Obamacare 2022 Rates for Maury County

Obamacare > Rates > Tennessee > Maury County

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 Maury County, TN.

The health insurance rates listed below are for calendar year 2022.

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, 58 Plans and 2022 Rates for Maury County, Tennessee

Below, you’ll find a summary of the 58 plans for Maury County, Tennessee and rates for each of these providers. This chart is designed to give you a preview of your health insurance options.

You may also be interested in:

Obamacare Rates and Providers for Other Years

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BlueCross BlueShield of Tennessee

Local: 1-423-535-5600 | Toll Free: 1-800-565-9140

Toc - Plan #1 BlueCross BlueShield of Tennessee
Expanded Bronze

(EPO) Bronze B07S HSA + Free Preventive Care

Benefits & Coverage Provider Directory
Customer Service Phone: 1-800-565-9140

Annual Out of Pocket Expenses:

Individual Family
$5,950 $11,900 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
$387.92
$440.29
$495.76
$692.83
$1,052.81
$684.68
$737.05
$792.52
$989.59
$981.44
$1,033.81
$1,089.28
$1,286.35
$1,278.20
$1,330.57
$1,386.04
$1,583.11
$296.76
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$775.84
$880.58
$991.52
$1,385.66
$2,105.62
$1,072.60
$1,177.34
$1,288.28
$1,682.42
$1,369.36
$1,474.10
$1,585.04
$1,979.18
$1,666.12
$1,770.86
$1,881.80
$2,275.94
$296.76
Toc - Plan #2 BlueCross BlueShield of Tennessee
Bronze

(EPO) Bronze B08S Free Telehealth

Benefits & Coverage Provider Directory
Customer Service Phone: 1-800-565-9140

Annual Out of Pocket Expenses:

Individual Family
$8,700 $17,400 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
$340.78
$386.79
$435.52
$608.63
$924.88
$601.48
$647.49
$696.22
$869.33
$862.18
$908.19
$956.92
$1,130.03
$1,122.88
$1,168.89
$1,217.62
$1,390.73
$260.70
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$681.56
$773.58
$871.04
$1,217.26
$1,849.76
$942.26
$1,034.28
$1,131.74
$1,477.96
$1,202.96
$1,294.98
$1,392.44
$1,738.66
$1,463.66
$1,555.68
$1,653.14
$1,999.36
$260.70
Toc - Plan #3 BlueCross BlueShield of Tennessee
Expanded Bronze

(EPO) Bronze B10S Free Telehealth

Benefits & Coverage Provider Directory
Customer Service Phone: 1-800-565-9140

Annual Out of Pocket Expenses:

Individual Family
$6,600 $13,200 Annual Deductible
$8,150 $16,300 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$388.52
$440.97
$496.53
$693.90
$1,054.44
$685.74
$738.19
$793.75
$991.12
$982.96
$1,035.41
$1,090.97
$1,288.34
$1,280.18
$1,332.63
$1,388.19
$1,585.56
$297.22
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$777.04
$881.94
$993.06
$1,387.80
$2,108.88
$1,074.26
$1,179.16
$1,290.28
$1,685.02
$1,371.48
$1,476.38
$1,587.50
$1,982.24
$1,668.70
$1,773.60
$1,884.72
$2,279.46
$297.22
Toc - Plan #4 BlueCross BlueShield of Tennessee
Expanded Bronze

(EPO) Bronze B13S 2 Free PCP Visits + Free Telehealth

Benefits & Coverage Provider Directory
Customer Service Phone: 1-800-565-9140

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 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
$439.96
$499.35
$562.27
$785.77
$1,194.05
$776.53
$835.92
$898.84
$1,122.34
$1,113.10
$1,172.49
$1,235.41
$1,458.91
$1,449.67
$1,509.06
$1,571.98
$1,795.48
$336.57
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$879.92
$998.70
$1,124.54
$1,571.54
$2,388.10
$1,216.49
$1,335.27
$1,461.11
$1,908.11
$1,553.06
$1,671.84
$1,797.68
$2,244.68
$1,889.63
$2,008.41
$2,134.25
$2,581.25
$336.57
Toc - Plan #5 BlueCross BlueShield of Tennessee
Silver

(EPO) Silver S01S Free Telehealth

Benefits & Coverage Provider Directory
Customer Service Phone: 1-800-565-9140

Annual Out of Pocket Expenses:

Individual Family
$725 $1,450 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
$597.15
$677.77
$763.16
$1,066.51
$1,620.67
$1,053.97
$1,134.59
$1,219.98
$1,523.33
$1,510.79
$1,591.41
$1,676.80
$1,980.15
$1,967.61
$2,048.23
$2,133.62
$2,436.97
$456.82
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,194.30
$1,355.54
$1,526.32
$2,133.02
$3,241.34
$1,651.12
$1,812.36
$1,983.14
$2,589.84
$2,107.94
$2,269.18
$2,439.96
$3,046.66
$2,564.76
$2,726.00
$2,896.78
$3,503.48
$456.82
Toc - Plan #6 BlueCross BlueShield of Tennessee
Silver

(EPO) Silver S04S Free Telehealth

Benefits & Coverage Provider Directory
Customer Service Phone: 1-800-565-9140

Annual Out of Pocket Expenses:

Individual Family
$3,400 $6,800 Annual Deductible
$7,900 $15,800 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
$534.53
$606.69
$683.13
$954.67
$1,450.71
$943.45
$1,015.61
$1,092.05
$1,363.59
$1,352.37
$1,424.53
$1,500.97
$1,772.51
$1,761.29
$1,833.45
$1,909.89
$2,181.43
$408.92
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,069.06
$1,213.38
$1,366.26
$1,909.34
$2,901.42
$1,477.98
$1,622.30
$1,775.18
$2,318.26
$1,886.90
$2,031.22
$2,184.10
$2,727.18
$2,295.82
$2,440.14
$2,593.02
$3,136.10
$408.92
Toc - Plan #7 BlueCross BlueShield of Tennessee
Silver

