Providers for Zip Code 44256

Obamacare 2015 Marketplace Rates For Medina County, Ohio

Saturday, November 22nd, 2014

Click for Medina, Ohio 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 Medina County, Ohio.

Obamacare Providers, Plans and 2015 Rates for Medina County

Medina County is in “Rating Area 11” of Ohio.

Currently, there are 8 providers offering 50 plans to Rating Area 11.

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

The table below shows premiums for the following scenarios for:

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

Each scenario is covered for age

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

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

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

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
$317.75
$360.65
$406.08
$567.50
$862.37
$635.50
$721.30
$812.16
$1135.00
$1724.74
$837.27
$923.07
$1013.93
$1336.77
$1039.04
$1124.84
$1215.70
$1538.54
$1240.81
$1326.61
$1417.47
$1740.31
$519.52
$562.42
$607.85
$769.27
$721.29
$764.19
$809.62
$971.04
$923.06
$965.96
$1011.39
$1172.81
$201.77

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
$378.32
$429.39
$483.49
$675.68
$1026.76
$756.64
$858.78
$966.98
$1351.36
$2053.52
$996.87
$1099.01
$1207.21
$1591.59
$1237.10
$1339.24
$1447.44
$1831.82
$1477.33
$1579.47
$1687.67
$2072.05
$618.55
$669.62
$723.72
$915.91
$858.78
$909.85
$963.95
$1156.14
$1099.01
$1150.08
$1204.18
$1396.37
$240.23

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
$328.87
$373.27
$420.30
$587.36
$892.55
$657.74
$746.54
$840.60
$1174.72
$1785.10
$866.57
$955.37
$1049.43
$1383.55
$1075.40
$1164.20
$1258.26
$1592.38
$1284.23
$1373.03
$1467.09
$1801.21
$537.70
$582.10
$629.13
$796.19
$746.53
$790.93
$837.96
$1005.02
$955.36
$999.76
$1046.79
$1213.85
$208.83

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
$385.60
$437.66
$492.80
$688.68
$1046.52
$771.20
$875.32
$985.60
$1377.36
$2093.04
$1016.06
$1120.18
$1230.46
$1622.22
$1260.92
$1365.04
$1475.32
$1867.08
$1505.78
$1609.90
$1720.18
$2111.94
$630.46
$682.52
$737.66
$933.54
$875.32
$927.38
$982.52
$1178.40
$1120.18
$1172.24
$1227.38
$1423.26
$244.86

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
$464.55
$527.26
$593.69
$829.69
$1260.79
$929.10
$1054.52
$1187.38
$1659.38
$2521.58
$1224.09
$1349.51
$1482.37
$1954.37
$1519.08
$1644.50
$1777.36
$2249.36
$1814.07
$1939.49
$2072.35
$2544.35
$759.54
$822.25
$888.68
$1124.68
$1054.53
$1117.24
$1183.67
$1419.67
$1349.52
$1412.23
$1478.66
$1714.66
$294.99

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
$530.48
$602.09
$677.95
$947.44
$1439.72
$1060.96
$1204.18
$1355.90
$1894.88
$2879.44
$1397.81
$1541.03
$1692.75
$2231.73
$1734.66
$1877.88
$2029.60
$2568.58
$2071.51
$2214.73
$2366.45
$2905.43
$867.33
$938.94
$1014.80
$1284.29
$1204.18
$1275.79
$1351.65
$1621.14
$1541.03
$1612.64
$1688.50
$1957.99
$336.85

InHealth Mutual

Local: 1-614-212-6004 | Toll Free: 1-800-580-8502

TTY: 1-800-545-8279

Plan: (PPO) InHealth Gold 2000-2080

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-580-8502 - Provider Directory for This Plan: (InHealth Mutual)

Deductible: Individual: $2,000 : Family: $4,000
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
$307.15
$348.62
$392.54
$548.57
$833.61
$614.30
$697.24
$785.08
$1097.14
$1667.22
$809.34
$892.28
$980.12
$1292.18
$1004.38
$1087.32
$1175.16
$1487.22
$1199.42
$1282.36
$1370.20
$1682.26
$502.19
$543.66
$587.58
$743.61
$697.23
$738.70
$782.62
$938.65
$892.27
$933.74
$977.66
$1133.69
$195.04

Plan: (PPO) InHealth Silver 2000-3070

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-580-8502 - Provider Directory for This Plan: (InHealth Mutual)

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
$280.48
$318.34
$358.45
$500.93
$761.21
$560.96
$636.68
$716.90
$1001.86
$1522.42
$739.06
$814.78
$895.00
$1179.96
$917.16
$992.88
$1073.10
$1358.06
$1095.26
$1170.98
$1251.20
$1536.16
$458.58
$496.44
$536.55
$679.03
$636.68
$674.54
$714.65
$857.13
$814.78
$852.64
$892.75
$1035.23
$178.10

Plan: (PPO) InHealth Bronze 6000-DC60

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-580-8502 - Provider Directory for This Plan: (InHealth Mutual)

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
$232.40
$263.78
$297.01
$415.07
$630.74
$464.80
$527.56
$594.02
$830.14
$1261.48
$612.38
$675.14
$741.60
$977.72
$759.96
$822.72
$889.18
$1125.30
$907.54
$970.30
$1036.76
$1272.88
$379.98
$411.36
$444.59
$562.65
$527.56
$558.94
$592.17
$710.23
$675.14
$706.52
$739.75
$857.81
$147.58

Plan: (PPO) InHealth Gold 1000-DC80

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-580-8502 - Provider Directory for This Plan: (InHealth Mutual)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$324.42
$368.22
$414.61
$579.42
$880.48
$648.84
$736.44
$829.22
$1158.84
$1760.96
$854.85
$942.45
$1035.23
$1364.85
$1060.86
$1148.46
$1241.24
$1570.86
$1266.87
$1354.47
$1447.25
$1776.87
$530.43
$574.23
$620.62
$785.43
$736.44
$780.24
$826.63
$991.44
$942.45
$986.25
$1032.64
$1197.45
$206.01

