Obamacare 2023 Rates for Lumpkin County

Obamacare > Rates > Georgia > Lumpkin County

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Obamacare is also known as the Affordable Care Act. This page gives you an overview of the rates for individual and family health insurance plans available from , the marketplace for Lumpkin County, GA.

The health insurance rates listed below are for calendar year 2023.

For information on subsidies to make your coverage affordable, you must take one of the following actions:

  • Contact a licensed health insurance agent
  • Complete an application at Healthcare.gov
  • Contact the provider directly

Obamacare Providers, 72 Plans and 2023 Rates for Lumpkin County, Georgia

Below, you’ll find a summary of the 72 plans for Lumpkin County, Georgia and rates for each of these providers.‡ This chart is designed to give you a preview of your health insurance options.

You may also be interested in:

Obamacare Rates and Providers for Other Years

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Lumpkin County Resources

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Cigna HealthCare of Georgia, Inc

Local:  | Toll Free: 

Toc - Plan #1 Cigna HealthCare of Georgia, Inc
Bronze

(HMO) Cigna Connect 9100

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 		$221.00
$250.83
$282.44
$394.70
$599.79 		$390.06
$419.89
$451.50
$563.76 		$559.12
$588.95
$620.56
$732.82 		$728.18
$758.01
$789.62
$901.88 		$169.06
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$442.00
$501.66
$564.88
$789.40
$1,199.58 		$611.06
$670.72
$733.94
$958.46 		$780.12
$839.78
$903.00
$1,127.52 		$949.18
$1,008.84
$1,072.06
$1,296.58 		$169.06
Toc - Plan #2 Cigna HealthCare of Georgia, Inc
Expanded Bronze

(HMO) Cigna Connect 7800

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$7,800 $15,600 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 		$228.80
$259.68
$292.40
$408.63
$620.96 		$403.83
$434.71
$467.43
$583.66 		$578.86
$609.74
$642.46
$758.69 		$753.89
$784.77
$817.49
$933.72 		$175.03
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$457.60
$519.36
$584.80
$817.26
$1,241.92 		$632.63
$694.39
$759.83
$992.29 		$807.66
$869.42
$934.86
$1,167.32 		$982.69
$1,044.45
$1,109.89
$1,342.35 		$175.03
Toc - Plan #3 Cigna HealthCare of Georgia, Inc
Expanded Bronze

(HMO) Cigna Connect 6500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

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 		$229.57
$260.56
$293.39
$410.01
$623.06 		$405.19
$436.18
$469.01
$585.63 		$580.81
$611.80
$644.63
$761.25 		$756.43
$787.42
$820.25
$936.87 		$175.62
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$459.14
$521.12
$586.78
$820.02
$1,246.12 		$634.76
$696.74
$762.40
$995.64 		$810.38
$872.36
$938.02
$1,171.26 		$986.00
$1,047.98
$1,113.64
$1,346.88 		$175.62
Toc - Plan #4 Cigna HealthCare of Georgia, Inc
Expanded Bronze

(HMO) Cigna Connect HSA 7050

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$232.05
$263.37
$296.56
$414.44
$629.78 		$409.57
$440.89
$474.08
$591.96 		$587.09
$618.41
$651.60
$769.48 		$764.61
$795.93
$829.12
$947.00 		$177.52
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$464.10
$526.74
$593.12
$828.88
$1,259.56 		$641.62
$704.26
$770.64
$1,006.40 		$819.14
$881.78
$948.16
$1,183.92 		$996.66
$1,059.30
$1,125.68
$1,361.44 		$177.52
Toc - Plan #5 Cigna HealthCare of Georgia, Inc
Expanded Bronze

(HMO) Cigna Connect 6800 Enhanced Diabetes Care

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

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 		$231.83
$263.13
$296.28
$414.05
$629.19 		$409.18
$440.48
$473.63
$591.40 		$586.53
$617.83
$650.98
$768.75 		$763.88
$795.18
$828.33
$946.10 		$177.35
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$463.66
$526.26
$592.56
$828.10
$1,258.38 		$641.01
$703.61
$769.91
$1,005.45 		$818.36
$880.96
$947.26
$1,182.80 		$995.71
$1,058.31
$1,124.61
$1,360.15 		$177.35
Toc - Plan #6 Cigna HealthCare of Georgia, Inc
Silver

(HMO) Cigna Connect 3700

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$3,700 $7,400 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 		$267.92
$304.08
$342.40
$478.50
$727.12 		$472.88
$509.04
$547.36
$683.46 		$677.84
$714.00
$752.32
$888.42 		$882.80
$918.96
$957.28
$1,093.38 		$204.96
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$535.84
$608.16
$684.80
$957.00
$1,454.24 		$740.80
$813.12
$889.76
$1,161.96 		$945.76
$1,018.08
$1,094.72
$1,366.92 		$1,150.72
$1,223.04
$1,299.68
$1,571.88 		$204.96
Toc - Plan #7 Cigna HealthCare of Georgia, Inc
Silver

(HMO) Cigna Connect 5000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 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 		$267.95
$304.12
$342.44
$478.55
$727.21 		$472.93
$509.10
$547.42
$683.53 		$677.91
$714.08
$752.40
$888.51 		$882.89
$919.06
$957.38
$1,093.49 		$204.98
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$535.90
$608.24
$684.88
$957.10
$1,454.42 		$740.88
$813.22
$889.86
$1,162.08 		$945.86
$1,018.20
$1,094.84
$1,367.06 		$1,150.84
$1,223.18
$1,299.82
$1,572.04 		$204.98
Toc - Plan #8 Cigna HealthCare of Georgia, Inc
Silver

(HMO) Cigna Connect 6000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

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 		$268.35
$304.58
$342.95
$479.27
$728.30 		$473.64
$509.87
$548.24
$684.56 		$678.93
$715.16
$753.53
$889.85 		$884.22
$920.45
$958.82
$1,095.14 		$205.29
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$536.70
$609.16
$685.90
$958.54
$1,456.60 		$741.99
$814.45
$891.19
$1,163.83 		$947.28
$1,019.74
$1,096.48
$1,369.12 		$1,152.57
$1,225.03
$1,301.77
$1,574.41 		$205.29
Toc - Plan #9 Cigna HealthCare of Georgia, Inc
Silver