(EPO) Silver S23S 2 Free PCP Visits + Free Telehealth

Benefits & Coverage Provider Directory
Customer Service Phone: 1-800-565-9140

Annual Out of Pocket Expenses:

Individual Family
$3,000 $6,000 Annual Deductible
$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$558.58
$633.99
$713.87
$997.62
$1,515.99
$985.89
$1,061.30
$1,141.18
$1,424.93
$1,413.20
$1,488.61
$1,568.49
$1,852.24
$1,840.51
$1,915.92
$1,995.80
$2,279.55
$427.31
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,117.16
$1,267.98
$1,427.74
$1,995.24
$3,031.98
$1,544.47
$1,695.29
$1,855.05
$2,422.55
$1,971.78
$2,122.60
$2,282.36
$2,849.86
$2,399.09
$2,549.91
$2,709.67
$3,277.17
$427.31
Toc - Plan #8 BlueCross BlueShield of Tennessee
Gold

(EPO) Gold G06S $35 PCP Copay + Free Telehealth + Rx Copays

Benefits & Coverage Provider Directory
Customer Service Phone: 1-800-565-9140

Annual Out of Pocket Expenses:

Individual Family
$2,750 $5,500 Annual Deductible
$6,350 $12,700 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
$641.71
$728.34
$820.11
$1,146.09
$1,741.60
$1,132.62
$1,219.25
$1,311.02
$1,637.00
$1,623.53
$1,710.16
$1,801.93
$2,127.91
$2,114.44
$2,201.07
$2,292.84
$2,618.82
$490.91
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,283.42
$1,456.68
$1,640.22
$2,292.18
$3,483.20
$1,774.33
$1,947.59
$2,131.13
$2,783.09
$2,265.24
$2,438.50
$2,622.04
$3,274.00
$2,756.15
$2,929.41
$3,112.95
$3,764.91
$490.91

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UnitedHealthcare

Local: 1-877-250-8188 | Toll Free: 1-877-250-8188 | TTY: 1-877-250-8188

Toc - Plan #9 UnitedHealthcare
Gold

(EPO) UHC Gold Value+ ($5 Rx)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-250-8188

Annual Out of Pocket Expenses:

Individual Family
$2,500 $5,000 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
$609.98
$692.33
$779.56
$1,089.43
$1,655.49
$1,076.62
$1,158.97
$1,246.20
$1,556.07
$1,543.26
$1,625.61
$1,712.84
$2,022.71
$2,009.90
$2,092.25
$2,179.48
$2,489.35
$466.64
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,219.96
$1,384.66
$1,559.12
$2,178.86
$3,310.98
$1,686.60
$1,851.30
$2,025.76
$2,645.50
$2,153.24
$2,317.94
$2,492.40
$3,112.14
$2,619.88
$2,784.58
$2,959.04
$3,578.78
$466.64
Toc - Plan #10 UnitedHealthcare
Silver

(EPO) UHC Silver Value+ Saver ($3 Rx + 3 Free Primary Care & 6 Free Virtual Visits)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-250-8188

Annual Out of Pocket Expenses:

Individual Family
$6,100 $12,200 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
$475.60
$539.81
$607.82
$849.43
$1,290.78
$839.44
$903.65
$971.66
$1,213.27
$1,203.28
$1,267.49
$1,335.50
$1,577.11
$1,567.12
$1,631.33
$1,699.34
$1,940.95
$363.84
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$951.20
$1,079.62
$1,215.64
$1,698.86
$2,581.56
$1,315.04
$1,443.46
$1,579.48
$2,062.70
$1,678.88
$1,807.30
$1,943.32
$2,426.54
$2,042.72
$2,171.14
$2,307.16
$2,790.38
$363.84
Toc - Plan #11 UnitedHealthcare
Expanded Bronze

(EPO) UHC Bronze Value+ (HSA)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-250-8188

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 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
$361.97
$410.84
$462.60
$646.49
$982.40
$638.88
$687.75
$739.51
$923.40
$915.79
$964.66
$1,016.42
$1,200.31
$1,192.70
$1,241.57
$1,293.33
$1,477.22
$276.91
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$723.94
$821.68
$925.20
$1,292.98
$1,964.80
$1,000.85
$1,098.59
$1,202.11
$1,569.89
$1,277.76
$1,375.50
$1,479.02
$1,846.80
$1,554.67
$1,652.41
$1,755.93
$2,123.71
$276.91
Toc - Plan #12 UnitedHealthcare
Expanded Bronze

(EPO) UHC Bronze Value+ ($3 Rx)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-250-8188

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 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
$355.17
$403.12
$453.91
$634.33
$963.93
$626.88
$674.83
$725.62
$906.04
$898.59
$946.54
$997.33
$1,177.75
$1,170.30
$1,218.25
$1,269.04
$1,449.46
$271.71
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$710.34
$806.24
$907.82
$1,268.66
$1,927.86
$982.05
$1,077.95
$1,179.53
$1,540.37
$1,253.76
$1,349.66
$1,451.24
$1,812.08
$1,525.47
$1,621.37
$1,722.95
$2,083.79
$271.71
Toc - Plan #13 UnitedHealthcare
Gold

(EPO) UHC Gold Advantage+ Extra ($3 Rx + Dental + Vision + 3 Free Primary Care & 6 Free Virtual Visits)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-250-8188

Annual Out of Pocket Expenses:

Individual Family
$1,000 $2,000 Annual Deductible
$6,500 $13,000 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
$630.05
$715.11
$805.21
$1,125.28
$1,709.97
$1,112.04
$1,197.10
$1,287.20
$1,607.27
$1,594.03
$1,679.09
$1,769.19
$2,089.26
$2,076.02
$2,161.08
$2,251.18
$2,571.25
$481.99
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,260.10
$1,430.22
$1,610.42
$2,250.56
$3,419.94
$1,742.09
$1,912.21
$2,092.41
$2,732.55
$2,224.08
$2,394.20
$2,574.40
$3,214.54
$2,706.07
$2,876.19
$3,056.39
$3,696.53
$481.99
Toc - Plan #14 UnitedHealthcare
Silver

