Providers for Zip Code 33411

Obamacare 2015 Marketplace Rates For Palm Beach County, Florida

Thursday, December 18th, 2014

Click for West Palm Beach, Florida 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 Palm Beach County, Florida.

Obamacare Providers, Plans and 2015 Rates for Palm Beach County

Palm Beach County is in “Rating Area 50” of Florida.

Currently, there are 8 providers offering 136 plans to Rating Area 50.

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 on available subsidies to make your coverage affordable, 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 West Palm Beach, FL area accept this insurance coverage as within the plan's "network".

Florida Blue (BlueCross BlueShield FL)

Local: 1-855-805-8175 | Toll Free: 1-855-805-8175

Plan: (EPO) BlueOptions Everyday Health 1423

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-805-8175 - Provider Directory for This Plan: (Florida Blue (BlueCross BlueShield FL))

Deductible: Individual: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $6,250 : Family: $12,500

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
Silver 21
30
40
50
60
$389.17
$441.71
$497.36
$695.06
$1056.21
$778.34
$883.42
$994.72
$1390.12
$2112.42
$1025.46
$1130.54
$1241.84
$1637.24
$1272.58
$1377.66
$1488.96
$1884.36
$1519.70
$1624.78
$1736.08
$2131.48
$636.29
$688.83
$744.48
$942.18
$883.41
$935.95
$991.60
$1189.30
$1130.53
$1183.07
$1238.72
$1436.42
$247.12

Plan: (EPO) BlueOptions Essential (HSA) 1419

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-805-8175 - Provider Directory for This Plan: (Florida Blue (BlueCross BlueShield FL))

Deductible: Individual: $6,250 : Family: $12,500
Out of Pocket Maximum per year: Individual: $6,250 : Family: $12,500

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
Bronze 21
30
40
50
60
$304.70
$345.83
$389.40
$544.19
$826.95
$609.40
$691.66
$778.80
$1088.38
$1653.90
$802.88
$885.14
$972.28
$1281.86
$996.36
$1078.62
$1165.76
$1475.34
$1189.84
$1272.10
$1359.24
$1668.82
$498.18
$539.31
$582.88
$737.67
$691.66
$732.79
$776.36
$931.15
$885.14
$926.27
$969.84
$1124.63
$193.48

Plan: (EPO) BlueOptions Everyday Health 1431

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-805-8175 - Provider Directory for This Plan: (Florida Blue (BlueCross BlueShield FL))

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
$372.52
$422.81
$476.08
$665.32
$1011.02
$745.04
$845.62
$952.16
$1330.64
$2022.04
$981.59
$1082.17
$1188.71
$1567.19
$1218.14
$1318.72
$1425.26
$1803.74
$1454.69
$1555.27
$1661.81
$2040.29
$609.07
$659.36
$712.63
$901.87
$845.62
$895.91
$949.18
$1138.42
$1082.17
$1132.46
$1185.73
$1374.97
$236.55

Plan: (EPO) BlueOptions Everyday Health 1418

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-805-8175 - Provider Directory for This Plan: (Florida Blue (BlueCross BlueShield FL))

Deductible: Individual: $800 : Family: $1,600
Out of Pocket Maximum per year: Individual: $2,500 : Family: $5,000

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
$431.68
$489.96
$551.69
$770.99
$1171.59
$863.36
$979.92
$1103.38
$1541.98
$2343.18
$1137.48
$1254.04
$1377.50
$1816.10
$1411.60
$1528.16
$1651.62
$2090.22
$1685.72
$1802.28
$1925.74
$2364.34
$705.80
$764.08
$825.81
$1045.11
$979.92
$1038.20
$1099.93
$1319.23
$1254.04
$1312.32
$1374.05
$1593.35
$274.12

Plan: (EPO) BlueOptions Everyday Health Premier 1418V

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-805-8175 - Provider Directory for This Plan: (Florida Blue (BlueCross BlueShield FL))

Deductible: Individual: $800 : Family: $1,600
Out of Pocket Maximum per year: Individual: $2,500 : Family: $5,000

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
$472.00
$535.71
$603.21
$842.98
$1280.99
$944.00
$1071.42
$1206.42
$1685.96
$2561.98
$1243.72
$1371.14
$1506.14
$1985.68
$1543.44
$1670.86
$1805.86
$2285.40
$1843.16
$1970.58
$2105.58
$2585.12
$771.72
$835.43
$902.93
$1142.70
$1071.44
$1135.15
$1202.65
$1442.42
$1371.16
$1434.87
$1502.37
$1742.14
$299.72

Plan: (EPO) BlueOptions Everyday Health 1416

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-805-8175 - Provider Directory for This Plan: (Florida Blue (BlueCross BlueShield FL))

Deductible: Individual: $6,000 : Family: $12,000
Out of Pocket Maximum per year: Individual: $6,250 : Family: $12,500

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
Bronze 21
30
40
50
60
$326.76
$370.87
$417.60
$583.59
$886.82
$653.52
$741.74
$835.20
$1167.18
$1773.64
$861.01
$949.23
$1042.69
$1374.67
$1068.50
$1156.72
$1250.18
$1582.16
$1275.99
$1364.21
$1457.67
$1789.65
$534.25
$578.36
$625.09
$791.08
$741.74
$785.85
$832.58
$998.57
$949.23
$993.34
$1040.07
$1206.06
$207.49

Plan: (EPO) BlueOptions All Copay 1424

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-805-8175 - Provider Directory for This Plan: (Florida Blue (BlueCross BlueShield FL))

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
$450.40
$511.20
$575.61
$804.41
$1222.38
$900.80
$1022.40
$1151.22
$1608.82
$2444.76
$1186.80
$1308.40
$1437.22
$1894.82
$1472.80
$1594.40
$1723.22
$2180.82
$1758.80
$1880.40
$2009.22
$2466.82
$736.40
$797.20
$861.61
$1090.41
$1022.40
$1083.20
$1147.61
$1376.41
$1308.40
$1369.20
$1433.61
$1662.41
$286.00

Plan: (EPO) BlueOptions Everyday Health 1410

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-805-8175 - Provider Directory for This Plan: (Florida Blue (BlueCross BlueShield FL))

Deductible: Individual: $5,750 : Family: $11,500
Out of Pocket Maximum per year: Individual: $6,250 : Family: $12,500

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
Silver 21
30
40
50
60
$338.12
$383.76
$432.11
$603.88
$917.65
$676.24
$767.52
$864.22
$1207.76
$1835.30
$890.94
$982.22
$1078.92
$1422.46
$1105.64
$1196.92
$1293.62
$1637.16
$1320.34
$1411.62
$1508.32
$1851.86
$552.82
$598.46
$646.81
$818.58
$767.52
$813.16
$861.51
$1033.28
$982.22
$1027.86
$1076.21
$1247.98
$214.70

Plan: (EPO) BlueOptions All Copay 1505

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-805-8175 - Provider Directory for This Plan: (Florida Blue (BlueCross BlueShield FL))

Deductible: Individual: $0 : Family: $0
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
$427.93
$485.70
$546.90
$764.29
$1161.41
$855.86
$971.40
$1093.80
$1528.58
$2322.82
$1127.60
$1243.14
$1365.54
$1800.32
$1399.34
$1514.88
$1637.28
$2072.06
$1671.08
$1786.62
$1909.02
$2343.80
$699.67
$757.44
$818.64
$1036.03
$971.41
$1029.18
$1090.38
$1307.77
$1243.15
$1300.92
$1362.12
$1579.51
$271.74

Plan: (EPO) BlueSelect Everyday Health 1456

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-805-8175 - Provider Directory for This Plan: (Florida Blue (BlueCross BlueShield FL))

Deductible: Individual: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $6,250 : Family: $12,500