(HMO) Cigna Connect 7200

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$7,200 $14,400 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 		$271.85
$308.54
$347.42
$485.52
$737.79 		$479.81
$516.50
$555.38
$693.48 		$687.77
$724.46
$763.34
$901.44 		$895.73
$932.42
$971.30
$1,109.40 		$207.96
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$543.70
$617.08
$694.84
$971.04
$1,475.58 		$751.66
$825.04
$902.80
$1,179.00 		$959.62
$1,033.00
$1,110.76
$1,386.96 		$1,167.58
$1,240.96
$1,318.72
$1,594.92 		$207.96
Toc - Plan #10 Cigna HealthCare of Georgia, Inc
Silver

(HMO) Cigna Connect 3800 Enhanced Diabetes Care

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

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 		$270.55
$307.07
$345.76
$483.20
$734.26 		$477.52
$514.04
$552.73
$690.17 		$684.49
$721.01
$759.70
$897.14 		$891.46
$927.98
$966.67
$1,104.11 		$206.97
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$541.10
$614.14
$691.52
$966.40
$1,468.52 		$748.07
$821.11
$898.49
$1,173.37 		$955.04
$1,028.08
$1,105.46
$1,380.34 		$1,162.01
$1,235.05
$1,312.43
$1,587.31 		$206.97
Toc - Plan #11 Cigna HealthCare of Georgia, Inc
Silver

(HMO) Cigna Connect 4200 Enhanced Asthma COPD Care

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

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 		$269.28
$305.63
$344.14
$480.93
$730.82 		$475.28
$511.63
$550.14
$686.93 		$681.28
$717.63
$756.14
$892.93 		$887.28
$923.63
$962.14
$1,098.93 		$206.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$538.56
$611.26
$688.28
$961.86
$1,461.64 		$744.56
$817.26
$894.28
$1,167.86 		$950.56
$1,023.26
$1,100.28
$1,373.86 		$1,156.56
$1,229.26
$1,306.28
$1,579.86 		$206.00
Toc - Plan #12 Cigna HealthCare of Georgia, Inc
Gold

(HMO) Cigna Connect 1600

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

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 		$339.37
$385.19
$433.72
$606.12
$921.06 		$598.99
$644.81
$693.34
$865.74 		$858.61
$904.43
$952.96
$1,125.36 		$1,118.23
$1,164.05
$1,212.58
$1,384.98 		$259.62
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$678.74
$770.38
$867.44
$1,212.24
$1,842.12 		$938.36
$1,030.00
$1,127.06
$1,471.86 		$1,197.98
$1,289.62
$1,386.68
$1,731.48 		$1,457.60
$1,549.24
$1,646.30
$1,991.10 		$259.62
Toc - Plan #13 Cigna HealthCare of Georgia, Inc
Gold

(HMO) Cigna Connect 1900 Enhanced Diabetes Care

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

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 		$341.54
$387.65
$436.49
$609.99
$926.94 		$602.82
$648.93
$697.77
$871.27 		$864.10
$910.21
$959.05
$1,132.55 		$1,125.38
$1,171.49
$1,220.33
$1,393.83 		$261.28
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$683.08
$775.30
$872.98
$1,219.98
$1,853.88 		$944.36
$1,036.58
$1,134.26
$1,481.26 		$1,205.64
$1,297.86
$1,395.54
$1,742.54 		$1,466.92
$1,559.14
$1,656.82
$2,003.82 		$261.28
Toc - Plan #14 Cigna HealthCare of Georgia, Inc
Expanded Bronze

(HMO) Cigna Connect 7600 Enhanced Asthma COPD Care

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

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 		$232.42
$263.79
$297.03
$415.10
$630.78 		$410.22
$441.59
$474.83
$592.90 		$588.02
$619.39
$652.63
$770.70 		$765.82
$797.19
$830.43
$948.50 		$177.80
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$464.84
$527.58
$594.06
$830.20
$1,261.56 		$642.64
$705.38
$771.86
$1,008.00 		$820.44
$883.18
$949.66
$1,185.80 		$998.24
$1,060.98
$1,127.46
$1,363.60 		$177.80
Toc - Plan #15 Cigna HealthCare of Georgia, Inc
Bronze

(HMO) Cigna Simple Choice 9100

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 		$221.00
$250.83
$282.44
$394.70
$599.79 		$390.06
$419.89
$451.50
$563.76 		$559.12
$588.95
$620.56
$732.82 		$728.18
$758.01
$789.62
$901.88 		$169.06
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$442.00
$501.66
$564.88
$789.40
$1,199.58 		$611.06
$670.72
$733.94
$958.46 		$780.12
$839.78
$903.00
$1,127.52 		$949.18
$1,008.84
$1,072.06
$1,296.58 		$169.06
Toc - Plan #16 Cigna HealthCare of Georgia, Inc
Expanded Bronze

(HMO) Cigna Simple Choice 7500

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 		$230.28
$261.37
$294.30
$411.29
$624.99 		$406.45
$437.54
$470.47
$587.46 		$582.62
$613.71
$646.64
$763.63 		$758.79
$789.88
$822.81
$939.80 		$176.17
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$460.56
$522.74
$588.60
$822.58
$1,249.98 		$636.73
$698.91
$764.77
$998.75 		$812.90
$875.08
$940.94
$1,174.92 		$989.07
$1,051.25
$1,117.11
$1,351.09 		$176.17
Toc - Plan #17 Cigna HealthCare of Georgia, Inc
Expanded Bronze

(HMO) Cigna Connect 0

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

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 		$247.43
$280.83
$316.21
$441.91
$671.52 		$436.71
$470.11
$505.49
$631.19 		$625.99
$659.39
$694.77
$820.47 		$815.27
$848.67
$884.05
$1,009.75 		$189.28
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$494.86
$561.66
$632.42
$883.82
$1,343.04 		$684.14
$750.94
$821.70
$1,073.10 		$873.42
$940.22
$1,010.98
$1,262.38 		$1,062.70
$1,129.50
$1,200.26
$1,451.66 		$189.28
Toc - Plan #18 Cigna HealthCare of Georgia, Inc
Gold

(HMO) Cigna Simple Choice 2000

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 		$337.80
$383.40
$431.70
$603.30
$916.78 		$596.21
$641.81
$690.11
$861.71 		$854.62
$900.22
$948.52
$1,120.12 		$1,113.03
$1,158.63
$1,206.93
$1,378.53 		$258.41
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$675.60
$766.80
$863.40
$1,206.60
$1,833.56 		$934.01
$1,025.21
$1,121.81
$1,465.01 		$1,192.42
$1,283.62
$1,380.22
$1,723.42 		$1,450.83
$1,542.03
$1,638.63
$1,981.83 		$258.41
Toc - Plan #19 Cigna HealthCare of Georgia, Inc
Silver

