Obamacare 2022 Rates for Fredericksburg City

Obamacare > Rates > Virginia > Fredericksburg City

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 Fredericksburg City, VA.

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, 40 Plans and 2022 Rates for Fredericksburg City, Virginia

Below, you’ll find a summary of the 40 plans for Fredericksburg City, Virginia 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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UnitedHealthcare

Local: 1-877-265-9199 | Toll Free: 1-877-265-9199 | TTY: 1-877-265-9199
Toc - Plan #1 UnitedHealthcare
Gold

(HMO) UHC Value Gold ($3 Walgreens Rx + 6 $0 Virtual Visits)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-265-9199

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 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 		$338.59
$384.30
$432.71
$604.72
$918.93 		$597.61
$643.32
$691.73
$863.74 		$856.63
$902.34
$950.75
$1,122.76 		$1,115.65
$1,161.36
$1,209.77
$1,381.78 		$259.02
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$677.18
$768.60
$865.42
$1,209.44
$1,837.86 		$936.20
$1,027.62
$1,124.44
$1,468.46 		$1,195.22
$1,286.64
$1,383.46
$1,727.48 		$1,454.24
$1,545.66
$1,642.48
$1,986.50 		$259.02
Toc - Plan #2 UnitedHealthcare
Silver

(HMO) UHC Value Base Silver ($3 Walgreens Rx + 6 $0 Virtual Visits)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-265-9199

Annual Out of Pocket Expenses:

Individual Family
$4,700 $9,400 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 		$354.69
$402.57
$453.29
$633.47
$962.62 		$626.03
$673.91
$724.63
$904.81 		$897.37
$945.25
$995.97
$1,176.15 		$1,168.71
$1,216.59
$1,267.31
$1,447.49 		$271.34
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$709.38
$805.14
$906.58
$1,266.94
$1,925.24 		$980.72
$1,076.48
$1,177.92
$1,538.28 		$1,252.06
$1,347.82
$1,449.26
$1,809.62 		$1,523.40
$1,619.16
$1,720.60
$2,080.96 		$271.34
Toc - Plan #3 UnitedHealthcare
Expanded Bronze

(HMO) UHC Value Bronze ($3 Walgreens Rx + 6 $0 Virtual Visits)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-265-9199

Annual Out of Pocket Expenses:

Individual Family
$7,900 $15,800 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 		$271.95
$308.66
$347.55
$485.70
$738.07 		$479.99
$516.70
$555.59
$693.74 		$688.03
$724.74
$763.63
$901.78 		$896.07
$932.78
$971.67
$1,109.82 		$208.04
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$543.90
$617.32
$695.10
$971.40
$1,476.14 		$751.94
$825.36
$903.14
$1,179.44 		$959.98
$1,033.40
$1,111.18
$1,387.48 		$1,168.02
$1,241.44
$1,319.22
$1,595.52 		$208.04
Toc - Plan #4 UnitedHealthcare
Expanded Bronze

(HMO) UHC Value Base Bronze ($3 Walgreens Rx + 6 $0 Virtual Visits)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-265-9199

Annual Out of Pocket Expenses:

Individual Family
$7,900 $15,800 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 		$270.88
$307.45
$346.19
$483.80
$735.17 		$478.10
$514.67
$553.41
$691.02 		$685.32
$721.89
$760.63
$898.24 		$892.54
$929.11
$967.85
$1,105.46 		$207.22
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$541.76
$614.90
$692.38
$967.60
$1,470.34 		$748.98
$822.12
$899.60
$1,174.82 		$956.20
$1,029.34
$1,106.82
$1,382.04 		$1,163.42
$1,236.56
$1,314.04
$1,589.26 		$207.22
Toc - Plan #5 UnitedHealthcare
Expanded Bronze

(HMO) UHC Bronze Virtual First ($3 Walgreens Rx + Unlimited Free App-based Care) (Disponible en español)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-265-9199

Annual Out of Pocket Expenses:

Individual Family
$7,600 $15,200 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$263.44
$299.01
$336.68
$470.51
$714.98 		$464.97
$500.54
$538.21
$672.04 		$666.50
$702.07
$739.74
$873.57 		$868.03
$903.60
$941.27
$1,075.10 		$201.53
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$526.88
$598.02
$673.36
$941.02
$1,429.96 		$728.41
$799.55
$874.89
$1,142.55 		$929.94
$1,001.08
$1,076.42
$1,344.08 		$1,131.47
$1,202.61
$1,277.95
$1,545.61 		$201.53
Toc - Plan #6 UnitedHealthcare
Bronze

(HMO) UHC Simple Bronze (Low Premium)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-265-9199

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 		$258.40
$293.28
$330.23
$461.50
$701.29 		$456.07
$490.95
$527.90
$659.17 		$653.74
$688.62
$725.57
$856.84 		$851.41
$886.29
$923.24
$1,054.51 		$197.67
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$516.80
$586.56
$660.46
$923.00
$1,402.58 		$714.47
$784.23
$858.13
$1,120.67 		$912.14
$981.90
$1,055.80
$1,318.34 		$1,109.81
$1,179.57
$1,253.47
$1,516.01 		$197.67
Toc - Plan #7 UnitedHealthcare
Gold

(HMO) UHC Value Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-265-9199

Annual Out of Pocket Expenses:

Individual Family
$1,400 $2,800 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 		$349.97
$397.21
$447.26
$625.04
$949.81 		$617.69
$664.93
$714.98
$892.76 		$885.41
$932.65
$982.70
$1,160.48 		$1,153.13
$1,200.37
$1,250.42
$1,428.20 		$267.72
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$699.94
$794.42
$894.52
$1,250.08
$1,899.62 		$967.66
$1,062.14
$1,162.24
$1,517.80 		$1,235.38
$1,329.86
$1,429.96
$1,785.52 		$1,503.10
$1,597.58
$1,697.68
$2,053.24 		$267.72
Toc - Plan #8 UnitedHealthcare
Gold

(HMO) UHC Advantage Plus Gold ($3 Walgreens Rx + Dental + Vision + 6 $0 Virtual Visits)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-265-9199

Annual Out of Pocket Expenses:

Individual Family
$2,250 $4,500 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 		$359.52
$408.06
$459.47
$642.11
$975.74 		$634.55
$683.09
$734.50
$917.14 		$909.58
$958.12
$1,009.53
$1,192.17 		$1,184.61
$1,233.15
$1,284.56
$1,467.20 		$275.03
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$719.04
$816.12
$918.94
$1,284.22
$1,951.48 		$994.07
$1,091.15
$1,193.97
$1,559.25 		$1,269.10
$1,366.18
$1,469.00
$1,834.28 		$1,544.13
$1,641.21
$1,744.03
$2,109.31 		$275.03
Toc - Plan #9 UnitedHealthcare
Silver

(HMO) UHC Silver Virtual First ($3 Walgreens Rx + Unlimited Free App-based Care) (Disponible en español)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-265-9199

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 		$339.70
$385.55
$434.13
$606.70
$921.93 		$599.57
$645.42
$694.00
$866.57 		$859.44
$905.29
$953.87
$1,126.44 		$1,119.31
$1,165.16
$1,213.74
$1,386.31 		$259.87
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$679.40
$771.10
$868.26
$1,213.40
$1,843.86 		$939.27
$1,030.97
$1,128.13
$1,473.27 		$1,199.14
$1,290.84
$1,388.00
$1,733.14 		$1,459.01
$1,550.71
$1,647.87
$1,993.01 		$259.87
Toc - Plan #10 UnitedHealthcare
Silver

(HMO) UHC Value Plus Silver ($3 Walgreens Rx + 3 $0 Primary Care Visits + 6 $0 Virtual Visits)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-265-9199

