Obamacare 2022 Rates for Crawford County

Obamacare > Rates > Wisconsin > Crawford 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 Crawford County, WI.

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 Crawford County, Wisconsin

Below, you’ll find a summary of the 40 plans for Crawford County, Wisconsin 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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Quartz

Local: 1-608-644-3430 | Toll Free: 1-800-362-3310 | TTY: 1-800-877-8973
Toc - Plan #1 Quartz
Gold

(HMO) Tiered Choice Plus Gold I406 with Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 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 		$408.25
$463.35
$521.73
$729.12
$1,107.97 		$720.55
$775.65
$834.03
$1,041.42 		$1,032.85
$1,087.95
$1,146.33
$1,353.72 		$1,345.15
$1,400.25
$1,458.63
$1,666.02 		$312.30
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$816.50
$926.70
$1,043.46
$1,458.24
$2,215.94 		$1,128.80
$1,239.00
$1,355.76
$1,770.54 		$1,441.10
$1,551.30
$1,668.06
$2,082.84 		$1,753.40
$1,863.60
$1,980.36
$2,395.14 		$312.30
Toc - Plan #2 Quartz
Gold

(HMO) Tiered Choice Plus Gold I407 Maintenance with Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$1,000 $2,000 Annual Deductible
$4,250 $8,500 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 		$465.52
$528.36
$594.93
$831.41
$1,263.41 		$821.64
$884.48
$951.05
$1,187.53 		$1,177.76
$1,240.60
$1,307.17
$1,543.65 		$1,533.88
$1,596.72
$1,663.29
$1,899.77 		$356.12
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$931.04
$1,056.72
$1,189.86
$1,662.82
$2,526.82 		$1,287.16
$1,412.84
$1,545.98
$2,018.94 		$1,643.28
$1,768.96
$1,902.10
$2,375.06 		$1,999.40
$2,125.08
$2,258.22
$2,731.18 		$356.12
Toc - Plan #3 Quartz
Gold

(HMO) Tiered Choice Plus Gold I409 with Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 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 		$402.87
$457.25
$514.86
$719.52
$1,093.37 		$711.06
$765.44
$823.05
$1,027.71 		$1,019.25
$1,073.63
$1,131.24
$1,335.90 		$1,327.44
$1,381.82
$1,439.43
$1,644.09 		$308.19
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$805.74
$914.50
$1,029.72
$1,439.04
$2,186.74 		$1,113.93
$1,222.69
$1,337.91
$1,747.23 		$1,422.12
$1,530.88
$1,646.10
$2,055.42 		$1,730.31
$1,839.07
$1,954.29
$2,363.61 		$308.19
Toc - Plan #4 Quartz
Silver

(HMO) Tiered Choice Plus Silver I305 with Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$4,250 $8,500 Annual Deductible
$5,500 $11,000 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 		$410.94
$466.41
$525.17
$733.93
$1,115.28 		$725.31
$780.78
$839.54
$1,048.30 		$1,039.68
$1,095.15
$1,153.91
$1,362.67 		$1,354.05
$1,409.52
$1,468.28
$1,677.04 		$314.37
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$821.88
$932.82
$1,050.34
$1,467.86
$2,230.56 		$1,136.25
$1,247.19
$1,364.71
$1,782.23 		$1,450.62
$1,561.56
$1,679.08
$2,096.60 		$1,764.99
$1,875.93
$1,993.45
$2,410.97 		$314.37
Toc - Plan #5 Quartz
Silver

(HMO) Tiered Choice Plus Silver I306 with Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$4,250 $8,500 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 		$403.66
$458.15
$515.88
$720.94
$1,095.53 		$712.46
$766.95
$824.68
$1,029.74 		$1,021.26
$1,075.75
$1,133.48
$1,338.54 		$1,330.06
$1,384.55
$1,442.28
$1,647.34 		$308.80
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$807.32
$916.30
$1,031.76
$1,441.88
$2,191.06 		$1,116.12
$1,225.10
$1,340.56
$1,750.68 		$1,424.92
$1,533.90
$1,649.36
$2,059.48 		$1,733.72
$1,842.70
$1,958.16
$2,368.28 		$308.80
Toc - Plan #6 Quartz
Silver

(HMO) Quartz One Silver I303 with Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