(HMO) Cigna Simple Choice 5800

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 		$268.35
$304.58
$342.95
$479.27
$728.30 		$473.64
$509.87
$548.24
$684.56 		$678.93
$715.16
$753.53
$889.85 		$884.22
$920.45
$958.82
$1,095.14 		$205.29
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$536.70
$609.16
$685.90
$958.54
$1,456.60 		$741.99
$814.45
$891.19
$1,163.83 		$947.28
$1,019.74
$1,096.48
$1,369.12 		$1,152.57
$1,225.03
$1,301.77
$1,574.41 		$205.29

ADVERTISEMENT

Blue Cross Blue Shield Healthcare Plan of Georgia, Inc

Local: 1-855-738-6652 | Toll Free: 1-855-738-6652

Toc - Plan #20 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Catastrophic

(HMO) Anthem Catastrophic Pathway X HMO 9100

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

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 		$199.24
$226.14
$254.63
$355.84
$540.74 		$351.66
$378.56
$407.05
$508.26 		$504.08
$530.98
$559.47
$660.68 		$656.50
$683.40
$711.89
$813.10 		$152.42
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$398.48
$452.28
$509.26
$711.68
$1,081.48 		$550.90
$604.70
$661.68
$864.10 		$703.32
$757.12
$814.10
$1,016.52 		$855.74
$909.54
$966.52
$1,168.94 		$152.42
Toc - Plan #21 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Expanded Bronze

(HMO) Anthem Bronze Pathway X HMO 0% for HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$289.62
$328.72
$370.13
$517.26
$786.03 		$511.18
$550.28
$591.69
$738.82 		$732.74
$771.84
$813.25
$960.38 		$954.30
$993.40
$1,034.81
$1,181.94 		$221.56
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$579.24
$657.44
$740.26
$1,034.52
$1,572.06 		$800.80
$879.00
$961.82
$1,256.08 		$1,022.36
$1,100.56
$1,183.38
$1,477.64 		$1,243.92
$1,322.12
$1,404.94
$1,699.20 		$221.56
Toc - Plan #22 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Expanded Bronze

(HMO) Anthem Bronze Pathway X HMO 5600($0 Virtual PCP+$0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$5,600 $11,200 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 		$280.52
$318.39
$358.50
$501.01
$761.33 		$495.12
$532.99
$573.10
$715.61 		$709.72
$747.59
$787.70
$930.21 		$924.32
$962.19
$1,002.30
$1,144.81 		$214.60
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$561.04
$636.78
$717.00
$1,002.02
$1,522.66 		$775.64
$851.38
$931.60
$1,216.62 		$990.24
$1,065.98
$1,146.20
$1,431.22 		$1,204.84
$1,280.58
$1,360.80
$1,645.82 		$214.60
Toc - Plan #23 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Expanded Bronze

(HMO) Anthem Bronze Pathway X HMO 6000($0 Virtual PCP+$0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

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 		$275.73
$312.95
$352.38
$492.45
$748.33 		$486.66
$523.88
$563.31
$703.38 		$697.59
$734.81
$774.24
$914.31 		$908.52
$945.74
$985.17
$1,125.24 		$210.93
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$551.46
$625.90
$704.76
$984.90
$1,496.66 		$762.39
$836.83
$915.69
$1,195.83 		$973.32
$1,047.76
$1,126.62
$1,406.76 		$1,184.25
$1,258.69
$1,337.55
$1,617.69 		$210.93
Toc - Plan #24 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Silver

(HMO) Anthem Silver Pathway X HMO 3000($0 Virtual PCP+$0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

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 		$346.09
$392.81
$442.30
$618.12
$939.29 		$610.85
$657.57
$707.06
$882.88 		$875.61
$922.33
$971.82
$1,147.64 		$1,140.37
$1,187.09
$1,236.58
$1,412.40 		$264.76
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$692.18
$785.62
$884.60
$1,236.24
$1,878.58 		$956.94
$1,050.38
$1,149.36
$1,501.00 		$1,221.70
$1,315.14
$1,414.12
$1,765.76 		$1,486.46
$1,579.90
$1,678.88
$2,030.52 		$264.76
Toc - Plan #25 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Silver

(HMO) Anthem Silver Pathway X HMO 5500($0 Virtual PCP+$0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$5,500 $11,000 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 		$348.70
$395.77
$445.64
$622.78
$946.37 		$615.46
$662.53
$712.40
$889.54 		$882.22
$929.29
$979.16
$1,156.30 		$1,148.98
$1,196.05
$1,245.92
$1,423.06 		$266.76
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$697.40
$791.54
$891.28
$1,245.56
$1,892.74 		$964.16
$1,058.30
$1,158.04
$1,512.32 		$1,230.92
$1,325.06
$1,424.80
$1,779.08 		$1,497.68
$1,591.82
$1,691.56
$2,045.84 		$266.76
Toc - Plan #26 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Bronze

(HMO) Anthem Bronze Pathway X HMO 8000($0 Virtual PCP+$0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

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 		$264.82
$300.57
$338.44
$472.97
$718.72 		$467.41
$503.16
$541.03
$675.56 		$670.00
$705.75
$743.62
$878.15 		$872.59
$908.34
$946.21
$1,080.74 		$202.59
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$529.64
$601.14
$676.88
$945.94
$1,437.44 		$732.23
$803.73
$879.47
$1,148.53 		$934.82
$1,006.32
$1,082.06
$1,351.12 		$1,137.41
$1,208.91
$1,284.65
$1,553.71 		$202.59
Toc - Plan #27 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Silver

(HMO) Anthem Silver Pathway X HMO 4950($0 Virtual PCP+$0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$4,950 $9,900 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 		$350.88
$398.25
$448.42
$626.67
$952.29 		$619.30
$666.67
$716.84
$895.09 		$887.72
$935.09
$985.26
$1,163.51 		$1,156.14
$1,203.51
$1,253.68
$1,431.93 		$268.42
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$701.76
$796.50
$896.84
$1,253.34
$1,904.58 		$970.18
$1,064.92
$1,165.26
$1,521.76 		$1,238.60
$1,333.34
$1,433.68
$1,790.18 		$1,507.02
$1,601.76
$1,702.10
$2,058.60 		$268.42
Toc - Plan #28 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Silver

(HMO) Anthem Silver Pathway X HMO 6500($0 Virtual PCP+$0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