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 		$356.24
$404.33
$455.27
$636.24
$966.83 		$628.76
$676.85
$727.79
$908.76 		$901.28
$949.37
$1,000.31
$1,181.28 		$1,173.80
$1,221.89
$1,272.83
$1,453.80 		$272.52
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$712.48
$808.66
$910.54
$1,272.48
$1,933.66 		$985.00
$1,081.18
$1,183.06
$1,545.00 		$1,257.52
$1,353.70
$1,455.58
$1,817.52 		$1,530.04
$1,626.22
$1,728.10
$2,090.04 		$272.52
Toc - Plan #11 UnitedHealthcare
Silver

(HMO) UHC Value Silver ($3 Walgreens Rx + 3 $0 Primary Care Visits + 6 $0 Virtual Visits)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-265-9199

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 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 		$359.48
$408.01
$459.42
$642.03
$975.63 		$634.48
$683.01
$734.42
$917.03 		$909.48
$958.01
$1,009.42
$1,192.03 		$1,184.48
$1,233.01
$1,284.42
$1,467.03 		$275.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$718.96
$816.02
$918.84
$1,284.06
$1,951.26 		$993.96
$1,091.02
$1,193.84
$1,559.06 		$1,268.96
$1,366.02
$1,468.84
$1,834.06 		$1,543.96
$1,641.02
$1,743.84
$2,109.06 		$275.00
Toc - Plan #12 UnitedHealthcare
Expanded Bronze

(HMO) UHC Value Plus Bronze ($3 Walgreens Rx + 3 $0 Primary Care Visits + 6 $0 Virtual Visits)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-265-9199

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$271.09
$307.69
$346.46
$484.17
$735.75 		$478.48
$515.08
$553.85
$691.56 		$685.87
$722.47
$761.24
$898.95 		$893.26
$929.86
$968.63
$1,106.34 		$207.39
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$542.18
$615.38
$692.92
$968.34
$1,471.50 		$749.57
$822.77
$900.31
$1,175.73 		$956.96
$1,030.16
$1,107.70
$1,383.12 		$1,164.35
$1,237.55
$1,315.09
$1,590.51 		$207.39

ADVERTISEMENT

Innovation Health Plan, Inc.

Local: 1-866-833-2957 | Toll Free: 1-866-833-2957

Toc - Plan #13 Innovation Health Plan, Inc.
Expanded Bronze

(HMO) Innovation Health Bronze: Low-Cost MinuteClinic Visits, Telehealth, CVS Store Discounts

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-833-2957

Annual Out of Pocket Expenses:

Individual Family
$5,500 $11,000 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 		$311.13
$353.13
$397.62
$555.67
$844.39 		$549.14
$591.14
$635.63
$793.68 		$787.15
$829.15
$873.64
$1,031.69 		$1,025.16
$1,067.16
$1,111.65
$1,269.70 		$238.01
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$622.26
$706.26
$795.24
$1,111.34
$1,688.78 		$860.27
$944.27
$1,033.25
$1,349.35 		$1,098.28
$1,182.28
$1,271.26
$1,587.36 		$1,336.29
$1,420.29
$1,509.27
$1,825.37 		$238.01
Toc - Plan #14 Innovation Health Plan, Inc.
Bronze

(HMO) Innovation Health Bronze: $0 MinuteClinic Visits, Telehealth, CVS Store Discounts

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-833-2957

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 		$279.52
$317.26
$357.23
$499.23
$758.62 		$493.35
$531.09
$571.06
$713.06 		$707.18
$744.92
$784.89
$926.89 		$921.01
$958.75
$998.72
$1,140.72 		$213.83
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$559.04
$634.52
$714.46
$998.46
$1,517.24 		$772.87
$848.35
$928.29
$1,212.29 		$986.70
$1,062.18
$1,142.12
$1,426.12 		$1,200.53
$1,276.01
$1,355.95
$1,639.95 		$213.83
Toc - Plan #15 Innovation Health Plan, Inc.
Gold

(HMO) Innovation Health Gold: $0 MinuteClinic Visits, Telehealth, CVS Store Discounts