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
Silver 21
30
40
50
60
$309.55
$351.33
$395.60
$552.85
$840.11
$619.10
$702.66
$791.20
$1105.70
$1680.22
$815.66
$899.22
$987.76
$1302.26
$1012.22
$1095.78
$1184.32
$1498.82
$1208.78
$1292.34
$1380.88
$1695.38
$506.11
$547.89
$592.16
$749.41
$702.67
$744.45
$788.72
$945.97
$899.23
$941.01
$985.28
$1142.53
$196.56

Plan: (EPO) BlueSelect Essential (HSA) 1452

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-805-8175 - Provider Directory for This Plan: (Florida Blue (BlueCross BlueShield FL))

Deductible: Individual: $6,250 : Family: $12,500
Out of Pocket Maximum per year: Individual: $6,250 : Family: $12,500

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
Bronze 21
30
40
50
60
$242.37
$275.08
$309.74
$432.86
$657.78
$484.74
$550.16
$619.48
$865.72
$1315.56
$638.64
$704.06
$773.38
$1019.62
$792.54
$857.96
$927.28
$1173.52
$946.44
$1011.86
$1081.18
$1327.42
$396.27
$428.98
$463.64
$586.76
$550.17
$582.88
$617.54
$740.66
$704.07
$736.78
$771.44
$894.56
$153.90

Plan: (EPO) BlueSelect Everyday Health 1464

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-805-8175 - Provider Directory for This Plan: (Florida Blue (BlueCross BlueShield FL))

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
$296.31
$336.31
$378.68
$529.20
$804.18
$592.62
$672.62
$757.36
$1058.40
$1608.36
$780.78
$860.78
$945.52
$1246.56
$968.94
$1048.94
$1133.68
$1434.72
$1157.10
$1237.10
$1321.84
$1622.88
$484.47
$524.47
$566.84
$717.36
$672.63
$712.63
$755.00
$905.52
$860.79
$900.79
$943.16
$1093.68
$188.16

Plan: (EPO) BlueSelect Everyday Health 1451

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-805-8175 - Provider Directory for This Plan: (Florida Blue (BlueCross BlueShield FL))

Deductible: Individual: $800 : Family: $1,600
Out of Pocket Maximum per year: Individual: $2,500 : Family: $5,000

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
$343.36
$389.71
$438.81
$613.24
$931.87
$686.72
$779.42
$877.62
$1226.48
$1863.74
$904.75
$997.45
$1095.65
$1444.51
$1122.78
$1215.48
$1313.68
$1662.54
$1340.81
$1433.51
$1531.71
$1880.57
$561.39
$607.74
$656.84
$831.27
$779.42
$825.77
$874.87
$1049.30
$997.45
$1043.80
$1092.90
$1267.33
$218.03

Plan: (EPO) BlueSelect Everyday Health Premier 1451V

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-805-8175 - Provider Directory for This Plan: (Florida Blue (BlueCross BlueShield FL))

Deductible: Individual: $800 : Family: $1,600
Out of Pocket Maximum per year: Individual: $2,500 : Family: $5,000

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
$375.42
$426.10
$479.79
$670.50
$1018.89
$750.84
$852.20
$959.58
$1341.00
$2037.78
$989.23
$1090.59
$1197.97
$1579.39
$1227.62
$1328.98
$1436.36
$1817.78
$1466.01
$1567.37
$1674.75
$2056.17
$613.81
$664.49
$718.18
$908.89
$852.20
$902.88
$956.57
$1147.28
$1090.59
$1141.27
$1194.96
$1385.67
$238.39

Plan: (EPO) BlueSelect Everyday Health 1449

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-805-8175 - Provider Directory for This Plan: (Florida Blue (BlueCross BlueShield FL))

Deductible: Individual: $6,000 : Family: $12,000
Out of Pocket Maximum per year: Individual: $6,250 : Family: $12,500

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
Bronze 21
30
40
50
60
$259.91
$295.00
$332.17
$464.20
$705.40
$519.82
$590.00
$664.34
$928.40
$1410.80
$684.86
$755.04
$829.38
$1093.44
$849.90
$920.08
$994.42
$1258.48
$1014.94
$1085.12
$1159.46
$1423.52
$424.95
$460.04
$497.21
$629.24
$589.99
$625.08
$662.25
$794.28
$755.03
$790.12
$827.29
$959.32
$165.04

Plan: (EPO) BlueSelect All Copay 1457

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-805-8175 - Provider Directory for This Plan: (Florida Blue (BlueCross BlueShield FL))

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
$358.25
$406.61
$457.84
$639.83
$972.28
$716.50
$813.22
$915.68
$1279.66
$1944.56
$943.99
$1040.71
$1143.17
$1507.15
$1171.48
$1268.20
$1370.66
$1734.64
$1398.97
$1495.69
$1598.15
$1962.13
$585.74
$634.10
$685.33
$867.32
$813.23
$861.59
$912.82
$1094.81
$1040.72
$1089.08
$1140.31
$1322.30
$227.49

Plan: (EPO) BlueSelect Everyday Health 1443

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-805-8175 - Provider Directory for This Plan: (Florida Blue (BlueCross BlueShield FL))

Deductible: Individual: $5,750 : Family: $11,500
Out of Pocket Maximum per year: Individual: $6,250 : Family: $12,500

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
Silver 21
30
40
50
60
$268.94
$305.25
$343.71
$480.33
$729.91
$537.88
$610.50
$687.42
$960.66
$1459.82
$708.66
$781.28
$858.20
$1131.44
$879.44
$952.06
$1028.98
$1302.22
$1050.22
$1122.84
$1199.76
$1473.00
$439.72
$476.03
$514.49
$651.11
$610.50
$646.81
$685.27
$821.89
$781.28
$817.59
$856.05
$992.67
$170.78

Plan: (EPO) BlueSelect All Copay 1535

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-805-8175 - Provider Directory for This Plan: (Florida Blue (BlueCross BlueShield FL))

Deductible: Individual: $0 : Family: $0
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
$340.38
$386.33
$435.01
$607.92
$923.79
$680.76
$772.66
$870.02
$1215.84
$1847.58
$896.90
$988.80
$1086.16
$1431.98
$1113.04
$1204.94
$1302.30
$1648.12
$1329.18
$1421.08
$1518.44
$1864.26
$556.52
$602.47
$651.15
$824.06
$772.66
$818.61
$867.29
$1040.20
$988.80
$1034.75
$1083.43
$1256.34
$216.14

Florida Blue HMO (a BlueCross BlueShield FL company)

Local: 1-855-805-8175 | Toll Free: 1-855-805-8175

Plan: (HMO) BlueCare Everyday Health 1490

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-805-8175 - Provider Directory for This Plan: (Florida Blue HMO (a BlueCross BlueShield FL company))

Deductible: Individual: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $6,250 : Family: $12,500

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
Silver 21
30
40
50
60
$345.44
$392.08
$441.48
$616.96
$937.53
$690.88
$784.16
$882.96
$1233.92
$1875.06
$910.24
$1003.52
$1102.32
$1453.28
$1129.60
$1222.88
$1321.68
$1672.64
$1348.96
$1442.24
$1541.04
$1892.00
$564.80
$611.44
$660.84
$836.32
$784.16
$830.80
$880.20
$1055.68
$1003.52
$1050.16
$1099.56
$1275.04
$219.36

Plan: (HMO) BlueCare Essential (HSA) 1486

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-805-8175 - Provider Directory for This Plan: (Florida Blue HMO (a BlueCross BlueShield FL company))

Deductible: Individual: $6,250 : Family: $12,500
Out of Pocket Maximum per year: Individual: $6,250 : Family: $12,500

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
Bronze 21
30
40
50
60
$270.01
$306.47
$345.08
$482.24
$732.82
$540.02
$612.94
$690.16
$964.48
$1465.64
$711.48
$784.40
$861.62
$1135.94
$882.94
$955.86
$1033.08
$1307.40
$1054.40
$1127.32
$1204.54
$1478.86
$441.47
$477.93
$516.54
$653.70
$612.93
$649.39
$688.00
$825.16
$784.39
$820.85
$859.46
$996.62
$171.46

