Tuscarawas County, Ohio Obamacare 2024 Rates

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

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

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

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

Obamacare Providers, 72 Plans and 2024 Rates for Tuscarawas County, Ohio

Below, you’ll find a summary of the 72 plans for Tuscarawas County, Ohio and rates for each of these providers. This chart is designed to give you a preview of your health insurance options.


Obamacare Rates and Providers for Other Years

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AultCare Insurance Company

Local: 1-330-363-6360 | Toll Free: 1-800-344-8858 | TTY: 1-171-1-

Toc - Plan #1 AultCare Insurance Company
Catastrophic

(PPO) AultCare Catastrophic Select

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-344-8858

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$256.84
$291.50
$328.23
$458.70
$697.04
$453.32
$487.98
$524.71
$655.18
$649.80
$684.46
$721.19
$851.66
$846.28
$880.94
$917.67
$1,048.14
$196.48
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$513.68
$583.00
$656.46
$917.40
$1,394.08
$710.16
$779.48
$852.94
$1,113.88
$906.64
$975.96
$1,049.42
$1,310.36
$1,103.12
$1,172.44
$1,245.90
$1,506.84
$196.48
Toc - Plan #2 AultCare Insurance Company
Gold

(PPO) AultCare Gold 1100 Select

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-344-8858

Annual Out of Pocket Expenses:

Individual Family
$1,100 $2,200 Annual Deductible
$6,900 $13,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$627.71
$712.45
$802.21
$1,121.09
$1,703.60
$1,107.91
$1,192.65
$1,282.41
$1,601.29
$1,588.11
$1,672.85
$1,762.61
$2,081.49
$2,068.31
$2,153.05
$2,242.81
$2,561.69
$480.20
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,255.42
$1,424.90
$1,604.42
$2,242.18
$3,407.20
$1,735.62
$1,905.10
$2,084.62
$2,722.38
$2,215.82
$2,385.30
$2,564.82
$3,202.58
$2,696.02
$2,865.50
$3,045.02
$3,682.78
$480.20
Toc - Plan #3 AultCare Insurance Company
Gold

(PPO) AultCare Gold 1100 Select No Pediatric Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-344-8858

Annual Out of Pocket Expenses:

Individual Family
$1,100 $2,200 Annual Deductible
$6,900 $13,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$621.23
$705.09
$793.92
$1,109.50
$1,686.00
$1,096.46
$1,180.32
$1,269.15
$1,584.73
$1,571.69
$1,655.55
$1,744.38
$2,059.96
$2,046.92
$2,130.78
$2,219.61
$2,535.19
$475.23
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,242.46
$1,410.18
$1,587.84
$2,219.00
$3,372.00
$1,717.69
$1,885.41
$2,063.07
$2,694.23
$2,192.92
$2,360.64
$2,538.30
$3,169.46
$2,668.15
$2,835.87
$3,013.53
$3,644.69
$475.23
Toc - Plan #4 AultCare Insurance Company
Catastrophic

(PPO) AultCare Catastrophic Select No Pediatric Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-344-8858

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$254.09
$288.39
$324.72
$453.80
$689.59
$448.47
$482.77
$519.10
$648.18
$642.85
$677.15
$713.48
$842.56
$837.23
$871.53
$907.86
$1,036.94
$194.38
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$508.18
$576.78
$649.44
$907.60
$1,379.18
$702.56
$771.16
$843.82
$1,101.98
$896.94
$965.54
$1,038.20
$1,296.36
$1,091.32
$1,159.92
$1,232.58
$1,490.74
$194.38
Toc - Plan #5 AultCare Insurance Company
Silver

(PPO) AultCare Silver 6850 Select

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-344-8858

Annual Out of Pocket Expenses:

Individual Family
$6,850 $13,700 Annual Deductible
$6,850 $13,700 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$438.42
$497.60
$560.29
$783.00
$1,189.85
$773.80
$832.98
$895.67
$1,118.38
$1,109.18
$1,168.36
$1,231.05
$1,453.76
$1,444.56
$1,503.74
$1,566.43
$1,789.14
$335.38
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$876.84
$995.20
$1,120.58
$1,566.00
$2,379.70
$1,212.22
$1,330.58
$1,455.96
$1,901.38
$1,547.60
$1,665.96
$1,791.34
$2,236.76
$1,882.98
$2,001.34
$2,126.72
$2,572.14
$335.38
Toc - Plan #6 AultCare Insurance Company
Silver

(PPO) AultCare Silver 6850 Select No Pediatric Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-344-8858

Annual Out of Pocket Expenses:

Individual Family
$6,850 $13,700 Annual Deductible
$6,850 $13,700 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$433.75
$492.30
$554.32
$774.67
$1,177.18
$765.56
$824.11
$886.13
$1,106.48
$1,097.37
$1,155.92
$1,217.94
$1,438.29
$1,429.18
$1,487.73
$1,549.75
$1,770.10
$331.81
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$867.50
$984.60
$1,108.64
$1,549.34
$2,354.36
$1,199.31
$1,316.41
$1,440.45
$1,881.15
$1,531.12
$1,648.22
$1,772.26
$2,212.96
$1,862.93
$1,980.03
$2,104.07
$2,544.77
$331.81
Toc - Plan #7 AultCare Insurance Company
Expanded Bronze

(PPO) AultCare Bronze 7050 Select

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-344-8858

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$410.18
$465.55
$524.20
$732.57
$1,113.21
$723.96
$779.33
$837.98
$1,046.35
$1,037.74
$1,093.11
$1,151.76
$1,360.13
$1,351.52
$1,406.89
$1,465.54
$1,673.91
$313.78
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$820.36
$931.10
$1,048.40
$1,465.14
$2,226.42
$1,134.14
$1,244.88
$1,362.18
$1,778.92
$1,447.92
$1,558.66
$1,675.96
$2,092.70
$1,761.70
$1,872.44
$1,989.74
$2,406.48
$313.78
Toc - Plan #8 AultCare Insurance Company
Expanded Bronze

(PPO) AultCare Standard Bronze Select No Pediatric Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-344-8858

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$343.58
$389.96
$439.09
$613.63
$932.47
$606.42
$652.80
$701.93
$876.47
$869.26
$915.64
$964.77
$1,139.31
$1,132.10
$1,178.48
$1,227.61
$1,402.15
$262.84
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$687.16
$779.92
$878.18
$1,227.26
$1,864.94
$950.00
$1,042.76
$1,141.02
$1,490.10
$1,212.84
$1,305.60
$1,403.86
$1,752.94
$1,475.68
$1,568.44
$1,666.70
$2,015.78
$262.84
Toc - Plan #9 AultCare Insurance Company
Bronze

