Obamacare 2023 Rates for Seminole County

Florida Blue (BlueCross BlueShield FL) Local: 1-800-352-2583 | Toll Free: 1-800-352-2583 | TTY: 1-800-955-8771

Toc - Plan #1 Florida Blue (BlueCross BlueShield FL)
Silver (EPO) BlueOptions Silver 1423 ($0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $5,950 $11,900 Annual Deductible $7,150 $14,300 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$823.64 $934.83 $1,052.61 $1,471.02 $2,235.36	$1,453.72 $1,564.91 $1,682.69 $2,101.10	$2,083.80 $2,194.99 $2,312.77 $2,731.18	$2,713.88 $2,825.07 $2,942.85 $3,361.26	$630.08
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,647.28 $1,869.66 $2,105.22 $2,942.04 $4,470.72	$2,277.36 $2,499.74 $2,735.30 $3,572.12	$2,907.44 $3,129.82 $3,365.38 $4,202.20	$3,537.52 $3,759.90 $3,995.46 $4,832.28	$630.08

Toc - Plan #2 Florida Blue (BlueCross BlueShield FL)
Expanded Bronze (EPO) BlueOptions Bronze 1419 ($0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $6,900 $13,800 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$532.87 $604.81 $681.01 $951.71 $1,446.21	$940.52 $1,012.46 $1,088.66 $1,359.36	$1,348.17 $1,420.11 $1,496.31 $1,767.01	$1,755.82 $1,827.76 $1,903.96 $2,174.66	$407.65
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,065.74 $1,209.62 $1,362.02 $1,903.42 $2,892.42	$1,473.39 $1,617.27 $1,769.67 $2,311.07	$1,881.04 $2,024.92 $2,177.32 $2,718.72	$2,288.69 $2,432.57 $2,584.97 $3,126.37	$407.65

Toc - Plan #3 Florida Blue (BlueCross BlueShield FL)
Silver (EPO) BlueOptions Silver 1431 ($0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $6,000 $12,000 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$828.16 $939.96 $1,058.39 $1,479.09 $2,247.63	$1,461.70 $1,573.50 $1,691.93 $2,112.63	$2,095.24 $2,207.04 $2,325.47 $2,746.17	$2,728.78 $2,840.58 $2,959.01 $3,379.71	$633.54
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,656.32 $1,879.92 $2,116.78 $2,958.18 $4,495.26	$2,289.86 $2,513.46 $2,750.32 $3,591.72	$2,923.40 $3,147.00 $3,383.86 $4,225.26	$3,556.94 $3,780.54 $4,017.40 $4,858.80	$633.54

Toc - Plan #4 Florida Blue (BlueCross BlueShield FL)
Platinum (EPO) BlueOptions Platinum 1418 ($0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $1,000 $2,000 Annual Deductible $4,000 $8,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$1,042.18 $1,182.87 $1,331.91 $1,861.33 $2,828.48	$1,839.45 $1,980.14 $2,129.18 $2,658.60	$2,636.72 $2,777.41 $2,926.45 $3,455.87	$3,433.99 $3,574.68 $3,723.72 $4,253.14	$797.27
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$2,084.36 $2,365.74 $2,663.82 $3,722.66 $5,656.96	$2,881.63 $3,163.01 $3,461.09 $4,519.93	$3,678.90 $3,960.28 $4,258.36 $5,317.20	$4,476.17 $4,757.55 $5,055.63 $6,114.47	$797.27

Toc - Plan #5 Florida Blue (BlueCross BlueShield FL)
Expanded Bronze (EPO) BlueOptions Bronze 1416 ($0 Virtual Visits / 3 PCP Visits for $0 / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $7,400 $14,800 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$555.05 $629.98 $709.35 $991.32 $1,506.41	$979.66 $1,054.59 $1,133.96 $1,415.93	$1,404.27 $1,479.20 $1,558.57 $1,840.54	$1,828.88 $1,903.81 $1,983.18 $2,265.15	$424.61
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,110.10 $1,259.96 $1,418.70 $1,982.64 $3,012.82	$1,534.71 $1,684.57 $1,843.31 $2,407.25	$1,959.32 $2,109.18 $2,267.92 $2,831.86	$2,383.93 $2,533.79 $2,692.53 $3,256.47	$424.61

Toc - Plan #6 Florida Blue (BlueCross BlueShield FL)
Platinum (EPO) BlueOptions Platinum 1424 ($0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $2,000 $4,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$1,092.02 $1,239.44 $1,395.60 $1,950.35 $2,963.74	$1,927.42 $2,074.84 $2,231.00 $2,785.75	$2,762.82 $2,910.24 $3,066.40 $3,621.15	$3,598.22 $3,745.64 $3,901.80 $4,456.55	$835.40
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$2,184.04 $2,478.88 $2,791.20 $3,900.70 $5,927.48	$3,019.44 $3,314.28 $3,626.60 $4,736.10	$3,854.84 $4,149.68 $4,462.00 $5,571.50	$4,690.24 $4,985.08 $5,297.40 $6,406.90	$835.40

Toc - Plan #7 Florida Blue (BlueCross BlueShield FL)
Silver (EPO) BlueOptions Silver 1410 ($0 Virtual Visits / $0 Lab / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $6,000 $12,000 Annual Deductible $7,900 $15,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$773.12 $877.49 $988.05 $1,380.79 $2,098.25	$1,364.56 $1,468.93 $1,579.49 $1,972.23	$1,956.00 $2,060.37 $2,170.93 $2,563.67	$2,547.44 $2,651.81 $2,762.37 $3,155.11	$591.44
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,546.24 $1,754.98 $1,976.10 $2,761.58 $4,196.50	$2,137.68 $2,346.42 $2,567.54 $3,353.02	$2,729.12 $2,937.86 $3,158.98 $3,944.46	$3,320.56 $3,529.30 $3,750.42 $4,535.90	$591.44

Toc - Plan #8 Florida Blue (BlueCross BlueShield FL)
Gold (EPO) BlueOptions Gold 1505 ($0 Virtual Visits / $20 PCP Visits / $15 Generic Meds / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $5,500 $11,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$895.05 $1,015.88 $1,143.87 $1,598.56 $2,429.17	$1,579.76 $1,700.59 $1,828.58 $2,283.27	$2,264.47 $2,385.30 $2,513.29 $2,967.98	$2,949.18 $3,070.01 $3,198.00 $3,652.69	$684.71
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,790.10 $2,031.76 $2,287.74 $3,197.12 $4,858.34	$2,474.81 $2,716.47 $2,972.45 $3,881.83	$3,159.52 $3,401.18 $3,657.16 $4,566.54	$3,844.23 $4,085.89 $4,341.87 $5,251.25	$684.71

Toc - Plan #9 Florida Blue (BlueCross BlueShield FL)
Expanded Bronze (EPO) BlueOptions Bronze (HSA) 1705 (Rewards $$$ / $4 Condition Care Rx)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $6,850 $13,700 Annual Deductible $6,850 $13,700 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$539.58 $612.42 $689.58 $963.69 $1,464.42	$952.36 $1,025.20 $1,102.36 $1,376.47	$1,365.14 $1,437.98 $1,515.14 $1,789.25	$1,777.92 $1,850.76 $1,927.92 $2,202.03	$412.78
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,079.16 $1,224.84 $1,379.16 $1,927.38 $2,928.84	$1,491.94 $1,637.62 $1,791.94 $2,340.16	$1,904.72 $2,050.40 $2,204.72 $2,752.94	$2,317.50 $2,463.18 $2,617.50 $3,165.72	$412.78

Toc - Plan #10 Florida Blue (BlueCross BlueShield FL)
Gold (EPO) BlueOptions Gold 1805 ($0 Virtual Visits / $20 Labs / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $1,500 $3,000 Annual Deductible $5,500 $11,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$865.95 $982.85 $1,106.68 $1,546.59 $2,350.19	$1,528.40 $1,645.30 $1,769.13 $2,209.04	$2,190.85 $2,307.75 $2,431.58 $2,871.49	$2,853.30 $2,970.20 $3,094.03 $3,533.94	$662.45
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,731.90 $1,965.70 $2,213.36 $3,093.18 $4,700.38	$2,394.35 $2,628.15 $2,875.81 $3,755.63	$3,056.80 $3,290.60 $3,538.26 $4,418.08	$3,719.25 $3,953.05 $4,200.71 $5,080.53	$662.45

Toc - Plan #11 Florida Blue (BlueCross BlueShield FL)
Expanded Bronze (EPO) BlueOptions Bronze 2119 ($0 Deductible / $0 Virtual Visits / $50 PCP Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$587.84 $667.20 $751.26 $1,049.88 $1,595.40	$1,037.54 $1,116.90 $1,200.96 $1,499.58	$1,487.24 $1,566.60 $1,650.66 $1,949.28	$1,936.94 $2,016.30 $2,100.36 $2,398.98	$449.70
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,175.68 $1,334.40 $1,502.52 $2,099.76 $3,190.80	$1,625.38 $1,784.10 $1,952.22 $2,549.46	$2,075.08 $2,233.80 $2,401.92 $2,999.16	$2,524.78 $2,683.50 $2,851.62 $3,448.86	$449.70

Toc - Plan #12 Florida Blue (BlueCross BlueShield FL)
Bronze (EPO) BlueOptions Bronze 2301S (Multilingual Available / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $9,100 $18,200 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$509.32 $578.08 $650.91 $909.65 $1,382.29	$898.95 $967.71 $1,040.54 $1,299.28	$1,288.58 $1,357.34 $1,430.17 $1,688.91	$1,678.21 $1,746.97 $1,819.80 $2,078.54	$389.63
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,018.64 $1,156.16 $1,301.82 $1,819.30 $2,764.58	$1,408.27 $1,545.79 $1,691.45 $2,208.93	$1,797.90 $1,935.42 $2,081.08 $2,598.56	$2,187.53 $2,325.05 $2,470.71 $2,988.19	$389.63

Toc - Plan #13 Florida Blue (BlueCross BlueShield FL)
Expanded Bronze (EPO) BlueOptions Bronze 2302S (Multilingual Available / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $7,500 $15,000 Annual Deductible $9,000 $18,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$547.52 $621.44 $699.73 $977.87 $1,485.97	$966.37 $1,040.29 $1,118.58 $1,396.72	$1,385.22 $1,459.14 $1,537.43 $1,815.57	$1,804.07 $1,877.99 $1,956.28 $2,234.42	$418.85
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,095.04 $1,242.88 $1,399.46 $1,955.74 $2,971.94	$1,513.89 $1,661.73 $1,818.31 $2,374.59	$1,932.74 $2,080.58 $2,237.16 $2,793.44	$2,351.59 $2,499.43 $2,656.01 $3,212.29	$418.85

Toc - Plan #14 Florida Blue (BlueCross BlueShield FL)
Silver (EPO) BlueOptions Silver 2303S ($40 PCP Visits / Multilingual Available/ Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $5,800 $11,600 Annual Deductible $8,900 $17,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$815.22 $925.27 $1,041.85 $1,455.98 $2,212.51	$1,438.86 $1,548.91 $1,665.49 $2,079.62	$2,062.50 $2,172.55 $2,289.13 $2,703.26	$2,686.14 $2,796.19 $2,912.77 $3,326.90	$623.64
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,630.44 $1,850.54 $2,083.70 $2,911.96 $4,425.02	$2,254.08 $2,474.18 $2,707.34 $3,535.60	$2,877.72 $3,097.82 $3,330.98 $4,159.24	$3,501.36 $3,721.46 $3,954.62 $4,782.88	$623.64

Toc - Plan #15 Florida Blue (BlueCross BlueShield FL)
Gold (EPO) BlueOptions Gold 2304S ($30 PCP Visits / Multilingual Available / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $2,000 $4,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$832.06 $944.39 $1,063.37 $1,486.06 $2,258.21	$1,468.59 $1,580.92 $1,699.90 $2,122.59	$2,105.12 $2,217.45 $2,336.43 $2,759.12	$2,741.65 $2,853.98 $2,972.96 $3,395.65	$636.53
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,664.12 $1,888.78 $2,126.74 $2,972.12 $4,516.42	$2,300.65 $2,525.31 $2,763.27 $3,608.65	$2,937.18 $3,161.84 $3,399.80 $4,245.18	$3,573.71 $3,798.37 $4,036.33 $4,881.71	$636.53

Toc - Plan #16 Florida Blue (BlueCross BlueShield FL)
Platinum (EPO) BlueOptions Platinum 2305S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Multilingual Available / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $3,000 $6,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$1,089.28 $1,236.33 $1,392.10 $1,945.45 $2,956.31	$1,922.58 $2,069.63 $2,225.40 $2,778.75	$2,755.88 $2,902.93 $3,058.70 $3,612.05	$3,589.18 $3,736.23 $3,892.00 $4,445.35	$833.30
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$2,178.56 $2,472.66 $2,784.20 $3,890.90 $5,912.62	$3,011.86 $3,305.96 $3,617.50 $4,724.20	$3,845.16 $4,139.26 $4,450.80 $5,557.50	$4,678.46 $4,972.56 $5,284.10 $6,390.80	$833.30

Toc - Plan #17 Florida Blue (BlueCross BlueShield FL)
Expanded Bronze (EPO) BlueOptions Bronze 2319 ($0 Deductible / $0 Virtual Visits / Multilingual Available / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$576.28 $654.08 $736.49 $1,029.24 $1,564.02	$1,017.13 $1,094.93 $1,177.34 $1,470.09	$1,457.98 $1,535.78 $1,618.19 $1,910.94	$1,898.83 $1,976.63 $2,059.04 $2,351.79	$440.85
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,152.56 $1,308.16 $1,472.98 $2,058.48 $3,128.04	$1,593.41 $1,749.01 $1,913.83 $2,499.33	$2,034.26 $2,189.86 $2,354.68 $2,940.18	$2,475.11 $2,630.71 $2,795.53 $3,381.03	$440.85

Toc - Plan #18 Florida Blue (BlueCross BlueShield FL)
Silver (EPO) BlueSelect Silver 1456 ($0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $5,950 $11,900 Annual Deductible $7,150 $14,300 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$538.58 $611.29 $688.31 $961.90 $1,461.71	$950.59 $1,023.30 $1,100.32 $1,373.91	$1,362.60 $1,435.31 $1,512.33 $1,785.92	$1,774.61 $1,847.32 $1,924.34 $2,197.93	$412.01
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,077.16 $1,222.58 $1,376.62 $1,923.80 $2,923.42	$1,489.17 $1,634.59 $1,788.63 $2,335.81	$1,901.18 $2,046.60 $2,200.64 $2,747.82	$2,313.19 $2,458.61 $2,612.65 $3,159.83	$412.01

Toc - Plan #19 Florida Blue (BlueCross BlueShield FL)
Expanded Bronze (EPO) BlueSelect Bronze 1452 ($0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $6,900 $13,800 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$405.52 $460.27 $518.25 $724.26 $1,100.58	$715.74 $770.49 $828.47 $1,034.48	$1,025.96 $1,080.71 $1,138.69 $1,344.70	$1,336.18 $1,390.93 $1,448.91 $1,654.92	$310.22
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$811.04 $920.54 $1,036.50 $1,448.52 $2,201.16	$1,121.26 $1,230.76 $1,346.72 $1,758.74	$1,431.48 $1,540.98 $1,656.94 $2,068.96	$1,741.70 $1,851.20 $1,967.16 $2,379.18	$310.22

Toc - Plan #20 Florida Blue (BlueCross BlueShield FL)
Silver (EPO) BlueSelect Silver 1464 ($0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $6,000 $12,000 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$536.91 $609.39 $686.17 $958.92 $1,457.17	$947.65 $1,020.13 $1,096.91 $1,369.66	$1,358.39 $1,430.87 $1,507.65 $1,780.40	$1,769.13 $1,841.61 $1,918.39 $2,191.14	$410.74
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,073.82 $1,218.78 $1,372.34 $1,917.84 $2,914.34	$1,484.56 $1,629.52 $1,783.08 $2,328.58	$1,895.30 $2,040.26 $2,193.82 $2,739.32	$2,306.04 $2,451.00 $2,604.56 $3,150.06	$410.74

Toc - Plan #21 Florida Blue (BlueCross BlueShield FL)
Platinum (EPO) BlueSelect Platinum 1451 ($0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $1,000 $2,000 Annual Deductible $4,000 $8,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$681.27 $773.24 $870.66 $1,216.75 $1,848.97	$1,202.44 $1,294.41 $1,391.83 $1,737.92	$1,723.61 $1,815.58 $1,913.00 $2,259.09	$2,244.78 $2,336.75 $2,434.17 $2,780.26	$521.17
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,362.54 $1,546.48 $1,741.32 $2,433.50 $3,697.94	$1,883.71 $2,067.65 $2,262.49 $2,954.67	$2,404.88 $2,588.82 $2,783.66 $3,475.84	$2,926.05 $3,109.99 $3,304.83 $3,997.01	$521.17

Toc - Plan #22 Florida Blue (BlueCross BlueShield FL)
Expanded Bronze (EPO) BlueSelect Bronze 1449 ($0 Virtual Visits / 3 PCP Visits for $0 / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $7,400 $14,800 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$418.89 $475.44 $535.34 $748.14 $1,136.87	$739.34 $795.89 $855.79 $1,068.59	$1,059.79 $1,116.34 $1,176.24 $1,389.04	$1,380.24 $1,436.79 $1,496.69 $1,709.49	$320.45
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$837.78 $950.88 $1,070.68 $1,496.28 $2,273.74	$1,158.23 $1,271.33 $1,391.13 $1,816.73	$1,478.68 $1,591.78 $1,711.58 $2,137.18	$1,799.13 $1,912.23 $2,032.03 $2,457.63	$320.45

Toc - Plan #23 Florida Blue (BlueCross BlueShield FL)
Platinum (EPO) BlueSelect Platinum 1457 ($0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $2,000 $4,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$712.94 $809.19 $911.14 $1,273.31 $1,934.92	$1,258.34 $1,354.59 $1,456.54 $1,818.71	$1,803.74 $1,899.99 $2,001.94 $2,364.11	$2,349.14 $2,445.39 $2,547.34 $2,909.51	$545.40
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,425.88 $1,618.38 $1,822.28 $2,546.62 $3,869.84	$1,971.28 $2,163.78 $2,367.68 $3,092.02	$2,516.68 $2,709.18 $2,913.08 $3,637.42	$3,062.08 $3,254.58 $3,458.48 $4,182.82	$545.40

Toc - Plan #24 Florida Blue (BlueCross BlueShield FL)
Silver (EPO) BlueSelect Silver 1443 ($0 Virtual Visits / $0 Labs / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $6,000 $12,000 Annual Deductible $7,900 $15,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$504.01 $572.05 $644.12 $900.16 $1,367.88	$889.58 $957.62 $1,029.69 $1,285.73	$1,275.15 $1,343.19 $1,415.26 $1,671.30	$1,660.72 $1,728.76 $1,800.83 $2,056.87	$385.57
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,008.02 $1,144.10 $1,288.24 $1,800.32 $2,735.76	$1,393.59 $1,529.67 $1,673.81 $2,185.89	$1,779.16 $1,915.24 $2,059.38 $2,571.46	$2,164.73 $2,300.81 $2,444.95 $2,957.03	$385.57

Toc - Plan #25 Florida Blue (BlueCross BlueShield FL)
Gold (EPO) BlueSelect Gold 1535 ($0 Virtual Visits / $20 PCP Visit / $15 Generic Meds / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $5,500 $11,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$594.69 $674.97 $760.01 $1,062.12 $1,613.99	$1,049.63 $1,129.91 $1,214.95 $1,517.06	$1,504.57 $1,584.85 $1,669.89 $1,972.00	$1,959.51 $2,039.79 $2,124.83 $2,426.94	$454.94
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,189.38 $1,349.94 $1,520.02 $2,124.24 $3,227.98	$1,644.32 $1,804.88 $1,974.96 $2,579.18	$2,099.26 $2,259.82 $2,429.90 $3,034.12	$2,554.20 $2,714.76 $2,884.84 $3,489.06	$454.94

Toc - Plan #26 Florida Blue (BlueCross BlueShield FL)
Expanded Bronze (EPO) BlueSelect Bronze (HSA) 1735 (Rewards $$$ / $4 Condition Care Rx)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $6,850 $13,700 Annual Deductible $6,850 $13,700 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$409.89 $465.23 $523.84 $732.06 $1,112.44	$723.46 $778.80 $837.41 $1,045.63	$1,037.03 $1,092.37 $1,150.98 $1,359.20	$1,350.60 $1,405.94 $1,464.55 $1,672.77	$313.57
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$819.78 $930.46 $1,047.68 $1,464.12 $2,224.88	$1,133.35 $1,244.03 $1,361.25 $1,777.69	$1,446.92 $1,557.60 $1,674.82 $2,091.26	$1,760.49 $1,871.17 $1,988.39 $2,404.83	$313.57

Toc - Plan #27 Florida Blue (BlueCross BlueShield FL)
Gold (EPO) BlueSelect Gold 1835 ($0 Virtual Visits / $20 Labs / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $1,500 $3,000 Annual Deductible $5,500 $11,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$575.31 $652.98 $735.25 $1,027.50 $1,561.39	$1,015.42 $1,093.09 $1,175.36 $1,467.61	$1,455.53 $1,533.20 $1,615.47 $1,907.72	$1,895.64 $1,973.31 $2,055.58 $2,347.83	$440.11
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,150.62 $1,305.96 $1,470.50 $2,055.00 $3,122.78	$1,590.73 $1,746.07 $1,910.61 $2,495.11	$2,030.84 $2,186.18 $2,350.72 $2,935.22	$2,470.95 $2,626.29 $2,790.83 $3,375.33	$440.11

Toc - Plan #28 Florida Blue (BlueCross BlueShield FL)
Expanded Bronze (EPO) BlueSelect Bronze 2139 ($0 Deductible / $0 Virtual Visits / $50 PCP Visit / $30 Generic Meds / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$443.83 $503.75 $567.21 $792.68 $1,204.55	$783.36 $843.28 $906.74 $1,132.21	$1,122.89 $1,182.81 $1,246.27 $1,471.74	$1,462.42 $1,522.34 $1,585.80 $1,811.27	$339.53
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$887.66 $1,007.50 $1,134.42 $1,585.36 $2,409.10	$1,227.19 $1,347.03 $1,473.95 $1,924.89	$1,566.72 $1,686.56 $1,813.48 $2,264.42	$1,906.25 $2,026.09 $2,153.01 $2,603.95	$339.53

Toc - Plan #29 Florida Blue (BlueCross BlueShield FL)
Bronze (EPO) BlueSelect Bronze 2341S (Multilingual Available / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $9,100 $18,200 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$384.67 $436.60 $491.61 $687.02 $1,043.99	$678.94 $730.87 $785.88 $981.29	$973.21 $1,025.14 $1,080.15 $1,275.56	$1,267.48 $1,319.41 $1,374.42 $1,569.83	$294.27
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$769.34 $873.20 $983.22 $1,374.04 $2,087.98	$1,063.61 $1,167.47 $1,277.49 $1,668.31	$1,357.88 $1,461.74 $1,571.76 $1,962.58	$1,652.15 $1,756.01 $1,866.03 $2,256.85	$294.27

Toc - Plan #30 Florida Blue (BlueCross BlueShield FL)
Expanded Bronze (EPO) BlueSelect Bronze 2342S (Multilingual Available / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $7,500 $15,000 Annual Deductible $9,000 $18,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$413.58 $469.41 $528.56 $738.65 $1,122.46	$729.97 $785.80 $844.95 $1,055.04	$1,046.36 $1,102.19 $1,161.34 $1,371.43	$1,362.75 $1,418.58 $1,477.73 $1,687.82	$316.39
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$827.16 $938.82 $1,057.12 $1,477.30 $2,244.92	$1,143.55 $1,255.21 $1,373.51 $1,793.69	$1,459.94 $1,571.60 $1,689.90 $2,110.08	$1,776.33 $1,887.99 $2,006.29 $2,426.47	$316.39

Toc - Plan #31 Florida Blue (BlueCross BlueShield FL)
Silver (EPO) BlueSelect Silver 2343S ($40 PCP Visits / Multilingual Available / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $5,800 $11,600 Annual Deductible $8,900 $17,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$531.50 $603.25 $679.26 $949.26 $1,442.49	$938.10 $1,009.85 $1,085.86 $1,355.86	$1,344.70 $1,416.45 $1,492.46 $1,762.46	$1,751.30 $1,823.05 $1,899.06 $2,169.06	$406.60
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,063.00 $1,206.50 $1,358.52 $1,898.52 $2,884.98	$1,469.60 $1,613.10 $1,765.12 $2,305.12	$1,876.20 $2,019.70 $2,171.72 $2,711.72	$2,282.80 $2,426.30 $2,578.32 $3,118.32	$406.60

Toc - Plan #32 Florida Blue (BlueCross BlueShield FL)
Gold (EPO) BlueSelect Gold 2344S ($30 PCP Visits / Multilingual Available / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $2,000 $4,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$552.89 $627.53 $706.59 $987.46 $1,500.54	$975.85 $1,050.49 $1,129.55 $1,410.42	$1,398.81 $1,473.45 $1,552.51 $1,833.38	$1,821.77 $1,896.41 $1,975.47 $2,256.34	$422.96
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,105.78 $1,255.06 $1,413.18 $1,974.92 $3,001.08	$1,528.74 $1,678.02 $1,836.14 $2,397.88	$1,951.70 $2,100.98 $2,259.10 $2,820.84	$2,374.66 $2,523.94 $2,682.06 $3,243.80	$422.96

Toc - Plan #33 Florida Blue (BlueCross BlueShield FL)
Platinum (EPO) BlueSelect Platinum 2345S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Multilingual Available / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $3,000 $6,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$711.12 $807.12 $908.81 $1,270.06 $1,929.98	$1,255.13 $1,351.13 $1,452.82 $1,814.07	$1,799.14 $1,895.14 $1,996.83 $2,358.08	$2,343.15 $2,439.15 $2,540.84 $2,902.09	$544.01
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,422.24 $1,614.24 $1,817.62 $2,540.12 $3,859.96	$1,966.25 $2,158.25 $2,361.63 $3,084.13	$2,510.26 $2,702.26 $2,905.64 $3,628.14	$3,054.27 $3,246.27 $3,449.65 $4,172.15	$544.01

Toc - Plan #34 Florida Blue (BlueCross BlueShield FL)
Expanded Bronze (EPO) BlueSelect Bronze 2339 ($0 Deductible / $0 Virtual Visits / Multilingual Available / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$435.27 $494.03 $556.28 $777.39 $1,181.32	$768.25 $827.01 $889.26 $1,110.37	$1,101.23 $1,159.99 $1,222.24 $1,443.35	$1,434.21 $1,492.97 $1,555.22 $1,776.33	$332.98
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$870.54 $988.06 $1,112.56 $1,554.78 $2,362.64	$1,203.52 $1,321.04 $1,445.54 $1,887.76	$1,536.50 $1,654.02 $1,778.52 $2,220.74	$1,869.48 $1,987.00 $2,111.50 $2,553.72	$332.98