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-833-2957

Annual Out of Pocket Expenses:

Individual Family
$1,450 $2,900 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 		$424.16
$481.42
$542.07
$757.55
$1,151.17 		$748.64
$805.90
$866.55
$1,082.03 		$1,073.12
$1,130.38
$1,191.03
$1,406.51 		$1,397.60
$1,454.86
$1,515.51
$1,730.99 		$324.48
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$848.32
$962.84
$1,084.14
$1,515.10
$2,302.34 		$1,172.80
$1,287.32
$1,408.62
$1,839.58 		$1,497.28
$1,611.80
$1,733.10
$2,164.06 		$1,821.76
$1,936.28
$2,057.58
$2,488.54 		$324.48
Toc - Plan #16 Innovation Health Plan, Inc.
Silver

(HMO) Innovation Health Silver 2: $0 MinuteClinic Visits, Telehealth, CVS Store Discounts

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-833-2957

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$361.42
$410.21
$461.89
$645.49
$980.89 		$637.91
$686.70
$738.38
$921.98 		$914.40
$963.19
$1,014.87
$1,198.47 		$1,190.89
$1,239.68
$1,291.36
$1,474.96 		$276.49
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$722.84
$820.42
$923.78
$1,290.98
$1,961.78 		$999.33
$1,096.91
$1,200.27
$1,567.47 		$1,275.82
$1,373.40
$1,476.76
$1,843.96 		$1,552.31
$1,649.89
$1,753.25
$2,120.45 		$276.49
Toc - Plan #17 Innovation Health Plan, Inc.
Silver

(HMO) Innovation Health Silver 1: $0 MinuteClinic Visits, Telehealth, CVS Store Discounts

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-833-2957

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 		$420.83
$477.64
$537.82
$751.61
$1,142.14 		$742.77
$799.58
$859.76
$1,073.55 		$1,064.71
$1,121.52
$1,181.70
$1,395.49 		$1,386.65
$1,443.46
$1,503.64
$1,717.43 		$321.94
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$841.66
$955.28
$1,075.64
$1,503.22
$2,284.28 		$1,163.60
$1,277.22
$1,397.58
$1,825.16 		$1,485.54
$1,599.16
$1,719.52
$2,147.10 		$1,807.48
$1,921.10
$2,041.46
$2,469.04 		$321.94

ADVERTISEMENT

HealthKeepers, Inc.

Local: 1-855-748-1810 | Toll Free: 1-855-748-1810

Toc - Plan #18 HealthKeepers, Inc.
Catastrophic

(HMO) Anthem HealthKeepers Catastrophic X 8700

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1810

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 		$224.41
$254.71
$286.80
$400.80
$609.05 		$396.08
$426.38
$458.47
$572.47 		$567.75
$598.05
$630.14
$744.14 		$739.42
$769.72
$801.81
$915.81 		$171.67
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$448.82
$509.42
$573.60
$801.60
$1,218.10 		$620.49
$681.09
$745.27
$973.27 		$792.16
$852.76
$916.94
$1,144.94 		$963.83
$1,024.43
$1,088.61
$1,316.61 		$171.67
Toc - Plan #19 HealthKeepers, Inc.
Expanded Bronze

(HMO) Anthem HealthKeepers Bronze X 5500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1810

Annual Out of Pocket Expenses:

Individual Family
$5,500 $11,000 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 		$289.77
$328.89
$370.33
$517.53
$786.44 		$511.44
$550.56
$592.00
$739.20 		$733.11
$772.23
$813.67
$960.87 		$954.78
$993.90
$1,035.34
$1,182.54 		$221.67
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$579.54
$657.78
$740.66
$1,035.06
$1,572.88 		$801.21
$879.45
$962.33
$1,256.73 		$1,022.88
$1,101.12
$1,184.00
$1,478.40 		$1,244.55
$1,322.79
$1,405.67
$1,700.07 		$221.67
Toc - Plan #20 HealthKeepers, Inc.
Expanded Bronze

