Obamacare 2022 Rates for Waukesha County
Obamacare > Rates > Wisconsin > Waukesha County
Obamacare > Rates > Wisconsin > Waukesha County
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Together with CCHPLocal: 1-844-201-4672 | Toll Free: 1-844-201-4672 | TTY: 1-844-531-4856 |
Toc - Plan #1 Together with CCHP | ||||||||||||||||||||
Expanded Bronze
(EPO) Together Bronze |
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Benefits & Coverage
Plan Brochure
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Customer Service Phone: 1-844-201-4672
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$320.11 $363.31 $409.08 $571.69 $868.74 |
$564.98 $608.18 $653.95 $816.56 |
$809.85 $853.05 $898.82 $1,061.43 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$640.22 $726.62 $818.16 $1,143.38 $1,737.48 |
$885.09 $971.49 $1,063.03 $1,388.25 |
$1,129.96 $1,216.36 $1,307.90 $1,633.12 |
Toc - Plan #2 Together with CCHP | ||||||||||||||||||||
Silver
(EPO) Together Standard Silver |
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Customer Service Phone: 1-844-201-4672
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$437.30 $496.32 $558.86 $781.00 $1,186.80 |
$771.83 $830.85 $893.39 $1,115.53 |
$1,106.36 $1,165.38 $1,227.92 $1,450.06 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$874.60 $992.64 $1,117.72 $1,562.00 $2,373.60 |
$1,209.13 $1,327.17 $1,452.25 $1,896.53 |
$1,543.66 $1,661.70 $1,786.78 $2,231.06 |
Toc - Plan #3 Together with CCHP | ||||||||||||||||||||
Silver
(EPO) Together Silver |
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Customer Service Phone: 1-844-201-4672
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$384.39 $436.27 $491.23 $686.50 $1,043.20 |
$678.44 $730.32 $785.28 $980.55 |
$972.49 $1,024.37 $1,079.33 $1,274.60 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$768.78 $872.54 $982.46 $1,373.00 $2,086.40 |
$1,062.83 $1,166.59 $1,276.51 $1,667.05 |
$1,356.88 $1,460.64 $1,570.56 $1,961.10 |
Toc - Plan #4 Together with CCHP | ||||||||||||||||||||
Gold
(EPO) Together Gold |
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Benefits & Coverage
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Customer Service Phone: 1-844-201-4672
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$450.86 $511.71 $576.18 $805.21 $1,223.59 |
$795.76 $856.61 $921.08 $1,150.11 |
$1,140.66 $1,201.51 $1,265.98 $1,495.01 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$901.72 $1,023.42 $1,152.36 $1,610.42 $2,447.18 |
$1,246.62 $1,368.32 $1,497.26 $1,955.32 |
$1,591.52 $1,713.22 $1,842.16 $2,300.22 |
Toc - Plan #5 Together with CCHP | ||||||||||||||||||||
Expanded Bronze
(EPO) Together Bronze HDHP |
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Customer Service Phone: 1-844-201-4672
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$352.03 $399.54 $449.88 $628.70 $955.38 |
$621.32 $668.83 $719.17 $897.99 |
$890.61 $938.12 $988.46 $1,167.28 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$704.06 $799.08 $899.76 $1,257.40 $1,910.76 |
$973.35 $1,068.37 $1,169.05 $1,526.69 |
$1,242.64 $1,337.66 $1,438.34 $1,795.98 |
Toc - Plan #6 Together with CCHP | ||||||||||||||||||||
Silver
(EPO) Together Silver Select |
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Customer Service Phone: 1-844-201-4672
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$421.56 $478.46 $538.74 $752.88 $1,144.08 |
$744.04 $800.94 $861.22 $1,075.36 |
$1,066.52 $1,123.42 $1,183.70 $1,397.84 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$843.12 $956.92 $1,077.48 $1,505.76 $2,288.16 |
$1,165.60 $1,279.40 $1,399.96 $1,828.24 |
$1,488.08 $1,601.88 $1,722.44 $2,150.72 |
Toc - Plan #7 Together with CCHP | ||||||||||||||||||||
Catastrophic
(EPO) Together Catastrophic |
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Benefits & Coverage
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Customer Service Phone: 1-844-201-4672
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$270.69 $307.22 $345.93 $483.44 $734.63 |
$477.76 $514.29 $553.00 $690.51 |
$684.83 $721.36 $760.07 $897.58 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$541.38 $614.44 $691.86 $966.88 $1,469.26 |
$748.45 $821.51 $898.93 $1,173.95 |
$955.52 $1,028.58 $1,106.00 $1,381.02 |
Toc - Plan #8 Together with CCHP | ||||||||||||||||||||
Expanded Bronze
(EPO) Together Bronze Copay |
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Benefits & Coverage
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Customer Service Phone: 1-844-201-4672
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$352.90 $400.53 $451.00 $630.27 $957.75 |
$622.86 $670.49 $720.96 $900.23 |
$892.82 $940.45 $990.92 $1,170.19 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$705.80 $801.06 $902.00 $1,260.54 $1,915.50 |
$975.76 $1,071.02 $1,171.96 $1,530.50 |
$1,245.72 $1,340.98 $1,441.92 $1,800.46 |
ADVERTISEMENT
QuartzLocal: 1-608-644-3430 | Toll Free: 1-800-362-3310 | TTY: 1-800-877-8973 |
Toc - Plan #9 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I406 with Dental |
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Customer Service Phone: 1-800-362-3310
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|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$404.83 $459.48 $517.37 $723.02 $1,098.71 |
$714.52 $769.17 $827.06 $1,032.71 |
$1,024.21 $1,078.86 $1,136.75 $1,342.40 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$809.66 $918.96 $1,034.74 $1,446.04 $2,197.42 |
$1,119.35 $1,228.65 $1,344.43 $1,755.73 |
$1,429.04 $1,538.34 $1,654.12 $2,065.42 |
Toc - Plan #10 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I407 Maintenance with Dental |
||||||||||||||||||||
Benefits & Coverage
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Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$461.63 $523.94 $589.95 $824.46 $1,252.85 |
$814.77 $877.08 $943.09 $1,177.60 |
$1,167.91 $1,230.22 $1,296.23 $1,530.74 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$923.26 $1,047.88 $1,179.90 $1,648.92 $2,505.70 |
$1,276.40 $1,401.02 $1,533.04 $2,002.06 |
$1,629.54 $1,754.16 $1,886.18 $2,355.20 |
Toc - Plan #11 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:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$399.50 $453.43 $510.56 $713.50 $1,084.23 |
$705.12 $759.05 $816.18 $1,019.12 |
$1,010.74 $1,064.67 $1,121.80 $1,324.74 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$799.00 $906.86 $1,021.12 $1,427.00 $2,168.46 |
$1,104.62 $1,212.48 $1,326.74 $1,732.62 |
$1,410.24 $1,518.10 $1,632.36 $2,038.24 |
Toc - Plan #12 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:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$407.51 $462.51 $520.79 $727.80 $1,105.96 |
$719.25 $774.25 $832.53 $1,039.54 |
$1,030.99 $1,085.99 $1,144.27 $1,351.28 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$815.02 $925.02 $1,041.58 $1,455.60 $2,211.92 |
$1,126.76 $1,236.76 $1,353.32 $1,767.34 |
$1,438.50 $1,548.50 $1,665.06 $2,079.08 |
Toc - Plan #13 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:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$400.29 $454.32 $511.56 $714.91 $1,086.37 |
$706.51 $760.54 $817.78 $1,021.13 |
$1,012.73 $1,066.76 $1,124.00 $1,327.35 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$800.58 $908.64 $1,023.12 $1,429.82 $2,172.74 |
$1,106.80 $1,214.86 $1,329.34 $1,736.04 |
$1,413.02 $1,521.08 $1,635.56 $2,042.26 |
Toc - Plan #14 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One Silver I303 with Dental |
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Benefits & Coverage
Plan Brochure
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Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$447.50 $507.91 $571.90 $799.23 $1,214.50 |
$789.83 $850.24 $914.23 $1,141.56 |