Aetna CVS Health Local: 1-877-336-3915 | Toll Free: 1-877-336-3915 | TTY: 1-877-336-3915

Toc - Plan #35 Aetna CVS Health
Silver (HMO) Silver S: Aetna network of doctors & hospitals + $0 walk-in & telemedicine via MinuteClinic at CVS
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-336-3915 Annual Out of Pocket Expenses: Individual Family $5,800 $11,600 Annual Deductible $8,900 $17,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$395.75 $449.17 $505.76 $706.80 $1,074.06	$698.50 $751.92 $808.51 $1,009.55	$1,001.25 $1,054.67 $1,111.26 $1,312.30	$1,304.00 $1,357.42 $1,414.01 $1,615.05	$302.75
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$791.50 $898.34 $1,011.52 $1,413.60 $2,148.12	$1,094.25 $1,201.09 $1,314.27 $1,716.35	$1,397.00 $1,503.84 $1,617.02 $2,019.10	$1,699.75 $1,806.59 $1,919.77 $2,321.85	$302.75

Toc - Plan #36 Aetna CVS Health
Silver (HMO) Silver 2: Aetna network of doctors & hospitals + $0 walk-in & telemedicine via MinuteClinic at CVS
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-336-3915 Annual Out of Pocket Expenses: Individual Family $5,000 $10,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$427.29 $484.97 $546.07 $763.13 $1,159.66	$754.16 $811.84 $872.94 $1,090.00	$1,081.03 $1,138.71 $1,199.81 $1,416.87	$1,407.90 $1,465.58 $1,526.68 $1,743.74	$326.87
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$854.58 $969.94 $1,092.14 $1,526.26 $2,319.32	$1,181.45 $1,296.81 $1,419.01 $1,853.13	$1,508.32 $1,623.68 $1,745.88 $2,180.00	$1,835.19 $1,950.55 $2,072.75 $2,506.87	$326.87

Toc - Plan #37 Aetna CVS Health
Silver (HMO) Silver 3: Aetna network of doctors & hospitals + $0 walk-in & telemedicine via MinuteClinic at CVS
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-336-3915 Annual Out of Pocket Expenses: Individual Family $6,500 $13,000 Annual Deductible $8,850 $17,700 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$411.71 $467.30 $526.17 $735.32 $1,117.39	$726.67 $782.26 $841.13 $1,050.28	$1,041.63 $1,097.22 $1,156.09 $1,365.24	$1,356.59 $1,412.18 $1,471.05 $1,680.20	$314.96
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$823.42 $934.60 $1,052.34 $1,470.64 $2,234.78	$1,138.38 $1,249.56 $1,367.30 $1,785.60	$1,453.34 $1,564.52 $1,682.26 $2,100.56	$1,768.30 $1,879.48 $1,997.22 $2,415.52	$314.96

Toc - Plan #38 Aetna CVS Health
Expanded Bronze (HMO) Bronze S: Aetna network of doctors & hospitals + $0 walk-in & telemedicine via MinuteClinic at CVS
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-336-3915 Annual Out of Pocket Expenses: Individual Family $7,500 $15,000 Annual Deductible $9,000 $18,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$324.77 $368.61 $415.05 $580.04 $881.42	$573.22 $617.06 $663.50 $828.49	$821.67 $865.51 $911.95 $1,076.94	$1,070.12 $1,113.96 $1,160.40 $1,325.39	$248.45
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$649.54 $737.22 $830.10 $1,160.08 $1,762.84	$897.99 $985.67 $1,078.55 $1,408.53	$1,146.44 $1,234.12 $1,327.00 $1,656.98	$1,394.89 $1,482.57 $1,575.45 $1,905.43	$248.45

Toc - Plan #39 Aetna CVS Health
Silver (HMO) Silver 1: Aetna network of doctors & hospitals + $0 walk-in & telemedicine via MinuteClinic at CVS
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-336-3915 Annual Out of Pocket Expenses: Individual Family $4,425 $8,850 Annual Deductible $8,850 $17,700 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$424.29 $481.57 $542.24 $757.78 $1,151.51	$748.87 $806.15 $866.82 $1,082.36	$1,073.45 $1,130.73 $1,191.40 $1,406.94	$1,398.03 $1,455.31 $1,515.98 $1,731.52	$324.58
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$848.58 $963.14 $1,084.48 $1,515.56 $2,303.02	$1,173.16 $1,287.72 $1,409.06 $1,840.14	$1,497.74 $1,612.30 $1,733.64 $2,164.72	$1,822.32 $1,936.88 $2,058.22 $2,489.30	$324.58

Toc - Plan #40 Aetna CVS Health
Gold (HMO) Gold: Aetna network of doctors & hospitals + $0 walk-in & telemedicine via MinuteClinic at CVS
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-336-3915 Annual Out of Pocket Expenses: Individual Family $1,500 $3,000 Annual Deductible $7,000 $14,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$482.37 $547.49 $616.46 $861.51 $1,309.14	$851.38 $916.50 $985.47 $1,230.52	$1,220.39 $1,285.51 $1,354.48 $1,599.53	$1,589.40 $1,654.52 $1,723.49 $1,968.54	$369.01
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$964.74 $1,094.98 $1,232.92 $1,723.02 $2,618.28	$1,333.75 $1,463.99 $1,601.93 $2,092.03	$1,702.76 $1,833.00 $1,970.94 $2,461.04	$2,071.77 $2,202.01 $2,339.95 $2,830.05	$369.01

Toc - Plan #41 Aetna CVS Health
Gold (HMO) Gold S: Aetna network of doctors & hospitals + $0 walk-in & telemedicine via MinuteClinic at CVS
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-336-3915 Annual Out of Pocket Expenses: Individual Family $2,000 $4,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$453.52 $514.74 $579.60 $809.98 $1,230.85	$800.46 $861.68 $926.54 $1,156.92	$1,147.40 $1,208.62 $1,273.48 $1,503.86	$1,494.34 $1,555.56 $1,620.42 $1,850.80	$346.94
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$907.04 $1,029.48 $1,159.20 $1,619.96 $2,461.70	$1,253.98 $1,376.42 $1,506.14 $1,966.90	$1,600.92 $1,723.36 $1,853.08 $2,313.84	$1,947.86 $2,070.30 $2,200.02 $2,660.78	$346.94

AvMed Local: 1-800-477-8768 | Toll Free:

Toc - Plan #42 AvMed
Platinum (HMO) AvMed Entrust Platinum 25 (2023)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $3,100 $6,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$755.40 $857.38 $965.41 $1,349.15 $2,050.16	$1,333.28 $1,435.26 $1,543.29 $1,927.03	$1,911.16 $2,013.14 $2,121.17 $2,504.91	$2,489.04 $2,591.02 $2,699.05 $3,082.79	$577.88
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,510.80 $1,714.76 $1,930.82 $2,698.30 $4,100.32	$2,088.68 $2,292.64 $2,508.70 $3,276.18	$2,666.56 $2,870.52 $3,086.58 $3,854.06	$3,244.44 $3,448.40 $3,664.46 $4,431.94	$577.88

Toc - Plan #43 AvMed
Gold (HMO) AvMed Entrust Gold 125 (2023)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: Annual Out of Pocket Expenses: Individual Family $2,000 $4,000 Annual Deductible $4,700 $9,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$527.74 $598.99 $674.46 $942.55 $1,432.29	$931.46 $1,002.71 $1,078.18 $1,346.27	$1,335.18 $1,406.43 $1,481.90 $1,749.99	$1,738.90 $1,810.15 $1,885.62 $2,153.71	$403.72
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,055.48 $1,197.98 $1,348.92 $1,885.10 $2,864.58	$1,459.20 $1,601.70 $1,752.64 $2,288.82	$1,862.92 $2,005.42 $2,156.36 $2,692.54	$2,266.64 $2,409.14 $2,560.08 $3,096.26	$403.72

Toc - Plan #44 AvMed
Silver (HMO) AvMed Entrust Silver 300 (2023)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: Annual Out of Pocket Expenses: Individual Family $3,000 $6,000 Annual Deductible $7,650 $15,300 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$515.01 $584.54 $658.18 $919.81 $1,397.74	$908.99 $978.52 $1,052.16 $1,313.79	$1,302.97 $1,372.50 $1,446.14 $1,707.77	$1,696.95 $1,766.48 $1,840.12 $2,101.75	$393.98
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,030.02 $1,169.08 $1,316.36 $1,839.62 $2,795.48	$1,424.00 $1,563.06 $1,710.34 $2,233.60	$1,817.98 $1,957.04 $2,104.32 $2,627.58	$2,211.96 $2,351.02 $2,498.30 $3,021.56	$393.98

Toc - Plan #45 AvMed
Silver (HMO) AvMed Entrust Silver 350 (2023)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: Annual Out of Pocket Expenses: Individual Family $3,500 $7,000 Annual Deductible $7,800 $15,600 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$495.69 $562.60 $633.49 $885.29 $1,345.29	$874.89 $941.80 $1,012.69 $1,264.49	$1,254.09 $1,321.00 $1,391.89 $1,643.69	$1,633.29 $1,700.20 $1,771.09 $2,022.89	$379.20
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$991.38 $1,125.20 $1,266.98 $1,770.58 $2,690.58	$1,370.58 $1,504.40 $1,646.18 $2,149.78	$1,749.78 $1,883.60 $2,025.38 $2,528.98	$2,128.98 $2,262.80 $2,404.58 $2,908.18	$379.20

Toc - Plan #46 AvMed
Silver (HMO) AvMed Entrust Silver 500 (2023)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: Annual Out of Pocket Expenses: Individual Family $5,500 $11,000 Annual Deductible $7,000 $14,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$492.79 $559.32 $629.79 $880.12 $1,337.43	$869.77 $936.30 $1,006.77 $1,257.10	$1,246.75 $1,313.28 $1,383.75 $1,634.08	$1,623.73 $1,690.26 $1,760.73 $2,011.06	$376.98
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$985.58 $1,118.64 $1,259.58 $1,760.24 $2,674.86	$1,362.56 $1,495.62 $1,636.56 $2,137.22	$1,739.54 $1,872.60 $2,013.54 $2,514.20	$2,116.52 $2,249.58 $2,390.52 $2,891.18	$376.98

Toc - Plan #47 AvMed
Silver (HMO) AvMed Entrust Silver 550 (2023)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: Annual Out of Pocket Expenses: Individual Family $6,500 $13,000 Annual Deductible $7,000 $14,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$489.82 $555.95 $626.00 $874.83 $1,329.38	$864.54 $930.67 $1,000.72 $1,249.55	$1,239.26 $1,305.39 $1,375.44 $1,624.27	$1,613.98 $1,680.11 $1,750.16 $1,998.99	$374.72
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$979.64 $1,111.90 $1,252.00 $1,749.66 $2,658.76	$1,354.36 $1,486.62 $1,626.72 $2,124.38	$1,729.08 $1,861.34 $2,001.44 $2,499.10	$2,103.80 $2,236.06 $2,376.16 $2,873.82	$374.72

Toc - Plan #48 AvMed
Expanded Bronze (HMO) AvMed Entrust Bronze 600 (2023)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: Annual Out of Pocket Expenses: Individual Family $6,500 $13,000 Annual Deductible $7,900 $15,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$404.27 $458.85 $516.66 $722.03 $1,097.20	$713.54 $768.12 $825.93 $1,031.30	$1,022.81 $1,077.39 $1,135.20 $1,340.57	$1,332.08 $1,386.66 $1,444.47 $1,649.84	$309.27
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$808.54 $917.70 $1,033.32 $1,444.06 $2,194.40	$1,117.81 $1,226.97 $1,342.59 $1,753.33	$1,427.08 $1,536.24 $1,651.86 $2,062.60	$1,736.35 $1,845.51 $1,961.13 $2,371.87	$309.27

Toc - Plan #49 AvMed
Expanded Bronze (HMO) AvMed Entrust Bronze 650 (2023)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: Annual Out of Pocket Expenses: Individual Family $8,200 $16,400 Annual Deductible $8,200 $16,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$390.20 $442.87 $498.67 $696.89 $1,059.00	$688.70 $741.37 $797.17 $995.39	$987.20 $1,039.87 $1,095.67 $1,293.89	$1,285.70 $1,338.37 $1,394.17 $1,592.39	$298.50
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$780.40 $885.74 $997.34 $1,393.78 $2,118.00	$1,078.90 $1,184.24 $1,295.84 $1,692.28	$1,377.40 $1,482.74 $1,594.34 $1,990.78	$1,675.90 $1,781.24 $1,892.84 $2,289.28	$298.50

Toc - Plan #50 AvMed
Catastrophic (HMO) AvMed Entrust Catastrophic 100 (2023)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: Annual Out of Pocket Expenses: Individual Family $9,100 $18,200 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$319.35 $362.46 $408.13 $570.35 $866.71	$563.65 $606.76 $652.43 $814.65	$807.95 $851.06 $896.73 $1,058.95	$1,052.25 $1,095.36 $1,141.03 $1,303.25	$244.30
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$638.70 $724.92 $816.26 $1,140.70 $1,733.42	$883.00 $969.22 $1,060.56 $1,385.00	$1,127.30 $1,213.52 $1,304.86 $1,629.30	$1,371.60 $1,457.82 $1,549.16 $1,873.60	$244.30

Toc - Plan #51 AvMed
Platinum (HMO) AvMed Entrust Platinum Standard (2023)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $3,000 $6,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$756.20 $858.29 $966.42 $1,350.57 $2,052.32	$1,334.69 $1,436.78 $1,544.91 $1,929.06	$1,913.18 $2,015.27 $2,123.40 $2,507.55	$2,491.67 $2,593.76 $2,701.89 $3,086.04	$578.49
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,512.40 $1,716.58 $1,932.84 $2,701.14 $4,104.64	$2,090.89 $2,295.07 $2,511.33 $3,279.63	$2,669.38 $2,873.56 $3,089.82 $3,858.12	$3,247.87 $3,452.05 $3,668.31 $4,436.61	$578.49

Toc - Plan #52 AvMed
Gold (HMO) AvMed Entrust Gold Standard (2023)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: Annual Out of Pocket Expenses: Individual Family $2,000 $4,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$524.19 $594.95 $669.91 $936.19 $1,422.64	$925.19 $995.95 $1,070.91 $1,337.19	$1,326.19 $1,396.95 $1,471.91 $1,738.19	$1,727.19 $1,797.95 $1,872.91 $2,139.19	$401.00
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,048.38 $1,189.90 $1,339.82 $1,872.38 $2,845.28	$1,449.38 $1,590.90 $1,740.82 $2,273.38	$1,850.38 $1,991.90 $2,141.82 $2,674.38	$2,251.38 $2,392.90 $2,542.82 $3,075.38	$401.00

Toc - Plan #53 AvMed
Silver (HMO) AvMed Entrust Silver Standard (2023)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: Annual Out of Pocket Expenses: Individual Family $5,800 $11,600 Annual Deductible $8,900 $17,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$475.28 $539.44 $607.41 $848.85 $1,289.91	$838.87 $903.03 $971.00 $1,212.44	$1,202.46 $1,266.62 $1,334.59 $1,576.03	$1,566.05 $1,630.21 $1,698.18 $1,939.62	$363.59
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$950.56 $1,078.88 $1,214.82 $1,697.70 $2,579.82	$1,314.15 $1,442.47 $1,578.41 $2,061.29	$1,677.74 $1,806.06 $1,942.00 $2,424.88	$2,041.33 $2,169.65 $2,305.59 $2,788.47	$363.59

Toc - Plan #54 AvMed
Expanded Bronze (HMO) AvMed Entrust Expanded Bronze Standard (2023)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: Annual Out of Pocket Expenses: Individual Family $7,500 $15,000 Annual Deductible $9,000 $18,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$401.55 $455.76 $513.19 $717.17 $1,089.82	$708.74 $762.95 $820.38 $1,024.36	$1,015.93 $1,070.14 $1,127.57 $1,331.55	$1,323.12 $1,377.33 $1,434.76 $1,638.74	$307.19
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$803.10 $911.52 $1,026.38 $1,434.34 $2,179.64	$1,110.29 $1,218.71 $1,333.57 $1,741.53	$1,417.48 $1,525.90 $1,640.76 $2,048.72	$1,724.67 $1,833.09 $1,947.95 $2,355.91	$307.19

Toc - Plan #55 AvMed
Platinum (HMO) AvMed Entrust Platinum 25 Dental+Vision (2023)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $3,100 $6,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$760.32 $862.96 $971.68 $1,357.92 $2,063.50	$1,341.96 $1,444.60 $1,553.32 $1,939.56	$1,923.60 $2,026.24 $2,134.96 $2,521.20	$2,505.24 $2,607.88 $2,716.60 $3,102.84	$581.64
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,520.64 $1,725.92 $1,943.36 $2,715.84 $4,127.00	$2,102.28 $2,307.56 $2,525.00 $3,297.48	$2,683.92 $2,889.20 $3,106.64 $3,879.12	$3,265.56 $3,470.84 $3,688.28 $4,460.76	$581.64

Toc - Plan #56 AvMed
Gold (HMO) AvMed Entrust Gold 125 Dental+Vision (2023)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: Annual Out of Pocket Expenses: Individual Family $2,000 $4,000 Annual Deductible $4,700 $9,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$532.86 $604.80 $680.99 $951.69 $1,446.18	$940.50 $1,012.44 $1,088.63 $1,359.33	$1,348.14 $1,420.08 $1,496.27 $1,766.97	$1,755.78 $1,827.72 $1,903.91 $2,174.61	$407.64
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,065.72 $1,209.60 $1,361.98 $1,903.38 $2,892.36	$1,473.36 $1,617.24 $1,769.62 $2,311.02	$1,881.00 $2,024.88 $2,177.26 $2,718.66	$2,288.64 $2,432.52 $2,584.90 $3,126.30	$407.64

Toc - Plan #57 AvMed
Silver (HMO) AvMed Entrust Silver 300 Dental+Vision (2023)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: Annual Out of Pocket Expenses: Individual Family $3,000 $6,000 Annual Deductible $7,650 $15,300 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$520.11 $590.32 $664.70 $928.91 $1,411.57	$917.99 $988.20 $1,062.58 $1,326.79	$1,315.87 $1,386.08 $1,460.46 $1,724.67	$1,713.75 $1,783.96 $1,858.34 $2,122.55	$397.88
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,040.22 $1,180.64 $1,329.40 $1,857.82 $2,823.14	$1,438.10 $1,578.52 $1,727.28 $2,255.70	$1,835.98 $1,976.40 $2,125.16 $2,653.58	$2,233.86 $2,374.28 $2,523.04 $3,051.46	$397.88

Toc - Plan #58 AvMed
Silver (HMO) AvMed Entrust Silver 350 Dental+Vision (2023)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: Annual Out of Pocket Expenses: Individual Family $3,500 $7,000 Annual Deductible $7,800 $15,600 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$500.79 $568.40 $640.01 $894.42 $1,359.15	$883.90 $951.51 $1,023.12 $1,277.53	$1,267.01 $1,334.62 $1,406.23 $1,660.64	$1,650.12 $1,717.73 $1,789.34 $2,043.75	$383.11
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,001.58 $1,136.80 $1,280.02 $1,788.84 $2,718.30	$1,384.69 $1,519.91 $1,663.13 $2,171.95	$1,767.80 $1,903.02 $2,046.24 $2,555.06	$2,150.91 $2,286.13 $2,429.35 $2,938.17	$383.11

Toc - Plan #59 AvMed
Silver (HMO) AvMed Entrust Silver 500 Dental+Vision (2023)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: Annual Out of Pocket Expenses: Individual Family $5,500 $11,000 Annual Deductible $7,000 $14,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$497.87 $565.08 $636.27 $889.19 $1,351.21	$878.74 $945.95 $1,017.14 $1,270.06	$1,259.61 $1,326.82 $1,398.01 $1,650.93	$1,640.48 $1,707.69 $1,778.88 $2,031.80	$380.87
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$995.74 $1,130.16 $1,272.54 $1,778.38 $2,702.42	$1,376.61 $1,511.03 $1,653.41 $2,159.25	$1,757.48 $1,891.90 $2,034.28 $2,540.12	$2,138.35 $2,272.77 $2,415.15 $2,920.99	$380.87

Toc - Plan #60 AvMed
Silver (HMO) AvMed Entrust Silver 550 Dental+Vision (2023)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: Annual Out of Pocket Expenses: Individual Family $6,500 $13,000 Annual Deductible $7,000 $14,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$494.92 $561.74 $632.51 $883.93 $1,343.22	$873.53 $940.35 $1,011.12 $1,262.54	$1,252.14 $1,318.96 $1,389.73 $1,641.15	$1,630.75 $1,697.57 $1,768.34 $2,019.76	$378.61
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$989.84 $1,123.48 $1,265.02 $1,767.86 $2,686.44	$1,368.45 $1,502.09 $1,643.63 $2,146.47	$1,747.06 $1,880.70 $2,022.24 $2,525.08	$2,125.67 $2,259.31 $2,400.85 $2,903.69	$378.61

Toc - Plan #61 AvMed
Expanded Bronze (HMO) AvMed Entrust Bronze 625 Dental+Vision (2023)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $8,350 $16,700 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$501.27 $568.94 $640.62 $895.27 $1,360.45	$884.74 $952.41 $1,024.09 $1,278.74	$1,268.21 $1,335.88 $1,407.56 $1,662.21	$1,651.68 $1,719.35 $1,791.03 $2,045.68	$383.47
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,002.54 $1,137.88 $1,281.24 $1,790.54 $2,720.90	$1,386.01 $1,521.35 $1,664.71 $2,174.01	$1,769.48 $1,904.82 $2,048.18 $2,557.48	$2,152.95 $2,288.29 $2,431.65 $2,940.95	$383.47

Ambetter from Sunshine Health Local: 1-877-687-1169 | Toll Free: 1-877-687-1169 | TTY: 1-800-955-8770

Toc - Plan #62 Ambetter from Sunshine Health
Gold (EPO) Complete Gold
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $1,450 $2,900 Annual Deductible $7,500 $15,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$432.09 $490.41 $552.20 $771.70 $1,172.67	$762.63 $820.95 $882.74 $1,102.24	$1,093.17 $1,151.49 $1,213.28 $1,432.78	$1,423.71 $1,482.03 $1,543.82 $1,763.32	$330.54
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$864.18 $980.82 $1,104.40 $1,543.40 $2,345.34	$1,194.72 $1,311.36 $1,434.94 $1,873.94	$1,525.26 $1,641.90 $1,765.48 $2,204.48	$1,855.80 $1,972.44 $2,096.02 $2,535.02	$330.54

Toc - Plan #63 Ambetter from Sunshine Health
Bronze (EPO) Clear Bronze
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $8,600 $17,200 Annual Deductible $8,600 $17,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$322.18 $365.66 $411.73 $575.39 $874.36	$568.64 $612.12 $658.19 $821.85	$815.10 $858.58 $904.65 $1,068.31	$1,061.56 $1,105.04 $1,151.11 $1,314.77	$246.46
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$644.36 $731.32 $823.46 $1,150.78 $1,748.72	$890.82 $977.78 $1,069.92 $1,397.24	$1,137.28 $1,224.24 $1,316.38 $1,643.70	$1,383.74 $1,470.70 $1,562.84 $1,890.16	$246.46

Toc - Plan #64 Ambetter from Sunshine Health
Expanded Bronze (EPO) Choice Bronze HSA
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $6,900 $13,800 Annual Deductible $6,900 $13,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$354.81 $402.70 $453.44 $633.68 $962.93	$626.23 $674.12 $724.86 $905.10	$897.65 $945.54 $996.28 $1,176.52	$1,169.07 $1,216.96 $1,267.70 $1,447.94	$271.42
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$709.62 $805.40 $906.88 $1,267.36 $1,925.86	$981.04 $1,076.82 $1,178.30 $1,538.78	$1,252.46 $1,348.24 $1,449.72 $1,810.20	$1,523.88 $1,619.66 $1,721.14 $2,081.62	$271.42

Toc - Plan #65 Ambetter from Sunshine Health
Silver (EPO) Everyday Silver
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $6,500 $13,000 Annual Deductible $8,400 $16,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$436.70 $495.65 $558.09 $779.93 $1,185.18	$770.77 $829.72 $892.16 $1,114.00	$1,104.84 $1,163.79 $1,226.23 $1,448.07	$1,438.91 $1,497.86 $1,560.30 $1,782.14	$334.07
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$873.40 $991.30 $1,116.18 $1,559.86 $2,370.36	$1,207.47 $1,325.37 $1,450.25 $1,893.93	$1,541.54 $1,659.44 $1,784.32 $2,228.00	$1,875.61 $1,993.51 $2,118.39 $2,562.07	$334.07

Toc - Plan #66 Ambetter from Sunshine Health
Expanded Bronze (EPO) Everyday Bronze
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $8,300 $16,600 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$346.41 $393.17 $442.70 $618.68 $940.14	$611.41 $658.17 $707.70 $883.68	$876.41 $923.17 $972.70 $1,148.68	$1,141.41 $1,188.17 $1,237.70 $1,413.68	$265.00
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$692.82 $786.34 $885.40 $1,237.36 $1,880.28	$957.82 $1,051.34 $1,150.40 $1,502.36	$1,222.82 $1,316.34 $1,415.40 $1,767.36	$1,487.82 $1,581.34 $1,680.40 $2,032.36	$265.00

Toc - Plan #67 Ambetter from Sunshine Health
Expanded Bronze (EPO) Elite Bronze
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$397.02 $450.61 $507.38 $709.06 $1,077.48	$700.73 $754.32 $811.09 $1,012.77	$1,004.44 $1,058.03 $1,114.80 $1,316.48	$1,308.15 $1,361.74 $1,418.51 $1,620.19	$303.71
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$794.04 $901.22 $1,014.76 $1,418.12 $2,154.96	$1,097.75 $1,204.93 $1,318.47 $1,721.83	$1,401.46 $1,508.64 $1,622.18 $2,025.54	$1,705.17 $1,812.35 $1,925.89 $2,329.25	$303.71

Toc - Plan #68 Ambetter from Sunshine Health
Silver (EPO) Clear Silver
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $5,400 $10,800 Annual Deductible $5,400 $10,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$431.48 $489.72 $551.42 $770.61 $1,171.01	$761.56 $819.80 $881.50 $1,100.69	$1,091.64 $1,149.88 $1,211.58 $1,430.77	$1,421.72 $1,479.96 $1,541.66 $1,760.85	$330.08
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$862.96 $979.44 $1,102.84 $1,541.22 $2,342.02	$1,193.04 $1,309.52 $1,432.92 $1,871.30	$1,523.12 $1,639.60 $1,763.00 $2,201.38	$1,853.20 $1,969.68 $2,093.08 $2,531.46	$330.08

