Obamacare 2022 Rates for Rockwall County
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Obamacare > Rates > Texas > Rockwall County
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Oscar Insurance CompanyLocal: 1-855-672-2755 | Toll Free: 1-855-672-2755 |
Toc - Plan #1 Oscar Insurance Company | ||||||||||||||||||||
Expanded Bronze
(EPO) Bronze Simple |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$262.34 $297.74 $335.25 $468.52 $711.96 |
$463.02 $498.42 $535.93 $669.20 |
$663.70 $699.10 $736.61 $869.88 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$524.68 $595.48 $670.50 $937.04 $1,423.92 |
$725.36 $796.16 $871.18 $1,137.72 |
$926.04 $996.84 $1,071.86 $1,338.40 |
Toc - Plan #2 Oscar Insurance Company | ||||||||||||||||||||
Expanded Bronze
(EPO) Bronze Classic- PCP Saver |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$266.64 $302.62 $340.75 $476.19 $723.62 |
$470.61 $506.59 $544.72 $680.16 |
$674.58 $710.56 $748.69 $884.13 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$533.28 $605.24 $681.50 $952.38 $1,447.24 |
$737.25 $809.21 $885.47 $1,156.35 |
$941.22 $1,013.18 $1,089.44 $1,360.32 |
Toc - Plan #3 Oscar Insurance Company | ||||||||||||||||||||
Expanded Bronze
(EPO) Bronze Classic |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$262.65 $298.10 $335.66 $469.08 $712.81 |
$463.57 $499.02 $536.58 $670.00 |
$664.49 $699.94 $737.50 $870.92 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$525.30 $596.20 $671.32 $938.16 $1,425.62 |
$726.22 $797.12 $872.24 $1,139.08 |
$927.14 $998.04 $1,073.16 $1,340.00 |
Toc - Plan #4 Oscar Insurance Company | ||||||||||||||||||||
Expanded Bronze
(EPO) Bronze Elite- $0 Ded+PCP Saver |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$314.17 $356.57 $401.50 $561.09 $852.63 |
$554.50 $596.90 $641.83 $801.42 |
$794.83 $837.23 $882.16 $1,041.75 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$628.34 $713.14 $803.00 $1,122.18 $1,705.26 |
$868.67 $953.47 $1,043.33 $1,362.51 |
$1,109.00 $1,193.80 $1,283.66 $1,602.84 |
Toc - Plan #5 Oscar Insurance Company | ||||||||||||||||||||
Silver
(EPO) Silver Classic |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$367.20 $416.77 $469.27 $655.81 $996.57 |
$648.10 $697.67 $750.17 $936.71 |
$929.00 $978.57 $1,031.07 $1,217.61 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$734.40 $833.54 $938.54 $1,311.62 $1,993.14 |
$1,015.30 $1,114.44 $1,219.44 $1,592.52 |
$1,296.20 $1,395.34 $1,500.34 $1,873.42 |
Toc - Plan #6 Oscar Insurance Company | ||||||||||||||||||||
Silver
(EPO) Silver Simple- Specialist Saver |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$359.78 $408.34 $459.79 $642.55 $976.42 |
$635.00 $683.56 $735.01 $917.77 |
$910.22 $958.78 $1,010.23 $1,192.99 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$719.56 $816.68 $919.58 $1,285.10 $1,952.84 |
$994.78 $1,091.90 $1,194.80 $1,560.32 |
$1,270.00 $1,367.12 $1,470.02 $1,835.54 |
Toc - Plan #7 Oscar Insurance Company | ||||||||||||||||||||
Silver
(EPO) Silver Classic- PCP Saver |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$367.55 $417.15 $469.71 $656.42 $997.49 |
$648.71 $698.31 $750.87 $937.58 |
$929.87 $979.47 $1,032.03 $1,218.74 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$735.10 $834.30 $939.42 $1,312.84 $1,994.98 |
$1,016.26 $1,115.46 $1,220.58 $1,594.00 |
$1,297.42 $1,396.62 $1,501.74 $1,875.16 |
Toc - Plan #8 Oscar Insurance Company | ||||||||||||||||||||
Catastrophic
(EPO) Secure |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$217.08 $246.38 $277.42 $387.69 $589.13 |
$383.14 $412.44 $443.48 $553.75 |
$549.20 $578.50 $609.54 $719.81 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$434.16 $492.76 $554.84 $775.38 $1,178.26 |
$600.22 $658.82 $720.90 $941.44 |
$766.28 $824.88 $886.96 $1,107.50 |
Toc - Plan #9 Oscar Insurance Company | ||||||||||||||||||||
Expanded Bronze
(EPO) Bronze Elite- $0 Ded+Specialist Saver |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$314.25 $356.66 $401.59 $561.22 $852.83 |
$554.64 $597.05 $641.98 $801.61 |
$795.03 $837.44 $882.37 $1,042.00 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$628.50 $713.32 $803.18 $1,122.44 $1,705.66 |
$868.89 $953.71 $1,043.57 $1,362.83 |
$1,109.28 $1,194.10 $1,283.96 $1,603.22 |
Toc - Plan #10 Oscar Insurance Company | ||||||||||||||||||||
Gold
(EPO) Gold Classic |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$362.14 $411.02 $462.81 $646.77 $982.83 |
$639.17 $688.05 $739.84 $923.80 |
$916.20 $965.08 $1,016.87 $1,200.83 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$724.28 $822.04 $925.62 $1,293.54 $1,965.66 |
$1,001.31 $1,099.07 $1,202.65 $1,570.57 |
$1,278.34 $1,376.10 $1,479.68 $1,847.60 |
Toc - Plan #11 Oscar Insurance Company | ||||||||||||||||||||
Expanded Bronze
(EPO) Bronze Simple- HSA |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$288.17 $327.06 $368.27 $514.66 $782.07 |
$508.61 $547.50 $588.71 $735.10 |
$729.05 $767.94 $809.15 $955.54 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$576.34 $654.12 $736.54 $1,029.32 $1,564.14 |
$796.78 $874.56 $956.98 $1,249.76 |
$1,017.22 $1,095.00 $1,177.42 $1,470.20 |
Toc - Plan #12 Oscar Insurance Company | ||||||||||||||||||||
Silver
(EPO) Silver Simple |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$360.19 $408.81 $460.31 $643.28 $977.53 |
$635.73 $684.35 $735.85 $918.82 |
$911.27 $959.89 $1,011.39 $1,194.36 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$720.38 $817.62 $920.62 $1,286.56 $1,955.06 |
$995.92 $1,093.16 $1,196.16 $1,562.10 |
$1,271.46 $1,368.70 $1,471.70 $1,837.64 |
Toc - Plan #13 Oscar Insurance Company | ||||||||||||||||||||
Silver
(EPO) Silver Elite |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$373.45 $423.86 $477.26 $666.97 $1,013.52 |
$659.13 $709.54 $762.94 $952.65 |
$944.81 $995.22 $1,048.62 $1,238.33 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$746.90 $847.72 $954.52 $1,333.94 $2,027.04 |
$1,032.58 $1,133.40 $1,240.20 $1,619.62 |
$1,318.26 $1,419.08 $1,525.88 $1,905.30 |
Toc - Plan #14 Oscar Insurance Company | ||||||||||||||||||||
Silver
(EPO) Silver Classic- $0 Ded |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$388.66 $441.11 $496.69 $694.12 $1,054.79 |
$685.97 $738.42 $794.00 $991.43 |
$983.28 $1,035.73 $1,091.31 $1,288.74 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$777.32 $882.22 $993.38 $1,388.24 $2,109.58 |
$1,074.63 $1,179.53 $1,290.69 $1,685.55 |