(PPO) AultCare Bronze 8550 Select

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-344-8858

Annual Out of Pocket Expenses:

Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$343.99
$390.43
$439.62
$614.37
$933.59
$607.14
$653.58
$702.77
$877.52
$870.29
$916.73
$965.92
$1,140.67
$1,133.44
$1,179.88
$1,229.07
$1,403.82
$263.15
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$687.98
$780.86
$879.24
$1,228.74
$1,867.18
$951.13
$1,044.01
$1,142.39
$1,491.89
$1,214.28
$1,307.16
$1,405.54
$1,755.04
$1,477.43
$1,570.31
$1,668.69
$2,018.19
$263.15
Toc - Plan #10 AultCare Insurance Company
Bronze

(PPO) AultCare Bronze 8550 Select No Pediatric Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-344-8858

Annual Out of Pocket Expenses:

Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$340.10
$386.00
$434.64
$607.40
$923.01
$600.27
$646.17
$694.81
$867.57
$860.44
$906.34
$954.98
$1,127.74
$1,120.61
$1,166.51
$1,215.15
$1,387.91
$260.17
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$680.20
$772.00
$869.28
$1,214.80
$1,846.02
$940.37
$1,032.17
$1,129.45
$1,474.97
$1,200.54
$1,292.34
$1,389.62
$1,735.14
$1,460.71
$1,552.51
$1,649.79
$1,995.31
$260.17
Toc - Plan #11 AultCare Insurance Company
Expanded Bronze

(PPO) AultCare Bronze 7000 Select

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-344-8858

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$339.07
$384.84
$433.33
$605.58
$920.23
$598.46
$644.23
$692.72
$864.97
$857.85
$903.62
$952.11
$1,124.36
$1,117.24
$1,163.01
$1,211.50
$1,383.75
$259.39
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$678.14
$769.68
$866.66
$1,211.16
$1,840.46
$937.53
$1,029.07
$1,126.05
$1,470.55
$1,196.92
$1,288.46
$1,385.44
$1,729.94
$1,456.31
$1,547.85
$1,644.83
$1,989.33
$259.39
Toc - Plan #12 AultCare Insurance Company
Gold

(PPO) AultCare Standard Gold Select No Pediatric Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-344-8858

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$627.87
$712.62
$802.41
$1,121.36
$1,704.01
$1,108.18
$1,192.93
$1,282.72
$1,601.67
$1,588.49
$1,673.24
$1,763.03
$2,081.98
$2,068.80
$2,153.55
$2,243.34
$2,562.29
$480.31
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,255.74
$1,425.24
$1,604.82
$2,242.72
$3,408.02
$1,736.05
$1,905.55
$2,085.13
$2,723.03
$2,216.36
$2,385.86
$2,565.44
$3,203.34
$2,696.67
$2,866.17
$3,045.75
$3,683.65
$480.31
Toc - Plan #13 AultCare Insurance Company
Silver

(PPO) AultCare Standard Silver Select No Pediatric Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-344-8858

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$409.61
$464.91
$523.48
$731.56
$1,111.68
$722.96
$778.26
$836.83
$1,044.91
$1,036.31
$1,091.61
$1,150.18
$1,358.26
$1,349.66
$1,404.96
$1,463.53
$1,671.61
$313.35
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$819.22
$929.82
$1,046.96
$1,463.12
$2,223.36
$1,132.57
$1,243.17
$1,360.31
$1,776.47
$1,445.92
$1,556.52
$1,673.66
$2,089.82
$1,759.27
$1,869.87
$1,987.01
$2,403.17
$313.35
Toc - Plan #14 AultCare Insurance Company
Silver

(PPO) AultCare Standard Silver Premier Select No Pediatric Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-344-8858

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$386.27
$438.41
$493.64
$689.86
$1,048.31
$681.76
$733.90
$789.13
$985.35
$977.25
$1,029.39
$1,084.62
$1,280.84
$1,272.74
$1,324.88
$1,380.11
$1,576.33
$295.49
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$772.54
$876.82
$987.28
$1,379.72
$2,096.62
$1,068.03
$1,172.31
$1,282.77
$1,675.21
$1,363.52
$1,467.80
$1,578.26
$1,970.70
$1,659.01
$1,763.29
$1,873.75
$2,266.19
$295.49

ADVERTISEMENT

Anthem Blue Cross and Blue Shield

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

Toc - Plan #15 Anthem Blue Cross and Blue Shield
Bronze

(HMO) Anthem Bronze Pathway HMO 9450 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1808

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$416.93
$473.22
$532.84
$744.64
$1,131.55
$735.88
$792.17
$851.79
$1,063.59
$1,054.83
$1,111.12
$1,170.74
$1,382.54
$1,373.78
$1,430.07
$1,489.69
$1,701.49
$318.95
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$833.86
$946.44
$1,065.68
$1,489.28
$2,263.10
$1,152.81
$1,265.39
$1,384.63
$1,808.23
$1,471.76
$1,584.34
$1,703.58
$2,127.18
$1,790.71
$1,903.29
$2,022.53
$2,446.13
$318.95
Toc - Plan #16 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Pathway HMO 4000 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1808

Annual Out of Pocket Expenses:

Individual Family
$4,000 $8,000 Annual Deductible
$8,600 $17,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$546.57
$620.36
$698.52
$976.17
$1,483.39
$964.70
$1,038.49
$1,116.65
$1,394.30
$1,382.83
$1,456.62
$1,534.78
$1,812.43
$1,800.96
$1,874.75
$1,952.91
$2,230.56
$418.13
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,093.14
$1,240.72
$1,397.04
$1,952.34
$2,966.78
$1,511.27
$1,658.85
$1,815.17
$2,370.47
$1,929.40
$2,076.98
$2,233.30
$2,788.60
$2,347.53
$2,495.11
$2,651.43
$3,206.73
$418.13
Toc - Plan #17 Anthem Blue Cross and Blue Shield
Expanded Bronze

(HMO) Anthem Bronze Pathway HMO 7450/0% (+ Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1808

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$455.58
$517.08
$582.23
$813.67
$1,236.44
$804.10
$865.60
$930.75
$1,162.19
$1,152.62
$1,214.12
$1,279.27
$1,510.71
$1,501.14
$1,562.64
$1,627.79
$1,859.23
$348.52
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$911.16
$1,034.16
$1,164.46
$1,627.34
$2,472.88
$1,259.68
$1,382.68
$1,512.98
$1,975.86
$1,608.20
$1,731.20
$1,861.50
$2,324.38
$1,956.72
$2,079.72
$2,210.02
$2,672.90
$348.52
Toc - Plan #18 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Pathway HMO 5400/0% ( + Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1808