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 		$344.61
$391.13
$440.41
$615.47
$935.27 		$608.24
$654.76
$704.04
$879.10 		$871.87
$918.39
$967.67
$1,142.73 		$1,135.50
$1,182.02
$1,231.30
$1,406.36 		$263.63
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$689.22
$782.26
$880.82
$1,230.94
$1,870.54 		$952.85
$1,045.89
$1,144.45
$1,494.57 		$1,216.48
$1,309.52
$1,408.08
$1,758.20 		$1,480.11
$1,573.15
$1,671.71
$2,021.83 		$263.63
Toc - Plan #29 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Gold

(HMO) Anthem Gold Pathway X HMO 1600($0 Virtual PCP+$0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$1,600 $3,200 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 		$385.09
$437.08
$492.15
$687.77
$1,045.13 		$679.68
$731.67
$786.74
$982.36 		$974.27
$1,026.26
$1,081.33
$1,276.95 		$1,268.86
$1,320.85
$1,375.92
$1,571.54 		$294.59
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$770.18
$874.16
$984.30
$1,375.54
$2,090.26 		$1,064.77
$1,168.75
$1,278.89
$1,670.13 		$1,359.36
$1,463.34
$1,573.48
$1,964.72 		$1,653.95
$1,757.93
$1,868.07
$2,259.31 		$294.59
Toc - Plan #30 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Expanded Bronze

(HMO) Anthem Bronze Pathway X HMO 5000($0 Virtual PCP+$0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 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 		$292.40
$331.87
$373.69
$522.23
$793.57 		$516.09
$555.56
$597.38
$745.92 		$739.78
$779.25
$821.07
$969.61 		$963.47
$1,002.94
$1,044.76
$1,193.30 		$223.69
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$584.80
$663.74
$747.38
$1,044.46
$1,587.14 		$808.49
$887.43
$971.07
$1,268.15 		$1,032.18
$1,111.12
$1,194.76
$1,491.84 		$1,255.87
$1,334.81
$1,418.45
$1,715.53 		$223.69
Toc - Plan #31 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Silver

(HMO) Anthem Silver Pathway X HMO 2600($0 PCP+$0 Select Drugs)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$2,600 $5,200 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 		$367.60
$417.23
$469.79
$656.53
$997.67 		$648.81
$698.44
$751.00
$937.74 		$930.02
$979.65
$1,032.21
$1,218.95 		$1,211.23
$1,260.86
$1,313.42
$1,500.16 		$281.21
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$735.20
$834.46
$939.58
$1,313.06
$1,995.34 		$1,016.41
$1,115.67
$1,220.79
$1,594.27 		$1,297.62
$1,396.88
$1,502.00
$1,875.48 		$1,578.83
$1,678.09
$1,783.21
$2,156.69 		$281.21
Toc - Plan #32 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Bronze

(HMO) Anthem Bronze Pathway X HMO 9100/0% Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

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 		$272.74
$309.56
$348.56
$487.11
$740.22 		$481.39
$518.21
$557.21
$695.76 		$690.04
$726.86
$765.86
$904.41 		$898.69
$935.51
$974.51
$1,113.06 		$208.65
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$545.48
$619.12
$697.12
$974.22
$1,480.44 		$754.13
$827.77
$905.77
$1,182.87 		$962.78
$1,036.42
$1,114.42
$1,391.52 		$1,171.43
$1,245.07
$1,323.07
$1,600.17 		$208.65
Toc - Plan #33 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Expanded Bronze

(HMO) Anthem Bronze Pathway X HMO 7500/50% Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

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 		$298.34
$338.62
$381.28
$532.84
$809.69 		$526.57
$566.85
$609.51
$761.07 		$754.80
$795.08
$837.74
$989.30 		$983.03
$1,023.31
$1,065.97
$1,217.53 		$228.23
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$596.68
$677.24
$762.56
$1,065.68
$1,619.38 		$824.91
$905.47
$990.79
$1,293.91 		$1,053.14
$1,133.70
$1,219.02
$1,522.14 		$1,281.37
$1,361.93
$1,447.25
$1,750.37 		$228.23
Toc - Plan #34 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Silver

(HMO) Anthem Silver Pathway X HMO 5800/40% Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

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 		$349.97
$397.22
$447.26
$625.05
$949.82 		$617.70
$664.95
$714.99
$892.78 		$885.43
$932.68
$982.72
$1,160.51 		$1,153.16
$1,200.41
$1,250.45
$1,428.24 		$267.73
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$699.94
$794.44
$894.52
$1,250.10
$1,899.64 		$967.67
$1,062.17
$1,162.25
$1,517.83 		$1,235.40
$1,329.90
$1,429.98
$1,785.56 		$1,503.13
$1,597.63
$1,697.71
$2,053.29 		$267.73
Toc - Plan #35 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Gold

(HMO) Anthem Gold Pathway X HMO 2000/25% Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

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 		$395.74
$449.16
$505.76
$706.79
$1,074.04 		$698.48
$751.90
$808.50
$1,009.53 		$1,001.22
$1,054.64
$1,111.24
$1,312.27 		$1,303.96
$1,357.38
$1,413.98
$1,615.01 		$302.74
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$791.48
$898.32
$1,011.52
$1,413.58
$2,148.08 		$1,094.22
$1,201.06
$1,314.26
$1,716.32 		$1,396.96
$1,503.80
$1,617.00
$2,019.06 		$1,699.70
$1,806.54
$1,919.74
$2,321.80 		$302.74

ADVERTISEMENT

Alliant Health Plans

Local: 1-800-811-4793 | Toll Free: 1-800-811-4793

Toc - Plan #36 Alliant Health Plans
Gold

(PPO) SoloCare Gold PPO (3 Free PCP Visits) 40002

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

Annual Out of Pocket Expenses:

Individual Family
$2,300 $4,600 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 		$288.32
$327.23
$368.46
$514.92
$782.47 		$508.88
$547.79
$589.02
$735.48 		$729.44
$768.35
$809.58
$956.04 		$950.00
$988.91
$1,030.14
$1,176.60 		$220.56
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$576.64
$654.46
$736.92
$1,029.84
$1,564.94 		$797.20
$875.02
$957.48
$1,250.40 		$1,017.76
$1,095.58
$1,178.04
$1,470.96 		$1,238.32
$1,316.14
$1,398.60
$1,691.52 		$220.56
Toc - Plan #37 Alliant Health Plans
Silver