Toc - Plan #69 Ambetter from Sunshine Health
Silver (EPO) Focused Silver
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $6,100 $12,200 Annual Deductible $7,500 $15,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$435.14 $493.87 $556.09 $777.14 $1,180.93	$768.01 $826.74 $888.96 $1,110.01	$1,100.88 $1,159.61 $1,221.83 $1,442.88	$1,433.75 $1,492.48 $1,554.70 $1,775.75	$332.87
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$870.28 $987.74 $1,112.18 $1,554.28 $2,361.86	$1,203.15 $1,320.61 $1,445.05 $1,887.15	$1,536.02 $1,653.48 $1,777.92 $2,220.02	$1,868.89 $1,986.35 $2,110.79 $2,552.89	$332.87

Toc - Plan #70 Ambetter from Sunshine Health
Gold (EPO) Everyday Gold
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $750 $1,500 Annual Deductible $7,500 $15,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$412.34 $467.99 $526.95 $736.41 $1,119.05	$727.77 $783.42 $842.38 $1,051.84	$1,043.20 $1,098.85 $1,157.81 $1,367.27	$1,358.63 $1,414.28 $1,473.24 $1,682.70	$315.43
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$824.68 $935.98 $1,053.90 $1,472.82 $2,238.10	$1,140.11 $1,251.41 $1,369.33 $1,788.25	$1,455.54 $1,566.84 $1,684.76 $2,103.68	$1,770.97 $1,882.27 $2,000.19 $2,419.11	$315.43

Toc - Plan #71 Ambetter from Sunshine Health
Silver (EPO) Enhanced Silver
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $3,850 $7,700 Annual Deductible $8,600 $17,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$437.70 $496.78 $559.37 $781.72 $1,187.90	$772.54 $831.62 $894.21 $1,116.56	$1,107.38 $1,166.46 $1,229.05 $1,451.40	$1,442.22 $1,501.30 $1,563.89 $1,786.24	$334.84
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$875.40 $993.56 $1,118.74 $1,563.44 $2,375.80	$1,210.24 $1,328.40 $1,453.58 $1,898.28	$1,545.08 $1,663.24 $1,788.42 $2,233.12	$1,879.92 $1,998.08 $2,123.26 $2,567.96	$334.84

Toc - Plan #72 Ambetter from Sunshine Health
Gold (EPO) Elite Gold
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $5,000 $10,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$479.78 $544.54 $613.15 $856.87 $1,302.10	$846.80 $911.56 $980.17 $1,223.89	$1,213.82 $1,278.58 $1,347.19 $1,590.91	$1,580.84 $1,645.60 $1,714.21 $1,957.93	$367.02
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$959.56 $1,089.08 $1,226.30 $1,713.74 $2,604.20	$1,326.58 $1,456.10 $1,593.32 $2,080.76	$1,693.60 $1,823.12 $1,960.34 $2,447.78	$2,060.62 $2,190.14 $2,327.36 $2,814.80	$367.02

Toc - Plan #73 Ambetter from Sunshine Health
Expanded Bronze (EPO) CMS Standard Expanded Bronze
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $7,500 $15,000 Annual Deductible $9,000 $18,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$339.93 $385.81 $434.42 $607.10 $922.55	$599.97 $645.85 $694.46 $867.14	$860.01 $905.89 $954.50 $1,127.18	$1,120.05 $1,165.93 $1,214.54 $1,387.22	$260.04
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$679.86 $771.62 $868.84 $1,214.20 $1,845.10	$939.90 $1,031.66 $1,128.88 $1,474.24	$1,199.94 $1,291.70 $1,388.92 $1,734.28	$1,459.98 $1,551.74 $1,648.96 $1,994.32	$260.04

Toc - Plan #74 Ambetter from Sunshine Health
Silver (EPO) CMS Standard Silver
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $5,800 $11,600 Annual Deductible $8,900 $17,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$431.22 $489.42 $551.09 $770.14 $1,170.30	$761.10 $819.30 $880.97 $1,100.02	$1,090.98 $1,149.18 $1,210.85 $1,429.90	$1,420.86 $1,479.06 $1,540.73 $1,759.78	$329.88
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$862.44 $978.84 $1,102.18 $1,540.28 $2,340.60	$1,192.32 $1,308.72 $1,432.06 $1,870.16	$1,522.20 $1,638.60 $1,761.94 $2,200.04	$1,852.08 $1,968.48 $2,091.82 $2,529.92	$329.88

Toc - Plan #75 Ambetter from Sunshine Health
Gold (EPO) CMS Standard Gold
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $2,000 $4,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$403.81 $458.31 $516.05 $721.18 $1,095.91	$712.72 $767.22 $824.96 $1,030.09	$1,021.63 $1,076.13 $1,133.87 $1,339.00	$1,330.54 $1,385.04 $1,442.78 $1,647.91	$308.91
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$807.62 $916.62 $1,032.10 $1,442.36 $2,191.82	$1,116.53 $1,225.53 $1,341.01 $1,751.27	$1,425.44 $1,534.44 $1,649.92 $2,060.18	$1,734.35 $1,843.35 $1,958.83 $2,369.09	$308.91

Toc - Plan #76 Ambetter from Sunshine Health
Silver (EPO) Everyday Silver + Vision + Adult Dental
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $6,500 $13,000 Annual Deductible $8,400 $16,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$452.90 $514.03 $578.80 $808.87 $1,229.15	$799.36 $860.49 $925.26 $1,155.33	$1,145.82 $1,206.95 $1,271.72 $1,501.79	$1,492.28 $1,553.41 $1,618.18 $1,848.25	$346.46
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$905.80 $1,028.06 $1,157.60 $1,617.74 $2,458.30	$1,252.26 $1,374.52 $1,504.06 $1,964.20	$1,598.72 $1,720.98 $1,850.52 $2,310.66	$1,945.18 $2,067.44 $2,196.98 $2,657.12	$346.46

Toc - Plan #77 Ambetter from Sunshine Health
Expanded Bronze (EPO) Choice Bronze HSA + Vision + Adult Dental
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $6,900 $13,800 Annual Deductible $6,900 $13,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$367.97 $417.64 $470.26 $657.18 $998.65	$649.46 $699.13 $751.75 $938.67	$930.95 $980.62 $1,033.24 $1,220.16	$1,212.44 $1,262.11 $1,314.73 $1,501.65	$281.49
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$735.94 $835.28 $940.52 $1,314.36 $1,997.30	$1,017.43 $1,116.77 $1,222.01 $1,595.85	$1,298.92 $1,398.26 $1,503.50 $1,877.34	$1,580.41 $1,679.75 $1,784.99 $2,158.83	$281.49

Toc - Plan #78 Ambetter from Sunshine Health
Gold (EPO) Complete Gold + Vision + Adult Dental
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $1,450 $2,900 Annual Deductible $7,500 $15,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$448.12 $508.60 $572.68 $800.32 $1,216.17	$790.92 $851.40 $915.48 $1,143.12	$1,133.72 $1,194.20 $1,258.28 $1,485.92	$1,476.52 $1,537.00 $1,601.08 $1,828.72	$342.80
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$896.24 $1,017.20 $1,145.36 $1,600.64 $2,432.34	$1,239.04 $1,360.00 $1,488.16 $1,943.44	$1,581.84 $1,702.80 $1,830.96 $2,286.24	$1,924.64 $2,045.60 $2,173.76 $2,629.04	$342.80

Toc - Plan #79 Ambetter from Sunshine Health
Bronze (EPO) Clear Bronze + Vision + Adult Dental
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $8,600 $17,200 Annual Deductible $8,600 $17,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$334.13 $379.22 $427.00 $596.74 $906.80	$589.73 $634.82 $682.60 $852.34	$845.33 $890.42 $938.20 $1,107.94	$1,100.93 $1,146.02 $1,193.80 $1,363.54	$255.60
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$668.26 $758.44 $854.00 $1,193.48 $1,813.60	$923.86 $1,014.04 $1,109.60 $1,449.08	$1,179.46 $1,269.64 $1,365.20 $1,704.68	$1,435.06 $1,525.24 $1,620.80 $1,960.28	$255.60

Toc - Plan #80 Ambetter from Sunshine Health
Silver (EPO) Clear Silver + Vision + Adult Dental
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $5,400 $10,800 Annual Deductible $5,400 $10,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$447.49 $507.89 $571.88 $799.19 $1,214.45	$789.81 $850.21 $914.20 $1,141.51	$1,132.13 $1,192.53 $1,256.52 $1,483.83	$1,474.45 $1,534.85 $1,598.84 $1,826.15	$342.32
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$894.98 $1,015.78 $1,143.76 $1,598.38 $2,428.90	$1,237.30 $1,358.10 $1,486.08 $1,940.70	$1,579.62 $1,700.42 $1,828.40 $2,283.02	$1,921.94 $2,042.74 $2,170.72 $2,625.34	$342.32

Toc - Plan #81 Ambetter from Sunshine Health
Silver (EPO) Enhanced Silver + Vision + Adult Dental
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $3,850 $7,700 Annual Deductible $8,600 $17,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$453.94 $515.21 $580.12 $810.72 $1,231.97	$801.20 $862.47 $927.38 $1,157.98	$1,148.46 $1,209.73 $1,274.64 $1,505.24	$1,495.72 $1,556.99 $1,621.90 $1,852.50	$347.26
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$907.88 $1,030.42 $1,160.24 $1,621.44 $2,463.94	$1,255.14 $1,377.68 $1,507.50 $1,968.70	$1,602.40 $1,724.94 $1,854.76 $2,315.96	$1,949.66 $2,072.20 $2,202.02 $2,663.22	$347.26

Toc - Plan #82 Ambetter from Sunshine Health
Gold (EPO) Elite Gold + Vision + Adult Dental
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $5,000 $10,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$497.58 $564.74 $635.89 $888.66 $1,350.40	$878.22 $945.38 $1,016.53 $1,269.30	$1,258.86 $1,326.02 $1,397.17 $1,649.94	$1,639.50 $1,706.66 $1,777.81 $2,030.58	$380.64
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$995.16 $1,129.48 $1,271.78 $1,777.32 $2,700.80	$1,375.80 $1,510.12 $1,652.42 $2,157.96	$1,756.44 $1,890.76 $2,033.06 $2,538.60	$2,137.08 $2,271.40 $2,413.70 $2,919.24	$380.64

Toc - Plan #83 Ambetter from Sunshine Health
Expanded Bronze (EPO) Everyday Bronze + Vision + Adult Dental
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $8,300 $16,600 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$359.26 $407.75 $459.13 $641.63 $975.02	$634.09 $682.58 $733.96 $916.46	$908.92 $957.41 $1,008.79 $1,191.29	$1,183.75 $1,232.24 $1,283.62 $1,466.12	$274.83
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$718.52 $815.50 $918.26 $1,283.26 $1,950.04	$993.35 $1,090.33 $1,193.09 $1,558.09	$1,268.18 $1,365.16 $1,467.92 $1,832.92	$1,543.01 $1,639.99 $1,742.75 $2,107.75	$274.83

Toc - Plan #84 Ambetter from Sunshine Health
Expanded Bronze (EPO) Elite Bronze + Vision + Adult Dental
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$411.75 $467.32 $526.20 $735.36 $1,117.45	$726.73 $782.30 $841.18 $1,050.34	$1,041.71 $1,097.28 $1,156.16 $1,365.32	$1,356.69 $1,412.26 $1,471.14 $1,680.30	$314.98
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$823.50 $934.64 $1,052.40 $1,470.72 $2,234.90	$1,138.48 $1,249.62 $1,367.38 $1,785.70	$1,453.46 $1,564.60 $1,682.36 $2,100.68	$1,768.44 $1,879.58 $1,997.34 $2,415.66	$314.98

Toc - Plan #85 Ambetter from Sunshine Health
Silver (EPO) Focused Silver + Vision + Adult Dental
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $6,100 $12,200 Annual Deductible $7,500 $15,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$451.28 $512.19 $576.72 $805.96 $1,224.74	$796.50 $857.41 $921.94 $1,151.18	$1,141.72 $1,202.63 $1,267.16 $1,496.40	$1,486.94 $1,547.85 $1,612.38 $1,841.62	$345.22
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$902.56 $1,024.38 $1,153.44 $1,611.92 $2,449.48	$1,247.78 $1,369.60 $1,498.66 $1,957.14	$1,593.00 $1,714.82 $1,843.88 $2,302.36	$1,938.22 $2,060.04 $2,189.10 $2,647.58	$345.22

Toc - Plan #86 Ambetter from Sunshine Health
Gold (EPO) Everyday Gold + Vision + Adult Dental
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $750 $1,500 Annual Deductible $7,500 $15,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$427.63 $485.35 $546.50 $763.73 $1,160.56	$754.76 $812.48 $873.63 $1,090.86	$1,081.89 $1,139.61 $1,200.76 $1,417.99	$1,409.02 $1,466.74 $1,527.89 $1,745.12	$327.13
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$855.26 $970.70 $1,093.00 $1,527.46 $2,321.12	$1,182.39 $1,297.83 $1,420.13 $1,854.59	$1,509.52 $1,624.96 $1,747.26 $2,181.72	$1,836.65 $1,952.09 $2,074.39 $2,508.85	$327.13

Florida Blue HMO (a BlueCross BlueShield FL company) Local: 1-800-352-2583 | Toll Free: 1-800-352-2583 | TTY: 1-800-955-8771

Toc - Plan #87 Florida Blue HMO (a BlueCross BlueShield FL company)
Platinum (HMO) BlueCare Platinum 2151 ($0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $2,000 $4,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$899.08 $1,020.46 $1,149.02 $1,605.76 $2,440.10	$1,586.88 $1,708.26 $1,836.82 $2,293.56	$2,274.68 $2,396.06 $2,524.62 $2,981.36	$2,962.48 $3,083.86 $3,212.42 $3,669.16	$687.80
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,798.16 $2,040.92 $2,298.04 $3,211.52 $4,880.20	$2,485.96 $2,728.72 $2,985.84 $3,899.32	$3,173.76 $3,416.52 $3,673.64 $4,587.12	$3,861.56 $4,104.32 $4,361.44 $5,274.92	$687.80

Toc - Plan #88 Florida Blue HMO (a BlueCross BlueShield FL company)
Expanded Bronze (HMO) BlueCare Bronze 2153 ($0 Virtual Visits / 3 PCP Visits for $0 / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $7,400 $14,800 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$528.56 $599.92 $675.50 $944.01 $1,434.51	$932.91 $1,004.27 $1,079.85 $1,348.36	$1,337.26 $1,408.62 $1,484.20 $1,752.71	$1,741.61 $1,812.97 $1,888.55 $2,157.06	$404.35
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,057.12 $1,199.84 $1,351.00 $1,888.02 $2,869.02	$1,461.47 $1,604.19 $1,755.35 $2,292.37	$1,865.82 $2,008.54 $2,159.70 $2,696.72	$2,270.17 $2,412.89 $2,564.05 $3,101.07	$404.35

Toc - Plan #89 Florida Blue HMO (a BlueCross BlueShield FL company)
Expanded Bronze (HMO) BlueCare Bronze 2154 ($0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $6,900 $13,800 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$498.67 $565.99 $637.30 $890.62 $1,353.39	$880.15 $947.47 $1,018.78 $1,272.10	$1,261.63 $1,328.95 $1,400.26 $1,653.58	$1,643.11 $1,710.43 $1,781.74 $2,035.06	$381.48
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$997.34 $1,131.98 $1,274.60 $1,781.24 $2,706.78	$1,378.82 $1,513.46 $1,656.08 $2,162.72	$1,760.30 $1,894.94 $2,037.56 $2,544.20	$2,141.78 $2,276.42 $2,419.04 $2,925.68	$381.48

Toc - Plan #90 Florida Blue HMO (a BlueCross BlueShield FL company)
Gold (HMO) BlueCare Gold 2156 ($0 Virtual Visits / $20 PCP Visit / $15 Generic Meds / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $5,500 $11,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$793.29 $900.38 $1,013.82 $1,416.82 $2,152.99	$1,400.16 $1,507.25 $1,620.69 $2,023.69	$2,007.03 $2,114.12 $2,227.56 $2,630.56	$2,613.90 $2,720.99 $2,834.43 $3,237.43	$606.87
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,586.58 $1,800.76 $2,027.64 $2,833.64 $4,305.98	$2,193.45 $2,407.63 $2,634.51 $3,440.51	$2,800.32 $3,014.50 $3,241.38 $4,047.38	$3,407.19 $3,621.37 $3,848.25 $4,654.25	$606.87

Toc - Plan #91 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver (HMO) BlueCare Silver 2157 ($0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $5,900 $11,800 Annual Deductible $7,700 $15,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$653.34 $741.54 $834.97 $1,166.87 $1,773.16	$1,153.15 $1,241.35 $1,334.78 $1,666.68	$1,652.96 $1,741.16 $1,834.59 $2,166.49	$2,152.77 $2,240.97 $2,334.40 $2,666.30	$499.81
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,306.68 $1,483.08 $1,669.94 $2,333.74 $3,546.32	$1,806.49 $1,982.89 $2,169.75 $2,833.55	$2,306.30 $2,482.70 $2,669.56 $3,333.36	$2,806.11 $2,982.51 $3,169.37 $3,833.17	$499.81

Toc - Plan #92 Florida Blue HMO (a BlueCross BlueShield FL company)
Expanded Bronze (HMO) BlueCare Bronze 2159 ($0 Deductible / $0 Virtual Visits / $50 PCP Visit / $30 Generic Meds / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$573.62 $651.06 $733.09 $1,024.49 $1,556.80	$1,012.44 $1,089.88 $1,171.91 $1,463.31	$1,451.26 $1,528.70 $1,610.73 $1,902.13	$1,890.08 $1,967.52 $2,049.55 $2,340.95	$438.82
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,147.24 $1,302.12 $1,466.18 $2,048.98 $3,113.60	$1,586.06 $1,740.94 $1,905.00 $2,487.80	$2,024.88 $2,179.76 $2,343.82 $2,926.62	$2,463.70 $2,618.58 $2,782.64 $3,365.44	$438.82

Toc - Plan #93 Florida Blue HMO (a BlueCross BlueShield FL company)
Bronze (HMO) BlueCare Bronze 2351S (Multilingual Available / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $9,100 $18,200 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$470.87 $534.44 $601.77 $840.97 $1,277.94	$831.09 $894.66 $961.99 $1,201.19	$1,191.31 $1,254.88 $1,322.21 $1,561.41	$1,551.53 $1,615.10 $1,682.43 $1,921.63	$360.22
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$941.74 $1,068.88 $1,203.54 $1,681.94 $2,555.88	$1,301.96 $1,429.10 $1,563.76 $2,042.16	$1,662.18 $1,789.32 $1,923.98 $2,402.38	$2,022.40 $2,149.54 $2,284.20 $2,762.60	$360.22

Toc - Plan #94 Florida Blue HMO (a BlueCross BlueShield FL company)
Expanded Bronze (HMO) BlueCare Bronze 2352S (Multilingual Available / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $7,500 $15,000 Annual Deductible $9,000 $18,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$518.77 $588.80 $662.99 $926.52 $1,407.94	$915.63 $985.66 $1,059.85 $1,323.38	$1,312.49 $1,382.52 $1,456.71 $1,720.24	$1,709.35 $1,779.38 $1,853.57 $2,117.10	$396.86
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,037.54 $1,177.60 $1,325.98 $1,853.04 $2,815.88	$1,434.40 $1,574.46 $1,722.84 $2,249.90	$1,831.26 $1,971.32 $2,119.70 $2,646.76	$2,228.12 $2,368.18 $2,516.56 $3,043.62	$396.86

Toc - Plan #95 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver (HMO) BlueCare Silver 2353S ($40 PCP Visits / Multilingual Available / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $5,800 $11,600 Annual Deductible $8,900 $17,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$697.42 $791.57 $891.30 $1,245.59 $1,892.80	$1,230.95 $1,325.10 $1,424.83 $1,779.12	$1,764.48 $1,858.63 $1,958.36 $2,312.65	$2,298.01 $2,392.16 $2,491.89 $2,846.18	$533.53
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,394.84 $1,583.14 $1,782.60 $2,491.18 $3,785.60	$1,928.37 $2,116.67 $2,316.13 $3,024.71	$2,461.90 $2,650.20 $2,849.66 $3,558.24	$2,995.43 $3,183.73 $3,383.19 $4,091.77	$533.53

Toc - Plan #96 Florida Blue HMO (a BlueCross BlueShield FL company)
Gold (HMO) BlueCare Gold 2354S ($30 PCP Visits / Multilingual Available / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $2,000 $4,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$719.01 $816.08 $918.89 $1,284.15 $1,951.39	$1,269.05 $1,366.12 $1,468.93 $1,834.19	$1,819.09 $1,916.16 $2,018.97 $2,384.23	$2,369.13 $2,466.20 $2,569.01 $2,934.27	$550.04
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,438.02 $1,632.16 $1,837.78 $2,568.30 $3,902.78	$1,988.06 $2,182.20 $2,387.82 $3,118.34	$2,538.10 $2,732.24 $2,937.86 $3,668.38	$3,088.14 $3,282.28 $3,487.90 $4,218.42	$550.04

Toc - Plan #97 Florida Blue HMO (a BlueCross BlueShield FL company)
Platinum (HMO) BlueCare Platinum 2355S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Multilingual Available / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $3,000 $6,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$896.62 $1,017.66 $1,145.88 $1,601.36 $2,433.43	$1,582.53 $1,703.57 $1,831.79 $2,287.27	$2,268.44 $2,389.48 $2,517.70 $2,973.18	$2,954.35 $3,075.39 $3,203.61 $3,659.09	$685.91
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,793.24 $2,035.32 $2,291.76 $3,202.72 $4,866.86	$2,479.15 $2,721.23 $2,977.67 $3,888.63	$3,165.06 $3,407.14 $3,663.58 $4,574.54	$3,850.97 $4,093.05 $4,349.49 $5,260.45	$685.91

Toc - Plan #98 Florida Blue HMO (a BlueCross BlueShield FL company)
Expanded Bronze (HMO) BlueCare Bronze 2359 ($0 Deductible / $0 Virtual Visits / Multilingual Available / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $0 Not Applicable Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$554.71 $629.60 $708.92 $990.71 $1,505.48	$979.06 $1,053.95 $1,133.27 $1,415.06	$1,403.41 $1,478.30 $1,557.62 $1,839.41	$1,827.76 $1,902.65 $1,981.97 $2,263.76	$424.35
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,109.42 $1,259.20 $1,417.84 $1,981.42 $3,010.96	$1,533.77 $1,683.55 $1,842.19 $2,405.77	$1,958.12 $2,107.90 $2,266.54 $2,830.12	$2,382.47 $2,532.25 $2,690.89 $3,254.47	$424.35

Toc - Plan #99 Florida Blue HMO (a BlueCross BlueShield FL company)
Expanded Bronze (HMO) myBlue Bronze 1601 ($0 Virtual Visits / 3 PCP Visits for $0 / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $8,000 $16,000 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$368.14 $417.84 $470.48 $657.50 $999.13	$649.77 $699.47 $752.11 $939.13	$931.40 $981.10 $1,033.74 $1,220.76	$1,213.03 $1,262.73 $1,315.37 $1,502.39	$281.63
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$736.28 $835.68 $940.96 $1,315.00 $1,998.26	$1,017.91 $1,117.31 $1,222.59 $1,596.63	$1,299.54 $1,398.94 $1,504.22 $1,878.26	$1,581.17 $1,680.57 $1,785.85 $2,159.89	$281.63

Toc - Plan #100 Florida Blue HMO (a BlueCross BlueShield FL company)
Expanded Bronze (HMO) myBlue Bronze 1602 ($0 Virtual Visits / $20 Labs / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $7,500 $15,000 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$346.55 $393.33 $442.89 $618.94 $940.54	$611.66 $658.44 $708.00 $884.05	$876.77 $923.55 $973.11 $1,149.16	$1,141.88 $1,188.66 $1,238.22 $1,414.27	$265.11
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$693.10 $786.66 $885.78 $1,237.88 $1,881.08	$958.21 $1,051.77 $1,150.89 $1,502.99	$1,223.32 $1,316.88 $1,416.00 $1,768.10	$1,488.43 $1,581.99 $1,681.11 $2,033.21	$265.11

Toc - Plan #101 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver (HMO) myBlue Silver 1603 ($0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $5,900 $11,800 Annual Deductible $7,200 $14,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$453.38 $514.59 $579.42 $809.74 $1,230.47	$800.22 $861.43 $926.26 $1,156.58	$1,147.06 $1,208.27 $1,273.10 $1,503.42	$1,493.90 $1,555.11 $1,619.94 $1,850.26	$346.84
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$906.76 $1,029.18 $1,158.84 $1,619.48 $2,460.94	$1,253.60 $1,376.02 $1,505.68 $1,966.32	$1,600.44 $1,722.86 $1,852.52 $2,313.16	$1,947.28 $2,069.70 $2,199.36 $2,660.00	$346.84

Toc - Plan #102 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver (HMO) myBlue Silver 1604 ($0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $5,500 $11,000 Annual Deductible $7,500 $15,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$432.17 $490.51 $552.31 $771.86 $1,172.91	$762.78 $821.12 $882.92 $1,102.47	$1,093.39 $1,151.73 $1,213.53 $1,433.08	$1,424.00 $1,482.34 $1,544.14 $1,763.69	$330.61
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$864.34 $981.02 $1,104.62 $1,543.72 $2,345.82	$1,194.95 $1,311.63 $1,435.23 $1,874.33	$1,525.56 $1,642.24 $1,765.84 $2,204.94	$1,856.17 $1,972.85 $2,096.45 $2,535.55	$330.61

Toc - Plan #103 Florida Blue HMO (a BlueCross BlueShield FL company)
Gold (HMO) myBlue Gold 1605 ($0 Virtual Visits / $0 Labs / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $940 $1,880 Annual Deductible $4,700 $9,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$513.26 $582.55 $655.95 $916.68 $1,392.99	$905.90 $975.19 $1,048.59 $1,309.32	$1,298.54 $1,367.83 $1,441.23 $1,701.96	$1,691.18 $1,760.47 $1,833.87 $2,094.60	$392.64
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,026.52 $1,165.10 $1,311.90 $1,833.36 $2,785.98	$1,419.16 $1,557.74 $1,704.54 $2,226.00	$1,811.80 $1,950.38 $2,097.18 $2,618.64	$2,204.44 $2,343.02 $2,489.82 $3,011.28	$392.64