$1,371.94 $1,476.84 $1,588.00 $1,982.86 |
Toc - Plan #15 Oscar Insurance Company | ||||||||||||||||||||
Gold
(EPO) Gold Classic- Low Ded |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$369.74 $419.64 $472.52 $660.34 $1,003.45 |
$652.58 $702.48 $755.36 $943.18 |
$935.42 $985.32 $1,038.20 $1,226.02 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$739.48 $839.28 $945.04 $1,320.68 $2,006.90 |
$1,022.32 $1,122.12 $1,227.88 $1,603.52 |
$1,305.16 $1,404.96 $1,510.72 $1,886.36 |
Toc - Plan #16 Oscar Insurance Company | ||||||||||||||||||||
Expanded Bronze
(EPO) Bronze Classic- $0 PCP |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$277.80 $315.29 $355.02 $496.14 $753.93 |
$490.31 $527.80 $567.53 $708.65 |
$702.82 $740.31 $780.04 $921.16 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$555.60 $630.58 $710.04 $992.28 $1,507.86 |
$768.11 $843.09 $922.55 $1,204.79 |
$980.62 $1,055.60 $1,135.06 $1,417.30 |
Toc - Plan #17 Oscar Insurance Company | ||||||||||||||||||||
Expanded Bronze
(EPO) Bronze Classic- Specialist Saver |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$301.69 $342.41 $385.55 $538.81 $818.77 |
$532.48 $573.20 $616.34 $769.60 |
$763.27 $803.99 $847.13 $1,000.39 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$603.38 $684.82 $771.10 $1,077.62 $1,637.54 |
$834.17 $915.61 $1,001.89 $1,308.41 |
$1,064.96 $1,146.40 $1,232.68 $1,539.20 |
Toc - Plan #18 Oscar Insurance Company | ||||||||||||||||||||
Expanded Bronze
(EPO) Bronze Classic- $3250 Ded |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$300.12 $340.62 $383.54 $535.99 $814.49 |
$529.70 $570.20 $613.12 $765.57 |
$759.28 $799.78 $842.70 $995.15 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$600.24 $681.24 $767.08 $1,071.98 $1,628.98 |
$829.82 $910.82 $996.66 $1,301.56 |
$1,059.40 $1,140.40 $1,226.24 $1,531.14 |
Toc - Plan #19 Oscar Insurance Company | ||||||||||||||||||||
Expanded Bronze
(EPO) Bronze Classic- $4700 Ded |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$276.84 $314.20 $353.79 $494.41 $751.31 |
$488.61 $525.97 $565.56 $706.18 |
$700.38 $737.74 $777.33 $917.95 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$553.68 $628.40 $707.58 $988.82 $1,502.62 |
$765.45 $840.17 $919.35 $1,200.59 |
$977.22 $1,051.94 $1,131.12 $1,412.36 |
Toc - Plan #20 Oscar Insurance Company | ||||||||||||||||||||
Silver
(EPO) Silver Simple- PCP Saver |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$355.97 $404.01 $454.91 $635.74 $966.07 |
$628.28 $676.32 $727.22 $908.05 |
$900.59 $948.63 $999.53 $1,180.36 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$711.94 $808.02 $909.82 $1,271.48 $1,932.14 |
$984.25 $1,080.33 $1,182.13 $1,543.79 |
$1,256.56 $1,352.64 $1,454.44 $1,816.10 |
Toc - Plan #21 Oscar Insurance Company | ||||||||||||||||||||
Silver
(EPO) Silver Elite- Specialist Saver |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$384.84 $436.79 $491.82 $687.31 $1,044.44 |
$679.24 $731.19 $786.22 $981.71 |
$973.64 $1,025.59 $1,080.62 $1,276.11 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$769.68 $873.58 $983.64 $1,374.62 $2,088.88 |
$1,064.08 $1,167.98 $1,278.04 $1,669.02 |
$1,358.48 $1,462.38 $1,572.44 $1,963.42 |
Toc - Plan #22 Oscar Insurance Company | ||||||||||||||||||||
Silver
(EPO) Silver Classic- Low Ded |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$370.28 $420.26 $473.21 $661.31 $1,004.92 |
$653.54 $703.52 $756.47 $944.57 |
$936.80 $986.78 $1,039.73 $1,227.83 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$740.56 $840.52 $946.42 $1,322.62 $2,009.84 |
$1,023.82 $1,123.78 $1,229.68 $1,605.88 |
$1,307.08 $1,407.04 $1,512.94 $1,889.14 |
Toc - Plan #23 Oscar Insurance Company | ||||||||||||||||||||
Silver
(EPO) Silver Elite- $0 PCP |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$382.30 $433.90 $488.57 $682.78 $1,037.54 |
$674.75 $726.35 $781.02 $975.23 |
$967.20 $1,018.80 $1,073.47 $1,267.68 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$764.60 $867.80 $977.14 $1,365.56 $2,075.08 |
$1,057.05 $1,160.25 $1,269.59 $1,658.01 |
$1,349.50 $1,452.70 $1,562.04 $1,950.46 |
Toc - Plan #24 Oscar Insurance Company | ||||||||||||||||||||
Silver
(EPO) Silver Simple- HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$381.49 $432.98 $487.53 $681.32 $1,035.33 |
$673.32 $724.81 $779.36 $973.15 |
$965.15 $1,016.64 $1,071.19 $1,264.98 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$762.98 $865.96 $975.06 $1,362.64 $2,070.66 |
$1,054.81 $1,157.79 $1,266.89 $1,654.47 |
$1,346.64 $1,449.62 $1,558.72 $1,946.30 |
Toc - Plan #25 Oscar Insurance Company | ||||||||||||||||||||
Silver
(EPO) Silver Elite- $0 Ded |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$377.80 $428.79 $482.81 $674.73 $1,025.32 |
$666.81 $717.80 $771.82 $963.74 |
$955.82 $1,006.81 $1,060.83 $1,252.75 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$755.60 $857.58 $965.62 $1,349.46 $2,050.64 |
$1,044.61 $1,146.59 $1,254.63 $1,638.47 |
$1,333.62 $1,435.60 $1,543.64 $1,927.48 |
Toc - Plan #26 Oscar Insurance Company | ||||||||||||||||||||
Gold
(EPO) Gold Simple |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$347.20 $394.06 $443.70 $620.07 $942.26 |
$612.80 $659.66 $709.30 $885.67 |
$878.40 $925.26 $974.90 $1,151.27 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$694.40 $788.12 $887.40 $1,240.14 $1,884.52 |
$960.00 $1,053.72 $1,153.00 $1,505.74 |
$1,225.60 $1,319.32 $1,418.60 $1,771.34 |
Toc - Plan #27 Oscar Insurance Company | ||||||||||||||||||||
Gold
(EPO) Gold Classic- $0 PCP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$353.98 $401.76 $452.38 $632.19 $960.68 |
$624.77 $672.55 $723.17 $902.98 |
$895.56 $943.34 $993.96 $1,173.77 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$707.96 $803.52 $904.76 $1,264.38 $1,921.36 |
$978.75 $1,074.31 $1,175.55 $1,535.17 |
$1,249.54 $1,345.10 $1,446.34 $1,805.96 |
Toc - Plan #28 Oscar Insurance Company | ||||||||||||||||||||
Gold
(EPO) Gold Elite- $0 Ded |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$405.12 $459.80 $517.73 $723.53 $1,099.47 |
$715.03 $769.71 $827.64 $1,033.44 |
$1,024.94 $1,079.62 $1,137.55 $1,343.35 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$810.24 $919.60 $1,035.46 $1,447.06 $2,198.94 |
$1,120.15 $1,229.51 $1,345.37 $1,756.97 |
$1,430.06 $1,539.42 $1,655.28 $2,066.88 |
Toc - Plan #29 Oscar Insurance Company | ||||||||||||||||||||
Gold
(EPO) Gold Elite |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$382.89 $434.57 $489.32 $683.83 $1,039.14 |