$1,132.16 $1,192.57 $1,256.56 $1,483.89 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$895.00 $1,015.82 $1,143.80 $1,598.46 $2,429.00 |
$1,237.33 $1,358.15 $1,486.13 $1,940.79 |
$1,579.66 $1,700.48 $1,828.46 $2,283.12 |
Toc - Plan #15 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One Bronze I201 with Dental |
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Benefits & Coverage
Plan Brochure
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Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$344.08 $390.53 $439.73 $614.53 $933.83 |
$607.30 $653.75 $702.95 $877.75 |
$870.52 $916.97 $966.17 $1,140.97 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$688.16 $781.06 $879.46 $1,229.06 $1,867.66 |
$951.38 $1,044.28 $1,142.68 $1,492.28 |
$1,214.60 $1,307.50 $1,405.90 $1,755.50 |
Toc - Plan #16 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One Bronze I202 with Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
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Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$340.11 $386.02 $434.66 $607.43 $923.05 |
$600.29 $646.20 $694.84 $867.61 |
$860.47 $906.38 $955.02 $1,127.79 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$680.22 $772.04 $869.32 $1,214.86 $1,846.10 |
$940.40 $1,032.22 $1,129.50 $1,475.04 |
$1,200.58 $1,292.40 $1,389.68 $1,735.22 |
Toc - Plan #17 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One Bronze I204 with Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
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Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$360.00 $408.59 $460.07 $642.95 $977.02 |
$635.39 $683.98 $735.46 $918.34 |
$910.78 $959.37 $1,010.85 $1,193.73 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$720.00 $817.18 $920.14 $1,285.90 $1,954.04 |
$995.39 $1,092.57 $1,195.53 $1,561.29 |
$1,270.78 $1,367.96 $1,470.92 $1,836.68 |
Toc - Plan #18 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I406 |
||||||||||||||||||||
Benefits & Coverage
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Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$387.86 $440.22 $495.68 $692.72 $1,052.65 |
$684.57 $736.93 $792.39 $989.43 |
$981.28 $1,033.64 $1,089.10 $1,286.14 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$775.72 $880.44 $991.36 $1,385.44 $2,105.30 |
$1,072.43 $1,177.15 $1,288.07 $1,682.15 |
$1,369.14 $1,473.86 $1,584.78 $1,978.86 |
Toc - Plan #19 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I407 Maintenance |
||||||||||||||||||||
Benefits & Coverage
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Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$442.28 $501.98 $565.23 $789.90 $1,200.33 |
$780.62 $840.32 $903.57 $1,128.24 |
$1,118.96 $1,178.66 $1,241.91 $1,466.58 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$884.56 $1,003.96 $1,130.46 $1,579.80 $2,400.66 |
$1,222.90 $1,342.30 $1,468.80 $1,918.14 |
$1,561.24 $1,680.64 $1,807.14 $2,256.48 |
Toc - Plan #20 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I409 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
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Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$382.76 $434.42 $489.16 $683.59 $1,038.79 |
$675.56 $727.22 $781.96 $976.39 |
$968.36 $1,020.02 $1,074.76 $1,269.19 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$765.52 $868.84 $978.32 $1,367.18 $2,077.58 |
$1,058.32 $1,161.64 $1,271.12 $1,659.98 |
$1,351.12 $1,454.44 $1,563.92 $1,952.78 |
Toc - Plan #21 Quartz | ||||||||||||||||||||
Silver
(HMO) Tiered Choice Plus Silver I305 |
||||||||||||||||||||
Benefits & Coverage
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Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$390.42 $443.13 $498.96 $697.29 $1,059.60 |
$689.09 $741.80 $797.63 $995.96 |
$987.76 $1,040.47 $1,096.30 $1,294.63 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$780.84 $886.26 $997.92 $1,394.58 $2,119.20 |
$1,079.51 $1,184.93 $1,296.59 $1,693.25 |
$1,378.18 $1,483.60 $1,595.26 $1,991.92 |
Toc - Plan #22 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:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$383.51 $435.28 $490.12 $684.94 $1,040.84 |
$676.89 $728.66 $783.50 $978.32 |
$970.27 $1,022.04 $1,076.88 $1,271.70 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$767.02 $870.56 $980.24 $1,369.88 $2,081.68 |
$1,060.40 $1,163.94 $1,273.62 $1,663.26 |
$1,353.78 $1,457.32 $1,567.00 $1,956.64 |
Toc - Plan #23 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$428.74 $486.62 $547.93 $765.73 $1,163.60 |
$756.72 $814.60 $875.91 $1,093.71 |
$1,084.70 $1,142.58 $1,203.89 $1,421.69 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$857.48 $973.24 $1,095.86 $1,531.46 $2,327.20 |
$1,185.46 $1,301.22 $1,423.84 $1,859.44 |
$1,513.44 $1,629.20 $1,751.82 $2,187.42 |
Toc - Plan #24 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$329.66 $374.16 $421.30 $588.77 $894.69 |
$581.85 $626.35 $673.49 $840.96 |
$834.04 $878.54 $925.68 $1,093.15 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$659.32 $748.32 $842.60 $1,177.54 $1,789.38 |
$911.51 $1,000.51 $1,094.79 $1,429.73 |
$1,163.70 $1,252.70 $1,346.98 $1,681.92 |
Toc - Plan #25 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$325.86 $369.84 $416.44 $581.97 $884.36 |
$575.14 $619.12 $665.72 $831.25 |
$824.42 $868.40 $915.00 $1,080.53 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$651.72 $739.68 $832.88 $1,163.94 $1,768.72 |
$901.00 $988.96 $1,082.16 $1,413.22 |
$1,150.28 $1,238.24 $1,331.44 $1,662.50 |
Toc - Plan #26 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$344.91 $391.46 $440.78 $615.99 $936.06 |
$608.76 $655.31 $704.63 $879.84 |
$872.61 $919.16 $968.48 $1,143.69 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$689.82 $782.92 $881.56 $1,231.98 $1,872.12 |
$953.67 $1,046.77 $1,145.41 $1,495.83 |
$1,217.52 $1,310.62 $1,409.26 $1,759.68 |
Toc - Plan #27 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$414.24 $470.15 $529.39 $739.82 $1,124.22 |
$731.13 $787.04 $846.28 $1,056.71 |
$1,048.02 $1,103.93 $1,163.17 $1,373.60 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$828.48 $940.30 $1,058.78 $1,479.64 $2,248.44 |
$1,145.37 $1,257.19 $1,375.67 $1,796.53 |
$1,462.26 $1,574.08 $1,692.56 $2,113.42 |
Toc - Plan #28 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$460.08 $522.19 $587.98 $821.70 $1,248.65 |
$812.04 $874.15 $939.94 $1,173.66 |
$1,164.00 $1,226.11 $1,291.90 $1,525.62 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$920.16 $1,044.38 $1,175.96 $1,643.40 $2,497.30 |
$1,272.12 $1,396.34 $1,527.92 $1,995.36 |
$1,624.08 $1,748.30 $1,879.88 $2,347.32 |
Toc - Plan #29 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$343.13 $389.44 $438.51 $612.82 $931.23 |
$605.62 $651.93 $701.00 $875.31 |
$868.11 $914.42 $963.49 $1,137.80 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$686.26 $778.88 $877.02 $1,225.64 $1,862.46 |
$948.75 $1,041.37 $1,139.51 $1,488.13 |
$1,211.24 $1,303.86 $1,402.00 $1,750.62 |
Toc - Plan #30 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$252.12 $286.15 $322.20 $450.28 $684.24 |
$444.99 $479.02 $515.07 $643.15 |
$637.86 $671.89 $707.94 $836.02 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$504.24 $572.30 $644.40 $900.56 $1,368.48 |
$697.11 $765.17 $837.27 $1,093.43 |
$889.98 $958.04 $1,030.14 $1,286.30 |
ADVERTISEMENT
Dean Health PlanLocal: 1-800-279-1302 | Toll Free: 1-800-279-1302 | TTY: 1-800-279-1302 |
Toc - Plan #31 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$245.11 $278.20 $313.25 $437.76 $665.22 |
$432.62 $465.71 $500.76 $625.27 |
$620.13 $653.22 $688.27 $812.78 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$490.22 $556.40 $626.50 $875.52 $1,330.44 |
$677.73 $743.91 $814.01 $1,063.03 |
$865.24 $931.42 $1,001.52 $1,250.54 |
