Obamacare 2022 Rates for Tooele County

Obamacare > Rates > Utah > Tooele 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 Tooele County, UT.

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, 62 Plans and 2022 Rates for Tooele County, Utah

Below, you’ll find a summary of the 62 plans for Tooele County, Utah 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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Molina Healthcare

Local: 1-801-858-0400 | Toll Free: 1-888-858-3973

Toc - Plan #1 Molina Healthcare
Gold

(HMO) Confident Care Gold 1

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-858-3973

Annual Out of Pocket Expenses:

Individual Family
$2,100 $4,200 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
$305.79
$425.05
$452.27
$650.43
$917.37
$548.29
$667.55
$694.77
$892.93
$790.79
$910.05
$937.27
$1,135.43
$1,033.29
$1,152.55
$1,179.77
$1,377.93
$242.50
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$611.58
$850.10
$904.54
$1,300.86
$1,834.74
$854.08
$1,092.60
$1,147.04
$1,543.36
$1,096.58
$1,335.10
$1,389.54
$1,785.86
$1,339.08
$1,577.60
$1,632.04
$2,028.36
$242.50
Toc - Plan #2 Molina Healthcare
Silver

(HMO) Constant Care Silver 1

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-858-3973

Annual Out of Pocket Expenses:

Individual Family
$0 $0 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
$306.71
$426.32
$453.62
$652.37
$920.12
$549.93
$669.54
$696.84
$895.59
$793.15
$912.76
$940.06
$1,138.81
$1,036.37
$1,155.98
$1,183.28
$1,382.03
$243.22
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$613.42
$852.64
$907.24
$1,304.74
$1,840.24
$856.64
$1,095.86
$1,150.46
$1,547.96
$1,099.86
$1,339.08
$1,393.68
$1,791.18
$1,343.08
$1,582.30
$1,636.90
$2,034.40
$243.22
Toc - Plan #3 Molina Healthcare
Silver

(HMO) Constant Care Silver 4

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-858-3973

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$303.88
$422.40
$449.45
$646.36
$911.64
$544.86
$663.38
$690.43
$887.34
$785.84
$904.36
$931.41
$1,128.32
$1,026.82
$1,145.34
$1,172.39
$1,369.30
$240.98
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$607.76
$844.80
$898.90
$1,292.72
$1,823.28
$848.74
$1,085.78
$1,139.88
$1,533.70
$1,089.72
$1,326.76
$1,380.86
$1,774.68
$1,330.70
$1,567.74
$1,621.84
$2,015.66
$240.98
Toc - Plan #4 Molina Healthcare
Silver

(HMO) Constant Care Silver 7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-858-3973

Annual Out of Pocket Expenses:

Individual Family
$0 $0 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
$300.38
$417.53
$444.27
$638.91
$901.14
$538.58
$655.73
$682.47
$877.11
$776.78
$893.93
$920.67
$1,115.31
$1,014.98
$1,132.13
$1,158.87
$1,353.51
$238.20
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$600.76
$835.06
$888.54
$1,277.82
$1,802.28
$838.96
$1,073.26
$1,126.74
$1,516.02
$1,077.16
$1,311.46
$1,364.94
$1,754.22
$1,315.36
$1,549.66
$1,603.14
$1,992.42
$238.20
Toc - Plan #5 Molina Healthcare
Gold

(HMO) Confident Care Gold 1 + Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-858-3973

Annual Out of Pocket Expenses:

Individual Family
$2,100 $4,200 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
$311.55
$433.05
$460.78
$662.66
$934.65
$558.61
$680.11
$707.84
$909.72
$805.67
$927.17
$954.90
$1,156.78
$1,052.73
$1,174.23
$1,201.96
$1,403.84
$247.06
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$623.10
$866.10
$921.56
$1,325.32
$1,869.30
$870.16
$1,113.16
$1,168.62
$1,572.38
$1,117.22
$1,360.22
$1,415.68
$1,819.44
$1,364.28
$1,607.28
$1,662.74
$2,066.50
$247.06
Toc - Plan #6 Molina Healthcare
Silver

(HMO) Constant Care Silver 1 + Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-858-3973

Annual Out of Pocket Expenses:

Individual Family
$0 $0 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
$309.18
$429.76
$457.28
$657.63
$927.54
$554.36
$674.94
$702.46
$902.81
$799.54
$920.12
$947.64
$1,147.99
$1,044.72
$1,165.30
$1,192.82
$1,393.17
$245.18
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$618.36
$859.52
$914.56
$1,315.26
$1,855.08
$863.54
$1,104.70
$1,159.74
$1,560.44
$1,108.72
$1,349.88
$1,404.92
$1,805.62
$1,353.90
$1,595.06
$1,650.10
$2,050.80
$245.18
Toc - Plan #7 Molina Healthcare
Silver

(HMO) Constant Care Silver 2

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-858-3973

Annual Out of Pocket Expenses:

Individual Family
$5,200 $10,400 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
$304.37
$423.08
$450.17
$647.40
$913.11
$545.74
$664.45
$691.54
$888.77
$787.11
$905.82
$932.91
$1,130.14
$1,028.48
$1,147.19
$1,174.28
$1,371.51
$241.37
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$608.74
$846.16
$900.34
$1,294.80
$1,826.22
$850.11
$1,087.53
$1,141.71
$1,536.17
$1,091.48
$1,328.90
$1,383.08
$1,777.54
$1,332.85
$1,570.27
$1,624.45
$2,018.91
$241.37

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Regence BlueCross BlueShield of Utah

