De Soto County, Florida Obamacare 2024 Rates

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

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

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

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

Obamacare Providers, 77 Plans and 2024 Rates for De Soto County, Florida

Below, you’ll find a summary of the 77 plans for De Soto County, Florida and rates for each of these providers. This chart is designed to give you a preview of your health insurance options.


Obamacare Rates and Providers for Other Years

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Florida Blue (BlueCross BlueShield FL)

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

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

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

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

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$842.72
$956.49
$1,077.00
$1,505.10
$2,287.14
$1,487.40
$1,601.17
$1,721.68
$2,149.78
$2,132.08
$2,245.85
$2,366.36
$2,794.46
$2,776.76
$2,890.53
$3,011.04
$3,439.14
$644.68
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,685.44
$1,912.98
$2,154.00
$3,010.20
$4,574.28
$2,330.12
$2,557.66
$2,798.68
$3,654.88
$2,974.80
$3,202.34
$3,443.36
$4,299.56
$3,619.48
$3,847.02
$4,088.04
$4,944.24
$644.68
Toc - Plan #2 Florida Blue (BlueCross BlueShield FL)
Expanded Bronze

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

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

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$602.33
$683.64
$769.78
$1,075.76
$1,634.72
$1,063.11
$1,144.42
$1,230.56
$1,536.54
$1,523.89
$1,605.20
$1,691.34
$1,997.32
$1,984.67
$2,065.98
$2,152.12
$2,458.10
$460.78
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,204.66
$1,367.28
$1,539.56
$2,151.52
$3,269.44
$1,665.44
$1,828.06
$2,000.34
$2,612.30
$2,126.22
$2,288.84
$2,461.12
$3,073.08
$2,587.00
$2,749.62
$2,921.90
$3,533.86
$460.78
Toc - Plan #3 Florida Blue (BlueCross BlueShield FL)
Platinum

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

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

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$1,137.11
$1,290.62
$1,453.23
$2,030.88
$3,086.12
$2,007.00
$2,160.51
$2,323.12
$2,900.77
$2,876.89
$3,030.40
$3,193.01
$3,770.66
$3,746.78
$3,900.29
$4,062.90
$4,640.55
$869.89
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$2,274.22
$2,581.24
$2,906.46
$4,061.76
$6,172.24
$3,144.11
$3,451.13
$3,776.35
$4,931.65
$4,014.00
$4,321.02
$4,646.24
$5,801.54
$4,883.89
$5,190.91
$5,516.13
$6,671.43
$869.89
Toc - Plan #4 Florida Blue (BlueCross BlueShield FL)
Bronze

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

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

Annual Out of Pocket Expenses:

Individual Family
$6,150 $12,300 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$563.54
$639.62
$720.20
$1,006.48
$1,529.45
$994.65
$1,070.73
$1,151.31
$1,437.59
$1,425.76
$1,501.84
$1,582.42
$1,868.70
$1,856.87
$1,932.95
$2,013.53
$2,299.81
$431.11
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,127.08
$1,279.24
$1,440.40
$2,012.96
$3,058.90
$1,558.19
$1,710.35
$1,871.51
$2,444.07
$1,989.30
$2,141.46
$2,302.62
$2,875.18
$2,420.41
$2,572.57
$2,733.73
$3,306.29
$431.11
Toc - Plan #5 Florida Blue (BlueCross BlueShield FL)
Silver

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

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

Annual Out of Pocket Expenses:

Individual Family
$2,800 $5,600 Annual Deductible
$7,150 $14,300 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$901.48
$1,023.18
$1,152.09
$1,610.04
$2,446.62
$1,591.11
$1,712.81
$1,841.72
$2,299.67
$2,280.74
$2,402.44
$2,531.35
$2,989.30
$2,970.37
$3,092.07
$3,220.98
$3,678.93
$689.63
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,802.96
$2,046.36
$2,304.18
$3,220.08
$4,893.24
$2,492.59
$2,735.99
$2,993.81
$3,909.71
$3,182.22
$3,425.62
$3,683.44
$4,599.34
$3,871.85
$4,115.25
$4,373.07
$5,288.97
$689.63
Toc - Plan #6 Florida Blue (BlueCross BlueShield FL)
Platinum

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

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

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$2,000 $4,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$1,182.72
$1,342.39
$1,511.52
$2,112.34
$3,209.90
$2,087.50
$2,247.17
$2,416.30
$3,017.12
$2,992.28
$3,151.95
$3,321.08
$3,921.90
$3,897.06
$4,056.73
$4,225.86
$4,826.68
$904.78
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$2,365.44
$2,684.78
$3,023.04
$4,224.68
$6,419.80
$3,270.22
$3,589.56
$3,927.82
$5,129.46
$4,175.00
$4,494.34
$4,832.60
$6,034.24
$5,079.78
$5,399.12
$5,737.38
$6,939.02
$904.78
Toc - Plan #7 Florida Blue (BlueCross BlueShield FL)
Gold

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

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

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$6,250 $12,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$970.43
$1,101.44
$1,240.21
$1,733.19
$2,633.75
$1,712.81
$1,843.82
$1,982.59
$2,475.57
$2,455.19
$2,586.20
$2,724.97
$3,217.95
$3,197.57
$3,328.58
$3,467.35
$3,960.33
$742.38
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,940.86
$2,202.88
$2,480.42
$3,466.38
$5,267.50
$2,683.24
$2,945.26
$3,222.80
$4,208.76
$3,425.62
$3,687.64
$3,965.18
$4,951.14
$4,168.00
$4,430.02
$4,707.56
$5,693.52
$742.38
Toc - Plan #8 Florida Blue (BlueCross BlueShield FL)
Expanded Bronze

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

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

Annual Out of Pocket Expenses:

Individual Family
$7,050 $14,100 Annual Deductible
$7,050 $14,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$585.89
$664.99
$748.77
$1,046.40
$1,590.11
$1,034.10
$1,113.20
$1,196.98
$1,494.61
$1,482.31
$1,561.41
$1,645.19
$1,942.82
$1,930.52
$2,009.62
$2,093.40
$2,391.03
$448.21
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,171.78
$1,329.98
$1,497.54
$2,092.80
$3,180.22
$1,619.99
$1,778.19
$1,945.75
$2,541.01
$2,068.20
$2,226.40
$2,393.96
$2,989.22
$2,516.41
$2,674.61
$2,842.17
$3,437.43
$448.21
Toc - Plan #9 Florida Blue (BlueCross BlueShield FL)
Gold

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

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

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$5,900 $11,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$941.75
$1,068.89
$1,203.56
$1,681.97
$2,555.91
$1,662.19
$1,789.33
$1,924.00
$2,402.41
$2,382.63
$2,509.77
$2,644.44
$3,122.85
$3,103.07
$3,230.21
$3,364.88
$3,843.29
$720.44
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,883.50
$2,137.78
$2,407.12
$3,363.94
$5,111.82
$2,603.94
$2,858.22
$3,127.56
$4,084.38
$3,324.38
$3,578.66
$3,848.00
$4,804.82
$4,044.82
$4,299.10
$4,568.44
$5,525.26
$720.44
Toc - Plan #10 Florida Blue (BlueCross BlueShield FL)
Expanded Bronze

