Obamacare 2021 Rates for Dodge County
Obamacare > Rates > Wisconsin > Dodge County
Obamacare > Rates > Wisconsin > Dodge County
ADVERTISEMENT
ADVERTISEMENT
QuartzLocal: 1-608-644-3430 | Toll Free: 1-800-362-3310 | TTY: 1-800-877-8973 |
Toc - Plan #1 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One Silver I302 with Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$435,50 $494,29 $556,56 $777,80 $1 181,93 |
$768,65 $827,44 $889,71 $1 110,95 |
$1 101,80 $1 160,59 $1 222,86 $1 444,10 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$871,00 $988,58 $1 113,12 $1 555,60 $2 363,86 |
$1 204,15 $1 321,73 $1 446,27 $1 888,75 |
$1 537,30 $1 654,88 $1 779,42 $2 221,90 |
Toc - Plan #2 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One Silver I303 with Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$419,34 $475,95 $535,91 $748,94 $1 138,08 |
$740,13 $796,74 $856,70 $1 069,73 |
$1 060,92 $1 117,53 $1 177,49 $1 390,52 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$838,68 $951,90 $1 071,82 $1 497,88 $2 276,16 |
$1 159,47 $1 272,69 $1 392,61 $1 818,67 |
$1 480,26 $1 593,48 $1 713,40 $2 139,46 |
Toc - Plan #3 Quartz | ||||||||||||||||||||
Gold
(HMO) Quartz One Gold I402 Maintenance with Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$385,03 $437,00 $492,06 $687,65 $1 044,96 |
$679,57 $731,54 $786,60 $982,19 |
$974,11 $1 026,08 $1 081,14 $1 276,73 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$770,06 $874,00 $984,12 $1 375,30 $2 089,92 |
$1 064,60 $1 168,54 $1 278,66 $1 669,84 |
$1 359,14 $1 463,08 $1 573,20 $1 964,38 |
Toc - Plan #4 Quartz | ||||||||||||||||||||
Gold
(HMO) Quartz One Gold I401 with Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$389,47 $442,04 $497,73 $695,58 $1 057,00 |
$687,41 $739,98 $795,67 $993,52 |
$985,35 $1 037,92 $1 093,61 $1 291,46 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$778,94 $884,08 $995,46 $1 391,16 $2 114,00 |
$1 076,88 $1 182,02 $1 293,40 $1 689,10 |
$1 374,82 $1 479,96 $1 591,34 $1 987,04 |
Toc - Plan #5 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One Silver I301 with Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$434,70 $493,38 $555,54 $776,37 $1 179,77 |
$767,24 $825,92 $888,08 $1 108,91 |
$1 099,78 $1 158,46 $1 220,62 $1 441,45 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$869,40 $986,76 $1 111,08 $1 552,74 $2 359,54 |
$1 201,94 $1 319,30 $1 443,62 $1 885,28 |
$1 534,48 $1 651,84 $1 776,16 $2 217,82 |
Toc - Plan #6 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One Bronze I202 with Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$300,39 $340,94 $383,90 $536,49 $815,26 |
$530,19 $570,74 $613,70 $766,29 |
$759,99 $800,54 $843,50 $996,09 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$600,78 $681,88 $767,80 $1 072,98 $1 630,52 |
$830,58 $911,68 $997,60 $1 302,78 |
$1 060,38 $1 141,48 $1 227,40 $1 532,58 |
Toc - Plan #7 Quartz | ||||||||||||||||||||
Gold
(HMO) Quartz One Gold I405 with Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$385,55 $437,60 $492,73 $688,59 $1 046,38 |
$680,49 $732,54 $787,67 $983,53 |
$975,43 $1 027,48 $1 082,61 $1 278,47 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$771,10 $875,20 $985,46 $1 377,18 $2 092,76 |
$1 066,04 $1 170,14 $1 280,40 $1 672,12 |
$1 360,98 $1 465,08 $1 575,34 $1 967,06 |
Toc - Plan #8 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One Bronze I201 with Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$301,47 $342,16 $385,27 $538,41 $818,17 |
$532,09 $572,78 $615,89 $769,03 |
$762,71 $803,40 $846,51 $999,65 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$602,94 $684,32 $770,54 $1 076,82 $1 636,34 |
$833,56 $914,94 $1 001,16 $1 307,44 |
$1 064,18 $1 145,56 $1 231,78 $1 538,06 |
Toc - Plan #9 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One Bronze I204 with Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$313,85 $356,22 $401,10 $560,53 $851,78 |
$553,94 $596,31 $641,19 $800,62 |
$794,03 $836,40 $881,28 $1 040,71 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$627,70 $712,44 $802,20 $1 121,06 $1 703,56 |
$867,79 $952,53 $1 042,29 $1 361,15 |
$1 107,88 $1 192,62 $1 282,38 $1 601,24 |
Toc - Plan #10 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One Silver I302 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$418,48 $474,97 $534,81 $747,40 $1 135,74 |
$738,61 $795,10 $854,94 $1 067,53 |
$1 058,74 $1 115,23 $1 175,07 $1 387,66 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$836,96 $949,94 $1 069,62 $1 494,80 $2 271,48 |
$1 157,09 $1 270,07 $1 389,75 $1 814,93 |
$1 477,22 $1 590,20 $1 709,88 $2 135,06 |
Toc - Plan #11 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One Silver I303 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$402,95 $457,35 $514,97 $719,67 $1 093,60 |