(HMO) Anthem HealthKeepers Bronze X 5900 for HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1810

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 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 		$294.57
$334.34
$376.46
$526.10
$799.46 		$519.92
$559.69
$601.81
$751.45 		$745.27
$785.04
$827.16
$976.80 		$970.62
$1,010.39
$1,052.51
$1,202.15 		$225.35
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$589.14
$668.68
$752.92
$1,052.20
$1,598.92 		$814.49
$894.03
$978.27
$1,277.55 		$1,039.84
$1,119.38
$1,203.62
$1,502.90 		$1,265.19
$1,344.73
$1,428.97
$1,728.25 		$225.35
Toc - Plan #21 HealthKeepers, Inc.
Bronze

(HMO) Anthem HealthKeepers Bronze X 8200

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1810

Annual Out of Pocket Expenses:

Individual Family
$8,200 $16,400 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 		$279.21
$316.90
$356.83
$498.67
$757.78 		$492.81
$530.50
$570.43
$712.27 		$706.41
$744.10
$784.03
$925.87 		$920.01
$957.70
$997.63
$1,139.47 		$213.60
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$558.42
$633.80
$713.66
$997.34
$1,515.56 		$772.02
$847.40
$927.26
$1,210.94 		$985.62
$1,061.00
$1,140.86
$1,424.54 		$1,199.22
$1,274.60
$1,354.46
$1,638.14 		$213.60
Toc - Plan #22 HealthKeepers, Inc.
Gold

(HMO) Anthem HealthKeepers Gold X 2000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1810

Annual Out of Pocket Expenses:

Individual Family
$2,000 $6,000 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 		$356.68
$404.83
$455.84
$637.03
$968.03 		$629.54
$677.69
$728.70
$909.89 		$902.40
$950.55
$1,001.56
$1,182.75 		$1,175.26
$1,223.41
$1,274.42
$1,455.61 		$272.86
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$713.36
$809.66
$911.68
$1,274.06
$1,936.06 		$986.22
$1,082.52
$1,184.54
$1,546.92 		$1,259.08
$1,355.38
$1,457.40
$1,819.78 		$1,531.94
$1,628.24
$1,730.26
$2,092.64 		$272.86
Toc - Plan #23 HealthKeepers, Inc.
Silver

(HMO) Anthem HealthKeepers Silver X 2200

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1810

Annual Out of Pocket Expenses:

Individual Family
$2,200 $4,400 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 		$372.83
$423.16
$476.48
$665.87
$1,011.86 		$658.04
$708.37
$761.69
$951.08 		$943.25
$993.58
$1,046.90
$1,236.29 		$1,228.46
$1,278.79
$1,332.11
$1,521.50 		$285.21
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$745.66
$846.32
$952.96
$1,331.74
$2,023.72 		$1,030.87
$1,131.53
$1,238.17
$1,616.95 		$1,316.08
$1,416.74
$1,523.38
$1,902.16 		$1,601.29
$1,701.95
$1,808.59
$2,187.37 		$285.21
Toc - Plan #24 HealthKeepers, Inc.
Silver

(HMO) Anthem HealthKeepers Silver X 6250

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1810

Annual Out of Pocket Expenses:

Individual Family
$6,250 $12,500 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 		$355.03
$402.96
$453.73
$634.08
$963.55 		$626.63
$674.56
$725.33
$905.68 		$898.23
$946.16
$996.93
$1,177.28 		$1,169.83
$1,217.76
$1,268.53
$1,448.88 		$271.60
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$710.06
$805.92
$907.46
$1,268.16
$1,927.10 		$981.66
$1,077.52
$1,179.06
$1,539.76 		$1,253.26
$1,349.12
$1,450.66
$1,811.36 		$1,524.86
$1,620.72
$1,722.26
$2,082.96 		$271.60
Toc - Plan #25 HealthKeepers, Inc.
Expanded Bronze