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

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

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$630.68
$715.82
$806.01
$1,126.39
$1,711.67
$1,113.15
$1,198.29
$1,288.48
$1,608.86
$1,595.62
$1,680.76
$1,770.95
$2,091.33
$2,078.09
$2,163.23
$2,253.42
$2,573.80
$482.47
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,261.36
$1,431.64
$1,612.02
$2,252.78
$3,423.34
$1,743.83
$1,914.11
$2,094.49
$2,735.25
$2,226.30
$2,396.58
$2,576.96
$3,217.72
$2,708.77
$2,879.05
$3,059.43
$3,700.19
$482.47
Toc - Plan #11 Florida Blue (BlueCross BlueShield FL)
Expanded Bronze

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

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

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$590.41
$670.12
$754.54
$1,054.47
$1,602.37
$1,042.07
$1,121.78
$1,206.20
$1,506.13
$1,493.73
$1,573.44
$1,657.86
$1,957.79
$1,945.39
$2,025.10
$2,109.52
$2,409.45
$451.66
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,180.82
$1,340.24
$1,509.08
$2,108.94
$3,204.74
$1,632.48
$1,791.90
$1,960.74
$2,560.60
$2,084.14
$2,243.56
$2,412.40
$3,012.26
$2,535.80
$2,695.22
$2,864.06
$3,463.92
$451.66
Toc - Plan #12 Florida Blue (BlueCross BlueShield FL)
Silver

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

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

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$875.83
$994.07
$1,119.31
$1,564.23
$2,377.00
$1,545.84
$1,664.08
$1,789.32
$2,234.24
$2,215.85
$2,334.09
$2,459.33
$2,904.25
$2,885.86
$3,004.10
$3,129.34
$3,574.26
$670.01
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,751.66
$1,988.14
$2,238.62
$3,128.46
$4,754.00
$2,421.67
$2,658.15
$2,908.63
$3,798.47
$3,091.68
$3,328.16
$3,578.64
$4,468.48
$3,761.69
$3,998.17
$4,248.65
$5,138.49
$670.01
Toc - Plan #13 Florida Blue (BlueCross BlueShield FL)
Gold

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

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

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$918.49
$1,042.49
$1,173.83
$1,640.42
$2,492.78
$1,621.13
$1,745.13
$1,876.47
$2,343.06
$2,323.77
$2,447.77
$2,579.11
$3,045.70
$3,026.41
$3,150.41
$3,281.75
$3,748.34
$702.64
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,836.98
$2,084.98
$2,347.66
$3,280.84
$4,985.56
$2,539.62
$2,787.62
$3,050.30
$3,983.48
$3,242.26
$3,490.26
$3,752.94
$4,686.12
$3,944.90
$4,192.90
$4,455.58
$5,388.76
$702.64
Toc - Plan #14 Florida Blue (BlueCross BlueShield FL)
Platinum

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

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

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$3,200 $6,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$1,175.32
$1,333.99
$1,502.06
$2,099.12
$3,189.82
$2,074.44
$2,233.11
$2,401.18
$2,998.24
$2,973.56
$3,132.23
$3,300.30
$3,897.36
$3,872.68
$4,031.35
$4,199.42
$4,796.48
$899.12
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$2,350.64
$2,667.98
$3,004.12
$4,198.24
$6,379.64
$3,249.76
$3,567.10
$3,903.24
$5,097.36
$4,148.88
$4,466.22
$4,802.36
$5,996.48
$5,048.00
$5,365.34
$5,701.48
$6,895.60
$899.12

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Aetna CVS Health

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

Toc - Plan #15 Aetna CVS Health
Silver

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$387.25
$439.53
$494.91
$691.63
$1,051.00
$683.50
$735.78
$791.16
$987.88
$979.75
$1,032.03
$1,087.41
$1,284.13
$1,276.00
$1,328.28
$1,383.66
$1,580.38
$296.25
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$774.50
$879.06
$989.82
$1,383.26
$2,102.00
$1,070.75
$1,175.31
$1,286.07
$1,679.51
$1,367.00
$1,471.56
$1,582.32
$1,975.76
$1,663.25
$1,767.81
$1,878.57
$2,272.01
$296.25
Toc - Plan #16 Aetna CVS Health
Expanded Bronze

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$309.24
$350.99
$395.21
$552.30
$839.27
$545.81
$587.56
$631.78
$788.87
$782.38
$824.13
$868.35
$1,025.44
$1,018.95
$1,060.70
$1,104.92
$1,262.01
$236.57
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$618.48
$701.98
$790.42
$1,104.60
$1,678.54
$855.05
$938.55
$1,026.99
$1,341.17
$1,091.62
$1,175.12
$1,263.56
$1,577.74
$1,328.19
$1,411.69
$1,500.13
$1,814.31
$236.57
Toc - Plan #17 Aetna CVS Health
Silver

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$8,395 $16,790 Annual Deductible
$8,885 $17,770 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$387.00
$439.25
$494.59
$691.18
$1,050.31
$683.06
$735.31
$790.65
$987.24
$979.12
$1,031.37
$1,086.71
$1,283.30
$1,275.18
$1,327.43
$1,382.77
$1,579.36
$296.06
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$774.00
$878.50
$989.18
$1,382.36
$2,100.62
$1,070.06
$1,174.56
$1,285.24
$1,678.42
$1,366.12
$1,470.62
$1,581.30
$1,974.48
$1,662.18
$1,766.68
$1,877.36
$2,270.54
$296.06
Toc - Plan #18 Aetna CVS Health
Gold

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$413.90
$469.77
$528.96
$739.22
$1,123.31
$730.53
$786.40
$845.59
$1,055.85
$1,047.16
$1,103.03
$1,162.22
$1,372.48
$1,363.79
$1,419.66
$1,478.85
$1,689.11
$316.63
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$827.80
$939.54
$1,057.92
$1,478.44
$2,246.62
$1,144.43
$1,256.17
$1,374.55
$1,795.07
$1,461.06
$1,572.80
$1,691.18
$2,111.70
$1,777.69
$1,889.43
$2,007.81
$2,428.33
$316.63
Toc - Plan #19 Aetna CVS Health
Silver

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$7,795 $15,590 Annual Deductible
$8,445 $16,890 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$395.16
$448.51
$505.01
$705.75
$1,072.46
$697.46
$750.81
$807.31
$1,008.05
$999.76
$1,053.11
$1,109.61
$1,310.35
$1,302.06
$1,355.41
$1,411.91
$1,612.65
$302.30
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$790.32
$897.02
$1,010.02
$1,411.50
$2,144.92
$1,092.62
$1,199.32
$1,312.32
$1,713.80
$1,394.92
$1,501.62
$1,614.62
$2,016.10
$1,697.22
$1,803.92
$1,916.92
$2,318.40
$302.30
Toc - Plan #20 Aetna CVS Health
Expanded Bronze