(EPO) UHC Silver Value+ ($3 Rx + 3 Free Primary Care & 6 Free Virtual Visits)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-250-8188

Annual Out of Pocket Expenses:

Individual Family
$3,800 $7,600 Annual Deductible
$8,050 $16,100 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
$478.32
$542.90
$611.30
$854.29
$1,298.17
$844.24
$908.82
$977.22
$1,220.21
$1,210.16
$1,274.74
$1,343.14
$1,586.13
$1,576.08
$1,640.66
$1,709.06
$1,952.05
$365.92
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$956.64
$1,085.80
$1,222.60
$1,708.58
$2,596.34
$1,322.56
$1,451.72
$1,588.52
$2,074.50
$1,688.48
$1,817.64
$1,954.44
$2,440.42
$2,054.40
$2,183.56
$2,320.36
$2,806.34
$365.92
Toc - Plan #15 UnitedHealthcare
Silver

(EPO) UHC Silver Value+ ($3 Rx + Unlimited Free Primary Care & Virtual Visits)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-250-8188

Annual Out of Pocket Expenses:

Individual Family
$4,300 $8,600 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
$478.66
$543.28
$611.73
$854.89
$1,299.09
$844.84
$909.46
$977.91
$1,221.07
$1,211.02
$1,275.64
$1,344.09
$1,587.25
$1,577.20
$1,641.82
$1,710.27
$1,953.43
$366.18
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$957.32
$1,086.56
$1,223.46
$1,709.78
$2,598.18
$1,323.50
$1,452.74
$1,589.64
$2,075.96
$1,689.68
$1,818.92
$1,955.82
$2,442.14
$2,055.86
$2,185.10
$2,322.00
$2,808.32
$366.18
Toc - Plan #16 UnitedHealthcare
Silver

(EPO) UHC Silver Advantage+ Extra ($3 Rx + Dental + Vision + 3 Free Primary Care & 6 Free Virtual Visits)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-250-8188

Annual Out of Pocket Expenses:

Individual Family
$2,700 $5,400 Annual Deductible
$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$491.25
$557.57
$627.82
$877.37
$1,333.26
$867.06
$933.38
$1,003.63
$1,253.18
$1,242.87
$1,309.19
$1,379.44
$1,628.99
$1,618.68
$1,685.00
$1,755.25
$2,004.80
$375.81
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$982.50
$1,115.14
$1,255.64
$1,754.74
$2,666.52
$1,358.31
$1,490.95
$1,631.45
$2,130.55
$1,734.12
$1,866.76
$2,007.26
$2,506.36
$2,109.93
$2,242.57
$2,383.07
$2,882.17
$375.81
Toc - Plan #17 UnitedHealthcare
Expanded Bronze

(EPO) UHC Bronze Value+ ($3 Rx + 3 Free Primary Care & 6 Free Virtual Visits)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-250-8188

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 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
$353.47
$401.19
$451.73
$631.30
$959.32
$623.87
$671.59
$722.13
$901.70
$894.27
$941.99
$992.53
$1,172.10
$1,164.67
$1,212.39
$1,262.93
$1,442.50
$270.40
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$706.94
$802.38
$903.46
$1,262.60
$1,918.64
$977.34
$1,072.78
$1,173.86
$1,533.00
$1,247.74
$1,343.18
$1,444.26
$1,803.40
$1,518.14
$1,613.58
$1,714.66
$2,073.80
$270.40
Toc - Plan #18 UnitedHealthcare
Bronze

(EPO) UHC Bronze Essential+ (Low Premium)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-250-8188

Annual Out of Pocket Expenses:

Individual Family
$8,700 $17,400 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
$340.20
$386.13
$434.78
$607.60
$923.31
$600.45
$646.38
$695.03
$867.85
$860.70
$906.63
$955.28
$1,128.10
$1,120.95
$1,166.88
$1,215.53
$1,388.35
$260.25
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$680.40
$772.26
$869.56
$1,215.20
$1,846.62
$940.65
$1,032.51
$1,129.81
$1,475.45
$1,200.90
$1,292.76
$1,390.06
$1,735.70
$1,461.15
$1,553.01
$1,650.31
$1,995.95
$260.25

ADVERTISEMENT

Ambetter of Tennessee

Local: 1-833-709-4735 | Toll Free: 1-833-709-4735

Toc - Plan #19 Ambetter of Tennessee
Bronze

(EPO) Ambetter Essential Care 1

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

Annual Out of Pocket Expenses:

Individual Family
$8,600 $17,200 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
$311.02
$353.00
$397.47
$555.47
$844.08
$548.94
$590.92
$635.39
$793.39
$786.86
$828.84
$873.31
$1,031.31
$1,024.78
$1,066.76
$1,111.23
$1,269.23
$237.92
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$622.04
$706.00
$794.94
$1,110.94
$1,688.16
$859.96
$943.92
$1,032.86
$1,348.86
$1,097.88
$1,181.84
$1,270.78
$1,586.78
$1,335.80
$1,419.76
$1,508.70
$1,824.70
$237.92
Toc - Plan #20 Ambetter of Tennessee
Silver

(EPO) Ambetter Balanced Care 11

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$8,500 $17,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$440.88
$500.39
$563.44
$787.40
$1,196.53
$778.15
$837.66
$900.71
$1,124.67
$1,115.42
$1,174.93
$1,237.98
$1,461.94
$1,452.69
$1,512.20
$1,575.25
$1,799.21
$337.27
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$881.76
$1,000.78
$1,126.88
$1,574.80
$2,393.06
$1,219.03
$1,338.05
$1,464.15
$1,912.07
$1,556.30
$1,675.32
$1,801.42
$2,249.34
$1,893.57
$2,012.59
$2,138.69
$2,586.61
$337.27
Toc - Plan #21 Ambetter of Tennessee
Gold