Local: 1-888-231-8424 | Toll Free: 1-888-231-8424

Toc - Plan #8 Regence BlueCross BlueShield of Utah
Silver

(EPO) Silver 3750

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-231-8424

Annual Out of Pocket Expenses:

Individual Family
$3,750 $7,500 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
$326.33
$453.60
$482.65
$694.10
$978.99
$585.11
$712.38
$741.43
$952.88
$843.89
$971.16
$1,000.21
$1,211.66
$1,102.67
$1,229.94
$1,258.99
$1,470.44
$258.78
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$652.66
$907.20
$965.30
$1,388.20
$1,957.98
$911.44
$1,165.98
$1,224.08
$1,646.98
$1,170.22
$1,424.76
$1,482.86
$1,905.76
$1,429.00
$1,683.54
$1,741.64
$2,164.54
$258.78
Toc - Plan #9 Regence BlueCross BlueShield of Utah
Expanded Bronze

(EPO) Bronze HDHP 6000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-231-8424

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$245.54
$341.30
$363.16
$522.27
$736.62
$440.26
$536.02
$557.88
$716.99
$634.98
$730.74
$752.60
$911.71
$829.70
$925.46
$947.32
$1,106.43
$194.72
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$491.08
$682.60
$726.32
$1,044.54
$1,473.24
$685.80
$877.32
$921.04
$1,239.26
$880.52
$1,072.04
$1,115.76
$1,433.98
$1,075.24
$1,266.76
$1,310.48
$1,628.70
$194.72
Toc - Plan #10 Regence BlueCross BlueShield of Utah
Expanded Bronze

(EPO) Bronze Essential 8000 With 4 Copay No Deductible Office Visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-231-8424

Annual Out of Pocket Expenses:

Individual Family
$8,000 $16,000 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
$225.91
$314.01
$334.11
$480.50
$677.72
$405.05
$493.15
$513.25
$659.64
$584.19
$672.29
$692.39
$838.78
$763.33
$851.43
$871.53
$1,017.92
$179.14
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$451.82
$628.02
$668.22
$961.00
$1,355.44
$630.96
$807.16
$847.36
$1,140.14
$810.10
$986.30
$1,026.50
$1,319.28
$989.24
$1,165.44
$1,205.64
$1,498.42
$179.14
Toc - Plan #11 Regence BlueCross BlueShield of Utah
Expanded Bronze

(EPO) Bronze Virtual Value 8500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-231-8424

Annual Out of Pocket Expenses:

Individual Family
$8,500 $17,000 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
$216.35
$300.73
$319.99
$460.18
$649.05
$387.92
$472.30
$491.56
$631.75
$559.49
$643.87
$663.13
$803.32
$731.06
$815.44
$834.70
$974.89
$171.57
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$432.70
$601.46
$639.98
$920.36
$1,298.10
$604.27
$773.03
$811.55
$1,091.93
$775.84
$944.60
$983.12
$1,263.50
$947.41
$1,116.17
$1,154.69
$1,435.07
$171.57
Toc - Plan #12 Regence BlueCross BlueShield of Utah
Silver

(EPO) Silver 5000 Separate RX Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-231-8424

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
$318.06
$442.10
$470.41
$676.51
$954.17
$570.28
$694.32
$722.63
$928.73
$822.50
$946.54
$974.85
$1,180.95
$1,074.72
$1,198.76
$1,227.07
$1,433.17
$252.22
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$636.12
$884.20
$940.82
$1,353.02
$1,908.34
$888.34
$1,136.42
$1,193.04
$1,605.24
$1,140.56
$1,388.64
$1,445.26
$1,857.46
$1,392.78
$1,640.86
$1,697.48
$2,109.68
$252.22
Toc - Plan #13 Regence BlueCross BlueShield of Utah
Silver

(EPO) Silver 6500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-231-8424

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 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
$294.41
$409.23
$435.43
$626.21
$883.23
$527.88
$642.70
$668.90
$859.68
$761.35
$876.17
$902.37
$1,093.15
$994.82
$1,109.64
$1,135.84
$1,326.62
$233.47
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$588.82
$818.46
$870.86
$1,252.42
$1,766.46
$822.29
$1,051.93
$1,104.33
$1,485.89
$1,055.76
$1,285.40
$1,337.80
$1,719.36
$1,289.23
$1,518.87
$1,571.27
$1,952.83
$233.47
Toc - Plan #14 Regence BlueCross BlueShield of Utah
Expanded Bronze

(EPO) Bronze 7000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-231-8424

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 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
$223.91
$311.23
$331.16
$476.25
$671.72
$401.47
$488.79
$508.72
$653.81
$579.03
$666.35
$686.28
$831.37
$756.59
$843.91
$863.84
$1,008.93
$177.56
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$447.82
$622.46
$662.32
$952.50
$1,343.44
$625.38
$800.02
$839.88
$1,130.06
$802.94
$977.58
$1,017.44
$1,307.62
$980.50
$1,155.14
$1,195.00
$1,485.18
$177.56
Toc - Plan #15 Regence BlueCross BlueShield of Utah
Gold

(EPO) Gold 2500 With Dental and Vision Exam

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-231-8424

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
$334.80
$465.38
$495.18
$712.13
$1,004.40
$600.30
$730.88
$760.68
$977.63
$865.80
$996.38
$1,026.18
$1,243.13
$1,131.30
$1,261.88
$1,291.68
$1,508.63
$265.50
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$669.60
$930.76
$990.36
$1,424.26
$2,008.80
$935.10
$1,196.26
$1,255.86
$1,689.76
$1,200.60
$1,461.76
$1,521.36
$1,955.26
$1,466.10
$1,727.26
$1,786.86
$2,220.76
$265.50