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$577.66
$655.64
$738.25
$1,031.70
$1,567.77
$1,019.57
$1,097.55
$1,180.16
$1,473.61
$1,461.48
$1,539.46
$1,622.07
$1,915.52
$1,903.39
$1,981.37
$2,063.98
$2,357.43
$441.91
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,155.32
$1,311.28
$1,476.50
$2,063.40
$3,135.54
$1,597.23
$1,753.19
$1,918.41
$2,505.31
$2,039.14
$2,195.10
$2,360.32
$2,947.22
$2,481.05
$2,637.01
$2,802.23
$3,389.13
$441.91
Toc - Plan #19 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Pathway HMO 5000 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1808

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 Annual Deductible
$7,950 $15,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$540.29
$613.23
$690.49
$964.96
$1,466.35
$953.61
$1,026.55
$1,103.81
$1,378.28
$1,366.93
$1,439.87
$1,517.13
$1,791.60
$1,780.25
$1,853.19
$1,930.45
$2,204.92
$413.32
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,080.58
$1,226.46
$1,380.98
$1,929.92
$2,932.70
$1,493.90
$1,639.78
$1,794.30
$2,343.24
$1,907.22
$2,053.10
$2,207.62
$2,756.56
$2,320.54
$2,466.42
$2,620.94
$3,169.88
$413.32
Toc - Plan #20 Anthem Blue Cross and Blue Shield
Catastrophic

(HMO) Anthem Catastrophic Pathway HMO 9450 ( + Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1808

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$323.23
$366.87
$413.09
$577.29
$877.25
$570.50
$614.14
$660.36
$824.56
$817.77
$861.41
$907.63
$1,071.83
$1,065.04
$1,108.68
$1,154.90
$1,319.10
$247.27
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$646.46
$733.74
$826.18
$1,154.58
$1,754.50
$893.73
$981.01
$1,073.45
$1,401.85
$1,141.00
$1,228.28
$1,320.72
$1,649.12
$1,388.27
$1,475.55
$1,567.99
$1,896.39
$247.27
Toc - Plan #21 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Pathway HMO 6000/25% ($0 Virtual PCP + $0 Select Drugs + Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1808

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$7,800 $15,600 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$542.65
$615.91
$693.51
$969.17
$1,472.75
$957.78
$1,031.04
$1,108.64
$1,384.30
$1,372.91
$1,446.17
$1,523.77
$1,799.43
$1,788.04
$1,861.30
$1,938.90
$2,214.56
$415.13
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,085.30
$1,231.82
$1,387.02
$1,938.34
$2,945.50
$1,500.43
$1,646.95
$1,802.15
$2,353.47
$1,915.56
$2,062.08
$2,217.28
$2,768.60
$2,330.69
$2,477.21
$2,632.41
$3,183.73
$415.13
Toc - Plan #22 Anthem Blue Cross and Blue Shield
Bronze

(HMO) Anthem Bronze Pathway HMO 5500 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1808

Annual Out of Pocket Expenses:

Individual Family
$5,500 $11,000 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$440.99
$500.52
$563.59
$787.61
$1,196.85
$778.35
$837.88
$900.95
$1,124.97
$1,115.71
$1,175.24
$1,238.31
$1,462.33
$1,453.07
$1,512.60
$1,575.67
$1,799.69
$337.36
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$881.98
$1,001.04
$1,127.18
$1,575.22
$2,393.70
$1,219.34
$1,338.40
$1,464.54
$1,912.58
$1,556.70
$1,675.76
$1,801.90
$2,249.94
$1,894.06
$2,013.12
$2,139.26
$2,587.30
$337.36
Toc - Plan #23 Anthem Blue Cross and Blue Shield
Bronze

(HMO) Anthem Bronze Pathway HMO 6000 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1808

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$432.20
$490.55
$552.35
$771.91
$1,172.99
$762.83
$821.18
$882.98
$1,102.54
$1,093.46
$1,151.81
$1,213.61
$1,433.17
$1,424.09
$1,482.44
$1,544.24
$1,763.80
$330.63
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$864.40
$981.10
$1,104.70
$1,543.82
$2,345.98
$1,195.03
$1,311.73
$1,435.33
$1,874.45
$1,525.66
$1,642.36
$1,765.96
$2,205.08
$1,856.29
$1,972.99
$2,096.59
$2,535.71
$330.63
Toc - Plan #24 Anthem Blue Cross and Blue Shield
Expanded Bronze

(HMO) Anthem Bronze Pathway HMO 7500/50% Standard (Cleveland)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1808

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$440.50
$499.97
$562.96
$786.73
$1,195.52
$777.48
$836.95
$899.94
$1,123.71
$1,114.46
$1,173.93
$1,236.92
$1,460.69
$1,451.44
$1,510.91
$1,573.90
$1,797.67
$336.98
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$881.00
$999.94
$1,125.92
$1,573.46
$2,391.04
$1,217.98
$1,336.92
$1,462.90
$1,910.44
$1,554.96
$1,673.90
$1,799.88
$2,247.42
$1,891.94
$2,010.88
$2,136.86
$2,584.40
$336.98
Toc - Plan #25 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Pathway HMO 5800/40% Standard (Cleveland)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1808

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$531.20
$602.91
$678.87
$948.72
$1,441.68
$937.57
$1,009.28
$1,085.24
$1,355.09
$1,343.94
$1,415.65
$1,491.61
$1,761.46
$1,750.31
$1,822.02
$1,897.98
$2,167.83
$406.37
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,062.40
$1,205.82
$1,357.74
$1,897.44
$2,883.36
$1,468.77
$1,612.19
$1,764.11
$2,303.81
$1,875.14
$2,018.56
$2,170.48
$2,710.18
$2,281.51
$2,424.93
$2,576.85
$3,116.55
$406.37
Toc - Plan #26 Anthem Blue Cross and Blue Shield
Gold

(HMO) Anthem Gold Pathway HMO 2000/25% Standard (Cincinnati)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1808

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$789.12
$895.65
$1,008.50
$1,409.37
$2,141.67
$1,392.80
$1,499.33
$1,612.18
$2,013.05
$1,996.48
$2,103.01
$2,215.86
$2,616.73
$2,600.16
$2,706.69
$2,819.54
$3,220.41
$603.68
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,578.24
$1,791.30
$2,017.00
$2,818.74
$4,283.34
$2,181.92
$2,394.98
$2,620.68
$3,422.42
$2,785.60
$2,998.66
$3,224.36
$4,026.10
$3,389.28
$3,602.34
$3,828.04
$4,629.78
$603.68
Toc - Plan #27 Anthem Blue Cross and Blue Shield
Bronze