Toc - Plan #104 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver (HMO) myBlue Silver 1710 ($0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $6,700 $13,400 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$460.61 $522.79 $588.66 $822.65 $1,250.10	$812.98 $875.16 $941.03 $1,175.02	$1,165.35 $1,227.53 $1,293.40 $1,527.39	$1,517.72 $1,579.90 $1,645.77 $1,879.76	$352.37
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$921.22 $1,045.58 $1,177.32 $1,645.30 $2,500.20	$1,273.59 $1,397.95 $1,529.69 $1,997.67	$1,625.96 $1,750.32 $1,882.06 $2,350.04	$1,978.33 $2,102.69 $2,234.43 $2,702.41	$352.37

Toc - Plan #105 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver (HMO) myBlue Silver 2017 ($0 Virtual Visits / $20 Labs / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $6,000 $12,000 Annual Deductible $7,400 $14,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$428.69 $486.56 $547.87 $765.64 $1,163.46	$756.64 $814.51 $875.82 $1,093.59	$1,084.59 $1,142.46 $1,203.77 $1,421.54	$1,412.54 $1,470.41 $1,531.72 $1,749.49	$327.95
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$857.38 $973.12 $1,095.74 $1,531.28 $2,326.92	$1,185.33 $1,301.07 $1,423.69 $1,859.23	$1,513.28 $1,629.02 $1,751.64 $2,187.18	$1,841.23 $1,956.97 $2,079.59 $2,515.13	$327.95

Toc - Plan #106 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver (HMO) myBlue Silver 2127 ($0 Virtual Visits / $25 Generic Meds / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $5,800 $11,600 Annual Deductible $7,600 $15,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$427.07 $484.72 $545.80 $762.75 $1,159.07	$753.78 $811.43 $872.51 $1,089.46	$1,080.49 $1,138.14 $1,199.22 $1,416.17	$1,407.20 $1,464.85 $1,525.93 $1,742.88	$326.71
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$854.14 $969.44 $1,091.60 $1,525.50 $2,318.14	$1,180.85 $1,296.15 $1,418.31 $1,852.21	$1,507.56 $1,622.86 $1,745.02 $2,178.92	$1,834.27 $1,949.57 $2,071.73 $2,505.63	$326.71

Toc - Plan #107 Florida Blue HMO (a BlueCross BlueShield FL company)
Expanded Bronze (HMO) myBlue Bronze 2129 ($0 Deductible / $0 Virtual Visits / $35 PCP Visit / $80 Specialist Visits / $25 Generic Meds / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$398.25 $452.01 $508.96 $711.27 $1,080.85	$702.91 $756.67 $813.62 $1,015.93	$1,007.57 $1,061.33 $1,118.28 $1,320.59	$1,312.23 $1,365.99 $1,422.94 $1,625.25	$304.66
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$796.50 $904.02 $1,017.92 $1,422.54 $2,161.70	$1,101.16 $1,208.68 $1,322.58 $1,727.20	$1,405.82 $1,513.34 $1,627.24 $2,031.86	$1,710.48 $1,818.00 $1,931.90 $2,336.52	$304.66

Toc - Plan #108 Florida Blue HMO (a BlueCross BlueShield FL company)
Expanded Bronze (HMO) myBlue Bronze 2126 ($0 Virtual Visits / 3 PCP Visits for $0 / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $8,200 $16,400 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$368.57 $418.33 $471.03 $658.27 $1,000.30	$650.53 $700.29 $752.99 $940.23	$932.49 $982.25 $1,034.95 $1,222.19	$1,214.45 $1,264.21 $1,316.91 $1,504.15	$281.96
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$737.14 $836.66 $942.06 $1,316.54 $2,000.60	$1,019.10 $1,118.62 $1,224.02 $1,598.50	$1,301.06 $1,400.58 $1,505.98 $1,880.46	$1,583.02 $1,682.54 $1,787.94 $2,162.42	$281.96

Toc - Plan #109 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver (HMO) myBlue Silver 2237 ($0 Virtual Visits / $80 PCP Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $4,100 $8,200 Annual Deductible $8,900 $17,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$419.59 $476.23 $536.24 $749.39 $1,138.77	$740.58 $797.22 $857.23 $1,070.38	$1,061.57 $1,118.21 $1,178.22 $1,391.37	$1,382.56 $1,439.20 $1,499.21 $1,712.36	$320.99
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$839.18 $952.46 $1,072.48 $1,498.78 $2,277.54	$1,160.17 $1,273.45 $1,393.47 $1,819.77	$1,481.16 $1,594.44 $1,714.46 $2,140.76	$1,802.15 $1,915.43 $2,035.45 $2,461.75	$320.99

Toc - Plan #110 Florida Blue HMO (a BlueCross BlueShield FL company)
Expanded Bronze (HMO) myBlue Bronze 2219 ($0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $2,400 $4,800 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$360.23 $408.86 $460.37 $643.37 $977.66	$635.81 $684.44 $735.95 $918.95	$911.39 $960.02 $1,011.53 $1,194.53	$1,186.97 $1,235.60 $1,287.11 $1,470.11	$275.58
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$720.46 $817.72 $920.74 $1,286.74 $1,955.32	$996.04 $1,093.30 $1,196.32 $1,562.32	$1,271.62 $1,368.88 $1,471.90 $1,837.90	$1,547.20 $1,644.46 $1,747.48 $2,113.48	$275.58

Toc - Plan #111 Florida Blue HMO (a BlueCross BlueShield FL company)
Expanded Bronze (HMO) myBlue Bronze 2266 ($0 Virtual Visits / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $2,700 $5,400 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$360.99 $409.72 $461.35 $644.73 $979.73	$637.15 $685.88 $737.51 $920.89	$913.31 $962.04 $1,013.67 $1,197.05	$1,189.47 $1,238.20 $1,289.83 $1,473.21	$276.16
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$721.98 $819.44 $922.70 $1,289.46 $1,959.46	$998.14 $1,095.60 $1,198.86 $1,565.62	$1,274.30 $1,371.76 $1,475.02 $1,841.78	$1,550.46 $1,647.92 $1,751.18 $2,117.94	$276.16

Toc - Plan #112 Florida Blue HMO (a BlueCross BlueShield FL company)
Bronze (HMO) myBlue Bronze 2311S (Multilingual Available / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $9,100 $18,200 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$327.98 $372.26 $419.16 $585.77 $890.14	$578.88 $623.16 $670.06 $836.67	$829.78 $874.06 $920.96 $1,087.57	$1,080.68 $1,124.96 $1,171.86 $1,338.47	$250.90
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$655.96 $744.52 $838.32 $1,171.54 $1,780.28	$906.86 $995.42 $1,089.22 $1,422.44	$1,157.76 $1,246.32 $1,340.12 $1,673.34	$1,408.66 $1,497.22 $1,591.02 $1,924.24	$250.90

Toc - Plan #113 Florida Blue HMO (a BlueCross BlueShield FL company)
Expanded Bronze (HMO) myBlue Bronze 2312S (Multilingual Available / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $7,500 $15,000 Annual Deductible $9,000 $18,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$351.85 $399.35 $449.66 $628.40 $954.92	$621.02 $668.52 $718.83 $897.57	$890.19 $937.69 $988.00 $1,166.74	$1,159.36 $1,206.86 $1,257.17 $1,435.91	$269.17
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$703.70 $798.70 $899.32 $1,256.80 $1,909.84	$972.87 $1,067.87 $1,168.49 $1,525.97	$1,242.04 $1,337.04 $1,437.66 $1,795.14	$1,511.21 $1,606.21 $1,706.83 $2,064.31	$269.17

Toc - Plan #114 Florida Blue HMO (a BlueCross BlueShield FL company)
Expanded Bronze (HMO) myBlue Bronze 2329 ($0 Deductible / $0 Virtual Visits / Multilingual Available / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$385.62 $437.68 $492.82 $688.72 $1,046.57	$680.62 $732.68 $787.82 $983.72	$975.62 $1,027.68 $1,082.82 $1,278.72	$1,270.62 $1,322.68 $1,377.82 $1,573.72	$295.00
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$771.24 $875.36 $985.64 $1,377.44 $2,093.14	$1,066.24 $1,170.36 $1,280.64 $1,672.44	$1,361.24 $1,465.36 $1,575.64 $1,967.44	$1,656.24 $1,760.36 $1,870.64 $2,262.44	$295.00

Toc - Plan #115 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver (HMO) myBlue Connected Care Silver 2230 ($0 Primary Care Virtual Visits / $0 Primary Care Visits with Select Providers / 24x7 Provider Access / Disponible en Español / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $5,500 $11,000 Annual Deductible $7,400 $14,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$415.85 $471.99 $531.46 $742.71 $1,128.62	$733.98 $790.12 $849.59 $1,060.84	$1,052.11 $1,108.25 $1,167.72 $1,378.97	$1,370.24 $1,426.38 $1,485.85 $1,697.10	$318.13
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$831.70 $943.98 $1,062.92 $1,485.42 $2,257.24	$1,149.83 $1,262.11 $1,381.05 $1,803.55	$1,467.96 $1,580.24 $1,699.18 $2,121.68	$1,786.09 $1,898.37 $2,017.31 $2,439.81	$318.13

Toc - Plan #116 Florida Blue HMO (a BlueCross BlueShield FL company)
Expanded Bronze (HMO) myBlue Connected Care Bronze 2231 ($0 Virtual Visits / $0 Primary Care Visits with Select Providers / 24x7 Provider Access / Disponible en Español / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $6,500 $13,000 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$341.11 $387.16 $435.94 $609.22 $925.77	$602.06 $648.11 $696.89 $870.17	$863.01 $909.06 $957.84 $1,131.12	$1,123.96 $1,170.01 $1,218.79 $1,392.07	$260.95
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$682.22 $774.32 $871.88 $1,218.44 $1,851.54	$943.17 $1,035.27 $1,132.83 $1,479.39	$1,204.12 $1,296.22 $1,393.78 $1,740.34	$1,465.07 $1,557.17 $1,654.73 $2,001.29	$260.95

Toc - Plan #117 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver (HMO) myBlue Connected Care Silver 2332 ($0 Virtual Visits / $0 Primary Care Visits with Select Providers / 24x7 Provider Access / Disponible en Español / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $4,000 $8,000 Annual Deductible $8,000 $16,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$402.73 $457.10 $514.69 $719.28 $1,093.01	$710.82 $765.19 $822.78 $1,027.37	$1,018.91 $1,073.28 $1,130.87 $1,335.46	$1,327.00 $1,381.37 $1,438.96 $1,643.55	$308.09
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$805.46 $914.20 $1,029.38 $1,438.56 $2,186.02	$1,113.55 $1,222.29 $1,337.47 $1,746.65	$1,421.64 $1,530.38 $1,645.56 $2,054.74	$1,729.73 $1,838.47 $1,953.65 $2,362.83	$308.09

Toc - Plan #118 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver (HMO) myBlue Silver 2337 ($0 Virtual Visits / $20 Labs / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $4,500 $9,000 Annual Deductible $8,300 $16,600 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$406.16 $460.99 $519.07 $725.40 $1,102.32	$716.87 $771.70 $829.78 $1,036.11	$1,027.58 $1,082.41 $1,140.49 $1,346.82	$1,338.29 $1,393.12 $1,451.20 $1,657.53	$310.71
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$812.32 $921.98 $1,038.14 $1,450.80 $2,204.64	$1,123.03 $1,232.69 $1,348.85 $1,761.51	$1,433.74 $1,543.40 $1,659.56 $2,072.22	$1,744.45 $1,854.11 $1,970.27 $2,382.93	$310.71

Toc - Plan #119 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver (HMO) myBlue Silver 2313S ($40 PCP Visits / Multilingual Available / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $5,800 $11,600 Annual Deductible $8,900 $17,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$422.35 $479.37 $539.76 $754.32 $1,146.26	$745.45 $802.47 $862.86 $1,077.42	$1,068.55 $1,125.57 $1,185.96 $1,400.52	$1,391.65 $1,448.67 $1,509.06 $1,723.62	$323.10
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$844.70 $958.74 $1,079.52 $1,508.64 $2,292.52	$1,167.80 $1,281.84 $1,402.62 $1,831.74	$1,490.90 $1,604.94 $1,725.72 $2,154.84	$1,814.00 $1,928.04 $2,048.82 $2,477.94	$323.10

Toc - Plan #120 Florida Blue HMO (a BlueCross BlueShield FL company)
Gold (HMO) myBlue Gold 2314S ($30 PCP Visits / Multilingual Available / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $2,000 $4,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$485.82 $551.41 $620.88 $867.67 $1,318.52	$857.47 $923.06 $992.53 $1,239.32	$1,229.12 $1,294.71 $1,364.18 $1,610.97	$1,600.77 $1,666.36 $1,735.83 $1,982.62	$371.65
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$971.64 $1,102.82 $1,241.76 $1,735.34 $2,637.04	$1,343.29 $1,474.47 $1,613.41 $2,106.99	$1,714.94 $1,846.12 $1,985.06 $2,478.64	$2,086.59 $2,217.77 $2,356.71 $2,850.29	$371.65

Toc - Plan #121 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver (HMO) myBlue Silver 2237D ($0 Virtual Visits / $80 PCP Visits / Adult Dental / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $4,100 $8,200 Annual Deductible $8,900 $17,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$428.12 $485.92 $547.14 $764.62 $1,161.92	$755.63 $813.43 $874.65 $1,092.13	$1,083.14 $1,140.94 $1,202.16 $1,419.64	$1,410.65 $1,468.45 $1,529.67 $1,747.15	$327.51
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$856.24 $971.84 $1,094.28 $1,529.24 $2,323.84	$1,183.75 $1,299.35 $1,421.79 $1,856.75	$1,511.26 $1,626.86 $1,749.30 $2,184.26	$1,838.77 $1,954.37 $2,076.81 $2,511.77	$327.51

Toc - Plan #122 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver (HMO) myBlue Connected Care Silver 2332D ($0 Virtual Visits / $0 Primary Care Visits with Select Providers / Adult Dental / 24x7 Provider Access / Disponible en Español / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $4,000 $8,000 Annual Deductible $8,000 $16,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$411.24 $466.76 $525.56 $734.47 $1,116.11	$725.84 $781.36 $840.16 $1,049.07	$1,040.44 $1,095.96 $1,154.76 $1,363.67	$1,355.04 $1,410.56 $1,469.36 $1,678.27	$314.60
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$822.48 $933.52 $1,051.12 $1,468.94 $2,232.22	$1,137.08 $1,248.12 $1,365.72 $1,783.54	$1,451.68 $1,562.72 $1,680.32 $2,098.14	$1,766.28 $1,877.32 $1,994.92 $2,412.74	$314.60

Toc - Plan #123 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver (HMO) myBlue Silver 2337D ($0 Virtual Visits / Adult Dental / $20 Labs / Rewards $$$)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-352-2583 Annual Out of Pocket Expenses: Individual Family $4,500 $9,000 Annual Deductible $8,300 $16,600 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$414.66 $470.64 $529.94 $740.58 $1,125.39	$731.87 $787.85 $847.15 $1,057.79	$1,049.08 $1,105.06 $1,164.36 $1,375.00	$1,366.29 $1,422.27 $1,481.57 $1,692.21	$317.21
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$829.32 $941.28 $1,059.88 $1,481.16 $2,250.78	$1,146.53 $1,258.49 $1,377.09 $1,798.37	$1,463.74 $1,575.70 $1,694.30 $2,115.58	$1,780.95 $1,892.91 $2,011.51 $2,432.79	$317.21

Health First Commercial Plans, Inc. Local: 1-855-443-4735 | Toll Free: 1-855-443-4735 | TTY: 1-800-955-8771

Toc - Plan #124 Health First Commercial Plans, Inc.
Expanded Bronze (HMO) Bronze Gym Access HSA 1658 (HSA Qualified, $0 Preventive Care, Open Access, Fitness Center Included)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-443-4735 Annual Out of Pocket Expenses: Individual Family $6,900 $13,800 Annual Deductible $6,900 $13,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$331.76 $376.54 $423.98 $592.52 $900.39	$585.55 $630.33 $677.77 $846.31	$839.34 $884.12 $931.56 $1,100.10	$1,093.13 $1,137.91 $1,185.35 $1,353.89	$253.79
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$663.52 $753.08 $847.96 $1,185.04 $1,800.78	$917.31 $1,006.87 $1,101.75 $1,438.83	$1,171.10 $1,260.66 $1,355.54 $1,692.62	$1,424.89 $1,514.45 $1,609.33 $1,946.41	$253.79

Toc - Plan #125 Health First Commercial Plans, Inc.
Silver (HMO) Silver Gym Access 1664 (Primary Care & Specialist Copays, $0 Preventive Care, $2 Tier 1 Prescriptions, Open Access, Fitness Center Included)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-443-4735 Annual Out of Pocket Expenses: Individual Family $6,000 $12,000 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$407.46 $462.47 $520.73 $727.72 $1,105.84	$719.17 $774.18 $832.44 $1,039.43	$1,030.88 $1,085.89 $1,144.15 $1,351.14	$1,342.59 $1,397.60 $1,455.86 $1,662.85	$311.71
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$814.92 $924.94 $1,041.46 $1,455.44 $2,211.68	$1,126.63 $1,236.65 $1,353.17 $1,767.15	$1,438.34 $1,548.36 $1,664.88 $2,078.86	$1,750.05 $1,860.07 $1,976.59 $2,390.57	$311.71

Toc - Plan #126 Health First Commercial Plans, Inc.
Silver (HMO) Silver Gym Access 1688 ($0 Preventive Care, $2 Tier 1 Perscriptions, Open Access, Fitness Center Included)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-443-4735 Annual Out of Pocket Expenses: Individual Family $3,850 $7,700 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$403.44 $457.90 $515.60 $720.54 $1,094.93	$712.07 $766.53 $824.23 $1,029.17	$1,020.70 $1,075.16 $1,132.86 $1,337.80	$1,329.33 $1,383.79 $1,441.49 $1,646.43	$308.63
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$806.88 $915.80 $1,031.20 $1,441.08 $2,189.86	$1,115.51 $1,224.43 $1,339.83 $1,749.71	$1,424.14 $1,533.06 $1,648.46 $2,058.34	$1,732.77 $1,841.69 $1,957.09 $2,366.97	$308.63

Toc - Plan #127 Health First Commercial Plans, Inc.
Gold (HMO) Gold Gym Access 1736 (Primary Care & Urgent Care Copay, 0% Coinsurance, $0 Preventive Care, $2 Tier 1 Prescriptions, Open Access)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-443-4735 Annual Out of Pocket Expenses: Individual Family $2,650 $5,300 Annual Deductible $8,150 $16,300 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$443.15 $502.98 $566.35 $791.47 $1,202.72	$782.16 $841.99 $905.36 $1,130.48	$1,121.17 $1,181.00 $1,244.37 $1,469.49	$1,460.18 $1,520.01 $1,583.38 $1,808.50	$339.01
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$886.30 $1,005.96 $1,132.70 $1,582.94 $2,405.44	$1,225.31 $1,344.97 $1,471.71 $1,921.95	$1,564.32 $1,683.98 $1,810.72 $2,260.96	$1,903.33 $2,022.99 $2,149.73 $2,599.97	$339.01

Toc - Plan #128 Health First Commercial Plans, Inc.
Gold (HMO) Gold Gym Access 1740 (Low Copays, $0 Outpatient Labs, $0 Preventive Care, $2 Tier 1 Prescriptions, Open Access)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-443-4735 Annual Out of Pocket Expenses: Individual Family $2,900 $5,800 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$429.20 $487.14 $548.52 $766.55 $1,164.85	$757.54 $815.48 $876.86 $1,094.89	$1,085.88 $1,143.82 $1,205.20 $1,423.23	$1,414.22 $1,472.16 $1,533.54 $1,751.57	$328.34
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$858.40 $974.28 $1,097.04 $1,533.10 $2,329.70	$1,186.74 $1,302.62 $1,425.38 $1,861.44	$1,515.08 $1,630.96 $1,753.72 $2,189.78	$1,843.42 $1,959.30 $2,082.06 $2,518.12	$328.34

Toc - Plan #129 Health First Commercial Plans, Inc.
Gold (HMO) Gold Gym Access 1742 (Emergency Room & Inpatient Hospitalization Copay, $0 Outpatient Labs, $0 MRI, $0 Preventive Care, $2 Tier 1 Prescriptions, Open Access)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-443-4735 Annual Out of Pocket Expenses: Individual Family $1,500 $3,000 Annual Deductible $7,750 $15,500 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$452.32 $513.38 $578.06 $807.84 $1,227.59	$798.34 $859.40 $924.08 $1,153.86	$1,144.36 $1,205.42 $1,270.10 $1,499.88	$1,490.38 $1,551.44 $1,616.12 $1,845.90	$346.02
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$904.64 $1,026.76 $1,156.12 $1,615.68 $2,455.18	$1,250.66 $1,372.78 $1,502.14 $1,961.70	$1,596.68 $1,718.80 $1,848.16 $2,307.72	$1,942.70 $2,064.82 $2,194.18 $2,653.74	$346.02

Toc - Plan #130 Health First Commercial Plans, Inc.
Gold (HMO) Gold Gym Access HSA 1744 (Low Deductible, Low Out of Pocket Maximum, HSA Qualified, $0 Preventive Care, Open Access, Fitness Center Included)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-443-4735 Annual Out of Pocket Expenses: Individual Family $1,700 $3,400 Annual Deductible $4,350 $8,700 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$440.02 $499.42 $562.35 $785.88 $1,194.21	$776.64 $836.04 $898.97 $1,122.50	$1,113.26 $1,172.66 $1,235.59 $1,459.12	$1,449.88 $1,509.28 $1,572.21 $1,795.74	$336.62
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$880.04 $998.84 $1,124.70 $1,571.76 $2,388.42	$1,216.66 $1,335.46 $1,461.32 $1,908.38	$1,553.28 $1,672.08 $1,797.94 $2,245.00	$1,889.90 $2,008.70 $2,134.56 $2,581.62	$336.62

Toc - Plan #131 Health First Commercial Plans, Inc.
Catastrophic (HMO) Catastrophic Gym Access 1746 (Primary Care Copay, $0 Preventive Care, Open Access)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-443-4735 Annual Out of Pocket Expenses: Individual Family $9,100 $18,200 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$179.00 $203.17 $228.77 $319.70 $485.81	$315.94 $340.11 $365.71 $456.64	$452.88 $477.05 $502.65 $593.58	$589.82 $613.99 $639.59 $730.52	$136.94
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$358.00 $406.34 $457.54 $639.40 $971.62	$494.94 $543.28 $594.48 $776.34	$631.88 $680.22 $731.42 $913.28	$768.82 $817.16 $868.36 $1,050.22	$136.94

Toc - Plan #132 Health First Commercial Plans, Inc.
Expanded Bronze (HMO) Bronze Gym Access 1796 (Primary Care & Specialist Copays, $0 Preventive Care, $2 Tier 1 Prescriptions, Open Access, Fitness Center Included)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-443-4735 Annual Out of Pocket Expenses: Individual Family $6,900 $13,800 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$320.18 $363.40 $409.19 $571.84 $868.96	$565.12 $608.34 $654.13 $816.78	$810.06 $853.28 $899.07 $1,061.72	$1,055.00 $1,098.22 $1,144.01 $1,306.66	$244.94
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$640.36 $726.80 $818.38 $1,143.68 $1,737.92	$885.30 $971.74 $1,063.32 $1,388.62	$1,130.24 $1,216.68 $1,308.26 $1,633.56	$1,375.18 $1,461.62 $1,553.20 $1,878.50	$244.94

Toc - Plan #133 Health First Commercial Plans, Inc.
Expanded Bronze (HMO) Bronze Gym Access 1656 (Primary Care & Urgent Care Copay, $0 Preventive Care, $2 Tier 1 Prescriptions, Open Access, Fitness Center Included)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-443-4735 Annual Out of Pocket Expenses: Individual Family $7,550 $15,100 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$335.68 $380.99 $428.99 $599.52 $911.02	$592.47 $637.78 $685.78 $856.31	$849.26 $894.57 $942.57 $1,113.10	$1,106.05 $1,151.36 $1,199.36 $1,369.89	$256.79
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$671.36 $761.98 $857.98 $1,199.04 $1,822.04	$928.15 $1,018.77 $1,114.77 $1,455.83	$1,184.94 $1,275.56 $1,371.56 $1,712.62	$1,441.73 $1,532.35 $1,628.35 $1,969.41	$256.79

Toc - Plan #134 Health First Commercial Plans, Inc.
Expanded Bronze (HMO) Bronze 1750 (Unlimited Primary Care, Specialist & Urgent Care Copay Visits, $0 Preventive Care, $2 Tier 1 Prescriptions, Open Access)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-443-4735 Annual Out of Pocket Expenses: Individual Family $8,500 $17,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$323.90 $367.63 $413.95 $578.49 $879.08	$571.69 $615.42 $661.74 $826.28	$819.48 $863.21 $909.53 $1,074.07	$1,067.27 $1,111.00 $1,157.32 $1,321.86	$247.79
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$647.80 $735.26 $827.90 $1,156.98 $1,758.16	$895.59 $983.05 $1,075.69 $1,404.77	$1,143.38 $1,230.84 $1,323.48 $1,652.56	$1,391.17 $1,478.63 $1,571.27 $1,900.35	$247.79

Toc - Plan #135 Health First Commercial Plans, Inc.
Gold (HMO) Gold 1770 (Low Primary Care, Specialist & Urgent Care Copay, $0 Preventive Care, $2 Tier 1 Prescriptions, Open Access)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-443-4735 Annual Out of Pocket Expenses: Individual Family $1,600 $3,200 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$429.63 $487.63 $549.06 $767.31 $1,166.01	$758.30 $816.30 $877.73 $1,095.98	$1,086.97 $1,144.97 $1,206.40 $1,424.65	$1,415.64 $1,473.64 $1,535.07 $1,753.32	$328.67
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$859.26 $975.26 $1,098.12 $1,534.62 $2,332.02	$1,187.93 $1,303.93 $1,426.79 $1,863.29	$1,516.60 $1,632.60 $1,755.46 $2,191.96	$1,845.27 $1,961.27 $2,084.13 $2,520.63	$328.67

Toc - Plan #136 Health First Commercial Plans, Inc.
Bronze (HMO) Bronze 1774 ($0 Preventive Care, Open Access)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-443-4735 Annual Out of Pocket Expenses: Individual Family $8,700 $17,400 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$311.68 $353.76 $398.33 $556.67 $845.91	$550.12 $592.20 $636.77 $795.11	$788.56 $830.64 $875.21 $1,033.55	$1,027.00 $1,069.08 $1,113.65 $1,271.99	$238.44
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$623.36 $707.52 $796.66 $1,113.34 $1,691.82	$861.80 $945.96 $1,035.10 $1,351.78	$1,100.24 $1,184.40 $1,273.54 $1,590.22	$1,338.68 $1,422.84 $1,511.98 $1,828.66	$238.44