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 		$451.27
$512.19
$576.72
$805.96
$1,224.74 		$796.49
$857.41
$921.94
$1,151.18 		$1,141.71
$1,202.63
$1,267.16
$1,496.40 		$1,486.93
$1,547.85
$1,612.38
$1,841.62 		$345.22
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$902.54
$1,024.38
$1,153.44
$1,611.92
$2,449.48 		$1,247.76
$1,369.60
$1,498.66
$1,957.14 		$1,592.98
$1,714.82
$1,843.88
$2,302.36 		$1,938.20
$2,060.04
$2,189.10
$2,647.58 		$345.22
Toc - Plan #7 Quartz
Expanded Bronze

(HMO) Quartz One Bronze I201 with Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$8,000 $16,000 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 		$346.98
$393.82
$443.44
$619.71
$941.70 		$612.42
$659.26
$708.88
$885.15 		$877.86
$924.70
$974.32
$1,150.59 		$1,143.30
$1,190.14
$1,239.76
$1,416.03 		$265.44
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$693.96
$787.64
$886.88
$1,239.42
$1,883.40 		$959.40
$1,053.08
$1,152.32
$1,504.86 		$1,224.84
$1,318.52
$1,417.76
$1,770.30 		$1,490.28
$1,583.96
$1,683.20
$2,035.74 		$265.44
Toc - Plan #8 Quartz
Expanded Bronze

(HMO) Quartz One Bronze I202 with Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

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 		$342.98
$389.28
$438.32
$612.55
$930.84 		$605.36
$651.66
$700.70
$874.93 		$867.74
$914.04
$963.08
$1,137.31 		$1,130.12
$1,176.42
$1,225.46
$1,399.69 		$262.38
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$685.96
$778.56
$876.64
$1,225.10
$1,861.68 		$948.34
$1,040.94
$1,139.02
$1,487.48 		$1,210.72
$1,303.32
$1,401.40
$1,749.86 		$1,473.10
$1,565.70
$1,663.78
$2,012.24 		$262.38
Toc - Plan #9 Quartz
Expanded Bronze

(HMO) Quartz One Bronze I204 with Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$3,050 $6,100 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 		$363.03
$412.03
$463.95
$648.36
$985.25 		$640.74
$689.74
$741.66
$926.07 		$918.45
$967.45
$1,019.37
$1,203.78 		$1,196.16
$1,245.16
$1,297.08
$1,481.49 		$277.71
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$726.06
$824.06
$927.90
$1,296.72
$1,970.50 		$1,003.77
$1,101.77
$1,205.61
$1,574.43 		$1,281.48
$1,379.48
$1,483.32
$1,852.14 		$1,559.19
$1,657.19
$1,761.03
$2,129.85 		$277.71
Toc - Plan #10 Quartz
Gold

(HMO) Tiered Choice Plus Gold I406

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 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 		$391.13
$443.93
$499.86
$698.56
$1,061.52 		$690.34
$743.14
$799.07
$997.77 		$989.55
$1,042.35
$1,098.28
$1,296.98 		$1,288.76
$1,341.56
$1,397.49
$1,596.19 		$299.21
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$782.26
$887.86
$999.72
$1,397.12
$2,123.04 		$1,081.47
$1,187.07
$1,298.93
$1,696.33 		$1,380.68
$1,486.28
$1,598.14
$1,995.54 		$1,679.89
$1,785.49
$1,897.35
$2,294.75 		$299.21
Toc - Plan #11 Quartz
Gold

(HMO) Tiered Choice Plus Gold I407 Maintenance

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$1,000 $2,000 Annual Deductible
$4,250 $8,500 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 		$446.01
$506.21
$569.99
$796.56
$1,210.45 		$787.20
$847.40
$911.18
$1,137.75 		$1,128.39
$1,188.59
$1,252.37
$1,478.94 		$1,469.58
$1,529.78
$1,593.56
$1,820.13 		$341.19
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$892.02
$1,012.42
$1,139.98
$1,593.12
$2,420.90 		$1,233.21
$1,353.61
$1,481.17
$1,934.31 		$1,574.40
$1,694.80
$1,822.36
$2,275.50 		$1,915.59
$2,035.99
$2,163.55
$2,616.69 		$341.19
Toc - Plan #12 Quartz
Gold