$711,21 $765,61 $823,23 $1 027,93 |
$1 019,47 $1 073,87 $1 131,49 $1 336,19 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$805,90 $914,70 $1 029,94 $1 439,34 $2 187,20 |
$1 114,16 $1 222,96 $1 338,20 $1 747,60 |
$1 422,42 $1 531,22 $1 646,46 $2 055,86 |
Toc - Plan #12 Quartz | ||||||||||||||||||||
Gold
(HMO) Quartz One Gold I402 Maintenance |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$369,98 $419,92 $472,83 $660,78 $1 004,12 |
$653,01 $702,95 $755,86 $943,81 |
$936,04 $985,98 $1 038,89 $1 226,84 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$739,96 $839,84 $945,66 $1 321,56 $2 008,24 |
$1 022,99 $1 122,87 $1 228,69 $1 604,59 |
$1 306,02 $1 405,90 $1 511,72 $1 887,62 |
Toc - Plan #13 Quartz | ||||||||||||||||||||
Gold
(HMO) Quartz One Gold I401 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$374,24 $424,76 $478,28 $668,39 $1 015,68 |
$660,53 $711,05 $764,57 $954,68 |
$946,82 $997,34 $1 050,86 $1 240,97 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$748,48 $849,52 $956,56 $1 336,78 $2 031,36 |
$1 034,77 $1 135,81 $1 242,85 $1 623,07 |
$1 321,06 $1 422,10 $1 529,14 $1 909,36 |
Toc - Plan #14 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One Silver I301 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$417,71 $474,10 $533,83 $746,03 $1 133,66 |
$737,26 $793,65 $853,38 $1 065,58 |
$1 056,81 $1 113,20 $1 172,93 $1 385,13 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$835,42 $948,20 $1 067,66 $1 492,06 $2 267,32 |
$1 154,97 $1 267,75 $1 387,21 $1 811,61 |
$1 474,52 $1 587,30 $1 706,76 $2 131,16 |
Toc - Plan #15 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One Bronze I202 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$288,65 $327,62 $368,89 $515,53 $783,39 |
$509,47 $548,44 $589,71 $736,35 |
$730,29 $769,26 $810,53 $957,17 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$577,30 $655,24 $737,78 $1 031,06 $1 566,78 |
$798,12 $876,06 $958,60 $1 251,88 |
$1 018,94 $1 096,88 $1 179,42 $1 472,70 |
Toc - Plan #16 Quartz | ||||||||||||||||||||
Gold
(HMO) Quartz One Gold I405 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$370,48 $420,49 $473,47 $661,68 $1 005,48 |
$653,90 $703,91 $756,89 $945,10 |
$937,32 $987,33 $1 040,31 $1 228,52 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$740,96 $840,98 $946,94 $1 323,36 $2 010,96 |
$1 024,38 $1 124,40 $1 230,36 $1 606,78 |
$1 307,80 $1 407,82 $1 513,78 $1 890,20 |
Toc - Plan #17 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One Bronze I201 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$289,68 $328,79 $370,21 $517,37 $786,19 |
$511,28 $550,39 $591,81 $738,97 |
$732,88 $771,99 $813,41 $960,57 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$579,36 $657,58 $740,42 $1 034,74 $1 572,38 |
$800,96 $879,18 $962,02 $1 256,34 |
$1 022,56 $1 100,78 $1 183,62 $1 477,94 |
Toc - Plan #18 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One Bronze I204 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$301,59 $342,29 $385,42 $538,62 $818,49 |
$532,30 $573,00 $616,13 $769,33 |
$763,01 $803,71 $846,84 $1 000,04 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$603,18 $684,58 $770,84 $1 077,24 $1 636,98 |
$833,89 $915,29 $1 001,55 $1 307,95 |
$1 064,60 $1 146,00 $1 232,26 $1 538,66 |
Toc - Plan #19 Quartz | ||||||||||||||||||||
Gold
(HMO) Quartz One Gold I404 HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$390,06 $442,71 $498,49 $696,63 $1 058,60 |
$688,45 $741,10 $796,88 $995,02 |
$986,84 $1 039,49 $1 095,27 $1 293,41 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$780,12 $885,42 $996,98 $1 393,26 $2 117,20 |
$1 078,51 $1 183,81 $1 295,37 $1 691,65 |
$1 376,90 $1 482,20 $1 593,76 $1 990,04 |
Toc - Plan #20 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One Bronze I203 HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$296,71 $336,76 $379,19 $529,91 $805,25 |
$523,69 $563,74 $606,17 $756,89 |
$750,67 $790,72 $833,15 $983,87 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$593,42 $673,52 $758,38 $1 059,82 $1 610,50 |
$820,40 $900,50 $985,36 $1 286,80 |
$1 047,38 $1 127,48 $1 212,34 $1 513,78 |
Toc - Plan #21 Quartz | ||||||||||||||||||||
Catastrophic
(HMO) Quartz One Catastrophic I101 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$216,08 $245,24 $276,14 $385,90 $586,42 |
$381,37 $410,53 $441,43 $551,19 |
$546,66 $575,82 $606,72 $716,48 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$432,16 $490,48 $552,28 $771,80 $1 172,84 |
$597,45 $655,77 $717,57 $937,09 |
$762,74 $821,06 $882,86 $1 102,38 |
Toc - Plan #22 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One Silver I304 HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$431,66 $489,92 $551,65 $770,93 $1 171,50 |