Toc - Plan #32 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$462.92 $525.41 $591.61 $826.77 $1,256.36 |
$817.05 $879.54 $945.74 $1,180.90 |
$1,171.18 $1,233.67 $1,299.87 $1,535.03 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$925.84 $1,050.82 $1,183.22 $1,653.54 $2,512.72 |
$1,279.97 $1,404.95 $1,537.35 $2,007.67 |
$1,634.10 $1,759.08 $1,891.48 $2,361.80 |
Toc - Plan #33 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$450.26 $511.05 $575.43 $804.17 $1,222.01 |
$794.71 $855.50 $919.88 $1,148.62 |
$1,139.16 $1,199.95 $1,264.33 $1,493.07 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$900.52 $1,022.10 $1,150.86 $1,608.34 $2,444.02 |
$1,244.97 $1,366.55 $1,495.31 $1,952.79 |
$1,589.42 $1,711.00 $1,839.76 $2,297.24 |
Toc - Plan #34 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$469.95 $533.39 $600.59 $839.32 $1,275.43 |
$829.46 $892.90 $960.10 $1,198.83 |
$1,188.97 $1,252.41 $1,319.61 $1,558.34 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$939.90 $1,066.78 $1,201.18 $1,678.64 $2,550.86 |
$1,299.41 $1,426.29 $1,560.69 $2,038.15 |
$1,658.92 $1,785.80 $1,920.20 $2,397.66 |
Toc - Plan #35 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$454.73 $516.11 $581.14 $812.14 $1,234.13 |
$802.60 $863.98 $929.01 $1,160.01 |
$1,150.47 $1,211.85 $1,276.88 $1,507.88 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$909.46 $1,032.22 $1,162.28 $1,624.28 $2,468.26 |
$1,257.33 $1,380.09 $1,510.15 $1,972.15 |
$1,605.20 $1,727.96 $1,858.02 $2,320.02 |
Toc - Plan #36 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$300.63 $341.21 $384.20 $536.92 $815.90 |
$530.61 $571.19 $614.18 $766.90 |
$760.59 $801.17 $844.16 $996.88 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$601.26 $682.42 $768.40 $1,073.84 $1,631.80 |
$831.24 $912.40 $998.38 $1,303.82 |
$1,061.22 $1,142.38 $1,228.36 $1,533.80 |
Toc - Plan #37 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$443.62 $503.51 $566.95 $792.31 $1,203.99 |
$782.99 $842.88 $906.32 $1,131.68 |
$1,122.36 $1,182.25 $1,245.69 $1,471.05 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$887.24 $1,007.02 $1,133.90 $1,584.62 $2,407.98 |
$1,226.61 $1,346.39 $1,473.27 $1,923.99 |
$1,565.98 $1,685.76 $1,812.64 $2,263.36 |
Toc - Plan #38 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$461.64 $523.96 $589.97 $824.48 $1,252.88 |
$814.79 $877.11 $943.12 $1,177.63 |
$1,167.94 $1,230.26 $1,296.27 $1,530.78 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$923.28 $1,047.92 $1,179.94 $1,648.96 $2,505.76 |
$1,276.43 $1,401.07 $1,533.09 $2,002.11 |
$1,629.58 $1,754.22 $1,886.24 $2,355.26 |
Toc - Plan #39 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$317.52 $360.38 $405.79 $567.08 $861.74 |
$560.42 $603.28 $648.69 $809.98 |
$803.32 $846.18 $891.59 $1,052.88 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$635.04 $720.76 $811.58 $1,134.16 $1,723.48 |
$877.94 $963.66 $1,054.48 $1,377.06 |
$1,120.84 $1,206.56 $1,297.38 $1,619.96 |
Toc - Plan #40 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$311.07 $353.07 $397.55 $555.57 $844.25 |
$549.04 $591.04 $635.52 $793.54 |
$787.01 $829.01 $873.49 $1,031.51 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$622.14 $706.14 $795.10 $1,111.14 $1,688.50 |
$860.11 $944.11 $1,033.07 $1,349.11 |
$1,098.08 $1,182.08 $1,271.04 $1,587.08 |
ADVERTISEMENT
Molina HealthcareLocal: 1-888-560-2043 | Toll Free: 1-888-560-2043 |
Toc - Plan #41 Molina Healthcare | ||||||||||||||||||||
Gold
(HMO) Confident Care Gold 1 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$436.97 $495.97 $558.45 $780.44 $1,185.95 |
$771.26 $830.26 $892.74 $1,114.73 |
$1,105.55 $1,164.55 $1,227.03 $1,449.02 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$873.94 $991.94 $1,116.90 $1,560.88 $2,371.90 |
$1,208.23 $1,326.23 $1,451.19 $1,895.17 |
$1,542.52 $1,660.52 $1,785.48 $2,229.46 |
Toc - Plan #42 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Constant Care Silver 1 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$391.76 $444.64 $500.67 $699.68 $1,063.23 |
$691.45 $744.33 $800.36 $999.37 |
$991.14 $1,044.02 $1,100.05 $1,299.06 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$783.52 $889.28 $1,001.34 $1,399.36 $2,126.46 |
$1,083.21 $1,188.97 $1,301.03 $1,699.05 |
$1,382.90 $1,488.66 $1,600.72 $1,998.74 |
Toc - Plan #43 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Constant Care Silver 4 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$387.95 $440.33 $495.80 $692.88 $1,052.90 |
$684.73 $737.11 $792.58 $989.66 |
$981.51 $1,033.89 $1,089.36 $1,286.44 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$775.90 $880.66 $991.60 $1,385.76 $2,105.80 |
$1,072.68 $1,177.44 $1,288.38 $1,682.54 |
$1,369.46 $1,474.22 $1,585.16 $1,979.32 |
Toc - Plan #44 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Constant Care Silver 7 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$380.90 $432.32 $486.79 $680.28 $1,033.75 |
$672.29 $723.71 $778.18 $971.67 |
$963.68 $1,015.10 $1,069.57 $1,263.06 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$761.80 $864.64 $973.58 $1,360.56 $2,067.50 |
$1,053.19 $1,156.03 $1,264.97 $1,651.95 |
$1,344.58 $1,447.42 $1,556.36 $1,943.34 |
Toc - Plan #45 Molina Healthcare | ||||||||||||||||||||
Gold
(HMO) Confident Care Gold 1 + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$431.13 $489.33 $550.98 $769.99 $1,170.08 |
$760.94 $819.14 $880.79 $1,099.80 |
$1,090.75 $1,148.95 $1,210.60 $1,429.61 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$862.26 $978.66 $1,101.96 $1,539.98 $2,340.16 |
$1,192.07 $1,308.47 $1,431.77 $1,869.79 |
$1,521.88 $1,638.28 $1,761.58 $2,199.60 |
Toc - Plan #46 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Constant Care Silver 1 + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$388.76 $441.24 $496.83 $694.32 $1,055.08 |
$686.16 $738.64 $794.23 $991.72 |
$983.56 $1,036.04 $1,091.63 $1,289.12 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$777.52 $882.48 $993.66 $1,388.64 $2,110.16 |
$1,074.92 $1,179.88 $1,291.06 $1,686.04 |
$1,372.32 $1,477.28 $1,588.46 $1,983.44 |
Toc - Plan #47 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Constant Care Silver 2 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$390.86 $443.63 $499.52 $698.07 $1,060.79 |
$689.87 $742.64 $798.53 $997.08 |
$988.88 $1,041.65 $1,097.54 $1,296.09 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$781.72 $887.26 $999.04 $1,396.14 $2,121.58 |
$1,080.73 $1,186.27 $1,298.05 $1,695.15 |
$1,379.74 $1,485.28 $1,597.06 $1,994.16 |
ADVERTISEMENT
Anthem Blue Cross and Blue ShieldLocal: 1-855-748-1813 | Toll Free: 1-855-748-1813 |
Toc - Plan #48 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(HMO) Anthem Bronze Pathway X 0 for HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$293.80 $333.46 $375.48 $524.73 $797.37 |
$518.56 $558.22 $600.24 $749.49 |
$743.32 $782.98 $825.00 $974.25 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$587.60 $666.92 $750.96 $1,049.46 $1,594.74 |
$812.36 $891.68 $975.72 $1,274.22 |
$1,037.12 $1,116.44 $1,200.48 $1,498.98 |
Toc - Plan #49 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(HMO) Anthem Bronze Pathway X 5000 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$290.53 $329.75 $371.30 $518.89 $788.50 |
$512.79 $552.01 $593.56 $741.15 |
$735.05 $774.27 $815.82 $963.41 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$581.06 $659.50 $742.60 $1,037.78 $1,577.00 |
$803.32 $881.76 $964.86 $1,260.04 |
$1,025.58 $1,104.02 $1,187.12 $1,482.30 |
Toc - Plan #50 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Bronze
(HMO) Anthem Bronze Pathway X 6550 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$281.71 $319.74 $360.03 $503.13 $764.56 |
$497.22 $535.25 $575.54 $718.64 |