(EPO) Ambetter Secure Care 5

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

Annual Out of Pocket Expenses:

Individual Family
$1,450 $2,900 Annual Deductible
$6,300 $12,600 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
$472.67
$536.46
$604.05
$844.16
$1,282.79
$834.25
$898.04
$965.63
$1,205.74
$1,195.83
$1,259.62
$1,327.21
$1,567.32
$1,557.41
$1,621.20
$1,688.79
$1,928.90
$361.58
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$945.34
$1,072.92
$1,208.10
$1,688.32
$2,565.58
$1,306.92
$1,434.50
$1,569.68
$2,049.90
$1,668.50
$1,796.08
$1,931.26
$2,411.48
$2,030.08
$2,157.66
$2,292.84
$2,773.06
$361.58
Toc - Plan #22 Ambetter of Tennessee
Expanded Bronze

(EPO) Ambetter Essential Care 2 HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

Annual Out of Pocket Expenses:

Individual Family
$6,900 $13,800 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
$339.01
$384.77
$433.25
$605.46
$920.06
$598.35
$644.11
$692.59
$864.80
$857.69
$903.45
$951.93
$1,124.14
$1,117.03
$1,162.79
$1,211.27
$1,383.48
$259.34
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$678.02
$769.54
$866.50
$1,210.92
$1,840.12
$937.36
$1,028.88
$1,125.84
$1,470.26
$1,196.70
$1,288.22
$1,385.18
$1,729.60
$1,456.04
$1,547.56
$1,644.52
$1,988.94
$259.34
Toc - Plan #23 Ambetter of Tennessee
Silver

(EPO) Ambetter Balanced Care 12

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$435.36
$494.12
$556.37
$777.53
$1,181.53
$768.40
$827.16
$889.41
$1,110.57
$1,101.44
$1,160.20
$1,222.45
$1,443.61
$1,434.48
$1,493.24
$1,555.49
$1,776.65
$333.04
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$870.72
$988.24
$1,112.74
$1,555.06
$2,363.06
$1,203.76
$1,321.28
$1,445.78
$1,888.10
$1,536.80
$1,654.32
$1,778.82
$2,221.14
$1,869.84
$1,987.36
$2,111.86
$2,554.18
$333.04
Toc - Plan #24 Ambetter of Tennessee
Silver

(EPO) Ambetter Balanced Care 29

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

Annual Out of Pocket Expenses:

Individual Family
$5,450 $10,900 Annual Deductible
$8,650 $17,300 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$429.70
$487.69
$549.14
$767.42
$1,166.17
$758.41
$816.40
$877.85
$1,096.13
$1,087.12
$1,145.11
$1,206.56
$1,424.84
$1,415.83
$1,473.82
$1,535.27
$1,753.55
$328.71
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$859.40
$975.38
$1,098.28
$1,534.84
$2,332.34
$1,188.11
$1,304.09
$1,426.99
$1,863.55
$1,516.82
$1,632.80
$1,755.70
$2,192.26
$1,845.53
$1,961.51
$2,084.41
$2,520.97
$328.71
Toc - Plan #25 Ambetter of Tennessee
Expanded Bronze

(EPO) Ambetter Essential Care 5

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

Annual Out of Pocket Expenses:

Individual Family
$8,300 $16,600 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
$337.27
$382.79
$431.02
$602.35
$915.33
$595.28
$640.80
$689.03
$860.36
$853.29
$898.81
$947.04
$1,118.37
$1,111.30
$1,156.82
$1,205.05
$1,376.38
$258.01
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$674.54
$765.58
$862.04
$1,204.70
$1,830.66
$932.55
$1,023.59
$1,120.05
$1,462.71
$1,190.56
$1,281.60
$1,378.06
$1,720.72
$1,448.57
$1,539.61
$1,636.07
$1,978.73
$258.01
Toc - Plan #26 Ambetter of Tennessee
Expanded Bronze

(EPO) Ambetter Essential Care: $1,500 Medical Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

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
$364.53
$413.72
$465.85
$651.02
$989.29
$643.38
$692.57
$744.70
$929.87
$922.23
$971.42
$1,023.55
$1,208.72
$1,201.08
$1,250.27
$1,302.40
$1,487.57
$278.85
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$729.06
$827.44
$931.70
$1,302.04
$1,978.58
$1,007.91
$1,106.29
$1,210.55
$1,580.89
$1,286.76
$1,385.14
$1,489.40
$1,859.74
$1,565.61
$1,663.99
$1,768.25
$2,138.59
$278.85
Toc - Plan #27 Ambetter of Tennessee
Expanded Bronze

(EPO) Ambetter Essential Care: $0 Medical Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

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
$383.42
$435.17
$490.00
$684.77
$1,040.57
$676.73
$728.48
$783.31
$978.08
$970.04
$1,021.79
$1,076.62
$1,271.39
$1,263.35
$1,315.10
$1,369.93
$1,564.70
$293.31
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$766.84
$870.34
$980.00
$1,369.54
$2,081.14
$1,060.15
$1,163.65
$1,273.31
$1,662.85
$1,353.46
$1,456.96
$1,566.62
$1,956.16
$1,646.77
$1,750.27
$1,859.93
$2,249.47
$293.31
Toc - Plan #28 Ambetter of Tennessee
Silver

(EPO) Ambetter Balanced Care 30

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

Annual Out of Pocket Expenses:

Individual Family
$6,100 $12,200 Annual Deductible
$6,100 $12,200 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
$411.02
$466.50
$525.27
$734.06
$1,115.48
$725.44
$780.92
$839.69
$1,048.48
$1,039.86
$1,095.34
$1,154.11
$1,362.90
$1,354.28
$1,409.76
$1,468.53
$1,677.32
$314.42
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$822.04
$933.00
$1,050.54
$1,468.12
$2,230.96
$1,136.46
$1,247.42
$1,364.96
$1,782.54
$1,450.88
$1,561.84
$1,679.38
$2,096.96
$1,765.30
$1,876.26
$1,993.80
$2,411.38
$314.42
Toc - Plan #29 Ambetter of Tennessee
Silver