$761,87 $820,13 $881,86 $1 101,14 |
$1 092,08 $1 150,34 $1 212,07 $1 431,35 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$863,32 $979,84 $1 103,30 $1 541,86 $2 343,00 |
$1 193,53 $1 310,05 $1 433,51 $1 872,07 |
$1 523,74 $1 640,26 $1 763,72 $2 202,28 |
Toc - Plan #23 Quartz | ||||||||||||||||||||
Gold
(HMO) Quartz One Gold I403 HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$395,80 $449,22 $505,82 $706,88 $1 074,18 |
$698,58 $752,00 $808,60 $1 009,66 |
$1 001,36 $1 054,78 $1 111,38 $1 312,44 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$791,60 $898,44 $1 011,64 $1 413,76 $2 148,36 |
$1 094,38 $1 201,22 $1 314,42 $1 716,54 |
$1 397,16 $1 504,00 $1 617,20 $2 019,32 |
ADVERTISEMENT
Security Health PlanLocal: 1-715-221-9258x19258 | Toll Free: 1-844-293-9624 | TTY: 1-877-727-2232 |
Toc - Plan #24 Security Health Plan | ||||||||||||||||||||
Catastrophic
(EPO) Select Protection |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$233,25 $264,72 $298,08 $416,56 $633,01 |
$411,68 $443,15 $476,51 $594,99 |
$590,11 $621,58 $654,94 $773,42 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$466,50 $529,44 $596,16 $833,12 $1 266,02 |
$644,93 $707,87 $774,59 $1 011,55 |
$823,36 $886,30 $953,02 $1 189,98 |
Toc - Plan #25 Security Health Plan | ||||||||||||||||||||
Bronze
(EPO) Select $8,550 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$341,00 $387,02 $435,79 $609,01 $925,45 |
$601,86 $647,88 $696,65 $869,87 |
$862,72 $908,74 $957,51 $1 130,73 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$682,00 $774,04 $871,58 $1 218,02 $1 850,90 |
$942,86 $1 034,90 $1 132,44 $1 478,88 |
$1 203,72 $1 295,76 $1 393,30 $1 739,74 |
Toc - Plan #26 Security Health Plan | ||||||||||||||||||||
Silver
(EPO) Select $6,950 - 30% |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$517,29 $587,11 $661,09 $923,87 $1 403,90 |
$913,01 $982,83 $1 056,81 $1 319,59 |
$1 308,73 $1 378,55 $1 452,53 $1 715,31 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1 034,58 $1 174,22 $1 322,18 $1 847,74 $2 807,80 |
$1 430,30 $1 569,94 $1 717,90 $2 243,46 |
$1 826,02 $1 965,66 $2 113,62 $2 639,18 |
Toc - Plan #27 Security Health Plan | ||||||||||||||||||||
Silver
(EPO) Select $4,500 HDHP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$541,84 $614,98 $692,46 $967,71 $1 470,54 |
$956,34 $1 029,48 $1 106,96 $1 382,21 |
$1 370,84 $1 443,98 $1 521,46 $1 796,71 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1 083,68 $1 229,96 $1 384,92 $1 935,42 $2 941,08 |
$1 498,18 $1 644,46 $1 799,42 $2 349,92 |
$1 912,68 $2 058,96 $2 213,92 $2 764,42 |
Toc - Plan #28 Security Health Plan | ||||||||||||||||||||
Bronze
(EPO) Select $7,500 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$346,11 $392,83 $442,32 $618,14 $939,33 |
$610,88 $657,60 $707,09 $882,91 |
$875,65 $922,37 $971,86 $1 147,68 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$692,22 $785,66 $884,64 $1 236,28 $1 878,66 |
$956,99 $1 050,43 $1 149,41 $1 501,05 |
$1 221,76 $1 315,20 $1 414,18 $1 765,82 |
Toc - Plan #29 Security Health Plan | ||||||||||||||||||||
Silver
(EPO) Select $4,800 - 30% |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$526,50 $597,56 $672,85 $940,31 $1 428,89 |
$929,26 $1 000,32 $1 075,61 $1 343,07 |
$1 332,02 $1 403,08 $1 478,37 $1 745,83 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1 053,00 $1 195,12 $1 345,70 $1 880,62 $2 857,78 |
$1 455,76 $1 597,88 $1 748,46 $2 283,38 |
$1 858,52 $2 000,64 $2 151,22 $2 686,14 |
Toc - Plan #30 Security Health Plan | ||||||||||||||||||||
Expanded Bronze
(EPO) Select $6,200 HDHP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$377,49 $428,44 $482,41 $674,17 $1 024,47 |
$666,26 $717,21 $771,18 $962,94 |
$955,03 $1 005,98 $1 059,95 $1 251,71 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$754,98 $856,88 $964,82 $1 348,34 $2 048,94 |
$1 043,75 $1 145,65 $1 253,59 $1 637,11 |
$1 332,52 $1 434,42 $1 542,36 $1 925,88 |
Toc - Plan #31 Security Health Plan | ||||||||||||||||||||
Gold
(EPO) Select $3,500 - 30% |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-293-9624
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$478,76 $543,38 $611,84 $855,05 $1 299,33 |
$845,00 $909,62 $978,08 $1 221,29 |
$1 211,24 $1 275,86 $1 344,32 $1 587,53 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$957,52 $1 086,76 $1 223,68 $1 710,10 $2 598,66 |
$1 323,76 $1 453,00 $1 589,92 $2 076,34 |
$1 690,00 $1 819,24 $1 956,16 $2 442,58 |
ADVERTISEMENT
Dean Health PlanLocal: 1-800-279-1302 | Toll Free: 1-800-279-1302 | TTY: 1-800-279-1302 |
Toc - Plan #32 Dean Health Plan | ||||||||||||||||||||
Catastrophic