$712.73 $750.76 $791.05 $934.15 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$563.42 $639.48 $720.06 $1,006.26 $1,529.12 |
$778.93 $854.99 $935.57 $1,221.77 |
$994.44 $1,070.50 $1,151.08 $1,437.28 |
Toc - Plan #51 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Bronze
(HMO) Anthem Bronze Pathway X 8700 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$278.72 $316.35 $356.20 $497.79 $756.45 |
$491.94 $529.57 $569.42 $711.01 |
$705.16 $742.79 $782.64 $924.23 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$557.44 $632.70 $712.40 $995.58 $1,512.90 |
$770.66 $845.92 $925.62 $1,208.80 |
$983.88 $1,059.14 $1,138.84 $1,422.02 |
Toc - Plan #52 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(HMO) Anthem Silver Pathway X 4000 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$346.60 $393.39 $442.95 $619.03 $940.67 |
$611.75 $658.54 $708.10 $884.18 |
$876.90 $923.69 $973.25 $1,149.33 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$693.20 $786.78 $885.90 $1,238.06 $1,881.34 |
$958.35 $1,051.93 $1,151.05 $1,503.21 |
$1,223.50 $1,317.08 $1,416.20 $1,768.36 |
Toc - Plan #53 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(HMO) Anthem Silver Pathway X 5000 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$338.95 $384.71 $433.18 $605.36 $919.91 |
$598.25 $644.01 $692.48 $864.66 |
$857.55 $903.31 $951.78 $1,123.96 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$677.90 $769.42 $866.36 $1,210.72 $1,839.82 |
$937.20 $1,028.72 $1,125.66 $1,470.02 |
$1,196.50 $1,288.02 $1,384.96 $1,729.32 |
Toc - Plan #54 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(HMO) Anthem Silver Pathway X 6550 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$337.24 $382.77 $430.99 $602.31 $915.27 |
$595.23 $640.76 $688.98 $860.30 |
$853.22 $898.75 $946.97 $1,118.29 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$674.48 $765.54 $861.98 $1,204.62 $1,830.54 |
$932.47 $1,023.53 $1,119.97 $1,462.61 |
$1,190.46 $1,281.52 $1,377.96 $1,720.60 |
Toc - Plan #55 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Gold
(HMO) Anthem Gold Pathway X 2700 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$364.41 $413.61 $465.72 $650.84 $989.01 |
$643.18 $692.38 $744.49 $929.61 |
$921.95 $971.15 $1,023.26 $1,208.38 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$728.82 $827.22 $931.44 $1,301.68 $1,978.02 |
$1,007.59 $1,105.99 $1,210.21 $1,580.45 |
$1,286.36 $1,384.76 $1,488.98 $1,859.22 |
ADVERTISEMENT
Network HealthLocal: 1-920-720-1400x1400 | Toll Free: 1-855-275-1400 | TTY: 1-800-947-3529 |
Toc - Plan #56 Network Health | ||||||||||||||||||||
Expanded Bronze
(HMO) Prestige Bronze 20 HDHP + Dental + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$367.11 $416.67 $469.16 $655.65 $996.32 |
$647.95 $697.51 $750.00 $936.49 |
$928.79 $978.35 $1,030.84 $1,217.33 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$734.22 $833.34 $938.32 $1,311.30 $1,992.64 |
$1,015.06 $1,114.18 $1,219.16 $1,592.14 |
$1,295.90 $1,395.02 $1,500.00 $1,872.98 |
Toc - Plan #57 Network Health | ||||||||||||||||||||
Silver
(HMO) Prestige Silver 20 HDHP + Dental + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$562.83 $638.81 $719.29 $1,005.21 $1,527.51 |
$993.40 $1,069.38 $1,149.86 $1,435.78 |
$1,423.97 $1,499.95 $1,580.43 $1,866.35 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,125.66 $1,277.62 $1,438.58 $2,010.42 $3,055.02 |
$1,556.23 $1,708.19 $1,869.15 $2,440.99 |
$1,986.80 $2,138.76 $2,299.72 $2,871.56 |
Toc - Plan #58 Network Health | ||||||||||||||||||||
Expanded Bronze
(HMO) Prestige Bronze Essential + Dental + Vision + Fitness + 3 Free PCP Visits |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$355.81 $403.85 $454.73 $635.48 $965.67 |
$628.01 $676.05 $726.93 $907.68 |
$900.21 $948.25 $999.13 $1,179.88 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$711.62 $807.70 $909.46 $1,270.96 $1,931.34 |
$983.82 $1,079.90 $1,181.66 $1,543.16 |
$1,256.02 $1,352.10 $1,453.86 $1,815.36 |
Toc - Plan #59 Network Health | ||||||||||||||||||||
Silver
(HMO) Prestige Silver Essential + Dental + Vision + Fitness + 3 Free PCP Visits |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$547.40 $621.30 $699.58 $977.65 $1,485.63 |
$966.16 $1,040.06 $1,118.34 $1,396.41 |
$1,384.92 $1,458.82 $1,537.10 $1,815.17 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,094.80 $1,242.60 $1,399.16 $1,955.30 $2,971.26 |
$1,513.56 $1,661.36 $1,817.92 $2,374.06 |
$1,932.32 $2,080.12 $2,236.68 $2,792.82 |
Toc - Plan #60 Network Health | ||||||||||||||||||||
Gold
(HMO) Prestige Gold Essential + Dental + Vision + Fitness + 3 Free PCP Visits |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$507.52 $576.04 $648.61 $906.43 $1,377.40 |
$895.77 $964.29 $1,036.86 $1,294.68 |
$1,284.02 $1,352.54 $1,425.11 $1,682.93 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,015.04 $1,152.08 $1,297.22 $1,812.86 $2,754.80 |
$1,403.29 $1,540.33 $1,685.47 $2,201.11 |
$1,791.54 $1,928.58 $2,073.72 $2,589.36 |
Toc - Plan #61 Network Health | ||||||||||||||||||||
Expanded Bronze
(HMO) Prestige Bronze 0 + Dental + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$325.78 $369.76 $416.35 $581.85 $884.17 |
$575.01 $618.99 $665.58 $831.08 |
$824.24 $868.22 $914.81 $1,080.31 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$651.56 $739.52 $832.70 $1,163.70 $1,768.34 |
$900.79 $988.75 $1,081.93 $1,412.93 |
$1,150.02 $1,237.98 $1,331.16 $1,662.16 |
Toc - Plan #62 Network Health | ||||||||||||||||||||
Gold
(HMO) Prestige Gold 50 + Dental + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$518.59 $588.59 $662.75 $926.19 $1,407.43 |
$915.31 $985.31 $1,059.47 $1,322.91 |
$1,312.03 $1,382.03 $1,456.19 $1,719.63 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,037.18 $1,177.18 $1,325.50 $1,852.38 $2,814.86 |
$1,433.90 $1,573.90 $1,722.22 $2,249.10 |
$1,830.62 $1,970.62 $2,118.94 $2,645.82 |
Toc - Plan #63 Network Health | ||||||||||||||||||||
Gold
(HMO) Prestige Gold 0 HDHP + Dental + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$523.14 $593.77 $668.58 $934.33 $1,419.81 |
$923.35 $993.98 $1,068.79 $1,334.54 |
$1,323.56 $1,394.19 $1,469.00 $1,734.75 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,046.28 $1,187.54 $1,337.16 $1,868.66 $2,839.62 |
$1,446.49 $1,587.75 $1,737.37 $2,268.87 |
$1,846.70 $1,987.96 $2,137.58 $2,669.08 |
Toc - Plan #64 Network Health | ||||||||||||||||||||
Expanded Bronze
(HMO) Signature Prestige Bronze Copay + Dental + Vision + Fitness |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$359.87 $408.45 $459.91 $642.72 $976.68 |
$635.17 $683.75 $735.21 $918.02 |
$910.47 $959.05 $1,010.51 $1,193.32 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$719.74 $816.90 $919.82 $1,285.44 $1,953.36 |
$995.04 $1,092.20 $1,195.12 $1,560.74 |
$1,270.34 $1,367.50 $1,470.42 $1,836.04 |
ADVERTISEMENT
WPS Health PlanLocal: 1-920-490-6900 | Toll Free: 1-800-332-6249 | TTY: 1-888-332-0144 |
Toc - Plan #65 WPS Health Plan | ||||||||||||||||||||
Bronze
(HMO) WPS HMO Bronze $8,700 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$308.44 $350.08 $394.19 $550.87 $837.11 |
$544.40 $586.04 $630.15 $786.83 |
$780.36 $822.00 $866.11 $1,022.79 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$616.88 $700.16 $788.38 $1,101.74 $1,674.22 |
$852.84 $936.12 $1,024.34 $1,337.70 |
$1,088.80 $1,172.08 $1,260.30 $1,573.66 |
Toc - Plan #66 WPS Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) WPS HMO Bronze $6,500 with 3 Free PCP Visits | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$320.63 $363.92 $409.77 $572.65 $870.19 |
$565.91 $609.20 $655.05 $817.93 |
$811.19 $854.48 $900.33 $1,063.21 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$641.26 $727.84 $819.54 $1,145.30 $1,740.38 |
$886.54 $973.12 $1,064.82 $1,390.58 |
$1,131.82 $1,218.40 $1,310.10 $1,635.86 |