Plan: (PPO) InHealth Silver-DC70

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-580-8502 - Provider Directory for This Plan: (InHealth Mutual)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$283.04
$321.26
$361.73
$505.52
$768.18
$566.08
$642.52
$723.46
$1011.04
$1536.36
$745.81
$822.25
$903.19
$1190.77
$925.54
$1001.98
$1082.92
$1370.50
$1105.27
$1181.71
$1262.65
$1550.23
$462.77
$500.99
$541.46
$685.25
$642.50
$680.72
$721.19
$864.98
$822.23
$860.45
$900.92
$1044.71
$179.73

Plan: (PPO) InHealth Gold 2000 HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-580-8502 - Provider Directory for This Plan: (InHealth Mutual)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$305.62
$346.87
$390.58
$545.83
$829.44
$611.24
$693.74
$781.16
$1091.66
$1658.88
$805.31
$887.81
$975.23
$1285.73
$999.38
$1081.88
$1169.30
$1479.80
$1193.45
$1275.95
$1363.37
$1673.87
$499.69
$540.94
$584.65
$739.90
$693.76
$735.01
$778.72
$933.97
$887.83
$929.08
$972.79
$1128.04
$194.07

Plan: (PPO) InHealth Silver 3500 HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-580-8502 - Provider Directory for This Plan: (InHealth Mutual)

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
$259.88
$294.96
$332.12
$464.14
$705.31
$519.76
$589.92
$664.24
$928.28
$1410.62
$684.78
$754.94
$829.26
$1093.30
$849.80
$919.96
$994.28
$1258.32
$1014.82
$1084.98
$1159.30
$1423.34
$424.90
$459.98
$497.14
$629.16
$589.92
$625.00
$662.16
$794.18
$754.94
$790.02
$827.18
$959.20
$165.02

Plan: (PPO) InHealth Bronze 6000 HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-580-8502 - Provider Directory for This Plan: (InHealth Mutual)

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
$211.94
$240.55
$270.85
$378.52
$575.20
$423.88
$481.10
$541.70
$757.04
$1150.40
$558.46
$615.68
$676.28
$891.62
$693.04
$750.26
$810.86
$1026.20
$827.62
$884.84
$945.44
$1160.78
$346.52
$375.13
$405.43
$513.10
$481.10
$509.71
$540.01
$647.68
$615.68
$644.29
$674.59
$782.26
$134.58

Plan: (PPO) InHealth Catastrophic 6600-DC100

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-580-8502 - Provider Directory for This Plan: (InHealth Mutual)

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
$162.16
$184.06
$207.25
$289.62
$440.11
$324.32
$368.12
$414.50
$579.24
$880.22
$427.29
$471.09
$517.47
$682.21
$530.26
$574.06
$620.44
$785.18
$633.23
$677.03
$723.41
$888.15
$265.13
$287.03
$310.22
$392.59
$368.10
$390.00
$413.19
$495.56
$471.07
$492.97
$516.16
$598.53
$102.97

HealthSpan Integrated Care

Local: 1-216-621-7100 | Toll Free: 1-800-686-7100

TTY: 1-877-676-6677

Plan: (HMO) HealthSpanOne Gold 250-70

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-686-7100 - Provider Directory for This Plan: (HealthSpan Integrated Care)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$269.61
$306.00
$344.56
$481.51
$731.71
$539.22
$612.00
$689.12
$963.02
$1463.42
$710.43
$783.21
$860.33
$1134.23
$881.64
$954.42
$1031.54
$1305.44
$1052.85
$1125.63
$1202.75
$1476.65
$440.82
$477.21
$515.77
$652.72
$612.03
$648.42
$686.98
$823.93
$783.24
$819.63
$858.19
$995.14
$171.21

Plan: (HMO) HealthSpanOne Gold 1000-80

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-686-7100 - Provider Directory for This Plan: (HealthSpan Integrated Care)

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
$264.21
$299.88
$337.66
$471.88
$717.07
$528.42
$599.76
$675.32
$943.76
$1434.14
$696.21
$767.55
$843.11
$1111.55
$864.00
$935.34
$1010.90
$1279.34
$1031.79
$1103.13
$1178.69
$1447.13
$432.00
$467.67
$505.45
$639.67
$599.79
$635.46
$673.24
$807.46
$767.58
$803.25
$841.03
$975.25
$167.79

Plan: (HMO) HealthSpanOne Silver 2000-70

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-686-7100 - Provider Directory for This Plan: (HealthSpan Integrated Care)

Deductible: Individual: $2,000 : Family: $4,000
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
Silver 21
30
40
50
60
$231.32
$262.55
$295.63
$413.14
$627.81
$462.64
$525.10
$591.26
$826.28
$1255.62
$609.54
$672.00
$738.16
$973.18
$756.44
$818.90
$885.06
$1120.08
$903.34
$965.80
$1031.96
$1266.98
$378.22
$409.45
$442.53
$560.04
$525.12
$556.35
$589.43
$706.94
$672.02
$703.25
$736.33
$853.84
$146.90

Plan: (HMO) HealthSpanOne Bronze 5000-80

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-686-7100 - Provider Directory for This Plan: (HealthSpan Integrated Care)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$196.27
$222.77
$250.84
$350.54
$532.68
$392.54
$445.54
$501.68
$701.08
$1065.36
$517.18
$570.18
$626.32
$825.72
$641.82
$694.82
$750.96
$950.36
$766.46
$819.46
$875.60
$1075.00
$320.91
$347.41
$375.48
$475.18
$445.55
$472.05
$500.12
$599.82
$570.19
$596.69
$624.76
$724.46
$124.64

Plan: (HMO) HealthSpanOne Silver 1500-70 HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-686-7100 - Provider Directory for This Plan: (HealthSpan Integrated Care)

Deductible: Individual: $1,500 : Family: $3,000
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
$222.69
$252.76
$284.60
$397.73
$604.39
$445.38
$505.52
$569.20
$795.46
$1208.78
$586.80
$646.94
$710.62
$936.88
$728.22
$788.36
$852.04
$1078.30
$869.64
$929.78
$993.46
$1219.72
$364.11
$394.18
$426.02
$539.15
$505.53
$535.60
$567.44
$680.57
$646.95
$677.02
$708.86
$821.99
$141.42

Plan: (HMO) HealthSpanOne Bronze 4000-70 HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-686-7100 - Provider Directory for This Plan: (HealthSpan Integrated Care)