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$340.55
$386.53
$435.23
$608.23
$924.26
$601.08
$647.06
$695.76
$868.76
$861.61
$907.59
$956.29
$1,129.29
$1,122.14
$1,168.12
$1,216.82
$1,389.82
$260.53
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$681.10
$773.06
$870.46
$1,216.46
$1,848.52
$941.63
$1,033.59
$1,130.99
$1,476.99
$1,202.16
$1,294.12
$1,391.52
$1,737.52
$1,462.69
$1,554.65
$1,652.05
$1,998.05
$260.53
Toc - Plan #21 Aetna CVS Health
Gold

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$795 $1,590 Annual Deductible
$9,195 $18,390 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$412.24
$467.89
$526.84
$736.25
$1,118.80
$727.60
$783.25
$842.20
$1,051.61
$1,042.96
$1,098.61
$1,157.56
$1,366.97
$1,358.32
$1,413.97
$1,472.92
$1,682.33
$315.36
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$824.48
$935.78
$1,053.68
$1,472.50
$2,237.60
$1,139.84
$1,251.14
$1,369.04
$1,787.86
$1,455.20
$1,566.50
$1,684.40
$2,103.22
$1,770.56
$1,881.86
$1,999.76
$2,418.58
$315.36
Toc - Plan #22 Aetna CVS Health
Gold

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 Annual Deductible
$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$417.73
$474.12
$533.86
$746.06
$1,133.71
$737.29
$793.68
$853.42
$1,065.62
$1,056.85
$1,113.24
$1,172.98
$1,385.18
$1,376.41
$1,432.80
$1,492.54
$1,704.74
$319.56
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$835.46
$948.24
$1,067.72
$1,492.12
$2,267.42
$1,155.02
$1,267.80
$1,387.28
$1,811.68
$1,474.58
$1,587.36
$1,706.84
$2,131.24
$1,794.14
$1,906.92
$2,026.40
$2,450.80
$319.56
Toc - Plan #23 Aetna CVS Health
Silver

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

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$7,795 $15,590 Annual Deductible
$8,845 $17,690 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$395.34
$448.71
$505.25
$706.08
$1,072.95
$697.78
$751.15
$807.69
$1,008.52
$1,000.22
$1,053.59
$1,110.13
$1,310.96
$1,302.66
$1,356.03
$1,412.57
$1,613.40
$302.44
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$790.68
$897.42
$1,010.50
$1,412.16
$2,145.90
$1,093.12
$1,199.86
$1,312.94
$1,714.60
$1,395.56
$1,502.30
$1,615.38
$2,017.04
$1,698.00
$1,804.74
$1,917.82
$2,319.48
$302.44

ADVERTISEMENT

Ambetter from Sunshine Health

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

Toc - Plan #24 Ambetter from Sunshine Health
Gold

(EPO) Complete Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$1,450 $2,900 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$440.69
$500.17
$563.19
$787.05
$1,196.00
$777.81
$837.29
$900.31
$1,124.17
$1,114.93
$1,174.41
$1,237.43
$1,461.29
$1,452.05
$1,511.53
$1,574.55
$1,798.41
$337.12
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$881.38
$1,000.34
$1,126.38
$1,574.10
$2,392.00
$1,218.50
$1,337.46
$1,463.50
$1,911.22
$1,555.62
$1,674.58
$1,800.62
$2,248.34
$1,892.74
$2,011.70
$2,137.74
$2,585.46
$337.12
Toc - Plan #25 Ambetter from Sunshine Health
Expanded Bronze

(EPO) Choice Bronze HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$364.03
$413.17
$465.22
$650.14
$987.96
$642.51
$691.65
$743.70
$928.62
$920.99
$970.13
$1,022.18
$1,207.10
$1,199.47
$1,248.61
$1,300.66
$1,485.58
$278.48
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$728.06
$826.34
$930.44
$1,300.28
$1,975.92
$1,006.54
$1,104.82
$1,208.92
$1,578.76
$1,285.02
$1,383.30
$1,487.40
$1,857.24
$1,563.50
$1,661.78
$1,765.88
$2,135.72
$278.48
Toc - Plan #26 Ambetter from Sunshine Health
Silver

(EPO) Everyday Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 Annual Deductible
$8,400 $16,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$459.46
$521.48
$587.18
$820.58
$1,246.96
$810.94
$872.96
$938.66
$1,172.06
$1,162.42
$1,224.44
$1,290.14
$1,523.54
$1,513.90
$1,575.92
$1,641.62
$1,875.02
$351.48
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$918.92
$1,042.96
$1,174.36
$1,641.16
$2,493.92
$1,270.40
$1,394.44
$1,525.84
$1,992.64
$1,621.88
$1,745.92
$1,877.32
$2,344.12
$1,973.36
$2,097.40
$2,228.80
$2,695.60
$351.48
Toc - Plan #27 Ambetter from Sunshine Health
Expanded Bronze

(EPO) Everyday Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$8,450 $16,900 Annual Deductible
$9,250 $18,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$359.08
$407.55
$458.89
$641.30
$974.52
$633.77
$682.24
$733.58
$915.99
$908.46
$956.93
$1,008.27
$1,190.68
$1,183.15
$1,231.62
$1,282.96
$1,465.37
$274.69
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$718.16
$815.10
$917.78
$1,282.60
$1,949.04
$992.85
$1,089.79
$1,192.47
$1,557.29
$1,267.54
$1,364.48
$1,467.16
$1,831.98
$1,542.23
$1,639.17
$1,741.85
$2,106.67
$274.69
Toc - Plan #28 Ambetter from Sunshine Health
Expanded Bronze

(EPO) Elite Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,250 $18,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$412.28
$467.93
$526.89
$736.32
$1,118.91
$727.67
$783.32
$842.28
$1,051.71
$1,043.06
$1,098.71
$1,157.67
$1,367.10
$1,358.45
$1,414.10
$1,473.06
$1,682.49
$315.39
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$824.56
$935.86
$1,053.78
$1,472.64
$2,237.82
$1,139.95
$1,251.25
$1,369.17
$1,788.03
$1,455.34
$1,566.64
$1,684.56
$2,103.42
$1,770.73
$1,882.03
$1,999.95
$2,418.81
$315.39
Toc - Plan #29 Ambetter from Sunshine Health
Silver

(EPO) Clear Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$447.47
$507.86
$571.85
$799.16
$1,214.40
$789.78
$850.17
$914.16
$1,141.47
$1,132.09
$1,192.48
$1,256.47
$1,483.78
$1,474.40
$1,534.79
$1,598.78
$1,826.09
$342.31
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$894.94
$1,015.72
$1,143.70
$1,598.32
$2,428.80
$1,237.25
$1,358.03
$1,486.01
$1,940.63
$1,579.56
$1,700.34
$1,828.32
$2,282.94
$1,921.87
$2,042.65
$2,170.63
$2,625.25
$342.31
Toc - Plan #30 Ambetter from Sunshine Health
Silver

(EPO) Focused Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$6,300 $12,600 Annual Deductible
$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$455.45
$516.92
$582.05
$813.42
$1,236.07
$803.86
$865.33
$930.46
$1,161.83
$1,152.27
$1,213.74
$1,278.87
$1,510.24
$1,500.68
$1,562.15
$1,627.28
$1,858.65
$348.41
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$910.90
$1,033.84
$1,164.10
$1,626.84
$2,472.14
$1,259.31
$1,382.25
$1,512.51
$1,975.25
$1,607.72
$1,730.66
$1,860.92
$2,323.66
$1,956.13
$2,079.07
$2,209.33
$2,672.07
$348.41
Toc - Plan #31 Ambetter from Sunshine Health
Gold