Toc - Plan #67 WPS Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) WPS HMO Bronze $7,500 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$309.24 $350.99 $395.21 $552.30 $839.28 |
$545.81 $587.56 $631.78 $788.87 |
$782.38 $824.13 $868.35 $1,025.44 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$618.48 $701.98 $790.42 $1,104.60 $1,678.56 |
$855.05 $938.55 $1,026.99 $1,341.17 |
$1,091.62 $1,175.12 $1,263.56 $1,577.74 |
Toc - Plan #68 WPS Health Plan | ||||||||||||||||||||
Silver
(HMO) WPS HMO Silver $7,500 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
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 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
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 |
Toc - Plan #69 WPS Health Plan | ||||||||||||||||||||
Silver
(HMO) WPS HMO Silver $4,500 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$407.23 $462.21 $520.44 $727.31 $1,105.22 |
$718.76 $773.74 $831.97 $1,038.84 |
$1,030.29 $1,085.27 $1,143.50 $1,350.37 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$814.46 $924.42 $1,040.88 $1,454.62 $2,210.44 |
$1,125.99 $1,235.95 $1,352.41 $1,766.15 |
$1,437.52 $1,547.48 $1,663.94 $2,077.68 |
Toc - Plan #70 WPS Health Plan | ||||||||||||||||||||
Silver
(HMO) WPS HMO Silver $5,000 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$422.00 $478.97 $539.32 $753.69 $1,145.31 |
$744.83 $801.80 $862.15 $1,076.52 |
$1,067.66 $1,124.63 $1,184.98 $1,399.35 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$844.00 $957.94 $1,078.64 $1,507.38 $2,290.62 |
$1,166.83 $1,280.77 $1,401.47 $1,830.21 |
$1,489.66 $1,603.60 $1,724.30 $2,153.04 |
Toc - Plan #71 WPS Health Plan | ||||||||||||||||||||
Gold
(HMO) WPS HMO Gold $3,000 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$552.08 $626.61 $705.56 $986.01 $1,498.35 |
$974.42 $1,048.95 $1,127.90 $1,408.35 |
$1,396.76 $1,471.29 $1,550.24 $1,830.69 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,104.16 $1,253.22 $1,411.12 $1,972.02 $2,996.70 |
$1,526.50 $1,675.56 $1,833.46 $2,394.36 |
$1,948.84 $2,097.90 $2,255.80 $2,816.70 |
Toc - Plan #72 WPS Health Plan | ||||||||||||||||||||
Catastrophic
(HMO) WPS HMO Catastrophic $8,700 with 3 Free PCP Visits | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$268.15 $304.35 $342.70 $478.92 $727.76 |
$473.28 $509.48 $547.83 $684.05 |
$678.41 $714.61 $752.96 $889.18 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$536.30 $608.70 $685.40 $957.84 $1,455.52 |
$741.43 $813.83 $890.53 $1,162.97 |
$946.56 $1,018.96 $1,095.66 $1,368.10 |
Toc - Plan #73 WPS Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) WPS HMO HDHP Bronze $7,050 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$321.29 $364.66 $410.61 $573.82 $871.98 |
$567.08 $610.45 $656.40 $819.61 |
$812.87 $856.24 $902.19 $1,065.40 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$642.58 $729.32 $821.22 $1,147.64 $1,743.96 |
$888.37 $975.11 $1,067.01 $1,393.43 |
$1,134.16 $1,220.90 $1,312.80 $1,639.22 |
Toc - Plan #74 WPS Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) WPS HMO HDHP Bronze $6,830 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$328.25 $372.56 $419.50 $586.25 $890.87 |
$579.36 $623.67 $670.61 $837.36 |
$830.47 $874.78 $921.72 $1,088.47 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$656.50 $745.12 $839.00 $1,172.50 $1,781.74 |
$907.61 $996.23 $1,090.11 $1,423.61 |
$1,158.72 $1,247.34 $1,341.22 $1,674.72 |
Toc - Plan #75 WPS Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) WPS HMO HDHP Bronze $6,000 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$322.02 $365.49 $411.54 $575.13 $873.96 |
$568.37 $611.84 $657.89 $821.48 |
$814.72 $858.19 $904.24 $1,067.83 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$644.04 $730.98 $823.08 $1,150.26 $1,747.92 |
$890.39 $977.33 $1,069.43 $1,396.61 |
$1,136.74 $1,223.68 $1,315.78 $1,642.96 |
Toc - Plan #76 WPS Health Plan | ||||||||||||||||||||
Silver
(HMO) WPS HMO HDHP Silver $4,500 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$410.14 $465.51 $524.16 $732.51 $1,113.12 |
$723.90 $779.27 $837.92 $1,046.27 |
$1,037.66 $1,093.03 $1,151.68 $1,360.03 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$820.28 $931.02 $1,048.32 $1,465.02 $2,226.24 |
$1,134.04 $1,244.78 $1,362.08 $1,778.78 |
$1,447.80 $1,558.54 $1,675.84 $2,092.54 |
Toc - Plan #77 WPS Health Plan | ||||||||||||||||||||
Silver
(HMO) WPS HMO HDHP Silver $5,250 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$413.00 $468.76 $527.81 $737.62 $1,120.88 |
$728.95 $784.71 $843.76 $1,053.57 |
$1,044.90 $1,100.66 $1,159.71 $1,369.52 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$826.00 $937.52 $1,055.62 $1,475.24 $2,241.76 |
$1,141.95 $1,253.47 $1,371.57 $1,791.19 |
$1,457.90 $1,569.42 $1,687.52 $2,107.14 |
Toc - Plan #78 WPS Health Plan | ||||||||||||||||||||
Silver
(HMO) WPS HMO HDHP Silver $6,125 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$393.98 $447.17 $503.51 $703.65 $1,069.26 |
$695.37 $748.56 $804.90 $1,005.04 |
$996.76 $1,049.95 $1,106.29 $1,306.43 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$787.96 $894.34 $1,007.02 $1,407.30 $2,138.52 |
$1,089.35 $1,195.73 $1,308.41 $1,708.69 |
$1,390.74 $1,497.12 $1,609.80 $2,010.08 |
Toc - Plan #79 WPS Health Plan | ||||||||||||||||||||
Bronze
(POS) WPS POS Bronze $8,700 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$329.91 $374.45 $421.62 $589.22 $895.38 |
$582.29 $626.83 $674.00 $841.60 |
$834.67 $879.21 $926.38 $1,093.98 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$659.82 $748.90 $843.24 $1,178.44 $1,790.76 |
$912.20 $1,001.28 $1,095.62 $1,430.82 |
$1,164.58 $1,253.66 $1,348.00 $1,683.20 |
Toc - Plan #80 WPS Health Plan | ||||||||||||||||||||
Expanded Bronze
(POS) WPS POS HDHP Bronze $6,000 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$344.41 $390.91 $440.16 $615.12 $934.73 |
$607.88 $654.38 $703.63 $878.59 |
$871.35 $917.85 $967.10 $1,142.06 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$688.82 $781.82 $880.32 $1,230.24 $1,869.46 |
$952.29 $1,045.29 $1,143.79 $1,493.71 |
$1,215.76 $1,308.76 $1,407.26 $1,757.18 |
ADVERTISEMENT
Common Ground Healthcare CooperativeLocal: 1-877-514-2442 | Toll Free: 1-877-514-2442 | TTY: 1-844-472-2442 |
Toc - Plan #81 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Solutions Bronze $0 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$286.68 $325.37 $366.36 $511.99 $778.01 |
$505.98 $544.67 $585.66 $731.29 |
$725.28 $763.97 $804.96 $950.59 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$573.36 $650.74 $732.72 $1,023.98 $1,556.02 |
$792.66 $870.04 $952.02 $1,243.28 |
$1,011.96 $1,089.34 $1,171.32 $1,462.58 |
Toc - Plan #82 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Solutions Silver $0 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$411.35 $466.87 $525.69 $734.65 $1,116.38 |
$726.02 $781.54 $840.36 $1,049.32 |
$1,040.69 $1,096.21 $1,155.03 $1,363.99 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$822.70 $933.74 $1,051.38 $1,469.30 $2,232.76 |
$1,137.37 $1,248.41 $1,366.05 $1,783.97 |
$1,452.04 $1,563.08 $1,680.72 $2,098.64 |
Toc - Plan #83 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Solutions Gold $0 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$436.77 $495.72 $558.18 $780.05 $1,185.36 |
$770.89 $829.84 $892.30 $1,114.17 |
$1,105.01 $1,163.96 $1,226.42 $1,448.29 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$873.54 $991.44 $1,116.36 $1,560.10 $2,370.72 |
$1,207.66 $1,325.56 $1,450.48 $1,894.22 |
$1,541.78 $1,659.68 $1,784.60 $2,228.34 |
Toc - Plan #84 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Value 2 Gold $3000 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$382.70 $434.35 $489.08 $683.48 $1,038.62 |
$675.46 $727.11 $781.84 $976.24 |