Deductible: Individual: $4,000 : Family: $8,000
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
$183.87
$208.69
$234.99
$328.39
$499.02
$367.74
$417.38
$469.98
$656.78
$998.04
$484.51
$534.15
$586.75
$773.55
$601.28
$650.92
$703.52
$890.32
$718.05
$767.69
$820.29
$1007.09
$300.64
$325.46
$351.76
$445.16
$417.41
$442.23
$468.53
$561.93
$534.18
$559.00
$585.30
$678.70
$116.77

Plan: (HMO) HealthSpanOne Gold 2000-100

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-686-7100 - Provider Directory for This Plan: (HealthSpan Integrated Care)

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $3,000 : Family: $6,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$268.26
$304.47
$342.83
$479.11
$728.05
$536.52
$608.94
$685.66
$958.22
$1456.10
$706.87
$779.29
$856.01
$1128.57
$877.22
$949.64
$1026.36
$1298.92
$1047.57
$1119.99
$1196.71
$1469.27
$438.61
$474.82
$513.18
$649.46
$608.96
$645.17
$683.53
$819.81
$779.31
$815.52
$853.88
$990.16
$170.35

Plan: (HMO) HealthSpanOne Silver 2500-80

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-686-7100 - Provider Directory for This Plan: (HealthSpan Integrated Care)

Deductible: Individual: $2,500 : Family: $5,000
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
Silver 21
30
40
50
60
$230.51
$261.63
$294.59
$411.69
$625.61
$461.02
$523.26
$589.18
$823.38
$1251.22
$607.41
$669.65
$735.57
$969.77
$753.80
$816.04
$881.96
$1116.16
$900.19
$962.43
$1028.35
$1262.55
$376.90
$408.02
$440.98
$558.08
$523.29
$554.41
$587.37
$704.47
$669.68
$700.80
$733.76
$850.86
$146.39

Plan: (HMO) HealthSpanOne Silver 3000 HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-686-7100 - Provider Directory for This Plan: (HealthSpan Integrated Care)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$228.89
$259.80
$292.53
$408.81
$621.22
$457.78
$519.60
$585.06
$817.62
$1242.44
$603.14
$664.96
$730.42
$962.98
$748.50
$810.32
$875.78
$1108.34
$893.86
$955.68
$1021.14
$1253.70
$374.25
$405.16
$437.89
$554.17
$519.61
$550.52
$583.25
$699.53
$664.97
$695.88
$728.61
$844.89
$145.36

Plan: (HMO) HealthSpanOne Bronze 6000 HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-686-7100 - Provider Directory for This Plan: (HealthSpan Integrated Care)

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
$180.37
$204.72
$230.51
$322.13
$489.51
$360.74
$409.44
$461.02
$644.26
$979.02
$475.28
$523.98
$575.56
$758.80
$589.82
$638.52
$690.10
$873.34
$704.36
$753.06
$804.64
$987.88
$294.91
$319.26
$345.05
$436.67
$409.45
$433.80
$459.59
$551.21
$523.99
$548.34
$574.13
$665.75
$114.54

Anthem Blue Cross and Blue Shield

Local: 1-855-748-1808 | Toll Free: 1-855-748-1808

Plan: (PPO) Anthem Catastrophic Pathway X PPO 6600 0

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Anthem Blue Cross and Blue Shield)

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
$162.12
$184.01
$207.19
$289.55
$439.99
$324.24
$368.02
$414.38
$579.10
$879.98
$427.19
$470.97
$517.33
$682.05
$530.14
$573.92
$620.28
$785.00
$633.09
$676.87
$723.23
$887.95
$265.07
$286.96
$310.14
$392.50
$368.02
$389.91
$413.09
$495.45
$470.97
$492.86
$516.04
$598.40
$102.95

Plan: (PPO) Anthem Bronze Pathway X PPO 0 for HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Anthem Blue Cross and Blue Shield)

Deductible: Individual: $6,000 : Family: $12,000
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
$201.97
$229.24
$258.12
$360.72
$548.15
$403.94
$458.48
$516.24
$721.44
$1096.30
$532.19
$586.73
$644.49
$849.69
$660.44
$714.98
$772.74
$977.94
$788.69
$843.23
$900.99
$1106.19
$330.22
$357.49
$386.37
$488.97
$458.47
$485.74
$514.62
$617.22
$586.72
$613.99
$642.87
$745.47
$128.25

Plan: (PPO) Anthem Bronze Pathway X PPO 4300 20

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Anthem Blue Cross and Blue Shield)

Deductible: Individual: $4,300 : Family: $8,600
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$217.42
$246.77
$277.86
$388.31
$590.08
$434.84
$493.54
$555.72
$776.62
$1180.16
$572.90
$631.60
$693.78
$914.68
$710.96
$769.66
$831.84
$1052.74
$849.02
$907.72
$969.90
$1190.80
$355.48
$384.83
$415.92
$526.37
$493.54
$522.89
$553.98
$664.43
$631.60
$660.95
$692.04
$802.49
$138.06

Plan: (PPO) Anthem Bronze Pathway X PPO 5000 30

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Anthem Blue Cross and Blue Shield)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$208.30
$236.42
$266.21
$372.02
$565.33
$416.60
$472.84
$532.42
$744.04
$1130.66
$548.87
$605.11
$664.69
$876.31
$681.14
$737.38
$796.96
$1008.58
$813.41
$869.65
$929.23
$1140.85
$340.57
$368.69
$398.48
$504.29
$472.84
$500.96
$530.75
$636.56
$605.11
$633.23
$663.02
$768.83
$132.27

Plan: (PPO) Anthem Bronze Pathway X PPO 6400 20

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Anthem Blue Cross and Blue Shield)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$216.45
$245.67
$276.62
$386.58
$587.45
$432.90
$491.34
$553.24
$773.16
$1174.90
$570.35
$628.79
$690.69
$910.61
$707.80
$766.24
$828.14
$1048.06
$845.25
$903.69
$965.59
$1185.51
$353.90
$383.12
$414.07
$524.03
$491.35
$520.57
$551.52
$661.48
$628.80
$658.02
$688.97
$798.93
$137.45