(HMO) Anthem HealthKeepers Bronze X 5800

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1810

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 		$297.66
$337.84
$380.41
$531.62
$807.85 		$525.37
$565.55
$608.12
$759.33 		$753.08
$793.26
$835.83
$987.04 		$980.79
$1,020.97
$1,063.54
$1,214.75 		$227.71
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$595.32
$675.68
$760.82
$1,063.24
$1,615.70 		$823.03
$903.39
$988.53
$1,290.95 		$1,050.74
$1,131.10
$1,216.24
$1,518.66 		$1,278.45
$1,358.81
$1,443.95
$1,746.37 		$227.71
Toc - Plan #26 HealthKeepers, Inc.
Silver

(HMO) Anthem HealthKeepers Silver X 5300

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1810

Annual Out of Pocket Expenses:

Individual Family
$5,300 $10,600 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 		$359.54
$408.08
$459.49
$642.14
$975.79 		$634.59
$683.13
$734.54
$917.19 		$909.64
$958.18
$1,009.59
$1,192.24 		$1,184.69
$1,233.23
$1,284.64
$1,467.29 		$275.05
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$719.08
$816.16
$918.98
$1,284.28
$1,951.58 		$994.13
$1,091.21
$1,194.03
$1,559.33 		$1,269.18
$1,366.26
$1,469.08
$1,834.38 		$1,544.23
$1,641.31
$1,744.13
$2,109.43 		$275.05
Toc - Plan #27 HealthKeepers, Inc.
Expanded Bronze

(HMO) Anthem HealthKeepers Bronze X 7000 0 PCP

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1810

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 		$296.97
$337.06
$379.53
$530.39
$805.98 		$524.15
$564.24
$606.71
$757.57 		$751.33
$791.42
$833.89
$984.75 		$978.51
$1,018.60
$1,061.07
$1,211.93 		$227.18
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$593.94
$674.12
$759.06
$1,060.78
$1,611.96 		$821.12
$901.30
$986.24
$1,287.96 		$1,048.30
$1,128.48
$1,213.42
$1,515.14 		$1,275.48
$1,355.66
$1,440.60
$1,742.32 		$227.18

ADVERTISEMENT

Kaiser Permanente

Local: 1-800-807-1140 | Toll Free: 1-800-807-1140 | TTY: 1-703-359-7616
Toc - Plan #28 Kaiser Permanente
Gold

(HMO) KP VA Gold 0/20/Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-807-1140

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$6,950 $13,900 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 		$364.18
$413.35
$465.43
$650.43
$988.39 		$642.78
$691.95
$744.03
$929.03 		$921.38
$970.55
$1,022.63
$1,207.63 		$1,199.98
$1,249.15
$1,301.23
$1,486.23 		$278.60
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$728.36
$826.70
$930.86
$1,300.86
$1,976.78 		$1,006.96
$1,105.30
$1,209.46
$1,579.46 		$1,285.56
$1,383.90
$1,488.06
$1,858.06 		$1,564.16
$1,662.50
$1,766.66
$2,136.66 		$278.60
Toc - Plan #29 Kaiser Permanente
Silver

(HMO) KP VA Silver 2500/35/Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-807-1140

Annual Out of Pocket Expenses:

Individual Family
$2,500 $5,000 Annual Deductible
$8,250 $16,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$386.24
$438.38
$493.62
$689.83
$1,048.26 		$681.71
$733.85
$789.09
$985.30 		$977.18
$1,029.32
$1,084.56
$1,280.77 		$1,272.65
$1,324.79
$1,380.03
$1,576.24 		$295.47
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$772.48
$876.76
$987.24
$1,379.66
$2,096.52 		$1,067.95
$1,172.23
$1,282.71
$1,675.13 		$1,363.42
$1,467.70
$1,578.18
$1,970.60 		$1,658.89
$1,763.17
$1,873.65
$2,266.07 		$295.47
Toc - Plan #30 Kaiser Permanente
Expanded Bronze

(HMO) KP VA Bronze 6000/55/Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-807-1140