(HMO) Dean Catastrophic Safety Net |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$225,28 $255,69 $287,91 $402,35 $611,41 |
$397,62 $428,03 $460,25 $574,69 |
$569,96 $600,37 $632,59 $747,03 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$450,56 $511,38 $575,82 $804,70 $1 222,82 |
$622,90 $683,72 $748,16 $977,04 |
$795,24 $856,06 $920,50 $1 149,38 |
Toc - Plan #33 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Dean Silver Copay Plus 4800X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$424,60 $481,92 $542,64 $758,34 $1 152,37 |
$749,42 $806,74 $867,46 $1 083,16 |
$1 074,24 $1 131,56 $1 192,28 $1 407,98 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$849,20 $963,84 $1 085,28 $1 516,68 $2 304,74 |
$1 174,02 $1 288,66 $1 410,10 $1 841,50 |
$1 498,84 $1 613,48 $1 734,92 $2 166,32 |
Toc - Plan #34 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Dean Silver Classic 5000X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$415,93 $472,08 $531,55 $742,84 $1 128,82 |
$734,11 $790,26 $849,73 $1 061,02 |
$1 052,29 $1 108,44 $1 167,91 $1 379,20 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$831,86 $944,16 $1 063,10 $1 485,68 $2 257,64 |
$1 150,04 $1 262,34 $1 381,28 $1 803,86 |
$1 468,22 $1 580,52 $1 699,46 $2 122,04 |
Toc - Plan #35 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Dean Silver Value Copay 5000X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$423,55 $480,73 $541,30 $756,47 $1 149,52 |
$747,57 $804,75 $865,32 $1 080,49 |
$1 071,59 $1 128,77 $1 189,34 $1 404,51 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$847,10 $961,46 $1 082,60 $1 512,94 $2 299,04 |
$1 171,12 $1 285,48 $1 406,62 $1 836,96 |
$1 495,14 $1 609,50 $1 730,64 $2 160,98 |
Toc - Plan #36 Dean Health Plan | ||||||||||||||||||||
Gold
(HMO) Dean Gold Value Copay 3700X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$405,26 $459,97 $517,93 $723,80 $1 099,88 |
$715,29 $770,00 $827,96 $1 033,83 |
$1 025,32 $1 080,03 $1 137,99 $1 343,86 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$810,52 $919,94 $1 035,86 $1 447,60 $2 199,76 |
$1 120,55 $1 229,97 $1 345,89 $1 757,63 |
$1 430,58 $1 540,00 $1 655,92 $2 067,66 |
Toc - Plan #37 Dean Health Plan | ||||||||||||||||||||
Bronze
(HMO) Dean Bronze Value Copay 8500X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$272,05 $308,78 $347,69 $485,89 $738,36 |
$480,17 $516,90 $555,81 $694,01 |
$688,29 $725,02 $763,93 $902,13 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$544,10 $617,56 $695,38 $971,78 $1 476,72 |
$752,22 $825,68 $903,50 $1 179,90 |
$960,34 $1 033,80 $1 111,62 $1 388,02 |
Toc - Plan #38 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Dean Silver HSA-E 4500X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$406,38 $461,24 $519,36 $725,80 $1 102,92 |
$717,26 $772,12 $830,24 $1 036,68 |
$1 028,14 $1 083,00 $1 141,12 $1 347,56 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$812,76 $922,48 $1 038,72 $1 451,60 $2 205,84 |
$1 123,64 $1 233,36 $1 349,60 $1 762,48 |
$1 434,52 $1 544,24 $1 660,48 $2 073,36 |
Toc - Plan #39 Dean Health Plan | ||||||||||||||||||||
Gold
(HMO) Dean Gold Copay Plus 1500X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$418,28 $474,74 $534,56 $747,04 $1 135,20 |
$738,26 $794,72 $854,54 $1 067,02 |
$1 058,24 $1 114,70 $1 174,52 $1 387,00 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$836,56 $949,48 $1 069,12 $1 494,08 $2 270,40 |
$1 156,54 $1 269,46 $1 389,10 $1 814,06 |
$1 476,52 $1 589,44 $1 709,08 $2 134,04 |
Toc - Plan #40 Dean Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) Dean Bronze HSA-E 6850X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$288,97 $327,98 $369,31 $516,10 $784,27 |
$510,03 $549,04 $590,37 $737,16 |
$731,09 $770,10 $811,43 $958,22 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$577,94 $655,96 $738,62 $1 032,20 $1 568,54 |
$799,00 $877,02 $959,68 $1 253,26 |
$1 020,06 $1 098,08 $1 180,74 $1 474,32 |
Toc - Plan #41 Dean Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) Dean Bronze Copay Plus 8500X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$279,36 $317,07 $357,02 $498,93 $758,17 |
$493,07 $530,78 $570,73 $712,64 |
$706,78 $744,49 $784,44 $926,35 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$558,72 $634,14 $714,04 $997,86 $1 516,34 |
$772,43 $847,85 $927,75 $1 211,57 |
$986,14 $1 061,56 $1 141,46 $1 425,28 |
Toc - Plan #42 Dean Health Plan | ||||||||||||||||||||
Gold
(HMO) Dean Gold Copay Elite 1500X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$397,64 $451,32 $508,18 $710,18 $1 079,18 |
$701,83 $755,51 $812,37 $1 014,37 |
$1 006,02 $1 059,70 $1 116,56 $1 318,56 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$795,28 $902,64 $1 016,36 $1 420,36 $2 158,36 |