ADVERTISEMENT

BridgeSpan Health Company

Local: 1-855-857-9944 | Toll Free: 1-855-857-9944 | TTY: 1-800-735-2900

Toc - Plan #16 BridgeSpan Health Company
Gold

(HMO) Gold Starter HDHP 2000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-857-9944

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$347.88
$483.55
$514.52
$739.94
$1,043.64
$623.74
$759.41
$790.38
$1,015.80
$899.60
$1,035.27
$1,066.24
$1,291.66
$1,175.46
$1,311.13
$1,342.10
$1,567.52
$275.86
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$695.76
$967.10
$1,029.04
$1,479.88
$2,087.28
$971.62
$1,242.96
$1,304.90
$1,755.74
$1,247.48
$1,518.82
$1,580.76
$2,031.60
$1,523.34
$1,794.68
$1,856.62
$2,307.46
$275.86
Toc - Plan #17 BridgeSpan Health Company
Silver

(HMO) BridgeSpan Silver Essential 4000 With 4 Copay No Deductible Office Visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-857-9944

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
$327.34
$455.01
$484.14
$696.25
$982.02
$586.92
$714.59
$743.72
$955.83
$846.50
$974.17
$1,003.30
$1,215.41
$1,106.08
$1,233.75
$1,262.88
$1,474.99
$259.58
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$654.68
$910.02
$968.28
$1,392.50
$1,964.04
$914.26
$1,169.60
$1,227.86
$1,652.08
$1,173.84
$1,429.18
$1,487.44
$1,911.66
$1,433.42
$1,688.76
$1,747.02
$2,171.24
$259.58
Toc - Plan #18 BridgeSpan Health Company
Expanded Bronze

(HMO) Bronze HDHP 6500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-857-9944

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$237.57
$330.22
$351.36
$505.30
$712.70
$425.96
$518.61
$539.75
$693.69
$614.35
$707.00
$728.14
$882.08
$802.74
$895.39
$916.53
$1,070.47
$188.39
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$475.14
$660.44
$702.72
$1,010.60
$1,425.40
$663.53
$848.83
$891.11
$1,198.99
$851.92
$1,037.22
$1,079.50
$1,387.38
$1,040.31
$1,225.61
$1,267.89
$1,575.77
$188.39
Toc - Plan #19 BridgeSpan Health Company
Expanded Bronze

(HMO) Bronze Virtual Saver 8000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-857-9944

Annual Out of Pocket Expenses:

Individual Family
$8,000 $16,000 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
$222.68
$309.53
$329.35
$473.65
$668.04
$399.26
$486.11
$505.93
$650.23
$575.84
$662.69
$682.51
$826.81
$752.42
$839.27
$859.09
$1,003.39
$176.58
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$445.36
$619.06
$658.70
$947.30
$1,336.08
$621.94
$795.64
$835.28
$1,123.88
$798.52
$972.22
$1,011.86
$1,300.46
$975.10
$1,148.80
$1,188.44
$1,477.04
$176.58

ADVERTISEMENT

University of Utah Health Plans

Local: 1-801-213-4111x1 | Toll Free: 1-888-271-5870 | TTY: 1-800-346-4128

Toc - Plan #20 University of Utah Health Plans
Gold

(EPO) Healthy Premier Gold Copay

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-271-5870

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$416.35
$578.73
$615.78
$885.58
$1,249.05
$746.52
$908.90
$945.95
$1,215.75
$1,076.69
$1,239.07
$1,276.12
$1,545.92
$1,406.86
$1,569.24
$1,606.29
$1,876.09
$330.17
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$832.70
$1,157.46
$1,231.56
$1,771.16
$2,498.10
$1,162.87
$1,487.63
$1,561.73
$2,101.33
$1,493.04
$1,817.80
$1,891.90
$2,431.50
$1,823.21
$2,147.97
$2,222.07
$2,761.67
$330.17
Toc - Plan #21 University of Utah Health Plans
Silver

(EPO) Healthy Premier Silver Copay

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-271-5870

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 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
$403.17
$560.41
$596.29
$857.54
$1,209.51
$722.88
$880.12
$916.00
$1,177.25
$1,042.59
$1,199.83
$1,235.71
$1,496.96
$1,362.30
$1,519.54
$1,555.42
$1,816.67
$319.71
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$806.34
$1,120.82
$1,192.58
$1,715.08
$2,419.02
$1,126.05
$1,440.53
$1,512.29
$2,034.79
$1,445.76
$1,760.24
$1,832.00
$2,354.50
$1,765.47
$2,079.95
$2,151.71
$2,674.21
$319.71
Toc - Plan #22 University of Utah Health Plans
Expanded Bronze

(EPO) Healthy Premier Bronze HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-271-5870

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$257.21
$357.52
$380.41
$547.09
$771.63
$461.18
$561.49
$584.38
$751.06
$665.15
$765.46
$788.35
$955.03
$869.12
$969.43
$992.32
$1,159.00
$203.97
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$514.42
$715.04
$760.82
$1,094.18
$1,543.26
$718.39
$919.01
$964.79
$1,298.15
$922.36
$1,122.98
$1,168.76
$1,502.12
$1,126.33
$1,326.95
$1,372.73
$1,706.09
$203.97
Toc - Plan #23 University of Utah Health Plans
Gold