Plan: (HMO) BlueCare Everyday Health 1498

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-805-8175 - Provider Directory for This Plan: (Florida Blue HMO (a BlueCross BlueShield FL company))

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
$330.09
$374.66
$421.86
$589.55
$895.88
$660.18
$749.32
$843.72
$1179.10
$1791.76
$869.79
$958.93
$1053.33
$1388.71
$1079.40
$1168.54
$1262.94
$1598.32
$1289.01
$1378.15
$1472.55
$1807.93
$539.70
$584.27
$631.47
$799.16
$749.31
$793.88
$841.08
$1008.77
$958.92
$1003.49
$1050.69
$1218.38
$209.61

Plan: (HMO) BlueCare Everyday Health 1485

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-805-8175 - Provider Directory for This Plan: (Florida Blue HMO (a BlueCross BlueShield FL company))

Deductible: Individual: $800 : Family: $1,600
Out of Pocket Maximum per year: Individual: $2,500 : Family: $5,000

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
$379.82
$431.09
$485.41
$678.36
$1030.83
$759.64
$862.18
$970.82
$1356.72
$2061.66
$1000.83
$1103.37
$1212.01
$1597.91
$1242.02
$1344.56
$1453.20
$1839.10
$1483.21
$1585.75
$1694.39
$2080.29
$621.01
$672.28
$726.60
$919.55
$862.20
$913.47
$967.79
$1160.74
$1103.39
$1154.66
$1208.98
$1401.93
$241.19

Plan: (HMO) BlueCare Everyday Health 1483

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-805-8175 - Provider Directory for This Plan: (Florida Blue HMO (a BlueCross BlueShield FL company))

Deductible: Individual: $6,000 : Family: $12,000
Out of Pocket Maximum per year: Individual: $6,250 : Family: $12,500

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
Bronze 21
30
40
50
60
$298.79
$339.13
$381.86
$533.64
$810.92
$597.58
$678.26
$763.72
$1067.28
$1621.84
$787.31
$867.99
$953.45
$1257.01
$977.04
$1057.72
$1143.18
$1446.74
$1166.77
$1247.45
$1332.91
$1636.47
$488.52
$528.86
$571.59
$723.37
$678.25
$718.59
$761.32
$913.10
$867.98
$908.32
$951.05
$1102.83
$189.73

Plan: (HMO) BlueCare All Copay 1491

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-805-8175 - Provider Directory for This Plan: (Florida Blue HMO (a BlueCross BlueShield FL company))

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
$395.66
$449.07
$505.65
$706.64
$1073.81
$791.32
$898.14
$1011.30
$1413.28
$2147.62
$1042.56
$1149.38
$1262.54
$1664.52
$1293.80
$1400.62
$1513.78
$1915.76
$1545.04
$1651.86
$1765.02
$2167.00
$646.90
$700.31
$756.89
$957.88
$898.14
$951.55
$1008.13
$1209.12
$1149.38
$1202.79
$1259.37
$1460.36
$251.24

Plan: (HMO) BlueCare Everyday Health 1477

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-805-8175 - Provider Directory for This Plan: (Florida Blue HMO (a BlueCross BlueShield FL company))

Deductible: Individual: $5,750 : Family: $11,500
Out of Pocket Maximum per year: Individual: $6,250 : Family: $12,500

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
Silver 21
30
40
50
60
$300.49
$341.05
$384.02
$536.67
$815.53
$600.98
$682.10
$768.04
$1073.34
$1631.06
$791.79
$872.91
$958.85
$1264.15
$982.60
$1063.72
$1149.66
$1454.96
$1173.41
$1254.53
$1340.47
$1645.77
$491.30
$531.86
$574.83
$727.48
$682.11
$722.67
$765.64
$918.29
$872.92
$913.48
$956.45
$1109.10
$190.81

Plan: (HMO) BlueCare All Copay 1565

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-805-8175 - Provider Directory for This Plan: (Florida Blue HMO (a BlueCross BlueShield FL company))

Deductible: Individual: $0 : Family: $0
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
$374.95
$425.57
$479.19
$669.67
$1017.62
$749.90
$851.14
$958.38
$1339.34
$2035.24
$988.00
$1089.24
$1196.48
$1577.44
$1226.10
$1327.34
$1434.58
$1815.54
$1464.20
$1565.44
$1672.68
$2053.64
$613.05
$663.67
$717.29
$907.77
$851.15
$901.77
$955.39
$1145.87
$1089.25
$1139.87
$1193.49
$1383.97
$238.10

Humana Medical Plan, Inc.

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

TTY: 1-800-325-2028

Plan: (HMO) Humana Basic 6600/South Florida HUMx (HMOx)

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana Medical Plan, 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
$129.13
$146.56
$165.03
$230.63
$350.46
$258.26
$293.12
$330.06
$461.26
$700.92
$340.26
$375.12
$412.06
$543.26
$422.26
$457.12
$494.06
$625.26
$504.26
$539.12
$576.06
$707.26
$211.13
$228.56
$247.03
$312.63
$293.13
$310.56
$329.03
$394.63
$375.13
$392.56
$411.03
$476.63
$82.00

Plan: (HMO) Humana Bronze 6300/South Florida HUMx (HMOx)

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana Medical Plan, 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
$155.99
$177.05
$199.36
$278.60
$423.36
$311.98
$354.10
$398.72
$557.20
$846.72
$411.03
$453.15
$497.77
$656.25
$510.08
$552.20
$596.82
$755.30
$609.13
$651.25
$695.87
$854.35
$255.04
$276.10
$298.41
$377.65
$354.09
$375.15
$397.46
$476.70
$453.14
$474.20
$496.51
$575.75
$99.05

Plan: (HMO) Humana Bronze 4850/South Florida HUMx (HMOx)

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

Deductible: Individual: $4,850 : Family: $9,700
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
Bronze 21
30
40
50
60
$175.24
$198.90
$223.96
$312.98
$475.60
$350.48
$397.80
$447.92
$625.96
$951.20
$461.76
$509.08
$559.20
$737.24
$573.04
$620.36
$670.48
$848.52
$684.32
$731.64
$781.76
$959.80
$286.52
$310.18
$335.24
$424.26
$397.80
$421.46
$446.52
$535.54
$509.08
$532.74
$557.80
$646.82
$111.28

Plan: (HMO) Humana Silver 4600/South Florida HUMx (HMOx)

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana Medical Plan, 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
$183.85
$208.67
$234.96
$328.36
$498.97
$367.70
$417.34
$469.92
$656.72
$997.94
$484.44
$534.08
$586.66
$773.46
$601.18
$650.82
$703.40
$890.20
$717.92
$767.56
$820.14
$1006.94
$300.59
$325.41
$351.70
$445.10
$417.33
$442.15
$468.44
$561.84
$534.07
$558.89
$585.18
$678.58
$116.74

Plan: (HMO) Humana Gold 2500/South Florida HUMx (HMOx)

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana Medical Plan, 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
$211.35
$239.88
$270.11
$377.47
$573.60
$422.70
$479.76
$540.22
$754.94
$1147.20
$556.91
$613.97
$674.43
$889.15
$691.12
$748.18
$808.64
$1023.36
$825.33
$882.39
$942.85
$1157.57
$345.56
$374.09
$404.32
$511.68
$479.77
$508.30
$538.53
$645.89
$613.98
$642.51
$672.74
$780.10
$134.21

Plan: (HMO) Humana Platinum 1000/South Florida HUMx (HMOx)

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana Medical Plan, 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
$245.34
$278.46
$313.54
$438.18
$665.85
$490.68
$556.92
$627.08
$876.36
$1331.70
$646.47
$712.71
$782.87
$1032.15
$802.26
$868.50
$938.66
$1187.94
$958.05
$1024.29
$1094.45
$1343.73
$401.13
$434.25
$469.33
$593.97
$556.92
$590.04
$625.12
$749.76
$712.71
$745.83
$780.91
$905.55
$155.79