$675.79 $727.47 $782.22 $976.73 |
$968.69 $1,020.37 $1,075.12 $1,269.63 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$765.78 $869.14 $978.64 $1,367.66 $2,078.28 |
$1,058.68 $1,162.04 $1,271.54 $1,660.56 |
$1,351.58 $1,454.94 $1,564.44 $1,953.46 |
Toc - Plan #30 Oscar Insurance Company | ||||||||||||||||||||
Gold
(EPO) Gold Classic- HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$356.48 $404.59 $455.57 $636.65 $967.46 |
$629.18 $677.29 $728.27 $909.35 |
$901.88 $949.99 $1,000.97 $1,182.05 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$712.96 $809.18 $911.14 $1,273.30 $1,934.92 |
$985.66 $1,081.88 $1,183.84 $1,546.00 |
$1,258.36 $1,354.58 $1,456.54 $1,818.70 |
Toc - Plan #31 Oscar Insurance Company | ||||||||||||||||||||
Expanded Bronze
(EPO) Bronze Classic- $4000 Ded |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$299.12 $339.49 $382.27 $534.22 $811.79 |
$527.94 $568.31 $611.09 $763.04 |
$756.76 $797.13 $839.91 $991.86 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$598.24 $678.98 $764.54 $1,068.44 $1,623.58 |
$827.06 $907.80 $993.36 $1,297.26 |
$1,055.88 $1,136.62 $1,222.18 $1,526.08 |
Toc - Plan #32 Oscar Insurance Company | ||||||||||||||||||||
Expanded Bronze
(EPO) Bronze Elite |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$307.38 $348.86 $392.81 $548.96 $834.19 |
$542.52 $584.00 $627.95 $784.10 |
$777.66 $819.14 $863.09 $1,019.24 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$614.76 $697.72 $785.62 $1,097.92 $1,668.38 |
$849.90 $932.86 $1,020.76 $1,333.06 |
$1,085.04 $1,168.00 $1,255.90 $1,568.20 |
Toc - Plan #33 Oscar Insurance Company | ||||||||||||||||||||
Expanded Bronze
(EPO) Bronze Elite- $1000 Ded |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$308.29 $349.90 $393.98 $550.59 $836.67 |
$544.12 $585.73 $629.81 $786.42 |
$779.95 $821.56 $865.64 $1,022.25 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$616.58 $699.80 $787.96 $1,101.18 $1,673.34 |
$852.41 $935.63 $1,023.79 $1,337.01 |
$1,088.24 $1,171.46 $1,259.62 $1,572.84 |
Toc - Plan #34 Oscar Insurance Company | ||||||||||||||||||||
Silver
(EPO) Silver Simple- For Diabetes |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-672-2755
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$363.78 $412.88 $464.90 $649.69 $987.27 |
$642.06 $691.16 $743.18 $927.97 |
$920.34 $969.44 $1,021.46 $1,206.25 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$727.56 $825.76 $929.80 $1,299.38 $1,974.54 |
$1,005.84 $1,104.04 $1,208.08 $1,577.66 |
$1,284.12 $1,382.32 $1,486.36 $1,855.94 |
ADVERTISEMENT
Ambetter from Superior HealthPlanLocal: 1-877-687-1196 | Toll Free: 1-877-687-1196 | TTY: 1-800-735-2989 |
Toc - Plan #35 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Silver
(EPO) Ambetter Balanced Care 11 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$426.61 $484.19 $545.19 $761.90 $1,157.78 |
$752.96 $810.54 $871.54 $1,088.25 |
$1,079.31 $1,136.89 $1,197.89 $1,414.60 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$853.22 $968.38 $1,090.38 $1,523.80 $2,315.56 |
$1,179.57 $1,294.73 $1,416.73 $1,850.15 |
$1,505.92 $1,621.08 $1,743.08 $2,176.50 |
Toc - Plan #36 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Bronze
(EPO) Ambetter Essential Care 1 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$357.41 $405.65 $456.76 $638.32 $969.99 |
$630.82 $679.06 $730.17 $911.73 |
$904.23 $952.47 $1,003.58 $1,185.14 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$714.82 $811.30 $913.52 $1,276.64 $1,939.98 |
$988.23 $1,084.71 $1,186.93 $1,550.05 |
$1,261.64 $1,358.12 $1,460.34 $1,823.46 |
Toc - Plan #37 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Expanded Bronze
(EPO) Ambetter Essential Care 10 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$377.46 $428.41 $482.38 $674.13 $1,024.40 |
$666.21 $717.16 $771.13 $962.88 |
$954.96 $1,005.91 $1,059.88 $1,251.63 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$754.92 $856.82 $964.76 $1,348.26 $2,048.80 |
$1,043.67 $1,145.57 $1,253.51 $1,637.01 |
$1,332.42 $1,434.32 $1,542.26 $1,925.76 |
Toc - Plan #38 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Gold
(EPO) Ambetter Secure Care 5 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$560.09 $635.69 $715.78 $1,000.30 $1,520.05 |
$988.55 $1,064.15 $1,144.24 $1,428.76 |
$1,417.01 $1,492.61 $1,572.70 $1,857.22 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,120.18 $1,271.38 $1,431.56 $2,000.60 $3,040.10 |
$1,548.64 $1,699.84 $1,860.02 $2,429.06 |
$1,977.10 $2,128.30 $2,288.48 $2,857.52 |
Toc - Plan #39 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Expanded Bronze
(EPO) Ambetter Essential Care 2 HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$390.64 $443.37 $499.23 $697.67 $1,060.18 |
$689.47 $742.20 $798.06 $996.50 |
$988.30 $1,041.03 $1,096.89 $1,295.33 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$781.28 $886.74 $998.46 $1,395.34 $2,120.36 |
$1,080.11 $1,185.57 $1,297.29 $1,694.17 |
$1,378.94 $1,484.40 $1,596.12 $1,993.00 |
Toc - Plan #40 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Silver
(EPO) Ambetter Balanced Care 5 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$428.99 $486.90 $548.24 $766.17 $1,164.26 |
$757.16 $815.07 $876.41 $1,094.34 |
$1,085.33 $1,143.24 $1,204.58 $1,422.51 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$857.98 $973.80 $1,096.48 $1,532.34 $2,328.52 |
$1,186.15 $1,301.97 $1,424.65 $1,860.51 |
$1,514.32 $1,630.14 $1,752.82 $2,188.68 |
Toc - Plan #41 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Silver
(EPO) Ambetter Balanced Care 12 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$420.85 $477.65 $537.83 $751.61 $1,142.15 |
$742.79 $799.59 $859.77 $1,073.55 |
$1,064.73 $1,121.53 $1,181.71 $1,395.49 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$841.70 $955.30 $1,075.66 $1,503.22 $2,284.30 |
$1,163.64 $1,277.24 $1,397.60 $1,825.16 |
$1,485.58 $1,599.18 $1,719.54 $2,147.10 |
Toc - Plan #42 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Silver
(EPO) Ambetter Balanced Care 29 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$415.39 $471.45 $530.85 $741.86 $1,127.33 |
$733.15 $789.21 $848.61 $1,059.62 |
$1,050.91 $1,106.97 $1,166.37 $1,377.38 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$830.78 $942.90 $1,061.70 $1,483.72 $2,254.66 |
$1,148.54 $1,260.66 $1,379.46 $1,801.48 |
$1,466.30 $1,578.42 $1,697.22 $2,119.24 |
