
$366.28
$415.74
$468.12
$654.18
$994.08
$482.58
$532.04
$584.42
$770.48
$598.88
$648.34
$700.72
$886.78
$715.18
$764.64
$817.02
$1003.08
$299.44
$324.17
$350.36
$443.39
$415.74
$440.47
$466.66
$559.69
$532.04
$556.77
$582.96
$675.99
$116.30

Plan: (PPO) AZ Blue Portfolio HSA PPO 6300 - Statewide Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-475-4771 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $6,300 : Family: $12,600
Out of Pocket Maximum per year: Individual: $6,300 : Family: $12,600

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$174.00
$197.49
$222.37
$310.76
$472.23
$348.00
$394.98
$444.74
$621.52
$944.46
$458.49
$505.47
$555.23
$732.01
$568.98
$615.96
$665.72
$842.50
$679.47
$726.45
$776.21
$952.99
$284.49
$307.98
$332.86
$421.25
$394.98
$418.47
$443.35
$531.74
$505.47
$528.96
$553.84
$642.23
$110.49

Plan: (PPO) AZ Blue SimpleHealth PPO - Statewide Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-475-4771 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $6,600 : Family: $13,200
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Catastrophic 21
30
40
50
60
$147.36
$167.25
$188.33
$263.18
$399.93
$294.72
$334.50
$376.66
$526.36
$799.86
$388.30
$428.08
$470.24
$619.94
$481.88
$521.66
$563.82
$713.52
$575.46
$615.24
$657.40
$807.10
$240.94
$260.83
$281.91
$356.76
$334.52
$354.41
$375.49
$450.34
$428.10
$447.99
$469.07
$543.92
$93.58

Plan: (PPO) AZ Blue CopayComplete PPO 25 - Statewide Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-475-4771 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $0 : Family: $0
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$320.84
$364.16
$410.04
$573.02
$870.76
$641.68
$728.32
$820.08
$1146.04
$1741.52
$845.42
$932.06
$1023.82
$1349.78
$1049.16
$1135.80
$1227.56
$1553.52
$1252.90
$1339.54
$1431.30
$1757.26
$524.58
$567.90
$613.78
$776.76
$728.32
$771.64
$817.52
$980.50
$932.06
$975.38
$1021.26
$1184.24
$203.74

Plan: (PPO) AZ Blue CopayComplete PPO 40 - Statewide Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-475-4771 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $0 : Family: $0
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$285.74
$324.31
$365.17
$510.33
$775.49
$571.48
$648.62
$730.34
$1020.66
$1550.98
$752.93
$830.07
$911.79
$1202.11
$934.38
$1011.52
$1093.24
$1383.56
$1115.83
$1192.97
$1274.69
$1565.01
$467.19
$505.76
$546.62
$691.78
$648.64
$687.21
$728.07
$873.23
$830.09
$868.66
$909.52
$1054.68
$181.45

Plan: (HMO) AZ Blue EverydayHealth HMO 1000 - Alliance Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-475-4771 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $1,000 : Family: $2,000
Out of Pocket Maximum per year: Individual: $4,500 : Family: $9,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$256.61
$291.25
$327.95
$458.30
$696.43
$513.22
$582.50
$655.90
$916.60
$1392.86
$676.17
$745.45
$818.85
$1079.55
$839.12
$908.40
$981.80
$1242.50
$1002.07
$1071.35
$1144.75
$1405.45
$419.56
$454.20
$490.90
$621.25
$582.51
$617.15
$653.85
$784.20
$745.46
$780.10
$816.80
$947.15
$162.95

Plan: (HMO) AZ Blue EverydayHealth HMO 3000 - Alliance Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-475-4771 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $3,000 : Family: $6,000
Out of Pocket Maximum per year: Individual: $4,500 : Family: $9,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$221.91
$251.86
$283.60
$396.32
$602.25
$443.82
$503.72
$567.20
$792.64
$1204.50
$584.73
$644.63
$708.11
$933.55
$725.64
$785.54
$849.02
$1074.46
$866.55
$926.45
$989.93
$1215.37
$362.82
$392.77
$424.51
$537.23
$503.73
$533.68
$565.42
$678.14
$644.64
$674.59
$706.33
$819.05
$140.91

Plan: (HMO) AZ Blue EverydayHealth HMO 4000 - Alliance Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-475-4771 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$202.24
$229.54
$258.46
$361.20
$548.88
$404.48
$459.08
$516.92
$722.40
$1097.76
$532.91
$587.51
$645.35
$850.83
$661.34
$715.94
$773.78
$979.26
$789.77
$844.37
$902.21
$1107.69
$330.67
$357.97
$386.89
$489.63
$459.10
$486.40
$515.32
$618.06
$587.53
$614.83
$643.75
$746.49
$128.43

Plan: (HMO) AZ Blue EverydayHealth HMO 6000 - Alliance Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-475-4771 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $6,000 : Family: $12,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$169.17
$192.00
$216.20
$302.13
$459.11
$338.34
$384.00
$432.40
$604.26
$918.22
$445.76
$491.42
$539.82
$711.68
$553.18
$598.84
$647.24
$819.10
$660.60
$706.26
$754.66
$926.52
$276.59
$299.42
$323.62
$409.55
$384.01
$406.84
$431.04
$516.97
$491.43
$514.26
$538.46
$624.39
$107.42

Plan: (HMO) AZ Blue EverydayHealth HMO 1000 - Select Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-475-4771 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $1,000 : Family: $2,000
Out of Pocket Maximum per year: Individual: $4,500 : Family: $9,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$256.61
$291.25
$327.95
$458.30
$696.43
$513.22
$582.50
$655.90
$916.60
$1392.86
$676.17
$745.45
$818.85
$1079.55
$839.12
$908.40
$981.80
$1242.50
$1002.07
$1071.35
$1144.75
$1405.45
$419.56
$454.20
$490.90
$621.25
$582.51
$617.15
$653.85
$784.20
$745.46
$780.10
$816.80
$947.15
$162.95

Plan: (HMO) AZ Blue EverydayHealth HMO 3000 - Select Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-475-4771 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $3,000 : Family: $6,000
Out of Pocket Maximum per year: Individual: $4,500 : Family: $9,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$221.91
$251.86
$283.60
$396.32
$602.25
$443.82
$503.72
$567.20
$792.64
$1204.50
$584.73
$644.63
$708.11
$933.55
$725.64
$785.54
$849.02
$1074.46
$866.55
$926.45
$989.93
$1215.37
$362.82
$392.77
$424.51
$537.23
$503.73
$533.68
$565.42
$678.14
$644.64
$674.59
$706.33
$819.05
$140.91

Plan: (HMO) AZ Blue EverydayHealth HMO 4000 - Select Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-475-4771 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$202.24
$229.54
$258.46
$361.20
$548.88
$404.48
$459.08
$516.92
$722.40
$1097.76
$532.91
$587.51
$645.35
$850.83
$661.34
$715.94
$773.78
$979.26
$789.77
$844.37
$902.21
$1107.69
$330.67
$357.97
$386.89
$489.63
$459.10
$486.40
$515.32
$618.06
$587.53
$614.83
$643.75
$746.49
$128.43

Plan: (HMO) AZ Blue EverydayHealth HMO 6000 - Select Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-475-4771 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $6,000 : Family: $12,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$169.17
$192.00
$216.20
$302.13
$459.11
$338.34
$384.00
$432.40
$604.26
$918.22
$445.76
$491.42
$539.82
$711.68
$553.18
$598.84
$647.24
$819.10
$660.60
$706.26
$754.66
$926.52
$276.59
$299.42
$323.62
$409.55
$384.01
$406.84
$431.04
$516.97
$491.43
$514.26
$538.46
$624.39
$107.42

Plan: (HMO) AZ Blue Essential HMO 1500 - Alliance Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-475-4771 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $1,500 : Family: $3,000
Out of Pocket Maximum per year: Individual: $3,000 : Family: $6,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$245.65
$278.82
$313.94
$438.73
$666.69
$491.30
$557.64
$627.88
$877.46
$1333.38
$647.29
$713.63
$783.87
$1033.45
$803.28
$869.62
$939.86
$1189.44
$959.27
$1025.61
$1095.85
$1345.43
$401.64
$434.81
$469.93
$594.72
$557.63
$590.80
$625.92
$750.71
$713.62
$746.79
$781.91
$906.70
$155.99

Plan: (HMO) AZ Blue Essential HMO 4000 - Alliance Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-475-4771 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$189.40
$214.97
$242.06
$338.27
$514.03
$378.80
$429.94
$484.12
$676.54
$1028.06
$499.07
$550.21
$604.39
$796.81
$619.34
$670.48
$724.66
$917.08
$739.61
$790.75
$844.93
$1037.35
$309.67
$335.24
$362.33
$458.54
$429.94
$455.51
$482.60
$578.81
$550.21
$575.78
$602.87
$699.08
$120.27