(HMO) Tiered Choice Plus Gold I409

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 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 		$385.98
$438.08
$493.28
$689.36
$1,047.54 		$681.25
$733.35
$788.55
$984.63 		$976.52
$1,028.62
$1,083.82
$1,279.90 		$1,271.79
$1,323.89
$1,379.09
$1,575.17 		$295.27
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$771.96
$876.16
$986.56
$1,378.72
$2,095.08 		$1,067.23
$1,171.43
$1,281.83
$1,673.99 		$1,362.50
$1,466.70
$1,577.10
$1,969.26 		$1,657.77
$1,761.97
$1,872.37
$2,264.53 		$295.27
Toc - Plan #13 Quartz
Silver

(HMO) Tiered Choice Plus Silver I305

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$4,250 $8,500 Annual Deductible
$5,500 $11,000 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 		$393.71
$446.86
$503.16
$703.17
$1,068.53 		$694.90
$748.05
$804.35
$1,004.36 		$996.09
$1,049.24
$1,105.54
$1,305.55 		$1,297.28
$1,350.43
$1,406.73
$1,606.74 		$301.19
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$787.42
$893.72
$1,006.32
$1,406.34
$2,137.06 		$1,088.61
$1,194.91
$1,307.51
$1,707.53 		$1,389.80
$1,496.10
$1,608.70
$2,008.72 		$1,690.99
$1,797.29
$1,909.89
$2,309.91 		$301.19
Toc - Plan #14 Quartz
Silver

(HMO) Tiered Choice Plus Silver I306

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$4,250 $8,500 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 		$386.74
$438.95
$494.25
$690.72
$1,049.61 		$682.60
$734.81
$790.11
$986.58 		$978.46
$1,030.67
$1,085.97
$1,282.44 		$1,274.32
$1,326.53
$1,381.83
$1,578.30 		$295.86
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$773.48
$877.90
$988.50
$1,381.44
$2,099.22 		$1,069.34
$1,173.76
$1,284.36
$1,677.30 		$1,365.20
$1,469.62
$1,580.22
$1,973.16 		$1,661.06
$1,765.48
$1,876.08
$2,269.02 		$295.86
Toc - Plan #15 Quartz
Silver

(HMO) Quartz One Silver I303

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

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 		$432.36
$490.72
$552.55
$772.18
$1,173.40 		$763.11
$821.47
$883.30
$1,102.93 		$1,093.86
$1,152.22
$1,214.05
$1,433.68 		$1,424.61
$1,482.97
$1,544.80
$1,764.43 		$330.75
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$864.72
$981.44
$1,105.10
$1,544.36
$2,346.80 		$1,195.47
$1,312.19
$1,435.85
$1,875.11 		$1,526.22
$1,642.94
$1,766.60
$2,205.86 		$1,856.97
$1,973.69
$2,097.35
$2,536.61 		$330.75
Toc - Plan #16 Quartz
Expanded Bronze

(HMO) Quartz One Bronze I201

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$8,000 $16,000 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 		$332.44
$377.31
$424.85
$593.73
$902.23 		$586.75
$631.62
$679.16
$848.04 		$841.06
$885.93
$933.47
$1,102.35 		$1,095.37
$1,140.24
$1,187.78
$1,356.66 		$254.31
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$664.88
$754.62
$849.70
$1,187.46
$1,804.46 		$919.19
$1,008.93
$1,104.01
$1,441.77 		$1,173.50
$1,263.24
$1,358.32
$1,696.08 		$1,427.81
$1,517.55
$1,612.63
$1,950.39 		$254.31
Toc - Plan #17 Quartz
Expanded Bronze

(HMO) Quartz One Bronze I202

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

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 		$328.60
$372.96
$419.95
$586.88
$891.82 		$579.98
$624.34
$671.33
$838.26 		$831.36
$875.72
$922.71
$1,089.64 		$1,082.74
$1,127.10
$1,174.09
$1,341.02 		$251.38
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$657.20
$745.92
$839.90
$1,173.76
$1,783.64 		$908.58
$997.30
$1,091.28
$1,425.14 		$1,159.96
$1,248.68
$1,342.66
$1,676.52 		$1,411.34
$1,500.06
$1,594.04
$1,927.90 		$251.38
Toc - Plan #18 Quartz
Expanded Bronze