(EPO) Ambetter Balanced Care 31

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

Annual Out of Pocket Expenses:

Individual Family
$5,450 $10,900 Annual Deductible
$6,450 $12,900 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
$411.11
$466.60
$525.38
$734.22
$1,115.72
$725.60
$781.09
$839.87
$1,048.71
$1,040.09
$1,095.58
$1,154.36
$1,363.20
$1,354.58
$1,410.07
$1,468.85
$1,677.69
$314.49
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$822.22
$933.20
$1,050.76
$1,468.44
$2,231.44
$1,136.71
$1,247.69
$1,365.25
$1,782.93
$1,451.20
$1,562.18
$1,679.74
$2,097.42
$1,765.69
$1,876.67
$1,994.23
$2,411.91
$314.49
Toc - Plan #30 Ambetter of Tennessee
Silver

(EPO) Ambetter Balanced Care 32

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

Annual Out of Pocket Expenses:

Individual Family
$8,100 $16,200 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
$422.30
$479.29
$539.68
$754.20
$1,146.08
$745.35
$802.34
$862.73
$1,077.25
$1,068.40
$1,125.39
$1,185.78
$1,400.30
$1,391.45
$1,448.44
$1,508.83
$1,723.35
$323.05
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$844.60
$958.58
$1,079.36
$1,508.40
$2,292.16
$1,167.65
$1,281.63
$1,402.41
$1,831.45
$1,490.70
$1,604.68
$1,725.46
$2,154.50
$1,813.75
$1,927.73
$2,048.51
$2,477.55
$323.05
Toc - Plan #31 Ambetter of Tennessee
Gold

(EPO) Ambetter Secure Care 20

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$443.50
$503.36
$566.78
$792.07
$1,203.62
$782.77
$842.63
$906.05
$1,131.34
$1,122.04
$1,181.90
$1,245.32
$1,470.61
$1,461.31
$1,521.17
$1,584.59
$1,809.88
$339.27
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$887.00
$1,006.72
$1,133.56
$1,584.14
$2,407.24
$1,226.27
$1,345.99
$1,472.83
$1,923.41
$1,565.54
$1,685.26
$1,812.10
$2,262.68
$1,904.81
$2,024.53
$2,151.37
$2,601.95
$339.27
Toc - Plan #32 Ambetter of Tennessee
Bronze

(EPO) Ambetter Essential Care 1 + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

Annual Out of Pocket Expenses:

Individual Family
$8,600 $17,200 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
$325.41
$369.33
$415.86
$581.16
$883.13
$574.34
$618.26
$664.79
$830.09
$823.27
$867.19
$913.72
$1,079.02
$1,072.20
$1,116.12
$1,162.65
$1,327.95
$248.93
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$650.82
$738.66
$831.72
$1,162.32
$1,766.26
$899.75
$987.59
$1,080.65
$1,411.25
$1,148.68
$1,236.52
$1,329.58
$1,660.18
$1,397.61
$1,485.45
$1,578.51
$1,909.11
$248.93
Toc - Plan #33 Ambetter of Tennessee
Silver

(EPO) Ambetter Balanced Care 11 + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$8,500 $17,000 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
$461.28
$523.54
$589.50
$823.83
$1,251.89
$814.15
$876.41
$942.37
$1,176.70
$1,167.02
$1,229.28
$1,295.24
$1,529.57
$1,519.89
$1,582.15
$1,648.11
$1,882.44
$352.87
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$922.56
$1,047.08
$1,179.00
$1,647.66
$2,503.78
$1,275.43
$1,399.95
$1,531.87
$2,000.53
$1,628.30
$1,752.82
$1,884.74
$2,353.40
$1,981.17
$2,105.69
$2,237.61
$2,706.27
$352.87
Toc - Plan #34 Ambetter of Tennessee
Gold

(EPO) Ambetter Secure Care 5 + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

Annual Out of Pocket Expenses:

Individual Family
$1,450 $2,900 Annual Deductible
$6,300 $12,600 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
$494.53
$561.28
$632.00
$883.22
$1,342.13
$872.84
$939.59
$1,010.31
$1,261.53
$1,251.15
$1,317.90
$1,388.62
$1,639.84
$1,629.46
$1,696.21
$1,766.93
$2,018.15
$378.31
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$989.06
$1,122.56
$1,264.00
$1,766.44
$2,684.26
$1,367.37
$1,500.87
$1,642.31
$2,144.75
$1,745.68
$1,879.18
$2,020.62
$2,523.06
$2,123.99
$2,257.49
$2,398.93
$2,901.37
$378.31
Toc - Plan #35 Ambetter of Tennessee
Expanded Bronze

(EPO) Ambetter Essential Care 2 HSA + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

Annual Out of Pocket Expenses:

Individual Family
$6,900 $13,800 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
$354.70
$402.57
$453.29
$633.47
$962.62
$626.04
$673.91
$724.63
$904.81
$897.38
$945.25
$995.97
$1,176.15
$1,168.72
$1,216.59
$1,267.31
$1,447.49
$271.34
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$709.40
$805.14
$906.58
$1,266.94
$1,925.24
$980.74
$1,076.48
$1,177.92
$1,538.28
$1,252.08
$1,347.82
$1,449.26
$1,809.62
$1,523.42
$1,619.16
$1,720.60
$2,080.96
$271.34
Toc - Plan #36 Ambetter of Tennessee
Silver

(EPO) Ambetter Balanced Care 12 + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$455.50
$516.98
$582.11
$813.50
$1,236.19
$803.95
$865.43
$930.56
$1,161.95
$1,152.40
$1,213.88
$1,279.01
$1,510.40
$1,500.85
$1,562.33
$1,627.46
$1,858.85
$348.45
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$911.00
$1,033.96
$1,164.22
$1,627.00
$2,472.38
$1,259.45
$1,382.41
$1,512.67
$1,975.45
$1,607.90
$1,730.86
$1,861.12
$2,323.90
$1,956.35
$2,079.31
$2,209.57
$2,672.35
$348.45
Toc - Plan #37 Ambetter of Tennessee
Expanded Bronze