(PPO) SoloCare Silver PPO (3 Free PCP Visits + $225 Specialty Drug Copay) 40017

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 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 		$283.79
$322.09
$362.67
$506.83
$770.17 		$500.88
$539.18
$579.76
$723.92 		$717.97
$756.27
$796.85
$941.01 		$935.06
$973.36
$1,013.94
$1,158.10 		$217.09
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$567.58
$644.18
$725.34
$1,013.66
$1,540.34 		$784.67
$861.27
$942.43
$1,230.75 		$1,001.76
$1,078.36
$1,159.52
$1,447.84 		$1,218.85
$1,295.45
$1,376.61
$1,664.93 		$217.09
Toc - Plan #38 Alliant Health Plans
Platinum

(PPO) SoloCare Platinum PPO Copay Plan (3 Free PCP Visits) 40184

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

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 		$377.37
$428.31
$482.27
$673.97
$1,024.17 		$666.05
$716.99
$770.95
$962.65 		$954.73
$1,005.67
$1,059.63
$1,251.33 		$1,243.41
$1,294.35
$1,348.31
$1,540.01 		$288.68
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$754.74
$856.62
$964.54
$1,347.94
$2,048.34 		$1,043.42
$1,145.30
$1,253.22
$1,636.62 		$1,332.10
$1,433.98
$1,541.90
$1,925.30 		$1,620.78
$1,722.66
$1,830.58
$2,213.98 		$288.68
Toc - Plan #39 Alliant Health Plans
Gold

(PPO) SoloCare Gold PPO (3 Free PCP Visits) 40330

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$7,100 $14,200 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 		$299.64
$340.08
$382.93
$535.14
$813.20 		$528.86
$569.30
$612.15
$764.36 		$758.08
$798.52
$841.37
$993.58 		$987.30
$1,027.74
$1,070.59
$1,222.80 		$229.22
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$599.28
$680.16
$765.86
$1,070.28
$1,626.40 		$828.50
$909.38
$995.08
$1,299.50 		$1,057.72
$1,138.60
$1,224.30
$1,528.72 		$1,286.94
$1,367.82
$1,453.52
$1,757.94 		$229.22
Toc - Plan #40 Alliant Health Plans
Silver

(PPO) SoloCare Silver PPO (3 Free PCP Visits + $225 Specialty Drug Copay) 40331

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 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 		$282.28
$320.38
$360.74
$504.13
$766.08 		$498.22
$536.32
$576.68
$720.07 		$714.16
$752.26
$792.62
$936.01 		$930.10
$968.20
$1,008.56
$1,151.95 		$215.94
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$564.56
$640.76
$721.48
$1,008.26
$1,532.16 		$780.50
$856.70
$937.42
$1,224.20 		$996.44
$1,072.64
$1,153.36
$1,440.14 		$1,212.38
$1,288.58
$1,369.30
$1,656.08 		$215.94
Toc - Plan #41 Alliant Health Plans
Silver

(PPO) SoloCare Silver PPO (3 Free PCP Visits + $225 Specialty Drug Copay) 40336

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

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 		$290.58
$329.80
$371.35
$518.96
$788.60 		$512.87
$552.09
$593.64
$741.25 		$735.16
$774.38
$815.93
$963.54 		$957.45
$996.67
$1,038.22
$1,185.83 		$222.29
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$581.16
$659.60
$742.70
$1,037.92
$1,577.20 		$803.45
$881.89
$964.99
$1,260.21 		$1,025.74
$1,104.18
$1,187.28
$1,482.50 		$1,248.03
$1,326.47
$1,409.57
$1,704.79 		$222.29
Toc - Plan #42 Alliant Health Plans
Platinum

(PPO) SoloCare Platinum PPO Copay Plan (3 Free PCP Visits + Dental) 40348

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

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 		$392.47
$445.44
$501.56
$700.93
$1,065.12 		$692.70
$745.67
$801.79
$1,001.16 		$992.93
$1,045.90
$1,102.02
$1,301.39 		$1,293.16
$1,346.13
$1,402.25
$1,601.62 		$300.23
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$784.94
$890.88
$1,003.12
$1,401.86
$2,130.24 		$1,085.17
$1,191.11
$1,303.35
$1,702.09 		$1,385.40
$1,491.34
$1,603.58
$2,002.32 		$1,685.63
$1,791.57
$1,903.81
$2,302.55 		$300.23
Toc - Plan #43 Alliant Health Plans
Platinum

(PPO) SoloCare Platinum PPO Copay Plan (3 Free PCP Visits + Chiro + Dental) 40349

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

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 		$396.24
$449.72
$506.39
$707.67
$1,075.38 		$699.36
$752.84
$809.51
$1,010.79 		$1,002.48
$1,055.96
$1,112.63
$1,313.91 		$1,305.60
$1,359.08
$1,415.75
$1,617.03 		$303.12
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$792.48
$899.44
$1,012.78
$1,415.34
$2,150.76 		$1,095.60
$1,202.56
$1,315.90
$1,718.46 		$1,398.72
$1,505.68
$1,619.02
$2,021.58 		$1,701.84
$1,808.80
$1,922.14
$2,324.70 		$303.12
Toc - Plan #44 Alliant Health Plans
Gold

(PPO) SoloCare Gold PPO (3 Free PCP Visits + Dental) 40354

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

Annual Out of Pocket Expenses:

Individual Family
$2,300 $4,600 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 		$300.01
$340.50
$383.40
$535.81
$814.21 		$529.51
$570.00
$612.90
$765.31 		$759.01
$799.50
$842.40
$994.81 		$988.51
$1,029.00
$1,071.90
$1,224.31 		$229.50
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$600.02
$681.00
$766.80
$1,071.62
$1,628.42 		$829.52
$910.50
$996.30
$1,301.12 		$1,059.02
$1,140.00
$1,225.80
$1,530.62 		$1,288.52
$1,369.50
$1,455.30
$1,760.12 		$229.50
Toc - Plan #45 Alliant Health Plans
Gold

(PPO) SoloCare Gold PPO (3 Free PCP Visits + Chiro + Dental) 40355

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

Annual Out of Pocket Expenses:

Individual Family
$2,300 $4,600 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 		$303.04
$343.94
$387.27
$541.21
$822.41 		$534.86
$575.76
$619.09
$773.03 		$766.68
$807.58
$850.91
$1,004.85 		$998.50
$1,039.40
$1,082.73
$1,236.67 		$231.82
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$606.08
$687.88
$774.54
$1,082.42
$1,644.82 		$837.90
$919.70
$1,006.36
$1,314.24 		$1,069.72
$1,151.52
$1,238.18
$1,546.06 		$1,301.54
$1,383.34
$1,470.00
$1,777.88 		$231.82
Toc - Plan #46 Alliant Health Plans
Gold