(EPO) Healthy Preferred Gold Copay

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-271-5870

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$378.50
$526.12
$559.80
$805.07
$1,135.50
$678.65
$826.27
$859.95
$1,105.22
$978.80
$1,126.42
$1,160.10
$1,405.37
$1,278.95
$1,426.57
$1,460.25
$1,705.52
$300.15
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$757.00
$1,052.24
$1,119.60
$1,610.14
$2,271.00
$1,057.15
$1,352.39
$1,419.75
$1,910.29
$1,357.30
$1,652.54
$1,719.90
$2,210.44
$1,657.45
$1,952.69
$2,020.05
$2,510.59
$300.15
Toc - Plan #24 University of Utah Health Plans
Silver

(EPO) Healthy Preferred Silver Copay

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-271-5870

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 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
$366.52
$509.46
$542.08
$779.59
$1,099.56
$657.17
$800.11
$832.73
$1,070.24
$947.82
$1,090.76
$1,123.38
$1,360.89
$1,238.47
$1,381.41
$1,414.03
$1,651.54
$290.65
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$733.04
$1,018.92
$1,084.16
$1,559.18
$2,199.12
$1,023.69
$1,309.57
$1,374.81
$1,849.83
$1,314.34
$1,600.22
$1,665.46
$2,140.48
$1,604.99
$1,890.87
$1,956.11
$2,431.13
$290.65
Toc - Plan #25 University of Utah Health Plans
Expanded Bronze

(EPO) Healthy Preferred Bronze HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-271-5870

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$233.82
$325.01
$345.82
$497.34
$701.46
$419.24
$510.43
$531.24
$682.76
$604.66
$695.85
$716.66
$868.18
$790.08
$881.27
$902.08
$1,053.60
$185.42
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$467.64
$650.02
$691.64
$994.68
$1,402.92
$653.06
$835.44
$877.06
$1,180.10
$838.48
$1,020.86
$1,062.48
$1,365.52
$1,023.90
$1,206.28
$1,247.90
$1,550.94
$185.42
Toc - Plan #26 University of Utah Health Plans
Expanded Bronze

(EPO) Healthy Premier Expanded Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-271-5870

Annual Out of Pocket Expenses:

Individual Family
$5,650 $11,300 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
$286.57
$398.33
$423.84
$609.53
$859.71
$513.82
$625.58
$651.09
$836.78
$741.07
$852.83
$878.34
$1,064.03
$968.32
$1,080.08
$1,105.59
$1,291.28
$227.25
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$573.14
$796.66
$847.68
$1,219.06
$1,719.42
$800.39
$1,023.91
$1,074.93
$1,446.31
$1,027.64
$1,251.16
$1,302.18
$1,673.56
$1,254.89
$1,478.41
$1,529.43
$1,900.81
$227.25
Toc - Plan #27 University of Utah Health Plans
Expanded Bronze

(EPO) Healthy Preferred Expanded Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-271-5870

Annual Out of Pocket Expenses:

Individual Family
$5,650 $11,300 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
$260.52
$362.12
$385.31
$554.13
$781.56
$467.11
$568.71
$591.90
$760.72
$673.70
$775.30
$798.49
$967.31
$880.29
$981.89
$1,005.08
$1,173.90
$206.59
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$521.04
$724.24
$770.62
$1,108.26
$1,563.12
$727.63
$930.83
$977.21
$1,314.85
$934.22
$1,137.42
$1,183.80
$1,521.44
$1,140.81
$1,344.01
$1,390.39
$1,728.03
$206.59
Toc - Plan #28 University of Utah Health Plans
Expanded Bronze

(EPO) Healthy Premier Expanded Bronze HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-271-5870

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 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
$286.14
$397.73
$423.20
$608.62
$858.42
$513.05
$624.64
$650.11
$835.53
$739.96
$851.55
$877.02
$1,062.44
$966.87
$1,078.46
$1,103.93
$1,289.35
$226.91
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$572.28
$795.46
$846.40
$1,217.24
$1,716.84
$799.19
$1,022.37
$1,073.31
$1,444.15
$1,026.10
$1,249.28
$1,300.22
$1,671.06
$1,253.01
$1,476.19
$1,527.13
$1,897.97
$226.91
Toc - Plan #29 University of Utah Health Plans
Expanded Bronze

(EPO) Healthy Preferred Expanded Bronze HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-271-5870

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 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
$260.13
$361.58
$384.73
$553.30
$780.39
$466.41
$567.86
$591.01
$759.58
$672.69
$774.14
$797.29
$965.86
$878.97
$980.42
$1,003.57
$1,172.14
$206.28
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$520.26
$723.16
$769.46
$1,106.60
$1,560.78
$726.54
$929.44
$975.74
$1,312.88
$932.82
$1,135.72
$1,182.02
$1,519.16
$1,139.10
$1,342.00
$1,388.30
$1,725.44
$206.28
Toc - Plan #30 University of Utah Health Plans
Silver

(EPO) Healthy Premier Silver 2300

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-271-5870

Annual Out of Pocket Expenses:

Individual Family
$2,300 $4,600 Annual Deductible
$8,300 $16,600 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
$406.42
$564.92
$601.10
$864.46
$1,219.26
$728.71
$887.21
$923.39
$1,186.75
$1,051.00
$1,209.50
$1,245.68
$1,509.04
$1,373.29
$1,531.79
$1,567.97
$1,831.33
$322.29
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$812.84
$1,129.84
$1,202.20
$1,728.92
$2,438.52
$1,135.13
$1,452.13
$1,524.49
$2,051.21
$1,457.42
$1,774.42
$1,846.78
$2,373.50
$1,779.71
$2,096.71
$2,169.07
$2,695.79
$322.29
Toc - Plan #31 University of Utah Health Plans
Silver

(EPO) Healthy Preferred Silver 2300

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-271-5870

Annual Out of Pocket Expenses:

Individual Family
$2,300 $4,600 Annual Deductible
$8,300 $16,600 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
$369.47
$513.56
$546.45
$785.86
$1,108.41
$662.46
$806.55
$839.44
$1,078.85
$955.45
$1,099.54
$1,132.43
$1,371.84
$1,248.44
$1,392.53
$1,425.42
$1,664.83
$292.99
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$738.94
$1,027.12
$1,092.90
$1,571.72
$2,216.82
$1,031.93
$1,320.11
$1,385.89
$1,864.71
$1,324.92
$1,613.10
$1,678.88
$2,157.70
$1,617.91
$1,906.09
$1,971.87
$2,450.69
$292.99
Toc - Plan #32 University of Utah Health Plans
Gold

(EPO) Healthy Preferred Wasatch Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-271-5870

Annual Out of Pocket Expenses:

Individual Family
$2,700 $5,400 Annual Deductible
$8,300 $16,600 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
$360.93
$501.69
$533.82
$767.70
$1,082.79
$647.15
$787.91
$820.04
$1,053.92
$933.37
$1,074.13
$1,106.26
$1,340.14
$1,219.59
$1,360.35
$1,392.48
$1,626.36
$286.22
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$721.86
$1,003.38
$1,067.64
$1,535.40
$2,165.58
$1,008.08
$1,289.60
$1,353.86
$1,821.62
$1,294.30
$1,575.82
$1,640.08
$2,107.84
$1,580.52
$1,862.04
$1,926.30
$2,394.06
$286.22
Toc - Plan #33 University of Utah Health Plans
Silver

(EPO) Healthy Preferred Wasatch Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-271-5870

Annual Out of Pocket Expenses:

Individual Family
$5,800 $11,600 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
$356.63
$495.72
$527.46
$758.55
$1,069.89
$639.44
$778.53
$810.27
$1,041.36
$922.25
$1,061.34
$1,093.08
$1,324.17
$1,205.06
$1,344.15
$1,375.89
$1,606.98
$282.81
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$713.26
$991.44
$1,054.92
$1,517.10
$2,139.78
$996.07
$1,274.25
$1,337.73
$1,799.91
$1,278.88
$1,557.06
$1,620.54
$2,082.72
$1,561.69
$1,839.87
$1,903.35
$2,365.53
$282.81
Toc - Plan #34 University of Utah Health Plans
Bronze

(EPO) Healthy Preferred Wasatch Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-271-5870

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
$223.75
$311.01
$330.93
$475.92
$671.25
$401.18
$488.44
$508.36
$653.35
$578.61
$665.87
$685.79
$830.78
$756.04
$843.30
$863.22
$1,008.21
$177.43
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$447.50
$622.02
$661.86
$951.84
$1,342.50
$624.93
$799.45
$839.29
$1,129.27
$802.36
$976.88
$1,016.72
$1,306.70
$979.79
$1,154.31
$1,194.15
$1,484.13
$177.43
Toc - Plan #35 University of Utah Health Plans
Expanded Bronze

(EPO) Healthy Premier Bronze w.3 Copays Before Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-271-5870

Annual Out of Pocket Expenses:

Individual Family
$7,800 $15,600 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
$257.60
$358.06
$380.99
$547.92
$772.80
$461.88
$562.34
$585.27
$752.20
$666.16
$766.62
$789.55
$956.48
$870.44
$970.90
$993.83
$1,160.76
$204.28
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$515.20
$716.12
$761.98
$1,095.84
$1,545.60
$719.48
$920.40
$966.26
$1,300.12
$923.76
$1,124.68
$1,170.54
$1,504.40
$1,128.04
$1,328.96
$1,374.82
$1,708.68
$204.28
Toc - Plan #36 University of Utah Health Plans
Expanded Bronze

(EPO) Healthy Preferred Bronze w.3 Copays Before Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-271-5870

Annual Out of Pocket Expenses:

Individual Family
$7,800 $15,600 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
$234.19
$325.52
$346.37
$498.12
$702.57
$419.90
$511.23
$532.08
$683.83
$605.61
$696.94
$717.79
$869.54
$791.32
$882.65
$903.50
$1,055.25
$185.71
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$468.38
$651.04
$692.74
$996.24
$1,405.14
$654.09
$836.75
$878.45
$1,181.95
$839.80
$1,022.46
$1,064.16
$1,367.66
$1,025.51
$1,208.17
$1,249.87
$1,553.37
$185.71

ADVERTISEMENT

SelectHealth

Local: 1-801-442-5038 | Toll Free: 1-800-538-5038

Toc - Plan #37 SelectHealth
Silver

(HMO) Med Silver 2500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-5038

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
$350.26
$486.85
$518.03
$744.99
$1,050.77
$628.01
$764.60
$795.78
$1,022.74
$905.76
$1,042.35
$1,073.53
$1,300.49
$1,183.51
$1,320.10
$1,351.28
$1,578.24
$277.75
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$700.52
$973.70
$1,036.06
$1,489.98
$2,101.54
$978.27
$1,251.45
$1,313.81
$1,767.73
$1,256.02
$1,529.20
$1,591.56
$2,045.48
$1,533.77
$1,806.95
$1,869.31
$2,323.23
$277.75
Toc - Plan #38 SelectHealth
Gold

(HMO) Med Gold 1500 - no deductible for office visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-5038