Plan: (HMO) AZ Blue Essential HMO 6000 - Alliance Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-475-4771 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $6,000 : Family: $12,000
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$161.31
$183.08
$206.15
$288.09
$437.78
$322.62
$366.16
$412.30
$576.18
$875.56
$425.05
$468.59
$514.73
$678.61
$527.48
$571.02
$617.16
$781.04
$629.91
$673.45
$719.59
$883.47
$263.74
$285.51
$308.58
$390.52
$366.17
$387.94
$411.01
$492.95
$468.60
$490.37
$513.44
$595.38
$102.43

Plan: (HMO) AZ Blue Essential HMO 1500 - Select Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-475-4771 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $1,500 : Family: $3,000
Out of Pocket Maximum per year: Individual: $3,000 : Family: $6,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$245.65
$278.82
$313.94
$438.73
$666.69
$491.30
$557.64
$627.88
$877.46
$1333.38
$647.29
$713.63
$783.87
$1033.45
$803.28
$869.62
$939.86
$1189.44
$959.27
$1025.61
$1095.85
$1345.43
$401.64
$434.81
$469.93
$594.72
$557.63
$590.80
$625.92
$750.71
$713.62
$746.79
$781.91
$906.70
$155.99

Plan: (HMO) AZ Blue Essential HMO 4000 - Select Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-475-4771 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$189.40
$214.97
$242.06
$338.27
$514.03
$378.80
$429.94
$484.12
$676.54
$1028.06
$499.07
$550.21
$604.39
$796.81
$619.34
$670.48
$724.66
$917.08
$739.61
$790.75
$844.93
$1037.35
$309.67
$335.24
$362.33
$458.54
$429.94
$455.51
$482.60
$578.81
$550.21
$575.78
$602.87
$699.08
$120.27

Plan: (HMO) AZ Blue Essential HMO 6000 - Select Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-475-4771 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $6,000 : Family: $12,000
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$161.31
$183.08
$206.15
$288.09
$437.78
$322.62
$366.16
$412.30
$576.18
$875.56
$425.05
$468.59
$514.73
$678.61
$527.48
$571.02
$617.16
$781.04
$629.91
$673.45
$719.59
$883.47
$263.74
$285.51
$308.58
$390.52
$366.17
$387.94
$411.01
$492.95
$468.60
$490.37
$513.44
$595.38
$102.43

Plan: (HMO) AZ Blue Portfolio HSA HMO 1500 - Alliance Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-475-4771 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $1,500 : Family: $3,000
Out of Pocket Maximum per year: Individual: $3,000 : Family: $6,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$235.40
$267.18
$300.84
$420.42
$638.87
$470.80
$534.36
$601.68
$840.84
$1277.74
$620.28
$683.84
$751.16
$990.32
$769.76
$833.32
$900.64
$1139.80
$919.24
$982.80
$1050.12
$1289.28
$384.88
$416.66
$450.32
$569.90
$534.36
$566.14
$599.80
$719.38
$683.84
$715.62
$749.28
$868.86
$149.48

Plan: (HMO) AZ Blue Portfolio HSA HMO 3500 - Alliance Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-475-4771 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $3,500 : Family: $7,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$188.06
$213.45
$240.34
$335.88
$510.39
$376.12
$426.90
$480.68
$671.76
$1020.78
$495.54
$546.32
$600.10
$791.18
$614.96
$665.74
$719.52
$910.60
$734.38
$785.16
$838.94
$1030.02
$307.48
$332.87
$359.76
$455.30
$426.90
$452.29
$479.18
$574.72
$546.32
$571.71
$598.60
$694.14
$119.42

Plan: (HMO) AZ Blue Portfolio HSA HMO 5500 - Alliance Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-475-4771 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $5,500 : Family: $11,000
Out of Pocket Maximum per year: Individual: $5,500 : Family: $11,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$151.65
$172.13
$193.81
$270.85
$411.58
$303.30
$344.26
$387.62
$541.70
$823.16
$399.60
$440.56
$483.92
$638.00
$495.90
$536.86
$580.22
$734.30
$592.20
$633.16
$676.52
$830.60
$247.95
$268.43
$290.11
$367.15
$344.25
$364.73
$386.41
$463.45
$440.55
$461.03
$482.71
$559.75
$96.30

Plan: (HMO) AZ Blue Portfolio HSA HMO 6300 - Alliance Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-475-4771 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $6,300 : Family: $12,600
Out of Pocket Maximum per year: Individual: $6,300 : Family: $12,600

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$144.08
$163.53
$184.13
$257.32
$391.02
$288.16
$327.06
$368.26
$514.64
$782.04
$379.65
$418.55
$459.75
$606.13
$471.14
$510.04
$551.24
$697.62
$562.63
$601.53
$642.73
$789.11
$235.57
$255.02
$275.62
$348.81
$327.06
$346.51
$367.11
$440.30
$418.55
$438.00
$458.60
$531.79
$91.49

Plan: (HMO) AZ Blue Portfolio HSA HMO 1500 - Select Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-475-4771 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $1,500 : Family: $3,000
Out of Pocket Maximum per year: Individual: $3,000 : Family: $6,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$235.40
$267.18
$300.84
$420.42
$638.87
$470.80
$534.36
$601.68
$840.84
$1277.74
$620.28
$683.84
$751.16
$990.32
$769.76
$833.32
$900.64
$1139.80
$919.24
$982.80
$1050.12
$1289.28
$384.88
$416.66
$450.32
$569.90
$534.36
$566.14
$599.80
$719.38
$683.84
$715.62
$749.28
$868.86
$149.48

Plan: (HMO) AZ Blue Portfolio HSA HMO 3500 - Select Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-475-4771 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $3,500 : Family: $7,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$188.06
$213.45
$240.34
$335.88
$510.39
$376.12
$426.90
$480.68
$671.76
$1020.78
$495.54
$546.32
$600.10
$791.18
$614.96
$665.74
$719.52
$910.60
$734.38
$785.16
$838.94
$1030.02
$307.48
$332.87
$359.76
$455.30
$426.90
$452.29
$479.18
$574.72
$546.32
$571.71
$598.60
$694.14
$119.42

Plan: (HMO) AZ Blue Portfolio HSA HMO 5500 - Select Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-475-4771 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $5,500 : Family: $11,000
Out of Pocket Maximum per year: Individual: $5,500 : Family: $11,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$151.65
$172.13
$193.81
$270.85
$411.58
$303.30
$344.26
$387.62
$541.70
$823.16
$399.60
$440.56
$483.92
$638.00
$495.90
$536.86
$580.22
$734.30
$592.20
$633.16
$676.52
$830.60
$247.95
$268.43
$290.11
$367.15
$344.25
$364.73
$386.41
$463.45
$440.55
$461.03
$482.71
$559.75
$96.30

Plan: (HMO) AZ Blue Portfolio HSA HMO 6300 - Select Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-475-4771 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $6,300 : Family: $12,600
Out of Pocket Maximum per year: Individual: $6,300 : Family: $12,600

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$144.08
$163.53
$184.13
$257.32
$391.02
$288.16
$327.06
$368.26
$514.64
$782.04
$379.65
$418.55
$459.75
$606.13
$471.14
$510.04
$551.24
$697.62
$562.63
$601.53
$642.73
$789.11
$235.57
$255.02
$275.62
$348.81
$327.06
$346.51
$367.11
$440.30
$418.55
$438.00
$458.60
$531.79
$91.49

Plan: (HMO) AZ Blue SimpleHealth HMO - Alliance Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-475-4771 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $6,600 : Family: $13,200
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Catastrophic 21
30
40
50
60
$122.02
$138.49
$155.94
$217.92
$331.15
$244.04
$276.98
$311.88
$435.84
$662.30
$321.52
$354.46
$389.36
$513.32
$399.00
$431.94
$466.84
$590.80
$476.48
$509.42
$544.32
$668.28
$199.50
$215.97
$233.42
$295.40
$276.98
$293.45
$310.90
$372.88
$354.46
$370.93
$388.38
$450.36
$77.48

Plan: (HMO) AZ Blue SimpleHealth HMO - Select Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-475-4771 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $6,600 : Family: $13,200
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Catastrophic 21
30
40
50
60
$122.02
$138.49
$155.94
$217.92
$331.15
$244.04
$276.98
$311.88
$435.84
$662.30
$321.52
$354.46
$389.36
$513.32
$399.00
$431.94
$466.84
$590.80
$476.48
$509.42
$544.32
$668.28
$199.50
$215.97
$233.42
$295.40
$276.98
$293.45
$310.90
$372.88
$354.46
$370.93
$388.38
$450.36
$77.48