(HMO) Quartz One Bronze I204

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$3,050 $6,100 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 		$347.81
$394.76
$444.50
$621.19
$943.95 		$613.88
$660.83
$710.57
$887.26 		$879.95
$926.90
$976.64
$1,153.33 		$1,146.02
$1,192.97
$1,242.71
$1,419.40 		$266.07
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$695.62
$789.52
$889.00
$1,242.38
$1,887.90 		$961.69
$1,055.59
$1,155.07
$1,508.45 		$1,227.76
$1,321.66
$1,421.14
$1,774.52 		$1,493.83
$1,587.73
$1,687.21
$2,040.59 		$266.07
Toc - Plan #19 Quartz
Gold

(HMO) Tiered Choice Plus Gold I408 HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$2,500 $5,000 Annual Deductible
$2,500 $5,000 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 		$417.73
$474.11
$533.85
$746.05
$1,133.70 		$737.29
$793.67
$853.41
$1,065.61 		$1,056.85
$1,113.23
$1,172.97
$1,385.17 		$1,376.41
$1,432.79
$1,492.53
$1,704.73 		$319.56
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$835.46
$948.22
$1,067.70
$1,492.10
$2,267.40 		$1,155.02
$1,267.78
$1,387.26
$1,811.66 		$1,474.58
$1,587.34
$1,706.82
$2,131.22 		$1,794.14
$1,906.90
$2,026.38
$2,450.78 		$319.56
Toc - Plan #20 Quartz
Silver

(HMO) Quartz One Silver I304 HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$5,250 $10,500 Annual Deductible
$5,250 $10,500 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 		$463.96
$526.59
$592.94
$828.62
$1,259.18 		$818.89
$881.52
$947.87
$1,183.55 		$1,173.82
$1,236.45
$1,302.80
$1,538.48 		$1,528.75
$1,591.38
$1,657.73
$1,893.41 		$354.93
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$927.92
$1,053.18
$1,185.88
$1,657.24
$2,518.36 		$1,282.85
$1,408.11
$1,540.81
$2,012.17 		$1,637.78
$1,763.04
$1,895.74
$2,367.10 		$1,992.71
$2,117.97
$2,250.67
$2,722.03 		$354.93
Toc - Plan #21 Quartz
Expanded Bronze

(HMO) Quartz One Bronze I203 HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$6,850 $13,700 Annual Deductible
$6,850 $13,700 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$346.02
$392.73
$442.21
$617.98
$939.08 		$610.72
$657.43
$706.91
$882.68 		$875.42
$922.13
$971.61
$1,147.38 		$1,140.12
$1,186.83
$1,236.31
$1,412.08 		$264.70
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$692.04
$785.46
$884.42
$1,235.96
$1,878.16 		$956.74
$1,050.16
$1,149.12
$1,500.66 		$1,221.44
$1,314.86
$1,413.82
$1,765.36 		$1,486.14
$1,579.56
$1,678.52
$2,030.06 		$264.70
Toc - Plan #22 Quartz
Catastrophic

(HMO) Quartz One Catastrophic I101

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

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 		$254.24
$288.56
$324.92
$454.07
$690.01 		$448.73
$483.05
$519.41
$648.56 		$643.22
$677.54
$713.90
$843.05 		$837.71
$872.03
$908.39
$1,037.54 		$194.49
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$508.48
$577.12
$649.84
$908.14
$1,380.02 		$702.97
$771.61
$844.33
$1,102.63 		$897.46
$966.10
$1,038.82
$1,297.12 		$1,091.95
$1,160.59
$1,233.31
$1,491.61 		$194.49

ADVERTISEMENT

Dean Health Plan

Local: 1-800-279-1302 | Toll Free: 1-800-279-1302 | TTY: 1-800-279-1302
Toc - Plan #23 Dean Health Plan
Catastrophic

(HMO) Dean Catastrophic Safety Net

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-279-1302

Annual Out of Pocket Expenses:

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 		$191.76
$217.64
$245.06
$342.48
$520.43 		$338.45
$364.33
$391.75
$489.17 		$485.14
$511.02
$538.44
$635.86 		$631.83
$657.71
$685.13
$782.55 		$146.69
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$383.52
$435.28
$490.12
$684.96
$1,040.86 		$530.21
$581.97
$636.81
$831.65 		$676.90
$728.66
$783.50
$978.34 		$823.59
$875.35
$930.19
$1,125.03 		$146.69
Toc - Plan #24 Dean Health Plan
Silver

(HMO) Dean Silver Copay Plus 4800X

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-279-1302

Annual Out of Pocket Expenses:

Individual Family
$4,800 $9,600 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 		$362.16
$411.05
$462.84
$646.82
$982.90 		$639.21
$688.10
$739.89
$923.87 		$916.26
$965.15
$1,016.94
$1,200.92 		$1,193.31
$1,242.20
$1,293.99
$1,477.97 		$277.05
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$724.32
$822.10
$925.68
$1,293.64
$1,965.80 		$1,001.37
$1,099.15
$1,202.73
$1,570.69 		$1,278.42
$1,376.20
$1,479.78
$1,847.74 		$1,555.47
$1,653.25
$1,756.83
$2,124.79 		$277.05
Toc - Plan #25 Dean Health Plan
Silver

(HMO) Dean Silver Classic 5000X

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-279-1302

Annual Out of Pocket Expenses:

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 		$352.26
$399.81
$450.18
$629.13
$956.03 		$621.74
$669.29
$719.66
$898.61 		$891.22
$938.77
$989.14
$1,168.09 		$1,160.70
$1,208.25
$1,258.62
$1,437.57 		$269.48
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$704.52
$799.62
$900.36
$1,258.26
$1,912.06 		$974.00
$1,069.10
$1,169.84
$1,527.74 		$1,243.48
$1,338.58
$1,439.32
$1,797.22 		$1,512.96
$1,608.06
$1,708.80
$2,066.70 		$269.48
Toc - Plan #26 Dean Health Plan
Silver

(HMO) Dean Silver Value Copay 5000X

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-279-1302

Annual Out of Pocket Expenses:

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 		$367.66
$417.29
$469.87
$656.64
$997.82 		$648.92
$698.55
$751.13
$937.90 		$930.18
$979.81
$1,032.39
$1,219.16 		$1,211.44
$1,261.07
$1,313.65
$1,500.42 		$281.26
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$735.32
$834.58
$939.74
$1,313.28
$1,995.64 		$1,016.58
$1,115.84
$1,221.00
$1,594.54 		$1,297.84
$1,397.10
$1,502.26
$1,875.80 		$1,579.10
$1,678.36
$1,783.52
$2,157.06 		$281.26
Toc - Plan #27 Dean Health Plan
Gold

(HMO) Dean Gold Value Copay 3700X

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-279-1302

Annual Out of Pocket Expenses:

Individual Family
$3,700 $7,400 Annual Deductible
$3,700 $7,400 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 		$355.75
$403.78
$454.65
$635.37
$965.51 		$627.90
$675.93
$726.80
$907.52 		$900.05
$948.08
$998.95
$1,179.67 		$1,172.20
$1,220.23
$1,271.10
$1,451.82 		$272.15
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$711.50
$807.56
$909.30
$1,270.74
$1,931.02 		$983.65
$1,079.71
$1,181.45
$1,542.89 		$1,255.80
$1,351.86
$1,453.60
$1,815.04 		$1,527.95
$1,624.01
$1,725.75
$2,087.19 		$272.15
Toc - Plan #28 Dean Health Plan
Bronze

(HMO) Dean Bronze Value Copay 8650X

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-279-1302

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$235.19
$266.94
$300.58
$420.05
$638.31 		$415.11
$446.86
$480.50
$599.97 		$595.03
$626.78
$660.42
$779.89 		$774.95
$806.70
$840.34
$959.81 		$179.92
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$470.38
$533.88
$601.16
$840.10
$1,276.62 		$650.30
$713.80
$781.08
$1,020.02 		$830.22
$893.72
$961.00
$1,199.94 		$1,010.14
$1,073.64
$1,140.92
$1,379.86 		$179.92
Toc - Plan #29 Dean Health Plan
Silver

(HMO) Dean Silver HSA-E 4500X

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-279-1302

Annual Out of Pocket Expenses:

Individual Family
$4,500 $9,000 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 		$347.06
$393.92
$443.55
$619.85
$941.93 		$612.56
$659.42
$709.05
$885.35 		$878.06
$924.92
$974.55
$1,150.85 		$1,143.56
$1,190.42
$1,240.05
$1,416.35 		$265.50
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$694.12
$787.84
$887.10
$1,239.70
$1,883.86 		$959.62
$1,053.34
$1,152.60
$1,505.20 		$1,225.12
$1,318.84
$1,418.10
$1,770.70 		$1,490.62
$1,584.34
$1,683.60
$2,036.20 		$265.50
Toc - Plan #30 Dean Health Plan
Gold