(EPO) Everyday Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$750 $1,500 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$421.25
$478.10
$538.34
$752.33
$1,143.24
$743.50
$800.35
$860.59
$1,074.58
$1,065.75
$1,122.60
$1,182.84
$1,396.83
$1,388.00
$1,444.85
$1,505.09
$1,719.08
$322.25
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$842.50
$956.20
$1,076.68
$1,504.66
$2,286.48
$1,164.75
$1,278.45
$1,398.93
$1,826.91
$1,487.00
$1,600.70
$1,721.18
$2,149.16
$1,809.25
$1,922.95
$2,043.43
$2,471.41
$322.25
Toc - Plan #32 Ambetter from Sunshine Health
Gold

(EPO) Elite Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$5,500 $11,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$484.57
$549.98
$619.27
$865.42
$1,315.10
$855.26
$920.67
$989.96
$1,236.11
$1,225.95
$1,291.36
$1,360.65
$1,606.80
$1,596.64
$1,662.05
$1,731.34
$1,977.49
$370.69
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$969.14
$1,099.96
$1,238.54
$1,730.84
$2,630.20
$1,339.83
$1,470.65
$1,609.23
$2,101.53
$1,710.52
$1,841.34
$1,979.92
$2,472.22
$2,081.21
$2,212.03
$2,350.61
$2,842.91
$370.69
Toc - Plan #33 Ambetter from Sunshine Health
Expanded Bronze

(EPO) Standard Expanded Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$352.13
$399.65
$450.00
$628.88
$955.64
$621.50
$669.02
$719.37
$898.25
$890.87
$938.39
$988.74
$1,167.62
$1,160.24
$1,207.76
$1,258.11
$1,436.99
$269.37
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$704.26
$799.30
$900.00
$1,257.76
$1,911.28
$973.63
$1,068.67
$1,169.37
$1,527.13
$1,243.00
$1,338.04
$1,438.74
$1,796.50
$1,512.37
$1,607.41
$1,708.11
$2,065.87
$269.37
Toc - Plan #34 Ambetter from Sunshine Health
Silver

(EPO) Standard Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$445.95
$506.14
$569.91
$796.45
$1,210.29
$787.10
$847.29
$911.06
$1,137.60
$1,128.25
$1,188.44
$1,252.21
$1,478.75
$1,469.40
$1,529.59
$1,593.36
$1,819.90
$341.15
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$891.90
$1,012.28
$1,139.82
$1,592.90
$2,420.58
$1,233.05
$1,353.43
$1,480.97
$1,934.05
$1,574.20
$1,694.58
$1,822.12
$2,275.20
$1,915.35
$2,035.73
$2,163.27
$2,616.35
$341.15
Toc - Plan #35 Ambetter from Sunshine Health
Gold

(EPO) Standard Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$418.70
$475.22
$535.09
$747.79
$1,136.34
$739.00
$795.52
$855.39
$1,068.09
$1,059.30
$1,115.82
$1,175.69
$1,388.39
$1,379.60
$1,436.12
$1,495.99
$1,708.69
$320.30
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$837.40
$950.44
$1,070.18
$1,495.58
$2,272.68
$1,157.70
$1,270.74
$1,390.48
$1,815.88
$1,478.00
$1,591.04
$1,710.78
$2,136.18
$1,798.30
$1,911.34
$2,031.08
$2,456.48
$320.30
Toc - Plan #36 Ambetter from Sunshine Health
Silver

(EPO) Everyday Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 Annual Deductible
$8,400 $16,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$475.28
$539.43
$607.39
$848.83
$1,289.87
$838.86
$903.01
$970.97
$1,212.41
$1,202.44
$1,266.59
$1,334.55
$1,575.99
$1,566.02
$1,630.17
$1,698.13
$1,939.57
$363.58
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$950.56
$1,078.86
$1,214.78
$1,697.66
$2,579.74
$1,314.14
$1,442.44
$1,578.36
$2,061.24
$1,677.72
$1,806.02
$1,941.94
$2,424.82
$2,041.30
$2,169.60
$2,305.52
$2,788.40
$363.58
Toc - Plan #37 Ambetter from Sunshine Health
Expanded Bronze

(EPO) Choice Bronze HSA + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$376.56
$427.39
$481.23
$672.52
$1,021.96
$664.62
$715.45
$769.29
$960.58
$952.68
$1,003.51
$1,057.35
$1,248.64
$1,240.74
$1,291.57
$1,345.41
$1,536.70
$288.06
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$753.12
$854.78
$962.46
$1,345.04
$2,043.92
$1,041.18
$1,142.84
$1,250.52
$1,633.10
$1,329.24
$1,430.90
$1,538.58
$1,921.16
$1,617.30
$1,718.96
$1,826.64
$2,209.22
$288.06
Toc - Plan #38 Ambetter from Sunshine Health
Gold

(EPO) Complete Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$1,450 $2,900 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$455.86
$517.39
$582.57
$814.14
$1,237.17
$804.58
$866.11
$931.29
$1,162.86
$1,153.30
$1,214.83
$1,280.01
$1,511.58
$1,502.02
$1,563.55
$1,628.73
$1,860.30
$348.72
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$911.72
$1,034.78
$1,165.14
$1,628.28
$2,474.34
$1,260.44
$1,383.50
$1,513.86
$1,977.00
$1,609.16
$1,732.22
$1,862.58
$2,325.72
$1,957.88
$2,080.94
$2,211.30
$2,674.44
$348.72
Toc - Plan #39 Ambetter from Sunshine Health
Silver

(EPO) Clear Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$462.87
$525.34
$591.53
$826.66
$1,256.20
$816.96
$879.43
$945.62
$1,180.75
$1,171.05
$1,233.52
$1,299.71
$1,534.84
$1,525.14
$1,587.61
$1,653.80
$1,888.93
$354.09
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$925.74
$1,050.68
$1,183.06
$1,653.32
$2,512.40
$1,279.83
$1,404.77
$1,537.15
$2,007.41
$1,633.92
$1,758.86
$1,891.24
$2,361.50
$1,988.01
$2,112.95
$2,245.33
$2,715.59
$354.09
Toc - Plan #40 Ambetter from Sunshine Health
Gold

(EPO) Elite Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$5,500 $11,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$501.25
$568.90
$640.58
$895.21
$1,360.36
$884.70
$952.35
$1,024.03
$1,278.66
$1,268.15
$1,335.80
$1,407.48
$1,662.11
$1,651.60
$1,719.25
$1,790.93
$2,045.56
$383.45
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,002.50
$1,137.80
$1,281.16
$1,790.42
$2,720.72
$1,385.95
$1,521.25
$1,664.61
$2,173.87
$1,769.40
$1,904.70
$2,048.06
$2,557.32
$2,152.85
$2,288.15
$2,431.51
$2,940.77
$383.45
Toc - Plan #41 Ambetter from Sunshine Health
Expanded Bronze