$968.22 $1,019.87 $1,074.60 $1,269.00 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$765.40 $868.70 $978.16 $1,366.96 $2,077.24 |
$1,058.16 $1,161.46 $1,270.92 $1,659.72 |
$1,350.92 $1,454.22 $1,563.68 $1,952.48 |
Toc - Plan #85 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Value 1 Gold $3600 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$371.58 $421.73 $474.87 $663.63 $1,008.44 |
$655.83 $705.98 $759.12 $947.88 |
$940.08 $990.23 $1,043.37 $1,232.13 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$743.16 $843.46 $949.74 $1,327.26 $2,016.88 |
$1,027.41 $1,127.71 $1,233.99 $1,611.51 |
$1,311.66 $1,411.96 $1,518.24 $1,895.76 |
Toc - Plan #86 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Value Premier Gold $1800 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$413.16 $468.92 $528.00 $737.88 $1,121.29 |
$729.22 $784.98 $844.06 $1,053.94 |
$1,045.28 $1,101.04 $1,160.12 $1,370.00 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$826.32 $937.84 $1,056.00 $1,475.76 $2,242.58 |
$1,142.38 $1,253.90 $1,372.06 $1,791.82 |
$1,458.44 $1,569.96 $1,688.12 $2,107.88 |
Toc - Plan #87 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Value Plus Gold $2000 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$385.14 $437.12 $492.19 $687.84 $1,045.23 |
$679.76 $731.74 $786.81 $982.46 |
$974.38 $1,026.36 $1,081.43 $1,277.08 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$770.28 $874.24 $984.38 $1,375.68 $2,090.46 |
$1,064.90 $1,168.86 $1,279.00 $1,670.30 |
$1,359.52 $1,463.48 $1,573.62 $1,964.92 |
Toc - Plan #88 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Value Plus Silver $4000 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$370.83 $420.88 $473.90 $662.28 $1,006.40 |
$654.51 $704.56 $757.58 $945.96 |
$938.19 $988.24 $1,041.26 $1,229.64 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$741.66 $841.76 $947.80 $1,324.56 $2,012.80 |
$1,025.34 $1,125.44 $1,231.48 $1,608.24 |
$1,309.02 $1,409.12 $1,515.16 $1,891.92 |
Toc - Plan #89 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Value Premier Silver $3000 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$386.24 $438.37 $493.60 $689.80 $1,048.21 |
$681.70 $733.83 $789.06 $985.26 |
$977.16 $1,029.29 $1,084.52 $1,280.72 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$772.48 $876.74 $987.20 $1,379.60 $2,096.42 |
$1,067.94 $1,172.20 $1,282.66 $1,675.06 |
$1,363.40 $1,467.66 $1,578.12 $1,970.52 |
Toc - Plan #90 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Value 2 Silver $6500 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$315.46 $358.04 $403.15 $563.40 $856.14 |
$556.78 $599.36 $644.47 $804.72 |
$798.10 $840.68 $885.79 $1,046.04 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$630.92 $716.08 $806.30 $1,126.80 $1,712.28 |
$872.24 $957.40 $1,047.62 $1,368.12 |
$1,113.56 $1,198.72 $1,288.94 $1,609.44 |
Toc - Plan #91 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Catastrophic
(EPO) CGHC Catastrophic $8700 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$195.70 $222.10 $250.09 $349.49 $531.09 |
$345.40 $371.80 $399.79 $499.19 |
$495.10 $521.50 $549.49 $648.89 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$391.40 $444.20 $500.18 $698.98 $1,062.18 |
$541.10 $593.90 $649.88 $848.68 |
$690.80 $743.60 $799.58 $998.38 |
Toc - Plan #92 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Value Plus Bronze $8700 Deductible ($35 PCP Copay) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$270.61 $307.13 $345.83 $483.29 $734.41 |
$477.62 $514.14 $552.84 $690.30 |
$684.63 $721.15 $759.85 $897.31 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$541.22 $614.26 $691.66 $966.58 $1,468.82 |
$748.23 $821.27 $898.67 $1,173.59 |
$955.24 $1,028.28 $1,105.68 $1,380.60 |
Toc - Plan #93 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Value Premier Bronze $8150 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$279.12 $316.80 $356.71 $498.50 $757.52 |
$492.64 $530.32 $570.23 $712.02 |
$706.16 $743.84 $783.75 $925.54 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$558.24 $633.60 $713.42 $997.00 $1,515.04 |
$771.76 $847.12 $926.94 $1,210.52 |
$985.28 $1,060.64 $1,140.46 $1,424.04 |
Toc - Plan #94 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC HSA Bronze $7000 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$281.01 $318.93 $359.11 $501.86 $762.63 |
$495.97 $533.89 $574.07 $716.82 |
$710.93 $748.85 $789.03 $931.78 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$562.02 $637.86 $718.22 $1,003.72 $1,525.26 |
$776.98 $852.82 $933.18 $1,218.68 |
$991.94 $1,067.78 $1,148.14 $1,433.64 |
Toc - Plan #95 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC HSA Gold $2800 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$438.66 $497.87 $560.60 $783.43 $1,190.50 |
$774.23 $833.44 $896.17 $1,119.00 |
$1,109.80 $1,169.01 $1,231.74 $1,454.57 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$877.32 $995.74 $1,121.20 $1,566.86 $2,381.00 |
$1,212.89 $1,331.31 $1,456.77 $1,902.43 |
$1,548.46 $1,666.88 $1,792.34 $2,238.00 |
Toc - Plan #96 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC HSA Silver $3000 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$426.69 $484.29 $545.30 $762.06 $1,158.02 |
$753.10 $810.70 $871.71 $1,088.47 |
$1,079.51 $1,137.11 $1,198.12 $1,414.88 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$853.38 $968.58 $1,090.60 $1,524.12 $2,316.04 |
$1,179.79 $1,294.99 $1,417.01 $1,850.53 |
$1,506.20 $1,621.40 $1,743.42 $2,176.94 |
Toc - Plan #97 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Bronze
(EPO) CGHC Value 1 Bronze $8700 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$268.81 $305.09 $343.53 $480.08 $729.53 |
$474.44 $510.72 $549.16 $685.71 |
$680.07 $716.35 $754.79 $891.34 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$537.62 $610.18 $687.06 $960.16 $1,459.06 |
$743.25 $815.81 $892.69 $1,165.79 |
$948.88 $1,021.44 $1,098.32 $1,371.42 |
Toc - Plan #98 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Value 2 Bronze $6000 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$276.64 $313.97 $353.53 $494.05 $750.76 |
$488.26 $525.59 $565.15 $705.67 |
$699.88 $737.21 $776.77 $917.29 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$553.28 $627.94 $707.06 $988.10 $1,501.52 |
$764.90 $839.56 $918.68 $1,199.72 |
$976.52 $1,051.18 $1,130.30 $1,411.34 |
Toc - Plan #99 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Value 1 Silver $7500 Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$315.40 $357.97 $403.07 $563.29 $855.97 |
$556.67 $599.24 $644.34 $804.56 |
$797.94 $840.51 $885.61 $1,045.83 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$630.80 $715.94 $806.14 $1,126.58 $1,711.94 |
$872.07 $957.21 $1,047.41 $1,367.85 |
$1,113.34 $1,198.48 $1,288.68 $1,609.12 |
Toc - Plan #100 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Value Premier Gold $1800 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$416.29 $472.47 $532.00 $743.47 $1,129.77 |
$734.74 $790.92 $850.45 $1,061.92 |
$1,053.19 $1,109.37 $1,168.90 $1,380.37 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$832.58 $944.94 $1,064.00 $1,486.94 $2,259.54 |
$1,151.03 $1,263.39 $1,382.45 $1,805.39 |
$1,469.48 $1,581.84 $1,700.90 $2,123.84 |
Toc - Plan #101 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Value Plus Gold $2000 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$388.24 $440.64 $496.16 $693.38 $1,053.67 |
$685.24 $737.64 $793.16 $990.38 |
$982.24 $1,034.64 $1,090.16 $1,287.38 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$776.48 $881.28 $992.32 $1,386.76 $2,107.34 |
$1,073.48 $1,178.28 $1,289.32 $1,683.76 |
$1,370.48 $1,475.28 $1,586.32 $1,980.76 |