Plan: (HMO) AZ Blue CopayComplete HMO 25 - Alliance Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-475-4771 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $0 : Family: $0
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$265.67
$301.54
$339.53
$474.48
$721.02
$531.34
$603.08
$679.06
$948.96
$1442.04
$700.04
$771.78
$847.76
$1117.66
$868.74
$940.48
$1016.46
$1286.36
$1037.44
$1109.18
$1185.16
$1455.06
$434.37
$470.24
$508.23
$643.18
$603.07
$638.94
$676.93
$811.88
$771.77
$807.64
$845.63
$980.58
$168.70

Plan: (HMO) AZ Blue CopayComplete HMO 40 - Alliance Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-475-4771 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $0 : Family: $0
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$236.60
$268.54
$302.37
$422.56
$642.12
$473.20
$537.08
$604.74
$845.12
$1284.24
$623.44
$687.32
$754.98
$995.36
$773.68
$837.56
$905.22
$1145.60
$923.92
$987.80
$1055.46
$1295.84
$386.84
$418.78
$452.61
$572.80
$537.08
$569.02
$602.85
$723.04
$687.32
$719.26
$753.09
$873.28
$150.24

Plan: (HMO) AZ Blue CopayComplete HMO 25 - Select Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-475-4771 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $0 : Family: $0
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$265.67
$301.54
$339.53
$474.48
$721.02
$531.34
$603.08
$679.06
$948.96
$1442.04
$700.04
$771.78
$847.76
$1117.66
$868.74
$940.48
$1016.46
$1286.36
$1037.44
$1109.18
$1185.16
$1455.06
$434.37
$470.24
$508.23
$643.18
$603.07
$638.94
$676.93
$811.88
$771.77
$807.64
$845.63
$980.58
$168.70

Plan: (HMO) AZ Blue CopayComplete HMO 40 - Select Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-475-4771 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $0 : Family: $0
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$236.60
$268.54
$302.37
$422.56
$642.12
$473.20
$537.08
$604.74
$845.12
$1284.24
$623.44
$687.32
$754.98
$995.36
$773.68
$837.56
$905.22
$1145.60
$923.92
$987.80
$1055.46
$1295.84
$386.84
$418.78
$452.61
$572.80
$537.08
$569.02
$602.85
$723.04
$687.32
$719.26
$753.09
$873.28
$150.24

Meritus

Local: 1-602-957-2113 | Toll Free: 1-855-755-2700

TTY: 1-855-568-2800

Plan: (HMO) Meritus Neighborhood Network Silver HMO MIHS

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-755-2700 - Provider Directory for This Plan: (Meritus)

Deductible: Individual: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$138.12
$156.76
$176.51
$246.67
$374.84
$276.24
$313.52
$353.02
$493.34
$749.68
$363.94
$401.22
$440.72
$581.04
$451.64
$488.92
$528.42
$668.74
$539.34
$576.62
$616.12
$756.44
$225.82
$244.46
$264.21
$334.37
$313.52
$332.16
$351.91
$422.07
$401.22
$419.86
$439.61
$509.77
$87.70

Plan: (HMO) Meritus Community Network Silver HMO Banner

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-755-2700 - Provider Directory for This Plan: (Meritus)

Deductible: Individual: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$161.46
$183.25
$206.34
$288.36
$438.19
$322.92
$366.50
$412.68
$576.72
$876.38
$425.44
$469.02
$515.20
$679.24
$527.96
$571.54
$617.72
$781.76
$630.48
$674.06
$720.24
$884.28
$263.98
$285.77
$308.86
$390.88
$366.50
$388.29
$411.38
$493.40
$469.02
$490.81
$513.90
$595.92
$102.52

Plan: (HMO) Meritus Healthy Bronze Complete HMO 6000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-755-2700 - Provider Directory for This Plan: (Meritus)

Deductible: Individual: $6,000 : Family: $12,000
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$155.38
$176.36
$198.58
$277.51
$421.70
$310.76
$352.72
$397.16
$555.02
$843.40
$409.43
$451.39
$495.83
$653.69
$508.10
$550.06
$594.50
$752.36
$606.77
$648.73
$693.17
$851.03
$254.05
$275.03
$297.25
$376.18
$352.72
$373.70
$395.92
$474.85
$451.39
$472.37
$494.59
$573.52
$98.67

Plan: (HMO) Meritus Healthy Bronze HMO Banner 6000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-755-2700 - Provider Directory for This Plan: (Meritus)

Deductible: Individual: $6,000 : Family: $12,000
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$139.85
$158.72
$178.72
$249.76
$379.53
$279.70
$317.44
$357.44
$499.52
$759.06
$368.50
$406.24
$446.24
$588.32
$457.30
$495.04
$535.04
$677.12
$546.10
$583.84
$623.84
$765.92
$228.65
$247.52
$267.52
$338.56
$317.45
$336.32
$356.32
$427.36
$406.25
$425.12
$445.12
$516.16
$88.80

Plan: (HMO) Meritus Healthy Bronze HMO Abrazo 6000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-755-2700 - Provider Directory for This Plan: (Meritus)

Deductible: Individual: $6,000 : Family: $12,000
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$138.29
$156.96
$176.73
$246.98
$375.31
$276.58
$313.92
$353.46
$493.96
$750.62
$364.39
$401.73
$441.27
$581.77
$452.20
$489.54
$529.08
$669.58
$540.01
$577.35
$616.89
$757.39
$226.10
$244.77
$264.54
$334.79
$313.91
$332.58
$352.35
$422.60
$401.72
$420.39
$440.16
$510.41
$87.81

Plan: (HMO) Meritus Healthy Silver Complete HMO 4000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-755-2700 - Provider Directory for This Plan: (Meritus)

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$171.01
$194.09
$218.54
$305.41
$464.10
$342.02
$388.18
$437.08
$610.82
$928.20
$450.61
$496.77
$545.67
$719.41
$559.20
$605.36
$654.26
$828.00
$667.79
$713.95
$762.85
$936.59
$279.60
$302.68
$327.13
$414.00
$388.19
$411.27
$435.72
$522.59
$496.78
$519.86
$544.31
$631.18
$108.59

Plan: (HMO) Meritus Healthy Silver HMO Banner 4000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-755-2700 - Provider Directory for This Plan: (Meritus)

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$153.91
$174.68
$196.69
$274.87
$417.69
$307.82
$349.36
$393.38
$549.74
$835.38
$405.55
$447.09
$491.11
$647.47
$503.28
$544.82
$588.84
$745.20
$601.01
$642.55
$686.57
$842.93
$251.64
$272.41
$294.42
$372.60
$349.37
$370.14
$392.15
$470.33
$447.10
$467.87
$489.88
$568.06
$97.73

Plan: (HMO) Meritus Healthy Silver HMO Abrazo 4000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-755-2700 - Provider Directory for This Plan: (Meritus)

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$152.20
$172.74
$194.50
$271.81
$413.05
$304.40
$345.48
$389.00
$543.62
$826.10
$401.04
$442.12
$485.64
$640.26
$497.68
$538.76
$582.28
$736.90
$594.32
$635.40
$678.92
$833.54
$248.84
$269.38
$291.14
$368.45
$345.48
$366.02
$387.78
$465.09
$442.12
$462.66
$484.42
$561.73
$96.64

Plan: (HMO) Meritus Healthy Silver HMO MIHS 4000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-755-2700 - Provider Directory for This Plan: (Meritus)

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$129.69
$147.19
$165.73
$231.61
$351.95
$259.38
$294.38
$331.46
$463.22
$703.90
$341.73
$376.73
$413.81
$545.57
$424.08
$459.08
$496.16
$627.92
$506.43
$541.43
$578.51
$710.27
$212.04
$229.54
$248.08
$313.96
$294.39
$311.89
$330.43
$396.31
$376.74
$394.24
$412.78
$478.66
$82.35

Plan: (HMO) Meritus Healthy Gold Complete HMO Plus 2000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-755-2700 - Provider Directory for This Plan: (Meritus)

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $4,500 : Family: $9,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$209.95
$238.29
$268.31
$374.97
$569.80
$419.90
$476.58
$536.62
$749.94
$1139.60
$553.22
$609.90
$669.94
$883.26
$686.54
$743.22
$803.26
$1016.58
$819.86
$876.54
$936.58
$1149.90
$343.27
$371.61
$401.63
$508.29
$476.59
$504.93
$534.95
$641.61
$609.91
$638.25
$668.27
$774.93
$133.32

Plan: (HMO) Meritus Healthy Gold HMO Plus Banner 2000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-755-2700 - Provider Directory for This Plan: (Meritus)

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $4,500 : Family: $9,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$189.52
$215.10
$242.20
$338.47
$514.34
$379.04
$430.20
$484.40
$676.94
$1028.68
$499.38
$550.54
$604.74
$797.28
$619.72
$670.88
$725.08
$917.62
$740.06
$791.22
$845.42
$1037.96
$309.86
$335.44
$362.54
$458.81
$430.20
$455.78
$482.88
$579.15
$550.54
$576.12
$603.22
$699.49
$120.34