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$6,000 $12,000 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
$420.13
$583.98
$621.37
$893.62
$1,260.39
$753.29
$917.14
$954.53
$1,226.78
$1,086.45
$1,250.30
$1,287.69
$1,559.94
$1,419.61
$1,583.46
$1,620.85
$1,893.10
$333.16
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$840.26
$1,167.96
$1,242.74
$1,787.24
$2,520.78
$1,173.42
$1,501.12
$1,575.90
$2,120.40
$1,506.58
$1,834.28
$1,909.06
$2,453.56
$1,839.74
$2,167.44
$2,242.22
$2,786.72
$333.16
Toc - Plan #39 SelectHealth
Expanded Bronze

(HMO) Med Expanded Bronze 7800 - no deductible for office visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-5038

Annual Out of Pocket Expenses:

Individual Family
$7,800 $15,600 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
$226.66
$315.06
$335.23
$482.11
$679.98
$406.40
$494.80
$514.97
$661.85
$586.14
$674.54
$694.71
$841.59
$765.88
$854.28
$874.45
$1,021.33
$179.74
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$453.32
$630.12
$670.46
$964.22
$1,359.96
$633.06
$809.86
$850.20
$1,143.96
$812.80
$989.60
$1,029.94
$1,323.70
$992.54
$1,169.34
$1,209.68
$1,503.44
$179.74
Toc - Plan #40 SelectHealth
Expanded Bronze

(HMO) Med Expanded Bronze 6900 HSA Qualified

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-5038

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
$230.59
$320.52
$341.05
$490.47
$691.77
$413.45
$503.38
$523.91
$673.33
$596.31
$686.24
$706.77
$856.19
$779.17
$869.10
$889.63
$1,039.05
$182.86
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$461.18
$641.04
$682.10
$980.94
$1,383.54
$644.04
$823.90
$864.96
$1,163.80
$826.90
$1,006.76
$1,047.82
$1,346.66
$1,009.76
$1,189.62
$1,230.68
$1,529.52
$182.86
Toc - Plan #41 SelectHealth
Catastrophic

(HMO) Med Catastrophic 8700

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-5038

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
$193.03
$268.32
$285.50
$410.58
$579.09
$346.11
$421.40
$438.58
$563.66
$499.19
$574.48
$591.66
$716.74
$652.27
$727.56
$744.74
$869.82
$153.08
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$386.06
$536.64
$571.00
$821.16
$1,158.18
$539.14
$689.72
$724.08
$974.24
$692.22
$842.80
$877.16
$1,127.32
$845.30
$995.88
$1,030.24
$1,280.40
$153.08
Toc - Plan #42 SelectHealth
Gold

(HMO) Value Gold 1500 - no deductible for office visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-5038

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$6,000 $12,000 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
$371.80
$516.80
$549.89
$790.82
$1,115.40
$666.64
$811.64
$844.73
$1,085.66
$961.48
$1,106.48
$1,139.57
$1,380.50
$1,256.32
$1,401.32
$1,434.41
$1,675.34
$294.84
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$743.60
$1,033.60
$1,099.78
$1,581.64
$2,230.80
$1,038.44
$1,328.44
$1,394.62
$1,876.48
$1,333.28
$1,623.28
$1,689.46
$2,171.32
$1,628.12
$1,918.12
$1,984.30
$2,466.16
$294.84
Toc - Plan #43 SelectHealth
Silver

(HMO) Value Silver 2500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-5038

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
$309.96
$430.85
$458.44
$659.29
$929.88
$555.76
$676.65
$704.24
$905.09
$801.56
$922.45
$950.04
$1,150.89
$1,047.36
$1,168.25
$1,195.84
$1,396.69
$245.80
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$619.92
$861.70
$916.88
$1,318.58
$1,859.76
$865.72
$1,107.50
$1,162.68
$1,564.38
$1,111.52
$1,353.30
$1,408.48
$1,810.18
$1,357.32
$1,599.10
$1,654.28
$2,055.98
$245.80
Toc - Plan #44 SelectHealth
Expanded Bronze

(HMO) Value Expanded Bronze 7800 - no deductible for office visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-5038

Annual Out of Pocket Expenses:

Individual Family
$7,800 $15,600 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
$200.59
$278.82
$296.67
$426.65
$601.76
$359.66
$437.89
$455.74
$585.72
$518.73
$596.96
$614.81
$744.79
$677.80
$756.03
$773.88
$903.86
$159.07
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$401.18
$557.64
$593.34
$853.30
$1,203.52
$560.25
$716.71
$752.41
$1,012.37
$719.32
$875.78
$911.48
$1,171.44
$878.39
$1,034.85
$1,070.55
$1,330.51
$159.07
Toc - Plan #45 SelectHealth
Expanded Bronze

(HMO) Value Expanded Bronze 6900 HSA Qualified

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-5038

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
$204.07
$283.65
$301.81
$434.05
$612.20
$365.89
$445.47
$463.63
$595.87
$527.71
$607.29
$625.45
$757.69
$689.53
$769.11
$787.27
$919.51
$161.82
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$408.14
$567.30
$603.62
$868.10
$1,224.40
$569.96
$729.12
$765.44
$1,029.92
$731.78
$890.94
$927.26
$1,191.74
$893.60
$1,052.76
$1,089.08
$1,353.56
$161.82
Toc - Plan #46 SelectHealth
Catastrophic

(HMO) Value Catastrophic 8700

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-5038

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
$170.83
$237.45
$252.65
$363.35
$512.48
$306.30
$372.92
$388.12
$498.82
$441.77
$508.39
$523.59
$634.29
$577.24
$643.86
$659.06
$769.76
$135.47
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$341.66
$474.90
$505.30
$726.70
$1,024.96
$477.13
$610.37
$640.77
$862.17
$612.60
$745.84
$776.24
$997.64
$748.07
$881.31
$911.71
$1,133.11
$135.47
Toc - Plan #47 SelectHealth
Expanded Bronze