$1 099,47 $1 206,83 $1 320,55 $1 724,55 |
$1 403,66 $1 511,02 $1 624,74 $2 028,74 |
Toc - Plan #43 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Dean Silver Copay Elite 4800X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$403,82 $458,33 $516,08 $721,22 $1 095,96 |
$712,74 $767,25 $825,00 $1 030,14 |
$1 021,66 $1 076,17 $1 133,92 $1 339,06 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$807,64 $916,66 $1 032,16 $1 442,44 $2 191,92 |
$1 116,56 $1 225,58 $1 341,08 $1 751,36 |
$1 425,48 $1 534,50 $1 650,00 $2 060,28 |
ADVERTISEMENT
Molina HealthcareLocal: 1-888-560-2043 | Toll Free: 1-888-560-2043 |
Toc - Plan #44 Molina Healthcare | ||||||||||||||||||||
Gold
(HMO) Confident Care Gold 1 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$395,71 $449,13 $505,72 $706,74 $1 073,96 |
$698,43 $751,85 $808,44 $1 009,46 |
$1 001,15 $1 054,57 $1 111,16 $1 312,18 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$791,42 $898,26 $1 011,44 $1 413,48 $2 147,92 |
$1 094,14 $1 200,98 $1 314,16 $1 716,20 |
$1 396,86 $1 503,70 $1 616,88 $2 018,92 |
Toc - Plan #45 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Constant Care Silver 1 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$348,80 $395,88 $445,76 $622,95 $946,63 |
$615,63 $662,71 $712,59 $889,78 |
$882,46 $929,54 $979,42 $1 156,61 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$697,60 $791,76 $891,52 $1 245,90 $1 893,26 |
$964,43 $1 058,59 $1 158,35 $1 512,73 |
$1 231,26 $1 325,42 $1 425,18 $1 779,56 |
Toc - Plan #46 Molina Healthcare | ||||||||||||||||||||
Bronze
(HMO) Core Care Bronze 1 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$276,46 $313,78 $353,31 $493,75 $750,30 |
$487,95 $525,27 $564,80 $705,24 |
$699,44 $736,76 $776,29 $916,73 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$552,92 $627,56 $706,62 $987,50 $1 500,60 |
$764,41 $839,05 $918,11 $1 198,99 |
$975,90 $1 050,54 $1 129,60 $1 410,48 |
Toc - Plan #47 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Constant Care Silver 4 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$345,11 $391,70 $441,05 $616,37 $936,63 |
$609,12 $655,71 $705,06 $880,38 |
$873,13 $919,72 $969,07 $1 144,39 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$690,22 $783,40 $882,10 $1 232,74 $1 873,26 |
$954,23 $1 047,41 $1 146,11 $1 496,75 |
$1 218,24 $1 311,42 $1 410,12 $1 760,76 |
Toc - Plan #48 Molina Healthcare | ||||||||||||||||||||
Expanded Bronze
(HMO) Core Care Bronze 4 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$289,59 $328,68 $370,09 $517,20 $785,94 |
$511,12 $550,21 $591,62 $738,73 |
$732,65 $771,74 $813,15 $960,26 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$579,18 $657,36 $740,18 $1 034,40 $1 571,88 |
$800,71 $878,89 $961,71 $1 255,93 |
$1 022,24 $1 100,42 $1 183,24 $1 477,46 |
Toc - Plan #49 Molina Healthcare | ||||||||||||||||||||
Expanded Bronze
(HMO) Core Care Bronze 5 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$281,56 $319,57 $359,83 $502,87 $764,16 |
$496,95 $534,96 $575,22 $718,26 |
$712,34 $750,35 $790,61 $933,65 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$563,12 $639,14 $719,66 $1 005,74 $1 528,32 |
$778,51 $854,53 $935,05 $1 221,13 |
$993,90 $1 069,92 $1 150,44 $1 436,52 |
Toc - Plan #50 Molina Healthcare | ||||||||||||||||||||
Gold
(HMO) Confident Care Gold 1 + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$398,84 $452,68 $509,72 $712,33 $1 082,45 |
$703,95 $757,79 $814,83 $1 017,44 |
$1 009,06 $1 062,90 $1 119,94 $1 322,55 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$797,68 $905,36 $1 019,44 $1 424,66 $2 164,90 |
$1 102,79 $1 210,47 $1 324,55 $1 729,77 |
$1 407,90 $1 515,58 $1 629,66 $2 034,88 |
Toc - Plan #51 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Constant Care Silver 1 + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$351,93 $399,44 $449,76 $628,54 $955,13 |
$621,15 $668,66 $718,98 $897,76 |
$890,37 $937,88 $988,20 $1 166,98 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$703,86 $798,88 $899,52 $1 257,08 $1 910,26 |
$973,08 $1 068,10 $1 168,74 $1 526,30 |
$1 242,30 $1 337,32 $1 437,96 $1 795,52 |
Toc - Plan #52 Molina Healthcare | ||||||||||||||||||||
Bronze
(HMO) Core Care Bronze 1 + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$279,59 $317,33 $357,31 $499,34 $758,80 |
$493,47 $531,21 $571,19 $713,22 |
$707,35 $745,09 $785,07 $927,10 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$559,18 $634,66 $714,62 $998,68 $1 517,60 |
$773,06 $848,54 $928,50 $1 212,56 |
$986,94 $1 062,42 $1 142,38 $1 426,44 |
Toc - Plan #53 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Constant Care Silver 2 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$348,42 $395,46 $445,28 $622,28 $945,61 |