(HMO) Anthem Bronze Pathway HMO 9450 Adult Dental & Vision ($0 Virtual PCP + $0 Select Drugs + Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1808

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$422.08
$479.06
$539.42
$753.83
$1,145.53
$744.97
$801.95
$862.31
$1,076.72
$1,067.86
$1,124.84
$1,185.20
$1,399.61
$1,390.75
$1,447.73
$1,508.09
$1,722.50
$322.89
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$844.16
$958.12
$1,078.84
$1,507.66
$2,291.06
$1,167.05
$1,281.01
$1,401.73
$1,830.55
$1,489.94
$1,603.90
$1,724.62
$2,153.44
$1,812.83
$1,926.79
$2,047.51
$2,476.33
$322.89
Toc - Plan #28 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Pathway HMO 5000 Adult Dental & Vision ($0 Virtual PCP + $0 Select Drugs + Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1808

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 Annual Deductible
$7,950 $15,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$545.44
$619.07
$697.07
$974.16
$1,480.32
$962.70
$1,036.33
$1,114.33
$1,391.42
$1,379.96
$1,453.59
$1,531.59
$1,808.68
$1,797.22
$1,870.85
$1,948.85
$2,225.94
$417.26
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,090.88
$1,238.14
$1,394.14
$1,948.32
$2,960.64
$1,508.14
$1,655.40
$1,811.40
$2,365.58
$1,925.40
$2,072.66
$2,228.66
$2,782.84
$2,342.66
$2,489.92
$2,645.92
$3,200.10
$417.26

ADVERTISEMENT

Oscar Insurance Corporation of Ohio

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

Toc - Plan #29 Oscar Insurance Corporation of Ohio
Expanded Bronze

(HMO) Bronze Simple

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

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$393.34
$446.42
$502.67
$702.48
$1,067.49
$694.23
$747.31
$803.56
$1,003.37
$995.12
$1,048.20
$1,104.45
$1,304.26
$1,296.01
$1,349.09
$1,405.34
$1,605.15
$300.89
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$786.68
$892.84
$1,005.34
$1,404.96
$2,134.98
$1,087.57
$1,193.73
$1,306.23
$1,705.85
$1,388.46
$1,494.62
$1,607.12
$2,006.74
$1,689.35
$1,795.51
$1,908.01
$2,307.63
$300.89
Toc - Plan #30 Oscar Insurance Corporation of Ohio
Expanded Bronze

(HMO) Bronze Classic PCP Saver

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

Annual Out of Pocket Expenses:

Individual Family
$7,750 $15,500 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$398.75
$452.57
$509.59
$712.15
$1,082.18
$703.79
$757.61
$814.63
$1,017.19
$1,008.83
$1,062.65
$1,119.67
$1,322.23
$1,313.87
$1,367.69
$1,424.71
$1,627.27
$305.04
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$797.50
$905.14
$1,019.18
$1,424.30
$2,164.36
$1,102.54
$1,210.18
$1,324.22
$1,729.34
$1,407.58
$1,515.22
$1,629.26
$2,034.38
$1,712.62
$1,820.26
$1,934.30
$2,339.42
$305.04
Toc - Plan #31 Oscar Insurance Corporation of Ohio
Expanded Bronze

(HMO) Bronze Classic

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

Annual Out of Pocket Expenses:

Individual Family
$7,750 $15,500 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$408.29
$463.40
$521.79
$729.20
$1,108.08
$720.63
$775.74
$834.13
$1,041.54
$1,032.97
$1,088.08
$1,146.47
$1,353.88
$1,345.31
$1,400.42
$1,458.81
$1,666.22
$312.34
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$816.58
$926.80
$1,043.58
$1,458.40
$2,216.16
$1,128.92
$1,239.14
$1,355.92
$1,770.74
$1,441.26
$1,551.48
$1,668.26
$2,083.08
$1,753.60
$1,863.82
$1,980.60
$2,395.42
$312.34
Toc - Plan #32 Oscar Insurance Corporation of Ohio
Silver

(HMO) Silver Classic

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

Annual Out of Pocket Expenses:

Individual Family
$5,400 $10,800 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$466.32
$529.26
$595.94
$832.83
$1,265.56
$823.05
$885.99
$952.67
$1,189.56
$1,179.78
$1,242.72
$1,309.40
$1,546.29
$1,536.51
$1,599.45
$1,666.13
$1,903.02
$356.73
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$932.64
$1,058.52
$1,191.88
$1,665.66
$2,531.12
$1,289.37
$1,415.25
$1,548.61
$2,022.39
$1,646.10
$1,771.98
$1,905.34
$2,379.12
$2,002.83
$2,128.71
$2,262.07
$2,735.85
$356.73
Toc - Plan #33 Oscar Insurance Corporation of Ohio
Catastrophic

(HMO) Secure

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

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$316.26
$358.94
$404.16
$564.82
$858.29
$558.19
$600.87
$646.09
$806.75
$800.12
$842.80
$888.02
$1,048.68
$1,042.05
$1,084.73
$1,129.95
$1,290.61
$241.93
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$632.52
$717.88
$808.32
$1,129.64
$1,716.58
$874.45
$959.81
$1,050.25
$1,371.57
$1,116.38
$1,201.74
$1,292.18
$1,613.50
$1,358.31
$1,443.67
$1,534.11
$1,855.43
$241.93
Toc - Plan #34 Oscar Insurance Corporation of Ohio
Gold

(HMO) Gold Classic

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

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$525.63
$596.57
$671.74
$938.75
$1,426.52
$927.73
$998.67
$1,073.84
$1,340.85
$1,329.83
$1,400.77
$1,475.94
$1,742.95
$1,731.93
$1,802.87
$1,878.04
$2,145.05
$402.10
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,051.26
$1,193.14
$1,343.48
$1,877.50
$2,853.04
$1,453.36
$1,595.24
$1,745.58
$2,279.60
$1,855.46
$1,997.34
$2,147.68
$2,681.70
$2,257.56
$2,399.44
$2,549.78
$3,083.80
$402.10
Toc - Plan #35 Oscar Insurance Corporation of Ohio
Expanded Bronze

(HMO) Bronze Simple HSA

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

Annual Out of Pocket Expenses:

Individual Family
$5,200 $10,400 Annual Deductible
$7,450 $14,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$404.39
$458.97
$516.80
$722.22
$1,097.48
$713.74
$768.32
$826.15
$1,031.57
$1,023.09
$1,077.67
$1,135.50
$1,340.92
$1,332.44
$1,387.02
$1,444.85
$1,650.27
$309.35
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$808.78
$917.94
$1,033.60
$1,444.44
$2,194.96
$1,118.13
$1,227.29
$1,342.95
$1,753.79
$1,427.48
$1,536.64
$1,652.30
$2,063.14
$1,736.83
$1,845.99
$1,961.65
$2,372.49
$309.35
Toc - Plan #36 Oscar Insurance Corporation of Ohio
Silver