Toc - Plan #102 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Value 2 Gold $3000 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$385.81 $437.88 $493.05 $689.03 $1,047.05 |
$680.94 $733.01 $788.18 $984.16 |
$976.07 $1,028.14 $1,083.31 $1,279.29 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$771.62 $875.76 $986.10 $1,378.06 $2,094.10 |
$1,066.75 $1,170.89 $1,281.23 $1,673.19 |
$1,361.88 $1,466.02 $1,576.36 $1,968.32 |
Toc - Plan #103 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Value 1 Gold $3600 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$374.68 $425.25 $478.82 $669.15 $1,016.85 |
$661.30 $711.87 $765.44 $955.77 |
$947.92 $998.49 $1,052.06 $1,242.39 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$749.36 $850.50 $957.64 $1,338.30 $2,033.70 |
$1,035.98 $1,137.12 $1,244.26 $1,624.92 |
$1,322.60 $1,423.74 $1,530.88 $1,911.54 |
Toc - Plan #104 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Value Plus Silver $4000 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$373.92 $424.39 $477.86 $667.81 $1,014.80 |
$659.96 $710.43 $763.90 $953.85 |
$946.00 $996.47 $1,049.94 $1,239.89 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$747.84 $848.78 $955.72 $1,335.62 $2,029.60 |
$1,033.88 $1,134.82 $1,241.76 $1,621.66 |
$1,319.92 $1,420.86 $1,527.80 $1,907.70 |
Toc - Plan #105 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Value Premier Silver $3000 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$389.34 $441.89 $497.57 $695.35 $1,056.65 |
$687.18 $739.73 $795.41 $993.19 |
$985.02 $1,037.57 $1,093.25 $1,291.03 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$778.68 $883.78 $995.14 $1,390.70 $2,113.30 |
$1,076.52 $1,181.62 $1,292.98 $1,688.54 |
$1,374.36 $1,479.46 $1,590.82 $1,986.38 |
Toc - Plan #106 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Value 1 Silver $7500 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$318.45 $361.43 $406.97 $568.74 $864.26 |
$562.06 $605.04 $650.58 $812.35 |
$805.67 $848.65 $894.19 $1,055.96 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$636.90 $722.86 $813.94 $1,137.48 $1,728.52 |
$880.51 $966.47 $1,057.55 $1,381.09 |
$1,124.12 $1,210.08 $1,301.16 $1,624.70 |
Toc - Plan #107 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Value 2 Silver $6500 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$318.53 $361.52 $407.07 $568.87 $864.46 |
$562.20 $605.19 $650.74 $812.54 |
$805.87 $848.86 $894.41 $1,056.21 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$637.06 $723.04 $814.14 $1,137.74 $1,728.92 |
$880.73 $966.71 $1,057.81 $1,381.41 |
$1,124.40 $1,210.38 $1,301.48 $1,625.08 |
Toc - Plan #108 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Bronze
(EPO) CGHC Value 1 Bronze $8700 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$271.84 $308.53 $347.40 $485.50 $737.76 |
$479.79 $516.48 $555.35 $693.45 |
$687.74 $724.43 $763.30 $901.40 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$543.68 $617.06 $694.80 $971.00 $1,475.52 |
$751.63 $825.01 $902.75 $1,178.95 |
$959.58 $1,032.96 $1,110.70 $1,386.90 |
Toc - Plan #109 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Value Plus Bronze $8700 Deductible ($35 PCP Copay+ Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$273.64 $310.57 $349.70 $488.71 $742.64 |
$482.97 $519.90 $559.03 $698.04 |
$692.30 $729.23 $768.36 $907.37 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$547.28 $621.14 $699.40 $977.42 $1,485.28 |
$756.61 $830.47 $908.73 $1,186.75 |
$965.94 $1,039.80 $1,118.06 $1,396.08 |
Toc - Plan #110 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Value Premier Bronze $8150 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$282.17 $320.25 $360.60 $503.94 $765.78 |
$498.02 $536.10 $576.45 $719.79 |
$713.87 $751.95 $792.30 $935.64 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$564.34 $640.50 $721.20 $1,007.88 $1,531.56 |
$780.19 $856.35 $937.05 $1,223.73 |
$996.04 $1,072.20 $1,152.90 $1,439.58 |
Toc - Plan #111 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Value 2 Bronze $6000 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$279.67 $317.41 $357.40 $499.47 $758.99 |
$493.61 $531.35 $571.34 $713.41 |
$707.55 $745.29 $785.28 $927.35 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$559.34 $634.82 $714.80 $998.94 $1,517.98 |
$773.28 $848.76 $928.74 $1,212.88 |
$987.22 $1,062.70 $1,142.68 $1,426.82 |
Toc - Plan #112 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC HSA Bronze $7000 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$284.05 $322.39 $363.00 $507.30 $770.89 |
$501.34 $539.68 $580.29 $724.59 |
$718.63 $756.97 $797.58 $941.88 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$568.10 $644.78 $726.00 $1,014.60 $1,541.78 |
$785.39 $862.07 $943.29 $1,231.89 |
$1,002.68 $1,079.36 $1,160.58 $1,449.18 |
Toc - Plan #113 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC HSA Silver $3000 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$429.83 $487.85 $549.31 $767.66 $1,166.54 |
$758.64 $816.66 $878.12 $1,096.47 |
$1,087.45 $1,145.47 $1,206.93 $1,425.28 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$859.66 $975.70 $1,098.62 $1,535.32 $2,333.08 |
$1,188.47 $1,304.51 $1,427.43 $1,864.13 |
$1,517.28 $1,633.32 $1,756.24 $2,192.94 |
Toc - Plan #114 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC HSA Gold $2800 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$441.81 $501.44 $564.62 $789.05 $1,199.04 |
$779.79 $839.42 $902.60 $1,127.03 |
$1,117.77 $1,177.40 $1,240.58 $1,465.01 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$883.62 $1,002.88 $1,129.24 $1,578.10 $2,398.08 |
$1,221.60 $1,340.86 $1,467.22 $1,916.08 |
$1,559.58 $1,678.84 $1,805.20 $2,254.06 |
Toc - Plan #115 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Solutions Bronze $0 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$289.72 $328.82 $370.25 $517.42 $786.27 |
$511.35 $550.45 $591.88 $739.05 |
$732.98 $772.08 $813.51 $960.68 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$579.44 $657.64 $740.50 $1,034.84 $1,572.54 |
$801.07 $879.27 $962.13 $1,256.47 |
$1,022.70 $1,100.90 $1,183.76 $1,478.10 |
Toc - Plan #116 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Solutions Silver $0 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$414.48 $470.42 $529.69 $740.24 $1,124.86 |
$731.55 $787.49 $846.76 $1,057.31 |
$1,048.62 $1,104.56 $1,163.83 $1,374.38 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$828.96 $940.84 $1,059.38 $1,480.48 $2,249.72 |
$1,146.03 $1,257.91 $1,376.45 $1,797.55 |
$1,463.10 $1,574.98 $1,693.52 $2,114.62 |
Toc - Plan #117 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Solutions Gold $0 Deductible (Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$439.91 $499.28 $562.19 $785.65 $1,193.88 |
$776.43 $835.80 $898.71 $1,122.17 |
$1,112.95 $1,172.32 $1,235.23 $1,458.69 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$879.82 $998.56 $1,124.38 $1,571.30 $2,387.76 |
$1,216.34 $1,335.08 $1,460.90 $1,907.82 |
$1,552.86 $1,671.60 $1,797.42 $2,244.34 |
Toc - Plan #118 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Value Premier Gold $1800 Deductible (Dental Exam+ Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$425.30 $482.71 $543.52 $759.57 $1,154.25 |
$750.65 $808.06 $868.87 $1,084.92 |
$1,076.00 $1,133.41 $1,194.22 $1,410.27 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$850.60 $965.42 $1,087.04 $1,519.14 $2,308.50 |
$1,175.95 $1,290.77 $1,412.39 $1,844.49 |
$1,501.30 $1,616.12 $1,737.74 $2,169.84 |
Toc - Plan #119 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Value Plus Gold $2000 Deductible (Dental Exam+ Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$397.27 $450.89 $507.70 $709.51 $1,078.16 |
$701.17 $754.79 $811.60 $1,013.41 |
$1,005.07 $1,058.69 $1,115.50 $1,317.31 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$794.54 $901.78 $1,015.40 $1,419.02 $2,156.32 |