Toc - Plan #137 Health First Commercial Plans, Inc.
Expanded Bronze (HMO) Bronze HSA 1794 (HSA Qualified, $0 Preventive Care, Open Access)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-443-4735 Annual Out of Pocket Expenses: Individual Family $6,900 $13,800 Annual Deductible $6,900 $13,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$328.27 $372.59 $419.54 $586.30 $890.94	$579.40 $623.72 $670.67 $837.43	$830.53 $874.85 $921.80 $1,088.56	$1,081.66 $1,125.98 $1,172.93 $1,339.69	$251.13
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$656.54 $745.18 $839.08 $1,172.60 $1,781.88	$907.67 $996.31 $1,090.21 $1,423.73	$1,158.80 $1,247.44 $1,341.34 $1,674.86	$1,409.93 $1,498.57 $1,592.47 $1,925.99	$251.13

Toc - Plan #138 Health First Commercial Plans, Inc.
Silver (HMO) Silver 1806 ($2,100 Deductible, $0 Preventive Care, Open Access)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-443-4735 Annual Out of Pocket Expenses: Individual Family $2,100 $4,200 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$390.78 $443.53 $499.41 $697.93 $1,060.57	$689.72 $742.47 $798.35 $996.87	$988.66 $1,041.41 $1,097.29 $1,295.81	$1,287.60 $1,340.35 $1,396.23 $1,594.75	$298.94
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$781.56 $887.06 $998.82 $1,395.86 $2,121.14	$1,080.50 $1,186.00 $1,297.76 $1,694.80	$1,379.44 $1,484.94 $1,596.70 $1,993.74	$1,678.38 $1,783.88 $1,895.64 $2,292.68	$298.94

Toc - Plan #139 Health First Commercial Plans, Inc.
Expanded Bronze (HMO) Bronze 1826 ($0 Deductible, $0 Primary Care Copay- Visits 1 & 2, Specialist, Urgent Care, Emergency Room & Hospitalization Copay, $0 Tier 1 Prescriptions, Open Access)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-443-4735 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $9,050 $18,100 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$341.99 $388.16 $437.07 $610.80 $928.17	$603.62 $649.79 $698.70 $872.43	$865.25 $911.42 $960.33 $1,134.06	$1,126.88 $1,173.05 $1,221.96 $1,395.69	$261.63
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$683.98 $776.32 $874.14 $1,221.60 $1,856.34	$945.61 $1,037.95 $1,135.77 $1,483.23	$1,207.24 $1,299.58 $1,397.40 $1,744.86	$1,468.87 $1,561.21 $1,659.03 $2,006.49	$261.63

Toc - Plan #140 Health First Commercial Plans, Inc.
Bronze (HMO) Bronze Standard 1827
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-443-4735 Annual Out of Pocket Expenses: Individual Family $9,100 $18,200 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$305.45 $346.69 $390.37 $545.54 $829.00	$539.12 $580.36 $624.04 $779.21	$772.79 $814.03 $857.71 $1,012.88	$1,006.46 $1,047.70 $1,091.38 $1,246.55	$233.67
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$610.90 $693.38 $780.74 $1,091.08 $1,658.00	$844.57 $927.05 $1,014.41 $1,324.75	$1,078.24 $1,160.72 $1,248.08 $1,558.42	$1,311.91 $1,394.39 $1,481.75 $1,792.09	$233.67

Toc - Plan #141 Health First Commercial Plans, Inc.
Expanded Bronze (HMO) Bronze Standard 1828
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-443-4735 Annual Out of Pocket Expenses: Individual Family $7,500 $15,000 Annual Deductible $9,000 $18,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$317.69 $360.58 $406.01 $567.40 $862.22	$560.73 $603.62 $649.05 $810.44	$803.77 $846.66 $892.09 $1,053.48	$1,046.81 $1,089.70 $1,135.13 $1,296.52	$243.04
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$635.38 $721.16 $812.02 $1,134.80 $1,724.44	$878.42 $964.20 $1,055.06 $1,377.84	$1,121.46 $1,207.24 $1,298.10 $1,620.88	$1,364.50 $1,450.28 $1,541.14 $1,863.92	$243.04

Toc - Plan #142 Health First Commercial Plans, Inc.
Silver (HMO) Silver Standard 1829
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-443-4735 Annual Out of Pocket Expenses: Individual Family $5,800 $11,600 Annual Deductible $8,900 $17,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$387.42 $439.72 $495.12 $691.93 $1,051.45	$683.79 $736.09 $791.49 $988.30	$980.16 $1,032.46 $1,087.86 $1,284.67	$1,276.53 $1,328.83 $1,384.23 $1,581.04	$296.37
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$774.84 $879.44 $990.24 $1,383.86 $2,102.90	$1,071.21 $1,175.81 $1,286.61 $1,680.23	$1,367.58 $1,472.18 $1,582.98 $1,976.60	$1,663.95 $1,768.55 $1,879.35 $2,272.97	$296.37

Toc - Plan #143 Health First Commercial Plans, Inc.
Gold (HMO) Gold Standard 1833
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-443-4735 Annual Out of Pocket Expenses: Individual Family $2,000 $4,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$420.75 $477.55 $537.72 $751.46 $1,141.92	$742.62 $799.42 $859.59 $1,073.33	$1,064.49 $1,121.29 $1,181.46 $1,395.20	$1,386.36 $1,443.16 $1,503.33 $1,717.07	$321.87
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$841.50 $955.10 $1,075.44 $1,502.92 $2,283.84	$1,163.37 $1,276.97 $1,397.31 $1,824.79	$1,485.24 $1,598.84 $1,719.18 $2,146.66	$1,807.11 $1,920.71 $2,041.05 $2,468.53	$321.87

Toc - Plan #144 Health First Commercial Plans, Inc.
Expanded Bronze (HMO) Bronze Savings 1820 (Primary Care Copay, $0 Preventive Care, $3 Tier 1 Prescriptions, Open Access)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-443-4735 Annual Out of Pocket Expenses: Individual Family $8,300 $16,600 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$299.70 $340.16 $383.01 $535.26 $813.38	$528.97 $569.43 $612.28 $764.53	$758.24 $798.70 $841.55 $993.80	$987.51 $1,027.97 $1,070.82 $1,223.07	$229.27
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$599.40 $680.32 $766.02 $1,070.52 $1,626.76	$828.67 $909.59 $995.29 $1,299.79	$1,057.94 $1,138.86 $1,224.56 $1,529.06	$1,287.21 $1,368.13 $1,453.83 $1,758.33	$229.27

Toc - Plan #145 Health First Commercial Plans, Inc.
Silver (HMO) Silver Savings 1821 (Primary Care Copay, $0 Preventive Care, $3 Tier 1 Prescriptions, Open Access)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-443-4735 Annual Out of Pocket Expenses: Individual Family $5,450 $10,900 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$375.75 $426.47 $480.21 $671.09 $1,019.78	$663.20 $713.92 $767.66 $958.54	$950.65 $1,001.37 $1,055.11 $1,245.99	$1,238.10 $1,288.82 $1,342.56 $1,533.44	$287.45
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$751.50 $852.94 $960.42 $1,342.18 $2,039.56	$1,038.95 $1,140.39 $1,247.87 $1,629.63	$1,326.40 $1,427.84 $1,535.32 $1,917.08	$1,613.85 $1,715.29 $1,822.77 $2,204.53	$287.45

Toc - Plan #146 Health First Commercial Plans, Inc.
Gold (HMO) Gold Savings 1825 ($25 Primary Care Copay, $50 Specialist Copay, $0 Preventive Care, $3 Tier 1 Prescriptions, Open Access)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-443-4735 Annual Out of Pocket Expenses: Individual Family $2,900 $5,800 Annual Deductible $8,650 $17,300 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$412.69 $468.40 $527.42 $737.07 $1,120.04	$728.40 $784.11 $843.13 $1,052.78	$1,044.11 $1,099.82 $1,158.84 $1,368.49	$1,359.82 $1,415.53 $1,474.55 $1,684.20	$315.71
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$825.38 $936.80 $1,054.84 $1,474.14 $2,240.08	$1,141.09 $1,252.51 $1,370.55 $1,789.85	$1,456.80 $1,568.22 $1,686.26 $2,105.56	$1,772.51 $1,883.93 $2,001.97 $2,421.27	$315.71

Oscar Insurance Company of Florida Local: 1-855-672-2755 | Toll Free: 1-855-672-2755

Toc - Plan #147 Oscar Insurance Company of Florida
Expanded Bronze (EPO) Bronze Classic- PCP Saver
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $7,750 $15,500 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$304.90 $346.05 $389.65 $544.53 $827.47	$538.14 $579.29 $622.89 $777.77	$771.38 $812.53 $856.13 $1,011.01	$1,004.62 $1,045.77 $1,089.37 $1,244.25	$233.24
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$609.80 $692.10 $779.30 $1,089.06 $1,654.94	$843.04 $925.34 $1,012.54 $1,322.30	$1,076.28 $1,158.58 $1,245.78 $1,555.54	$1,309.52 $1,391.82 $1,479.02 $1,788.78	$233.24

Toc - Plan #148 Oscar Insurance Company of Florida
Expanded Bronze (EPO) Bronze Classic
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $7,750 $15,500 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$295.74 $335.65 $377.94 $528.17 $802.61	$521.97 $561.88 $604.17 $754.40	$748.20 $788.11 $830.40 $980.63	$974.43 $1,014.34 $1,056.63 $1,206.86	$226.23
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$591.48 $671.30 $755.88 $1,056.34 $1,605.22	$817.71 $897.53 $982.11 $1,282.57	$1,043.94 $1,123.76 $1,208.34 $1,508.80	$1,270.17 $1,349.99 $1,434.57 $1,735.03	$226.23

Toc - Plan #149 Oscar Insurance Company of Florida
Expanded Bronze (EPO) Bronze Elite- Deductible+PCP Saver Plus
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$360.11 $408.71 $460.21 $643.14 $977.31	$635.59 $684.19 $735.69 $918.62	$911.07 $959.67 $1,011.17 $1,194.10	$1,186.55 $1,235.15 $1,286.65 $1,469.58	$275.48
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$720.22 $817.42 $920.42 $1,286.28 $1,954.62	$995.70 $1,092.90 $1,195.90 $1,561.76	$1,271.18 $1,368.38 $1,471.38 $1,837.24	$1,546.66 $1,643.86 $1,746.86 $2,112.72	$275.48

Toc - Plan #150 Oscar Insurance Company of Florida
Silver (EPO) Silver Classic
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $5,400 $10,800 Annual Deductible $8,650 $17,300 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$400.34 $454.37 $511.62 $714.99 $1,086.49	$706.59 $760.62 $817.87 $1,021.24	$1,012.84 $1,066.87 $1,124.12 $1,327.49	$1,319.09 $1,373.12 $1,430.37 $1,633.74	$306.25
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$800.68 $908.74 $1,023.24 $1,429.98 $2,172.98	$1,106.93 $1,214.99 $1,329.49 $1,736.23	$1,413.18 $1,521.24 $1,635.74 $2,042.48	$1,719.43 $1,827.49 $1,941.99 $2,348.73	$306.25

Toc - Plan #151 Oscar Insurance Company of Florida
Silver (EPO) Silver Simple- Specialist Saver
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $6,500 $13,000 Annual Deductible $9,000 $18,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$398.01 $451.73 $508.65 $710.83 $1,080.18	$702.48 $756.20 $813.12 $1,015.30	$1,006.95 $1,060.67 $1,117.59 $1,319.77	$1,311.42 $1,365.14 $1,422.06 $1,624.24	$304.47
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$796.02 $903.46 $1,017.30 $1,421.66 $2,160.36	$1,100.49 $1,207.93 $1,321.77 $1,726.13	$1,404.96 $1,512.40 $1,626.24 $2,030.60	$1,709.43 $1,816.87 $1,930.71 $2,335.07	$304.47

Toc - Plan #152 Oscar Insurance Company of Florida
Silver (EPO) Silver Classic- PCP Saver
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $6,000 $12,000 Annual Deductible $8,650 $17,300 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$400.92 $455.03 $512.36 $716.03 $1,088.07	$707.62 $761.73 $819.06 $1,022.73	$1,014.32 $1,068.43 $1,125.76 $1,329.43	$1,321.02 $1,375.13 $1,432.46 $1,636.13	$306.70
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$801.84 $910.06 $1,024.72 $1,432.06 $2,176.14	$1,108.54 $1,216.76 $1,331.42 $1,738.76	$1,415.24 $1,523.46 $1,638.12 $2,045.46	$1,721.94 $1,830.16 $1,944.82 $2,352.16	$306.70

Toc - Plan #153 Oscar Insurance Company of Florida
Catastrophic (EPO) Secure
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $9,100 $18,200 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$228.32 $259.13 $291.78 $407.76 $619.62	$402.97 $433.78 $466.43 $582.41	$577.62 $608.43 $641.08 $757.06	$752.27 $783.08 $815.73 $931.71	$174.65
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$456.64 $518.26 $583.56 $815.52 $1,239.24	$631.29 $692.91 $758.21 $990.17	$805.94 $867.56 $932.86 $1,164.82	$980.59 $1,042.21 $1,107.51 $1,339.47	$174.65

Toc - Plan #154 Oscar Insurance Company of Florida
Expanded Bronze (EPO) Bronze Elite- Deductible+Specialist Saver Plus
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$359.17 $407.65 $459.01 $641.46 $974.76	$633.93 $682.41 $733.77 $916.22	$908.69 $957.17 $1,008.53 $1,190.98	$1,183.45 $1,231.93 $1,283.29 $1,465.74	$274.76
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$718.34 $815.30 $918.02 $1,282.92 $1,949.52	$993.10 $1,090.06 $1,192.78 $1,557.68	$1,267.86 $1,364.82 $1,467.54 $1,832.44	$1,542.62 $1,639.58 $1,742.30 $2,107.20	$274.76

Toc - Plan #155 Oscar Insurance Company of Florida
Gold (EPO) Gold Classic
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $3,500 $7,000 Annual Deductible $7,000 $14,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$423.86 $481.06 $541.67 $756.99 $1,150.32	$748.10 $805.30 $865.91 $1,081.23	$1,072.34 $1,129.54 $1,190.15 $1,405.47	$1,396.58 $1,453.78 $1,514.39 $1,729.71	$324.24
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$847.72 $962.12 $1,083.34 $1,513.98 $2,300.64	$1,171.96 $1,286.36 $1,407.58 $1,838.22	$1,496.20 $1,610.60 $1,731.82 $2,162.46	$1,820.44 $1,934.84 $2,056.06 $2,486.70	$324.24

Toc - Plan #156 Oscar Insurance Company of Florida
Expanded Bronze (EPO) Bronze Simple- HSA
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $5,200 $10,400 Annual Deductible $7,450 $14,900 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$316.26 $358.94 $404.17 $564.82 $858.30	$558.19 $600.87 $646.10 $806.75	$800.12 $842.80 $888.03 $1,048.68	$1,042.05 $1,084.73 $1,129.96 $1,290.61	$241.93
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$632.52 $717.88 $808.34 $1,129.64 $1,716.60	$874.45 $959.81 $1,050.27 $1,371.57	$1,116.38 $1,201.74 $1,292.20 $1,613.50	$1,358.31 $1,443.67 $1,534.13 $1,855.43	$241.93

Toc - Plan #157 Oscar Insurance Company of Florida
Silver (EPO) Silver Simple
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $4,500 $9,000 Annual Deductible $9,000 $18,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$397.43 $451.07 $507.91 $709.80 $1,078.60	$701.46 $755.10 $811.94 $1,013.83	$1,005.49 $1,059.13 $1,115.97 $1,317.86	$1,309.52 $1,363.16 $1,420.00 $1,621.89	$304.03
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$794.86 $902.14 $1,015.82 $1,419.60 $2,157.20	$1,098.89 $1,206.17 $1,319.85 $1,723.63	$1,402.92 $1,510.20 $1,623.88 $2,027.66	$1,706.95 $1,814.23 $1,927.91 $2,331.69	$304.03

Toc - Plan #158 Oscar Insurance Company of Florida
Silver (EPO) Silver Elite
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $5,000 $10,000 Annual Deductible $8,400 $16,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$405.58 $460.32 $518.31 $724.34 $1,100.71	$715.84 $770.58 $828.57 $1,034.60	$1,026.10 $1,080.84 $1,138.83 $1,344.86	$1,336.36 $1,391.10 $1,449.09 $1,655.12	$310.26
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$811.16 $920.64 $1,036.62 $1,448.68 $2,201.42	$1,121.42 $1,230.90 $1,346.88 $1,758.94	$1,431.68 $1,541.16 $1,657.14 $2,069.20	$1,741.94 $1,851.42 $1,967.40 $2,379.46	$310.26

Toc - Plan #159 Oscar Insurance Company of Florida
Silver (EPO) Silver Classic- Deductible Saver
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $9,000 $18,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$408.49 $463.63 $522.04 $729.55 $1,108.62	$720.98 $776.12 $834.53 $1,042.04	$1,033.47 $1,088.61 $1,147.02 $1,354.53	$1,345.96 $1,401.10 $1,459.51 $1,667.02	$312.49
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$816.98 $927.26 $1,044.08 $1,459.10 $2,217.24	$1,129.47 $1,239.75 $1,356.57 $1,771.59	$1,441.96 $1,552.24 $1,669.06 $2,084.08	$1,754.45 $1,864.73 $1,981.55 $2,396.57	$312.49

Toc - Plan #160 Oscar Insurance Company of Florida
Expanded Bronze (EPO) Bronze Classic- PCP Saver Plus
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $8,500 $17,000 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$314.55 $357.01 $401.99 $561.77 $853.67	$555.18 $597.64 $642.62 $802.40	$795.81 $838.27 $883.25 $1,043.03	$1,036.44 $1,078.90 $1,123.88 $1,283.66	$240.63
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$629.10 $714.02 $803.98 $1,123.54 $1,707.34	$869.73 $954.65 $1,044.61 $1,364.17	$1,110.36 $1,195.28 $1,285.24 $1,604.80	$1,350.99 $1,435.91 $1,525.87 $1,845.43	$240.63

Toc - Plan #161 Oscar Insurance Company of Florida
Expanded Bronze (EPO) Bronze Classic- Deductible Saver
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $4,700 $9,400 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$323.78 $367.48 $413.78 $578.26 $878.72	$571.47 $615.17 $661.47 $825.95	$819.16 $862.86 $909.16 $1,073.64	$1,066.85 $1,110.55 $1,156.85 $1,321.33	$247.69
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$647.56 $734.96 $827.56 $1,156.52 $1,757.44	$895.25 $982.65 $1,075.25 $1,404.21	$1,142.94 $1,230.34 $1,322.94 $1,651.90	$1,390.63 $1,478.03 $1,570.63 $1,899.59	$247.69

Toc - Plan #162 Oscar Insurance Company of Florida
Silver (EPO) Silver Simple- PCP Saver
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $5,500 $11,000 Annual Deductible $8,900 $17,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$394.53 $447.78 $504.19 $704.61 $1,070.72	$696.34 $749.59 $806.00 $1,006.42	$998.15 $1,051.40 $1,107.81 $1,308.23	$1,299.96 $1,353.21 $1,409.62 $1,610.04	$301.81
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$789.06 $895.56 $1,008.38 $1,409.22 $2,141.44	$1,090.87 $1,197.37 $1,310.19 $1,711.03	$1,392.68 $1,499.18 $1,612.00 $2,012.84	$1,694.49 $1,800.99 $1,913.81 $2,314.65	$301.81

Toc - Plan #163 Oscar Insurance Company of Florida
Silver (EPO) Silver Elite- PCP Saver Plus
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $4,000 $8,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$410.24 $465.61 $524.27 $732.67 $1,113.37	$724.07 $779.44 $838.10 $1,046.50	$1,037.90 $1,093.27 $1,151.93 $1,360.33	$1,351.73 $1,407.10 $1,465.76 $1,674.16	$313.83
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$820.48 $931.22 $1,048.54 $1,465.34 $2,226.74	$1,134.31 $1,245.05 $1,362.37 $1,779.17	$1,448.14 $1,558.88 $1,676.20 $2,093.00	$1,761.97 $1,872.71 $1,990.03 $2,406.83	$313.83

Toc - Plan #164 Oscar Insurance Company of Florida
Silver (EPO) Silver Elite- Deductible Saver Plus
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$400.34 $454.37 $511.62 $714.99 $1,086.49	$706.59 $760.62 $817.87 $1,021.24	$1,012.84 $1,066.87 $1,124.12 $1,327.49	$1,319.09 $1,373.12 $1,430.37 $1,633.74	$306.25
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$800.68 $908.74 $1,023.24 $1,429.98 $2,172.98	$1,106.93 $1,214.99 $1,329.49 $1,736.23	$1,413.18 $1,521.24 $1,635.74 $2,042.48	$1,719.43 $1,827.49 $1,941.99 $2,348.73	$306.25

Toc - Plan #165 Oscar Insurance Company of Florida
Gold (EPO) Gold Elite- Deductible Saver Plus
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$464.67 $527.39 $593.84 $829.89 $1,261.09	$820.14 $882.86 $949.31 $1,185.36	$1,175.61 $1,238.33 $1,304.78 $1,540.83	$1,531.08 $1,593.80 $1,660.25 $1,896.30	$355.47
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$929.34 $1,054.78 $1,187.68 $1,659.78 $2,522.18	$1,284.81 $1,410.25 $1,543.15 $2,015.25	$1,640.28 $1,765.72 $1,898.62 $2,370.72	$1,995.75 $2,121.19 $2,254.09 $2,726.19	$355.47

Toc - Plan #166 Oscar Insurance Company of Florida
Gold (EPO) Gold Elite
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $500 $1,000 Annual Deductible $5,500 $11,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$435.08 $493.80 $556.02 $777.03 $1,180.77	$767.91 $826.63 $888.85 $1,109.86	$1,100.74 $1,159.46 $1,221.68 $1,442.69	$1,433.57 $1,492.29 $1,554.51 $1,775.52	$332.83
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$870.16 $987.60 $1,112.04 $1,554.06 $2,361.54	$1,202.99 $1,320.43 $1,444.87 $1,886.89	$1,535.82 $1,653.26 $1,777.70 $2,219.72	$1,868.65 $1,986.09 $2,110.53 $2,552.55	$332.83

Toc - Plan #167 Oscar Insurance Company of Florida
Expanded Bronze (EPO) Bronze Elite- Deductible Saver Plus
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$350.75 $398.08 $448.24 $626.41 $951.90	$619.06 $666.39 $716.55 $894.72	$887.37 $934.70 $984.86 $1,163.03	$1,155.68 $1,203.01 $1,253.17 $1,431.34	$268.31
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$701.50 $796.16 $896.48 $1,252.82 $1,903.80	$969.81 $1,064.47 $1,164.79 $1,521.13	$1,238.12 $1,332.78 $1,433.10 $1,789.44	$1,506.43 $1,601.09 $1,701.41 $2,057.75	$268.31

Toc - Plan #168 Oscar Insurance Company of Florida
Silver (EPO) Silver Simple- For Diabetes
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $6,450 $12,900 Annual Deductible $8,550 $17,100 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$399.18 $453.05 $510.13 $712.91 $1,083.34	$704.54 $758.41 $815.49 $1,018.27	$1,009.90 $1,063.77 $1,120.85 $1,323.63	$1,315.26 $1,369.13 $1,426.21 $1,628.99	$305.36
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$798.36 $906.10 $1,020.26 $1,425.82 $2,166.68	$1,103.72 $1,211.46 $1,325.62 $1,731.18	$1,409.08 $1,516.82 $1,630.98 $2,036.54	$1,714.44 $1,822.18 $1,936.34 $2,341.90	$305.36

Toc - Plan #169 Oscar Insurance Company of Florida
Expanded Bronze (EPO) Bronze Classic- Standard
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $7,500 $15,000 Annual Deductible $9,000 $18,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$320.55 $363.81 $409.65 $572.48 $869.94	$565.76 $609.02 $654.86 $817.69	$810.97 $854.23 $900.07 $1,062.90	$1,056.18 $1,099.44 $1,145.28 $1,308.11	$245.21
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$641.10 $727.62 $819.30 $1,144.96 $1,739.88	$886.31 $972.83 $1,064.51 $1,390.17	$1,131.52 $1,218.04 $1,309.72 $1,635.38	$1,376.73 $1,463.25 $1,554.93 $1,880.59	$245.21

Toc - Plan #170 Oscar Insurance Company of Florida
Bronze (EPO) Bronze Simple- Standard
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $9,100 $18,200 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$282.06 $320.13 $360.46 $503.75 $765.49	$497.83 $535.90 $576.23 $719.52	$713.60 $751.67 $792.00 $935.29	$929.37 $967.44 $1,007.77 $1,151.06	$215.77
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$564.12 $640.26 $720.92 $1,007.50 $1,530.98	$779.89 $856.03 $936.69 $1,223.27	$995.66 $1,071.80 $1,152.46 $1,439.04	$1,211.43 $1,287.57 $1,368.23 $1,654.81	$215.77

Toc - Plan #171 Oscar Insurance Company of Florida
Silver (EPO) Silver Classic- Standard
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $5,800 $11,600 Annual Deductible $8,900 $17,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$395.11 $448.44 $504.94 $705.65 $1,072.30	$697.36 $750.69 $807.19 $1,007.90	$999.61 $1,052.94 $1,109.44 $1,310.15	$1,301.86 $1,355.19 $1,411.69 $1,612.40	$302.25
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$790.22 $896.88 $1,009.88 $1,411.30 $2,144.60	$1,092.47 $1,199.13 $1,312.13 $1,713.55	$1,394.72 $1,501.38 $1,614.38 $2,015.80	$1,696.97 $1,803.63 $1,916.63 $2,318.05	$302.25

Toc - Plan #172 Oscar Insurance Company of Florida
Gold (EPO) Gold Classic- Standard
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-855-672-2755 Annual Out of Pocket Expenses: Individual Family $2,000 $4,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$404.19 $458.74 $516.54 $721.86 $1,096.94	$713.39 $767.94 $825.74 $1,031.06	$1,022.59 $1,077.14 $1,134.94 $1,340.26	$1,331.79 $1,386.34 $1,444.14 $1,649.46	$309.20
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$808.38 $917.48 $1,033.08 $1,443.72 $2,193.88	$1,117.58 $1,226.68 $1,342.28 $1,752.92	$1,426.78 $1,535.88 $1,651.48 $2,062.12	$1,735.98 $1,845.08 $1,960.68 $2,371.32	$309.20