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
$240.83
$273.33
$307.77
$430.11
$653.59
$481.66
$546.66
$615.54
$860.22
$1307.18
$634.58
$699.58
$768.46
$1013.14
$787.50
$852.50
$921.38
$1166.06
$940.42
$1005.42
$1074.30
$1318.98
$393.75
$426.25
$460.69
$583.03
$546.67
$579.17
$613.61
$735.95
$699.59
$732.09
$766.53
$888.87
$152.92

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: $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
Silver 21
30
40
50
60
$296.38
$336.38
$378.76
$529.32
$804.36
$592.76
$672.76
$757.52
$1058.64
$1608.72
$780.95
$860.95
$945.71
$1246.83
$969.14
$1049.14
$1133.90
$1435.02
$1157.33
$1237.33
$1322.09
$1623.21
$484.57
$524.57
$566.95
$717.51
$672.76
$712.76
$755.14
$905.70
$860.95
$900.95
$943.33
$1093.89
$188.19

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
$289.79
$328.90
$370.33
$517.54
$786.46
$579.58
$657.80
$740.66
$1035.08
$1572.92
$763.59
$841.81
$924.67
$1219.09
$947.60
$1025.82
$1108.68
$1403.10
$1131.61
$1209.83
$1292.69
$1587.11
$473.80
$512.91
$554.34
$701.55
$657.81
$696.92
$738.35
$885.56
$841.82
$880.93
$922.36
$1069.57
$184.01

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: $6,350 : 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
$287.01
$325.74
$366.78
$512.57
$778.90
$574.02
$651.48
$733.56
$1025.14
$1557.80
$756.26
$833.72
$915.80
$1207.38
$938.50
$1015.96
$1098.04
$1389.62
$1120.74
$1198.20
$1280.28
$1571.86
$469.25
$507.98
$549.02
$694.81
$651.49
$690.22
$731.26
$877.05
$833.73
$872.46
$913.50
$1059.29
$182.24

Plan: (PPO) myCigna Health Flex 5000

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

Deductible: Individual: $5,000 : Family: $10,000
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
Silver 21
30
40
50
60
$289.59
$328.67
$370.08
$517.19
$785.92
$579.18
$657.34
$740.16
$1034.38
$1571.84
$763.06
$841.22
$924.04
$1218.26
$946.94
$1025.10
$1107.92
$1402.14
$1130.82
$1208.98
$1291.80
$1586.02
$473.47
$512.55
$553.96
$701.07
$657.35
$696.43
$737.84
$884.95
$841.23
$880.31
$921.72
$1068.83
$183.88

Plan: (PPO) myCigna Copay Assure Silver

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

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
$315.42
$357.98
$403.09
$563.31
$856.01
$630.84
$715.96
$806.18
$1126.62
$1712.02
$831.12
$916.24
$1006.46
$1326.90
$1031.40
$1116.52
$1206.74
$1527.18
$1231.68
$1316.80
$1407.02
$1727.46
$515.70
$558.26
$603.37
$763.59
$715.98
$758.54
$803.65
$963.87
$916.26
$958.82
$1003.93
$1164.15
$200.28

Plan: (PPO) myCigna Health Flex 1000

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

Deductible: Individual: $1,000 : Family: $2,000
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
$335.28
$380.53
$428.47
$598.79
$909.92
$670.56
$761.06
$856.94
$1197.58
$1819.84
$883.45
$973.95
$1069.83
$1410.47
$1096.34
$1186.84
$1282.72
$1623.36
$1309.23
$1399.73
$1495.61
$1836.25
$548.17
$593.42
$641.36
$811.68
$761.06
$806.31
$854.25
$1024.57
$973.95
$1019.20
$1067.14
$1237.46
$212.89

Plan: (PPO) myCigna Copay Assure Gold

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

Deductible: Individual: $0 : Family: $0
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
$347.16
$394.01
$443.65
$620.00
$942.16
$694.32
$788.02
$887.30
$1240.00
$1884.32
$914.75
$1008.45
$1107.73
$1460.43
$1135.18
$1228.88
$1328.16
$1680.86
$1355.61
$1449.31
$1548.59
$1901.29
$567.59
$614.44
$664.08
$840.43
$788.02
$834.87
$884.51
$1060.86
$1008.45
$1055.30
$1104.94
$1281.29
$220.43

Plan: (PPO) myCigna Health Flex 5000 Bronze

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

Deductible: Individual: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

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
$250.72
$284.55
$320.40
$447.76
$680.41
$501.44
$569.10
$640.80
$895.52
$1360.82
$660.63
$728.29
$799.99
$1054.71
$819.82
$887.48
$959.18
$1213.90
$979.01
$1046.67
$1118.37
$1373.09
$409.91
$443.74
$479.59
$606.95
$569.10
$602.93
$638.78
$766.14
$728.29
$762.12
$797.97
$925.33
$159.19

Molina Marketplace

Local: 1-888-560-5716 | Toll Free: 1-888-560-5716

TTY: 1-800-955-8771

Plan: (HMO) Molina Marketplace Gold Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-560-5716 - Provider Directory for This Plan: (Molina Marketplace)

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
$261.08
$296.32
$333.66
$466.28
$708.56
$522.16
$592.64
$667.32
$932.56
$1417.12
$687.94
$758.42
$833.10
$1098.34
$853.72
$924.20
$998.88
$1264.12
$1019.50
$1089.98
$1164.66
$1429.90
$426.86
$462.10
$499.44
$632.06
$592.64
$627.88
$665.22
$797.84
$758.42
$793.66
$831.00
$963.62
$165.78

Plan: (HMO) Molina Marketplace Silver Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-560-5716 - Provider Directory for This Plan: (Molina Marketplace)

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
$226.34
$256.90
$289.27
$404.25
$614.30
$452.68
$513.80
$578.54
$808.50
$1228.60
$596.41
$657.53
$722.27
$952.23
$740.14
$801.26
$866.00
$1095.96
$883.87
$944.99
$1009.73
$1239.69
$370.07
$400.63
$433.00
$547.98
$513.80
$544.36
$576.73
$691.71
$657.53
$688.09
$720.46
$835.44
$143.73

Plan: (HMO) Molina Marketplace Bronze Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-560-5716 - Provider Directory for This Plan: (Molina Marketplace)

Deductible: Individual: $4,500 : Family: $9,000
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
$192.77
$218.79
$246.36
$344.28
$523.17
$385.54
$437.58
$492.72
$688.56
$1046.34
$507.95
$559.99
$615.13
$810.97
$630.36
$682.40
$737.54
$933.38
$752.77
$804.81
$859.95
$1055.79
$315.18
$341.20
$368.77
$466.69
$437.59
$463.61
$491.18
$589.10
$560.00
$586.02
$613.59
$711.51
$122.41

CoventryOne

Local: 1-855-449-2889 | Toll Free: 1-855-449-2889

TTY: 1-888-444-7352

Plan: (HMO) Coventry Gold $5 Copay Carelink HMO

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-449-2889 - Provider Directory for This Plan: (CoventryOne)

Deductible: Individual: $1,400 : Family: $2,800
Out of Pocket Maximum per year: Individual: $5,650 : Family: $11,300

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
$248.50
$282.04
$317.58
$443.81
$674.42
$497.00
$564.08
$635.16
$887.62
$1348.84
$654.79
$721.87
$792.95
$1045.41
$812.58
$879.66
$950.74
$1203.20
$970.37
$1037.45
$1108.53
$1360.99
$406.29
$439.83
$475.37
$601.60
$564.08
$597.62
$633.16
$759.39
$721.87
$755.41
$790.95
$917.18
$157.79

Plan: (HMO) Coventry Silver $10 Copay Carelink HMO

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-449-2889 - Provider Directory for This Plan: (CoventryOne)