(HMO) Silver Simple PCP Saver

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

Annual Out of Pocket Expenses:

Individual Family
$5,750 $11,500 Annual Deductible
$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$445.48
$505.61
$569.31
$795.62
$1,209.01
$786.27
$846.40
$910.10
$1,136.41
$1,127.06
$1,187.19
$1,250.89
$1,477.20
$1,467.85
$1,527.98
$1,591.68
$1,817.99
$340.79
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$890.96
$1,011.22
$1,138.62
$1,591.24
$2,418.02
$1,231.75
$1,352.01
$1,479.41
$1,932.03
$1,572.54
$1,692.80
$1,820.20
$2,272.82
$1,913.33
$2,033.59
$2,160.99
$2,613.61
$340.79
Toc - Plan #37 Oscar Insurance Corporation of Ohio
Silver

(HMO) Silver Elite Saver Plus

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

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$479.42
$544.13
$612.69
$856.23
$1,301.12
$846.17
$910.88
$979.44
$1,222.98
$1,212.92
$1,277.63
$1,346.19
$1,589.73
$1,579.67
$1,644.38
$1,712.94
$1,956.48
$366.75
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$958.84
$1,088.26
$1,225.38
$1,712.46
$2,602.24
$1,325.59
$1,455.01
$1,592.13
$2,079.21
$1,692.34
$1,821.76
$1,958.88
$2,445.96
$2,059.09
$2,188.51
$2,325.63
$2,812.71
$366.75
Toc - Plan #38 Oscar Insurance Corporation of Ohio
Gold

(HMO) Gold Elite Saver Plus

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

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$570.24
$647.21
$728.76
$1,018.44
$1,547.61
$1,006.47
$1,083.44
$1,164.99
$1,454.67
$1,442.70
$1,519.67
$1,601.22
$1,890.90
$1,878.93
$1,955.90
$2,037.45
$2,327.13
$436.23
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,140.48
$1,294.42
$1,457.52
$2,036.88
$3,095.22
$1,576.71
$1,730.65
$1,893.75
$2,473.11
$2,012.94
$2,166.88
$2,329.98
$2,909.34
$2,449.17
$2,603.11
$2,766.21
$3,345.57
$436.23
Toc - Plan #39 Oscar Insurance Corporation of Ohio
Gold

(HMO) Gold Elite

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

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$554.27
$629.09
$708.35
$989.91
$1,504.27
$978.28
$1,053.10
$1,132.36
$1,413.92
$1,402.29
$1,477.11
$1,556.37
$1,837.93
$1,826.30
$1,901.12
$1,980.38
$2,261.94
$424.01
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,108.54
$1,258.18
$1,416.70
$1,979.82
$3,008.54
$1,532.55
$1,682.19
$1,840.71
$2,403.83
$1,956.56
$2,106.20
$2,264.72
$2,827.84
$2,380.57
$2,530.21
$2,688.73
$3,251.85
$424.01
Toc - Plan #40 Oscar Insurance Corporation of Ohio
Silver

(HMO) Silver Simple Diabetes

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

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$461.19
$523.44
$589.39
$823.67
$1,251.64
$813.99
$876.24
$942.19
$1,176.47
$1,166.79
$1,229.04
$1,294.99
$1,529.27
$1,519.59
$1,581.84
$1,647.79
$1,882.07
$352.80
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$922.38
$1,046.88
$1,178.78
$1,647.34
$2,503.28
$1,275.18
$1,399.68
$1,531.58
$2,000.14
$1,627.98
$1,752.48
$1,884.38
$2,352.94
$1,980.78
$2,105.28
$2,237.18
$2,705.74
$352.80
Toc - Plan #41 Oscar Insurance Corporation of Ohio
Expanded Bronze

(HMO) Bronze Classic Standard

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

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$399.89
$453.86
$511.04
$714.18
$1,085.27
$705.80
$759.77
$816.95
$1,020.09
$1,011.71
$1,065.68
$1,122.86
$1,326.00
$1,317.62
$1,371.59
$1,428.77
$1,631.91
$305.91
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$799.78
$907.72
$1,022.08
$1,428.36
$2,170.54
$1,105.69
$1,213.63
$1,327.99
$1,734.27
$1,411.60
$1,519.54
$1,633.90
$2,040.18
$1,717.51
$1,825.45
$1,939.81
$2,346.09
$305.91
Toc - Plan #42 Oscar Insurance Corporation of Ohio
Silver

(HMO) Silver Classic Standard

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

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$441.44
$501.02
$564.14
$788.39
$1,198.03
$779.13
$838.71
$901.83
$1,126.08
$1,116.82
$1,176.40
$1,239.52
$1,463.77
$1,454.51
$1,514.09
$1,577.21
$1,801.46
$337.69
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$882.88
$1,002.04
$1,128.28
$1,576.78
$2,396.06
$1,220.57
$1,339.73
$1,465.97
$1,914.47
$1,558.26
$1,677.42
$1,803.66
$2,252.16
$1,895.95
$2,015.11
$2,141.35
$2,589.85
$337.69
Toc - Plan #43 Oscar Insurance Corporation of Ohio
Gold

(HMO) Gold Classic Standard

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

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$514.03
$583.41
$656.92
$918.04
$1,395.05
$907.26
$976.64
$1,050.15
$1,311.27
$1,300.49
$1,369.87
$1,443.38
$1,704.50
$1,693.72
$1,763.10
$1,836.61
$2,097.73
$393.23
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,028.06
$1,166.82
$1,313.84
$1,836.08
$2,790.10
$1,421.29
$1,560.05
$1,707.07
$2,229.31
$1,814.52
$1,953.28
$2,100.30
$2,622.54
$2,207.75
$2,346.51
$2,493.53
$3,015.77
$393.23

ADVERTISEMENT

CareSource

Local: 1-833-230-2099 | Toll Free: 1-833-230-2099 | TTY: 1-800-750-0750

Toc - Plan #44 CareSource
Silver

(HMO) CareSource Marketplace Low Premium Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$410.01
$465.36
$523.99
$732.27
$1,112.76
$723.67
$779.02
$837.65
$1,045.93
$1,037.33
$1,092.68
$1,151.31
$1,359.59
$1,350.99
$1,406.34
$1,464.97
$1,673.25
$313.66
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$820.02
$930.72
$1,047.98
$1,464.54
$2,225.52
$1,133.68
$1,244.38
$1,361.64
$1,778.20
$1,447.34
$1,558.04
$1,675.30
$2,091.86
$1,761.00
$1,871.70
$1,988.96
$2,405.52
$313.66
Toc - Plan #45 CareSource
Gold