(HMO) Value Expanded Bronze 5900 Copay Plan - no deductible for office visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-5038

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$245.42
$341.13
$362.98
$522.01
$736.26
$440.04
$535.75
$557.60
$716.63
$634.66
$730.37
$752.22
$911.25
$829.28
$924.99
$946.84
$1,105.87
$194.62
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$490.84
$682.26
$725.96
$1,044.02
$1,472.52
$685.46
$876.88
$920.58
$1,238.64
$880.08
$1,071.50
$1,115.20
$1,433.26
$1,074.70
$1,266.12
$1,309.82
$1,627.88
$194.62
Toc - Plan #48 SelectHealth
Expanded Bronze

(HMO) Med Expanded Bronze 5900 Copay Plan - no deductible for all office visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-5038

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$277.32
$385.48
$410.16
$589.86
$831.96
$497.24
$605.40
$630.08
$809.78
$717.16
$825.32
$850.00
$1,029.70
$937.08
$1,045.24
$1,069.92
$1,249.62
$219.92
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$554.64
$770.96
$820.32
$1,179.72
$1,663.92
$774.56
$990.88
$1,040.24
$1,399.64
$994.48
$1,210.80
$1,260.16
$1,619.56
$1,214.40
$1,430.72
$1,480.08
$1,839.48
$219.92
Toc - Plan #49 SelectHealth
Expanded Bronze

(HMO) Value Expanded Bronze 8700 - $0 PCP Office Visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-5038

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
$243.87
$338.98
$360.69
$518.72
$731.61
$437.26
$532.37
$554.08
$712.11
$630.65
$725.76
$747.47
$905.50
$824.04
$919.15
$940.86
$1,098.89
$193.39
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$487.74
$677.96
$721.38
$1,037.44
$1,463.22
$681.13
$871.35
$914.77
$1,230.83
$874.52
$1,064.74
$1,108.16
$1,424.22
$1,067.91
$1,258.13
$1,301.55
$1,617.61
$193.39
Toc - Plan #50 SelectHealth
Expanded Bronze

(HMO) Med Expanded Bronze 8700 - $0 PCP Office Visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-5038

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
$275.57
$383.05
$407.58
$586.15
$826.71
$494.10
$601.58
$626.11
$804.68
$712.63
$820.11
$844.64
$1,023.21
$931.16
$1,038.64
$1,063.17
$1,241.74
$218.53
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$551.14
$766.10
$815.16
$1,172.30
$1,653.42
$769.67
$984.63
$1,033.69
$1,390.83
$988.20
$1,203.16
$1,252.22
$1,609.36
$1,206.73
$1,421.69
$1,470.75
$1,827.89
$218.53
Toc - Plan #51 SelectHealth
Expanded Bronze

(HMO) Med Benchmark Expanded Bronze 6800

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-5038

Annual Out of Pocket Expenses:

Individual Family
$6,800 $13,600 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
$219.27
$304.79
$324.30
$466.39
$657.81
$393.15
$478.67
$498.18
$640.27
$567.03
$652.55
$672.06
$814.15
$740.91
$826.43
$845.94
$988.03
$173.88
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$438.54
$609.58
$648.60
$932.78
$1,315.62
$612.42
$783.46
$822.48
$1,106.66
$786.30
$957.34
$996.36
$1,280.54
$960.18
$1,131.22
$1,170.24
$1,454.42
$173.88
Toc - Plan #52 SelectHealth
Expanded Bronze

(HMO) Value Benchmark Expanded Bronze 6800

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-5038

Annual Out of Pocket Expenses:

Individual Family
$6,800 $13,600 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
$194.05
$269.73
$287.00
$412.74
$582.14
$347.93
$423.61
$440.88
$566.62
$501.81
$577.49
$594.76
$720.50
$655.69
$731.37
$748.64
$874.38
$153.88
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$388.10
$539.46
$574.00
$825.48
$1,164.28
$541.98
$693.34
$727.88
$979.36
$695.86
$847.22
$881.76
$1,133.24
$849.74
$1,001.10
$1,035.64
$1,287.12
$153.88
Toc - Plan #53 SelectHealth
Expanded Bronze

(HMO) Value Benchmark Expanded Bronze 3800

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-5038

Annual Out of Pocket Expenses:

Individual Family
$3,800 $7,600 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
$224.95
$312.68
$332.70
$478.46
$674.84
$403.33
$491.06
$511.08
$656.84
$581.71
$669.44
$689.46
$835.22
$760.09
$847.82
$867.84
$1,013.60
$178.38
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$449.90
$625.36
$665.40
$956.92
$1,349.68
$628.28
$803.74
$843.78
$1,135.30
$806.66
$982.12
$1,022.16
$1,313.68
$985.04
$1,160.50
$1,200.54
$1,492.06
$178.38
Toc - Plan #54 SelectHealth
Expanded Bronze

(HMO) Med Benchmark Expanded Bronze 3800

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-5038

Annual Out of Pocket Expenses:

Individual Family
$3,800 $7,600 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
$254.19
$353.32
$375.94
$540.66
$762.56
$455.76
$554.89
$577.51
$742.23
$657.33
$756.46
$779.08
$943.80
$858.90
$958.03
$980.65
$1,145.37
$201.57
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$508.38
$706.64
$751.88
$1,081.32
$1,525.12
$709.95
$908.21
$953.45
$1,282.89
$911.52
$1,109.78
$1,155.02
$1,484.46
$1,113.09
$1,311.35
$1,356.59
$1,686.03
$201.57
Toc - Plan #55 SelectHealth
Bronze