Plan: (HMO) Meritus Healthy Gold HMO Plus Abrazo 2000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-755-2700 - Provider Directory for This Plan: (Meritus)

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $4,500 : Family: $9,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$187.47
$212.77
$239.58
$334.81
$508.78
$374.94
$425.54
$479.16
$669.62
$1017.56
$493.98
$544.58
$598.20
$788.66
$613.02
$663.62
$717.24
$907.70
$732.06
$782.66
$836.28
$1026.74
$306.51
$331.81
$358.62
$453.85
$425.55
$450.85
$477.66
$572.89
$544.59
$569.89
$596.70
$691.93
$119.04

Plan: (HMO) Meritus Healthy Platinum Complete HMO Plus 500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-755-2700 - Provider Directory for This Plan: (Meritus)

Deductible: Individual: $500 : Family: $1,000
Out of Pocket Maximum per year: Individual: $2,000 : Family: $4,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Platinum 21
30
40
50
60
$249.95
$283.69
$319.43
$446.41
$678.36
$499.90
$567.38
$638.86
$892.82
$1356.72
$658.62
$726.10
$797.58
$1051.54
$817.34
$884.82
$956.30
$1210.26
$976.06
$1043.54
$1115.02
$1368.98
$408.67
$442.41
$478.15
$605.13
$567.39
$601.13
$636.87
$763.85
$726.11
$759.85
$795.59
$922.57
$158.72

Plan: (HMO) Meritus Healthy Platinum HMO Plus Banner 500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-755-2700 - Provider Directory for This Plan: (Meritus)

Deductible: Individual: $500 : Family: $1,000
Out of Pocket Maximum per year: Individual: $2,000 : Family: $4,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Platinum 21
30
40
50
60
$225.52
$255.96
$288.20
$402.76
$612.04
$451.04
$511.92
$576.40
$805.52
$1224.08
$594.24
$655.12
$719.60
$948.72
$737.44
$798.32
$862.80
$1091.92
$880.64
$941.52
$1006.00
$1235.12
$368.72
$399.16
$431.40
$545.96
$511.92
$542.36
$574.60
$689.16
$655.12
$685.56
$717.80
$832.36
$143.20

Plan: (HMO) Meritus Healthy Platinum HMO Plus Abrazo 500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-755-2700 - Provider Directory for This Plan: (Meritus)

Deductible: Individual: $500 : Family: $1,000
Out of Pocket Maximum per year: Individual: $2,000 : Family: $4,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Platinum 21
30
40
50
60
$223.07
$253.18
$285.07
$398.39
$605.39
$446.14
$506.36
$570.14
$796.78
$1210.78
$587.79
$648.01
$711.79
$938.43
$729.44
$789.66
$853.44
$1080.08
$871.09
$931.31
$995.09
$1221.73
$364.72
$394.83
$426.72
$540.04
$506.37
$536.48
$568.37
$681.69
$648.02
$678.13
$710.02
$823.34
$141.65

Phoenix Health Plans, Inc.

Local: 1-855-463-7275 | Toll Free: 1-855-463-7275

TTY: 1-855-463-7279

Plan: (HMO) Phoenix Choice

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-463-7275 - Provider Directory for This Plan: (Phoenix Health Plans, Inc.)

Deductible: Individual: $1,500 : Family: $3,000
Out of Pocket Maximum per year: Individual: $4,500 : Family: $9,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$240.79
$273.29
$307.73
$430.04
$653.49
$481.58
$546.58
$615.46
$860.08
$1306.98
$634.48
$699.48
$768.36
$1012.98
$787.38
$852.38
$921.26
$1165.88
$940.28
$1005.28
$1074.16
$1318.78
$393.69
$426.19
$460.63
$582.94
$546.59
$579.09
$613.53
$735.84
$699.49
$731.99
$766.43
$888.74
$152.90

Plan: (HMO) Phoenix Choice

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-463-7275 - Provider Directory for This Plan: (Phoenix Health Plans, Inc.)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$197.16
$223.77
$251.97
$352.12
$535.09
$394.32
$447.54
$503.94
$704.24
$1070.18
$519.52
$572.74
$629.14
$829.44
$644.72
$697.94
$754.34
$954.64
$769.92
$823.14
$879.54
$1079.84
$322.36
$348.97
$377.17
$477.32
$447.56
$474.17
$502.37
$602.52
$572.76
$599.37
$627.57
$727.72
$125.20

Plan: (HMO) Phoenix Choice

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-463-7275 - Provider Directory for This Plan: (Phoenix Health Plans, Inc.)

Deductible: Individual: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$169.46
$192.33
$216.56
$302.65
$459.90
$338.92
$384.66
$433.12
$605.30
$919.80
$446.52
$492.26
$540.72
$712.90
$554.12
$599.86
$648.32
$820.50
$661.72
$707.46
$755.92
$928.10
$277.06
$299.93
$324.16
$410.25
$384.66
$407.53
$431.76
$517.85
$492.26
$515.13
$539.36
$625.45
$107.60

Plan: (HMO) Phoenix Choice

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-463-7275 - Provider Directory for This Plan: (Phoenix Health Plans, Inc.)

Deductible: Individual: $6,600 : Family: $13,200
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Catastrophic 21
30
40
50
60
$99.02
$112.39
$126.54
$176.85
$268.73
$198.04
$224.78
$253.08
$353.70
$537.46
$260.92
$287.66
$315.96
$416.58
$323.80
$350.54
$378.84
$479.46
$386.68
$413.42
$441.72
$542.34
$161.90
$175.27
$189.42
$239.73
$224.78
$238.15
$252.30
$302.61
$287.66
$301.03
$315.18
$365.49
$62.88

Health Choice Insurance Co.

Local: 1-480-800-6700 | Toll Free: 1-855-452-4242

TTY: 1-800-367-8939

Plan: (HMO) Health Choice Essential Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-452-4242 - Provider Directory for This Plan: (Health Choice Insurance Co.)

Deductible: Individual: $1,600 : Family: $3,200
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$201.58
$228.78
$257.60
$360.00
$547.05
$403.16
$457.56
$515.20
$720.00
$1094.10
$531.16
$585.56
$643.20
$848.00
$659.16
$713.56
$771.20
$976.00
$787.16
$841.56
$899.20
$1104.00
$329.58
$356.78
$385.60
$488.00
$457.58
$484.78
$513.60
$616.00
$585.58
$612.78
$641.60
$744.00
$128.00

Plan: (HMO) Health Choice Essential Bronze

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-452-4242 - Provider Directory for This Plan: (Health Choice Insurance Co.)

Deductible: Individual: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$162.05
$183.91
$207.08
$289.40
$439.76
$324.10
$367.82
$414.16
$578.80
$879.52
$426.99
$470.71
$517.05
$681.69
$529.88
$573.60
$619.94
$784.58
$632.77
$676.49
$722.83
$887.47
$264.94
$286.80
$309.97
$392.29
$367.83
$389.69
$412.86
$495.18
$470.72
$492.58
$515.75
$598.07
$102.89

Plan: (HMO) Health Choice Essential Basic

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-452-4242 - Provider Directory for This Plan: (Health Choice Insurance Co.)

Deductible: Individual: $6,600 : Family: $13,200
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Catastrophic 21
30
40
50
60
$129.65
$147.14
$165.68
$231.54
$351.85
$259.30
$294.28
$331.36
$463.08
$703.70
$341.62
$376.60
$413.68
$545.40
$423.94
$458.92
$496.00
$627.72
$506.26
$541.24
$578.32
$710.04
$211.97
$229.46
$248.00
$313.86
$294.29
$311.78
$330.32
$396.18
$376.61
$394.10
$412.64
$478.50
$82.32

Plan: (HMO) Health Choice Value Gold

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-452-4242 - Provider Directory for This Plan: (Health Choice Insurance Co.)

Deductible: Individual: $1,000 : Family: $2,000
Out of Pocket Maximum per year: Individual: $3,800 : Family: $7,600

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$179.87
$204.14
$229.86
$321.22
$488.13
$359.74
$408.28
$459.72
$642.44
$976.26
$473.95
$522.49
$573.93
$756.65
$588.16
$636.70
$688.14
$870.86
$702.37
$750.91
$802.35
$985.07
$294.08
$318.35
$344.07
$435.43
$408.29
$432.56
$458.28
$549.64
$522.50
$546.77
$572.49
$663.85
$114.21

Plan: (HMO) Health Choice Value Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-452-4242 - Provider Directory for This Plan: (Health Choice Insurance Co.)