(EPO) Ambetter Essential Care 5 + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

Annual Out of Pocket Expenses:

Individual Family
$8,300 $16,600 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
$352.88
$400.50
$450.96
$630.22
$957.68
$622.82
$670.44
$720.90
$900.16
$892.76
$940.38
$990.84
$1,170.10
$1,162.70
$1,210.32
$1,260.78
$1,440.04
$269.94
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$705.76
$801.00
$901.92
$1,260.44
$1,915.36
$975.70
$1,070.94
$1,171.86
$1,530.38
$1,245.64
$1,340.88
$1,441.80
$1,800.32
$1,515.58
$1,610.82
$1,711.74
$2,070.26
$269.94
Toc - Plan #38 Ambetter of Tennessee
Expanded Bronze

(EPO) Ambetter Essential Care: $1,500 Medical Deductible + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

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
$381.39
$432.86
$487.40
$681.14
$1,035.06
$673.14
$724.61
$779.15
$972.89
$964.89
$1,016.36
$1,070.90
$1,264.64
$1,256.64
$1,308.11
$1,362.65
$1,556.39
$291.75
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$762.78
$865.72
$974.80
$1,362.28
$2,070.12
$1,054.53
$1,157.47
$1,266.55
$1,654.03
$1,346.28
$1,449.22
$1,558.30
$1,945.78
$1,638.03
$1,740.97
$1,850.05
$2,237.53
$291.75
Toc - Plan #39 Ambetter of Tennessee
Expanded Bronze

(EPO) Ambetter Essential Care: $0 Medical Deductible + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

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
$401.16
$455.30
$512.67
$716.45
$1,088.71
$708.04
$762.18
$819.55
$1,023.33
$1,014.92
$1,069.06
$1,126.43
$1,330.21
$1,321.80
$1,375.94
$1,433.31
$1,637.09
$306.88
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$802.32
$910.60
$1,025.34
$1,432.90
$2,177.42
$1,109.20
$1,217.48
$1,332.22
$1,739.78
$1,416.08
$1,524.36
$1,639.10
$2,046.66
$1,722.96
$1,831.24
$1,945.98
$2,353.54
$306.88
Toc - Plan #40 Ambetter of Tennessee
Silver

(EPO) Ambetter Balanced Care 31 + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

Annual Out of Pocket Expenses:

Individual Family
$5,450 $10,900 Annual Deductible
$6,450 $12,900 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
$430.13
$488.18
$549.69
$768.19
$1,167.33
$759.17
$817.22
$878.73
$1,097.23
$1,088.21
$1,146.26
$1,207.77
$1,426.27
$1,417.25
$1,475.30
$1,536.81
$1,755.31
$329.04
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$860.26
$976.36
$1,099.38
$1,536.38
$2,334.66
$1,189.30
$1,305.40
$1,428.42
$1,865.42
$1,518.34
$1,634.44
$1,757.46
$2,194.46
$1,847.38
$1,963.48
$2,086.50
$2,523.50
$329.04
Toc - Plan #41 Ambetter of Tennessee
Silver

(EPO) Ambetter Balanced Care 32 + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

Annual Out of Pocket Expenses:

Individual Family
$8,100 $16,200 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
$441.83
$501.47
$564.65
$789.09
$1,199.10
$779.82
$839.46
$902.64
$1,127.08
$1,117.81
$1,177.45
$1,240.63
$1,465.07
$1,455.80
$1,515.44
$1,578.62
$1,803.06
$337.99
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$883.66
$1,002.94
$1,129.30
$1,578.18
$2,398.20
$1,221.65
$1,340.93
$1,467.29
$1,916.17
$1,559.64
$1,678.92
$1,805.28
$2,254.16
$1,897.63
$2,016.91
$2,143.27
$2,592.15
$337.99
Toc - Plan #42 Ambetter of Tennessee
Gold

(EPO) Ambetter Secure Care 20 + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$464.01
$526.64
$593.00
$828.71
$1,259.31
$818.97
$881.60
$947.96
$1,183.67
$1,173.93
$1,236.56
$1,302.92
$1,538.63
$1,528.89
$1,591.52
$1,657.88
$1,893.59
$354.96
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$928.02
$1,053.28
$1,186.00
$1,657.42
$2,518.62
$1,282.98
$1,408.24
$1,540.96
$2,012.38
$1,637.94
$1,763.20
$1,895.92
$2,367.34
$1,992.90
$2,118.16
$2,250.88
$2,722.30
$354.96
Toc - Plan #43 Ambetter of Tennessee
Silver

(EPO) Ambetter Balanced Care 29 + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

Annual Out of Pocket Expenses:

Individual Family
$5,450 $10,900 Annual Deductible
$8,650 $17,300 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$449.58
$510.26
$574.54
$802.92
$1,220.12
$793.50
$854.18
$918.46
$1,146.84
$1,137.42
$1,198.10
$1,262.38
$1,490.76
$1,481.34
$1,542.02
$1,606.30
$1,834.68
$343.92
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$899.16
$1,020.52
$1,149.08
$1,605.84
$2,440.24
$1,243.08
$1,364.44
$1,493.00
$1,949.76
$1,587.00
$1,708.36
$1,836.92
$2,293.68
$1,930.92
$2,052.28
$2,180.84
$2,637.60
$343.92

ADVERTISEMENT

Bright HealthCare

Local: 1-855-827-4448 | Toll Free: 1-855-827-4448

Toc - Plan #44 Bright HealthCare
Expanded Bronze

(EPO) Bronze 8700 + $0 Mental Health ($0 Telehealth + $0 Primary Care + $0 Prescription List)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

Annual Out of Pocket Expenses:

Individual Family
$8,700 $17,400 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
$307.45
$348.95
$392.91
$549.10
$834.41
$542.65
$584.15
$628.11
$784.30
$777.85
$819.35
$863.31
$1,019.50
$1,013.05
$1,054.55
$1,098.51
$1,254.70
$235.20
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$614.90
$697.90
$785.82
$1,098.20
$1,668.82
$850.10
$933.10
$1,021.02
$1,333.40
$1,085.30
$1,168.30
$1,256.22
$1,568.60
$1,320.50
$1,403.50
$1,491.42
$1,803.80
$235.20
Toc - Plan #45 Bright HealthCare
Expanded Bronze

(EPO) Bronze 5300 HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

Annual Out of Pocket Expenses:

Individual Family
$5,300 $10,600 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
$334.75
$379.94
$427.81
$597.87
$908.52
$590.84
$636.03
$683.90
$853.96
$846.93
$892.12
$939.99
$1,110.05
$1,103.02
$1,148.21
$1,196.08
$1,366.14
$256.09
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$669.50
$759.88
$855.62
$1,195.74
$1,817.04
$925.59
$1,015.97
$1,111.71
$1,451.83
$1,181.68
$1,272.06
$1,367.80
$1,707.92
$1,437.77
$1,528.15
$1,623.89
$1,964.01
$256.09
Toc - Plan #46 Bright HealthCare
Expanded Bronze

(EPO) Bronze 7200 ($0 Telehealth + $0 Primary Care + $0 Mental Health + $0 Prescription List)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

Annual Out of Pocket Expenses:

Individual Family
$7,200 $14,400 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
$316.86
$359.63
$404.94
$565.91
$859.95
$559.26
$602.03
$647.34
$808.31
$801.66
$844.43
$889.74
$1,050.71
$1,044.06
$1,086.83
$1,132.14
$1,293.11
$242.40
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$633.72
$719.26
$809.88
$1,131.82
$1,719.90
$876.12
$961.66
$1,052.28
$1,374.22
$1,118.52
$1,204.06
$1,294.68
$1,616.62
$1,360.92
$1,446.46
$1,537.08
$1,859.02
$242.40
Toc - Plan #47 Bright HealthCare
Expanded Bronze

(EPO) Bronze $0 Medical Deductible ($0 Telehealth + $0 Primary Care + $0 Specialist + $0 Mental Health + $0 Prescription

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

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
$349.00
$396.12
$446.03
$623.32
$947.20
$615.99
$663.11
$713.02
$890.31
$882.98
$930.10
$980.01
$1,157.30
$1,149.97
$1,197.09
$1,247.00
$1,424.29
$266.99
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$698.00
$792.24
$892.06
$1,246.64
$1,894.40
$964.99
$1,059.23
$1,159.05
$1,513.63
$1,231.98
$1,326.22
$1,426.04
$1,780.62
$1,498.97
$1,593.21
$1,693.03
$2,047.61
$266.99
Toc - Plan #48 Bright HealthCare
Expanded Bronze

(EPO) Bronze 7200 + Adult Dental & Vision ($0 Telehealth + $0 Primary Care + $0 Mental Health + $0 Prescription List)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

Annual Out of Pocket Expenses:

Individual Family
$7,200 $14,400 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
$329.93
$374.47
$421.65
$589.25
$895.42
$582.32
$626.86
$674.04
$841.64
$834.71
$879.25
$926.43
$1,094.03
$1,087.10
$1,131.64
$1,178.82
$1,346.42
$252.39
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$659.86
$748.94
$843.30
$1,178.50
$1,790.84
$912.25
$1,001.33
$1,095.69
$1,430.89
$1,164.64
$1,253.72
$1,348.08
$1,683.28
$1,417.03
$1,506.11
$1,600.47
$1,935.67
$252.39
Toc - Plan #49 Bright HealthCare
Silver

(EPO) Silver 5000 ($0 Telehealth + $0 Primary Care + $0 Mental Health + $0 Prescription List)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 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
$399.09
$452.97
$510.04
$712.77
$1,083.13
$704.39
$758.27
$815.34
$1,018.07
$1,009.69
$1,063.57
$1,120.64
$1,323.37
$1,314.99
$1,368.87
$1,425.94
$1,628.67
$305.30
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$798.18
$905.94
$1,020.08
$1,425.54
$2,166.26
$1,103.48
$1,211.24
$1,325.38
$1,730.84
$1,408.78
$1,516.54
$1,630.68
$2,036.14
$1,714.08
$1,821.84
$1,935.98
$2,341.44
$305.30
Toc - Plan #50 Bright HealthCare
Silver

(EPO) Silver 3000 ($0 Telehealth + $0 Primary Care + $0 Mental Health + $0 Prescription List)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

Annual Out of Pocket Expenses:

Individual Family
$3,000 $6,000 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
$401.69
$455.92
$513.36
$717.42
$1,090.18
$708.98
$763.21
$820.65
$1,024.71
$1,016.27
$1,070.50
$1,127.94
$1,332.00
$1,323.56
$1,377.79
$1,435.23
$1,639.29
$307.29
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$803.38
$911.84
$1,026.72
$1,434.84
$2,180.36
$1,110.67
$1,219.13
$1,334.01
$1,742.13
$1,417.96
$1,526.42
$1,641.30
$2,049.42
$1,725.25
$1,833.71
$1,948.59
$2,356.71
$307.29
Toc - Plan #51 Bright HealthCare
Silver

(EPO) Silver $0 Deductible($0 Telehealth + $0 Primary Care + $0 Mental Health + $0 Prescription List)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

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
$414.84
$470.84
$530.16
$740.90
$1,125.87
$732.19
$788.19
$847.51
$1,058.25
$1,049.54
$1,105.54
$1,164.86
$1,375.60
$1,366.89
$1,422.89
$1,482.21
$1,692.95
$317.35
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$829.68
$941.68
$1,060.32
$1,481.80
$2,251.74
$1,147.03
$1,259.03
$1,377.67
$1,799.15
$1,464.38
$1,576.38
$1,695.02
$2,116.50
$1,781.73
$1,893.73
$2,012.37
$2,433.85
$317.35
Toc - Plan #52 Bright HealthCare
Silver