$614,96 $662,00 $711,82 $888,82 |
$881,50 $928,54 $978,36 $1 155,36 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$696,84 $790,92 $890,56 $1 244,56 $1 891,22 |
$963,38 $1 057,46 $1 157,10 $1 511,10 |
$1 229,92 $1 324,00 $1 423,64 $1 777,64 |
Toc - Plan #54 Molina Healthcare | ||||||||||||||||||||
Bronze
(HMO) Core Care Bronze 2 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$274,01 $311,01 $350,19 $489,39 $743,67 |
$483,63 $520,63 $559,81 $699,01 |
$693,25 $730,25 $769,43 $908,63 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$548,02 $622,02 $700,38 $978,78 $1 487,34 |
$757,64 $831,64 $910,00 $1 188,40 |
$967,26 $1 041,26 $1 119,62 $1 398,02 |
ADVERTISEMENT
Arise Health PlanLocal: 1-920-490-6900 | Toll Free: 1-800-332-6249 | TTY: 1-888-332-0144 |
Toc - Plan #55 Arise Health Plan | ||||||||||||||||||||
Bronze
(HMO) WPS HMO Bronze $8,550 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$299,32 $339,73 $382,53 $534,59 $812,35 |
$528,30 $568,71 $611,51 $763,57 |
$757,28 $797,69 $840,49 $992,55 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$598,64 $679,46 $765,06 $1 069,18 $1 624,70 |
$827,62 $908,44 $994,04 $1 298,16 |
$1 056,60 $1 137,42 $1 223,02 $1 527,14 |
Toc - Plan #56 Arise Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) WPS HMO Bronze $6,500 with 3 Free PCP Visits | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$310,79 $352,75 $397,19 $555,07 $843,48 |
$548,54 $590,50 $634,94 $792,82 |
$786,29 $828,25 $872,69 $1 030,57 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$621,58 $705,50 $794,38 $1 110,14 $1 686,96 |
$859,33 $943,25 $1 032,13 $1 347,89 |
$1 097,08 $1 181,00 $1 269,88 $1 585,64 |
Toc - Plan #57 Arise Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) WPS HMO Bronze $7,200 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$304,51 $345,62 $389,16 $543,85 $826,44 |
$537,46 $578,57 $622,11 $776,80 |
$770,41 $811,52 $855,06 $1 009,75 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$609,02 $691,24 $778,32 $1 087,70 $1 652,88 |
$841,97 $924,19 $1 011,27 $1 320,65 |
$1 074,92 $1 157,14 $1 244,22 $1 553,60 |
Toc - Plan #58 Arise Health Plan | ||||||||||||||||||||
Silver
(HMO) WPS HMO Silver $7,500 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$402,38 $456,70 $514,24 $718,65 $1 092,06 |
$710,20 $764,52 $822,06 $1 026,47 |
$1 018,02 $1 072,34 $1 129,88 $1 334,29 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$804,76 $913,40 $1 028,48 $1 437,30 $2 184,12 |
$1 112,58 $1 221,22 $1 336,30 $1 745,12 |
$1 420,40 $1 529,04 $1 644,12 $2 052,94 |
Toc - Plan #59 Arise Health Plan | ||||||||||||||||||||
Silver
(HMO) WPS HMO Silver $4,500 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$403,34 $457,79 $515,47 $720,37 $1 094,66 |
$711,90 $766,35 $824,03 $1 028,93 |
$1 020,46 $1 074,91 $1 132,59 $1 337,49 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$806,68 $915,58 $1 030,94 $1 440,74 $2 189,32 |
$1 115,24 $1 224,14 $1 339,50 $1 749,30 |
$1 423,80 $1 532,70 $1 648,06 $2 057,86 |
Toc - Plan #60 Arise Health Plan | ||||||||||||||||||||
Silver
(HMO) WPS HMO Silver $5,000 with 3 Free PCP Visits | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$419,56 $476,20 $536,20 $749,33 $1 138,69 |
$740,52 $797,16 $857,16 $1 070,29 |
$1 061,48 $1 118,12 $1 178,12 $1 391,25 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$839,12 $952,40 $1 072,40 $1 498,66 $2 277,38 |
$1 160,08 $1 273,36 $1 393,36 $1 819,62 |
$1 481,04 $1 594,32 $1 714,32 $2 140,58 |
Toc - Plan #61 Arise Health Plan | ||||||||||||||||||||
Gold
(HMO) WPS HMO Gold $2,500 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$555,76 $630,79 $710,26 $992,59 $1 508,33 |
$980,92 $1 055,95 $1 135,42 $1 417,75 |
$1 406,08 $1 481,11 $1 560,58 $1 842,91 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1 111,52 $1 261,58 $1 420,52 $1 985,18 $3 016,66 |
$1 536,68 $1 686,74 $1 845,68 $2 410,34 |
$1 961,84 $2 111,90 $2 270,84 $2 835,50 |
Toc - Plan #62 Arise Health Plan | ||||||||||||||||||||
Catastrophic
(HMO) WPS HMO Catastrophic $8,550 with 3 Free PCP Visits | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$260,22 $295,35 $332,56 $464,75 $706,24 |
$459,29 $494,42 $531,63 $663,82 |
$658,36 $693,49 $730,70 $862,89 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$520,44 $590,70 $665,12 $929,50 $1 412,48 |
$719,51 $789,77 $864,19 $1 128,57 |
$918,58 $988,84 $1 063,26 $1 327,64 |
Toc - Plan #63 Arise Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) WPS HMO HDHP Bronze $7,000 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$311,17 $353,18 $397,68 $555,75 $844,52 |
$549,22 $591,23 $635,73 $793,80 |
$787,27 $829,28 $873,78 $1 031,85 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$622,34 $706,36 $795,36 $1 111,50 $1 689,04 |