$1,098.44 $1,205.68 $1,319.30 $1,722.92 |
$1,402.34 $1,509.58 $1,623.20 $2,026.82 |
Toc - Plan #120 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Value 2 Gold $3000 Deductible (Dental Exam+ Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$394.83 $448.12 $504.58 $705.15 $1,071.55 |
$696.87 $750.16 $806.62 $1,007.19 |
$998.91 $1,052.20 $1,108.66 $1,309.23 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$789.66 $896.24 $1,009.16 $1,410.30 $2,143.10 |
$1,091.70 $1,198.28 $1,311.20 $1,712.34 |
$1,393.74 $1,500.32 $1,613.24 $2,014.38 |
Toc - Plan #121 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Value 1 Gold $3600 Deductible (Dental Exam+ Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$383.69 $435.48 $490.35 $685.26 $1,041.32 |
$677.21 $729.00 $783.87 $978.78 |
$970.73 $1,022.52 $1,077.39 $1,272.30 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$767.38 $870.96 $980.70 $1,370.52 $2,082.64 |
$1,060.90 $1,164.48 $1,274.22 $1,664.04 |
$1,354.42 $1,458.00 $1,567.74 $1,957.56 |
Toc - Plan #122 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Value Plus Silver $4000 Deductible (Dental Exam+ Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$382.95 $434.64 $489.40 $683.93 $1,039.30 |
$675.90 $727.59 $782.35 $976.88 |
$968.85 $1,020.54 $1,075.30 $1,269.83 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$765.90 $869.28 $978.80 $1,367.86 $2,078.60 |
$1,058.85 $1,162.23 $1,271.75 $1,660.81 |
$1,351.80 $1,455.18 $1,564.70 $1,953.76 |
Toc - Plan #123 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Value Premier Silver $3000 Deductible (Dental Exam+ Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$398.36 $452.13 $509.09 $711.45 $1,081.12 |
$703.10 $756.87 $813.83 $1,016.19 |
$1,007.84 $1,061.61 $1,118.57 $1,320.93 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$796.72 $904.26 $1,018.18 $1,422.90 $2,162.24 |
$1,101.46 $1,209.00 $1,322.92 $1,727.64 |
$1,406.20 $1,513.74 $1,627.66 $2,032.38 |
Toc - Plan #124 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Value 1 Silver $7500 Deductible (Dental Exam+ Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$327.48 $371.68 $418.51 $584.86 $888.76 |
$578.00 $622.20 $669.03 $835.38 |
$828.52 $872.72 $919.55 $1,085.90 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$654.96 $743.36 $837.02 $1,169.72 $1,777.52 |
$905.48 $993.88 $1,087.54 $1,420.24 |
$1,156.00 $1,244.40 $1,338.06 $1,670.76 |
Toc - Plan #125 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Value 2 Silver $6500 Deductible (Dental Exam+ Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$327.54 $371.75 $418.59 $584.98 $888.93 |
$578.10 $622.31 $669.15 $835.54 |
$828.66 $872.87 $919.71 $1,086.10 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$655.08 $743.50 $837.18 $1,169.96 $1,777.86 |
$905.64 $994.06 $1,087.74 $1,420.52 |
$1,156.20 $1,244.62 $1,338.30 $1,671.08 |
Toc - Plan #126 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Bronze
(EPO) CGHC Value 1 Bronze $8700 Deductible (Dental Exam+ Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$280.86 $318.77 $358.93 $501.60 $762.23 |
$495.71 $533.62 $573.78 $716.45 |
$710.56 $748.47 $788.63 $931.30 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$561.72 $637.54 $717.86 $1,003.20 $1,524.46 |
$776.57 $852.39 $932.71 $1,218.05 |
$991.42 $1,067.24 $1,147.56 $1,432.90 |
Toc - Plan #127 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Value Plus Bronze $8700 Deductible ($35 PCP Copay+ Dental Exam+ Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$282.66 $320.81 $361.23 $504.81 $767.11 |
$498.89 $537.04 $577.46 $721.04 |
$715.12 $753.27 $793.69 $937.27 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$565.32 $641.62 $722.46 $1,009.62 $1,534.22 |
$781.55 $857.85 $938.69 $1,225.85 |
$997.78 $1,074.08 $1,154.92 $1,442.08 |
Toc - Plan #128 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Value Premier Bronze $8150 Deductible (Dental Exam+ Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$291.19 $330.48 $372.12 $520.04 $790.25 |
$513.94 $553.23 $594.87 $742.79 |
$736.69 $775.98 $817.62 $965.54 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$582.38 $660.96 $744.24 $1,040.08 $1,580.50 |
$805.13 $883.71 $966.99 $1,262.83 |
$1,027.88 $1,106.46 $1,189.74 $1,485.58 |
Toc - Plan #129 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Value 2 Bronze $6000 Deductible (Dental Exam+ Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$288.70 $327.66 $368.94 $515.59 $783.49 |
$509.54 $548.50 $589.78 $736.43 |
$730.38 $769.34 $810.62 $957.27 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$577.40 $655.32 $737.88 $1,031.18 $1,566.98 |
$798.24 $876.16 $958.72 $1,252.02 |
$1,019.08 $1,097.00 $1,179.56 $1,472.86 |
Toc - Plan #130 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC HSA Bronze $7000 Deductible (Dental Exam+ Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$293.07 $332.62 $374.53 $523.40 $795.36 |
$517.26 $556.81 $598.72 $747.59 |
$741.45 $781.00 $822.91 $971.78 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$586.14 $665.24 $749.06 $1,046.80 $1,590.72 |
$810.33 $889.43 $973.25 $1,270.99 |
$1,034.52 $1,113.62 $1,197.44 $1,495.18 |
Toc - Plan #131 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC HSA Silver $3000 Deductible (Dental Exam+ Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$438.85 $498.08 $560.84 $783.77 $1,191.01 |
$774.56 $833.79 $896.55 $1,119.48 |
$1,110.27 $1,169.50 $1,232.26 $1,455.19 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$877.70 $996.16 $1,121.68 $1,567.54 $2,382.02 |
$1,213.41 $1,331.87 $1,457.39 $1,903.25 |
$1,549.12 $1,667.58 $1,793.10 $2,238.96 |
Toc - Plan #132 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC HSA Gold $2800 Deductible (Dental Exam+ Allergy Testing+ Vision Exam) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$450.83 $511.68 $576.14 $805.16 $1,223.51 |
$795.70 $856.55 $921.01 $1,150.03 |
$1,140.57 $1,201.42 $1,265.88 $1,494.90 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$901.66 $1,023.36 $1,152.28 $1,610.32 $2,447.02 |
$1,246.53 $1,368.23 $1,497.15 $1,955.19 |
$1,591.40 $1,713.10 $1,842.02 $2,300.06 |
Toc - Plan #133 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Solutions Bronze $0 Deductible (Dental Exam+ Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$298.74 $339.06 $381.77 $533.53 $810.75 |
$527.27 $567.59 $610.30 $762.06 |
$755.80 $796.12 $838.83 $990.59 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$597.48 $678.12 $763.54 $1,067.06 $1,621.50 |
$826.01 $906.65 $992.07 $1,295.59 |
$1,054.54 $1,135.18 $1,220.60 $1,524.12 |
Toc - Plan #134 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Solutions Silver $0 Deductible (Dental Exam+ Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$423.49 $480.65 $541.21 $756.34 $1,149.33 |
$747.45 $804.61 $865.17 $1,080.30 |
$1,071.41 $1,128.57 $1,189.13 $1,404.26 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$846.98 $961.30 $1,082.42 $1,512.68 $2,298.66 |
$1,170.94 $1,285.26 $1,406.38 $1,836.64 |
$1,494.90 $1,609.22 $1,730.34 $2,160.60 |
Toc - Plan #135 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Solutions Gold $0 Deductible (Dental Exam+ Allergy Testing+ Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$448.93 $509.53 $573.72 $801.78 $1,218.38 |
$792.36 $852.96 $917.15 $1,145.21 |
$1,135.79 $1,196.39 $1,260.58 $1,488.64 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$897.86 $1,019.06 $1,147.44 $1,603.56 $2,436.76 |
$1,241.29 $1,362.49 $1,490.87 $1,946.99 |
$1,584.72 $1,705.92 $1,834.30 $2,290.42 |
‡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 Waukesha County here.
Waukesha County is in “Rating Area 12” of Wisconsin.
Currently, there are 135 plans offered in Rating Area 12.