Cigna Healthcare Local: 1-877-900-1237 | Toll Free: 1-877-900-1237 | TTY: 1-800-676-3777

Toc - Plan #173 Cigna Healthcare
Bronze (EPO) Cigna Connect 8700
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-900-1237 Annual Out of Pocket Expenses: Individual Family $8,700 $17,400 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$344.87 $391.43 $440.74 $615.93 $935.97	$608.69 $655.25 $704.56 $879.75	$872.51 $919.07 $968.38 $1,143.57	$1,136.33 $1,182.89 $1,232.20 $1,407.39	$263.82
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$689.74 $782.86 $881.48 $1,231.86 $1,871.94	$953.56 $1,046.68 $1,145.30 $1,495.68	$1,217.38 $1,310.50 $1,409.12 $1,759.50	$1,481.20 $1,574.32 $1,672.94 $2,023.32	$263.82

Toc - Plan #174 Cigna Healthcare
Expanded Bronze (EPO) Cigna Connect 7300
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-900-1237 Annual Out of Pocket Expenses: Individual Family $7,300 $14,600 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$358.19 $406.54 $457.77 $639.73 $972.12	$632.20 $680.55 $731.78 $913.74	$906.21 $954.56 $1,005.79 $1,187.75	$1,180.22 $1,228.57 $1,279.80 $1,461.76	$274.01
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$716.38 $813.08 $915.54 $1,279.46 $1,944.24	$990.39 $1,087.09 $1,189.55 $1,553.47	$1,264.40 $1,361.10 $1,463.56 $1,827.48	$1,538.41 $1,635.11 $1,737.57 $2,101.49	$274.01

Toc - Plan #175 Cigna Healthcare
Expanded Bronze (EPO) Cigna Connect 8200
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-900-1237 Annual Out of Pocket Expenses: Individual Family $8,200 $16,400 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$358.33 $406.71 $457.95 $639.98 $972.51	$632.45 $680.83 $732.07 $914.10	$906.57 $954.95 $1,006.19 $1,188.22	$1,180.69 $1,229.07 $1,280.31 $1,462.34	$274.12
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$716.66 $813.42 $915.90 $1,279.96 $1,945.02	$990.78 $1,087.54 $1,190.02 $1,554.08	$1,264.90 $1,361.66 $1,464.14 $1,828.20	$1,539.02 $1,635.78 $1,738.26 $2,102.32	$274.12

Toc - Plan #176 Cigna Healthcare
Silver (EPO) Cigna Connect 4400
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-900-1237 Annual Out of Pocket Expenses: Individual Family $4,400 $8,800 Annual Deductible $9,050 $18,100 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$411.71 $467.29 $526.16 $735.31 $1,117.38	$726.67 $782.25 $841.12 $1,050.27	$1,041.63 $1,097.21 $1,156.08 $1,365.23	$1,356.59 $1,412.17 $1,471.04 $1,680.19	$314.96
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$823.42 $934.58 $1,052.32 $1,470.62 $2,234.76	$1,138.38 $1,249.54 $1,367.28 $1,785.58	$1,453.34 $1,564.50 $1,682.24 $2,100.54	$1,768.30 $1,879.46 $1,997.20 $2,415.50	$314.96

Toc - Plan #177 Cigna Healthcare
Silver (EPO) Cigna Connect 4500
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-900-1237 Annual Out of Pocket Expenses: Individual Family $4,500 $9,000 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$415.98 $472.13 $531.62 $742.93 $1,128.96	$734.20 $790.35 $849.84 $1,061.15	$1,052.42 $1,108.57 $1,168.06 $1,379.37	$1,370.64 $1,426.79 $1,486.28 $1,697.59	$318.22
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$831.96 $944.26 $1,063.24 $1,485.86 $2,257.92	$1,150.18 $1,262.48 $1,381.46 $1,804.08	$1,468.40 $1,580.70 $1,699.68 $2,122.30	$1,786.62 $1,898.92 $2,017.90 $2,440.52	$318.22

Toc - Plan #178 Cigna Healthcare
Silver (EPO) Cigna Connect 8900
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-900-1237 Annual Out of Pocket Expenses: Individual Family $8,900 $17,800 Annual Deductible $8,900 $17,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$419.25 $475.84 $535.80 $748.77 $1,137.83	$739.97 $796.56 $856.52 $1,069.49	$1,060.69 $1,117.28 $1,177.24 $1,390.21	$1,381.41 $1,438.00 $1,497.96 $1,710.93	$320.72
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$838.50 $951.68 $1,071.60 $1,497.54 $2,275.66	$1,159.22 $1,272.40 $1,392.32 $1,818.26	$1,479.94 $1,593.12 $1,713.04 $2,138.98	$1,800.66 $1,913.84 $2,033.76 $2,459.70	$320.72

Toc - Plan #179 Cigna Healthcare
Silver (EPO) Cigna Connect 3500
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-900-1237 Annual Out of Pocket Expenses: Individual Family $3,500 $7,000 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$419.91 $476.60 $536.64 $749.96 $1,139.64	$741.14 $797.83 $857.87 $1,071.19	$1,062.37 $1,119.06 $1,179.10 $1,392.42	$1,383.60 $1,440.29 $1,500.33 $1,713.65	$321.23
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$839.82 $953.20 $1,073.28 $1,499.92 $2,279.28	$1,161.05 $1,274.43 $1,394.51 $1,821.15	$1,482.28 $1,595.66 $1,715.74 $2,142.38	$1,803.51 $1,916.89 $2,036.97 $2,463.61	$321.23

Toc - Plan #180 Cigna Healthcare
Gold (EPO) Cigna Connect 1950
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-900-1237 Annual Out of Pocket Expenses: Individual Family $1,950 $3,900 Annual Deductible $8,000 $16,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$499.79 $567.26 $638.73 $892.62 $1,356.42	$882.13 $949.60 $1,021.07 $1,274.96	$1,264.47 $1,331.94 $1,403.41 $1,657.30	$1,646.81 $1,714.28 $1,785.75 $2,039.64	$382.34
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$999.58 $1,134.52 $1,277.46 $1,785.24 $2,712.84	$1,381.92 $1,516.86 $1,659.80 $2,167.58	$1,764.26 $1,899.20 $2,042.14 $2,549.92	$2,146.60 $2,281.54 $2,424.48 $2,932.26	$382.34

Toc - Plan #181 Cigna Healthcare
Expanded Bronze (EPO) Cigna Connect 8000
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-900-1237 Annual Out of Pocket Expenses: Individual Family $8,000 $16,000 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$357.38 $405.63 $456.74 $638.29 $969.94	$630.78 $679.03 $730.14 $911.69	$904.18 $952.43 $1,003.54 $1,185.09	$1,177.58 $1,225.83 $1,276.94 $1,458.49	$273.40
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$714.76 $811.26 $913.48 $1,276.58 $1,939.88	$988.16 $1,084.66 $1,186.88 $1,549.98	$1,261.56 $1,358.06 $1,460.28 $1,823.38	$1,534.96 $1,631.46 $1,733.68 $2,096.78	$273.40

Toc - Plan #182 Cigna Healthcare
Expanded Bronze (EPO) Cigna Connect 6800 Enhanced Diabetes Care
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-900-1237 Annual Out of Pocket Expenses: Individual Family $6,800 $13,600 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$357.15 $405.36 $456.43 $637.86 $969.29	$630.37 $678.58 $729.65 $911.08	$903.59 $951.80 $1,002.87 $1,184.30	$1,176.81 $1,225.02 $1,276.09 $1,457.52	$273.22
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$714.30 $810.72 $912.86 $1,275.72 $1,938.58	$987.52 $1,083.94 $1,186.08 $1,548.94	$1,260.74 $1,357.16 $1,459.30 $1,822.16	$1,533.96 $1,630.38 $1,732.52 $2,095.38	$273.22

Toc - Plan #183 Cigna Healthcare
Silver (EPO) Cigna Connect 3000
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-900-1237 Annual Out of Pocket Expenses: Individual Family $3,000 $6,000 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$413.04 $468.80 $527.86 $737.68 $1,120.98	$729.01 $784.77 $843.83 $1,053.65	$1,044.98 $1,100.74 $1,159.80 $1,369.62	$1,360.95 $1,416.71 $1,475.77 $1,685.59	$315.97
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$826.08 $937.60 $1,055.72 $1,475.36 $2,241.96	$1,142.05 $1,253.57 $1,371.69 $1,791.33	$1,458.02 $1,569.54 $1,687.66 $2,107.30	$1,773.99 $1,885.51 $2,003.63 $2,423.27	$315.97

Toc - Plan #184 Cigna Healthcare
Silver (EPO) Cigna Connect 0B
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-900-1237 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$431.05 $489.24 $550.88 $769.85 $1,169.87	$760.80 $818.99 $880.63 $1,099.60	$1,090.55 $1,148.74 $1,210.38 $1,429.35	$1,420.30 $1,478.49 $1,540.13 $1,759.10	$329.75
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$862.10 $978.48 $1,101.76 $1,539.70 $2,339.74	$1,191.85 $1,308.23 $1,431.51 $1,869.45	$1,521.60 $1,637.98 $1,761.26 $2,199.20	$1,851.35 $1,967.73 $2,091.01 $2,528.95	$329.75

Toc - Plan #185 Cigna Healthcare
Silver (EPO) Cigna Connect 4200 Enhanced Asthma COPD Care
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-900-1237 Annual Out of Pocket Expenses: Individual Family $4,200 $8,400 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$416.69 $472.94 $532.53 $744.20 $1,130.89	$735.45 $791.70 $851.29 $1,062.96	$1,054.21 $1,110.46 $1,170.05 $1,381.72	$1,372.97 $1,429.22 $1,488.81 $1,700.48	$318.76
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$833.38 $945.88 $1,065.06 $1,488.40 $2,261.78	$1,152.14 $1,264.64 $1,383.82 $1,807.16	$1,470.90 $1,583.40 $1,702.58 $2,125.92	$1,789.66 $1,902.16 $2,021.34 $2,444.68	$318.76

Toc - Plan #186 Cigna Healthcare
Gold (EPO) Cigna Connect 900
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-900-1237 Annual Out of Pocket Expenses: Individual Family $900 $1,800 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$519.51 $589.64 $663.93 $927.84 $1,409.94	$916.93 $987.06 $1,061.35 $1,325.26	$1,314.35 $1,384.48 $1,458.77 $1,722.68	$1,711.77 $1,781.90 $1,856.19 $2,120.10	$397.42
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,039.02 $1,179.28 $1,327.86 $1,855.68 $2,819.88	$1,436.44 $1,576.70 $1,725.28 $2,253.10	$1,833.86 $1,974.12 $2,122.70 $2,650.52	$2,231.28 $2,371.54 $2,520.12 $3,047.94	$397.42

Toc - Plan #187 Cigna Healthcare
Gold (EPO) Cigna Connect 1900 Enhanced Diabetes Care
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-900-1237 Annual Out of Pocket Expenses: Individual Family $1,900 $3,800 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$502.77 $570.65 $642.54 $897.95 $1,364.53	$887.39 $955.27 $1,027.16 $1,282.57	$1,272.01 $1,339.89 $1,411.78 $1,667.19	$1,656.63 $1,724.51 $1,796.40 $2,051.81	$384.62
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,005.54 $1,141.30 $1,285.08 $1,795.90 $2,729.06	$1,390.16 $1,525.92 $1,669.70 $2,180.52	$1,774.78 $1,910.54 $2,054.32 $2,565.14	$2,159.40 $2,295.16 $2,438.94 $2,949.76	$384.62

Toc - Plan #188 Cigna Healthcare
Gold (EPO) Cigna Simple Choice 2000
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-900-1237 Annual Out of Pocket Expenses: Individual Family $2,000 $4,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$500.45 $568.01 $639.58 $893.80 $1,358.22	$883.29 $950.85 $1,022.42 $1,276.64	$1,266.13 $1,333.69 $1,405.26 $1,659.48	$1,648.97 $1,716.53 $1,788.10 $2,042.32	$382.84
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,000.90 $1,136.02 $1,279.16 $1,787.60 $2,716.44	$1,383.74 $1,518.86 $1,662.00 $2,170.44	$1,766.58 $1,901.70 $2,044.84 $2,553.28	$2,149.42 $2,284.54 $2,427.68 $2,936.12	$382.84

Toc - Plan #189 Cigna Healthcare
Silver (EPO) Cigna Simple Choice 5800
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-900-1237 Annual Out of Pocket Expenses: Individual Family $5,800 $11,600 Annual Deductible $8,900 $17,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$412.14 $467.77 $526.71 $736.07 $1,118.54	$727.42 $783.05 $841.99 $1,051.35	$1,042.70 $1,098.33 $1,157.27 $1,366.63	$1,357.98 $1,413.61 $1,472.55 $1,681.91	$315.28
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$824.28 $935.54 $1,053.42 $1,472.14 $2,237.08	$1,139.56 $1,250.82 $1,368.70 $1,787.42	$1,454.84 $1,566.10 $1,683.98 $2,102.70	$1,770.12 $1,881.38 $1,999.26 $2,417.98	$315.28

Toc - Plan #190 Cigna Healthcare
Bronze (EPO) Cigna Simple Choice 9100
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-900-1237 Annual Out of Pocket Expenses: Individual Family $9,100 $18,200 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$341.55 $387.66 $436.50 $610.01 $926.97	$602.84 $648.95 $697.79 $871.30	$864.13 $910.24 $959.08 $1,132.59	$1,125.42 $1,171.53 $1,220.37 $1,393.88	$261.29
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$683.10 $775.32 $873.00 $1,220.02 $1,853.94	$944.39 $1,036.61 $1,134.29 $1,481.31	$1,205.68 $1,297.90 $1,395.58 $1,742.60	$1,466.97 $1,559.19 $1,656.87 $2,003.89	$261.29

Toc - Plan #191 Cigna Healthcare
Expanded Bronze (EPO) Cigna Simple Choice 7500
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-900-1237 Annual Out of Pocket Expenses: Individual Family $7,500 $15,000 Annual Deductible $9,000 $18,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$355.91 $403.96 $454.86 $635.66 $965.95	$628.18 $676.23 $727.13 $907.93	$900.45 $948.50 $999.40 $1,180.20	$1,172.72 $1,220.77 $1,271.67 $1,452.47	$272.27
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$711.82 $807.92 $909.72 $1,271.32 $1,931.90	$984.09 $1,080.19 $1,181.99 $1,543.59	$1,256.36 $1,352.46 $1,454.26 $1,815.86	$1,528.63 $1,624.73 $1,726.53 $2,088.13	$272.27

Toc - Plan #192 Cigna Healthcare
Expanded Bronze (EPO) Cigna Connect 0A
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-900-1237 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$383.50 $435.28 $490.12 $684.94 $1,040.83	$676.88 $728.66 $783.50 $978.32	$970.26 $1,022.04 $1,076.88 $1,271.70	$1,263.64 $1,315.42 $1,370.26 $1,565.08	$293.38
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$767.00 $870.56 $980.24 $1,369.88 $2,081.66	$1,060.38 $1,163.94 $1,273.62 $1,663.26	$1,353.76 $1,457.32 $1,567.00 $1,956.64	$1,647.14 $1,750.70 $1,860.38 $2,250.02	$293.38

Toc - Plan #193 Cigna Healthcare
Expanded Bronze (EPO) Cigna Connect 7600 Enhanced Asthma COPD Care
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-900-1237 Annual Out of Pocket Expenses: Individual Family $7,600 $15,200 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$357.05 $405.25 $456.31 $637.69 $969.04	$630.19 $678.39 $729.45 $910.83	$903.33 $951.53 $1,002.59 $1,183.97	$1,176.47 $1,224.67 $1,275.73 $1,457.11	$273.14
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$714.10 $810.50 $912.62 $1,275.38 $1,938.08	$987.24 $1,083.64 $1,185.76 $1,548.52	$1,260.38 $1,356.78 $1,458.90 $1,821.66	$1,533.52 $1,629.92 $1,732.04 $2,094.80	$273.14

Toc - Plan #194 Cigna Healthcare
Gold (EPO) Cigna Connect 2100 Enhanced Asthma COPD Care
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-900-1237 Annual Out of Pocket Expenses: Individual Family $2,100 $4,200 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$499.83 $567.31 $638.79 $892.70 $1,356.55	$882.20 $949.68 $1,021.16 $1,275.07	$1,264.57 $1,332.05 $1,403.53 $1,657.44	$1,646.94 $1,714.42 $1,785.90 $2,039.81	$382.37
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$999.66 $1,134.62 $1,277.58 $1,785.40 $2,713.10	$1,382.03 $1,516.99 $1,659.95 $2,167.77	$1,764.40 $1,899.36 $2,042.32 $2,550.14	$2,146.77 $2,281.73 $2,424.69 $2,932.51	$382.37

Toc - Plan #195 Cigna Healthcare
Expanded Bronze (EPO) Cigna Connect 5400
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-900-1237 Annual Out of Pocket Expenses: Individual Family $5,400 $10,800 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$363.83 $412.95 $464.97 $649.80 $987.43	$642.16 $691.28 $743.30 $928.13	$920.49 $969.61 $1,021.63 $1,206.46	$1,198.82 $1,247.94 $1,299.96 $1,484.79	$278.33
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$727.66 $825.90 $929.94 $1,299.60 $1,974.86	$1,005.99 $1,104.23 $1,208.27 $1,577.93	$1,284.32 $1,382.56 $1,486.60 $1,856.26	$1,562.65 $1,660.89 $1,764.93 $2,134.59	$278.33

Toc - Plan #196 Cigna Healthcare
Silver (EPO) Cigna Connect 3800 Enhanced Diabetes Care
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-900-1237 Annual Out of Pocket Expenses: Individual Family $3,800 $7,600 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$416.16 $472.35 $531.86 $743.27 $1,129.47	$734.53 $790.72 $850.23 $1,061.64	$1,052.90 $1,109.09 $1,168.60 $1,380.01	$1,371.27 $1,427.46 $1,486.97 $1,698.38	$318.37
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$832.32 $944.70 $1,063.72 $1,486.54 $2,258.94	$1,150.69 $1,263.07 $1,382.09 $1,804.91	$1,469.06 $1,581.44 $1,700.46 $2,123.28	$1,787.43 $1,899.81 $2,018.83 $2,441.65	$318.37

Molina Healthcare Local: 1-888-560-5716 | Toll Free: 1-888-560-5716 | TTY: 1-800-955-8771

Toc - Plan #197 Molina Healthcare
Gold (HMO) Confident Care Gold 1
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-560-5716 Annual Out of Pocket Expenses: Individual Family $1,900 $3,800 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$452.69 $513.80 $578.53 $808.50 $1,228.59	$799.00 $860.11 $924.84 $1,154.81	$1,145.31 $1,206.42 $1,271.15 $1,501.12	$1,491.62 $1,552.73 $1,617.46 $1,847.43	$346.31
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$905.38 $1,027.60 $1,157.06 $1,617.00 $2,457.18	$1,251.69 $1,373.91 $1,503.37 $1,963.31	$1,598.00 $1,720.22 $1,849.68 $2,309.62	$1,944.31 $2,066.53 $2,195.99 $2,655.93	$346.31

Toc - Plan #198 Molina Healthcare
Silver (HMO) Constant Care Silver 1
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-560-5716 Annual Out of Pocket Expenses: Individual Family $2,500 $5,000 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$393.60 $446.74 $503.02 $702.97 $1,068.23	$694.70 $747.84 $804.12 $1,004.07	$995.80 $1,048.94 $1,105.22 $1,305.17	$1,296.90 $1,350.04 $1,406.32 $1,606.27	$301.10
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$787.20 $893.48 $1,006.04 $1,405.94 $2,136.46	$1,088.30 $1,194.58 $1,307.14 $1,707.04	$1,389.40 $1,495.68 $1,608.24 $2,008.14	$1,690.50 $1,796.78 $1,909.34 $2,309.24	$301.10

Toc - Plan #199 Molina Healthcare
Expanded Bronze (HMO) Core Care Bronze 4
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-560-5716 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $8,550 $17,100 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$361.31 $410.09 $461.76 $645.30 $980.60	$637.71 $686.49 $738.16 $921.70	$914.11 $962.89 $1,014.56 $1,198.10	$1,190.51 $1,239.29 $1,290.96 $1,474.50	$276.40
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$722.62 $820.18 $923.52 $1,290.60 $1,961.20	$999.02 $1,096.58 $1,199.92 $1,567.00	$1,275.42 $1,372.98 $1,476.32 $1,843.40	$1,551.82 $1,649.38 $1,752.72 $2,119.80	$276.40

Toc - Plan #200 Molina Healthcare
Gold (HMO) Confident Care Gold 8
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-560-5716 Annual Out of Pocket Expenses: Individual Family $2,000 $4,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$462.11 $524.50 $590.58 $825.33 $1,254.17	$815.63 $878.02 $944.10 $1,178.85	$1,169.15 $1,231.54 $1,297.62 $1,532.37	$1,522.67 $1,585.06 $1,651.14 $1,885.89	$353.52
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$924.22 $1,049.00 $1,181.16 $1,650.66 $2,508.34	$1,277.74 $1,402.52 $1,534.68 $2,004.18	$1,631.26 $1,756.04 $1,888.20 $2,357.70	$1,984.78 $2,109.56 $2,241.72 $2,711.22	$353.52

Toc - Plan #201 Molina Healthcare
Silver (HMO) Constant Care Silver 8
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-560-5716 Annual Out of Pocket Expenses: Individual Family $5,800 $11,600 Annual Deductible $8,900 $17,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$401.05 $455.19 $512.54 $716.27 $1,088.45	$707.85 $761.99 $819.34 $1,023.07	$1,014.65 $1,068.79 $1,126.14 $1,329.87	$1,321.45 $1,375.59 $1,432.94 $1,636.67	$306.80
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$802.10 $910.38 $1,025.08 $1,432.54 $2,176.90	$1,108.90 $1,217.18 $1,331.88 $1,739.34	$1,415.70 $1,523.98 $1,638.68 $2,046.14	$1,722.50 $1,830.78 $1,945.48 $2,352.94	$306.80

Toc - Plan #202 Molina Healthcare
Expanded Bronze (HMO) Core Care Bronze 8
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-560-5716 Annual Out of Pocket Expenses: Individual Family $7,500 $15,000 Annual Deductible $9,000 $18,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$312.57 $354.76 $399.46 $558.25 $848.31	$551.68 $593.87 $638.57 $797.36	$790.79 $832.98 $877.68 $1,036.47	$1,029.90 $1,072.09 $1,116.79 $1,275.58	$239.11
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$625.14 $709.52 $798.92 $1,116.50 $1,696.62	$864.25 $948.63 $1,038.03 $1,355.61	$1,103.36 $1,187.74 $1,277.14 $1,594.72	$1,342.47 $1,426.85 $1,516.25 $1,833.83	$239.11

Toc - Plan #203 Molina Healthcare
Gold (HMO) Confident Care Gold 1 + Vision
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-560-5716 Annual Out of Pocket Expenses: Individual Family $1,900 $3,800 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$456.94 $518.62 $583.97 $816.09 $1,240.13	$806.50 $868.18 $933.53 $1,165.65	$1,156.06 $1,217.74 $1,283.09 $1,515.21	$1,505.62 $1,567.30 $1,632.65 $1,864.77	$349.56
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$913.88 $1,037.24 $1,167.94 $1,632.18 $2,480.26	$1,263.44 $1,386.80 $1,517.50 $1,981.74	$1,613.00 $1,736.36 $1,867.06 $2,331.30	$1,962.56 $2,085.92 $2,216.62 $2,680.86	$349.56

Toc - Plan #204 Molina Healthcare
Silver (HMO) Constant Care Silver 1 + Vision
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-560-5716 Annual Out of Pocket Expenses: Individual Family $2,500 $5,000 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$397.86 $451.57 $508.46 $710.57 $1,079.78	$702.22 $755.93 $812.82 $1,014.93	$1,006.58 $1,060.29 $1,117.18 $1,319.29	$1,310.94 $1,364.65 $1,421.54 $1,623.65	$304.36
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$795.72 $903.14 $1,016.92 $1,421.14 $2,159.56	$1,100.08 $1,207.50 $1,321.28 $1,725.50	$1,404.44 $1,511.86 $1,625.64 $2,029.86	$1,708.80 $1,816.22 $1,930.00 $2,334.22	$304.36

Florida Health Care Plans Local: 1-386-676-7110 | Toll Free: 1-800-232-0578 | TTY: 1-800-955-8771

Toc - Plan #205 Florida Health Care Plans
Catastrophic (HMO) Gym Access IND Essential Plus Catastrophic HMO 36
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $9,100 $18,200 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$229.05 $259.97 $292.73 $409.08 $621.64	$404.27 $435.19 $467.95 $584.30	$579.49 $610.41 $643.17 $759.52	$754.71 $785.63 $818.39 $934.74	$175.22
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$458.10 $519.94 $585.46 $818.16 $1,243.28	$633.32 $695.16 $760.68 $993.38	$808.54 $870.38 $935.90 $1,168.60	$983.76 $1,045.60 $1,111.12 $1,343.82	$175.22

Toc - Plan #206 Florida Health Care Plans
Catastrophic (POS) Gym Access IND Essential Plus Catastrophic POS 37
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $9,100 $18,200 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$247.37 $280.76 $316.14 $441.80 $671.36	$436.61 $470.00 $505.38 $631.04	$625.85 $659.24 $694.62 $820.28	$815.09 $848.48 $883.86 $1,009.52	$189.24
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$494.74 $561.52 $632.28 $883.60 $1,342.72	$683.98 $750.76 $821.52 $1,072.84	$873.22 $940.00 $1,010.76 $1,262.08	$1,062.46 $1,129.24 $1,200.00 $1,451.32	$189.24

Toc - Plan #207 Florida Health Care Plans
Silver (HMO) Gym Access IND Essential Plus Silver HMO 53
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $4,000 $8,000 Annual Deductible $8,900 $17,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$404.74 $459.38 $517.26 $722.87 $1,098.46	$714.37 $769.01 $826.89 $1,032.50	$1,024.00 $1,078.64 $1,136.52 $1,342.13	$1,333.63 $1,388.27 $1,446.15 $1,651.76	$309.63
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$809.48 $918.76 $1,034.52 $1,445.74 $2,196.92	$1,119.11 $1,228.39 $1,344.15 $1,755.37	$1,428.74 $1,538.02 $1,653.78 $2,065.00	$1,738.37 $1,847.65 $1,963.41 $2,374.63	$309.63