Toc - Plan #43 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Expanded Bronze
(EPO) Ambetter Essential Care 22 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$414.96 $470.97 $530.31 $741.10 $1,126.17 |
$732.40 $788.41 $847.75 $1,058.54 |
$1,049.84 $1,105.85 $1,165.19 $1,375.98 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$829.92 $941.94 $1,060.62 $1,482.20 $2,252.34 |
$1,147.36 $1,259.38 $1,378.06 $1,799.64 |
$1,464.80 $1,576.82 $1,695.50 $2,117.08 |
Toc - Plan #44 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Expanded Bronze
(EPO) Ambetter Essential Care: $1,500 Medical Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$425.24 $482.64 $543.44 $759.46 $1,154.07 |
$750.54 $807.94 $868.74 $1,084.76 |
$1,075.84 $1,133.24 $1,194.04 $1,410.06 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$850.48 $965.28 $1,086.88 $1,518.92 $2,308.14 |
$1,175.78 $1,290.58 $1,412.18 $1,844.22 |
$1,501.08 $1,615.88 $1,737.48 $2,169.52 |
Toc - Plan #45 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Expanded Bronze
(EPO) Ambetter Essential Care: $0 Medical Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$448.62 $509.17 $573.32 $801.21 $1,217.52 |
$791.80 $852.35 $916.50 $1,144.39 |
$1,134.98 $1,195.53 $1,259.68 $1,487.57 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$897.24 $1,018.34 $1,146.64 $1,602.42 $2,435.04 |
$1,240.42 $1,361.52 $1,489.82 $1,945.60 |
$1,583.60 $1,704.70 $1,833.00 $2,288.78 |
Toc - Plan #46 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Silver
(EPO) Ambetter Balanced Care 30 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$394.01 $447.19 $503.54 $703.69 $1,069.33 |
$695.42 $748.60 $804.95 $1,005.10 |
$996.83 $1,050.01 $1,106.36 $1,306.51 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$788.02 $894.38 $1,007.08 $1,407.38 $2,138.66 |
$1,089.43 $1,195.79 $1,308.49 $1,708.79 |
$1,390.84 $1,497.20 $1,609.90 $2,010.20 |
Toc - Plan #47 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Silver
(EPO) Ambetter Balanced Care 31 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$394.57 $447.82 $504.25 $704.68 $1,070.83 |
$696.41 $749.66 $806.09 $1,006.52 |
$998.25 $1,051.50 $1,107.93 $1,308.36 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$789.14 $895.64 $1,008.50 $1,409.36 $2,141.66 |
$1,090.98 $1,197.48 $1,310.34 $1,711.20 |
$1,392.82 $1,499.32 $1,612.18 $2,013.04 |
Toc - Plan #48 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Silver
(EPO) Ambetter Balanced Care 32 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$407.32 $462.30 $520.55 $727.46 $1,105.45 |
$718.91 $773.89 $832.14 $1,039.05 |
$1,030.50 $1,085.48 $1,143.73 $1,350.64 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$814.64 $924.60 $1,041.10 $1,454.92 $2,210.90 |
$1,126.23 $1,236.19 $1,352.69 $1,766.51 |
$1,437.82 $1,547.78 $1,664.28 $2,078.10 |
Toc - Plan #49 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Gold
(EPO) Ambetter Secure Care 20 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$523.91 $594.63 $669.55 $935.69 $1,421.87 |
$924.69 $995.41 $1,070.33 $1,336.47 |
$1,325.47 $1,396.19 $1,471.11 $1,737.25 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,047.82 $1,189.26 $1,339.10 $1,871.38 $2,843.74 |
$1,448.60 $1,590.04 $1,739.88 $2,272.16 |
$1,849.38 $1,990.82 $2,140.66 $2,672.94 |
Toc - Plan #50 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Gold
(EPO) Ambetter Secure Care 5 + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$565.67 $642.03 $722.92 $1,010.28 $1,535.21 |
$998.40 $1,074.76 $1,155.65 $1,443.01 |
$1,431.13 $1,507.49 $1,588.38 $1,875.74 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,131.34 $1,284.06 $1,445.84 $2,020.56 $3,070.42 |
$1,564.07 $1,716.79 $1,878.57 $2,453.29 |
$1,996.80 $2,149.52 $2,311.30 $2,886.02 |
Toc - Plan #51 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Bronze
(EPO) Ambetter Essential Care 1 + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$360.98 $409.70 $461.32 $644.69 $979.66 |
$637.12 $685.84 $737.46 $920.83 |
$913.26 $961.98 $1,013.60 $1,196.97 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$721.96 $819.40 $922.64 $1,289.38 $1,959.32 |
$998.10 $1,095.54 $1,198.78 $1,565.52 |
$1,274.24 $1,371.68 $1,474.92 $1,841.66 |
Toc - Plan #52 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Expanded Bronze
(EPO) Ambetter Essential Care 10 + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$381.23 $432.68 $487.19 $680.85 $1,034.62 |
$672.86 $724.31 $778.82 $972.48 |
$964.49 $1,015.94 $1,070.45 $1,264.11 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$762.46 $865.36 $974.38 $1,361.70 $2,069.24 |
$1,054.09 $1,156.99 $1,266.01 $1,653.33 |
$1,345.72 $1,448.62 $1,557.64 $1,944.96 |
Toc - Plan #53 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Silver
(EPO) Ambetter Balanced Care 11 + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$430.86 $489.02 $550.63 $769.50 $1,169.33 |
$760.46 $818.62 $880.23 $1,099.10 |
$1,090.06 $1,148.22 $1,209.83 $1,428.70 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$861.72 $978.04 $1,101.26 $1,539.00 $2,338.66 |
$1,191.32 $1,307.64 $1,430.86 $1,868.60 |
$1,520.92 $1,637.24 $1,760.46 $2,198.20 |
Toc - Plan #54 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Expanded Bronze
(EPO) Ambetter Essential Care 2 HSA + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$394.54 $447.79 $504.21 $704.63 $1,070.75 |
$696.36 $749.61 $806.03 $1,006.45 |
$998.18 $1,051.43 $1,107.85 $1,308.27 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$789.08 $895.58 $1,008.42 $1,409.26 $2,141.50 |
$1,090.90 $1,197.40 $1,310.24 $1,711.08 |
$1,392.72 $1,499.22 $1,612.06 $2,012.90 |
Toc - Plan #55 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Silver
(EPO) Ambetter Balanced Care 5 + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$433.27 $491.75 $553.71 $773.81 $1,175.88 |
$764.72 $823.20 $885.16 $1,105.26 |
$1,096.17 $1,154.65 $1,216.61 $1,436.71 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$866.54 $983.50 $1,107.42 $1,547.62 $2,351.76 |
$1,197.99 $1,314.95 $1,438.87 $1,879.07 |
$1,529.44 $1,646.40 $1,770.32 $2,210.52 |
Toc - Plan #56 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Silver
(EPO) Ambetter Balanced Care 12 + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$425.04 $482.41 $543.19 $759.11 $1,153.54 |
$750.19 $807.56 $868.34 $1,084.26 |
$1,075.34 $1,132.71 $1,193.49 $1,409.41 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$850.08 $964.82 $1,086.38 $1,518.22 $2,307.08 |