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$285.14
$323.64
$364.41
$509.26
$773.88 		$503.27
$541.77
$582.54
$727.39 		$721.40
$759.90
$800.67
$945.52 		$939.53
$978.03
$1,018.80
$1,163.65 		$218.13
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$570.28
$647.28
$728.82
$1,018.52
$1,547.76 		$788.41
$865.41
$946.95
$1,236.65 		$1,006.54
$1,083.54
$1,165.08
$1,454.78 		$1,224.67
$1,301.67
$1,383.21
$1,672.91 		$218.13
Toc - Plan #31 Kaiser Permanente
Catastrophic

(HMO) KP VA Catastrophic 8700/0/Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-807-1140

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 		$189.00
$214.52
$241.54
$337.56
$512.95 		$333.59
$359.11
$386.13
$482.15 		$478.18
$503.70
$530.72
$626.74 		$622.77
$648.29
$675.31
$771.33 		$144.59
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$378.00
$429.04
$483.08
$675.12
$1,025.90 		$522.59
$573.63
$627.67
$819.71 		$667.18
$718.22
$772.26
$964.30 		$811.77
$862.81
$916.85
$1,108.89 		$144.59
Toc - Plan #32 Kaiser Permanente
Platinum

(HMO) KP VA Platinum 0/15/Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-807-1140

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$4,000 $8,000 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 		$409.17
$464.41
$522.92
$730.78
$1,110.49 		$722.19
$777.43
$835.94
$1,043.80 		$1,035.21
$1,090.45
$1,148.96
$1,356.82 		$1,348.23
$1,403.47
$1,461.98
$1,669.84 		$313.02
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$818.34
$928.82
$1,045.84
$1,461.56
$2,220.98 		$1,131.36
$1,241.84
$1,358.86
$1,774.58 		$1,444.38
$1,554.86
$1,671.88
$2,087.60 		$1,757.40
$1,867.88
$1,984.90
$2,400.62 		$313.02
Toc - Plan #33 Kaiser Permanente
Silver

(HMO) KP VA Silver 5000/40/Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-807-1140

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 Annual Deductible
$8,500 $17,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$367.62
$417.25
$469.82
$656.57
$997.73 		$648.85
$698.48
$751.05
$937.80 		$930.08
$979.71
$1,032.28
$1,219.03 		$1,211.31
$1,260.94
$1,313.51
$1,500.26 		$281.23
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$735.24
$834.50
$939.64
$1,313.14
$1,995.46 		$1,016.47
$1,115.73
$1,220.87
$1,594.37 		$1,297.70
$1,396.96
$1,502.10
$1,875.60 		$1,578.93
$1,678.19
$1,783.33
$2,156.83 		$281.23
Toc - Plan #34 Kaiser Permanente
Gold

(HMO) KP VA Gold 1250/20/Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-807-1140

Annual Out of Pocket Expenses:

Individual Family
$1,250 $2,500 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$353.10
$400.77
$451.27
$630.65
$958.33 		$623.23
$670.90
$721.40
$900.78 		$893.36
$941.03
$991.53
$1,170.91 		$1,163.49
$1,211.16
$1,261.66
$1,441.04 		$270.13
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$706.20
$801.54
$902.54
$1,261.30
$1,916.66 		$976.33
$1,071.67
$1,172.67
$1,531.43 		$1,246.46
$1,341.80
$1,442.80
$1,801.56 		$1,516.59
$1,611.93
$1,712.93
$2,071.69 		$270.13
Toc - Plan #35 Kaiser Permanente
Gold

(HMO) KP VA Gold 1700/25/Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-807-1140

Annual Out of Pocket Expenses:

Individual Family
$1,700 $3,400 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 		$337.99
$383.62
$431.96
$603.66
$917.31 		$596.55
$642.18
$690.52
$862.22 		$855.11
$900.74
$949.08
$1,120.78 		$1,113.67
$1,159.30
$1,207.64
$1,379.34 		$258.56
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$675.98
$767.24
$863.92
$1,207.32
$1,834.62 		$934.54
$1,025.80
$1,122.48
$1,465.88 		$1,193.10
$1,284.36
$1,381.04
$1,724.44 		$1,451.66
$1,542.92
$1,639.60
$1,983.00 		$258.56
Toc - Plan #36 Kaiser Permanente
Silver