(HMO) Value Benchmark Bronze 8700

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-5038

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
$187.46
$260.57
$277.26
$398.73
$562.38
$336.12
$409.23
$425.92
$547.39
$484.78
$557.89
$574.58
$696.05
$633.44
$706.55
$723.24
$844.71
$148.66
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$374.92
$521.14
$554.52
$797.46
$1,124.76
$523.58
$669.80
$703.18
$946.12
$672.24
$818.46
$851.84
$1,094.78
$820.90
$967.12
$1,000.50
$1,243.44
$148.66
Toc - Plan #56 SelectHealth
Bronze

(HMO) Med Benchmark Bronze 8700

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-5038

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
$211.83
$294.44
$313.30
$450.56
$635.49
$379.81
$462.42
$481.28
$618.54
$547.79
$630.40
$649.26
$786.52
$715.77
$798.38
$817.24
$954.50
$167.98
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$423.66
$588.88
$626.60
$901.12
$1,270.98
$591.64
$756.86
$794.58
$1,069.10
$759.62
$924.84
$962.56
$1,237.08
$927.60
$1,092.82
$1,130.54
$1,405.06
$167.98
Toc - Plan #57 SelectHealth
Silver

(HMO) Value Benchmark Silver 6500 - no deductible for office visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-5038

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 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
$299.57
$416.41
$443.07
$637.19
$898.71
$537.13
$653.97
$680.63
$874.75
$774.69
$891.53
$918.19
$1,112.31
$1,012.25
$1,129.09
$1,155.75
$1,349.87
$237.56
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$599.14
$832.82
$886.14
$1,274.38
$1,797.42
$836.70
$1,070.38
$1,123.70
$1,511.94
$1,074.26
$1,307.94
$1,361.26
$1,749.50
$1,311.82
$1,545.50
$1,598.82
$1,987.06
$237.56
Toc - Plan #58 SelectHealth
Silver

(HMO) Med Benchmark Silver 6500 - no deductible for office visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-5038

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 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
$338.51
$470.53
$500.66
$720.02
$1,015.53
$606.95
$738.97
$769.10
$988.46
$875.39
$1,007.41
$1,037.54
$1,256.90
$1,143.83
$1,275.85
$1,305.98
$1,525.34
$268.44
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$677.02
$941.06
$1,001.32
$1,440.04
$2,031.06
$945.46
$1,209.50
$1,269.76
$1,708.48
$1,213.90
$1,477.94
$1,538.20
$1,976.92
$1,482.34
$1,746.38
$1,806.64
$2,245.36
$268.44
Toc - Plan #59 SelectHealth
Expanded Bronze

(HMO) Value Benchmark Expanded Bronze 0 Copay Plan

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-5038

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
$220.70
$306.77
$326.41
$469.42
$662.09
$395.71
$481.78
$501.42
$644.43
$570.72
$656.79
$676.43
$819.44
$745.73
$831.80
$851.44
$994.45
$175.01
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$441.40
$613.54
$652.82
$938.84
$1,324.18
$616.41
$788.55
$827.83
$1,113.85
$791.42
$963.56
$1,002.84
$1,288.86
$966.43
$1,138.57
$1,177.85
$1,463.87
$175.01
Toc - Plan #60 SelectHealth
Expanded Bronze

(HMO) Med Benchmark Expanded Bronze 0 Copay Plan

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-5038

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
$249.39
$346.65
$368.84
$530.44
$748.16
$447.15
$544.41
$566.60
$728.20
$644.91
$742.17
$764.36
$925.96
$842.67
$939.93
$962.12
$1,123.72
$197.76
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$498.78
$693.30
$737.68
$1,060.88
$1,496.32
$696.54
$891.06
$935.44
$1,258.64
$894.30
$1,088.82
$1,133.20
$1,456.40
$1,092.06
$1,286.58
$1,330.96
$1,654.16
$197.76
Toc - Plan #61 SelectHealth
Silver

(HMO) Value Benchmark Silver 0 Copay Plan

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-5038

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
$306.50
$426.04
$453.32
$651.93
$919.50
$549.56
$669.10
$696.38
$894.99
$792.62
$912.16
$939.44
$1,138.05
$1,035.68
$1,155.22
$1,182.50
$1,381.11
$243.06
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$613.00
$852.08
$906.64
$1,303.86
$1,839.00
$856.06
$1,095.14
$1,149.70
$1,546.92
$1,099.12
$1,338.20
$1,392.76
$1,789.98
$1,342.18
$1,581.26
$1,635.82
$2,033.04
$243.06
Toc - Plan #62 SelectHealth
Silver

(HMO) Med Benchmark Silver 0 Copay Plan

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-5038

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
$346.34
$481.42
$512.24
$736.67
$1,039.02
$620.99
$756.07
$786.89
$1,011.32
$895.64
$1,030.72
$1,061.54
$1,285.97
$1,170.29
$1,305.37
$1,336.19
$1,560.62
$274.65
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$692.68
$962.84
$1,024.48
$1,473.34
$2,078.04
$967.33
$1,237.49
$1,299.13
$1,747.99
$1,241.98
$1,512.14
$1,573.78
$2,022.64
$1,516.63
$1,786.79
$1,848.43
$2,297.29
$274.65

‡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 Tooele County here.

Tooele County is in “Rating Area 3” of Utah.

Currently, there are 62 plans offered in Rating Area 3.

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2022 Obamacare Plans for Tooele County, UT

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