$1,175.23 $1,289.97 $1,411.53 $1,843.37 |
$1,500.38 $1,615.12 $1,736.68 $2,168.52 |
Toc - Plan #57 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Expanded Bronze
(EPO) Ambetter Essential Care 22 + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$419.10 $475.67 $535.59 $748.49 $1,137.41 |
$739.70 $796.27 $856.19 $1,069.09 |
$1,060.30 $1,116.87 $1,176.79 $1,389.69 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$838.20 $951.34 $1,071.18 $1,496.98 $2,274.82 |
$1,158.80 $1,271.94 $1,391.78 $1,817.58 |
$1,479.40 $1,592.54 $1,712.38 $2,138.18 |
Toc - Plan #58 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Expanded Bronze
(EPO) Ambetter Essential Care: $1,500 Medical Deductible + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$429.48 $487.45 $548.86 $767.04 $1,165.59 |
$758.03 $816.00 $877.41 $1,095.59 |
$1,086.58 $1,144.55 $1,205.96 $1,424.14 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$858.96 $974.90 $1,097.72 $1,534.08 $2,331.18 |
$1,187.51 $1,303.45 $1,426.27 $1,862.63 |
$1,516.06 $1,632.00 $1,754.82 $2,191.18 |
Toc - Plan #59 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Expanded Bronze
(EPO) Ambetter Essential Care: $0 Medical Deductible + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$453.09 $514.25 $579.04 $809.21 $1,229.67 |
$799.70 $860.86 $925.65 $1,155.82 |
$1,146.31 $1,207.47 $1,272.26 $1,502.43 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$906.18 $1,028.50 $1,158.08 $1,618.42 $2,459.34 |
$1,252.79 $1,375.11 $1,504.69 $1,965.03 |
$1,599.40 $1,721.72 $1,851.30 $2,311.64 |
Toc - Plan #60 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Silver
(EPO) Ambetter Balanced Care 31 + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$398.50 $452.29 $509.27 $711.71 $1,081.51 |
$703.35 $757.14 $814.12 $1,016.56 |
$1,008.20 $1,061.99 $1,118.97 $1,321.41 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$797.00 $904.58 $1,018.54 $1,423.42 $2,163.02 |
$1,101.85 $1,209.43 $1,323.39 $1,728.27 |
$1,406.70 $1,514.28 $1,628.24 $2,033.12 |
Toc - Plan #61 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Silver
(EPO) Ambetter Balanced Care 32 + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$411.39 $466.91 $525.74 $734.72 $1,116.47 |
$726.09 $781.61 $840.44 $1,049.42 |
$1,040.79 $1,096.31 $1,155.14 $1,364.12 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$822.78 $933.82 $1,051.48 $1,469.44 $2,232.94 |
$1,137.48 $1,248.52 $1,366.18 $1,784.14 |
$1,452.18 $1,563.22 $1,680.88 $2,098.84 |
Toc - Plan #62 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Gold
(EPO) Ambetter Secure Care 20 + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$529.14 $600.56 $676.23 $945.02 $1,436.05 |
$933.92 $1,005.34 $1,081.01 $1,349.80 |
$1,338.70 $1,410.12 $1,485.79 $1,754.58 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,058.28 $1,201.12 $1,352.46 $1,890.04 $2,872.10 |
$1,463.06 $1,605.90 $1,757.24 $2,294.82 |
$1,867.84 $2,010.68 $2,162.02 $2,699.60 |
Toc - Plan #63 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Silver
(EPO) Ambetter Balanced Care 29 + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$419.53 $476.15 $536.15 $749.26 $1,138.58 |
$740.46 $797.08 $857.08 $1,070.19 |
$1,061.39 $1,118.01 $1,178.01 $1,391.12 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$839.06 $952.30 $1,072.30 $1,498.52 $2,277.16 |
$1,159.99 $1,273.23 $1,393.23 $1,819.45 |
$1,480.92 $1,594.16 $1,714.16 $2,140.38 |
Toc - Plan #64 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Gold
(EPO) Ambetter Secure Care 5 + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$583.30 $662.03 $745.44 $1,041.75 $1,583.04 |
$1,029.52 $1,108.25 $1,191.66 $1,487.97 |
$1,475.74 $1,554.47 $1,637.88 $1,934.19 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,166.60 $1,324.06 $1,490.88 $2,083.50 $3,166.08 |
$1,612.82 $1,770.28 $1,937.10 $2,529.72 |
$2,059.04 $2,216.50 $2,383.32 $2,975.94 |
Toc - Plan #65 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Bronze
(EPO) Ambetter Essential Care 1 + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$372.22 $422.46 $475.69 $664.77 $1,010.19 |
$656.96 $707.20 $760.43 $949.51 |
$941.70 $991.94 $1,045.17 $1,234.25 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$744.44 $844.92 $951.38 $1,329.54 $2,020.38 |
$1,029.18 $1,129.66 $1,236.12 $1,614.28 |
$1,313.92 $1,414.40 $1,520.86 $1,899.02 |
Toc - Plan #66 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Expanded Bronze
(EPO) Ambetter Essential Care 10 + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$393.10 $446.16 $502.37 $702.07 $1,066.86 |
$693.82 $746.88 $803.09 $1,002.79 |
$994.54 $1,047.60 $1,103.81 $1,303.51 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$786.20 $892.32 $1,004.74 $1,404.14 $2,133.72 |
$1,086.92 $1,193.04 $1,305.46 $1,704.86 |
$1,387.64 $1,493.76 $1,606.18 $2,005.58 |
Toc - Plan #67 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Silver
(EPO) Ambetter Balanced Care 11 + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$444.28 $504.25 $567.78 $793.47 $1,205.76 |
$784.15 $844.12 $907.65 $1,133.34 |
$1,124.02 $1,183.99 $1,247.52 $1,473.21 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$888.56 $1,008.50 $1,135.56 $1,586.94 $2,411.52 |
$1,228.43 $1,348.37 $1,475.43 $1,926.81 |
$1,568.30 $1,688.24 $1,815.30 $2,266.68 |
Toc - Plan #68 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Expanded Bronze
(EPO) Ambetter Essential Care 2 HSA + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$406.83 $461.74 $519.92 $726.58 $1,104.12 |
$718.05 $772.96 $831.14 $1,037.80 |
$1,029.27 $1,084.18 $1,142.36 $1,349.02 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$813.66 $923.48 $1,039.84 $1,453.16 $2,208.24 |
$1,124.88 $1,234.70 $1,351.06 $1,764.38 |
$1,436.10 $1,545.92 $1,662.28 $2,075.60 |
Toc - Plan #69 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Silver
(EPO) Ambetter Balanced Care 5 + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$446.77 $507.08 $570.96 $797.92 $1,212.51 |
$788.54 $848.85 $912.73 $1,139.69 |
$1,130.31 $1,190.62 $1,254.50 $1,481.46 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$893.54 $1,014.16 $1,141.92 $1,595.84 $2,425.02 |
$1,235.31 $1,355.93 $1,483.69 $1,937.61 |
$1,577.08 $1,697.70 $1,825.46 $2,279.38 |
Toc - Plan #70 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Silver