Plan: (PPO) Anthem Bronze Pathway X PPO 5550 20

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Anthem Blue Cross and Blue Shield)

Deductible: Individual: $5,550 : Family: $11,100
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
$217.84
$247.25
$278.40
$389.06
$591.22
$435.68
$494.50
$556.80
$778.12
$1182.44
$574.01
$632.83
$695.13
$916.45
$712.34
$771.16
$833.46
$1054.78
$850.67
$909.49
$971.79
$1193.11
$356.17
$385.58
$416.73
$527.39
$494.50
$523.91
$555.06
$665.72
$632.83
$662.24
$693.39
$804.05
$138.33

Plan: (PPO) Anthem Silver Pathway X PPO 3000 10

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Anthem Blue Cross and Blue Shield)

Deductible: Individual: $3,000 : Family: $6,000
Out of Pocket Maximum per year: Individual: $4,650 : Family: $9,300

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
Silver 21
30
40
50
60
$253.59
$287.82
$324.09
$452.91
$688.24
$507.18
$575.64
$648.18
$905.82
$1376.48
$668.21
$736.67
$809.21
$1066.85
$829.24
$897.70
$970.24
$1227.88
$990.27
$1058.73
$1131.27
$1388.91
$414.62
$448.85
$485.12
$613.94
$575.65
$609.88
$646.15
$774.97
$736.68
$770.91
$807.18
$936.00
$161.03

Plan: (PPO) Anthem Silver Pathway X PPO 10 for HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Anthem Blue Cross and Blue Shield)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$258.81
$293.75
$330.76
$462.23
$702.41
$517.62
$587.50
$661.52
$924.46
$1404.82
$681.96
$751.84
$825.86
$1088.80
$846.30
$916.18
$990.20
$1253.14
$1010.64
$1080.52
$1154.54
$1417.48
$423.15
$458.09
$495.10
$626.57
$587.49
$622.43
$659.44
$790.91
$751.83
$786.77
$823.78
$955.25
$164.34

Plan: (PPO) Anthem Silver Pathway X PPO 3500 0

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Anthem Blue Cross and Blue Shield)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $4,500 : Family: $9,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$266.46
$302.43
$340.54
$475.90
$723.17
$532.92
$604.86
$681.08
$951.80
$1446.34
$702.12
$774.06
$850.28
$1121.00
$871.32
$943.26
$1019.48
$1290.20
$1040.52
$1112.46
$1188.68
$1459.40
$435.66
$471.63
$509.74
$645.10
$604.86
$640.83
$678.94
$814.30
$774.06
$810.03
$848.14
$983.50
$169.20

Plan: (PPO) Anthem Silver Pathway X PPO 2000 20

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Anthem Blue Cross and Blue Shield)

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $5,500 : Family: $11,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$264.32
$300.00
$337.80
$472.08
$717.36
$528.64
$600.00
$675.60
$944.16
$1434.72
$696.48
$767.84
$843.44
$1112.00
$864.32
$935.68
$1011.28
$1279.84
$1032.16
$1103.52
$1179.12
$1447.68
$432.16
$467.84
$505.64
$639.92
$600.00
$635.68
$673.48
$807.76
$767.84
$803.52
$841.32
$975.60
$167.84

Plan: (PPO) Anthem Silver Pathway X PPO 2500 10

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Anthem Blue Cross and Blue Shield)

Deductible: Individual: $2,500 : Family: $5,000
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
Silver 21
30
40
50
60
$267.53
$303.65
$341.90
$477.81
$726.08
$535.06
$607.30
$683.80
$955.62
$1452.16
$704.94
$777.18
$853.68
$1125.50
$874.82
$947.06
$1023.56
$1295.38
$1044.70
$1116.94
$1193.44
$1465.26
$437.41
$473.53
$511.78
$647.69
$607.29
$643.41
$681.66
$817.57
$777.17
$813.29
$851.54
$987.45
$169.88

Plan: (PPO) Anthem Gold Pathway X PPO 1250 10

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Anthem Blue Cross and Blue Shield)

Deductible: Individual: $1,250 : Family: $2,500
Out of Pocket Maximum per year: Individual: $3,100 : Family: $6,200

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
$303.08
$344.00
$387.34
$541.30
$822.56
$606.16
$688.00
$774.68
$1082.60
$1645.12
$798.62
$880.46
$967.14
$1275.06
$991.08
$1072.92
$1159.60
$1467.52
$1183.54
$1265.38
$1352.06
$1659.98
$495.54
$536.46
$579.80
$733.76
$688.00
$728.92
$772.26
$926.22
$880.46
$921.38
$964.72
$1118.68
$192.46

Plan: (PPO) Anthem Silver Pathway X PPO 3500 25

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Anthem Blue Cross and Blue Shield)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $5,500 : Family: $11,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$245.59
$278.74
$313.86
$438.62
$666.53
$491.18
$557.48
$627.72
$877.24
$1333.06
$647.13
$713.43
$783.67
$1033.19
$803.08
$869.38
$939.62
$1189.14
$959.03
$1025.33
$1095.57
$1345.09
$401.54
$434.69
$469.81
$594.57
$557.49
$590.64
$625.76
$750.52
$713.44
$746.59
$781.71
$906.47
$155.95

Plan: (PPO) Anthem Silver Pathway X PPO 2000 15

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Anthem Blue Cross and Blue Shield)

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
$266.58
$302.57
$340.69
$476.11
$723.50
$533.16
$605.14
$681.38
$952.22
$1447.00
$702.44
$774.42
$850.66
$1121.50
$871.72
$943.70
$1019.94
$1290.78
$1041.00
$1112.98
$1189.22
$1460.06
$435.86
$471.85
$509.97
$645.39
$605.14
$641.13
$679.25
$814.67
$774.42
$810.41
$848.53
$983.95
$169.28

UnitedHealthcare

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

Plan: (HMO) UnitedHealthcare 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
$360.83
$409.54
$461.14
$644.44
$979.28
$721.66
$819.08
$922.28
$1288.88
$1958.56
$950.79
$1048.21
$1151.41
$1518.01
$1179.92
$1277.34
$1380.54
$1747.14
$1409.05
$1506.47
$1609.67
$1976.27
$589.96
$638.67
$690.27
$873.57
$819.09
$867.80
$919.40
$1102.70
$1048.22
$1096.93
$1148.53
$1331.83
$229.13