Deductible: Individual: $1,600 : Family: $3,200
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$152.50
$173.07
$194.88
$272.34
$413.85
$305.00
$346.14
$389.76
$544.68
$827.70
$401.83
$442.97
$486.59
$641.51
$498.66
$539.80
$583.42
$738.34
$595.49
$636.63
$680.25
$835.17
$249.33
$269.90
$291.71
$369.17
$346.16
$366.73
$388.54
$466.00
$442.99
$463.56
$485.37
$562.83
$96.83

Plan: (HMO) Health Choice Value Bronze

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-452-4242 - Provider Directory for This Plan: (Health Choice Insurance Co.)

Deductible: Individual: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$119.94
$136.12
$153.27
$214.20
$325.49
$239.88
$272.24
$306.54
$428.40
$650.98
$316.04
$348.40
$382.70
$504.56
$392.20
$424.56
$458.86
$580.72
$468.36
$500.72
$535.02
$656.88
$196.10
$212.28
$229.43
$290.36
$272.26
$288.44
$305.59
$366.52
$348.42
$364.60
$381.75
$442.68
$76.16

Plan: (HMO) Health Choice Value Basic

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-452-4242 - Provider Directory for This Plan: (Health Choice Insurance Co.)

Deductible: Individual: $6,600 : Family: $13,200
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Catastrophic 21
30
40
50
60
$95.43
$108.31
$121.95
$170.43
$258.98
$190.86
$216.62
$243.90
$340.86
$517.96
$251.45
$277.21
$304.49
$401.45
$312.04
$337.80
$365.08
$462.04
$372.63
$398.39
$425.67
$522.63
$156.02
$168.90
$182.54
$231.02
$216.61
$229.49
$243.13
$291.61
$277.20
$290.08
$303.72
$352.20
$60.59

Assurant Health

Local: 1-414-271-3011 | Toll Free: 1-800-800-1212

Plan: (PPO) Assurant Health Bronze Plan 001

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-800-1212 - Provider Directory for This Plan: (Assurant Health)

Deductible: Individual: $6,000 : Family: $12,000
Out of Pocket Maximum per year: Individual: $6,000 : Family: $12,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$206.45
$234.32
$263.84
$368.72
$560.31
$412.90
$468.64
$527.68
$737.44
$1120.62
$544.00
$599.74
$658.78
$868.54
$675.10
$730.84
$789.88
$999.64
$806.20
$861.94
$920.98
$1130.74
$337.55
$365.42
$394.94
$499.82
$468.65
$496.52
$526.04
$630.92
$599.75
$627.62
$657.14
$762.02
$131.10

Plan: (PPO) Assurant Health Silver Plan 001

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-800-1212 - Provider Directory for This Plan: (Assurant Health)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $3,500 : Family: $7,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$245.87
$279.06
$314.22
$439.12
$667.29
$491.74
$558.12
$628.44
$878.24
$1334.58
$647.87
$714.25
$784.57
$1034.37
$804.00
$870.38
$940.70
$1190.50
$960.13
$1026.51
$1096.83
$1346.63
$402.00
$435.19
$470.35
$595.25
$558.13
$591.32
$626.48
$751.38
$714.26
$747.45
$782.61
$907.51
$156.13

Plan: (PPO) Assurant Health Bronze Plan 002

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-800-1212 - Provider Directory for This Plan: (Assurant Health)

Deductible: Individual: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$213.60
$242.44
$272.98
$381.49
$579.71
$427.20
$484.88
$545.96
$762.98
$1159.42
$562.84
$620.52
$681.60
$898.62
$698.48
$756.16
$817.24
$1034.26
$834.12
$891.80
$952.88
$1169.90
$349.24
$378.08
$408.62
$517.13
$484.88
$513.72
$544.26
$652.77
$620.52
$649.36
$679.90
$788.41
$135.64

Plan: (PPO) Assurant Health Silver Plan 002

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-800-1212 - Provider Directory for This Plan: (Assurant Health)

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$250.55
$284.37
$320.20
$447.48
$679.99
$501.10
$568.74
$640.40
$894.96
$1359.98
$660.20
$727.84
$799.50
$1054.06
$819.30
$886.94
$958.60
$1213.16
$978.40
$1046.04
$1117.70
$1372.26
$409.65
$443.47
$479.30
$606.58
$568.75
$602.57
$638.40
$765.68
$727.85
$761.67
$797.50
$924.78
$159.10

Plan: (PPO) Assurant Health Gold Plan 002

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-800-1212 - Provider Directory for This Plan: (Assurant Health)

Deductible: Individual: $0 : Family: $0
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$301.55
$342.26
$385.38
$538.57
$818.41
$603.10
$684.52
$770.76
$1077.14
$1636.82
$794.58
$876.00
$962.24
$1268.62
$986.06
$1067.48
$1153.72
$1460.10
$1177.54
$1258.96
$1345.20
$1651.58
$493.03
$533.74
$576.86
$730.05
$684.51
$725.22
$768.34
$921.53
$875.99
$916.70
$959.82
$1113.01
$191.48

Plan: (PPO) Assurant Health Platinum Plan 002

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-800-1212 - Provider Directory for This Plan: (Assurant Health)

Deductible: Individual: $0 : Family: $0
Out of Pocket Maximum per year: Individual: $2,000 : Family: $4,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Platinum 21
30
40
50
60
$344.66
$391.19
$440.48
$615.56
$935.41
$689.32
$782.38
$880.96
$1231.12
$1870.82
$908.18
$1001.24
$1099.82
$1449.98
$1127.04
$1220.10
$1318.68
$1668.84
$1345.90
$1438.96
$1537.54
$1887.70
$563.52
$610.05
$659.34
$834.42
$782.38
$828.91
$878.20
$1053.28
$1001.24
$1047.77
$1097.06
$1272.14
$218.86

Aetna

Local: 1-855-586-6960 | Toll Free: 1-855-586-6960

TTY: 1-855-586-6960

Plan: (POS) Aetna Banner Health Network Bronze $20 Copay

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-586-6960 - Provider Directory for This Plan: (Aetna)

Deductible: Individual: $5,750 : Family: $11,500
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$165.12
$187.41
$211.02
$294.90
$448.13
$330.24
$374.82
$422.04
$589.80
$896.26
$435.09
$479.67
$526.89
$694.65
$539.94
$584.52
$631.74
$799.50
$644.79
$689.37
$736.59
$904.35
$269.97
$292.26
$315.87
$399.75
$374.82
$397.11
$420.72
$504.60
$479.67
$501.96
$525.57
$609.45
$104.85

Plan: (POS) Aetna Banner Health Network Bronze HSA Eligible

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-586-6960 - Provider Directory for This Plan: (Aetna)

Deductible: Individual: $6,300 : Family: $12,600
Out of Pocket Maximum per year: Individual: $6,300 : Family: $12,600

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$149.69
$169.90
$191.31
$267.35
$406.26
$299.38
$339.80
$382.62
$534.70
$812.52
$394.43
$434.85
$477.67
$629.75
$489.48
$529.90
$572.72
$724.80
$584.53
$624.95
$667.77
$819.85
$244.74
$264.95
$286.36
$362.40
$339.79
$360.00
$381.41
$457.45
$434.84
$455.05
$476.46
$552.50
$95.05

Plan: (POS) Aetna Banner Health Network Catastrophic 100%

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-586-6960 - Provider Directory for This Plan: (Aetna)

Deductible: Individual: $6,600 : Family: $13,200
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Catastrophic 21
30
40
50
60
$124.27
$141.04
$158.81
$221.94
$337.26
$248.54
$282.08
$317.62
$443.88
$674.52
$327.45
$360.99
$396.53
$522.79
$406.36
$439.90
$475.44
$601.70
$485.27
$518.81
$554.35
$680.61
$203.18
$219.95
$237.72
$300.85
$282.09
$298.86
$316.63
$379.76
$361.00
$377.77
$395.54
$458.67
$78.91

Plan: (POS) Aetna Banner Health Network Gold $5 Copay

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-586-6960 - Provider Directory for This Plan: (Aetna)

Deductible: Individual: $1,400 : Family: $2,800
Out of Pocket Maximum per year: Individual: $5,000 : Family: $10,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$243.68
$276.57
$311.42
$435.21
$661.34
$487.36
$553.14
$622.84
$870.42
$1322.68
$642.09
$707.87
$777.57
$1025.15
$796.82
$862.60
$932.30
$1179.88
$951.55
$1017.33
$1087.03
$1334.61
$398.41
$431.30
$466.15
$589.94
$553.14
$586.03
$620.88
$744.67
$707.87
$740.76
$775.61
$899.40
$154.73

Plan: (POS) Aetna Banner Health Network Silver $10 Copay

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-586-6960 - Provider Directory for This Plan: (Aetna)

Deductible: Individual: $3,750 : Family: $7,500
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$201.40
$228.59
$257.39
$359.70
$546.59
$402.80
$457.18
$514.78
$719.40
$1093.18
$530.69
$585.07
$642.67
$847.29
$658.58
$712.96
$770.56
$975.18
$786.47
$840.85
$898.45
$1103.07
$329.29
$356.48
$385.28
$487.59
$457.18
$484.37
$513.17
$615.48
$585.07
$612.26
$641.06
$743.37
$127.89