(PPO) SoloCare Gold PPO (3 Free PCP Visits + Dental) 40357

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$7,100 $14,200 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 		$311.34
$353.35
$397.87
$556.03
$844.94 		$549.50
$591.51
$636.03
$794.19 		$787.66
$829.67
$874.19
$1,032.35 		$1,025.82
$1,067.83
$1,112.35
$1,270.51 		$238.16
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$622.68
$706.70
$795.74
$1,112.06
$1,689.88 		$860.84
$944.86
$1,033.90
$1,350.22 		$1,099.00
$1,183.02
$1,272.06
$1,588.38 		$1,337.16
$1,421.18
$1,510.22
$1,826.54 		$238.16
Toc - Plan #47 Alliant Health Plans
Gold

(PPO) SoloCare Gold PPO (3 Free PCP Visits + Chiro + Dental) 40358

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$7,100 $14,200 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 		$314.73
$357.21
$402.21
$562.09
$854.16 		$555.49
$597.97
$642.97
$802.85 		$796.25
$838.73
$883.73
$1,043.61 		$1,037.01
$1,079.49
$1,124.49
$1,284.37 		$240.76
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$629.46
$714.42
$804.42
$1,124.18
$1,708.32 		$870.22
$955.18
$1,045.18
$1,364.94 		$1,110.98
$1,195.94
$1,285.94
$1,605.70 		$1,351.74
$1,436.70
$1,526.70
$1,846.46 		$240.76
Toc - Plan #48 Alliant Health Plans
Silver

(PPO) SoloCare Silver PPO (3 Free PCP Visits +$225 Specialty Drug Copay + Dental) 40368

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 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 		$295.11
$334.94
$377.14
$527.05
$800.90 		$520.86
$560.69
$602.89
$752.80 		$746.61
$786.44
$828.64
$978.55 		$972.36
$1,012.19
$1,054.39
$1,204.30 		$225.75
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$590.22
$669.88
$754.28
$1,054.10
$1,601.80 		$815.97
$895.63
$980.03
$1,279.85 		$1,041.72
$1,121.38
$1,205.78
$1,505.60 		$1,267.47
$1,347.13
$1,431.53
$1,731.35 		$225.75
Toc - Plan #49 Alliant Health Plans
Silver

(PPO) SoloCare Silver PPO (3 Free PCP Visits + Chiro + $225 Specialty Drug Copay + Dental) 40369

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 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 		$297.37
$337.50
$380.03
$531.09
$807.04 		$524.85
$564.98
$607.51
$758.57 		$752.33
$792.46
$834.99
$986.05 		$979.81
$1,019.94
$1,062.47
$1,213.53 		$227.48
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$594.74
$675.00
$760.06
$1,062.18
$1,614.08 		$822.22
$902.48
$987.54
$1,289.66 		$1,049.70
$1,129.96
$1,215.02
$1,517.14 		$1,277.18
$1,357.44
$1,442.50
$1,744.62 		$227.48
Toc - Plan #50 Alliant Health Plans
Silver

(PPO) SoloCare Silver PPO (3 Free PCP Visits + $225 Specialty Drug Copay + Dental) 40372

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 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 		$293.60
$333.23
$375.21
$524.36
$796.81 		$518.20
$557.83
$599.81
$748.96 		$742.80
$782.43
$824.41
$973.56 		$967.40
$1,007.03
$1,049.01
$1,198.16 		$224.60
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$587.20
$666.46
$750.42
$1,048.72
$1,593.62 		$811.80
$891.06
$975.02
$1,273.32 		$1,036.40
$1,115.66
$1,199.62
$1,497.92 		$1,261.00
$1,340.26
$1,424.22
$1,722.52 		$224.60
Toc - Plan #51 Alliant Health Plans
Silver

(PPO) SoloCare Silver PPO (3 Free PCP Visits + Chiro + $225 Specialty Drug Copay + Dental) 40373

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 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 		$296.25
$336.23
$378.59
$529.08
$803.98 		$522.87
$562.85
$605.21
$755.70 		$749.49
$789.47
$831.83
$982.32 		$976.11
$1,016.09
$1,058.45
$1,208.94 		$226.62
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$592.50
$672.46
$757.18
$1,058.16
$1,607.96 		$819.12
$899.08
$983.80
$1,284.78 		$1,045.74
$1,125.70
$1,210.42
$1,511.40 		$1,272.36
$1,352.32
$1,437.04
$1,738.02 		$226.62
Toc - Plan #52 Alliant Health Plans
Silver

(PPO) SoloCare Silver PPO (3 Free PCP Visits + $225 Specialty Drug Copay + Dental) 40375

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

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 		$302.28
$343.08
$386.31
$539.86
$820.37 		$533.52
$574.32
$617.55
$771.10 		$764.76
$805.56
$848.79
$1,002.34 		$996.00
$1,036.80
$1,080.03
$1,233.58 		$231.24
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$604.56
$686.16
$772.62
$1,079.72
$1,640.74 		$835.80
$917.40
$1,003.86
$1,310.96 		$1,067.04
$1,148.64
$1,235.10
$1,542.20 		$1,298.28
$1,379.88
$1,466.34
$1,773.44 		$231.24
Toc - Plan #53 Alliant Health Plans
Silver

(PPO) SoloCare Silver PPO (3 Free PCP Visits + Chiro + $225 Specialty Drug Copay + Dental) 40376

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

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 		$304.54
$345.65
$389.19
$543.90
$826.51 		$537.51
$578.62
$622.16
$776.87 		$770.48
$811.59
$855.13
$1,009.84 		$1,003.45
$1,044.56
$1,088.10
$1,242.81 		$232.97
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$609.08
$691.30
$778.38
$1,087.80
$1,653.02 		$842.05
$924.27
$1,011.35
$1,320.77 		$1,075.02
$1,157.24
$1,244.32
$1,553.74 		$1,307.99
$1,390.21
$1,477.29
$1,786.71 		$232.97
Toc - Plan #54 Alliant Health Plans
Platinum