(EPO) Silver 6700 ($0 Telehealth + $0 Primary Care + $0 Specialist + $0 Mental Health + $0 Prescription List)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

Annual Out of Pocket Expenses:

Individual Family
$6,700 $13,400 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
$404.47
$459.07
$516.91
$722.38
$1,097.73
$713.89
$768.49
$826.33
$1,031.80
$1,023.31
$1,077.91
$1,135.75
$1,341.22
$1,332.73
$1,387.33
$1,445.17
$1,650.64
$309.42
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$808.94
$918.14
$1,033.82
$1,444.76
$2,195.46
$1,118.36
$1,227.56
$1,343.24
$1,754.18
$1,427.78
$1,536.98
$1,652.66
$2,063.60
$1,737.20
$1,846.40
$1,962.08
$2,373.02
$309.42
Toc - Plan #53 Bright HealthCare
Silver

(EPO) Silver 6700 + Adult Dental & Vision ($0 Telehealth + $0 Primary Care + $0 Specialist + $0 Mental Health + $0 Presc

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

Annual Out of Pocket Expenses:

Individual Family
$6,700 $13,400 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
$417.54
$473.90
$533.61
$745.72
$1,133.20
$736.96
$793.32
$853.03
$1,065.14
$1,056.38
$1,112.74
$1,172.45
$1,384.56
$1,375.80
$1,432.16
$1,491.87
$1,703.98
$319.42
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$835.08
$947.80
$1,067.22
$1,491.44
$2,266.40
$1,154.50
$1,267.22
$1,386.64
$1,810.86
$1,473.92
$1,586.64
$1,706.06
$2,130.28
$1,793.34
$1,906.06
$2,025.48
$2,449.70
$319.42
Toc - Plan #54 Bright HealthCare
Gold

(EPO) Gold 1000 ($0 Telehealth + $0 Primary Care + $0 Specialist + $0 Mental Health + $0 Prescription List)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

Annual Out of Pocket Expenses:

Individual Family
$1,000 $2,000 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
$492.10
$558.53
$628.90
$878.89
$1,335.56
$868.56
$934.99
$1,005.36
$1,255.35
$1,245.02
$1,311.45
$1,381.82
$1,631.81
$1,621.48
$1,687.91
$1,758.28
$2,008.27
$376.46
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$984.20
$1,117.06
$1,257.80
$1,757.78
$2,671.12
$1,360.66
$1,493.52
$1,634.26
$2,134.24
$1,737.12
$1,869.98
$2,010.72
$2,510.70
$2,113.58
$2,246.44
$2,387.18
$2,887.16
$376.46
Toc - Plan #55 Bright HealthCare
Gold

(EPO) Gold $0 Deductible + Adult Dental & Vision ($0 Telehealth + $0 Primary Care + $0 Mental Health + $0 Prescription L

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$6,500 $13,000 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
$530.04
$601.60
$677.40
$946.66
$1,438.54
$935.52
$1,007.08
$1,082.88
$1,352.14
$1,341.00
$1,412.56
$1,488.36
$1,757.62
$1,746.48
$1,818.04
$1,893.84
$2,163.10
$405.48
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,060.08
$1,203.20
$1,354.80
$1,893.32
$2,877.08
$1,465.56
$1,608.68
$1,760.28
$2,298.80
$1,871.04
$2,014.16
$2,165.76
$2,704.28
$2,276.52
$2,419.64
$2,571.24
$3,109.76
$405.48
Toc - Plan #56 Bright HealthCare
Catastrophic

(EPO) Catastrophic 8700 ($0 Primary Care)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

Annual Out of Pocket Expenses:

Individual Family
$8,700 $17,400 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
$295.25
$335.10
$377.32
$527.31
$801.30
$521.11
$560.96
$603.18
$753.17
$746.97
$786.82
$829.04
$979.03
$972.83
$1,012.68
$1,054.90
$1,204.89
$225.86
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$590.50
$670.20
$754.64
$1,054.62
$1,602.60
$816.36
$896.06
$980.50
$1,280.48
$1,042.22
$1,121.92
$1,206.36
$1,506.34
$1,268.08
$1,347.78
$1,432.22
$1,732.20
$225.86
Toc - Plan #57 Bright HealthCare
Expanded Bronze

(EPO) Bronze 8700 ($25 Generic)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

Annual Out of Pocket Expenses:

Individual Family
$8,700 $17,400 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
$305.65
$346.91
$390.62
$545.89
$829.54
$539.47
$580.73
$624.44
$779.71
$773.29
$814.55
$858.26
$1,013.53
$1,007.11
$1,048.37
$1,092.08
$1,247.35
$233.82
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$611.30
$693.82
$781.24
$1,091.78
$1,659.08
$845.12
$927.64
$1,015.06
$1,325.60
$1,078.94
$1,161.46
$1,248.88
$1,559.42
$1,312.76
$1,395.28
$1,482.70
$1,793.24
$233.82
Toc - Plan #58 Bright HealthCare
Silver

(EPO) Silver 4000 ($35 Primary Care + $15 Generic)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

Annual Out of Pocket Expenses:

Individual Family
$4,000 $8,000 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
$393.01
$446.07
$502.27
$701.92
$1,066.63
$693.66
$746.72
$802.92
$1,002.57
$994.31
$1,047.37
$1,103.57
$1,303.22
$1,294.96
$1,348.02
$1,404.22
$1,603.87
$300.65
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$786.02
$892.14
$1,004.54
$1,403.84
$2,133.26
$1,086.67
$1,192.79
$1,305.19
$1,704.49
$1,387.32
$1,493.44
$1,605.84
$2,005.14
$1,687.97
$1,794.09
$1,906.49
$2,305.79
$300.65

‡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 Maury County here.

Maury County is in “Rating Area 8” of Tennessee.

Currently, there are 58 plans offered in Rating Area 8.

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2022 Obamacare Plans for Maury County, TN

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