Plan: (POS) Aetna Banner Health Network Silver $5 Copay 2750

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-586-6960 - Provider Directory for This Plan: (Aetna)

Deductible: Individual: $2,750 : Family: $5,500
Out of Pocket Maximum per year: Individual: $6,000 : Family: $12,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$214.54
$243.50
$274.18
$383.17
$582.26
$429.08
$487.00
$548.36
$766.34
$1164.52
$565.31
$623.23
$684.59
$902.57
$701.54
$759.46
$820.82
$1038.80
$837.77
$895.69
$957.05
$1175.03
$350.77
$379.73
$410.41
$519.40
$487.00
$515.96
$546.64
$655.63
$623.23
$652.19
$682.87
$791.86
$136.23

Cigna Healthcare

Local: 1-877-900-1237 | Toll Free: 1-877-900-1237

Plan: (PPO) myCigna Health Savings 6100

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-900-1237 - Provider Directory for This Plan: (Cigna Healthcare)

Deductible: Individual: $6,100 : Family: $12,200
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$230.13
$261.20
$294.11
$411.01
$624.57
$460.26
$522.40
$588.22
$822.02
$1249.14
$606.39
$668.53
$734.35
$968.15
$752.52
$814.66
$880.48
$1114.28
$898.65
$960.79
$1026.61
$1260.41
$376.26
$407.33
$440.24
$557.14
$522.39
$553.46
$586.37
$703.27
$668.52
$699.59
$732.50
$849.40
$146.13

Plan: (PPO) myCigna Health Flex 5500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-900-1237 - Provider Directory for This Plan: (Cigna Healthcare)

Deductible: Individual: $5,500 : Family: $11,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$241.26
$273.83
$308.33
$430.89
$654.78
$482.52
$547.66
$616.66
$861.78
$1309.56
$635.72
$700.86
$769.86
$1014.98
$788.92
$854.06
$923.06
$1168.18
$942.12
$1007.26
$1076.26
$1321.38
$394.46
$427.03
$461.53
$584.09
$547.66
$580.23
$614.73
$737.29
$700.86
$733.43
$767.93
$890.49
$153.20

Plan: (PPO) myCigna Health Flex 5100

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-900-1237 - Provider Directory for This Plan: (Cigna Healthcare)

Deductible: Individual: $5,100 : Family: $10,200
Out of Pocket Maximum per year: Individual: $6,400 : Family: $12,800

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$247.85
$281.31
$316.75
$442.66
$672.66
$495.70
$562.62
$633.50
$885.32
$1345.32
$653.08
$720.00
$790.88
$1042.70
$810.46
$877.38
$948.26
$1200.08
$967.84
$1034.76
$1105.64
$1357.46
$405.23
$438.69
$474.13
$600.04
$562.61
$596.07
$631.51
$757.42
$719.99
$753.45
$788.89
$914.80
$157.38

Plan: (PPO) myCigna Health Savings 3400

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-900-1237 - Provider Directory for This Plan: (Cigna Healthcare)

Deductible: Individual: $3,400 : Family: $6,800
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$280.91
$318.83
$359.00
$501.71
$762.39
$561.82
$637.66
$718.00
$1003.42
$1524.78
$740.20
$816.04
$896.38
$1181.80
$918.58
$994.42
$1074.76
$1360.18
$1096.96
$1172.80
$1253.14
$1538.56
$459.29
$497.21
$537.38
$680.09
$637.67
$675.59
$715.76
$858.47
$816.05
$853.97
$894.14
$1036.85
$178.38

Plan: (PPO) myCigna Health Flex 1500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-900-1237 - Provider Directory for This Plan: (Cigna Healthcare)

Deductible: Individual: $1,500 : Family: $3,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$276.20
$313.49
$352.98
$493.29
$749.61
$552.40
$626.98
$705.96
$986.58
$1499.22
$727.79
$802.37
$881.35
$1161.97
$903.18
$977.76
$1056.74
$1337.36
$1078.57
$1153.15
$1232.13
$1512.75
$451.59
$488.88
$528.37
$668.68
$626.98
$664.27
$703.76
$844.07
$802.37
$839.66
$879.15
$1019.46
$175.39

Plan: (PPO) myCigna Health Flex 2750

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-900-1237 - Provider Directory for This Plan: (Cigna Healthcare)

Deductible: Individual: $2,750 : Family: $5,500
Out of Pocket Maximum per year: Individual: $6,300 : Family: $12,600

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$273.83
$310.80
$349.95
$489.06
$743.17
$547.66
$621.60
$699.90
$978.12
$1486.34
$721.54
$795.48
$873.78
$1152.00
$895.42
$969.36
$1047.66
$1325.88
$1069.30
$1143.24
$1221.54
$1499.76
$447.71
$484.68
$523.83
$662.94
$621.59
$658.56
$697.71
$836.82
$795.47
$832.44
$871.59
$1010.70
$173.88

Plan: (PPO) myCigna Health Flex 3500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-900-1237 - Provider Directory for This Plan: (Cigna Healthcare)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$283.60
$321.89
$362.44
$506.51
$769.69
$567.20
$643.78
$724.88
$1013.02
$1539.38
$747.29
$823.87
$904.97
$1193.11
$927.38
$1003.96
$1085.06
$1373.20
$1107.47
$1184.05
$1265.15
$1553.29
$463.69
$501.98
$542.53
$686.60
$643.78
$682.07
$722.62
$866.69
$823.87
$862.16
$902.71
$1046.78
$180.09

Plan: (PPO) myCigna Health Flex 1250

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-900-1237 - Provider Directory for This Plan: (Cigna Healthcare)

Deductible: Individual: $1,250 : Family: $2,500
Out of Pocket Maximum per year: Individual: $4,000 : Family: $8,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$321.73
$365.16
$411.17
$574.61
$873.18
$643.46
$730.32
$822.34
$1149.22
$1746.36
$847.76
$934.62
$1026.64
$1353.52
$1052.06
$1138.92
$1230.94
$1557.82
$1256.36
$1343.22
$1435.24
$1762.12
$526.03
$569.46
$615.47
$778.91
$730.33
$773.76
$819.77
$983.21
$934.63
$978.06
$1024.07
$1187.51
$204.30

University Healthcare Marketplace (UHM)

Local: 1-855-231-9236 | Toll Free: 1-855-231-9236

Plan: (HMO) Bronze Canyon

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-231-9236 - Provider Directory for This Plan: (University Healthcare Marketplace (UHM))

Deductible: Individual: $6,400 : Family: $12,800
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$127.26
$144.44
$162.64
$227.29
$345.38
$254.52
$288.88
$325.28
$454.58
$690.76
$335.33
$369.69
$406.09
$535.39
$416.14
$450.50
$486.90
$616.20
$496.95
$531.31
$567.71
$697.01
$208.07
$225.25
$243.45
$308.10
$288.88
$306.06
$324.26
$388.91
$369.69
$386.87
$405.07
$469.72
$80.81

Plan: (HMO) Silver Canyon

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-231-9236 - Provider Directory for This Plan: (University Healthcare Marketplace (UHM))

Deductible: Individual: $2,300 : Family: $4,600
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$158.30
$179.67
$202.31
$282.72
$429.63
$316.60
$359.34
$404.62
$565.44
$859.26
$417.12
$459.86
$505.14
$665.96
$517.64
$560.38
$605.66
$766.48
$618.16
$660.90
$706.18
$867.00
$258.82
$280.19
$302.83
$383.24
$359.34
$380.71
$403.35
$483.76
$459.86
$481.23
$503.87
$584.28
$100.52

Plan: (HMO) Gold Canyon

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-231-9236 - Provider Directory for This Plan: (University Healthcare Marketplace (UHM))

Deductible: Individual: $600 : Family: $1,200
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$197.55
$224.22
$252.47
$352.82
$536.15
$395.10
$448.44
$504.94
$705.64
$1072.30
$520.54
$573.88
$630.38
$831.08
$645.98
$699.32
$755.82
$956.52
$771.42
$824.76
$881.26
$1081.96
$322.99
$349.66
$377.91
$478.26
$448.43
$475.10
$503.35
$603.70
$573.87
$600.54
$628.79
$729.14
$125.44

Health Net

Local: 1-877-288-9085 | Toll Free: 1-877-288-9085

TTY: 1-888-926-5180

Plan: (HMO) CommunityCare HMO Bronze 40%/40%/$5000 With Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-288-9085 - Provider Directory for This Plan: (Health Net)