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
$225.76
$256.24
$288.52
$403.20
$612.71
$451.52
$512.48
$577.04
$806.40
$1225.42
$594.88
$655.84
$720.40
$949.76
$738.24
$799.20
$863.76
$1093.12
$881.60
$942.56
$1007.12
$1236.48
$369.12
$399.60
$431.88
$546.56
$512.48
$542.96
$575.24
$689.92
$655.84
$686.32
$718.60
$833.28
$143.36

Plan: (HMO) Coventry Bronze $20 Copay Carelink HMO

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-449-2889 - Provider Directory for This Plan: (CoventryOne)

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
$182.01
$206.58
$232.60
$325.06
$493.96
$364.02
$413.16
$465.20
$650.12
$987.92
$479.59
$528.73
$580.77
$765.69
$595.16
$644.30
$696.34
$881.26
$710.73
$759.87
$811.91
$996.83
$297.58
$322.15
$348.17
$440.63
$413.15
$437.72
$463.74
$556.20
$528.72
$553.29
$579.31
$671.77
$115.57

Plan: (HMO) Coventry Bronze Ded Only HSA Eligible Carelink HMO

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-449-2889 - Provider Directory for This Plan: (CoventryOne)

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
$172.27
$195.53
$220.16
$307.68
$467.54
$344.54
$391.06
$440.32
$615.36
$935.08
$453.93
$500.45
$549.71
$724.75
$563.32
$609.84
$659.10
$834.14
$672.71
$719.23
$768.49
$943.53
$281.66
$304.92
$329.55
$417.07
$391.05
$414.31
$438.94
$526.46
$500.44
$523.70
$548.33
$635.85
$109.39

Plan: (HMO) Coventry Silver $5 Copay 2750 Carelink HMO

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-449-2889 - Provider Directory for This Plan: (CoventryOne)

Deductible: Individual: $2,750 : Family: $5,500
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
$224.77
$255.11
$287.25
$401.44
$610.02
$449.54
$510.22
$574.50
$802.88
$1220.04
$592.27
$652.95
$717.23
$945.61
$735.00
$795.68
$859.96
$1088.34
$877.73
$938.41
$1002.69
$1231.07
$367.50
$397.84
$429.98
$544.17
$510.23
$540.57
$572.71
$686.90
$652.96
$683.30
$715.44
$829.63
$142.73

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
$260.97
$296.20
$333.52
$466.09
$708.27
$521.94
$592.40
$667.04
$932.18
$1416.54
$687.66
$758.12
$832.76
$1097.90
$853.38
$923.84
$998.48
$1263.62
$1019.10
$1089.56
$1164.20
$1429.34
$426.69
$461.92
$499.24
$631.81
$592.41
$627.64
$664.96
$797.53
$758.13
$793.36
$830.68
$963.25
$165.72

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
$310.70
$352.64
$397.07
$554.91
$843.24
$621.40
$705.28
$794.14
$1109.82
$1686.48
$818.69
$902.57
$991.43
$1307.11
$1015.98
$1099.86
$1188.72
$1504.40
$1213.27
$1297.15
$1386.01
$1701.69
$507.99
$549.93
$594.36
$752.20
$705.28
$747.22
$791.65
$949.49
$902.57
$944.51
$988.94
$1146.78
$197.29

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
$270.15
$306.62
$345.25
$482.49
$733.19
$540.30
$613.24
$690.50
$964.98
$1466.38
$711.85
$784.79
$862.05
$1136.53
$883.40
$956.34
$1033.60
$1308.08
$1054.95
$1127.89
$1205.15
$1479.63
$441.70
$478.17
$516.80
$654.04
$613.25
$649.72
$688.35
$825.59
$784.80
$821.27
$859.90
$997.14
$171.55

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
$316.71
$359.47
$404.76
$565.64
$859.55
$633.42
$718.94
$809.52
$1131.28
$1719.10
$834.53
$920.05
$1010.63
$1332.39
$1035.64
$1121.16
$1211.74
$1533.50
$1236.75
$1322.27
$1412.85
$1734.61
$517.82
$560.58
$605.87
$766.75
$718.93
$761.69
$806.98
$967.86
$920.04
$962.80
$1008.09
$1168.97
$201.11

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
$381.32
$432.80
$487.33
$681.04
$1034.90
$762.64
$865.60
$974.66
$1362.08
$2069.80
$1004.78
$1107.74
$1216.80
$1604.22
$1246.92
$1349.88
$1458.94
$1846.36
$1489.06
$1592.02
$1701.08
$2088.50
$623.46
$674.94
$729.47
$923.18
$865.60
$917.08
$971.61
$1165.32
$1107.74
$1159.22
$1213.75
$1407.46
$242.14

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
$435.48
$494.27
$556.54
$777.77
$1181.89
$870.96
$988.54
$1113.08
$1555.54
$2363.78
$1147.49
$1265.07
$1389.61
$1832.07
$1424.02
$1541.60
$1666.14
$2108.60
$1700.55
$1818.13
$1942.67
$2385.13
$712.01
$770.80
$833.07
$1054.30
$988.54
$1047.33
$1109.60
$1330.83
$1265.07
$1323.86
$1386.13
$1607.36
$276.53

UnitedHealthcare

Local: 1-877-632-4195 | Toll Free: 1-877-632-4195

Plan: (HMO) United Healthcare Platinum Compass 250

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-632-4195 - 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
$296.71
$336.77
$379.20
$529.92
$805.27
$593.42
$673.54
$758.40
$1059.84
$1610.54
$781.83
$861.95
$946.81
$1248.25
$970.24
$1050.36
$1135.22
$1436.66
$1158.65
$1238.77
$1323.63
$1625.07
$485.12
$525.18
$567.61
$718.33
$673.53
$713.59
$756.02
$906.74
$861.94
$902.00
$944.43
$1095.15
$188.41

Plan: (HMO) United Healthcare Gold Compass 1500-3

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-632-4195 - Provider Directory for This Plan: (UnitedHealthcare)

Deductible: Individual: $1,500 : Family: $3,000
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
$268.30
$304.52
$342.89
$479.18
$728.17
$536.60
$609.04
$685.78
$958.36
$1456.34
$706.97
$779.41
$856.15
$1128.73
$877.34
$949.78
$1026.52
$1299.10
$1047.71
$1120.15
$1196.89
$1469.47
$438.67
$474.89
$513.26
$649.55
$609.04
$645.26
$683.63
$819.92
$779.41
$815.63
$854.00
$990.29
$170.37

Plan: (HMO) United Healthcare Gold Compass H.S.A. 1300

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-632-4195 - Provider Directory for This Plan: (UnitedHealthcare)

Deductible: Individual: $1,300 : Family: $2,600
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
$262.80
$298.28
$335.86
$469.36
$713.24
$525.60
$596.56
$671.72
$938.72
$1426.48
$692.48
$763.44
$838.60
$1105.60
$859.36
$930.32
$1005.48
$1272.48
$1026.24
$1097.20
$1172.36
$1439.36
$429.68
$465.16
$502.74
$636.24
$596.56
$632.04
$669.62
$803.12
$763.44
$798.92
$836.50
$970.00
$166.88

Plan: (HMO) United Healthcare Silver Compass 4000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-632-4195 - Provider Directory for This Plan: (UnitedHealthcare)

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
$247.68
$281.12
$316.54
$442.36
$672.20
$495.36
$562.24
$633.08
$884.72
$1344.40
$652.64
$719.52
$790.36
$1042.00
$809.92
$876.80
$947.64
$1199.28
$967.20
$1034.08
$1104.92
$1356.56
$404.96
$438.40
$473.82
$599.64
$562.24
$595.68
$631.10
$756.92
$719.52
$752.96
$788.38
$914.20
$157.28

Plan: (HMO) United Healthcare Silver Compass H.S.A. 3600

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-632-4195 - Provider Directory for This Plan: (UnitedHealthcare)