(EPO) Standard Expanded Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$364.24
$413.41
$465.49
$650.52
$988.53
$642.88
$692.05
$744.13
$929.16
$921.52
$970.69
$1,022.77
$1,207.80
$1,200.16
$1,249.33
$1,301.41
$1,486.44
$278.64
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$728.48
$826.82
$930.98
$1,301.04
$1,977.06
$1,007.12
$1,105.46
$1,209.62
$1,579.68
$1,285.76
$1,384.10
$1,488.26
$1,858.32
$1,564.40
$1,662.74
$1,766.90
$2,136.96
$278.64
Toc - Plan #42 Ambetter from Sunshine Health
Silver

(EPO) Standard Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$461.30
$523.56
$589.53
$823.86
$1,251.94
$814.19
$876.45
$942.42
$1,176.75
$1,167.08
$1,229.34
$1,295.31
$1,529.64
$1,519.97
$1,582.23
$1,648.20
$1,882.53
$352.89
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$922.60
$1,047.12
$1,179.06
$1,647.72
$2,503.88
$1,275.49
$1,400.01
$1,531.95
$2,000.61
$1,628.38
$1,752.90
$1,884.84
$2,353.50
$1,981.27
$2,105.79
$2,237.73
$2,706.39
$352.89
Toc - Plan #43 Ambetter from Sunshine Health
Gold

(EPO) Standard Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$433.11
$491.57
$553.51
$773.53
$1,175.45
$764.44
$822.90
$884.84
$1,104.86
$1,095.77
$1,154.23
$1,216.17
$1,436.19
$1,427.10
$1,485.56
$1,547.50
$1,767.52
$331.33
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$866.22
$983.14
$1,107.02
$1,547.06
$2,350.90
$1,197.55
$1,314.47
$1,438.35
$1,878.39
$1,528.88
$1,645.80
$1,769.68
$2,209.72
$1,860.21
$1,977.13
$2,101.01
$2,541.05
$331.33
Toc - Plan #44 Ambetter from Sunshine Health
Expanded Bronze

(EPO) Everyday Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$8,450 $16,900 Annual Deductible
$9,250 $18,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$371.44
$421.57
$474.69
$663.37
$1,008.06
$655.58
$705.71
$758.83
$947.51
$939.72
$989.85
$1,042.97
$1,231.65
$1,223.86
$1,273.99
$1,327.11
$1,515.79
$284.14
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$742.88
$843.14
$949.38
$1,326.74
$2,016.12
$1,027.02
$1,127.28
$1,233.52
$1,610.88
$1,311.16
$1,411.42
$1,517.66
$1,895.02
$1,595.30
$1,695.56
$1,801.80
$2,179.16
$284.14
Toc - Plan #45 Ambetter from Sunshine Health
Expanded Bronze

(EPO) Elite Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,250 $18,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$426.47
$484.03
$545.02
$761.66
$1,157.42
$752.71
$810.27
$871.26
$1,087.90
$1,078.95
$1,136.51
$1,197.50
$1,414.14
$1,405.19
$1,462.75
$1,523.74
$1,740.38
$326.24
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$852.94
$968.06
$1,090.04
$1,523.32
$2,314.84
$1,179.18
$1,294.30
$1,416.28
$1,849.56
$1,505.42
$1,620.54
$1,742.52
$2,175.80
$1,831.66
$1,946.78
$2,068.76
$2,502.04
$326.24
Toc - Plan #46 Ambetter from Sunshine Health
Silver

(EPO) Focused Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$6,300 $12,600 Annual Deductible
$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$471.13
$534.72
$602.09
$841.41
$1,278.61
$831.53
$895.12
$962.49
$1,201.81
$1,191.93
$1,255.52
$1,322.89
$1,562.21
$1,552.33
$1,615.92
$1,683.29
$1,922.61
$360.40
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$942.26
$1,069.44
$1,204.18
$1,682.82
$2,557.22
$1,302.66
$1,429.84
$1,564.58
$2,043.22
$1,663.06
$1,790.24
$1,924.98
$2,403.62
$2,023.46
$2,150.64
$2,285.38
$2,764.02
$360.40
Toc - Plan #47 Ambetter from Sunshine Health
Gold

(EPO) Everyday Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$750 $1,500 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$435.74
$494.56
$556.87
$778.22
$1,182.58
$769.08
$827.90
$890.21
$1,111.56
$1,102.42
$1,161.24
$1,223.55
$1,444.90
$1,435.76
$1,494.58
$1,556.89
$1,778.24
$333.34
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$871.48
$989.12
$1,113.74
$1,556.44
$2,365.16
$1,204.82
$1,322.46
$1,447.08
$1,889.78
$1,538.16
$1,655.80
$1,780.42
$2,223.12
$1,871.50
$1,989.14
$2,113.76
$2,556.46
$333.34

ADVERTISEMENT

Florida Blue HMO (a BlueCross BlueShield FL company)

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

Toc - Plan #48 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver

(POS) BlueCare Silver 24K01-02 ($0 Virtual Visits / Rewards $$$)

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

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$557.56
$632.83
$712.56
$995.80
$1,513.22
$984.09
$1,059.36
$1,139.09
$1,422.33
$1,410.62
$1,485.89
$1,565.62
$1,848.86
$1,837.15
$1,912.42
$1,992.15
$2,275.39
$426.53
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,115.12
$1,265.66
$1,425.12
$1,991.60
$3,026.44
$1,541.65
$1,692.19
$1,851.65
$2,418.13
$1,968.18
$2,118.72
$2,278.18
$2,844.66
$2,394.71
$2,545.25
$2,704.71
$3,271.19
$426.53
Toc - Plan #49 Florida Blue HMO (a BlueCross BlueShield FL company)
Expanded Bronze

(POS) BlueCare Bronze 24K01-03 ($0 Virtual Visits / 3 PCP Visits for $0 then $40 / Rewards $$$)

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

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$470.45
$533.96
$601.24
$840.22
$1,276.80
$830.34
$893.85
$961.13
$1,200.11
$1,190.23
$1,253.74
$1,321.02
$1,560.00
$1,550.12
$1,613.63
$1,680.91
$1,919.89
$359.89
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$940.90
$1,067.92
$1,202.48
$1,680.44
$2,553.60
$1,300.79
$1,427.81
$1,562.37
$2,040.33
$1,660.68
$1,787.70
$1,922.26
$2,400.22
$2,020.57
$2,147.59
$2,282.15
$2,760.11
$359.89
Toc - Plan #50 Florida Blue HMO (a BlueCross BlueShield FL company)
Platinum

(POS) BlueCare Platinum 24K01-04 ($0 Virtual Visits / Rewards $$$)

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

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$762.02
$864.89
$973.86
$1,360.97
$2,068.12
$1,344.97
$1,447.84
$1,556.81
$1,943.92
$1,927.92
$2,030.79
$2,139.76
$2,526.87
$2,510.87
$2,613.74
$2,722.71
$3,109.82
$582.95
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,524.04
$1,729.78
$1,947.72
$2,721.94
$4,136.24
$2,106.99
$2,312.73
$2,530.67
$3,304.89
$2,689.94
$2,895.68
$3,113.62
$3,887.84
$3,272.89
$3,478.63
$3,696.57
$4,470.79
$582.95
Toc - Plan #51 Florida Blue HMO (a BlueCross BlueShield FL company)
Bronze