Toc - Plan #208 Florida Health Care Plans
Gold (HMO) Gym Access IND Essential Plus Gold HMO 63
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $2,000 $4,000 Annual Deductible $5,200 $10,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$443.39 $503.25 $566.65 $791.89 $1,203.36	$782.58 $842.44 $905.84 $1,131.08	$1,121.77 $1,181.63 $1,245.03 $1,470.27	$1,460.96 $1,520.82 $1,584.22 $1,809.46	$339.19
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$886.78 $1,006.50 $1,133.30 $1,583.78 $2,406.72	$1,225.97 $1,345.69 $1,472.49 $1,922.97	$1,565.16 $1,684.88 $1,811.68 $2,262.16	$1,904.35 $2,024.07 $2,150.87 $2,601.35	$339.19

Toc - Plan #209 Florida Health Care Plans
Platinum (HMO) Gym Access IND Essential Plus Platinum HMO 65
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $2,000 $4,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$606.90 $688.83 $775.62 $1,083.92 $1,647.13	$1,071.18 $1,153.11 $1,239.90 $1,548.20	$1,535.46 $1,617.39 $1,704.18 $2,012.48	$1,999.74 $2,081.67 $2,168.46 $2,476.76	$464.28
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,213.80 $1,377.66 $1,551.24 $2,167.84 $3,294.26	$1,678.08 $1,841.94 $2,015.52 $2,632.12	$2,142.36 $2,306.22 $2,479.80 $3,096.40	$2,606.64 $2,770.50 $2,944.08 $3,560.68	$464.28

Toc - Plan #210 Florida Health Care Plans
Silver (POS) Gym Access IND Essential Plus Silver POS 54
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $4,000 $8,000 Annual Deductible $8,900 $17,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$417.08 $473.39 $533.03 $744.90 $1,131.96	$736.15 $792.46 $852.10 $1,063.97	$1,055.22 $1,111.53 $1,171.17 $1,383.04	$1,374.29 $1,430.60 $1,490.24 $1,702.11	$319.07
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$834.16 $946.78 $1,066.06 $1,489.80 $2,263.92	$1,153.23 $1,265.85 $1,385.13 $1,808.87	$1,472.30 $1,584.92 $1,704.20 $2,127.94	$1,791.37 $1,903.99 $2,023.27 $2,447.01	$319.07

Toc - Plan #211 Florida Health Care Plans
Platinum (HMO) Gym Access IND Platinum HMO 4000
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $4,000 $8,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$601.94 $683.20 $769.28 $1,075.06 $1,633.67	$1,062.42 $1,143.68 $1,229.76 $1,535.54	$1,522.90 $1,604.16 $1,690.24 $1,996.02	$1,983.38 $2,064.64 $2,150.72 $2,456.50	$460.48
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,203.88 $1,366.40 $1,538.56 $2,150.12 $3,267.34	$1,664.36 $1,826.88 $1,999.04 $2,610.60	$2,124.84 $2,287.36 $2,459.52 $3,071.08	$2,585.32 $2,747.84 $2,920.00 $3,531.56	$460.48

Toc - Plan #212 Florida Health Care Plans
Platinum (POS) Gym Access IND Platinum POS 4000
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $4,000 $8,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$650.10 $737.86 $830.83 $1,161.08 $1,764.37	$1,147.43 $1,235.19 $1,328.16 $1,658.41	$1,644.76 $1,732.52 $1,825.49 $2,155.74	$2,142.09 $2,229.85 $2,322.82 $2,653.07	$497.33
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,300.20 $1,475.72 $1,661.66 $2,322.16 $3,528.74	$1,797.53 $1,973.05 $2,158.99 $2,819.49	$2,294.86 $2,470.38 $2,656.32 $3,316.82	$2,792.19 $2,967.71 $3,153.65 $3,814.15	$497.33

Toc - Plan #213 Florida Health Care Plans
Gold (HMO) Gym Access IND Gold HMO 55001
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $2,800 $5,600 Annual Deductible $7,000 $14,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$448.00 $508.48 $572.54 $800.13 $1,215.87	$790.72 $851.20 $915.26 $1,142.85	$1,133.44 $1,193.92 $1,257.98 $1,485.57	$1,476.16 $1,536.64 $1,600.70 $1,828.29	$342.72
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$896.00 $1,016.96 $1,145.08 $1,600.26 $2,431.74	$1,238.72 $1,359.68 $1,487.80 $1,942.98	$1,581.44 $1,702.40 $1,830.52 $2,285.70	$1,924.16 $2,045.12 $2,173.24 $2,628.42	$342.72

Toc - Plan #214 Florida Health Care Plans
Gold (POS) Gym Access IND Gold POS 55001
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $2,800 $5,600 Annual Deductible $7,000 $14,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$483.84 $549.16 $618.35 $864.14 $1,313.14	$853.98 $919.30 $988.49 $1,234.28	$1,224.12 $1,289.44 $1,358.63 $1,604.42	$1,594.26 $1,659.58 $1,728.77 $1,974.56	$370.14
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$967.68 $1,098.32 $1,236.70 $1,728.28 $2,626.28	$1,337.82 $1,468.46 $1,606.84 $2,098.42	$1,707.96 $1,838.60 $1,976.98 $2,468.56	$2,078.10 $2,208.74 $2,347.12 $2,838.70	$370.14

Toc - Plan #215 Florida Health Care Plans
Gold (HMO) Gym Access IND Gold HMO 4500
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $2,550 $5,100 Annual Deductible $5,000 $10,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$446.14 $506.37 $570.17 $796.81 $1,210.82	$787.44 $847.67 $911.47 $1,138.11	$1,128.74 $1,188.97 $1,252.77 $1,479.41	$1,470.04 $1,530.27 $1,594.07 $1,820.71	$341.30
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$892.28 $1,012.74 $1,140.34 $1,593.62 $2,421.64	$1,233.58 $1,354.04 $1,481.64 $1,934.92	$1,574.88 $1,695.34 $1,822.94 $2,276.22	$1,916.18 $2,036.64 $2,164.24 $2,617.52	$341.30

Toc - Plan #216 Florida Health Care Plans
Expanded Bronze (HMO) Gym Access IND Bronze HMO HSA 5065
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $6,300 $12,600 Annual Deductible $7,500 $15,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$312.09 $354.22 $398.85 $557.39 $847.01	$550.84 $592.97 $637.60 $796.14	$789.59 $831.72 $876.35 $1,034.89	$1,028.34 $1,070.47 $1,115.10 $1,273.64	$238.75
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$624.18 $708.44 $797.70 $1,114.78 $1,694.02	$862.93 $947.19 $1,036.45 $1,353.53	$1,101.68 $1,185.94 $1,275.20 $1,592.28	$1,340.43 $1,424.69 $1,513.95 $1,831.03	$238.75

Toc - Plan #217 Florida Health Care Plans
Expanded Bronze (HMO) Gym Access IND Bronze HMO HSA 6060
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $7,500 $15,000 Annual Deductible $7,500 $15,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$309.92 $351.76 $396.08 $553.52 $841.12	$547.01 $588.85 $633.17 $790.61	$784.10 $825.94 $870.26 $1,027.70	$1,021.19 $1,063.03 $1,107.35 $1,264.79	$237.09
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$619.84 $703.52 $792.16 $1,107.04 $1,682.24	$856.93 $940.61 $1,029.25 $1,344.13	$1,094.02 $1,177.70 $1,266.34 $1,581.22	$1,331.11 $1,414.79 $1,503.43 $1,818.31	$237.09

Toc - Plan #218 Florida Health Care Plans
Expanded Bronze (HMO) Gym Access IND Bronze HMO BC 3841
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $8,000 $16,000 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$323.11 $366.73 $412.93 $577.07 $876.92	$570.29 $613.91 $660.11 $824.25	$817.47 $861.09 $907.29 $1,071.43	$1,064.65 $1,108.27 $1,154.47 $1,318.61	$247.18
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$646.22 $733.46 $825.86 $1,154.14 $1,753.84	$893.40 $980.64 $1,073.04 $1,401.32	$1,140.58 $1,227.82 $1,320.22 $1,648.50	$1,387.76 $1,475.00 $1,567.40 $1,895.68	$247.18

Toc - Plan #219 Florida Health Care Plans
Expanded Bronze (POS) Gym Access IND Bronze POS BC 3841
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $8,000 $16,000 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$348.96 $396.07 $445.97 $623.24 $947.08	$615.91 $663.02 $712.92 $890.19	$882.86 $929.97 $979.87 $1,157.14	$1,149.81 $1,196.92 $1,246.82 $1,424.09	$266.95
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$697.92 $792.14 $891.94 $1,246.48 $1,894.16	$964.87 $1,059.09 $1,158.89 $1,513.43	$1,231.82 $1,326.04 $1,425.84 $1,780.38	$1,498.77 $1,592.99 $1,692.79 $2,047.33	$266.95

Toc - Plan #220 Florida Health Care Plans
Silver (HMO) Gym Access IND Silver HMO BC 0941
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $5,000 $10,000 Annual Deductible $7,500 $15,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$392.30 $445.26 $501.36 $700.65 $1,064.70	$692.41 $745.37 $801.47 $1,000.76	$992.52 $1,045.48 $1,101.58 $1,300.87	$1,292.63 $1,345.59 $1,401.69 $1,600.98	$300.11
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$784.60 $890.52 $1,002.72 $1,401.30 $2,129.40	$1,084.71 $1,190.63 $1,302.83 $1,701.41	$1,384.82 $1,490.74 $1,602.94 $2,001.52	$1,684.93 $1,790.85 $1,903.05 $2,301.63	$300.11

Toc - Plan #221 Florida Health Care Plans
Silver (POS) Gym Access IND Silver POS BC 0941
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $5,000 $10,000 Annual Deductible $7,500 $15,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$423.69 $480.89 $541.48 $756.71 $1,149.89	$747.81 $805.01 $865.60 $1,080.83	$1,071.93 $1,129.13 $1,189.72 $1,404.95	$1,396.05 $1,453.25 $1,513.84 $1,729.07	$324.12
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$847.38 $961.78 $1,082.96 $1,513.42 $2,299.78	$1,171.50 $1,285.90 $1,407.08 $1,837.54	$1,495.62 $1,610.02 $1,731.20 $2,161.66	$1,819.74 $1,934.14 $2,055.32 $2,485.78	$324.12

Toc - Plan #222 Florida Health Care Plans
Silver (HMO) Gym Access IND Silver HMO BC 7741
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $6,000 $12,000 Annual Deductible $8,650 $17,300 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$388.62 $441.08 $496.66 $694.08 $1,054.71	$685.91 $738.37 $793.95 $991.37	$983.20 $1,035.66 $1,091.24 $1,288.66	$1,280.49 $1,332.95 $1,388.53 $1,585.95	$297.29
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$777.24 $882.16 $993.32 $1,388.16 $2,109.42	$1,074.53 $1,179.45 $1,290.61 $1,685.45	$1,371.82 $1,476.74 $1,587.90 $1,982.74	$1,669.11 $1,774.03 $1,885.19 $2,280.03	$297.29

Toc - Plan #223 Florida Health Care Plans
Silver (POS) Gym Access IND Silver POS BC 7741
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $6,000 $12,000 Annual Deductible $8,650 $17,300 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$419.71 $476.37 $536.39 $749.60 $1,139.09	$740.79 $797.45 $857.47 $1,070.68	$1,061.87 $1,118.53 $1,178.55 $1,391.76	$1,382.95 $1,439.61 $1,499.63 $1,712.84	$321.08
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$839.42 $952.74 $1,072.78 $1,499.20 $2,278.18	$1,160.50 $1,273.82 $1,393.86 $1,820.28	$1,481.58 $1,594.90 $1,714.94 $2,141.36	$1,802.66 $1,915.98 $2,036.02 $2,462.44	$321.08

Toc - Plan #224 Florida Health Care Plans
Gold (HMO) Gym Access IND Gold HMO BC 5651
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $5,900 $11,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$465.46 $528.30 $594.86 $831.31 $1,263.26	$821.54 $884.38 $950.94 $1,187.39	$1,177.62 $1,240.46 $1,307.02 $1,543.47	$1,533.70 $1,596.54 $1,663.10 $1,899.55	$356.08
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$930.92 $1,056.60 $1,189.72 $1,662.62 $2,526.52	$1,287.00 $1,412.68 $1,545.80 $2,018.70	$1,643.08 $1,768.76 $1,901.88 $2,374.78	$1,999.16 $2,124.84 $2,257.96 $2,730.86	$356.08

Toc - Plan #225 Florida Health Care Plans
Gold (POS) Gym Access IND Gold POS BC 5651
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $5,900 $11,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$502.85 $570.73 $642.64 $898.09 $1,364.73	$887.53 $955.41 $1,027.32 $1,282.77	$1,272.21 $1,340.09 $1,412.00 $1,667.45	$1,656.89 $1,724.77 $1,796.68 $2,052.13	$384.68
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,005.70 $1,141.46 $1,285.28 $1,796.18 $2,729.46	$1,390.38 $1,526.14 $1,669.96 $2,180.86	$1,775.06 $1,910.82 $2,054.64 $2,565.54	$2,159.74 $2,295.50 $2,439.32 $2,950.22	$384.68

Toc - Plan #226 Florida Health Care Plans
Platinum (HMO) Gym Access IND Platinum HMO BC 5841
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $800 $1,600 Annual Deductible $2,500 $5,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$598.14 $678.89 $764.42 $1,068.28 $1,623.35	$1,055.72 $1,136.47 $1,222.00 $1,525.86	$1,513.30 $1,594.05 $1,679.58 $1,983.44	$1,970.88 $2,051.63 $2,137.16 $2,441.02	$457.58
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,196.28 $1,357.78 $1,528.84 $2,136.56 $3,246.70	$1,653.86 $1,815.36 $1,986.42 $2,594.14	$2,111.44 $2,272.94 $2,444.00 $3,051.72	$2,569.02 $2,730.52 $2,901.58 $3,509.30	$457.58

Toc - Plan #227 Florida Health Care Plans
Platinum (POS) Gym Access IND Platinum POS BC 5841
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $800 $1,600 Annual Deductible $2,500 $5,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$645.99 $733.20 $825.58 $1,153.74 $1,753.22	$1,140.17 $1,227.38 $1,319.76 $1,647.92	$1,634.35 $1,721.56 $1,813.94 $2,142.10	$2,128.53 $2,215.74 $2,308.12 $2,636.28	$494.18
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,291.98 $1,466.40 $1,651.16 $2,307.48 $3,506.44	$1,786.16 $1,960.58 $2,145.34 $2,801.66	$2,280.34 $2,454.76 $2,639.52 $3,295.84	$2,774.52 $2,948.94 $3,133.70 $3,790.02	$494.18

Toc - Plan #228 Florida Health Care Plans
Platinum (HMO) Gym Access IND Platinum HMO BC 1941
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $2,000 $4,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$617.72 $701.11 $789.45 $1,103.25 $1,676.49	$1,090.28 $1,173.67 $1,262.01 $1,575.81	$1,562.84 $1,646.23 $1,734.57 $2,048.37	$2,035.40 $2,118.79 $2,207.13 $2,520.93	$472.56
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,235.44 $1,402.22 $1,578.90 $2,206.50 $3,352.98	$1,708.00 $1,874.78 $2,051.46 $2,679.06	$2,180.56 $2,347.34 $2,524.02 $3,151.62	$2,653.12 $2,819.90 $2,996.58 $3,624.18	$472.56

Toc - Plan #229 Florida Health Care Plans
Platinum (POS) Gym Access IND Platinum POS BC 1941
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $2,000 $4,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$667.14 $757.20 $852.60 $1,191.51 $1,810.62	$1,177.50 $1,267.56 $1,362.96 $1,701.87	$1,687.86 $1,777.92 $1,873.32 $2,212.23	$2,198.22 $2,288.28 $2,383.68 $2,722.59	$510.36
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,334.28 $1,514.40 $1,705.20 $2,383.02 $3,621.24	$1,844.64 $2,024.76 $2,215.56 $2,893.38	$2,355.00 $2,535.12 $2,725.92 $3,403.74	$2,865.36 $3,045.48 $3,236.28 $3,914.10	$510.36

Toc - Plan #230 Florida Health Care Plans
Platinum (HMO) Gym Access IND Platinum HMO 91
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $250 $500 Annual Deductible $2,500 $5,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$613.14 $695.91 $783.59 $1,095.07 $1,664.06	$1,082.19 $1,164.96 $1,252.64 $1,564.12	$1,551.24 $1,634.01 $1,721.69 $2,033.17	$2,020.29 $2,103.06 $2,190.74 $2,502.22	$469.05
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,226.28 $1,391.82 $1,567.18 $2,190.14 $3,328.12	$1,695.33 $1,860.87 $2,036.23 $2,659.19	$2,164.38 $2,329.92 $2,505.28 $3,128.24	$2,633.43 $2,798.97 $2,974.33 $3,597.29	$469.05

Toc - Plan #231 Florida Health Care Plans
Expanded Bronze (HMO) Gym Access IND Bronze Standardized HMO
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $7,150 $14,300 Annual Deductible $9,000 $18,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$322.93 $366.53 $412.70 $576.75 $876.43	$569.97 $613.57 $659.74 $823.79	$817.01 $860.61 $906.78 $1,070.83	$1,064.05 $1,107.65 $1,153.82 $1,317.87	$247.04
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$645.86 $733.06 $825.40 $1,153.50 $1,752.86	$892.90 $980.10 $1,072.44 $1,400.54	$1,139.94 $1,227.14 $1,319.48 $1,647.58	$1,386.98 $1,474.18 $1,566.52 $1,894.62	$247.04

Toc - Plan #232 Florida Health Care Plans
Silver (HMO) Gym Access IND Silver Standardized HMO 1
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $4,200 $8,400 Annual Deductible $8,800 $17,600 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$430.42 $488.53 $550.08 $768.73 $1,168.16	$759.69 $817.80 $879.35 $1,098.00	$1,088.96 $1,147.07 $1,208.62 $1,427.27	$1,418.23 $1,476.34 $1,537.89 $1,756.54	$329.27
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$860.84 $977.06 $1,100.16 $1,537.46 $2,336.32	$1,190.11 $1,306.33 $1,429.43 $1,866.73	$1,519.38 $1,635.60 $1,758.70 $2,196.00	$1,848.65 $1,964.87 $2,087.97 $2,525.27	$329.27

Toc - Plan #233 Florida Health Care Plans
Expanded Bronze (HMO) Gym Access IND Bronze HMO 1340
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $9,100 $18,200 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$307.18 $348.65 $392.58 $548.62 $833.69	$542.17 $583.64 $627.57 $783.61	$777.16 $818.63 $862.56 $1,018.60	$1,012.15 $1,053.62 $1,097.55 $1,253.59	$234.99
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$614.36 $697.30 $785.16 $1,097.24 $1,667.38	$849.35 $932.29 $1,020.15 $1,332.23	$1,084.34 $1,167.28 $1,255.14 $1,567.22	$1,319.33 $1,402.27 $1,490.13 $1,802.21	$234.99

Toc - Plan #234 Florida Health Care Plans
Expanded Bronze (HMO) Gym Access IND Bronze HMO 1041
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $7,200 $14,400 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$318.17 $361.12 $406.62 $568.25 $863.51	$561.57 $604.52 $650.02 $811.65	$804.97 $847.92 $893.42 $1,055.05	$1,048.37 $1,091.32 $1,136.82 $1,298.45	$243.40
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$636.34 $722.24 $813.24 $1,136.50 $1,727.02	$879.74 $965.64 $1,056.64 $1,379.90	$1,123.14 $1,209.04 $1,300.04 $1,623.30	$1,366.54 $1,452.44 $1,543.44 $1,866.70	$243.40

Toc - Plan #235 Florida Health Care Plans
Expanded Bronze (POS) Gym Access IND Bronze POS 1042
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $7,550 $15,100 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$343.63 $390.02 $439.16 $613.72 $932.61	$606.51 $652.90 $702.04 $876.60	$869.39 $915.78 $964.92 $1,139.48	$1,132.27 $1,178.66 $1,227.80 $1,402.36	$262.88
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$687.26 $780.04 $878.32 $1,227.44 $1,865.22	$950.14 $1,042.92 $1,141.20 $1,490.32	$1,213.02 $1,305.80 $1,404.08 $1,753.20	$1,475.90 $1,568.68 $1,666.96 $2,016.08	$262.88

Toc - Plan #236 Florida Health Care Plans
Gold (HMO) Gym Access IND Gold HMO H.S.A 9010
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $1,750 $3,500 Annual Deductible $4,000 $8,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$412.11 $467.74 $526.68 $736.03 $1,118.47	$727.37 $783.00 $841.94 $1,051.29	$1,042.63 $1,098.26 $1,157.20 $1,366.55	$1,357.89 $1,413.52 $1,472.46 $1,681.81	$315.26
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$824.22 $935.48 $1,053.36 $1,472.06 $2,236.94	$1,139.48 $1,250.74 $1,368.62 $1,787.32	$1,454.74 $1,566.00 $1,683.88 $2,102.58	$1,770.00 $1,881.26 $1,999.14 $2,417.84	$315.26

Toc - Plan #237 Florida Health Care Plans
Expanded Bronze (HMO) Gym Access IND Bronze HMO OA 1211
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $9,000 $18,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$351.54 $399.00 $449.27 $627.85 $954.08	$620.47 $667.93 $718.20 $896.78	$889.40 $936.86 $987.13 $1,165.71	$1,158.33 $1,205.79 $1,256.06 $1,434.64	$268.93
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$703.08 $798.00 $898.54 $1,255.70 $1,908.16	$972.01 $1,066.93 $1,167.47 $1,524.63	$1,240.94 $1,335.86 $1,436.40 $1,793.56	$1,509.87 $1,604.79 $1,705.33 $2,062.49	$268.93

Toc - Plan #238 Florida Health Care Plans
Silver (HMO) Gym Access IND Silver HMO OA 1009
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $7,900 $15,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$417.76 $474.16 $533.90 $746.12 $1,133.80	$737.35 $793.75 $853.49 $1,065.71	$1,056.94 $1,113.34 $1,173.08 $1,385.30	$1,376.53 $1,432.93 $1,492.67 $1,704.89	$319.59
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$835.52 $948.32 $1,067.80 $1,492.24 $2,267.60	$1,155.11 $1,267.91 $1,387.39 $1,811.83	$1,474.70 $1,587.50 $1,706.98 $2,131.42	$1,794.29 $1,907.09 $2,026.57 $2,451.01	$319.59

Toc - Plan #239 Florida Health Care Plans
Expanded Bronze (HMO) Gym Access IND Bronze HMO OA 0928
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $2,900 $5,800 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$326.73 $370.84 $417.56 $583.54 $886.75	$576.68 $620.79 $667.51 $833.49	$826.63 $870.74 $917.46 $1,083.44	$1,076.58 $1,120.69 $1,167.41 $1,333.39	$249.95
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$653.46 $741.68 $835.12 $1,167.08 $1,773.50	$903.41 $991.63 $1,085.07 $1,417.03	$1,153.36 $1,241.58 $1,335.02 $1,666.98	$1,403.31 $1,491.53 $1,584.97 $1,916.93	$249.95

Toc - Plan #240 Florida Health Care Plans
Gold (HMO) Gym Access IND Gold HMO OA 28
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $8,800 $17,600 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$471.22 $534.83 $602.22 $841.60 $1,278.89	$831.70 $895.31 $962.70 $1,202.08	$1,192.18 $1,255.79 $1,323.18 $1,562.56	$1,552.66 $1,616.27 $1,683.66 $1,923.04	$360.48
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$942.44 $1,069.66 $1,204.44 $1,683.20 $2,557.78	$1,302.92 $1,430.14 $1,564.92 $2,043.68	$1,663.40 $1,790.62 $1,925.40 $2,404.16	$2,023.88 $2,151.10 $2,285.88 $2,764.64	$360.48

Toc - Plan #241 Florida Health Care Plans
Bronze (HMO) Gym Access IND Bronze HMO OA Standard 2440
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $9,100 $18,200 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$303.10 $344.02 $387.36 $541.34 $822.61	$534.97 $575.89 $619.23 $773.21	$766.84 $807.76 $851.10 $1,005.08	$998.71 $1,039.63 $1,082.97 $1,236.95	$231.87
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$606.20 $688.04 $774.72 $1,082.68 $1,645.22	$838.07 $919.91 $1,006.59 $1,314.55	$1,069.94 $1,151.78 $1,238.46 $1,546.42	$1,301.81 $1,383.65 $1,470.33 $1,778.29	$231.87

Toc - Plan #242 Florida Health Care Plans
Expanded Bronze (HMO) Gym Access IND Bronze HMO OA Standard 2450
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $7,500 $15,000 Annual Deductible $9,000 $18,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$322.25 $365.75 $411.84 $575.54 $874.59	$568.77 $612.27 $658.36 $822.06	$815.29 $858.79 $904.88 $1,068.58	$1,061.81 $1,105.31 $1,151.40 $1,315.10	$246.52
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$644.50 $731.50 $823.68 $1,151.08 $1,749.18	$891.02 $978.02 $1,070.20 $1,397.60	$1,137.54 $1,224.54 $1,316.72 $1,644.12	$1,384.06 $1,471.06 $1,563.24 $1,890.64	$246.52

Toc - Plan #243 Florida Health Care Plans
Silver (HMO) Gym Access IND Silver HMO OA Standard 1440
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $5,800 $11,600 Annual Deductible $8,900 $17,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$387.03 $439.28 $494.62 $691.24 $1,050.40	$683.11 $735.36 $790.70 $987.32	$979.19 $1,031.44 $1,086.78 $1,283.40	$1,275.27 $1,327.52 $1,382.86 $1,579.48	$296.08
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$774.06 $878.56 $989.24 $1,382.48 $2,100.80	$1,070.14 $1,174.64 $1,285.32 $1,678.56	$1,366.22 $1,470.72 $1,581.40 $1,974.64	$1,662.30 $1,766.80 $1,877.48 $2,270.72	$296.08

Toc - Plan #244 Florida Health Care Plans
Gold (HMO) Gym Access IND Gold HMO OA Standard 3450
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $2,000 $4,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$415.77 $471.90 $531.35 $742.57 $1,128.40	$733.83 $789.96 $849.41 $1,060.63	$1,051.89 $1,108.02 $1,167.47 $1,378.69	$1,369.95 $1,426.08 $1,485.53 $1,696.75	$318.06
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$831.54 $943.80 $1,062.70 $1,485.14 $2,256.80	$1,149.60 $1,261.86 $1,380.76 $1,803.20	$1,467.66 $1,579.92 $1,698.82 $2,121.26	$1,785.72 $1,897.98 $2,016.88 $2,439.32	$318.06