(HMO) CareSource Marketplace Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$654.38
$742.71
$836.29
$1,168.71
$1,775.97
$1,154.98
$1,243.31
$1,336.89
$1,669.31
$1,655.58
$1,743.91
$1,837.49
$2,169.91
$2,156.18
$2,244.51
$2,338.09
$2,670.51
$500.60
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,308.76
$1,485.42
$1,672.58
$2,337.42
$3,551.94
$1,809.36
$1,986.02
$2,173.18
$2,838.02
$2,309.96
$2,486.62
$2,673.78
$3,338.62
$2,810.56
$2,987.22
$3,174.38
$3,839.22
$500.60
Toc - Plan #46 CareSource
Silver

(HMO) CareSource Marketplace Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$403.32
$457.76
$515.44
$720.32
$1,094.60
$711.86
$766.30
$823.98
$1,028.86
$1,020.40
$1,074.84
$1,132.52
$1,337.40
$1,328.94
$1,383.38
$1,441.06
$1,645.94
$308.54
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$806.64
$915.52
$1,030.88
$1,440.64
$2,189.20
$1,115.18
$1,224.06
$1,339.42
$1,749.18
$1,423.72
$1,532.60
$1,647.96
$2,057.72
$1,732.26
$1,841.14
$1,956.50
$2,366.26
$308.54
Toc - Plan #47 CareSource
Expanded Bronze

(HMO) CareSource Marketplace Bronze First

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$324.48
$368.28
$414.69
$579.52
$880.64
$572.71
$616.51
$662.92
$827.75
$820.94
$864.74
$911.15
$1,075.98
$1,069.17
$1,112.97
$1,159.38
$1,324.21
$248.23
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$648.96
$736.56
$829.38
$1,159.04
$1,761.28
$897.19
$984.79
$1,077.61
$1,407.27
$1,145.42
$1,233.02
$1,325.84
$1,655.50
$1,393.65
$1,481.25
$1,574.07
$1,903.73
$248.23
Toc - Plan #48 CareSource
Silver

(HMO) CareSource Marketplace Diabetes Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$425.64
$483.09
$543.96
$760.18
$1,155.17
$751.25
$808.70
$869.57
$1,085.79
$1,076.86
$1,134.31
$1,195.18
$1,411.40
$1,402.47
$1,459.92
$1,520.79
$1,737.01
$325.61
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$851.28
$966.18
$1,087.92
$1,520.36
$2,310.34
$1,176.89
$1,291.79
$1,413.53
$1,845.97
$1,502.50
$1,617.40
$1,739.14
$2,171.58
$1,828.11
$1,943.01
$2,064.75
$2,497.19
$325.61
Toc - Plan #49 CareSource
Gold

(HMO) CareSource Marketplace Diabetes Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$670.31
$760.80
$856.66
$1,197.17
$1,819.22
$1,183.10
$1,273.59
$1,369.45
$1,709.96
$1,695.89
$1,786.38
$1,882.24
$2,222.75
$2,208.68
$2,299.17
$2,395.03
$2,735.54
$512.79
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,340.62
$1,521.60
$1,713.32
$2,394.34
$3,638.44
$1,853.41
$2,034.39
$2,226.11
$2,907.13
$2,366.20
$2,547.18
$2,738.90
$3,419.92
$2,878.99
$3,059.97
$3,251.69
$3,932.71
$512.79
Toc - Plan #50 CareSource
Gold

(HMO) CareSource Marketplace Core Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$611.33
$693.86
$781.28
$1,091.83
$1,659.14
$1,079.00
$1,161.53
$1,248.95
$1,559.50
$1,546.67
$1,629.20
$1,716.62
$2,027.17
$2,014.34
$2,096.87
$2,184.29
$2,494.84
$467.67
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,222.66
$1,387.72
$1,562.56
$2,183.66
$3,318.28
$1,690.33
$1,855.39
$2,030.23
$2,651.33
$2,158.00
$2,323.06
$2,497.90
$3,119.00
$2,625.67
$2,790.73
$2,965.57
$3,586.67
$467.67
Toc - Plan #51 CareSource
Silver

(HMO) CareSource Marketplace Core Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$416.22
$472.40
$531.92
$743.36
$1,129.60
$734.62
$790.80
$850.32
$1,061.76
$1,053.02
$1,109.20
$1,168.72
$1,380.16
$1,371.42
$1,427.60
$1,487.12
$1,698.56
$318.40
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$832.44
$944.80
$1,063.84
$1,486.72
$2,259.20
$1,150.84
$1,263.20
$1,382.24
$1,805.12
$1,469.24
$1,581.60
$1,700.64
$2,123.52
$1,787.64
$1,900.00
$2,019.04
$2,441.92
$318.40
Toc - Plan #52 CareSource
Silver

(HMO) CareSource Marketplace Low Premium Silver Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$415.50
$471.59
$531.00
$742.07
$1,127.65
$733.35
$789.44
$848.85
$1,059.92
$1,051.20
$1,107.29
$1,166.70
$1,377.77
$1,369.05
$1,425.14
$1,484.55
$1,695.62
$317.85
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$831.00
$943.18
$1,062.00
$1,484.14
$2,255.30
$1,148.85
$1,261.03
$1,379.85
$1,801.99
$1,466.70
$1,578.88
$1,697.70
$2,119.84
$1,784.55
$1,896.73
$2,015.55
$2,437.69
$317.85
Toc - Plan #53 CareSource
Gold

(HMO) CareSource Marketplace Gold Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$661.88
$751.23
$845.88
$1,182.11
$1,796.34
$1,168.22
$1,257.57
$1,352.22
$1,688.45
$1,674.56
$1,763.91
$1,858.56
$2,194.79
$2,180.90
$2,270.25
$2,364.90
$2,701.13
$506.34
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,323.76
$1,502.46
$1,691.76
$2,364.22
$3,592.68
$1,830.10
$2,008.80
$2,198.10
$2,870.56
$2,336.44
$2,515.14
$2,704.44
$3,376.90
$2,842.78
$3,021.48
$3,210.78
$3,883.24
$506.34
Toc - Plan #54 CareSource
Silver