(HMO) KP VA Silver 6500/40/Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-807-1140

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 		$352.66
$400.27
$450.70
$629.86
$957.13 		$622.45
$670.06
$720.49
$899.65 		$892.24
$939.85
$990.28
$1,169.44 		$1,162.03
$1,209.64
$1,260.07
$1,439.23 		$269.79
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$705.32
$800.54
$901.40
$1,259.72
$1,914.26 		$975.11
$1,070.33
$1,171.19
$1,529.51 		$1,244.90
$1,340.12
$1,440.98
$1,799.30 		$1,514.69
$1,609.91
$1,710.77
$2,069.09 		$269.79
Toc - Plan #37 Kaiser Permanente
Bronze

(HMO) KP VA Bronze 7500/40%/Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-807-1140

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$262.38
$297.80
$335.32
$468.61
$712.10 		$463.10
$498.52
$536.04
$669.33 		$663.82
$699.24
$736.76
$870.05 		$864.54
$899.96
$937.48
$1,070.77 		$200.72
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$524.76
$595.60
$670.64
$937.22
$1,424.20 		$725.48
$796.32
$871.36
$1,137.94 		$926.20
$997.04
$1,072.08
$1,338.66 		$1,126.92
$1,197.76
$1,272.80
$1,539.38 		$200.72
Toc - Plan #38 Kaiser Permanente
Expanded Bronze

(HMO) KP VA Bronze 6900/0%/HSA/Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-807-1140

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 		$277.74
$315.24
$354.95
$496.04
$753.79 		$490.21
$527.71
$567.42
$708.51 		$702.68
$740.18
$779.89
$920.98 		$915.15
$952.65
$992.36
$1,133.45 		$212.47
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$555.48
$630.48
$709.90
$992.08
$1,507.58 		$767.95
$842.95
$922.37
$1,204.55 		$980.42
$1,055.42
$1,134.84
$1,417.02 		$1,192.89
$1,267.89
$1,347.31
$1,629.49 		$212.47
Toc - Plan #39 Kaiser Permanente
Gold

(HMO) KP VA Gold Virtual 2000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-807-1140

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$5,000 $10,000 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 		$325.16
$369.06
$415.56
$580.74
$882.49 		$573.91
$617.81
$664.31
$829.49 		$822.66
$866.56
$913.06
$1,078.24 		$1,071.41
$1,115.31
$1,161.81
$1,326.99 		$248.75
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$650.32
$738.12
$831.12
$1,161.48
$1,764.98 		$899.07
$986.87
$1,079.87
$1,410.23 		$1,147.82
$1,235.62
$1,328.62
$1,658.98 		$1,396.57
$1,484.37
$1,577.37
$1,907.73 		$248.75
Toc - Plan #40 Kaiser Permanente
Silver

(HMO) KP VA Silver Virtual Forward 4000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-807-1140

Annual Out of Pocket Expenses:

Individual Family
$4,000 $8,000 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 		$341.43
$387.53
$436.35
$609.80
$926.65 		$602.63
$648.73
$697.55
$871.00 		$863.83
$909.93
$958.75
$1,132.20 		$1,125.03
$1,171.13
$1,219.95
$1,393.40 		$261.20
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$682.86
$775.06
$872.70
$1,219.60
$1,853.30 		$944.06
$1,036.26
$1,133.90
$1,480.80 		$1,205.26
$1,297.46
$1,395.10
$1,742.00 		$1,466.46
$1,558.66
$1,656.30
$2,003.20 		$261.20

‡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 Fredericksburg City here.

Fredericksburg City is in “Rating Area 10” of Virginia.

Currently, there are 40 plans offered in Rating Area 10.

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