Plan: (HMO) UnitedHealthcare Gold Compass 1250

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

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$328.73
$373.11
$420.12
$587.12
$892.18
$657.46
$746.22
$840.24
$1174.24
$1784.36
$866.21
$954.97
$1048.99
$1382.99
$1074.96
$1163.72
$1257.74
$1591.74
$1283.71
$1372.47
$1466.49
$1800.49
$537.48
$581.86
$628.87
$795.87
$746.23
$790.61
$837.62
$1004.62
$954.98
$999.36
$1046.37
$1213.37
$208.75

Plan: (HMO) UnitedHealthcare Gold Compass 500

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

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$322.66
$366.22
$412.36
$576.28
$875.71
$645.32
$732.44
$824.72
$1152.56
$1751.42
$850.21
$937.33
$1029.61
$1357.45
$1055.10
$1142.22
$1234.50
$1562.34
$1259.99
$1347.11
$1439.39
$1767.23
$527.55
$571.11
$617.25
$781.17
$732.44
$776.00
$822.14
$986.06
$937.33
$980.89
$1027.03
$1190.95
$204.89

Plan: (HMO) UnitedHealthcare Silver Compass HSA 2600

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

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$289.12
$328.16
$369.50
$516.38
$784.68
$578.24
$656.32
$739.00
$1032.76
$1569.36
$761.83
$839.91
$922.59
$1216.35
$945.42
$1023.50
$1106.18
$1399.94
$1129.01
$1207.09
$1289.77
$1583.53
$472.71
$511.75
$553.09
$699.97
$656.30
$695.34
$736.68
$883.56
$839.89
$878.93
$920.27
$1067.15
$183.59

Plan: (HMO) UnitedHealthcare Silver Compass HSA 1600

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

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$301.27
$341.94
$385.02
$538.06
$817.64
$602.54
$683.88
$770.04
$1076.12
$1635.28
$793.84
$875.18
$961.34
$1267.42
$985.14
$1066.48
$1152.64
$1458.72
$1176.44
$1257.78
$1343.94
$1650.02
$492.57
$533.24
$576.32
$729.36
$683.87
$724.54
$767.62
$920.66
$875.17
$915.84
$958.92
$1111.96
$191.30

Plan: (HMO) UnitedHealthcare Silver Compass 2000

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

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$297.22
$337.34
$379.85
$530.83
$806.65
$594.44
$674.68
$759.70
$1061.66
$1613.30
$783.17
$863.41
$948.43
$1250.39
$971.90
$1052.14
$1137.16
$1439.12
$1160.63
$1240.87
$1325.89
$1627.85
$485.95
$526.07
$568.58
$719.56
$674.68
$714.80
$757.31
$908.29
$863.41
$903.53
$946.04
$1097.02
$188.73

Plan: (HMO) UnitedHealthcare Silver Compass 3500

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

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$300.11
$340.63
$383.54
$536.00
$814.50
$600.22
$681.26
$767.08
$1072.00
$1629.00
$790.79
$871.83
$957.65
$1262.57
$981.36
$1062.40
$1148.22
$1453.14
$1171.93
$1252.97
$1338.79
$1643.71
$490.68
$531.20
$574.11
$726.57
$681.25
$721.77
$764.68
$917.14
$871.82
$912.34
$955.25
$1107.71
$190.57

Plan: (HMO) UnitedHealthcare Silver Compass 5000

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

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$300.40
$340.95
$383.91
$536.51
$815.29
$600.80
$681.90
$767.82
$1073.02
$1630.58
$791.55
$872.65
$958.57
$1263.77
$982.30
$1063.40
$1149.32
$1454.52
$1173.05
$1254.15
$1340.07
$1645.27
$491.15
$531.70
$574.66
$727.26
$681.90
$722.45
$765.41
$918.01
$872.65
$913.20
$956.16
$1108.76
$190.75

Plan: (HMO) UnitedHealthcare Bronze Compass HSA 4900

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

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$246.33
$279.59
$314.81
$439.95
$668.55
$492.66
$559.18
$629.62
$879.90
$1337.10
$649.08
$715.60
$786.04
$1036.32
$805.50
$872.02
$942.46
$1192.74
$961.92
$1028.44
$1098.88
$1349.16
$402.75
$436.01
$471.23
$596.37
$559.17
$592.43
$627.65
$752.79
$715.59
$748.85
$784.07
$909.21
$156.42

Plan: (HMO) UnitedHealthcare Bronze Compass 5500

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

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$271.78
$308.47
$347.33
$485.39
$737.60
$543.56
$616.94
$694.66
$970.78
$1475.20
$716.14
$789.52
$867.24
$1143.36
$888.72
$962.10
$1039.82
$1315.94
$1061.30
$1134.68
$1212.40
$1488.52
$444.36
$481.05
$519.91
$657.97
$616.94
$653.63
$692.49
$830.55
$789.52
$826.21
$865.07
$1003.13
$172.58

SummaCare

Local: 1-330-996-8675 | Toll Free: 1-888-996-8675

Plan: (PPO) SummaCare Individual 2750-LK

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-996-8675 - Provider Directory for This Plan: (SummaCare)

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
$265.86
$301.76
$339.77
$474.83
$721.56
$531.72
$603.52
$679.54
$949.66
$1443.12
$700.54
$772.34
$848.36
$1118.48
$869.36
$941.16
$1017.18
$1287.30
$1038.18
$1109.98
$1186.00
$1456.12
$434.68
$470.58
$508.59
$643.65
$603.50
$639.40
$677.41
$812.47
$772.32
$808.22
$846.23
$981.29
$168.82

Plan: (PPO) SummaCare Individual 2750-LK

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-996-8675 - Provider Directory for This Plan: (SummaCare)

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
$295.32
$335.19
$377.42
$527.44
$801.50
$590.64
$670.38
$754.84
$1054.88
$1603.00
$778.17
$857.91
$942.37
$1242.41
$965.70
$1045.44
$1129.90
$1429.94
$1153.23
$1232.97
$1317.43
$1617.47
$482.85
$522.72
$564.95
$714.97
$670.38
$710.25
$752.48
$902.50
$857.91
$897.78
$940.01
$1090.03
$187.53