Toc - Plan #245 Florida Health Care Plans
Platinum (HMO) Gym Access IND Platinum HMO OA Standard 4450
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $3,000 $6,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$603.09 $684.51 $770.75 $1,077.12 $1,636.79	$1,064.45 $1,145.87 $1,232.11 $1,538.48	$1,525.81 $1,607.23 $1,693.47 $1,999.84	$1,987.17 $2,068.59 $2,154.83 $2,461.20	$461.36
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,206.18 $1,369.02 $1,541.50 $2,154.24 $3,273.58	$1,667.54 $1,830.38 $2,002.86 $2,615.60	$2,128.90 $2,291.74 $2,464.22 $3,076.96	$2,590.26 $2,753.10 $2,925.58 $3,538.32	$461.36

Toc - Plan #246 Florida Health Care Plans
Expanded Bronze (POS) Gym Access IND Bronze POS OA Standard 2450
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $7,500 $15,000 Annual Deductible $9,000 $18,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$348.03 $395.01 $444.78 $621.58 $944.55	$614.27 $661.25 $711.02 $887.82	$880.51 $927.49 $977.26 $1,154.06	$1,146.75 $1,193.73 $1,243.50 $1,420.30	$266.24
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$696.06 $790.02 $889.56 $1,243.16 $1,889.10	$962.30 $1,056.26 $1,155.80 $1,509.40	$1,228.54 $1,322.50 $1,422.04 $1,775.64	$1,494.78 $1,588.74 $1,688.28 $2,041.88	$266.24

Toc - Plan #247 Florida Health Care Plans
Silver (POS) Gym Access IND Silver POS OA Standard 1440
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $5,800 $11,600 Annual Deductible $8,900 $17,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$417.99 $474.42 $534.19 $746.53 $1,134.42	$737.75 $794.18 $853.95 $1,066.29	$1,057.51 $1,113.94 $1,173.71 $1,386.05	$1,377.27 $1,433.70 $1,493.47 $1,705.81	$319.76
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$835.98 $948.84 $1,068.38 $1,493.06 $2,268.84	$1,155.74 $1,268.60 $1,388.14 $1,812.82	$1,475.50 $1,588.36 $1,707.90 $2,132.58	$1,795.26 $1,908.12 $2,027.66 $2,452.34	$319.76

Toc - Plan #248 Florida Health Care Plans
Gold (POS) Gym Access IND Gold POS OA Standard 3450
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $2,000 $4,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$449.03 $509.65 $573.86 $801.97 $1,218.67	$792.54 $853.16 $917.37 $1,145.48	$1,136.05 $1,196.67 $1,260.88 $1,488.99	$1,479.56 $1,540.18 $1,604.39 $1,832.50	$343.51
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$898.06 $1,019.30 $1,147.72 $1,603.94 $2,437.34	$1,241.57 $1,362.81 $1,491.23 $1,947.45	$1,585.08 $1,706.32 $1,834.74 $2,290.96	$1,928.59 $2,049.83 $2,178.25 $2,634.47	$343.51

Toc - Plan #249 Florida Health Care Plans
Platinum (POS) Gym Access IND Platinum POS OA Standard 4450
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-800-232-0578 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $3,000 $6,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$651.34 $739.27 $832.41 $1,163.29 $1,767.74	$1,149.62 $1,237.55 $1,330.69 $1,661.57	$1,647.90 $1,735.83 $1,828.97 $2,159.85	$2,146.18 $2,234.11 $2,327.25 $2,658.13	$498.28
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,302.68 $1,478.54 $1,664.82 $2,326.58 $3,535.48	$1,800.96 $1,976.82 $2,163.10 $2,824.86	$2,299.24 $2,475.10 $2,661.38 $3,323.14	$2,797.52 $2,973.38 $3,159.66 $3,821.42	$498.28

UnitedHealthcare Local: 1-888-200-0405 | Toll Free: 1-888-200-0405 | TTY: 1-888-200-0405

Toc - Plan #250 UnitedHealthcare
Gold (HMO) UHC Gold Value $2,150 Indiv Ded ($0 Virtual Urgent Care + $0 PCP Visits, $1 Generic Rx Pref Pharm)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-200-0405 Annual Out of Pocket Expenses: Individual Family $2,150 $4,300 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$477.91 $542.43 $610.77 $853.54 $1,297.04	$843.51 $908.03 $976.37 $1,219.14	$1,209.11 $1,273.63 $1,341.97 $1,584.74	$1,574.71 $1,639.23 $1,707.57 $1,950.34	$365.60
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$955.82 $1,084.86 $1,221.54 $1,707.08 $2,594.08	$1,321.42 $1,450.46 $1,587.14 $2,072.68	$1,687.02 $1,816.06 $1,952.74 $2,438.28	$2,052.62 $2,181.66 $2,318.34 $2,803.88	$365.60

Toc - Plan #251 UnitedHealthcare
Gold (HMO) UHC Gold Value $2,200 Indiv Ded ($0 Virtual Urgent Care + $0 PCP Visits, $1 Generic Rx Pref Pharm)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-200-0405 Annual Out of Pocket Expenses: Individual Family $2,200 $4,400 Annual Deductible $8,400 $16,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$476.76 $541.12 $609.30 $851.49 $1,293.93	$841.48 $905.84 $974.02 $1,216.21	$1,206.20 $1,270.56 $1,338.74 $1,580.93	$1,570.92 $1,635.28 $1,703.46 $1,945.65	$364.72
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$953.52 $1,082.24 $1,218.60 $1,702.98 $2,587.86	$1,318.24 $1,446.96 $1,583.32 $2,067.70	$1,682.96 $1,811.68 $1,948.04 $2,432.42	$2,047.68 $2,176.40 $2,312.76 $2,797.14	$364.72

Toc - Plan #252 UnitedHealthcare
Silver (HMO) UHC Silver Value $4,000 Indiv Ded ($0 Virtual Urgent Care + $0 PCP Visits, $3 Generic Rx Pref Pharm)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-200-0405 Annual Out of Pocket Expenses: Individual Family $4,000 $8,000 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$426.66 $484.26 $545.27 $762.02 $1,157.96	$753.06 $810.66 $871.67 $1,088.42	$1,079.46 $1,137.06 $1,198.07 $1,414.82	$1,405.86 $1,463.46 $1,524.47 $1,741.22	$326.40
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$853.32 $968.52 $1,090.54 $1,524.04 $2,315.92	$1,179.72 $1,294.92 $1,416.94 $1,850.44	$1,506.12 $1,621.32 $1,743.34 $2,176.84	$1,832.52 $1,947.72 $2,069.74 $2,503.24	$326.40

Toc - Plan #253 UnitedHealthcare
Silver (HMO) UHC Silver Virtual First $3,800 Indiv Ded ($0 App-based Care, $3 Generic Rx Pref Pharm) (Disponible en español)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-200-0405 Annual Out of Pocket Expenses: Individual Family $3,800 $7,600 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$414.08 $469.98 $529.20 $739.55 $1,123.82	$730.85 $786.75 $845.97 $1,056.32	$1,047.62 $1,103.52 $1,162.74 $1,373.09	$1,364.39 $1,420.29 $1,479.51 $1,689.86	$316.77
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$828.16 $939.96 $1,058.40 $1,479.10 $2,247.64	$1,144.93 $1,256.73 $1,375.17 $1,795.87	$1,461.70 $1,573.50 $1,691.94 $2,112.64	$1,778.47 $1,890.27 $2,008.71 $2,429.41	$316.77

Toc - Plan #254 UnitedHealthcare
Silver (HMO) UHC Silver Value $3,400 Indiv Ded ($0 Virtual Urgent Care + $0 PCP Visits, $3 Generic Rx Pref Pharm)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-200-0405 Annual Out of Pocket Expenses: Individual Family $3,400 $6,800 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$425.47 $482.91 $543.76 $759.90 $1,154.74	$750.96 $808.40 $869.25 $1,085.39	$1,076.45 $1,133.89 $1,194.74 $1,410.88	$1,401.94 $1,459.38 $1,520.23 $1,736.37	$325.49
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$850.94 $965.82 $1,087.52 $1,519.80 $2,309.48	$1,176.43 $1,291.31 $1,413.01 $1,845.29	$1,501.92 $1,616.80 $1,738.50 $2,170.78	$1,827.41 $1,942.29 $2,063.99 $2,496.27	$325.49

Toc - Plan #255 UnitedHealthcare
Silver (HMO) UHC Silver Value $3,000 Indiv Ded ($0 Virtual Urgent Care + $0 PCP Visits, $3 Generic Rx Pref Pharm)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-200-0405 Annual Out of Pocket Expenses: Individual Family $3,000 $6,000 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$425.28 $482.69 $543.51 $759.55 $1,154.21	$750.62 $808.03 $868.85 $1,084.89	$1,075.96 $1,133.37 $1,194.19 $1,410.23	$1,401.30 $1,458.71 $1,519.53 $1,735.57	$325.34
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$850.56 $965.38 $1,087.02 $1,519.10 $2,308.42	$1,175.90 $1,290.72 $1,412.36 $1,844.44	$1,501.24 $1,616.06 $1,737.70 $2,169.78	$1,826.58 $1,941.40 $2,063.04 $2,495.12	$325.34

Toc - Plan #256 UnitedHealthcare
Silver (HMO) UHC Silver Virtual First $3,400 Indiv Ded ($0 App-based Care, $3 Generic Rx Pref Pharm) (Disponible en español)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-200-0405 Annual Out of Pocket Expenses: Individual Family $3,400 $6,800 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$414.65 $470.62 $529.92 $740.56 $1,125.35	$731.85 $787.82 $847.12 $1,057.76	$1,049.05 $1,105.02 $1,164.32 $1,374.96	$1,366.25 $1,422.22 $1,481.52 $1,692.16	$317.20
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$829.30 $941.24 $1,059.84 $1,481.12 $2,250.70	$1,146.50 $1,258.44 $1,377.04 $1,798.32	$1,463.70 $1,575.64 $1,694.24 $2,115.52	$1,780.90 $1,892.84 $2,011.44 $2,432.72	$317.20

Toc - Plan #257 UnitedHealthcare
Bronze (HMO) UHC Bronze Essential $9,100 Indiv Ded ($3 Generic Rx Pref Pharm)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-200-0405 Annual Out of Pocket Expenses: Individual Family $9,100 $18,200 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$332.09 $376.92 $424.41 $593.11 $901.29	$586.14 $630.97 $678.46 $847.16	$840.19 $885.02 $932.51 $1,101.21	$1,094.24 $1,139.07 $1,186.56 $1,355.26	$254.05
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$664.18 $753.84 $848.82 $1,186.22 $1,802.58	$918.23 $1,007.89 $1,102.87 $1,440.27	$1,172.28 $1,261.94 $1,356.92 $1,694.32	$1,426.33 $1,515.99 $1,610.97 $1,948.37	$254.05

Toc - Plan #258 UnitedHealthcare
Expanded Bronze (HMO) UHC Bronze Value ($0 Virtual Urgent Care + $0 PCP Visits, $3 Generic Rx Pref Pharm)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-200-0405 Annual Out of Pocket Expenses: Individual Family $7,500 $15,000 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$340.57 $386.55 $435.25 $608.26 $924.31	$601.11 $647.09 $695.79 $868.80	$861.65 $907.63 $956.33 $1,129.34	$1,122.19 $1,168.17 $1,216.87 $1,389.88	$260.54
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$681.14 $773.10 $870.50 $1,216.52 $1,848.62	$941.68 $1,033.64 $1,131.04 $1,477.06	$1,202.22 $1,294.18 $1,391.58 $1,737.60	$1,462.76 $1,554.72 $1,652.12 $1,998.14	$260.54

Toc - Plan #259 UnitedHealthcare
Expanded Bronze (HMO) UHC Bronze Virtual First ($0 App-based Care, $3 Generic Rx Pref Pharm) (Disponible en español)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-200-0405 Annual Out of Pocket Expenses: Individual Family $7,250 $14,500 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$331.40 $376.14 $423.53 $591.88 $899.43	$584.92 $629.66 $677.05 $845.40	$838.44 $883.18 $930.57 $1,098.92	$1,091.96 $1,136.70 $1,184.09 $1,352.44	$253.52
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$662.80 $752.28 $847.06 $1,183.76 $1,798.86	$916.32 $1,005.80 $1,100.58 $1,437.28	$1,169.84 $1,259.32 $1,354.10 $1,690.80	$1,423.36 $1,512.84 $1,607.62 $1,944.32	$253.52

Toc - Plan #260 UnitedHealthcare
Gold (HMO) UHC Gold Advantage $0 Medical Ded ($0 Virtual Urgent Care + $0 PCP Visits, $1 Generic Rx Pref Pharm)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-200-0405 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $5,000 $10,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$508.05 $576.64 $649.29 $907.38 $1,378.86	$896.71 $965.30 $1,037.95 $1,296.04	$1,285.37 $1,353.96 $1,426.61 $1,684.70	$1,674.03 $1,742.62 $1,815.27 $2,073.36	$388.66
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,016.10 $1,153.28 $1,298.58 $1,814.76 $2,757.72	$1,404.76 $1,541.94 $1,687.24 $2,203.42	$1,793.42 $1,930.60 $2,075.90 $2,592.08	$2,182.08 $2,319.26 $2,464.56 $2,980.74	$388.66

Toc - Plan #261 UnitedHealthcare
Gold (HMO) UHC Gold Advantage+ ($0 Virtual Urgent Care + $0 PCP Visits, $1 Generic Rx Pref Pharm, Dental + Vision)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-200-0405 Annual Out of Pocket Expenses: Individual Family $1,000 $2,000 Annual Deductible $5,500 $11,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$508.37 $577.00 $649.70 $907.95 $1,379.72	$897.27 $965.90 $1,038.60 $1,296.85	$1,286.17 $1,354.80 $1,427.50 $1,685.75	$1,675.07 $1,743.70 $1,816.40 $2,074.65	$388.90
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$1,016.74 $1,154.00 $1,299.40 $1,815.90 $2,759.44	$1,405.64 $1,542.90 $1,688.30 $2,204.80	$1,794.54 $1,931.80 $2,077.20 $2,593.70	$2,183.44 $2,320.70 $2,466.10 $2,982.60	$388.90

Toc - Plan #262 UnitedHealthcare
Gold (HMO) UHC Gold Standard
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-200-0405 Annual Out of Pocket Expenses: Individual Family $2,000 $4,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$485.79 $551.38 $620.85 $867.63 $1,318.45	$857.42 $923.01 $992.48 $1,239.26	$1,229.05 $1,294.64 $1,364.11 $1,610.89	$1,600.68 $1,666.27 $1,735.74 $1,982.52	$371.63
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$971.58 $1,102.76 $1,241.70 $1,735.26 $2,636.90	$1,343.21 $1,474.39 $1,613.33 $2,106.89	$1,714.84 $1,846.02 $1,984.96 $2,478.52	$2,086.47 $2,217.65 $2,356.59 $2,850.15	$371.63

Toc - Plan #263 UnitedHealthcare
Silver (HMO) UHC Silver Advantage ($0 Virtual Urgent Care + $0 PCP Visits, $3 Generic Rx Pref Pharm)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-200-0405 Annual Out of Pocket Expenses: Individual Family $2,000 $4,000 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$427.05 $484.70 $545.77 $762.71 $1,159.02	$753.74 $811.39 $872.46 $1,089.40	$1,080.43 $1,138.08 $1,199.15 $1,416.09	$1,407.12 $1,464.77 $1,525.84 $1,742.78	$326.69
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$854.10 $969.40 $1,091.54 $1,525.42 $2,318.04	$1,180.79 $1,296.09 $1,418.23 $1,852.11	$1,507.48 $1,622.78 $1,744.92 $2,178.80	$1,834.17 $1,949.47 $2,071.61 $2,505.49	$326.69

Toc - Plan #264 UnitedHealthcare
Silver (HMO) UHC Silver Advantage $0 Medical Ded ($0 Virtual Urgent Care + $0 PCP Visits, $3 Generic Rx Pref Pharm)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-200-0405 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$445.99 $506.20 $569.98 $796.54 $1,210.42	$787.17 $847.38 $911.16 $1,137.72	$1,128.35 $1,188.56 $1,252.34 $1,478.90	$1,469.53 $1,529.74 $1,593.52 $1,820.08	$341.18
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$891.98 $1,012.40 $1,139.96 $1,593.08 $2,420.84	$1,233.16 $1,353.58 $1,481.14 $1,934.26	$1,574.34 $1,694.76 $1,822.32 $2,275.44	$1,915.52 $2,035.94 $2,163.50 $2,616.62	$341.18

Toc - Plan #265 UnitedHealthcare
Silver (HMO) UHC Silver Advantage+ ($0 Virtual Urgent Care + $0 PCP Visits, $3 Generic Rx Pref Pharm, Dental + Vision)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-200-0405 Annual Out of Pocket Expenses: Individual Family $2,000 $4,000 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$448.10 $508.59 $572.67 $800.31 $1,216.14	$790.90 $851.39 $915.47 $1,143.11	$1,133.70 $1,194.19 $1,258.27 $1,485.91	$1,476.50 $1,536.99 $1,601.07 $1,828.71	$342.80
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$896.20 $1,017.18 $1,145.34 $1,600.62 $2,432.28	$1,239.00 $1,359.98 $1,488.14 $1,943.42	$1,581.80 $1,702.78 $1,830.94 $2,286.22	$1,924.60 $2,045.58 $2,173.74 $2,629.02	$342.80

Toc - Plan #266 UnitedHealthcare
Silver (HMO) UHC Silver Standard
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-200-0405 Annual Out of Pocket Expenses: Individual Family $5,800 $11,600 Annual Deductible $8,900 $17,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$427.41 $485.11 $546.23 $763.35 $1,159.99	$754.38 $812.08 $873.20 $1,090.32	$1,081.35 $1,139.05 $1,200.17 $1,417.29	$1,408.32 $1,466.02 $1,527.14 $1,744.26	$326.97
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$854.82 $970.22 $1,092.46 $1,526.70 $2,319.98	$1,181.79 $1,297.19 $1,419.43 $1,853.67	$1,508.76 $1,624.16 $1,746.40 $2,180.64	$1,835.73 $1,951.13 $2,073.37 $2,507.61	$326.97

Toc - Plan #267 UnitedHealthcare
Bronze (HMO) UHC Bronze Essential $6,350 Indiv Ded ($3 Generic Rx Pref Pharm)
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-200-0405 Annual Out of Pocket Expenses: Individual Family $6,350 $12,700 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$330.58 $375.21 $422.48 $590.42 $897.20	$583.48 $628.11 $675.38 $843.32	$836.38 $881.01 $928.28 $1,096.22	$1,089.28 $1,133.91 $1,181.18 $1,349.12	$252.90
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$661.16 $750.42 $844.96 $1,180.84 $1,794.40	$914.06 $1,003.32 $1,097.86 $1,433.74	$1,166.96 $1,256.22 $1,350.76 $1,686.64	$1,419.86 $1,509.12 $1,603.66 $1,939.54	$252.90

Toc - Plan #268 UnitedHealthcare
Expanded Bronze (HMO) UHC Bronze Standard $7,500 Indiv Ded
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-200-0405 Annual Out of Pocket Expenses: Individual Family $7,500 $15,000 Annual Deductible $9,000 $18,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$342.59 $388.84 $437.83 $611.86 $929.78	$604.67 $650.92 $699.91 $873.94	$866.75 $913.00 $961.99 $1,136.02	$1,128.83 $1,175.08 $1,224.07 $1,398.10	$262.08
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$685.18 $777.68 $875.66 $1,223.72 $1,859.56	$947.26 $1,039.76 $1,137.74 $1,485.80	$1,209.34 $1,301.84 $1,399.82 $1,747.88	$1,471.42 $1,563.92 $1,661.90 $2,009.96	$262.08

Toc - Plan #269 UnitedHealthcare
Bronze (HMO) UHC Bronze Standard $9,100 Indiv Ded
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-888-200-0405 Annual Out of Pocket Expenses: Individual Family $9,100 $18,200 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$323.82 $367.54 $413.84 $578.35 $878.85	$571.54 $615.26 $661.56 $826.07	$819.26 $862.98 $909.28 $1,073.79	$1,066.98 $1,110.70 $1,157.00 $1,321.51	$247.72
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$647.64 $735.08 $827.68 $1,156.70 $1,757.70	$895.36 $982.80 $1,075.40 $1,404.42	$1,143.08 $1,230.52 $1,323.12 $1,652.14	$1,390.80 $1,478.24 $1,570.84 $1,899.86	$247.72

Ambetter from Sunshine Health Local: 1-877-687-1169 | Toll Free: 1-877-687-1169 | TTY: 1-800-955-8770

Toc - Plan #270 Ambetter from Sunshine Health
Expanded Bronze (HMO) Elite VALUE Bronze
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $0 $0 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$374.48 $425.03 $478.58 $668.81 $1,016.32	$660.95 $711.50 $765.05 $955.28	$947.42 $997.97 $1,051.52 $1,241.75	$1,233.89 $1,284.44 $1,337.99 $1,528.22	$286.47
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$748.96 $850.06 $957.16 $1,337.62 $2,032.64	$1,035.43 $1,136.53 $1,243.63 $1,624.09	$1,321.90 $1,423.00 $1,530.10 $1,910.56	$1,608.37 $1,709.47 $1,816.57 $2,197.03	$286.47

Toc - Plan #271 Ambetter from Sunshine Health
Silver (HMO) Complete VALUE Silver
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $6,000 $12,000 Annual Deductible $8,500 $17,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$416.65 $472.89 $532.47 $744.12 $1,130.76	$735.38 $791.62 $851.20 $1,062.85	$1,054.11 $1,110.35 $1,169.93 $1,381.58	$1,372.84 $1,429.08 $1,488.66 $1,700.31	$318.73
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$833.30 $945.78 $1,064.94 $1,488.24 $2,261.52	$1,152.03 $1,264.51 $1,383.67 $1,806.97	$1,470.76 $1,583.24 $1,702.40 $2,125.70	$1,789.49 $1,901.97 $2,021.13 $2,444.43	$318.73

Toc - Plan #272 Ambetter from Sunshine Health
Silver (HMO) Clear VALUE Silver
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $5,400 $10,800 Annual Deductible $5,400 $10,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$406.99 $461.92 $520.12 $726.86 $1,104.54	$718.33 $773.26 $831.46 $1,038.20	$1,029.67 $1,084.60 $1,142.80 $1,349.54	$1,341.01 $1,395.94 $1,454.14 $1,660.88	$311.34
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$813.98 $923.84 $1,040.24 $1,453.72 $2,209.08	$1,125.32 $1,235.18 $1,351.58 $1,765.06	$1,436.66 $1,546.52 $1,662.92 $2,076.40	$1,748.00 $1,857.86 $1,974.26 $2,387.74	$311.34

Toc - Plan #273 Ambetter from Sunshine Health
Silver (HMO) Focused VALUE Silver
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $6,100 $12,200 Annual Deductible $7,500 $15,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$410.47 $465.87 $524.56 $733.08 $1,113.98	$724.47 $779.87 $838.56 $1,047.08	$1,038.47 $1,093.87 $1,152.56 $1,361.08	$1,352.47 $1,407.87 $1,466.56 $1,675.08	$314.00
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$820.94 $931.74 $1,049.12 $1,466.16 $2,227.96	$1,134.94 $1,245.74 $1,363.12 $1,780.16	$1,448.94 $1,559.74 $1,677.12 $2,094.16	$1,762.94 $1,873.74 $1,991.12 $2,408.16	$314.00

Toc - Plan #274 Ambetter from Sunshine Health
Gold (HMO) Complete VALUE Gold
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $1,450 $2,900 Annual Deductible $7,500 $15,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$407.59 $462.60 $520.89 $727.94 $1,106.17	$719.39 $774.40 $832.69 $1,039.74	$1,031.19 $1,086.20 $1,144.49 $1,351.54	$1,342.99 $1,398.00 $1,456.29 $1,663.34	$311.80
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$815.18 $925.20 $1,041.78 $1,455.88 $2,212.34	$1,126.98 $1,237.00 $1,353.58 $1,767.68	$1,438.78 $1,548.80 $1,665.38 $2,079.48	$1,750.58 $1,860.60 $1,977.18 $2,391.28	$311.80

Toc - Plan #275 Ambetter from Sunshine Health
Expanded Bronze (HMO) CMS Standard Expanded Bronze VALUE
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $7,500 $15,000 Annual Deductible $9,000 $18,000 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$320.68 $363.96 $409.82 $572.72 $870.30	$565.99 $609.27 $655.13 $818.03	$811.30 $854.58 $900.44 $1,063.34	$1,056.61 $1,099.89 $1,145.75 $1,308.65	$245.31
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$641.36 $727.92 $819.64 $1,145.44 $1,740.60	$886.67 $973.23 $1,064.95 $1,390.75	$1,131.98 $1,218.54 $1,310.26 $1,636.06	$1,377.29 $1,463.85 $1,555.57 $1,881.37	$245.31

Toc - Plan #276 Ambetter from Sunshine Health
Silver (HMO) CMS Standard Silver VALUE
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $5,800 $11,600 Annual Deductible $8,900 $17,800 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$406.77 $461.68 $519.84 $726.48 $1,103.96	$717.94 $772.85 $831.01 $1,037.65	$1,029.11 $1,084.02 $1,142.18 $1,348.82	$1,340.28 $1,395.19 $1,453.35 $1,659.99	$311.17
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$813.54 $923.36 $1,039.68 $1,452.96 $2,207.92	$1,124.71 $1,234.53 $1,350.85 $1,764.13	$1,435.88 $1,545.70 $1,662.02 $2,075.30	$1,747.05 $1,856.87 $1,973.19 $2,386.47	$311.17

Toc - Plan #277 Ambetter from Sunshine Health
Gold (HMO) CMS Standard Gold VALUE
Benefits & Coverage Plan Brochure Provider Directory Customer Service Phone: 1-877-687-1169 Annual Out of Pocket Expenses: Individual Family $2,000 $4,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year Monthly Premiums: [show premiums]
Age	Individual	Individual 1 Child	Individual 2 Children	Individual 3+ Children	Child 0-14
21 30 40 50 60	$380.92 $432.34 $486.81 $680.31 $1,033.80	$672.32 $723.74 $778.21 $971.71	$963.72 $1,015.14 $1,069.61 $1,263.11	$1,255.12 $1,306.54 $1,361.01 $1,554.51	$291.40
Age	Couple	Couple 1 Child	Couple 2 Chidren	Couple 3+ Children	Child 0-14
21 30 40 50 60	$761.84 $864.68 $973.62 $1,360.62 $2,067.60	$1,053.24 $1,156.08 $1,265.02 $1,652.02	$1,344.64 $1,447.48 $1,556.42 $1,943.42	$1,636.04 $1,738.88 $1,847.82 $2,234.82	$291.40

‡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 Seminole County here.

Seminole County is in “Rating Area 57” of Florida.

Currently, there are 277 plans offered in Rating Area 57.