(EPO) Ambetter Balanced Care 12 + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$438.29 $497.44 $560.12 $782.76 $1,189.48 |
$773.57 $832.72 $895.40 $1,118.04 |
$1,108.85 $1,168.00 $1,230.68 $1,453.32 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$876.58 $994.88 $1,120.24 $1,565.52 $2,378.96 |
$1,211.86 $1,330.16 $1,455.52 $1,900.80 |
$1,547.14 $1,665.44 $1,790.80 $2,236.08 |
Toc - Plan #71 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Expanded Bronze
(EPO) Ambetter Essential Care 22 + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$432.16 $490.49 $552.28 $771.81 $1,172.84 |
$762.75 $821.08 $882.87 $1,102.40 |
$1,093.34 $1,151.67 $1,213.46 $1,432.99 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$864.32 $980.98 $1,104.56 $1,543.62 $2,345.68 |
$1,194.91 $1,311.57 $1,435.15 $1,874.21 |
$1,525.50 $1,642.16 $1,765.74 $2,204.80 |
Toc - Plan #72 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Expanded Bronze
(EPO) Ambetter Essential Care: $1,500 Medical Deductible + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$442.86 $502.64 $565.97 $790.94 $1,201.90 |
$781.64 $841.42 $904.75 $1,129.72 |
$1,120.42 $1,180.20 $1,243.53 $1,468.50 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$885.72 $1,005.28 $1,131.94 $1,581.88 $2,403.80 |
$1,224.50 $1,344.06 $1,470.72 $1,920.66 |
$1,563.28 $1,682.84 $1,809.50 $2,259.44 |
Toc - Plan #73 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Expanded Bronze
(EPO) Ambetter Essential Care: $0 Medical Deductible + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$467.21 $530.27 $597.08 $834.42 $1,267.98 |
$824.62 $887.68 $954.49 $1,191.83 |
$1,182.03 $1,245.09 $1,311.90 $1,549.24 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$934.42 $1,060.54 $1,194.16 $1,668.84 $2,535.96 |
$1,291.83 $1,417.95 $1,551.57 $2,026.25 |
$1,649.24 $1,775.36 $1,908.98 $2,383.66 |
Toc - Plan #74 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Silver
(EPO) Ambetter Balanced Care 31 + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$410.92 $466.38 $525.14 $733.88 $1,115.21 |
$725.27 $780.73 $839.49 $1,048.23 |
$1,039.62 $1,095.08 $1,153.84 $1,362.58 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$821.84 $932.76 $1,050.28 $1,467.76 $2,230.42 |
$1,136.19 $1,247.11 $1,364.63 $1,782.11 |
$1,450.54 $1,561.46 $1,678.98 $2,096.46 |
Toc - Plan #75 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Silver
(EPO) Ambetter Balanced Care 32 + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$424.20 $481.46 $542.12 $757.61 $1,151.26 |
$748.71 $805.97 $866.63 $1,082.12 |
$1,073.22 $1,130.48 $1,191.14 $1,406.63 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$848.40 $962.92 $1,084.24 $1,515.22 $2,302.52 |
$1,172.91 $1,287.43 $1,408.75 $1,839.73 |
$1,497.42 $1,611.94 $1,733.26 $2,164.24 |
Toc - Plan #76 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Gold
(EPO) Ambetter Secure Care 20 + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$545.62 $619.27 $697.29 $974.47 $1,480.80 |
$963.01 $1,036.66 $1,114.68 $1,391.86 |
$1,380.40 $1,454.05 $1,532.07 $1,809.25 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,091.24 $1,238.54 $1,394.58 $1,948.94 $2,961.60 |
$1,508.63 $1,655.93 $1,811.97 $2,366.33 |
$1,926.02 $2,073.32 $2,229.36 $2,783.72 |
Toc - Plan #77 Ambetter from Superior HealthPlan | ||||||||||||||||||||
Silver
(EPO) Ambetter Balanced Care 29 + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$432.60 $490.99 $552.85 $772.61 $1,174.05 |
$763.53 $821.92 $883.78 $1,103.54 |
$1,094.46 $1,152.85 $1,214.71 $1,434.47 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$865.20 $981.98 $1,105.70 $1,545.22 $2,348.10 |
$1,196.13 $1,312.91 $1,436.63 $1,876.15 |
$1,527.06 $1,643.84 $1,767.56 $2,207.08 |
ADVERTISEMENT
Blue Cross and Blue Shield of TexasLocal: 1-888-697-0683 | Toll Free: 1-888-697-0683 | TTY: 1-800-735-2989 |
Toc - Plan #78 Blue Cross and Blue Shield of Texas | ||||||||||||||||||||
Gold
(HMO) Blue Advantage Gold HMO? 206 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-697-0683
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$405.57 $460.33 $518.32 $724.36 $1,100.73 |
$715.83 $770.59 $828.58 $1,034.62 |
$1,026.09 $1,080.85 $1,138.84 $1,344.88 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$811.14 $920.66 $1,036.64 $1,448.72 $2,201.46 |
$1,121.40 $1,230.92 $1,346.90 $1,758.98 |
$1,431.66 $1,541.18 $1,657.16 $2,069.24 |
Toc - Plan #79 Blue Cross and Blue Shield of Texas | ||||||||||||||||||||
Catastrophic
(HMO) Blue Advantage Security HMO? 200 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-697-0683
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$301.66 $342.39 $385.53 $538.77 $818.72 |
$532.43 $573.16 $616.30 $769.54 |
$763.20 $803.93 $847.07 $1,000.31 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$603.32 $684.78 $771.06 $1,077.54 $1,637.44 |
$834.09 $915.55 $1,001.83 $1,308.31 |
$1,064.86 $1,146.32 $1,232.60 $1,539.08 |
Toc - Plan #80 Blue Cross and Blue Shield of Texas | ||||||||||||||||||||
Silver
(HMO) Blue Advantage Silver HMO? 205 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-697-0683
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$431.63 $489.90 $551.63 $770.90 $1,171.46 |
$761.83 $820.10 $881.83 $1,101.10 |
$1,092.03 $1,150.30 $1,212.03 $1,431.30 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$863.26 $979.80 $1,103.26 $1,541.80 $2,342.92 |
$1,193.46 $1,310.00 $1,433.46 $1,872.00 |
$1,523.66 $1,640.20 $1,763.66 $2,202.20 |
Toc - Plan #81 Blue Cross and Blue Shield of Texas | ||||||||||||||||||||
Expanded Bronze
(HMO) Blue Advantage Bronze HMO? 204 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-697-0683
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$334.95 $380.17 $428.07 $598.22 $909.06 |
$591.19 $636.41 $684.31 $854.46 |
$847.43 $892.65 $940.55 $1,110.70 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$669.90 $760.34 $856.14 $1,196.44 $1,818.12 |
$926.14 $1,016.58 $1,112.38 $1,452.68 |
$1,182.38 $1,272.82 $1,368.62 $1,708.92 |
Toc - Plan #82 Blue Cross and Blue Shield of Texas | ||||||||||||||||||||
Bronze
(HMO) Blue Advantage Bronze HMO? 301 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-697-0683
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$326.65 $370.75 $417.46 $583.40 $886.53 |
$576.54 $620.64 $667.35 $833.29 |
$826.43 $870.53 $917.24 $1,083.18 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$653.30 $741.50 $834.92 $1,166.80 $1,773.06 |