Plan: (PPO) SummaCare Individual 5000-LH

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-996-8675 - Provider Directory for This Plan: (SummaCare)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$232.75
$264.17
$297.46
$415.69
$631.69
$465.50
$528.34
$594.92
$831.38
$1263.38
$613.30
$676.14
$742.72
$979.18
$761.10
$823.94
$890.52
$1126.98
$908.90
$971.74
$1038.32
$1274.78
$380.55
$411.97
$445.26
$563.49
$528.35
$559.77
$593.06
$711.29
$676.15
$707.57
$740.86
$859.09
$147.80

Plan: (PPO) SummaCare Individual 5000-LH

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-996-8675 - Provider Directory for This Plan: (SummaCare)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$258.55
$293.45
$330.43
$461.77
$701.70
$517.10
$586.90
$660.86
$923.54
$1403.40
$681.28
$751.08
$825.04
$1087.72
$845.46
$915.26
$989.22
$1251.90
$1009.64
$1079.44
$1153.40
$1416.08
$422.73
$457.63
$494.61
$625.95
$586.91
$621.81
$658.79
$790.13
$751.09
$785.99
$822.97
$954.31
$164.18

Plan: (PPO) SummaCare Individual 750-LT

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-996-8675 - Provider Directory for This Plan: (SummaCare)

Deductible: Individual: $750 : Family: $1,500
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$284.92
$323.39
$364.13
$508.87
$773.28
$569.84
$646.78
$728.26
$1017.74
$1546.56
$750.77
$827.71
$909.19
$1198.67
$931.70
$1008.64
$1090.12
$1379.60
$1112.63
$1189.57
$1271.05
$1560.53
$465.85
$504.32
$545.06
$689.80
$646.78
$685.25
$725.99
$870.73
$827.71
$866.18
$906.92
$1051.66
$180.93

Plan: (PPO) SummaCare Individual 750-LT

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-996-8675 - Provider Directory for This Plan: (SummaCare)

Deductible: Individual: $750 : Family: $1,500
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$316.69
$359.44
$404.73
$565.61
$859.49
$633.38
$718.88
$809.46
$1131.22
$1718.98
$834.48
$919.98
$1010.56
$1332.32
$1035.58
$1121.08
$1211.66
$1533.42
$1236.68
$1322.18
$1412.76
$1734.52
$517.79
$560.54
$605.83
$766.71
$718.89
$761.64
$806.93
$967.81
$919.99
$962.74
$1008.03
$1168.91
$201.10

Plan: (PPO) SummaCare Individual 6450-LD

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-996-8675 - Provider Directory for This Plan: (SummaCare)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$169.80
$192.72
$217.00
$303.26
$460.83
$339.60
$385.44
$434.00
$606.52
$921.66
$447.42
$493.26
$541.82
$714.34
$555.24
$601.08
$649.64
$822.16
$663.06
$708.90
$757.46
$929.98
$277.62
$300.54
$324.82
$411.08
$385.44
$408.36
$432.64
$518.90
$493.26
$516.18
$540.46
$626.72
$107.82

Plan: (PPO) SummaCare Individual 6450-LD

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-996-8675 - Provider Directory for This Plan: (SummaCare)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$188.67
$214.14
$241.11
$336.96
$512.04
$377.34
$428.28
$482.22
$673.92
$1024.08
$497.14
$548.08
$602.02
$793.72
$616.94
$667.88
$721.82
$913.52
$736.74
$787.68
$841.62
$1033.32
$308.47
$333.94
$360.91
$456.76
$428.27
$453.74
$480.71
$576.56
$548.07
$573.54
$600.51
$696.36
$119.80

Plan: (PPO) SummaCare Individual Value-L0

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-996-8675 - Provider Directory for This Plan: (SummaCare)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Catastrophic 21
30
40
50
60
$147.66
$167.59
$188.71
$263.72
$400.75
$295.32
$335.18
$377.42
$527.44
$801.50
$389.08
$428.94
$471.18
$621.20
$482.84
$522.70
$564.94
$714.96
$576.60
$616.46
$658.70
$808.72
$241.42
$261.35
$282.47
$357.48
$335.18
$355.11
$376.23
$451.24
$428.94
$448.87
$469.99
$545.00
$93.76

Plan: (PPO) SummaCare Individual Value-L0

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-996-8675 - Provider Directory for This Plan: (SummaCare)

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
$164.02
$186.17
$209.62
$292.95
$445.16
$328.04
$372.34
$419.24
$585.90
$890.32
$432.19
$476.49
$523.39
$690.05
$536.34
$580.64
$627.54
$794.20
$640.49
$684.79
$731.69
$898.35
$268.17
$290.32
$313.77
$397.10
$372.32
$394.47
$417.92
$501.25
$476.47
$498.62
$522.07
$605.40
$104.15

Aetna

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

Plan: (POS) Aetna Bronze $20 Copay

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-336-3915 - Provider Directory for This Plan: (Aetna)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$178.16
$202.21
$227.68
$318.19
$483.52
$356.32
$404.42
$455.36
$636.38
$967.04
$469.45
$517.55
$568.49
$749.51
$582.58
$630.68
$681.62
$862.64
$695.71
$743.81
$794.75
$975.77
$291.29
$315.34
$340.81
$431.32
$404.42
$428.47
$453.94
$544.45
$517.55
$541.60
$567.07
$657.58
$113.13

Plan: (POS) Aetna Bronze Deductible Only HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-336-3915 - Provider Directory for This Plan: (Aetna)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$167.48
$190.09
$214.04
$299.13
$454.55
$334.96
$380.18
$428.08
$598.26
$909.10
$441.31
$486.53
$534.43
$704.61
$547.66
$592.88
$640.78
$810.96
$654.01
$699.23
$747.13
$917.31
$273.83
$296.44
$320.39
$405.48
$380.18
$402.79
$426.74
$511.83
$486.53
$509.14
$533.09
$618.18
$106.35