(HMO) Dean Gold Copay Plus 1500X

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-279-1302

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$5,100 $10,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$361.16
$409.91
$461.56
$645.03
$980.18 		$637.44
$686.19
$737.84
$921.31 		$913.72
$962.47
$1,014.12
$1,197.59 		$1,190.00
$1,238.75
$1,290.40
$1,473.87 		$276.28
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$722.32
$819.82
$923.12
$1,290.06
$1,960.36 		$998.60
$1,096.10
$1,199.40
$1,566.34 		$1,274.88
$1,372.38
$1,475.68
$1,842.62 		$1,551.16
$1,648.66
$1,751.96
$2,118.90 		$276.28
Toc - Plan #31 Dean Health Plan
Expanded Bronze

(HMO) Dean Bronze HSA-E 6950X

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-279-1302

Annual Out of Pocket Expenses:

Individual Family
$6,950 $13,900 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 		$248.41
$281.94
$317.46
$443.65
$674.17 		$438.44
$471.97
$507.49
$633.68 		$628.47
$662.00
$697.52
$823.71 		$818.50
$852.03
$887.55
$1,013.74 		$190.03
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$496.82
$563.88
$634.92
$887.30
$1,348.34 		$686.85
$753.91
$824.95
$1,077.33 		$876.88
$943.94
$1,014.98
$1,267.36 		$1,066.91
$1,133.97
$1,205.01
$1,457.39 		$190.03
Toc - Plan #32 Dean Health Plan
Expanded Bronze

(HMO) Dean Bronze Copay Plus 8650X

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-279-1302

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$243.36
$276.22
$311.02
$434.65
$660.49 		$429.53
$462.39
$497.19
$620.82 		$615.70
$648.56
$683.36
$806.99 		$801.87
$834.73
$869.53
$993.16 		$186.17
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$486.72
$552.44
$622.04
$869.30
$1,320.98 		$672.89
$738.61
$808.21
$1,055.47 		$859.06
$924.78
$994.38
$1,241.64 		$1,045.23
$1,110.95
$1,180.55
$1,427.81 		$186.17

ADVERTISEMENT

Medica

Local: 1-888-592-8211 | Toll Free: 1-888-592-8211 | TTY: 1-800-947-3529
Toc - Plan #33 Medica
Gold

(EPO) Engage by Medica Gold Copay ($0 Virtual Care + $5 Generic Drugs + Online Wellness)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$1,300 $3,900 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 		$605.21
$686.90
$773.44
$1,080.88
$1,642.51 		$1,068.19
$1,149.88
$1,236.42
$1,543.86 		$1,531.17
$1,612.86
$1,699.40
$2,006.84 		$1,994.15
$2,075.84
$2,162.38
$2,469.82 		$462.98
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,210.42
$1,373.80
$1,546.88
$2,161.76
$3,285.02 		$1,673.40
$1,836.78
$2,009.86
$2,624.74 		$2,136.38
$2,299.76
$2,472.84
$3,087.72 		$2,599.36
$2,762.74
$2,935.82
$3,550.70 		$462.98
Toc - Plan #34 Medica
Silver

(EPO) Engage by Medica Silver Copay ($0 Virtual Care + Online Wellness)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$3,900 $7,800 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 		$605.69
$687.45
$774.06
$1,081.75
$1,643.82 		$1,069.04
$1,150.80
$1,237.41
$1,545.10 		$1,532.39
$1,614.15
$1,700.76
$2,008.45 		$1,995.74
$2,077.50
$2,164.11
$2,471.80 		$463.35
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,211.38
$1,374.90
$1,548.12
$2,163.50
$3,287.64 		$1,674.73
$1,838.25
$2,011.47
$2,626.85 		$2,138.08
$2,301.60
$2,474.82
$3,090.20 		$2,601.43
$2,764.95
$2,938.17
$3,553.55 		$463.35
Toc - Plan #35 Medica
Expanded Bronze

(EPO) Engage by Medica Bronze Copay ($0 Virtual Care + Online Wellness)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$7,200 $14,400 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$450.61
$511.43
$575.86
$804.77
$1,222.92 		$795.32
$856.14
$920.57
$1,149.48 		$1,140.03
$1,200.85
$1,265.28
$1,494.19 		$1,484.74
$1,545.56
$1,609.99
$1,838.90 		$344.71
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$901.22
$1,022.86
$1,151.72
$1,609.54
$2,445.84 		$1,245.93
$1,367.57
$1,496.43
$1,954.25 		$1,590.64
$1,712.28
$1,841.14
$2,298.96 		$1,935.35
$2,056.99
$2,185.85
$2,643.67 		$344.71
Toc - Plan #36 Medica
Expanded Bronze