$903.19 $991.39 $1,084.81 $1,416.69 |
$1,153.08 $1,241.28 $1,334.70 $1,666.58 |
Toc - Plan #83 Blue Cross and Blue Shield of Texas | ||||||||||||||||||||
Gold
(HMO) Blue Advantage Gold HMO? 603 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-697-0683
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$428.09 $485.89 $547.10 $764.58 $1,161.85 |
$755.58 $813.38 $874.59 $1,092.07 |
$1,083.07 $1,140.87 $1,202.08 $1,419.56 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$856.18 $971.78 $1,094.20 $1,529.16 $2,323.70 |
$1,183.67 $1,299.27 $1,421.69 $1,856.65 |
$1,511.16 $1,626.76 $1,749.18 $2,184.14 |
Toc - Plan #84 Blue Cross and Blue Shield of Texas | ||||||||||||||||||||
Gold
(HMO) Blue Advantage Plus Gold? 203 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-697-0683
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$448.81 $509.40 $573.57 $801.57 $1,218.06 |
$792.15 $852.74 $916.91 $1,144.91 |
$1,135.49 $1,196.08 $1,260.25 $1,488.25 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$897.62 $1,018.80 $1,147.14 $1,603.14 $2,436.12 |
$1,240.96 $1,362.14 $1,490.48 $1,946.48 |
$1,584.30 $1,705.48 $1,833.82 $2,289.82 |
Toc - Plan #85 Blue Cross and Blue Shield of Texas | ||||||||||||||||||||
Silver
(HMO) Blue Advantage Plus Silver? 202 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-697-0683
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$478.78 $543.41 $611.88 $855.10 $1,299.40 |
$845.05 $909.68 $978.15 $1,221.37 |
$1,211.32 $1,275.95 $1,344.42 $1,587.64 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$957.56 $1,086.82 $1,223.76 $1,710.20 $2,598.80 |
$1,323.83 $1,453.09 $1,590.03 $2,076.47 |
$1,690.10 $1,819.36 $1,956.30 $2,442.74 |
Toc - Plan #86 Blue Cross and Blue Shield of Texas | ||||||||||||||||||||
Expanded Bronze
(HMO) Blue Advantage Plus Bronze? 303 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-697-0683
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$370.70 $420.75 $473.76 $662.08 $1,006.09 |
$654.29 $704.34 $757.35 $945.67 |
$937.88 $987.93 $1,040.94 $1,229.26 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$741.40 $841.50 $947.52 $1,324.16 $2,012.18 |
$1,024.99 $1,125.09 $1,231.11 $1,607.75 |
$1,308.58 $1,408.68 $1,514.70 $1,891.34 |
Toc - Plan #87 Blue Cross and Blue Shield of Texas | ||||||||||||||||||||
Bronze
(HMO) Blue Advantage Plus Bronze? 305 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-697-0683
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$336.34 $381.74 $429.84 $600.70 $912.82 |
$593.64 $639.04 $687.14 $858.00 |
$850.94 $896.34 $944.44 $1,115.30 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$672.68 $763.48 $859.68 $1,201.40 $1,825.64 |
$929.98 $1,020.78 $1,116.98 $1,458.70 |
$1,187.28 $1,278.08 $1,374.28 $1,716.00 |
Toc - Plan #88 Blue Cross and Blue Shield of Texas | ||||||||||||||||||||
Silver
(HMO) Blue Advantage Plus Silver? 605 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-697-0683
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$486.96 $552.71 $622.34 $869.72 $1,321.62 |
$859.49 $925.24 $994.87 $1,242.25 |
$1,232.02 $1,297.77 $1,367.40 $1,614.78 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$973.92 $1,105.42 $1,244.68 $1,739.44 $2,643.24 |
$1,346.45 $1,477.95 $1,617.21 $2,111.97 |
$1,718.98 $1,850.48 $1,989.74 $2,484.50 |
ADVERTISEMENT
Scott and White Health PlanLocal: 1-844-633-5325 | Toll Free: 1-844-633-5325 | TTY: 1-800-735-2989 |
Toc - Plan #89 Scott and White Health Plan | ||||||||||||||||||||
Gold
(HMO) BSW Elite Gold HMO 001 ($0 Preventive Care and Preventive Rx Drugs) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-633-5325
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$370.51 $420.53 $473.52 $661.74 $1,005.57 |
$653.95 $703.97 $756.96 $945.18 |
$937.39 $987.41 $1,040.40 $1,228.62 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$741.02 $841.06 $947.04 $1,323.48 $2,011.14 |
$1,024.46 $1,124.50 $1,230.48 $1,606.92 |
$1,307.90 $1,407.94 $1,513.92 $1,890.36 |
Toc - Plan #90 Scott and White Health Plan | ||||||||||||||||||||
Silver
(HMO) BSW Prime Silver HMO 003 ($0 Preventive Care and Preventive Rx Drugs) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-633-5325
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$373.07 $423.44 $476.79 $666.31 $1,012.52 |
$658.47 $708.84 $762.19 $951.71 |
$943.87 $994.24 $1,047.59 $1,237.11 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$746.14 $846.88 $953.58 $1,332.62 $2,025.04 |
$1,031.54 $1,132.28 $1,238.98 $1,618.02 |
$1,316.94 $1,417.68 $1,524.38 $1,903.42 |
Toc - Plan #91 Scott and White Health Plan | ||||||||||||||||||||
Gold
(HMO) BSW Elite Gold HMO 004 ($0 deductible, $15 PCP visit, $0 Preventive Care and Preventive Rx Drugs) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-633-5325
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$406.13 $460.95 $519.03 $725.34 $1,102.23 |
$716.82 $771.64 $829.72 $1,036.03 |
$1,027.51 $1,082.33 $1,140.41 $1,346.72 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$812.26 $921.90 $1,038.06 $1,450.68 $2,204.46 |
$1,122.95 $1,232.59 $1,348.75 $1,761.37 |
$1,433.64 $1,543.28 $1,659.44 $2,072.06 |
Toc - Plan #92 Scott and White Health Plan | ||||||||||||||||||||
Silver
(HMO) BSW Prime Silver HMO 005 ($0 deductible copay only, $0 Preventive Care and Preventive Rx Drugs) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-633-5325
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$384.86 $436.81 $491.85 $687.35 $1,044.50 |
$679.27 $731.22 $786.26 $981.76 |
$973.68 $1,025.63 $1,080.67 $1,276.17 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$769.72 $873.62 $983.70 $1,374.70 $2,089.00 |
$1,064.13 $1,168.03 $1,278.11 $1,669.11 |
$1,358.54 $1,462.44 $1,572.52 $1,963.52 |
Toc - Plan #93 Scott and White Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) BSW Savers Bronze HMO H S A 006 ($0 Preventive Care and Preventive Rx Drugs) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-633-5325
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$297.57 $337.74 $380.29 $531.45 $807.60 |
$525.21 $565.38 $607.93 $759.09 |
$752.85 $793.02 $835.57 $986.73 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$595.14 $675.48 $760.58 $1,062.90 $1,615.20 |
$822.78 $903.12 $988.22 $1,290.54 |
$1,050.42 $1,130.76 $1,215.86 $1,518.18 |
Toc - Plan #94 Scott and White Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) BSW Vital Bronze HMO 007 ($20 Generic Rx Drugs, $0 Preventive Care and Preventive Rx Drugs) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-633-5325