Plan: (POS) Aetna Gold $5 Copay

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-336-3915 - Provider Directory for This Plan: (Aetna)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$266.40
$302.37
$340.46
$475.80
$723.02
$532.80
$604.74
$680.92
$951.60
$1446.04
$701.97
$773.91
$850.09
$1120.77
$871.14
$943.08
$1019.26
$1289.94
$1040.31
$1112.25
$1188.43
$1459.11
$435.57
$471.54
$509.63
$644.97
$604.74
$640.71
$678.80
$814.14
$773.91
$809.88
$847.97
$983.31
$169.17

Plan: (POS) Aetna Silver $10 Copay

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-336-3915 - Provider Directory for This Plan: (Aetna)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$223.45
$253.62
$285.57
$399.08
$606.44
$446.90
$507.24
$571.14
$798.16
$1212.88
$588.79
$649.13
$713.03
$940.05
$730.68
$791.02
$854.92
$1081.94
$872.57
$932.91
$996.81
$1223.83
$365.34
$395.51
$427.46
$540.97
$507.23
$537.40
$569.35
$682.86
$649.12
$679.29
$711.24
$824.75
$141.89

Plan: (POS) Aetna Silver $5 Copay 2750

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-336-3915 - Provider Directory for This Plan: (Aetna)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$238.04
$270.17
$304.21
$425.14
$646.04
$476.08
$540.34
$608.42
$850.28
$1292.08
$627.23
$691.49
$759.57
$1001.43
$778.38
$842.64
$910.72
$1152.58
$929.53
$993.79
$1061.87
$1303.73
$389.19
$421.32
$455.36
$576.29
$540.34
$572.47
$606.51
$727.44
$691.49
$723.62
$757.66
$878.59
$151.15

CareSource Just4Me

Local: 1-800-479-9502 | Toll Free: 1-800-479-9502

TTY: 1-800-750-0750

Plan: (HMO) CareSource Just4Me Ultra Healthcare with Heart

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-479-9502 - Provider Directory for This Plan: (CareSource Just4Me)

Deductible: Individual: $1,000 : Family: $2,000
Out of Pocket Maximum per year: Individual: $1,750 : Family: $3,500

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$235.64
$267.45
$301.14
$420.85
$639.52
$471.28
$534.90
$602.28
$841.70
$1279.04
$620.91
$684.53
$751.91
$991.33
$770.54
$834.16
$901.54
$1140.96
$920.17
$983.79
$1051.17
$1290.59
$385.27
$417.08
$450.77
$570.48
$534.90
$566.71
$600.40
$720.11
$684.53
$716.34
$750.03
$869.74
$149.63

Plan: (HMO) CareSource Just4Me Healthcare with Heart

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-479-9502 - Provider Directory for This Plan: (CareSource Just4Me)

Deductible: Individual: $3,500 : Family: $7,000
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
Silver 21
30
40
50
60
$190.49
$216.21
$243.45
$340.22
$516.99
$380.98
$432.42
$486.90
$680.44
$1033.98
$501.94
$553.38
$607.86
$801.40
$622.90
$674.34
$728.82
$922.36
$743.86
$795.30
$849.78
$1043.32
$311.45
$337.17
$364.41
$461.18
$432.41
$458.13
$485.37
$582.14
$553.37
$579.09
$606.33
$703.10
$120.96

Plan: (HMO) CareSource Just4Me Healthcare with Heart

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-479-9502 - Provider Directory for This Plan: (CareSource Just4Me)

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
Bronze 21
30
40
50
60
$152.58
$173.18
$195.00
$272.51
$414.11
$305.16
$346.36
$390.00
$545.02
$828.22
$402.05
$443.25
$486.89
$641.91
$498.94
$540.14
$583.78
$738.80
$595.83
$637.03
$680.67
$835.69
$249.47
$270.07
$291.89
$369.40
$346.36
$366.96
$388.78
$466.29
$443.25
$463.85
$485.67
$563.18
$96.89

Plan: (HMO) CareSource Just4Me Ultra Dental and Vision! Healthcare with Heart

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-479-9502 - Provider Directory for This Plan: (CareSource Just4Me)

Deductible: Individual: $1,000 : Family: $2,000
Out of Pocket Maximum per year: Individual: $1,750 : Family: $3,500

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$253.35
$287.56
$323.79
$452.49
$687.60
$506.70
$575.12
$647.58
$904.98
$1375.20
$667.58
$736.00
$808.46
$1065.86
$828.46
$896.88
$969.34
$1226.74
$989.34
$1057.76
$1130.22
$1387.62
$414.23
$448.44
$484.67
$613.37
$575.11
$609.32
$645.55
$774.25
$735.99
$770.20
$806.43
$935.13
$160.88

Plan: (HMO) CareSource Just4Me Dental and Vision! Healthcare with Heart

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-479-9502 - Provider Directory for This Plan: (CareSource Just4Me)

Deductible: Individual: $3,500 : Family: $7,000
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
Silver 21
30
40
50
60
$208.02
$236.10
$265.84
$371.52
$564.56
$416.04
$472.20
$531.68
$743.04
$1129.12
$548.13
$604.29
$663.77
$875.13
$680.22
$736.38
$795.86
$1007.22
$812.31
$868.47
$927.95
$1139.31
$340.11
$368.19
$397.93
$503.61
$472.20
$500.28
$530.02
$635.70
$604.29
$632.37
$662.11
$767.79
$132.09

Plan: (HMO) CareSource Just4Me Dental and Vision! Healthcare with Heart

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-479-9502 - Provider Directory for This Plan: (CareSource Just4Me)

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
Bronze 21
30
40
50
60
$170.11
$193.07
$217.40
$303.81
$461.67
$340.22
$386.14
$434.80
$607.62
$923.34
$448.24
$494.16
$542.82
$715.64
$556.26
$602.18
$650.84
$823.66
$664.28
$710.20
$758.86
$931.68
$278.13
$301.09
$325.42
$411.83
$386.15
$409.11
$433.44
$519.85
$494.17
$517.13
$541.46
$627.87
$108.02

MedMutual

Local: 1-888-308-0357 | Toll Free: 1-888-308-0357

Plan: (PPO) Market Classic 1000 - Gold

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-308-0357 - Provider Directory for This Plan: (MedMutual)