(HMO) CareSource Marketplace Silver Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$408.80
$463.99
$522.45
$730.12
$1,109.49
$721.53
$776.72
$835.18
$1,042.85
$1,034.26
$1,089.45
$1,147.91
$1,355.58
$1,346.99
$1,402.18
$1,460.64
$1,668.31
$312.73
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$817.60
$927.98
$1,044.90
$1,460.24
$2,218.98
$1,130.33
$1,240.71
$1,357.63
$1,772.97
$1,443.06
$1,553.44
$1,670.36
$2,085.70
$1,755.79
$1,866.17
$1,983.09
$2,398.43
$312.73
Toc - Plan #55 CareSource
Expanded Bronze

(HMO) CareSource Marketplace Bronze First Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$329.73
$374.24
$421.39
$588.89
$894.88
$581.97
$626.48
$673.63
$841.13
$834.21
$878.72
$925.87
$1,093.37
$1,086.45
$1,130.96
$1,178.11
$1,345.61
$252.24
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$659.46
$748.48
$842.78
$1,177.78
$1,789.76
$911.70
$1,000.72
$1,095.02
$1,430.02
$1,163.94
$1,252.96
$1,347.26
$1,682.26
$1,416.18
$1,505.20
$1,599.50
$1,934.50
$252.24
Toc - Plan #56 CareSource
Silver

(HMO) CareSource Marketplace Diabetes Silver Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$431.12
$489.32
$550.97
$769.98
$1,170.06
$760.93
$819.13
$880.78
$1,099.79
$1,090.74
$1,148.94
$1,210.59
$1,429.60
$1,420.55
$1,478.75
$1,540.40
$1,759.41
$329.81
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$862.24
$978.64
$1,101.94
$1,539.96
$2,340.12
$1,192.05
$1,308.45
$1,431.75
$1,869.77
$1,521.86
$1,638.26
$1,761.56
$2,199.58
$1,851.67
$1,968.07
$2,091.37
$2,529.39
$329.81
Toc - Plan #57 CareSource
Gold

(HMO) CareSource Marketplace Diabetes Gold Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$677.82
$769.32
$866.25
$1,210.58
$1,839.59
$1,196.35
$1,287.85
$1,384.78
$1,729.11
$1,714.88
$1,806.38
$1,903.31
$2,247.64
$2,233.41
$2,324.91
$2,421.84
$2,766.17
$518.53
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,355.64
$1,538.64
$1,732.50
$2,421.16
$3,679.18
$1,874.17
$2,057.17
$2,251.03
$2,939.69
$2,392.70
$2,575.70
$2,769.56
$3,458.22
$2,911.23
$3,094.23
$3,288.09
$3,976.75
$518.53
Toc - Plan #58 CareSource
Gold

(HMO) CareSource Marketplace Core Gold Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$618.84
$702.38
$790.87
$1,105.24
$1,679.51
$1,092.25
$1,175.79
$1,264.28
$1,578.65
$1,565.66
$1,649.20
$1,737.69
$2,052.06
$2,039.07
$2,122.61
$2,211.10
$2,525.47
$473.41
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,237.68
$1,404.76
$1,581.74
$2,210.48
$3,359.02
$1,711.09
$1,878.17
$2,055.15
$2,683.89
$2,184.50
$2,351.58
$2,528.56
$3,157.30
$2,657.91
$2,824.99
$3,001.97
$3,630.71
$473.41
Toc - Plan #59 CareSource
Silver

(HMO) CareSource Marketplace Core Silver Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$421.70
$478.63
$538.93
$753.15
$1,144.49
$744.30
$801.23
$861.53
$1,075.75
$1,066.90
$1,123.83
$1,184.13
$1,398.35
$1,389.50
$1,446.43
$1,506.73
$1,720.95
$322.60
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$843.40
$957.26
$1,077.86
$1,506.30
$2,288.98
$1,166.00
$1,279.86
$1,400.46
$1,828.90
$1,488.60
$1,602.46
$1,723.06
$2,151.50
$1,811.20
$1,925.06
$2,045.66
$2,474.10
$322.60

ADVERTISEMENT

MedMutual

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

Toc - Plan #60 MedMutual
Gold

(HMO) Market HMO 2500

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-308-0357

Annual Out of Pocket Expenses:

Individual Family
$2,500 $5,000 Annual Deductible
$5,750 $11,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$545.64
$619.31
$697.33
$974.52
$1,480.88
$963.06
$1,036.73
$1,114.75
$1,391.94
$1,380.48
$1,454.15
$1,532.17
$1,809.36
$1,797.90
$1,871.57
$1,949.59
$2,226.78
$417.42
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,091.28
$1,238.62
$1,394.66
$1,949.04
$2,961.76
$1,508.70
$1,656.04
$1,812.08
$2,366.46
$1,926.12
$2,073.46
$2,229.50
$2,783.88
$2,343.54
$2,490.88
$2,646.92
$3,201.30
$417.42
Toc - Plan #61 MedMutual
Gold

(HMO) Market HMO Standard Gold

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-308-0357

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$561.26
$637.03
$717.28
$1,002.40
$1,523.25
$990.62
$1,066.39
$1,146.64
$1,431.76
$1,419.98
$1,495.75
$1,576.00
$1,861.12
$1,849.34
$1,925.11
$2,005.36
$2,290.48
$429.36
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,122.52
$1,274.06
$1,434.56
$2,004.80
$3,046.50
$1,551.88
$1,703.42
$1,863.92
$2,434.16
$1,981.24
$2,132.78
$2,293.28
$2,863.52
$2,410.60
$2,562.14
$2,722.64
$3,292.88
$429.36
Toc - Plan #62 MedMutual
Silver

(HMO) Market HMO 3850

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-308-0357

Annual Out of Pocket Expenses:

Individual Family
$3,850 $7,700 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$499.98
$567.48
$638.97
$892.96
$1,356.94
$882.46
$949.96
$1,021.45
$1,275.44
$1,264.94
$1,332.44
$1,403.93
$1,657.92
$1,647.42
$1,714.92
$1,786.41
$2,040.40
$382.48
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$999.96
$1,134.96
$1,277.94
$1,785.92
$2,713.88
$1,382.44
$1,517.44
$1,660.42
$2,168.40
$1,764.92
$1,899.92
$2,042.90
$2,550.88
$2,147.40
$2,282.40
$2,425.38
$2,933.36
$382.48
Toc - Plan #63 MedMutual
Silver

(HMO) Market HMO 4000 HSA

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-308-0357

Annual Out of Pocket Expenses:

Individual Family
$4,000 $8,000 Annual Deductible
$5,850 $11,700 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$510.13
$578.99
$651.94
$911.09
$1,384.48
$900.38
$969.24
$1,042.19
$1,301.34
$1,290.63
$1,359.49
$1,432.44
$1,691.59
$1,680.88
$1,749.74
$1,822.69
$2,081.84
$390.25
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,020.26
$1,157.98
$1,303.88
$1,822.18
$2,768.96
$1,410.51
$1,548.23
$1,694.13
$2,212.43
$1,800.76
$1,938.48
$2,084.38
$2,602.68
$2,191.01
$2,328.73
$2,474.63
$2,992.93
$390.25
Toc - Plan #64 MedMutual
Silver