(PPO) SoloCare PPO Platinum Standardized

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

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 		$389.82
$442.44
$498.18
$696.21
$1,057.95 		$688.03
$740.65
$796.39
$994.42 		$986.24
$1,038.86
$1,094.60
$1,292.63 		$1,284.45
$1,337.07
$1,392.81
$1,590.84 		$298.21
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$779.64
$884.88
$996.36
$1,392.42
$2,115.90 		$1,077.85
$1,183.09
$1,294.57
$1,690.63 		$1,376.06
$1,481.30
$1,592.78
$1,988.84 		$1,674.27
$1,779.51
$1,890.99
$2,287.05 		$298.21
Toc - Plan #55 Alliant Health Plans
Gold

(PPO) SoloCare PPO Gold Standardized

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

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 		$282.28
$320.38
$360.74
$504.13
$766.08 		$498.22
$536.32
$576.68
$720.07 		$714.16
$752.26
$792.62
$936.01 		$930.10
$968.20
$1,008.56
$1,151.95 		$215.94
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$564.56
$640.76
$721.48
$1,008.26
$1,532.16 		$780.50
$856.70
$937.42
$1,224.20 		$996.44
$1,072.64
$1,153.36
$1,440.14 		$1,212.38
$1,288.58
$1,369.30
$1,656.08 		$215.94
Toc - Plan #56 Alliant Health Plans
Silver

(PPO) SoloCare PPO Silver Standardized

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

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 		$267.94
$304.10
$342.42
$478.53
$727.17 		$472.91
$509.07
$547.39
$683.50 		$677.88
$714.04
$752.36
$888.47 		$882.85
$919.01
$957.33
$1,093.44 		$204.97
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$535.88
$608.20
$684.84
$957.06
$1,454.34 		$740.85
$813.17
$889.81
$1,162.03 		$945.82
$1,018.14
$1,094.78
$1,367.00 		$1,150.79
$1,223.11
$1,299.75
$1,571.97 		$204.97
Toc - Plan #57 Alliant Health Plans
Gold

(HMO) SoloCare Gold No Referral HMO (3 Free PCP Visits) 110003

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

Annual Out of Pocket Expenses:

Individual Family
$2,300 $4,600 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 		$286.81
$325.52
$366.53
$512.23
$778.38 		$506.21
$544.92
$585.93
$731.63 		$725.61
$764.32
$805.33
$951.03 		$945.01
$983.72
$1,024.73
$1,170.43 		$219.40
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$573.62
$651.04
$733.06
$1,024.46
$1,556.76 		$793.02
$870.44
$952.46
$1,243.86 		$1,012.42
$1,089.84
$1,171.86
$1,463.26 		$1,231.82
$1,309.24
$1,391.26
$1,682.66 		$219.40
Toc - Plan #58 Alliant Health Plans
Gold

(HMO) SoloCare Gold No Referral HMO (3 Free PCP Visits) 110004

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$7,100 $14,200 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 		$298.51
$338.79
$381.48
$533.11
$810.12 		$526.86
$567.14
$609.83
$761.46 		$755.21
$795.49
$838.18
$989.81 		$983.56
$1,023.84
$1,066.53
$1,218.16 		$228.35
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$597.02
$677.58
$762.96
$1,066.22
$1,620.24 		$825.37
$905.93
$991.31
$1,294.57 		$1,053.72
$1,134.28
$1,219.66
$1,522.92 		$1,282.07
$1,362.63
$1,448.01
$1,751.27 		$228.35
Toc - Plan #59 Alliant Health Plans
Silver

(HMO) SoloCare Silver No Referral HMO (3 Free PCP Visits + $225 Specialty Drug Copay) 110008

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 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 		$280.02
$317.81
$357.85
$500.10
$759.94 		$494.23
$532.02
$572.06
$714.31 		$708.44
$746.23
$786.27
$928.52 		$922.65
$960.44
$1,000.48
$1,142.73 		$214.21
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$560.04
$635.62
$715.70
$1,000.20
$1,519.88 		$774.25
$849.83
$929.91
$1,214.41 		$988.46
$1,064.04
$1,144.12
$1,428.62 		$1,202.67
$1,278.25
$1,358.33
$1,642.83 		$214.21
Toc - Plan #60 Alliant Health Plans
Silver

(HMO) SoloCare Silver No Referral HMO (3 Free PCP Visits + $225 Specialty Drug Copay) 110009

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 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 		$278.50
$316.09
$355.91
$497.39
$755.83 		$491.55
$529.14
$568.96
$710.44 		$704.60
$742.19
$782.01
$923.49 		$917.65
$955.24
$995.06
$1,136.54 		$213.05
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$557.00
$632.18
$711.82
$994.78
$1,511.66 		$770.05
$845.23
$924.87
$1,207.83 		$983.10
$1,058.28
$1,137.92
$1,420.88 		$1,196.15
$1,271.33
$1,350.97
$1,633.93 		$213.05
Toc - Plan #61 Alliant Health Plans
Silver

(HMO) SoloCare Silver HMO (3 Free PCP Visits + $225 Specialty Drug Copay) 110010

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

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 		$286.81
$325.52
$366.53
$512.23
$778.38 		$506.21
$544.92
$585.93
$731.63 		$725.61
$764.32
$805.33
$951.03 		$945.01
$983.72
$1,024.73
$1,170.43 		$219.40
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$573.62
$651.04
$733.06
$1,024.46
$1,556.76 		$793.02
$870.44
$952.46
$1,243.86 		$1,012.42
$1,089.84
$1,171.86
$1,463.26 		$1,231.82
$1,309.24
$1,391.26
$1,682.66 		$219.40
Toc - Plan #62 Alliant Health Plans
Expanded Bronze

(HMO) SoloCare Bronze No Referral HMO ($250 Specialty Drug Copay) 110011

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

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 		$217.38
$246.71
$277.79
$388.22
$589.93 		$383.67
$413.00
$444.08
$554.51 		$549.96
$579.29
$610.37
$720.80 		$716.25
$745.58
$776.66
$887.09 		$166.29
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$434.76
$493.42
$555.58
$776.44
$1,179.86 		$601.05
$659.71
$721.87
$942.73 		$767.34
$826.00
$888.16
$1,109.02 		$933.63
$992.29
$1,054.45
$1,275.31 		$166.29
Toc - Plan #63 Alliant Health Plans
Expanded Bronze

(HMO) SoloCare Bronze No Referral HMO ($250 Specialty Drug Copay + Dental) 110013