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

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
$229.12
$260.05
$292.82
$409.21
$621.83
$458.24
$520.10
$585.64
$818.42
$1243.66
$603.73
$665.59
$731.13
$963.91
$749.22
$811.08
$876.62
$1109.40
$894.71
$956.57
$1022.11
$1254.89
$374.61
$405.54
$438.31
$554.70
$520.10
$551.03
$583.80
$700.19
$665.59
$696.52
$729.29
$845.68
$145.49

Plan: (HMO) United Healthcare Bronze Compass 4200

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-632-4195 - Provider Directory for This Plan: (UnitedHealthcare)

Deductible: Individual: $4,200 : Family: $8,400
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
$204.15
$231.71
$260.90
$364.61
$554.06
$408.30
$463.42
$521.80
$729.22
$1108.12
$537.94
$593.06
$651.44
$858.86
$667.58
$722.70
$781.08
$988.50
$797.22
$852.34
$910.72
$1118.14
$333.79
$361.35
$390.54
$494.25
$463.43
$490.99
$520.18
$623.89
$593.07
$620.63
$649.82
$753.53
$129.64

Plan: (HMO) United Healthcare Bronze Compass H.S.A. 6275

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-632-4195 - Provider Directory for This Plan: (UnitedHealthcare)

Deductible: Individual: $6,275 : Family: $12,550
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
$189.03
$214.55
$241.58
$337.61
$513.03
$378.06
$429.10
$483.16
$675.22
$1026.06
$498.09
$549.13
$603.19
$795.25
$618.12
$669.16
$723.22
$915.28
$738.15
$789.19
$843.25
$1035.31
$309.06
$334.58
$361.61
$457.64
$429.09
$454.61
$481.64
$577.67
$549.12
$574.64
$601.67
$697.70
$120.03

Plan: (HMO) United Healthcare Catastrophic Compass 6600

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-632-4195 - 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
$183.07
$207.78
$233.96
$326.96
$496.85
$366.14
$415.56
$467.92
$653.92
$993.70
$482.39
$531.81
$584.17
$770.17
$598.64
$648.06
$700.42
$886.42
$714.89
$764.31
$816.67
$1002.67
$299.32
$324.03
$350.21
$443.21
$415.57
$440.28
$466.46
$559.46
$531.82
$556.53
$582.71
$675.71
$116.25

Ambetter from Sunshine Health

Local: 1-877-687-1169 | Toll Free: 1-877-687-1169

TTY: 1-877-941-9230

Plan: (HMO) Ambetter Secure Care 2

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1169 - Provider Directory for This Plan: (Ambetter from Sunshine Health)

Deductible: Individual: $500 : Family: $1,000
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
Gold 21
30
40
50
60
$304.23
$345.28
$388.79
$543.33
$825.64
$608.46
$690.56
$777.58
$1086.66
$1651.28
$801.64
$883.74
$970.76
$1279.84
$994.82
$1076.92
$1163.94
$1473.02
$1188.00
$1270.10
$1357.12
$1666.20
$497.41
$538.46
$581.97
$736.51
$690.59
$731.64
$775.15
$929.69
$883.77
$924.82
$968.33
$1122.87
$193.18

Plan: (HMO) Ambetter Secure Care 1 with 3 Free PCP Visits

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1169 - Provider Directory for This Plan: (Ambetter from Sunshine Health)

Deductible: Individual: $1,000 : Family: $2,000
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
Gold 21
30
40
50
60
$301.39
$342.07
$385.16
$538.26
$817.94
$602.78
$684.14
$770.32
$1076.52
$1635.88
$794.16
$875.52
$961.70
$1267.90
$985.54
$1066.90
$1153.08
$1459.28
$1176.92
$1258.28
$1344.46
$1650.66
$492.77
$533.45
$576.54
$729.64
$684.15
$724.83
$767.92
$921.02
$875.53
$916.21
$959.30
$1112.40
$191.38

Plan: (HMO) Ambetter Balanced Care 3

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1169 - Provider Directory for This Plan: (Ambetter from Sunshine Health)

Deductible: Individual: $2,500 : Family: $5,000
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
$258.34
$293.20
$330.14
$461.37
$701.09
$516.68
$586.40
$660.28
$922.74
$1402.18
$680.72
$750.44
$824.32
$1086.78
$844.76
$914.48
$988.36
$1250.82
$1008.80
$1078.52
$1152.40
$1414.86
$422.38
$457.24
$494.18
$625.41
$586.42
$621.28
$658.22
$789.45
$750.46
$785.32
$822.26
$953.49
$164.04

Plan: (HMO) Ambetter Balanced Care 4

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1169 - Provider Directory for This Plan: (Ambetter from Sunshine 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
$251.63
$285.59
$321.57
$449.40
$682.90
$503.26
$571.18
$643.14
$898.80
$1365.80
$663.04
$730.96
$802.92
$1058.58
$822.82
$890.74
$962.70
$1218.36
$982.60
$1050.52
$1122.48
$1378.14
$411.41
$445.37
$481.35
$609.18
$571.19
$605.15
$641.13
$768.96
$730.97
$764.93
$800.91
$928.74
$159.78

Plan: (HMO) Ambetter Balanced Care 5

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1169 - Provider Directory for This Plan: (Ambetter from Sunshine Health)

Deductible: Individual: $3,000 : Family: $6,000
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
$257.82
$292.61
$329.48
$460.45
$699.69
$515.64
$585.22
$658.96
$920.90
$1399.38
$679.35
$748.93
$822.67
$1084.61
$843.06
$912.64
$986.38
$1248.32
$1006.77
$1076.35
$1150.09
$1412.03
$421.53
$456.32
$493.19
$624.16
$585.24
$620.03
$656.90
$787.87
$748.95
$783.74
$820.61
$951.58
$163.71

Plan: (HMO) Ambetter Essential Care 3 with 3 Free PCP Visits

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1169 - Provider Directory for This Plan: (Ambetter from Sunshine Health)

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
$198.01
$224.73
$253.04
$353.62
$537.37
$396.02
$449.46
$506.08
$707.24
$1074.74
$521.75
$575.19
$631.81
$832.97
$647.48
$700.92
$757.54
$958.70
$773.21
$826.65
$883.27
$1084.43
$323.74
$350.46
$378.77
$479.35
$449.47
$476.19
$504.50
$605.08
$575.20
$601.92
$630.23
$730.81
$125.73

Plan: (HMO) Ambetter Essential Care 4 with 3 Free PCP Visits

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1169 - Provider Directory for This Plan: (Ambetter from Sunshine Health)

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
Bronze 21
30
40
50
60
$207.03
$234.97
$264.57
$369.74
$561.85
$414.06
$469.94
$529.14
$739.48
$1123.70
$545.52
$601.40
$660.60
$870.94
$676.98
$732.86
$792.06
$1002.40
$808.44
$864.32
$923.52
$1133.86
$338.49
$366.43
$396.03
$501.20
$469.95
$497.89
$527.49
$632.66
$601.41
$629.35
$658.95
$764.12
$131.46

Plan: (HMO) Ambetter Balanced Care 2

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1169 - Provider Directory for This Plan: (Ambetter from Sunshine Health)

Deductible: Individual: $5,000 : Family: $10,000
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
Silver 21
30
40
50
60
$238.74
$270.96
$305.10
$426.37
$647.92
$477.48
$541.92
$610.20
$852.74
$1295.84
$629.07
$693.51
$761.79
$1004.33
$780.66
$845.10
$913.38
$1155.92
$932.25
$996.69
$1064.97
$1307.51
$390.33
$422.55
$456.69
$577.96
$541.92
$574.14
$608.28
$729.55
$693.51
$725.73
$759.87
$881.14
$151.59

Plan: (HMO) Ambetter Balanced Care 1

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1169 - Provider Directory for This Plan: (Ambetter from Sunshine 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
Silver 21
30
40
50
60
$248.80
$282.37
$317.95
$444.33
$675.21
$497.60
$564.74
$635.90
$888.66
$1350.42
$655.58
$722.72
$793.88
$1046.64
$813.56
$880.70
$951.86
$1204.62
$971.54
$1038.68
$1109.84
$1362.60
$406.78
$440.35
$475.93
$602.31
$564.76
$598.33
$633.91
$760.29
$722.74
$756.31
$791.89
$918.27
$157.98