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
$292.69
$332.20
$374.06
$522.74
$794.36
$585.38
$664.40
$748.12
$1045.48
$1588.72
$771.24
$850.26
$933.98
$1231.34
$957.10
$1036.12
$1119.84
$1417.20
$1142.96
$1221.98
$1305.70
$1603.06
$478.55
$518.06
$559.92
$708.60
$664.41
$703.92
$745.78
$894.46
$850.27
$889.78
$931.64
$1080.32

Plan: (PPO) Market Classic 1000 Child Only - Gold

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-308-0357 - Provider Directory for This Plan: (MedMutual)

Deductible: Individual: $1,000 : Family: See Plan Brochure
Out of Pocket Maximum per year: Individual: $5,000 : Family: See Plan Brochure

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


























$185.86

Plan: (PPO) Market HSA 2000 - Gold

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-308-0357 - Provider Directory for This Plan: (MedMutual)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$292.46
$331.94
$373.76
$522.33
$793.73
$584.92
$663.88
$747.52
$1044.66
$1587.46
$770.63
$849.59
$933.23
$1230.37
$956.34
$1035.30
$1118.94
$1416.08
$1142.05
$1221.01
$1304.65
$1601.79
$478.17
$517.65
$559.47
$708.04
$663.88
$703.36
$745.18
$893.75
$849.59
$889.07
$930.89
$1079.46

Plan: (PPO) Market HSA 2000 Child Only - Gold

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-308-0357 - Provider Directory for This Plan: (MedMutual)

Deductible: Individual: $2,000 : Family: See Plan Brochure
Out of Pocket Maximum per year: Individual: $2,000 : Family: See Plan Brochure

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


























$185.71

Plan: (PPO) Market HSA 4000 - Bronze

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-308-0357 - Provider Directory for This Plan: (MedMutual)

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: Individual: $6,450 : Family: $12,900

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$190.25
$215.93
$243.14
$339.78
$516.33
$380.50
$431.86
$486.28
$679.56
$1032.66
$501.31
$552.67
$607.09
$800.37
$622.12
$673.48
$727.90
$921.18
$742.93
$794.29
$848.71
$1041.99
$311.06
$336.74
$363.95
$460.59
$431.87
$457.55
$484.76
$581.40
$552.68
$578.36
$605.57
$702.21

Plan: (PPO) Market HSA 4000 Child Only - Bronze

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-308-0357 - Provider Directory for This Plan: (MedMutual)

Deductible: Individual: $4,000 : Family: See Plan Brochure
Out of Pocket Maximum per year: Individual: $6,450 : Family: See Plan Brochure

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


























$120.81

Plan: (PPO) Market HSA 6000 - Bronze

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-308-0357 - Provider Directory for This Plan: (MedMutual)

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
$179.33
$203.54
$229.18
$320.28
$486.70
$358.66
$407.08
$458.36
$640.56
$973.40
$472.54
$520.96
$572.24
$754.44
$586.42
$634.84
$686.12
$868.32
$700.30
$748.72
$800.00
$982.20
$293.21
$317.42
$343.06
$434.16
$407.09
$431.30
$456.94
$548.04
$520.97
$545.18
$570.82
$661.92

Plan: (PPO) Market HSA 6000 Child Only - Bronze

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-308-0357 - Provider Directory for This Plan: (MedMutual)

Deductible: Individual: $6,000 : Family: See Plan Brochure
Out of Pocket Maximum per year: Individual: $6,000 : Family: See Plan Brochure

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


























$113.88

Plan: (PPO) Market Young Adult Essentials

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-308-0357 - Provider Directory for This Plan: (MedMutual)

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
$126.37
$143.43
$161.50
$225.69
$342.96
$252.74
$286.86
$323.00
$451.38
$685.92
$332.98
$367.10
$403.24
$531.62
$413.22
$447.34
$483.48
$611.86
$493.46
$527.58
$563.72
$692.10
$206.61
$223.67
$241.74
$305.93
$286.85
$303.91
$321.98
$386.17
$367.09
$384.15
$402.22
$466.41
$80.24

Plan: (PPO) Market Classic 2000 - Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-308-0357 - Provider Directory for This Plan: (MedMutual)

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
$241.59
$274.20
$308.75
$431.47
$655.66
$483.18
$548.40
$617.50
$862.94
$1311.32
$636.59
$701.81
$770.91
$1016.35
$790.00
$855.22
$924.32
$1169.76
$943.41
$1008.63
$1077.73
$1323.17
$395.00
$427.61
$462.16
$584.88
$548.41
$581.02
$615.57
$738.29
$701.82
$734.43
$768.98
$891.70

Plan: (PPO) Market Classic 2000 Child Only - Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-308-0357 - Provider Directory for This Plan: (MedMutual)

Deductible: Individual: $2,000 : Family: See Plan Brochure
Out of Pocket Maximum per year: Individual: $6,600 : Family: See Plan Brochure

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60


























$153.41

Plan: (PPO) Market HSA 3000 - Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-308-0357 - Provider Directory for This Plan: (MedMutual)

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

Monthly Premiums:

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

Plan: (PPO) Market HSA 3000 Child Only - Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-308-0357 - Provider Directory for This Plan: (MedMutual)

Deductible: Individual: $3,000 : Family: See Plan Brochure
Out of Pocket Maximum per year: Individual: $3,000 : Family: See Plan Brochure

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60


























$158.72

Plan: (PPO) Market Classic 5000 - Bronze

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-308-0357 - Provider Directory for This Plan: (MedMutual)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$209.06
$237.29
$267.18
$373.39
$567.40
$418.12
$474.58
$534.36
$746.78
$1134.80
$550.88
$607.34
$667.12
$879.54
$683.64
$740.10
$799.88
$1012.30
$816.40
$872.86
$932.64
$1145.06
$341.82
$370.05
$399.94
$506.15
$474.58
$502.81
$532.70
$638.91
$607.34
$635.57
$665.46
$771.67

Plan: (PPO) Market Classic 5000 Child Only - Bronze

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-308-0357 - Provider Directory for This Plan: (MedMutual)

Deductible: Individual: $5,000 : Family: See Plan Brochure
Out of Pocket Maximum per year: Individual: $6,600 : Family: See Plan Brochure

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


























$132.76

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

‡Source: HealthCare.gov has released sample rates for all counties in the 36 states served by HealthCare.gov. We have integrated that data into our tables and provide you that information for Medina County here.

 

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