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

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 		$226.05
$256.55
$288.88
$403.70
$613.47 		$398.97
$429.47
$461.80
$576.62 		$571.89
$602.39
$634.72
$749.54 		$744.81
$775.31
$807.64
$922.46 		$172.92
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$452.10
$513.10
$577.76
$807.40
$1,226.94 		$625.02
$686.02
$750.68
$980.32 		$797.94
$858.94
$923.60
$1,153.24 		$970.86
$1,031.86
$1,096.52
$1,326.16 		$172.92
Toc - Plan #64 Alliant Health Plans
Expanded Bronze

(HMO) SoloCare Bronze No Referral HMO 110015

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

Annual Out of Pocket Expenses:

Individual Family
$8,500 $17,000 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 		$216.99
$246.28
$277.31
$387.53
$588.90 		$382.98
$412.27
$443.30
$553.52 		$548.97
$578.26
$609.29
$719.51 		$714.96
$744.25
$775.28
$885.50 		$165.99
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$433.98
$492.56
$554.62
$775.06
$1,177.80 		$599.97
$658.55
$720.61
$941.05 		$765.96
$824.54
$886.60
$1,107.04 		$931.95
$990.53
$1,052.59
$1,273.03 		$165.99
Toc - Plan #65 Alliant Health Plans
Expanded Bronze

(HMO) SoloCare Bronze No Referral HMO (+ Dental) 110017

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

Annual Out of Pocket Expenses:

Individual Family
$8,500 $17,000 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 		$225.68
$256.13
$288.40
$403.04
$612.46 		$398.31
$428.76
$461.03
$575.67 		$570.94
$601.39
$633.66
$748.30 		$743.57
$774.02
$806.29
$920.93 		$172.63
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$451.36
$512.26
$576.80
$806.08
$1,224.92 		$623.99
$684.89
$749.43
$978.71 		$796.62
$857.52
$922.06
$1,151.34 		$969.25
$1,030.15
$1,094.69
$1,323.97 		$172.63
Toc - Plan #66 Alliant Health Plans
Expanded Bronze

(HMO) SoloCare Bronze No Referral HMO HDHP 110019

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$222.65
$252.70
$284.54
$397.64
$604.25 		$392.97
$423.02
$454.86
$567.96 		$563.29
$593.34
$625.18
$738.28 		$733.61
$763.66
$795.50
$908.60 		$170.32
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$445.30
$505.40
$569.08
$795.28
$1,208.50 		$615.62
$675.72
$739.40
$965.60 		$785.94
$846.04
$909.72
$1,135.92 		$956.26
$1,016.36
$1,080.04
$1,306.24 		$170.32
Toc - Plan #67 Alliant Health Plans
Expanded Bronze

(HMO) SoloCare Bronze No Referral HMO HDHP (+ Dental) 110021

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$231.33
$262.55
$295.63
$413.14
$627.81 		$408.29
$439.51
$472.59
$590.10 		$585.25
$616.47
$649.55
$767.06 		$762.21
$793.43
$826.51
$944.02 		$176.96
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$462.66
$525.10
$591.26
$826.28
$1,255.62 		$639.62
$702.06
$768.22
$1,003.24 		$816.58
$879.02
$945.18
$1,180.20 		$993.54
$1,055.98
$1,122.14
$1,357.16 		$176.96
Toc - Plan #68 Alliant Health Plans
Catastrophic

(HMO) SoloCare Catastropic No Referral HMO 110023

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

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 		$162.28
$184.17
$207.38
$289.81
$440.40 		$286.42
$308.31
$331.52
$413.95 		$410.56
$432.45
$455.66
$538.09 		$534.70
$556.59
$579.80
$662.23 		$124.14
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$324.56
$368.34
$414.76
$579.62
$880.80 		$448.70
$492.48
$538.90
$703.76 		$572.84
$616.62
$663.04
$827.90 		$696.98
$740.76
$787.18
$952.04 		$124.14
Toc - Plan #69 Alliant Health Plans
Gold

(HMO) SoloCare HMO Gold Standardized

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

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 		$280.77
$318.67
$358.81
$501.44
$761.99 		$495.55
$533.45
$573.59
$716.22 		$710.33
$748.23
$788.37
$931.00 		$925.11
$963.01
$1,003.15
$1,145.78 		$214.78
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$561.54
$637.34
$717.62
$1,002.88
$1,523.98 		$776.32
$852.12
$932.40
$1,217.66 		$991.10
$1,066.90
$1,147.18
$1,432.44 		$1,205.88
$1,281.68
$1,361.96
$1,647.22 		$214.78
Toc - Plan #70 Alliant Health Plans
Silver

(HMO) SoloCare HMO Silver Standardized

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

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 		$264.92
$300.67
$338.55
$473.13
$718.96 		$467.58
$503.33
$541.21
$675.79 		$670.24
$705.99
$743.87
$878.45 		$872.90
$908.65
$946.53
$1,081.11 		$202.66
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$529.84
$601.34
$677.10
$946.26
$1,437.92 		$732.50
$804.00
$879.76
$1,148.92 		$935.16
$1,006.66
$1,082.42
$1,351.58 		$1,137.82
$1,209.32
$1,285.08
$1,554.24 		$202.66
Toc - Plan #71 Alliant Health Plans
Bronze

(HMO) SoloCare HMO Bronze Standardized

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

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 		$200.77
$227.86
$256.57
$358.56
$544.86 		$354.35
$381.44
$410.15
$512.14 		$507.93
$535.02
$563.73
$665.72 		$661.51
$688.60
$717.31
$819.30 		$153.58
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$401.54
$455.72
$513.14
$717.12
$1,089.72 		$555.12
$609.30
$666.72
$870.70 		$708.70
$762.88
$820.30
$1,024.28 		$862.28
$916.46
$973.88
$1,177.86 		$153.58
Toc - Plan #72 Alliant Health Plans
Expanded Bronze

(HMO) SoloCare HMO Expanded Bronze Standardized

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-811-4793

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 		$201.90
$229.15
$258.02
$360.58
$547.94 		$356.35
$383.60
$412.47
$515.03 		$510.80
$538.05
$566.92
$669.48 		$665.25
$692.50
$721.37
$823.93 		$154.45
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$403.80
$458.30
$516.04
$721.16
$1,095.88 		$558.25
$612.75
$670.49
$875.61 		$712.70
$767.20
$824.94
$1,030.06 		$867.15
$921.65
$979.39
$1,184.51 		$154.45

‡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 Lumpkin County here.

Lumpkin County is in “Rating Area 10” of Georgia.

Currently, there are 72 plans offered in Rating Area 10.

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2023 Obamacare Plans for Lumpkin County, GA

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