Plan: (HMO) Ambetter Essential Care 2

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1169 - Provider Directory for This Plan: (Ambetter from Sunshine Health)

Deductible: Individual: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

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
$197.23
$223.85
$252.05
$352.24
$535.27
$394.46
$447.70
$504.10
$704.48
$1070.54
$519.70
$572.94
$629.34
$829.72
$644.94
$698.18
$754.58
$954.96
$770.18
$823.42
$879.82
$1080.20
$322.47
$349.09
$377.29
$477.48
$447.71
$474.33
$502.53
$602.72
$572.95
$599.57
$627.77
$727.96
$125.24

Plan: (HMO) Ambetter Essential Care 1

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1169 - Provider Directory for This Plan: (Ambetter from Sunshine Health)

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

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
$194.91
$221.22
$249.09
$348.10
$528.97
$389.82
$442.44
$498.18
$696.20
$1057.94
$513.58
$566.20
$621.94
$819.96
$637.34
$689.96
$745.70
$943.72
$761.10
$813.72
$869.46
$1067.48
$318.67
$344.98
$372.85
$471.86
$442.43
$468.74
$496.61
$595.62
$566.19
$592.50
$620.37
$719.38
$123.76

Plan: (HMO) Ambetter Secure Care 2 + Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1169 - Provider Directory for This Plan: (Ambetter from Sunshine Health)

Deductible: Individual: $500 : Family: $1,000
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
Gold 21
30
40
50
60
$309.88
$351.70
$396.02
$553.43
$840.99
$619.76
$703.40
$792.04
$1106.86
$1681.98
$816.53
$900.17
$988.81
$1303.63
$1013.30
$1096.94
$1185.58
$1500.40
$1210.07
$1293.71
$1382.35
$1697.17
$506.65
$548.47
$592.79
$750.20
$703.42
$745.24
$789.56
$946.97
$900.19
$942.01
$986.33
$1143.74
$196.77

Plan: (HMO) Ambetter Secure Care 1 with 3 Free PCP Visits + Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1169 - Provider Directory for This Plan: (Ambetter from Sunshine Health)

Deductible: Individual: $1,000 : Family: $2,000
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
Gold 21
30
40
50
60
$306.99
$348.43
$392.32
$548.27
$833.15
$613.98
$696.86
$784.64
$1096.54
$1666.30
$808.91
$891.79
$979.57
$1291.47
$1003.84
$1086.72
$1174.50
$1486.40
$1198.77
$1281.65
$1369.43
$1681.33
$501.92
$543.36
$587.25
$743.20
$696.85
$738.29
$782.18
$938.13
$891.78
$933.22
$977.11
$1133.06
$194.93

Plan: (HMO) Ambetter Balanced Care 3 + Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1169 - Provider Directory for This Plan: (Ambetter from Sunshine Health)

Deductible: Individual: $2,500 : Family: $5,000
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
$263.14
$298.65
$336.28
$469.95
$714.13
$526.28
$597.30
$672.56
$939.90
$1428.26
$693.37
$764.39
$839.65
$1106.99
$860.46
$931.48
$1006.74
$1274.08
$1027.55
$1098.57
$1173.83
$1441.17
$430.23
$465.74
$503.37
$637.04
$597.32
$632.83
$670.46
$804.13
$764.41
$799.92
$837.55
$971.22
$167.09

Plan: (HMO) Ambetter Balanced Care 4 + Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1169 - Provider Directory for This Plan: (Ambetter from Sunshine 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
$256.31
$290.90
$327.55
$457.75
$695.60
$512.62
$581.80
$655.10
$915.50
$1391.20
$675.37
$744.55
$817.85
$1078.25
$838.12
$907.30
$980.60
$1241.00
$1000.87
$1070.05
$1143.35
$1403.75
$419.06
$453.65
$490.30
$620.50
$581.81
$616.40
$653.05
$783.25
$744.56
$779.15
$815.80
$946.00
$162.75

Plan: (HMO) Ambetter Balanced Care 5 + Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1169 - Provider Directory for This Plan: (Ambetter from Sunshine Health)

Deductible: Individual: $3,000 : Family: $6,000
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
$262.61
$298.05
$335.61
$469.01
$712.71
$525.22
$596.10
$671.22
$938.02
$1425.42
$691.97
$762.85
$837.97
$1104.77
$858.72
$929.60
$1004.72
$1271.52
$1025.47
$1096.35
$1171.47
$1438.27
$429.36
$464.80
$502.36
$635.76
$596.11
$631.55
$669.11
$802.51
$762.86
$798.30
$835.86
$969.26
$166.75

Plan: (HMO) Ambetter Essential Care 3 with 3 Free PCP Visits + Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1169 - Provider Directory for This Plan: (Ambetter from Sunshine Health)

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
$201.69
$228.91
$257.75
$360.20
$547.36
$403.38
$457.82
$515.50
$720.40
$1094.72
$531.45
$585.89
$643.57
$848.47
$659.52
$713.96
$771.64
$976.54
$787.59
$842.03
$899.71
$1104.61
$329.76
$356.98
$385.82
$488.27
$457.83
$485.05
$513.89
$616.34
$585.90
$613.12
$641.96
$744.41
$128.07

Plan: (HMO) Ambetter Essential Care 4 with 3 Free PCP Visits + Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1169 - Provider Directory for This Plan: (Ambetter from Sunshine Health)

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
Bronze 21
30
40
50
60
$210.88
$239.34
$269.49
$376.61
$572.30
$421.76
$478.68
$538.98
$753.22
$1144.60
$555.66
$612.58
$672.88
$887.12
$689.56
$746.48
$806.78
$1021.02
$823.46
$880.38
$940.68
$1154.92
$344.78
$373.24
$403.39
$510.51
$478.68
$507.14
$537.29
$644.41
$612.58
$641.04
$671.19
$778.31
$133.90

Plan: (HMO) Ambetter Balanced Care 2 + Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1169 - Provider Directory for This Plan: (Ambetter from Sunshine Health)

Deductible: Individual: $5,000 : Family: $10,000
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
Silver 21
30
40
50
60
$243.18
$276.00
$310.77
$434.30
$659.97
$486.36
$552.00
$621.54
$868.60
$1319.94
$640.77
$706.41
$775.95
$1023.01
$795.18
$860.82
$930.36
$1177.42
$949.59
$1015.23
$1084.77
$1331.83
$397.59
$430.41
$465.18
$588.71
$552.00
$584.82
$619.59
$743.12
$706.41
$739.23
$774.00
$897.53
$154.41

Plan: (HMO) Ambetter Balanced Care 1 + Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1169 - Provider Directory for This Plan: (Ambetter from Sunshine 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
Silver 21
30
40
50
60
$253.42
$287.62
$323.86
$452.59
$687.76
$506.84
$575.24
$647.72
$905.18
$1375.52
$667.76
$736.16
$808.64
$1066.10
$828.68
$897.08
$969.56
$1227.02
$989.60
$1058.00
$1130.48
$1387.94
$414.34
$448.54
$484.78
$613.51
$575.26
$609.46
$645.70
$774.43
$736.18
$770.38
$806.62
$935.35
$160.92

Plan: (HMO) Ambetter Essential Care 2 + Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1169 - Provider Directory for This Plan: (Ambetter from Sunshine Health)

Deductible: Individual: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

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
$200.90
$228.01
$256.74
$358.79
$545.22
$401.80
$456.02
$513.48
$717.58
$1090.44
$529.37
$583.59
$641.05
$845.15
$656.94
$711.16
$768.62
$972.72
$784.51
$838.73
$896.19
$1100.29
$328.47
$355.58
$384.31
$486.36
$456.04
$483.15
$511.88
$613.93
$583.61
$610.72
$639.45
$741.50
$127.57