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$307.36 $348.86 $392.81 $548.95 $834.18 |
$542.49 $583.99 $627.94 $784.08 |
$777.62 $819.12 $863.07 $1,019.21 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$614.72 $697.72 $785.62 $1,097.90 $1,668.36 |
$849.85 $932.85 $1,020.75 $1,333.03 |
$1,084.98 $1,167.98 $1,255.88 $1,568.16 |
Toc - Plan #95 Scott and White Health Plan | ||||||||||||||||||||
Silver
(HMO) BSW Prime Silver HMO 008 ($35 PCP visit, $0 Preventive Care and Preventive Rx Drugs) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-633-5325
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$352.99 $400.65 $451.13 $630.45 $958.03 |
$623.03 $670.69 $721.17 $900.49 |
$893.07 $940.73 $991.21 $1,170.53 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$705.98 $801.30 $902.26 $1,260.90 $1,916.06 |
$976.02 $1,071.34 $1,172.30 $1,530.94 |
$1,246.06 $1,341.38 $1,442.34 $1,800.98 |
Toc - Plan #96 Scott and White Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) BSW Vital Bronze HMO 009 (No limit on PCP visit copay, $0 Preventive Care and Preventive Rx Drugs) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-633-5325
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$291.87 $331.28 $373.02 $521.29 $792.15 |
$515.15 $554.56 $596.30 $744.57 |
$738.43 $777.84 $819.58 $967.85 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$583.74 $662.56 $746.04 $1,042.58 $1,584.30 |
$807.02 $885.84 $969.32 $1,265.86 |
$1,030.30 $1,109.12 $1,192.60 $1,489.14 |
Toc - Plan #97 Scott and White Health Plan | ||||||||||||||||||||
Gold
(HMO) BSW Elite Gold HMO 012 ($0 Preventive Care and Preventive Rx Drugs) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-633-5325
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$364.82 $414.07 $466.24 $651.57 $990.12 |
$643.91 $693.16 $745.33 $930.66 |
$923.00 $972.25 $1,024.42 $1,209.75 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$729.64 $828.14 $932.48 $1,303.14 $1,980.24 |
$1,008.73 $1,107.23 $1,211.57 $1,582.23 |
$1,287.82 $1,386.32 $1,490.66 $1,861.32 |
ADVERTISEMENT
Ambetter from Superior HealthplanLocal: 1-877-687-1196 | Toll Free: 1-877-687-1196 | TTY: 1-877-941-9237 |
Toc - Plan #98 Ambetter from Superior Healthplan | ||||||||||||||||||||
Expanded Bronze
(HMO) Ambetter Virtual Access Bronze ($0 Virtual Primary Care + $0 Virtual Urgent Care + $0 Preferred Labs) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$382.57 $434.20 $488.91 $683.25 $1,038.26 |
$675.23 $726.86 $781.57 $975.91 |
$967.89 $1,019.52 $1,074.23 $1,268.57 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$765.14 $868.40 $977.82 $1,366.50 $2,076.52 |
$1,057.80 $1,161.06 $1,270.48 $1,659.16 |
$1,350.46 $1,453.72 $1,563.14 $1,951.82 |
Toc - Plan #99 Ambetter from Superior Healthplan | ||||||||||||||||||||
Silver
(HMO) Ambetter Virtual Access Silver ($0 Virtual Primary Care + $0 Virtual Urgent Care + $0 Preferred Labs) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$411.56 $467.11 $525.96 $735.03 $1,116.94 |
$726.39 $781.94 $840.79 $1,049.86 |
$1,041.22 $1,096.77 $1,155.62 $1,364.69 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$823.12 $934.22 $1,051.92 $1,470.06 $2,233.88 |
$1,137.95 $1,249.05 $1,366.75 $1,784.89 |
$1,452.78 $1,563.88 $1,681.58 $2,099.72 |
Toc - Plan #100 Ambetter from Superior Healthplan | ||||||||||||||||||||
Gold
(HMO) Ambetter Virtual Access Gold ($0 Virtual Primary Care + $0 Virtual Urgent Care + $0 Preferred Labs) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$547.17 $621.03 $699.28 $977.23 $1,485.00 |
$965.75 $1,039.61 $1,117.86 $1,395.81 |
$1,384.33 $1,458.19 $1,536.44 $1,814.39 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,094.34 $1,242.06 $1,398.56 $1,954.46 $2,970.00 |
$1,512.92 $1,660.64 $1,817.14 $2,373.04 |
$1,931.50 $2,079.22 $2,235.72 $2,791.62 |
Toc - Plan #101 Ambetter from Superior Healthplan | ||||||||||||||||||||
Silver
(HMO) Ambetter Value Silver 11 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$356.62 $404.75 $455.75 $636.90 $967.83 |
$629.43 $677.56 $728.56 $909.71 |
$902.24 $950.37 $1,001.37 $1,182.52 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$713.24 $809.50 $911.50 $1,273.80 $1,935.66 |
$986.05 $1,082.31 $1,184.31 $1,546.61 |
$1,258.86 $1,355.12 $1,457.12 $1,819.42 |
Toc - Plan #102 Ambetter from Superior Healthplan | ||||||||||||||||||||
Silver
(HMO) Ambetter Value Silver 30 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$329.37 $373.82 $420.92 $588.23 $893.87 |
$581.33 $625.78 $672.88 $840.19 |
$833.29 $877.74 $924.84 $1,092.15 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$658.74 $747.64 $841.84 $1,176.46 $1,787.74 |
$910.70 $999.60 $1,093.80 $1,428.42 |
$1,162.66 $1,251.56 $1,345.76 $1,680.38 |
Toc - Plan #103 Ambetter from Superior Healthplan | ||||||||||||||||||||
Silver
(HMO) Ambetter Value Silver 31 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$329.84 $374.35 $421.52 $589.07 $895.15 |
$582.16 $626.67 $673.84 $841.39 |
$834.48 $878.99 $926.16 $1,093.71 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$659.68 $748.70 $843.04 $1,178.14 $1,790.30 |
$912.00 $1,001.02 $1,095.36 $1,430.46 |
$1,164.32 $1,253.34 $1,347.68 $1,682.78 |
Toc - Plan #104 Ambetter from Superior Healthplan | ||||||||||||||||||||
Silver
(HMO) Ambetter Value Silver 32 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$340.51 $386.47 $435.16 $608.14 $924.12 |
$600.99 $646.95 $695.64 $868.62 |
$861.47 $907.43 $956.12 $1,129.10 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$681.02 $772.94 $870.32 $1,216.28 $1,848.24 |
$941.50 $1,033.42 $1,130.80 $1,476.76 |
$1,201.98 $1,293.90 $1,391.28 $1,737.24 |
Toc - Plan #105 Ambetter from Superior Healthplan | ||||||||||||||||||||
Gold
(HMO) Ambetter Value Gold 20 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-687-1196
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$437.98 $497.10 $559.73 $782.21 $1,188.65 |
$773.03 $832.15 $894.78 $1,117.26 |
$1,108.08 $1,167.20 $1,229.83 $1,452.31 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$875.96 $994.20 $1,119.46 $1,564.42 $2,377.30 |
$1,211.01 $1,329.25 $1,454.51 $1,899.47 |
$1,546.06 $1,664.30 $1,789.56 $2,234.52 |
‡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 Rockwall County here.
Rockwall County is in “Rating Area 8” of Texas.
Currently, there are 105 plans offered in Rating Area 8.