(HMO) Market HMO Select Silver

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-308-0357

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$8,250 $16,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$530.81
$602.47
$678.38
$948.03
$1,440.62
$936.88
$1,008.54
$1,084.45
$1,354.10
$1,342.95
$1,414.61
$1,490.52
$1,760.17
$1,749.02
$1,820.68
$1,896.59
$2,166.24
$406.07
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,061.62
$1,204.94
$1,356.76
$1,896.06
$2,881.24
$1,467.69
$1,611.01
$1,762.83
$2,302.13
$1,873.76
$2,017.08
$2,168.90
$2,708.20
$2,279.83
$2,423.15
$2,574.97
$3,114.27
$406.07
Toc - Plan #65 MedMutual
Silver

(HMO) Market HMO Standard Silver

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-308-0357

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$497.64
$564.82
$635.98
$888.78
$1,350.59
$878.33
$945.51
$1,016.67
$1,269.47
$1,259.02
$1,326.20
$1,397.36
$1,650.16
$1,639.71
$1,706.89
$1,778.05
$2,030.85
$380.69
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$995.28
$1,129.64
$1,271.96
$1,777.56
$2,701.18
$1,375.97
$1,510.33
$1,652.65
$2,158.25
$1,756.66
$1,891.02
$2,033.34
$2,538.94
$2,137.35
$2,271.71
$2,414.03
$2,919.63
$380.69
Toc - Plan #66 MedMutual
Silver

(HMO) Market HMO 6900

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-308-0357

Annual Out of Pocket Expenses:

Individual Family
$6,900 $13,800 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$492.95
$559.50
$629.99
$880.41
$1,337.87
$870.06
$936.61
$1,007.10
$1,257.52
$1,247.17
$1,313.72
$1,384.21
$1,634.63
$1,624.28
$1,690.83
$1,761.32
$2,011.74
$377.11
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$985.90
$1,119.00
$1,259.98
$1,760.82
$2,675.74
$1,363.01
$1,496.11
$1,637.09
$2,137.93
$1,740.12
$1,873.22
$2,014.20
$2,515.04
$2,117.23
$2,250.33
$2,391.31
$2,892.15
$377.11
Toc - Plan #67 MedMutual
Expanded Bronze

(HMO) Market HMO 7300 HSA

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-308-0357

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$361.03
$409.77
$461.40
$644.80
$979.84
$637.22
$685.96
$737.59
$920.99
$913.41
$962.15
$1,013.78
$1,197.18
$1,189.60
$1,238.34
$1,289.97
$1,473.37
$276.19
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$722.06
$819.54
$922.80
$1,289.60
$1,959.68
$998.25
$1,095.73
$1,198.99
$1,565.79
$1,274.44
$1,371.92
$1,475.18
$1,841.98
$1,550.63
$1,648.11
$1,751.37
$2,118.17
$276.19
Toc - Plan #68 MedMutual
Expanded Bronze

(HMO) Market HMO 8300

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-308-0357

Annual Out of Pocket Expenses:

Individual Family
$8,300 $16,600 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$346.59
$393.38
$442.94
$619.01
$940.64
$611.73
$658.52
$708.08
$884.15
$876.87
$923.66
$973.22
$1,149.29
$1,142.01
$1,188.80
$1,238.36
$1,414.43
$265.14
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$693.18
$786.76
$885.88
$1,238.02
$1,881.28
$958.32
$1,051.90
$1,151.02
$1,503.16
$1,223.46
$1,317.04
$1,416.16
$1,768.30
$1,488.60
$1,582.18
$1,681.30
$2,033.44
$265.14
Toc - Plan #69 MedMutual
Expanded Bronze

(HMO) Market HMO Standard Expanded Bronze

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-308-0357

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$373.13
$423.50
$476.86
$666.41
$1,012.67
$658.57
$708.94
$762.30
$951.85
$944.01
$994.38
$1,047.74
$1,237.29
$1,229.45
$1,279.82
$1,333.18
$1,522.73
$285.44
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$746.26
$847.00
$953.72
$1,332.82
$2,025.34
$1,031.70
$1,132.44
$1,239.16
$1,618.26
$1,317.14
$1,417.88
$1,524.60
$1,903.70
$1,602.58
$1,703.32
$1,810.04
$2,189.14
$285.44
Toc - Plan #70 MedMutual
Bronze

(HMO) Market HMO 9450

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-308-0357

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$343.47
$389.83
$438.95
$613.43
$932.17
$606.22
$652.58
$701.70
$876.18
$868.97
$915.33
$964.45
$1,138.93
$1,131.72
$1,178.08
$1,227.20
$1,401.68
$262.75
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$686.94
$779.66
$877.90
$1,226.86
$1,864.34
$949.69
$1,042.41
$1,140.65
$1,489.61
$1,212.44
$1,305.16
$1,403.40
$1,752.36
$1,475.19
$1,567.91
$1,666.15
$2,015.11
$262.75
Toc - Plan #71 MedMutual
Expanded Bronze

(HMO) Market HMO Select Bronze

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-308-0357

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$409.04
$464.26
$522.75
$730.54
$1,110.13
$721.95
$777.17
$835.66
$1,043.45
$1,034.86
$1,090.08
$1,148.57
$1,356.36
$1,347.77
$1,402.99
$1,461.48
$1,669.27
$312.91
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$818.08
$928.52
$1,045.50
$1,461.08
$2,220.26
$1,130.99
$1,241.43
$1,358.41
$1,773.99
$1,443.90
$1,554.34
$1,671.32
$2,086.90
$1,756.81
$1,867.25
$1,984.23
$2,399.81
$312.91
Toc - Plan #72 MedMutual
Catastrophic

(HMO) Market HMO Young Adult Essentials

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-308-0357

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$224.42
$254.72
$286.81
$400.82
$609.09
$396.10
$426.40
$458.49
$572.50
$567.78
$598.08
$630.17
$744.18
$739.46
$769.76
$801.85
$915.86
$171.68
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$448.84
$509.44
$573.62
$801.64
$1,218.18
$620.52
$681.12
$745.30
$973.32
$792.20
$852.80
$916.98
$1,145.00
$963.88
$1,024.48
$1,088.66
$1,316.68
$171.68

‡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 Tuscarawas County here.

Tuscarawas County is in “Rating Area 16” of Ohio.

Currently, there are 72 plans offered in Rating Area 16.

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