$860,39 $944,41 $1 033,41 $1 349,55 |
$1 098,44 $1 182,46 $1 271,46 $1 587,60 |
Toc - Plan #64 Arise Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) WPS HMO HDHP Bronze $6,830 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$317,52 $360,39 $405,79 $567,09 $861,75 |
$560,42 $603,29 $648,69 $809,99 |
$803,32 $846,19 $891,59 $1 052,89 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$635,04 $720,78 $811,58 $1 134,18 $1 723,50 |
$877,94 $963,68 $1 054,48 $1 377,08 |
$1 120,84 $1 206,58 $1 297,38 $1 619,98 |
Toc - Plan #65 Arise Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) WPS HMO HDHP Bronze $6,000 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$311,82 $353,92 $398,51 $556,91 $846,28 |
$550,36 $592,46 $637,05 $795,45 |
$788,90 $831,00 $875,59 $1 033,99 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$623,64 $707,84 $797,02 $1 113,82 $1 692,56 |
$862,18 $946,38 $1 035,56 $1 352,36 |
$1 100,72 $1 184,92 $1 274,10 $1 590,90 |
Toc - Plan #66 Arise Health Plan | ||||||||||||||||||||
Silver
(HMO) WPS HMO HDHP Silver $2,800 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$413,53 $469,36 $528,49 $738,56 $1 122,32 |
$729,88 $785,71 $844,84 $1 054,91 |
$1 046,23 $1 102,06 $1 161,19 $1 371,26 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$827,06 $938,72 $1 056,98 $1 477,12 $2 244,64 |
$1 143,41 $1 255,07 $1 373,33 $1 793,47 |
$1 459,76 $1 571,42 $1 689,68 $2 109,82 |
Toc - Plan #67 Arise Health Plan | ||||||||||||||||||||
Silver
(HMO) WPS HMO HDHP Silver $4,500 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$412,57 $468,27 $527,26 $736,85 $1 119,71 |
$728,19 $783,89 $842,88 $1 052,47 |
$1 043,81 $1 099,51 $1 158,50 $1 368,09 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$825,14 $936,54 $1 054,52 $1 473,70 $2 239,42 |
$1 140,76 $1 252,16 $1 370,14 $1 789,32 |
$1 456,38 $1 567,78 $1 685,76 $2 104,94 |
Toc - Plan #68 Arise Health Plan | ||||||||||||||||||||
Silver
(HMO) WPS HMO HDHP Silver $5,500 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$391,74 $444,62 $500,64 $699,65 $1 063,18 |
$691,42 $744,30 $800,32 $999,33 |
$991,10 $1 043,98 $1 100,00 $1 299,01 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$783,48 $889,24 $1 001,28 $1 399,30 $2 126,36 |
$1 083,16 $1 188,92 $1 300,96 $1 698,98 |
$1 382,84 $1 488,60 $1 600,64 $1 998,66 |
Toc - Plan #69 Arise Health Plan | ||||||||||||||||||||
Bronze
(POS) WPS POS Bronze $8,550 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$320,15 $363,37 $409,15 $571,79 $868,89 |
$565,06 $608,28 $654,06 $816,70 |
$809,97 $853,19 $898,97 $1 061,61 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$640,30 $726,74 $818,30 $1 143,58 $1 737,78 |
$885,21 $971,65 $1 063,21 $1 388,49 |
$1 130,12 $1 216,56 $1 308,12 $1 633,40 |
Toc - Plan #70 Arise Health Plan | ||||||||||||||||||||
Expanded Bronze
(POS) WPS POS HDHP Bronze $6,000 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$333,48 $378,50 $426,19 $595,60 $905,06 |
$588,59 $633,61 $681,30 $850,71 |
$843,70 $888,72 $936,41 $1 105,82 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$666,96 $757,00 $852,38 $1 191,20 $1 810,12 |
$922,07 $1 012,11 $1 107,49 $1 446,31 |
$1 177,18 $1 267,22 $1 362,60 $1 701,42 |
ADVERTISEMENT
Group Health Cooperative-SCWLocal: 1-608-828-4831 | Toll Free: 1-855-344-2729 | TTY: 1-608-828-4815 |
Toc - Plan #71 Group Health Cooperative-SCW | ||||||||||||||||||||
Platinum
(HMO) Platinum 500 Ded/1500 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$431,21 $489,42 $551,08 $770,13 $1 170,29 |
$761,09 $819,30 $880,96 $1 100,01 |
$1 090,97 $1 149,18 $1 210,84 $1 429,89 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$862,42 $978,84 $1 102,16 $1 540,26 $2 340,58 |
$1 192,30 $1 308,72 $1 432,04 $1 870,14 |
$1 522,18 $1 638,60 $1 761,92 $2 200,02 |
Toc - Plan #72 Group Health Cooperative-SCW | ||||||||||||||||||||
Gold
(HMO) Gold 2500 Ded/2500 MOOP HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$352,53 $400,13 $450,54 $629,62 $956,77 |
$622,22 $669,82 $720,23 $899,31 |
$891,91 $939,51 $989,92 $1 169,00 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$705,06 $800,26 $901,08 $1 259,24 $1 913,54 |
$974,75 $1 069,95 $1 170,77 $1 528,93 |
$1 244,44 $1 339,64 $1 440,46 $1 798,62 |
Toc - Plan #73 Group Health Cooperative-SCW | ||||||||||||||||||||
Expanded Bronze
(HMO) Bronze 4000 Ded/8500 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$274,92 $312,03 $351,34 $491,00 $746,12 |
$485,23 $522,34 $561,65 $701,31 |
$695,54 $732,65 $771,96 $911,62 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$549,84 $624,06 $702,68 $982,00 $1 492,24 |
$760,15 $834,37 $912,99 $1 192,31 |
$970,46 $1 044,68 $1 123,30 $1 402,62 |