Plan: (HMO) Ambetter Essential Care 1 + Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1169 - Provider Directory for This Plan: (Ambetter from Sunshine Health)

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

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
$198.54
$225.33
$253.72
$354.57
$538.81
$397.08
$450.66
$507.44
$709.14
$1077.62
$523.15
$576.73
$633.51
$835.21
$649.22
$702.80
$759.58
$961.28
$775.29
$828.87
$885.65
$1087.35
$324.61
$351.40
$379.79
$480.64
$450.68
$477.47
$505.86
$606.71
$576.75
$603.54
$631.93
$732.78
$126.07

Plan: (HMO) Ambetter Secure Care 2 + Vision + Adult Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1169 - Provider Directory for This Plan: (Ambetter from Sunshine Health)

Deductible: Individual: $500 : Family: $1,000
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
Gold 21
30
40
50
60
$319.74
$362.89
$408.62
$571.04
$867.75
$639.48
$725.78
$817.24
$1142.08
$1735.50
$842.51
$928.81
$1020.27
$1345.11
$1045.54
$1131.84
$1223.30
$1548.14
$1248.57
$1334.87
$1426.33
$1751.17
$522.77
$565.92
$611.65
$774.07
$725.80
$768.95
$814.68
$977.10
$928.83
$971.98
$1017.71
$1180.13
$203.03

Plan: (HMO) Ambetter Secure Care 1 with 3 Free PCP Visits + Vision + Adult Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1169 - Provider Directory for This Plan: (Ambetter from Sunshine Health)

Deductible: Individual: $1,000 : Family: $2,000
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
Gold 21
30
40
50
60
$316.76
$359.51
$404.81
$565.72
$859.66
$633.52
$719.02
$809.62
$1131.44
$1719.32
$834.66
$920.16
$1010.76
$1332.58
$1035.80
$1121.30
$1211.90
$1533.72
$1236.94
$1322.44
$1413.04
$1734.86
$517.90
$560.65
$605.95
$766.86
$719.04
$761.79
$807.09
$968.00
$920.18
$962.93
$1008.23
$1169.14
$201.14

Plan: (HMO) Ambetter Balanced Care 3 + Vision + Adult Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1169 - Provider Directory for This Plan: (Ambetter from Sunshine Health)

Deductible: Individual: $2,500 : Family: $5,000
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
$271.51
$308.15
$346.98
$484.90
$736.85
$543.02
$616.30
$693.96
$969.80
$1473.70
$715.42
$788.70
$866.36
$1142.20
$887.82
$961.10
$1038.76
$1314.60
$1060.22
$1133.50
$1211.16
$1487.00
$443.91
$480.55
$519.38
$657.30
$616.31
$652.95
$691.78
$829.70
$788.71
$825.35
$864.18
$1002.10
$172.40

Plan: (HMO) Ambetter Balanced Care 4 + Vision + Adult Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1169 - Provider Directory for This Plan: (Ambetter from Sunshine 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
$264.47
$300.16
$337.97
$472.32
$717.73
$528.94
$600.32
$675.94
$944.64
$1435.46
$696.87
$768.25
$843.87
$1112.57
$864.80
$936.18
$1011.80
$1280.50
$1032.73
$1104.11
$1179.73
$1448.43
$432.40
$468.09
$505.90
$640.25
$600.33
$636.02
$673.83
$808.18
$768.26
$803.95
$841.76
$976.11
$167.93

Plan: (HMO) Ambetter Balanced Care 5 + Vision + Adult Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1169 - Provider Directory for This Plan: (Ambetter from Sunshine Health)

Deductible: Individual: $3,000 : Family: $6,000
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
$270.97
$307.54
$346.29
$483.93
$735.38
$541.94
$615.08
$692.58
$967.86
$1470.76
$714.00
$787.14
$864.64
$1139.92
$886.06
$959.20
$1036.70
$1311.98
$1058.12
$1131.26
$1208.76
$1484.04
$443.03
$479.60
$518.35
$655.99
$615.09
$651.66
$690.41
$828.05
$787.15
$823.72
$862.47
$1000.11
$172.06

Plan: (HMO) Ambetter Essential Care 3 with 3 Free PCP Visits + Vision + Adult Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1169 - Provider Directory for This Plan: (Ambetter from Sunshine Health)

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
$208.11
$236.19
$265.95
$371.66
$564.77
$416.22
$472.38
$531.90
$743.32
$1129.54
$548.36
$604.52
$664.04
$875.46
$680.50
$736.66
$796.18
$1007.60
$812.64
$868.80
$928.32
$1139.74
$340.25
$368.33
$398.09
$503.80
$472.39
$500.47
$530.23
$635.94
$604.53
$632.61
$662.37
$768.08
$132.14

Plan: (HMO) Ambetter Essential Care 4 with 3 Free PCP Visits + Vision + Adult Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1169 - Provider Directory for This Plan: (Ambetter from Sunshine Health)

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
Bronze 21
30
40
50
60
$217.59
$246.95
$278.07
$388.60
$590.51
$435.18
$493.90
$556.14
$777.20
$1181.02
$573.34
$632.06
$694.30
$915.36
$711.50
$770.22
$832.46
$1053.52
$849.66
$908.38
$970.62
$1191.68
$355.75
$385.11
$416.23
$526.76
$493.91
$523.27
$554.39
$664.92
$632.07
$661.43
$692.55
$803.08
$138.16

Plan: (HMO) Ambetter Balanced Care 2 + Vision + Adult Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1169 - Provider Directory for This Plan: (Ambetter from Sunshine Health)

Deductible: Individual: $5,000 : Family: $10,000
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
Silver 21
30
40
50
60
$250.92
$284.78
$320.66
$448.12
$680.96
$501.84
$569.56
$641.32
$896.24
$1361.92
$661.17
$728.89
$800.65
$1055.57
$820.50
$888.22
$959.98
$1214.90
$979.83
$1047.55
$1119.31
$1374.23
$410.25
$444.11
$479.99
$607.45
$569.58
$603.44
$639.32
$766.78
$728.91
$762.77
$798.65
$926.11
$159.33

Plan: (HMO) Ambetter Balanced Care 1 + Vision + Adult Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1169 - Provider Directory for This Plan: (Ambetter from Sunshine 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
Silver 21
30
40
50
60
$261.49
$296.77
$334.17
$466.99
$709.64
$522.98
$593.54
$668.34
$933.98
$1419.28
$689.02
$759.58
$834.38
$1100.02
$855.06
$925.62
$1000.42
$1266.06
$1021.10
$1091.66
$1166.46
$1432.10
$427.53
$462.81
$500.21
$633.03
$593.57
$628.85
$666.25
$799.07
$759.61
$794.89
$832.29
$965.11
$166.04

Plan: (HMO) Ambetter Essential Care 2 + Vision + Adult Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1169 - Provider Directory for This Plan: (Ambetter from Sunshine Health)

Deductible: Individual: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

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
$207.29
$235.27
$264.91
$370.21
$562.57
$414.58
$470.54
$529.82
$740.42
$1125.14
$546.20
$602.16
$661.44
$872.04
$677.82
$733.78
$793.06
$1003.66
$809.44
$865.40
$924.68
$1135.28
$338.91
$366.89
$396.53
$501.83
$470.53
$498.51
$528.15
$633.45
$602.15
$630.13
$659.77
$765.07
$131.62

Plan: (HMO) Ambetter Essential Care 1 + Vision + Adult Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1169 - Provider Directory for This Plan: (Ambetter from Sunshine Health)

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

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
$204.85
$232.50
$261.79
$365.85
$555.95
$409.70
$465.00
$523.58
$731.70
$1111.90
$539.78
$595.08
$653.66
$861.78
$669.86
$725.16
$783.74
$991.86
$799.94
$855.24
$913.82
$1121.94
$334.93
$362.58
$391.87
$495.93
$465.01
$492.66
$521.95
$626.01
$595.09
$622.74
$652.03
$756.09
$130.08

†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 Palm Beach County here.

 

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