(POS) BlueCare Bronze 24K01-05 ($0 Virtual Visits / Rewards $$$)

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

Annual Out of Pocket Expenses:

Individual Family
$6,150 $12,300 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$428.65
$486.52
$547.81
$765.57
$1,163.36
$756.57
$814.44
$875.73
$1,093.49
$1,084.49
$1,142.36
$1,203.65
$1,421.41
$1,412.41
$1,470.28
$1,531.57
$1,749.33
$327.92
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$857.30
$973.04
$1,095.62
$1,531.14
$2,326.72
$1,185.22
$1,300.96
$1,423.54
$1,859.06
$1,513.14
$1,628.88
$1,751.46
$2,186.98
$1,841.06
$1,956.80
$2,079.38
$2,514.90
$327.92
Toc - Plan #52 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver

(POS) BlueCare Silver 24K01-06 ($0 Virtual Visits / Rewards $$$)

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

Annual Out of Pocket Expenses:

Individual Family
$2,800 $5,600 Annual Deductible
$7,150 $14,300 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$613.66
$696.50
$784.26
$1,096.00
$1,665.47
$1,083.11
$1,165.95
$1,253.71
$1,565.45
$1,552.56
$1,635.40
$1,723.16
$2,034.90
$2,022.01
$2,104.85
$2,192.61
$2,504.35
$469.45
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,227.32
$1,393.00
$1,568.52
$2,192.00
$3,330.94
$1,696.77
$1,862.45
$2,037.97
$2,661.45
$2,166.22
$2,331.90
$2,507.42
$3,130.90
$2,635.67
$2,801.35
$2,976.87
$3,600.35
$469.45
Toc - Plan #53 Florida Blue HMO (a BlueCross BlueShield FL company)
Platinum

(POS) BlueCare Platinum 24K01-07 ($0 Virtual Visits / Rewards $$$)

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

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$2,000 $4,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$801.34
$909.52
$1,024.11
$1,431.19
$2,174.84
$1,414.37
$1,522.55
$1,637.14
$2,044.22
$2,027.40
$2,135.58
$2,250.17
$2,657.25
$2,640.43
$2,748.61
$2,863.20
$3,270.28
$613.03
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,602.68
$1,819.04
$2,048.22
$2,862.38
$4,349.68
$2,215.71
$2,432.07
$2,661.25
$3,475.41
$2,828.74
$3,045.10
$3,274.28
$4,088.44
$3,441.77
$3,658.13
$3,887.31
$4,701.47
$613.03
Toc - Plan #54 Florida Blue HMO (a BlueCross BlueShield FL company)
Gold

(POS) BlueCare Gold 24K01-08 ($0 Virtual Visits / $20 PCP Visit / $15 Generic Meds / Rewards $$$)

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

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$6,250 $12,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$693.23
$786.82
$885.95
$1,238.11
$1,881.43
$1,223.55
$1,317.14
$1,416.27
$1,768.43
$1,753.87
$1,847.46
$1,946.59
$2,298.75
$2,284.19
$2,377.78
$2,476.91
$2,829.07
$530.32
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,386.46
$1,573.64
$1,771.90
$2,476.22
$3,762.86
$1,916.78
$2,103.96
$2,302.22
$3,006.54
$2,447.10
$2,634.28
$2,832.54
$3,536.86
$2,977.42
$3,164.60
$3,362.86
$4,067.18
$530.32
Toc - Plan #55 Florida Blue HMO (a BlueCross BlueShield FL company)
Expanded Bronze

(POS) BlueCare Bronze (HSA) 24K01-09 (Rewards $$$ / $4 Condition Care Rx)

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

Annual Out of Pocket Expenses:

Individual Family
$7,050 $14,100 Annual Deductible
$7,050 $14,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$450.50
$511.32
$575.74
$804.59
$1,222.66
$795.13
$855.95
$920.37
$1,149.22
$1,139.76
$1,200.58
$1,265.00
$1,493.85
$1,484.39
$1,545.21
$1,609.63
$1,838.48
$344.63
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$901.00
$1,022.64
$1,151.48
$1,609.18
$2,445.32
$1,245.63
$1,367.27
$1,496.11
$1,953.81
$1,590.26
$1,711.90
$1,840.74
$2,298.44
$1,934.89
$2,056.53
$2,185.37
$2,643.07
$344.63
Toc - Plan #56 Florida Blue HMO (a BlueCross BlueShield FL company)
Gold

(POS) BlueCare Gold 24K01-10 ($0 Virtual Visits / $20 Labs / Rewards $$$)

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

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$5,900 $11,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$665.04
$754.82
$849.92
$1,187.76
$1,804.92
$1,173.80
$1,263.58
$1,358.68
$1,696.52
$1,682.56
$1,772.34
$1,867.44
$2,205.28
$2,191.32
$2,281.10
$2,376.20
$2,714.04
$508.76
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,330.08
$1,509.64
$1,699.84
$2,375.52
$3,609.84
$1,838.84
$2,018.40
$2,208.60
$2,884.28
$2,347.60
$2,527.16
$2,717.36
$3,393.04
$2,856.36
$3,035.92
$3,226.12
$3,901.80
$508.76
Toc - Plan #57 Florida Blue HMO (a BlueCross BlueShield FL company)
Expanded Bronze

(POS) BlueCare Bronze 24K01-25 ($0 Virtual Visits / $50 PCP Visit / $30 Generic Meds / Rewards $$$)

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

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$501.94
$569.70
$641.48
$896.46
$1,362.27
$885.92
$953.68
$1,025.46
$1,280.44
$1,269.90
$1,337.66
$1,409.44
$1,664.42
$1,653.88
$1,721.64
$1,793.42
$2,048.40
$383.98
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,003.88
$1,139.40
$1,282.96
$1,792.92
$2,724.54
$1,387.86
$1,523.38
$1,666.94
$2,176.90
$1,771.84
$1,907.36
$2,050.92
$2,560.88
$2,155.82
$2,291.34
$2,434.90
$2,944.86
$383.98
Toc - Plan #58 Florida Blue HMO (a BlueCross BlueShield FL company)
Expanded Bronze

(POS) BlueCare Bronze 24K01-31S (Multilingual Available / Rewards $$$)

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

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$458.33
$520.20
$585.75
$818.58
$1,243.91
$808.95
$870.82
$936.37
$1,169.20
$1,159.57
$1,221.44
$1,286.99
$1,519.82
$1,510.19
$1,572.06
$1,637.61
$1,870.44
$350.62
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$916.66
$1,040.40
$1,171.50
$1,637.16
$2,487.82
$1,267.28
$1,391.02
$1,522.12
$1,987.78
$1,617.90
$1,741.64
$1,872.74
$2,338.40
$1,968.52
$2,092.26
$2,223.36
$2,689.02
$350.62
Toc - Plan #59 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver

(POS) BlueCare Silver 24K01-32S ($40 PCP Visits / Multilingual Available / Rewards $$$)

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

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$590.47
$670.18
$754.62
$1,054.58
$1,602.54
$1,042.18
$1,121.89
$1,206.33
$1,506.29
$1,493.89
$1,573.60
$1,658.04
$1,958.00
$1,945.60
$2,025.31
$2,109.75
$2,409.71
$451.71
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,180.94
$1,340.36
$1,509.24
$2,109.16
$3,205.08
$1,632.65
$1,792.07
$1,960.95
$2,560.87
$2,084.36
$2,243.78
$2,412.66
$3,012.58
$2,536.07
$2,695.49
$2,864.37
$3,464.29
$451.71
Toc - Plan #60 Florida Blue HMO (a BlueCross BlueShield FL company)
Gold

(POS) BlueCare Gold 24K01-33S ($30 PCP Visit / Multilingual Available/ Rewards $$$)

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

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$644.53
$731.54
$823.71
$1,151.13
$1,749.25
$1,137.60
$1,224.61
$1,316.78
$1,644.20
$1,630.67
$1,717.68
$1,809.85
$2,137.27
$2,123.74
$2,210.75
$2,302.92
$2,630.34
$493.07
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,289.06
$1,463.08
$1,647.42
$2,302.26
$3,498.50
$1,782.13
$1,956.15
$2,140.49
$2,795.33
$2,275.20
$2,449.22
$2,633.56
$3,288.40
$2,768.27
$2,942.29
$3,126.63
$3,781.47
$493.07
Toc - Plan #61 Florida Blue HMO (a BlueCross BlueShield FL company)
Platinum

(POS) BlueCare Platinum 24K01-34S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Multilingual Available / Rewards $$$)

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

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$3,200 $6,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$798.81
$906.65
$1,020.88
$1,426.67
$2,167.97
$1,409.90
$1,517.74
$1,631.97
$2,037.76
$2,020.99
$2,128.83
$2,243.06
$2,648.85
$2,632.08
$2,739.92
$2,854.15
$3,259.94
$611.09
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,597.62
$1,813.30
$2,041.76
$2,853.34
$4,335.94
$2,208.71
$2,424.39
$2,652.85
$3,464.43
$2,819.80
$3,035.48
$3,263.94
$4,075.52
$3,430.89
$3,646.57
$3,875.03
$4,686.61
$611.09

ADVERTISEMENT

UnitedHealthcare

Local: 1-888-200-0405 | Toll Free: 1-888-200-0405 | TTY: 1-888-200-0405

Toc - Plan #62 UnitedHealthcare
Silver

(HMO) UHC Silver Virtual First (Unlimited $0 App-based Care, $3 Tier 2 Rx) (Disponible en espanol)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family
$3,900 $7,800 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$417.33
$473.67
$533.34
$745.34
$1,132.62
$736.58
$792.92
$852.59
$1,064.59
$1,055.83
$1,112.17
$1,171.84
$1,383.84
$1,375.08
$1,431.42
$1,491.09
$1,703.09
$319.25
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$834.66
$947.34
$1,066.68
$1,490.68
$2,265.24
$1,153.91
$1,266.59
$1,385.93
$1,809.93
$1,473.16
$1,585.84
$1,705.18
$2,129.18
$1,792.41
$1,905.09
$2,024.43
$2,448.43
$319.25
Toc - Plan #63 UnitedHealthcare
Expanded Bronze

(HMO) UHC Bronze Value ($0 Virtual Urgent Care + $0 PCP Visits, $3 Tier 2 Rx)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family
$8,250 $16,500 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$334.46
$379.61
$427.44
$597.34
$907.72
$590.32
$635.47
$683.30
$853.20
$846.18
$891.33
$939.16
$1,109.06
$1,102.04
$1,147.19
$1,195.02
$1,364.92
$255.86
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$668.92
$759.22
$854.88
$1,194.68
$1,815.44
$924.78
$1,015.08
$1,110.74
$1,450.54
$1,180.64
$1,270.94
$1,366.60
$1,706.40
$1,436.50
$1,526.80
$1,622.46
$1,962.26
$255.86
Toc - Plan #64 UnitedHealthcare
Expanded Bronze

(HMO) UHC Bronze Virtual First (Unlimited $0 App-based Care, $3 Tier 2 Rx) (Disponible en espanol)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family
$7,250 $14,500 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$334.97
$380.19
$428.09
$598.26
$909.11
$591.22
$636.44
$684.34
$854.51
$847.47
$892.69
$940.59
$1,110.76
$1,103.72
$1,148.94
$1,196.84
$1,367.01
$256.25
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$669.94
$760.38
$856.18
$1,196.52
$1,818.22
$926.19
$1,016.63
$1,112.43
$1,452.77
$1,182.44
$1,272.88
$1,368.68
$1,709.02
$1,438.69
$1,529.13
$1,624.93
$1,965.27
$256.25
Toc - Plan #65 UnitedHealthcare
Gold

(HMO) UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $3 Tier 2 Rx)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$7,750 $15,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$479.66
$544.42
$613.01
$856.68
$1,301.81
$846.60
$911.36
$979.95
$1,223.62
$1,213.54
$1,278.30
$1,346.89
$1,590.56
$1,580.48
$1,645.24
$1,713.83
$1,957.50
$366.94
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$959.32
$1,088.84
$1,226.02
$1,713.36
$2,603.62
$1,326.26
$1,455.78
$1,592.96
$2,080.30
$1,693.20
$1,822.72
$1,959.90
$2,447.24
$2,060.14
$2,189.66
$2,326.84
$2,814.18
$366.94
Toc - Plan #66 UnitedHealthcare
Gold

(HMO) UHC Gold Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$471.50
$535.16
$602.58
$842.11
$1,279.66
$832.20
$895.86
$963.28
$1,202.81
$1,192.90
$1,256.56
$1,323.98
$1,563.51
$1,553.60
$1,617.26
$1,684.68
$1,924.21
$360.70
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$943.00
$1,070.32
$1,205.16
$1,684.22
$2,559.32
$1,303.70
$1,431.02
$1,565.86
$2,044.92
$1,664.40
$1,791.72
$1,926.56
$2,405.62
$2,025.10
$2,152.42
$2,287.26
$2,766.32
$360.70
Toc - Plan #67 UnitedHealthcare
Silver

(HMO) UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$434.11
$492.72
$554.80
$775.33
$1,178.18
$766.21
$824.82
$886.90
$1,107.43
$1,098.31
$1,156.92
$1,219.00
$1,439.53
$1,430.41
$1,489.02
$1,551.10
$1,771.63
$332.10
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$868.22
$985.44
$1,109.60
$1,550.66
$2,356.36
$1,200.32
$1,317.54
$1,441.70
$1,882.76
$1,532.42
$1,649.64
$1,773.80
$2,214.86
$1,864.52
$1,981.74
$2,105.90
$2,546.96
$332.10
Toc - Plan #68 UnitedHealthcare
Silver