(EPO) Engage by Medica Bronze HSA ($0 Virtual Care after deductible + Online Wellness)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$6,800 $13,600 Annual Deductible
$7,050 $14,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$494.47
$561.21
$631.92
$883.10
$1,341.96 		$872.73
$939.47
$1,010.18
$1,261.36 		$1,250.99
$1,317.73
$1,388.44
$1,639.62 		$1,629.25
$1,695.99
$1,766.70
$2,017.88 		$378.26
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$988.94
$1,122.42
$1,263.84
$1,766.20
$2,683.92 		$1,367.20
$1,500.68
$1,642.10
$2,144.46 		$1,745.46
$1,878.94
$2,020.36
$2,522.72 		$2,123.72
$2,257.20
$2,398.62
$2,900.98 		$378.26
Toc - Plan #37 Medica
Catastrophic

(EPO) Engage by Medica Catastrophic ($0 Virtual Care + Online Wellness)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

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 		$278.54
$316.13
$355.97
$497.46
$755.94 		$491.62
$529.21
$569.05
$710.54 		$704.70
$742.29
$782.13
$923.62 		$917.78
$955.37
$995.21
$1,136.70 		$213.08
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$557.08
$632.26
$711.94
$994.92
$1,511.88 		$770.16
$845.34
$925.02
$1,208.00 		$983.24
$1,058.42
$1,138.10
$1,421.08 		$1,196.32
$1,271.50
$1,351.18
$1,634.16 		$213.08
Toc - Plan #38 Medica
Silver

(EPO) Engage by Medica Silver Share ($0 Virtual Care + Online Wellness)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$2,000 $6,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$596.97
$677.55
$762.91
$1,066.17
$1,620.15 		$1,053.64
$1,134.22
$1,219.58
$1,522.84 		$1,510.31
$1,590.89
$1,676.25
$1,979.51 		$1,966.98
$2,047.56
$2,132.92
$2,436.18 		$456.67
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,193.94
$1,355.10
$1,525.82
$2,132.34
$3,240.30 		$1,650.61
$1,811.77
$1,982.49
$2,589.01 		$2,107.28
$2,268.44
$2,439.16
$3,045.68 		$2,563.95
$2,725.11
$2,895.83
$3,502.35 		$456.67
Toc - Plan #39 Medica
Expanded Bronze

(EPO) Engage by Medica Bronze Share Plus ($0 Virtual Care + Online Wellness)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$2,500 $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 		$452.85
$513.97
$578.73
$808.77
$1,229.00 		$799.27
$860.39
$925.15
$1,155.19 		$1,145.69
$1,206.81
$1,271.57
$1,501.61 		$1,492.11
$1,553.23
$1,617.99
$1,848.03 		$346.42
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$905.70
$1,027.94
$1,157.46
$1,617.54
$2,458.00 		$1,252.12
$1,374.36
$1,503.88
$1,963.96 		$1,598.54
$1,720.78
$1,850.30
$2,310.38 		$1,944.96
$2,067.20
$2,196.72
$2,656.80 		$346.42
Toc - Plan #40 Medica
Bronze

(EPO) Engage by Medica Bronze Value ($0 Virtual Care + Online Wellness)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

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 		$411.05
$466.53
$525.31
$734.11
$1,115.56 		$725.49
$780.97
$839.75
$1,048.55 		$1,039.93
$1,095.41
$1,154.19
$1,362.99 		$1,354.37
$1,409.85
$1,468.63
$1,677.43 		$314.44
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$822.10
$933.06
$1,050.62
$1,468.22
$2,231.12 		$1,136.54
$1,247.50
$1,365.06
$1,782.66 		$1,450.98
$1,561.94
$1,679.50
$2,097.10 		$1,765.42
$1,876.38
$1,993.94
$2,411.54 		$314.44

‡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 Crawford County here.

Crawford County is in “Rating Area 7” of Wisconsin.

Currently, there are 40 plans offered in Rating Area 7.

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2022 Obamacare Plans for Crawford County, WI

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