Toc - Plan #74 Group Health Cooperative-SCW | ||||||||||||||||||||
Expanded Bronze
(HMO) Bronze 7000 Ded/7000 MOOP HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$275,07 $312,20 $351,53 $491,26 $746,52 |
$485,50 $522,63 $561,96 $701,69 |
$695,93 $733,06 $772,39 $912,12 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$550,14 $624,40 $703,06 $982,52 $1 493,04 |
$760,57 $834,83 $913,49 $1 192,95 |
$971,00 $1 045,26 $1 123,92 $1 403,38 |
Toc - Plan #75 Group Health Cooperative-SCW | ||||||||||||||||||||
Gold
(HMO) Gold 2500 Ded/6500 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$348,87 $395,96 $445,85 $623,07 $946,81 |
$615,75 $662,84 $712,73 $889,95 |
$882,63 $929,72 $979,61 $1 156,83 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$697,74 $791,92 $891,70 $1 246,14 $1 893,62 |
$964,62 $1 058,80 $1 158,58 $1 513,02 |
$1 231,50 $1 325,68 $1 425,46 $1 779,90 |
Toc - Plan #76 Group Health Cooperative-SCW | ||||||||||||||||||||
Gold
(HMO) Gold Simple Choice 1600 Ded/5400 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$359,04 $407,51 $458,86 $641,25 $974,43 |
$633,71 $682,18 $733,53 $915,92 |
$908,38 $956,85 $1 008,20 $1 190,59 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$718,08 $815,02 $917,72 $1 282,50 $1 948,86 |
$992,75 $1 089,69 $1 192,39 $1 557,17 |
$1 267,42 $1 364,36 $1 467,06 $1 831,84 |
Toc - Plan #77 Group Health Cooperative-SCW | ||||||||||||||||||||
Silver
(HMO) Silver Simple Choice 4550X Ded/7900 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$393,13 $446,20 $502,42 $702,12 $1 066,94 |
$693,87 $746,94 $803,16 $1 002,86 |
$994,61 $1 047,68 $1 103,90 $1 303,60 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$786,26 $892,40 $1 004,84 $1 404,24 $2 133,88 |
$1 087,00 $1 193,14 $1 305,58 $1 704,98 |
$1 387,74 $1 493,88 $1 606,32 $2 005,72 |
Toc - Plan #78 Group Health Cooperative-SCW | ||||||||||||||||||||
Expanded Bronze
(HMO) Bronze Simple Choice 6850 Ded/8200 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$284,09 $322,44 $363,07 $507,38 $771,01 |
$501,42 $539,77 $580,40 $724,71 |
$718,75 $757,10 $797,73 $942,04 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$568,18 $644,88 $726,14 $1 014,76 $1 542,02 |
$785,51 $862,21 $943,47 $1 232,09 |
$1 002,84 $1 079,54 $1 160,80 $1 449,42 |
Toc - Plan #79 Group Health Cooperative-SCW | ||||||||||||||||||||
Platinum
(HMO) Platinum No Ded/2000 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$435,73 $494,55 $556,86 $778,20 $1 182,55 |
$769,06 $827,88 $890,19 $1 111,53 |
$1 102,39 $1 161,21 $1 223,52 $1 444,86 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$871,46 $989,10 $1 113,72 $1 556,40 $2 365,10 |
$1 204,79 $1 322,43 $1 447,05 $1 889,73 |
$1 538,12 $1 655,76 $1 780,38 $2 223,06 |
Toc - Plan #80 Group Health Cooperative-SCW | ||||||||||||||||||||
Bronze
(HMO) Bronze 8550 Ded/8550 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$270,02 $306,47 $345,08 $482,24 $732,81 |
$476,58 $513,03 $551,64 $688,80 |
$683,14 $719,59 $758,20 $895,36 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$540,04 $612,94 $690,16 $964,48 $1 465,62 |
$746,60 $819,50 $896,72 $1 171,04 |
$953,16 $1 026,06 $1 103,28 $1 377,60 |
Toc - Plan #81 Group Health Cooperative-SCW | ||||||||||||||||||||
Silver
(HMO) Silver 4900 Ded/7900 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$440,99 $500,52 $563,58 $787,61 $1 196,84 |
$778,35 $837,88 $900,94 $1 124,97 |
$1 115,71 $1 175,24 $1 238,30 $1 462,33 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$881,98 $1 001,04 $1 127,16 $1 575,22 $2 393,68 |
$1 219,34 $1 338,40 $1 464,52 $1 912,58 |
$1 556,70 $1 675,76 $1 801,88 $2 249,94 |
Toc - Plan #82 Group Health Cooperative-SCW | ||||||||||||||||||||
Gold
(HMO) Gold 1500 Ded/8550 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$336,70 $382,16 $430,31 $601,35 $913,80 |
$594,28 $639,74 $687,89 $858,93 |
$851,86 $897,32 $945,47 $1 116,51 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$673,40 $764,32 $860,62 $1 202,70 $1 827,60 |
$930,98 $1 021,90 $1 118,20 $1 460,28 |
$1 188,56 $1 279,48 $1 375,78 $1 717,86 |
Toc - Plan #83 Group Health Cooperative-SCW | ||||||||||||||||||||
Silver
(HMO) Silver 8100X Ded/8150 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$408,54 $463,69 $522,11 $729,65 $1 108,76 |
$721,07 $776,22 $834,64 $1 042,18 |
$1 033,60 $1 088,75 $1 147,17 $1 354,71 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$817,08 $927,38 $1 044,22 $1 459,30 $2 217,52 |
$1 129,61 $1 239,91 $1 356,75 $1 771,83 |
$1 442,14 $1 552,44 $1 669,28 $2 084,36 |
‡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 Dodge County here.
Dodge County is in “Rating Area 11” of Wisconsin.
Currently, there are 83 plans offered in Rating Area 11.