(HMO) UHC Silver Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$412.69
$468.41
$527.42
$737.07
$1,120.05
$728.40
$784.12
$843.13
$1,052.78
$1,044.11
$1,099.83
$1,158.84
$1,368.49
$1,359.82
$1,415.54
$1,474.55
$1,684.20
$315.71
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$825.38
$936.82
$1,054.84
$1,474.14
$2,240.10
$1,141.09
$1,252.53
$1,370.55
$1,789.85
$1,456.80
$1,568.24
$1,686.26
$2,105.56
$1,772.51
$1,883.95
$2,001.97
$2,421.27
$315.71
Toc - Plan #69 UnitedHealthcare
Bronze

(HMO) UHC Bronze Essential ($0 Virtual Urgent Care, $3 Tier 2 Rx)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family
$6,350 $12,700 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$329.55
$374.04
$421.17
$588.58
$894.41
$581.66
$626.15
$673.28
$840.69
$833.77
$878.26
$925.39
$1,092.80
$1,085.88
$1,130.37
$1,177.50
$1,344.91
$252.11
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$659.10
$748.08
$842.34
$1,177.16
$1,788.82
$911.21
$1,000.19
$1,094.45
$1,429.27
$1,163.32
$1,252.30
$1,346.56
$1,681.38
$1,415.43
$1,504.41
$1,598.67
$1,933.49
$252.11
Toc - Plan #70 UnitedHealthcare
Expanded Bronze

(HMO) UHC Bronze Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$335.46
$380.75
$428.72
$599.14
$910.44
$592.09
$637.38
$685.35
$855.77
$848.72
$894.01
$941.98
$1,112.40
$1,105.35
$1,150.64
$1,198.61
$1,369.03
$256.63
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$670.92
$761.50
$857.44
$1,198.28
$1,820.88
$927.55
$1,018.13
$1,114.07
$1,454.91
$1,184.18
$1,274.76
$1,370.70
$1,711.54
$1,440.81
$1,531.39
$1,627.33
$1,968.17
$256.63
Toc - Plan #71 UnitedHealthcare
Expanded Bronze

(HMO) UHC Bronze Copay Focus $0 Indiv Med Ded

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$351.78
$399.27
$449.57
$628.28
$954.73
$620.89
$668.38
$718.68
$897.39
$890.00
$937.49
$987.79
$1,166.50
$1,159.11
$1,206.60
$1,256.90
$1,435.61
$269.11
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$703.56
$798.54
$899.14
$1,256.56
$1,909.46
$972.67
$1,067.65
$1,168.25
$1,525.67
$1,241.78
$1,336.76
$1,437.36
$1,794.78
$1,510.89
$1,605.87
$1,706.47
$2,063.89
$269.11
Toc - Plan #72 UnitedHealthcare
Silver

(HMO) UHC Silver Value ($0 Virtual Urgent Care, $3 Tier 2 Rx)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$416.41
$472.62
$532.17
$743.70
$1,130.13
$734.96
$791.17
$850.72
$1,062.25
$1,053.51
$1,109.72
$1,169.27
$1,380.80
$1,372.06
$1,428.27
$1,487.82
$1,699.35
$318.55
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$832.82
$945.24
$1,064.34
$1,487.40
$2,260.26
$1,151.37
$1,263.79
$1,382.89
$1,805.95
$1,469.92
$1,582.34
$1,701.44
$2,124.50
$1,788.47
$1,900.89
$2,019.99
$2,443.05
$318.55
Toc - Plan #73 UnitedHealthcare
Silver

(HMO) UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, $0 Insulin)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family
$2,750 $5,500 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$421.11
$477.96
$538.18
$752.10
$1,142.89
$743.26
$800.11
$860.33
$1,074.25
$1,065.41
$1,122.26
$1,182.48
$1,396.40
$1,387.56
$1,444.41
$1,504.63
$1,718.55
$322.15
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$842.22
$955.92
$1,076.36
$1,504.20
$2,285.78
$1,164.37
$1,278.07
$1,398.51
$1,826.35
$1,486.52
$1,600.22
$1,720.66
$2,148.50
$1,808.67
$1,922.37
$2,042.81
$2,470.65
$322.15
Toc - Plan #74 UnitedHealthcare
Gold

(HMO) UHC Gold Value ($0 Virtual Urgent Care, $3 Tier 2 Rx)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$468.87
$532.16
$599.21
$837.40
$1,272.51
$827.55
$890.84
$957.89
$1,196.08
$1,186.23
$1,249.52
$1,316.57
$1,554.76
$1,544.91
$1,608.20
$1,675.25
$1,913.44
$358.68
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$937.74
$1,064.32
$1,198.42
$1,674.80
$2,545.02
$1,296.42
$1,423.00
$1,557.10
$2,033.48
$1,655.10
$1,781.68
$1,915.78
$2,392.16
$2,013.78
$2,140.36
$2,274.46
$2,750.84
$358.68
Toc - Plan #75 UnitedHealthcare
Gold

(HMO) UHC Gold Virtual First (Unlimited $0 App-based Care, $3 Tier 2 Rx) (Disponible en espanol)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family
$1,000 $2,000 Annual Deductible
$8,400 $16,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$470.13
$533.60
$600.83
$839.65
$1,275.94
$829.78
$893.25
$960.48
$1,199.30
$1,189.43
$1,252.90
$1,320.13
$1,558.95
$1,549.08
$1,612.55
$1,679.78
$1,918.60
$359.65
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$940.26
$1,067.20
$1,201.66
$1,679.30
$2,551.88
$1,299.91
$1,426.85
$1,561.31
$2,038.95
$1,659.56
$1,786.50
$1,920.96
$2,398.60
$2,019.21
$2,146.15
$2,280.61
$2,758.25
$359.65
Toc - Plan #76 UnitedHealthcare
Gold

(HMO) UHC Gold Advantage+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family
$500 $1,000 Annual Deductible
$7,750 $15,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$497.07
$564.17
$635.25
$887.76
$1,349.04
$877.33
$944.43
$1,015.51
$1,268.02
$1,257.59
$1,324.69
$1,395.77
$1,648.28
$1,637.85
$1,704.95
$1,776.03
$2,028.54
$380.26
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$994.14
$1,128.34
$1,270.50
$1,775.52
$2,698.08
$1,374.40
$1,508.60
$1,650.76
$2,155.78
$1,754.66
$1,888.86
$2,031.02
$2,536.04
$2,134.92
$2,269.12
$2,411.28
$2,916.30
$380.26
Toc - Plan #77 UnitedHealthcare
Silver

(HMO) UHC Silver Advantage+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, $0 Insulin)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family
$2,750 $5,500 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$439.61
$498.96
$561.83
$785.15
$1,193.11
$775.91
$835.26
$898.13
$1,121.45
$1,112.21
$1,171.56
$1,234.43
$1,457.75
$1,448.51
$1,507.86
$1,570.73
$1,794.05
$336.30
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$879.22
$997.92
$1,123.66
$1,570.30
$2,386.22
$1,215.52
$1,334.22
$1,459.96
$1,906.60
$1,551.82
$1,670.52
$1,796.26
$2,242.90
$1,888.12
$2,006.82
$2,132.56
$2,579.20
$336.30

‡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 De Soto County here.

De Soto County is in “” of Florida.

Currently, there are 77 plans offered in .

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