Deductible: Individual: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $6,000 : Family: $12,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$155.98
$177.03
$199.34
$278.57
$423.32
$311.96
$354.06
$398.68
$557.14
$846.64
$411.00
$453.10
$497.72
$656.18
$510.04
$552.14
$596.76
$755.22
$609.08
$651.18
$695.80
$854.26
$255.02
$276.07
$298.38
$377.61
$354.06
$375.11
$397.42
$476.65
$453.10
$474.15
$496.46
$575.69
$99.04

Plan: (HMO) CommunityCare HMO Basic 0%/0%/$6350 With Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-288-9085 - Provider Directory for This Plan: (Health Net)

Deductible: Individual: $6,350 : Family: $12,700
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Catastrophic 21
30
40
50
60
$117.95
$133.88
$150.75
$210.67
$320.13
$235.90
$267.76
$301.50
$421.34
$640.26
$310.80
$342.66
$376.40
$496.24
$385.70
$417.56
$451.30
$571.14
$460.60
$492.46
$526.20
$646.04
$192.85
$208.78
$225.65
$285.57
$267.75
$283.68
$300.55
$360.47
$342.65
$358.58
$375.45
$435.37
$74.90

Plan: (HMO) CommunityCare HMO Bronze 40%/40%/$5000 Without Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-288-9085 - Provider Directory for This Plan: (Health Net)

Deductible: Individual: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $6,000 : Family: $12,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$152.94
$173.59
$195.46
$273.15
$415.08
$305.88
$347.18
$390.92
$546.30
$830.16
$403.00
$444.30
$488.04
$643.42
$500.12
$541.42
$585.16
$740.54
$597.24
$638.54
$682.28
$837.66
$250.06
$270.71
$292.58
$370.27
$347.18
$367.83
$389.70
$467.39
$444.30
$464.95
$486.82
$564.51
$97.12

Plan: (HMO) CommunityCare HMO Basic 0%/0%/$6350 Without Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-288-9085 - Provider Directory for This Plan: (Health Net)

Deductible: Individual: $6,350 : Family: $12,700
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Catastrophic 21
30
40
50
60
$115.66
$131.27
$147.81
$206.57
$313.90
$231.32
$262.54
$295.62
$413.14
$627.80
$304.76
$335.98
$369.06
$486.58
$378.20
$409.42
$442.50
$560.02
$451.64
$482.86
$515.94
$633.46
$189.10
$204.71
$221.25
$280.01
$262.54
$278.15
$294.69
$353.45
$335.98
$351.59
$368.13
$426.89
$73.44

Plan: (HMO) CommunityCare HMO Platinum $15/$30/$3000 with Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-288-9085 - Provider Directory for This Plan: (Health Net)

Deductible: Individual: $200 : Family: $400
Out of Pocket Maximum per year: Individual: $3,000 : Family: $6,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Platinum 21
30
40
50
60
$228.38
$259.22
$291.87
$407.89
$619.83
$456.76
$518.44
$583.74
$815.78
$1239.66
$601.78
$663.46
$728.76
$960.80
$746.80
$808.48
$873.78
$1105.82
$891.82
$953.50
$1018.80
$1250.84
$373.40
$404.24
$436.89
$552.91
$518.42
$549.26
$581.91
$697.93
$663.44
$694.28
$726.93
$842.95
$145.02

Plan: (HMO) CommunityCare HMO Gold $30/$60/$6000/$375 with Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-288-9085 - Provider Directory for This Plan: (Health Net)

Deductible: Individual: $450 : Family: $900
Out of Pocket Maximum per year: Individual: $6,000 : Family: $12,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$202.69
$230.05
$259.04
$362.01
$550.10
$405.38
$460.10
$518.08
$724.02
$1100.20
$534.09
$588.81
$646.79
$852.73
$662.80
$717.52
$775.50
$981.44
$791.51
$846.23
$904.21
$1110.15
$331.40
$358.76
$387.75
$490.72
$460.11
$487.47
$516.46
$619.43
$588.82
$616.18
$645.17
$748.14
$128.71

Plan: (HMO) CommunityCare HMO Silver $30/$50/$4500 with Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-288-9085 - Provider Directory for This Plan: (Health Net)

Deductible: Individual: $4,500 : Family: $9,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$177.52
$201.48
$226.87
$317.04
$481.78
$355.04
$402.96
$453.74
$634.08
$963.56
$467.76
$515.68
$566.46
$746.80
$580.48
$628.40
$679.18
$859.52
$693.20
$741.12
$791.90
$972.24
$290.24
$314.20
$339.59
$429.76
$402.96
$426.92
$452.31
$542.48
$515.68
$539.64
$565.03
$655.20
$112.72

Plan: (HMO) CommunityCare HMO Platinum $15/$30/$3000 without Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-288-9085 - Provider Directory for This Plan: (Health Net)

Deductible: Individual: $200 : Family: $400
Out of Pocket Maximum per year: Individual: $3,000 : Family: $6,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Platinum 21
30
40
50
60
$223.94
$254.17
$286.20
$399.96
$607.78
$447.88
$508.34
$572.40
$799.92
$1215.56
$590.08
$650.54
$714.60
$942.12
$732.28
$792.74
$856.80
$1084.32
$874.48
$934.94
$999.00
$1226.52
$366.14
$396.37
$428.40
$542.16
$508.34
$538.57
$570.60
$684.36
$650.54
$680.77
$712.80
$826.56
$142.20

Plan: (HMO) CommunityCare HMO Gold $30/$60/$6000/$375 without Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-288-9085 - Provider Directory for This Plan: (Health Net)

Deductible: Individual: $450 : Family: $900
Out of Pocket Maximum per year: Individual: $6,000 : Family: $12,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$198.75
$225.58
$254.00
$354.96
$539.40
$397.50
$451.16
$508.00
$709.92
$1078.80
$523.70
$577.36
$634.20
$836.12
$649.90
$703.56
$760.40
$962.32
$776.10
$829.76
$886.60
$1088.52
$324.95
$351.78
$380.20
$481.16
$451.15
$477.98
$506.40
$607.36
$577.35
$604.18
$632.60
$733.56
$126.20

Plan: (HMO) CommunityCare HMO Silver $30/$50/$4500 without Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-288-9085 - Provider Directory for This Plan: (Health Net)

Deductible: Individual: $4,500 : Family: $9,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$174.06
$197.56
$222.45
$310.88
$472.41
$348.12
$395.12
$444.90
$621.76
$944.82
$458.65
$505.65
$555.43
$732.29
$569.18
$616.18
$665.96
$842.82
$679.71
$726.71
$776.49
$953.35
$284.59
$308.09
$332.98
$421.41
$395.12
$418.62
$443.51
$531.94
$505.65
$529.15
$554.04
$642.47
$110.53

Meritus

Local: 1-602-957-2113 | Toll Free: 1-855-755-2700

TTY: 1-855-568-2800

Plan: (PPO) Meritus Choice Bronze PPO Plus 6000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-755-2700 - Provider Directory for This Plan: (Meritus)

Deductible: Individual: $6,000 : Family: $12,000
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$187.82
$213.17
$240.03
$335.45
$509.74
$375.64
$426.34
$480.06
$670.90
$1019.48
$494.91
$545.61
$599.33
$790.17
$614.18
$664.88
$718.60
$909.44
$733.45
$784.15
$837.87
$1028.71
$307.09
$332.44
$359.30
$454.72
$426.36
$451.71
$478.57
$573.99
$545.63
$570.98
$597.84
$693.26
$119.27

Plan: (PPO) Meritus Choice Silver PPO Plus 4000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-755-2700 - Provider Directory for This Plan: (Meritus)

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$203.77
$231.27
$260.41
$363.92
$553.02
$407.54
$462.54
$520.82
$727.84
$1106.04
$536.93
$591.93
$650.21
$857.23
$666.32
$721.32
$779.60
$986.62
$795.71
$850.71
$908.99
$1116.01
$333.16
$360.66
$389.80
$493.31
$462.55
$490.05
$519.19
$622.70
$591.94
$619.44
$648.58
$752.09
$129.39

Plan: (PPO) Meritus Choice Gold PPO Plus 2000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-755-2700 - Provider Directory for This Plan: (Meritus)

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $4,500 : Family: $9,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$239.50
$271.83
$306.08
$427.74
$650.00
$479.00
$543.66
$612.16
$855.48
$1300.00
$631.08
$695.74
$764.24
$1007.56
$783.16
$847.82
$916.32
$1159.64
$935.24
$999.90
$1068.40
$1311.72
$391.58
$423.91
$458.16
$579.82
$543.66
$575.99
$610.24
$731.90
$695.74
$728.07
$762.32
$883.98
$152.08

Plan: (PPO) Meritus Saver Bronze PPO HSA Plus 6300

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-755-2700 - Provider Directory for This Plan: (Meritus)

Deductible: Individual: $6,300 : Family: $12,600
Out of Pocket Maximum per year: Individual: $6,300 : Family: $12,600

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$166.45
$188.91
$212.71
$297.26
$451.72
$332.90
$377.82
$425.42
$594.52
$903.44
$438.59
$483.51
$531.11
$700.21
$544.28
$589.20
$636.80
$805.90
$649.97
$694.89
$742.49
$911.59
$272.14
$294.60
$318.40
$402.95
$377.83
$400.29
$424.09
$508.64
$483.52
$505.98
$529.78
$614.33
$105.69

Plan: (PPO) Meritus Saver Silver PPO HSA Plus 2000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-755-2700 - Provider Directory for This Plan: (Meritus)

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $4,500 : Family: $9,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$201.06
$228.20
$256.95
$359.09
$545.67
$402.12
$456.40
$513.90
$718.18
$1091.34
$529.79
$584.07
$641.57
$845.85
$657.46
$711.74
$769.24
$973.52
$785.13
$839.41
$896.91
$1101.19
$328.73
$355.87
$384.62
$486.76
$456.40
$483.54
$512.29
$614.43
$584.07
$611.21
$639.96
$742.10
$127.67

Plan: (PPO) Meritus Saver Gold PPO HSA Plus 1500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-755-2700 - Provider Directory for This Plan: (Meritus)

Deductible: Individual: $1,500 : Family: $3,000
Out of Pocket Maximum per year: Individual: $3,000 : Family: $6,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$236.99
$268.98
$302.87
$423.26
$643.18
$473.98
$537.96
$605.74
$846.52
$1286.36
$624.47
$688.45
$756.23
$997.01
$774.96
$838.94
$906.72
$1147.50
$925.45
$989.43
$1057.21
$1297.99
$387.48
$419.47
$453.36
$573.75
$537.97
$569.96
$603.85
$724.24
$688.46
$720.45
$754.34
$874.73
$150.49

UnitedHealthcare

Local: 1-920-661-1111 | Toll Free: 1-877-855-6538

Plan: (PPO) UnitedHealthcare Bronze Compass Plus 5500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-855-6538 - Provider Directory for This Plan: (UnitedHealthcare)

Deductible: Individual: $5,500 : Family: $11,000
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$192.29
$218.25
$245.75
$343.43
$521.88
$384.58
$436.50
$491.50
$686.86
$1043.76
$506.68
$558.60
$613.60
$808.96
$628.78
$680.70
$735.70
$931.06
$750.88
$802.80
$857.80
$1053.16
$314.39
$340.35
$367.85
$465.53
$436.49
$462.45
$489.95
$587.63
$558.59
$584.55
$612.05
$709.73
$122.10

Plan: (PPO) UnitedHealthcare Bronze Compass Plus HSA 4900

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-855-6538 - Provider Directory for This Plan: (UnitedHealthcare)

Deductible: Individual: $4,900 : Family: $9,800
Out of Pocket Maximum per year: Individual: $6,450 : Family: $12,900

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$174.06
$197.56
$222.45
$310.88
$472.41
$348.12
$395.12
$444.90
$621.76
$944.82
$458.65
$505.65
$555.43
$732.29
$569.18
$616.18
$665.96
$842.82
$679.71
$726.71
$776.49
$953.35
$284.59
$308.09
$332.98
$421.41
$395.12
$418.62
$443.51
$531.94
$505.65
$529.15
$554.04
$642.47
$110.53

Plan: (PPO) UnitedHealthcare Catastrophic Compass Plus 6600

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-855-6538 - Provider Directory for This Plan: (UnitedHealthcare)

Deductible: Individual: $6,600 : Family: $13,200
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Catastrophic 21
30
40
50
60
$159.73
$181.29
$204.13
$285.28
$433.51
$319.46
$362.58
$408.26
$570.56
$867.02
$420.89
$464.01
$509.69
$671.99
$522.32
$565.44
$611.12
$773.42
$623.75
$666.87
$712.55
$874.85
$261.16
$282.72
$305.56
$386.71
$362.59
$384.15
$406.99
$488.14
$464.02
$485.58
$508.42
$589.57
$101.43

Plan: (PPO) UnitedHealthcare Gold Compass Plus 1250

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-855-6538 - Provider Directory for This Plan: (UnitedHealthcare)

Deductible: Individual: $1,250 : Family: $2,500
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$233.45
$264.97
$298.35
$416.94
$633.59
$466.90
$529.94
$596.70
$833.88
$1267.18
$615.14
$678.18
$744.94
$982.12
$763.38
$826.42
$893.18
$1130.36
$911.62
$974.66
$1041.42
$1278.60
$381.69
$413.21
$446.59
$565.18
$529.93
$561.45
$594.83
$713.42
$678.17
$709.69
$743.07
$861.66
$148.24

Plan: (PPO) UnitedHealthcare Gold Compass Plus 500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-855-6538 - Provider Directory for This Plan: (UnitedHealthcare)

Deductible: Individual: $500 : Family: $1,000
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$230.17
$261.25
$294.16
$411.09
$624.69
$460.34
$522.50
$588.32
$822.18
$1249.38
$606.50
$668.66
$734.48
$968.34
$752.66
$814.82
$880.64
$1114.50
$898.82
$960.98
$1026.80
$1260.66
$376.33
$407.41
$440.32
$557.25
$522.49
$553.57
$586.48
$703.41
$668.65
$699.73
$732.64
$849.57
$146.16

Plan: (PPO) UnitedHealthcare Platinum Compass Plus 250

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-855-6538 - Provider Directory for This Plan: (UnitedHealthcare)

Deductible: Individual: $250 : Family: $500
Out of Pocket Maximum per year: Individual: $1,500 : Family: $3,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Platinum 21
30
40
50
60
$257.21
$291.93
$328.71
$459.37
$698.06
$514.42
$583.86
$657.42
$918.74
$1396.12
$677.75
$747.19
$820.75
$1082.07
$841.08
$910.52
$984.08
$1245.40
$1004.41
$1073.85
$1147.41
$1408.73
$420.54
$455.26
$492.04
$622.70
$583.87
$618.59
$655.37
$786.03
$747.20
$781.92
$818.70
$949.36
$163.33

Plan: (PPO) UnitedHealthcare Silver Compass Plus 2000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-855-6538 - Provider Directory for This Plan: (UnitedHealthcare)

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$210.72
$239.17
$269.30
$376.35
$571.90
$421.44
$478.34
$538.60
$752.70
$1143.80
$555.25
$612.15
$672.41
$886.51
$689.06
$745.96
$806.22
$1020.32
$822.87
$879.77
$940.03
$1154.13
$344.53
$372.98
$403.11
$510.16
$478.34
$506.79
$536.92
$643.97
$612.15
$640.60
$670.73
$777.78
$133.81

Plan: (PPO) UnitedHealthcare Silver Compass Plus HSA 2600

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-855-6538 - Provider Directory for This Plan: (UnitedHealthcare)

Deductible: Individual: $2,600 : Family: $5,200
Out of Pocket Maximum per year: Individual: $6,450 : Family: $12,900

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$204.78
$232.43
$261.71
$365.74
$555.78
$409.56
$464.86
$523.42
$731.48
$1111.56
$539.60
$594.90
$653.46
$861.52
$669.64
$724.94
$783.50
$991.56
$799.68
$854.98
$913.54
$1121.60
$334.82
$362.47
$391.75
$495.78
$464.86
$492.51
$521.79
$625.82
$594.90
$622.55
$651.83
$755.86
$130.04

Plan: (PPO) UnitedHealthcare Silver Compass Plus 3500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-855-6538 - Provider Directory for This Plan: (UnitedHealthcare)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$212.36
$241.03
$271.39
$379.27
$576.34
$424.72
$482.06
$542.78
$758.54
$1152.68
$559.57
$616.91
$677.63
$893.39
$694.42
$751.76
$812.48
$1028.24
$829.27
$886.61
$947.33
$1163.09
$347.21
$375.88
$406.24
$514.12
$482.06
$510.73
$541.09
$648.97
$616.91
$645.58
$675.94
$783.82
$134.85

Plan: (PPO) UnitedHealthcare Silver Compass Plus HSA 1600

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-855-6538 - Provider Directory for This Plan: (UnitedHealthcare)

Deductible: Individual: $1,600 : Family: $3,200
Out of Pocket Maximum per year: Individual: $6,450 : Family: $12,900

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$213.79
$242.65
$273.23
$381.83
$580.23
$427.58
$485.30
$546.46
$763.66
$1160.46
$563.34
$621.06
$682.22
$899.42
$699.10
$756.82
$817.98
$1035.18
$834.86
$892.58
$953.74
$1170.94
$349.55
$378.41
$408.99
$517.59
$485.31
$514.17
$544.75
$653.35
$621.07
$649.93
$680.51
$789.11
$135.76

†Source: Our summary of lowest costs and numbers of providers is based on a government report released September 25, 2013. For more detailed information about specific plans and providers, see HealthCare.gov.

‡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 Maricopa County here.

 

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