Obamacare 2023 Rates for Cook County
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Oscar Health Plan, Inc.Local: | Toll Free: |
Toc - Plan #1 Oscar Health Plan, Inc. | ||||||||||||||||||||
Expanded Bronze
(HMO) Bronze Classic (Choice) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone:
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$268.79 $305.07 $343.50 $480.04 $729.47 |
$474.41 $510.69 $549.12 $685.66 |
$680.03 $716.31 $754.74 $891.28 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$537.58 $610.14 $687.00 $960.08 $1,458.94 |
$743.20 $815.76 $892.62 $1,165.70 |
$948.82 $1,021.38 $1,098.24 $1,371.32 |
Toc - Plan #2 Oscar Health Plan, Inc. | ||||||||||||||||||||
Expanded Bronze
(HMO) Bronze Elite- Deductible+PCP Saver Plus (Choice) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone:
Annual Out of Pocket Expenses:
Monthly Premiums:
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$320.62 $363.89 $409.74 $572.61 $870.14 |
$565.89 $609.16 $655.01 $817.88 |
$811.16 $854.43 $900.28 $1,063.15 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$641.24 $727.78 $819.48 $1,145.22 $1,740.28 |
$886.51 $973.05 $1,064.75 $1,390.49 |
$1,131.78 $1,218.32 $1,310.02 $1,635.76 |
Toc - Plan #3 Oscar Health Plan, Inc. | ||||||||||||||||||||
Silver
(HMO) Silver Classic (Choice) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone:
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$357.04 $405.23 $456.29 $637.66 $968.99 |
$630.17 $678.36 $729.42 $910.79 |
$903.30 $951.49 $1,002.55 $1,183.92 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$714.08 $810.46 $912.58 $1,275.32 $1,937.98 |
$987.21 $1,083.59 $1,185.71 $1,548.45 |
$1,260.34 $1,356.72 $1,458.84 $1,821.58 |
Toc - Plan #4 Oscar Health Plan, Inc. | ||||||||||||||||||||
Catastrophic
(HMO) Secure (Choice) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone:
Annual Out of Pocket Expenses:
Monthly Premiums:
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$244.46 $277.45 $312.40 $436.58 $663.43 |
$431.46 $464.45 $499.40 $623.58 |
$618.46 $651.45 $686.40 $810.58 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$488.92 $554.90 $624.80 $873.16 $1,326.86 |
$675.92 $741.90 $811.80 $1,060.16 |
$862.92 $928.90 $998.80 $1,247.16 |
Toc - Plan #5 Oscar Health Plan, Inc. | ||||||||||||||||||||
Expanded Bronze
(HMO) Bronze Simple- $5200 Ded (Choice) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone:
Annual Out of Pocket Expenses:
Monthly Premiums:
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$281.99 $320.05 $360.37 $503.62 $765.29 |
$497.70 $535.76 $576.08 $719.33 |
$713.41 $751.47 $791.79 $935.04 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$563.98 $640.10 $720.74 $1,007.24 $1,530.58 |
$779.69 $855.81 $936.45 $1,222.95 |
$995.40 $1,071.52 $1,152.16 $1,438.66 |
Toc - Plan #6 Oscar Health Plan, Inc. | ||||||||||||||||||||
Silver
(HMO) Silver Simple- Specialist Saver (Choice) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone:
Annual Out of Pocket Expenses:
Monthly Premiums:
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$351.55 $398.99 $449.26 $627.84 $954.07 |
$620.48 $667.92 $718.19 $896.77 |
$889.41 $936.85 $987.12 $1,165.70 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$703.10 $797.98 $898.52 $1,255.68 $1,908.14 |
$972.03 $1,066.91 $1,167.45 $1,524.61 |
$1,240.96 $1,335.84 $1,436.38 $1,793.54 |
Toc - Plan #7 Oscar Health Plan, Inc. | ||||||||||||||||||||
Expanded Bronze
(HMO) Bronze Classic- PCP Saver Plus Rx Copay (Choice) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone:
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$286.42 $325.08 $366.03 $511.53 $777.32 |
$505.53 $544.19 $585.14 $730.64 |
$724.64 $763.30 $804.25 $949.75 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$572.84 $650.16 $732.06 $1,023.06 $1,554.64 |
$791.95 $869.27 $951.17 $1,242.17 |
$1,011.06 $1,088.38 $1,170.28 $1,461.28 |
Toc - Plan #8 Oscar Health Plan, Inc. | ||||||||||||||||||||
Expanded Bronze
(HMO) Bronze Classic- Deductible Saver (Choice) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone:
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$289.90 $329.02 $370.47 $517.74 $786.75 |
$511.66 $550.78 $592.23 $739.50 |
$733.42 $772.54 $813.99 $961.26 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$579.80 $658.04 $740.94 $1,035.48 $1,573.50 |
$801.56 $879.80 $962.70 $1,257.24 |
$1,023.32 $1,101.56 $1,184.46 $1,479.00 |
Toc - Plan #9 Oscar Health Plan, Inc. | ||||||||||||||||||||
Silver
(HMO) Silver Simple- PCP Saver (Choice) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone:
Annual Out of Pocket Expenses:
Monthly Premiums:
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$342.58 $388.81 $437.80 $611.82 $929.73 |
$604.64 $650.87 $699.86 $873.88 |
$866.70 $912.93 $961.92 $1,135.94 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$685.16 $777.62 $875.60 $1,223.64 $1,859.46 |
$947.22 $1,039.68 $1,137.66 $1,485.70 |
$1,209.28 $1,301.74 $1,399.72 $1,747.76 |
Toc - Plan #10 Oscar Health Plan, Inc. | ||||||||||||||||||||
Silver
(HMO) Silver Elite- Deductible Saver Plus Rx Copay (Choice) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone:
Annual Out of Pocket Expenses:
Monthly Premiums:
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$362.07 $410.94 $462.72 $646.64 $982.64 |
$639.05 $687.92 $739.70 $923.62 |
$916.03 $964.90 $1,016.68 $1,200.60 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$724.14 $821.88 $925.44 $1,293.28 $1,965.28 |
$1,001.12 $1,098.86 $1,202.42 $1,570.26 |
$1,278.10 $1,375.84 $1,479.40 $1,847.24 |
Toc - Plan #11 Oscar Health Plan, Inc. | ||||||||||||||||||||
Silver
(HMO) Silver Simple- For Diabetes (Choice) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone:
Annual Out of Pocket Expenses:
Monthly Premiums:
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$353.62 $401.35 $451.91 $631.55 $959.70 |
$624.13 $671.86 $722.42 $902.06 |
$894.64 $942.37 $992.93 $1,172.57 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$707.24 $802.70 $903.82 $1,263.10 $1,919.40 |
$977.75 $1,073.21 $1,174.33 $1,533.61 |
$1,248.26 $1,343.72 $1,444.84 $1,804.12 |
Toc - Plan #12 Oscar Health Plan, Inc. | ||||||||||||||||||||
Expanded Bronze
(HMO) Bronze Classic- Standard (Choice) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone:
Annual Out of Pocket Expenses:
Monthly Premiums:
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$283.76 $322.06 $362.63 $506.78 $770.10 |
$500.83 $539.13 $579.70 $723.85 |
$717.90 $756.20 $796.77 $940.92 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$567.52 $644.12 $725.26 $1,013.56 $1,540.20 |
$784.59 $861.19 $942.33 $1,230.63 |
$1,001.66 $1,078.26 $1,159.40 $1,447.70 |
Toc - Plan #13 Oscar Health Plan, Inc. | ||||||||||||||||||||
Bronze
(HMO) Bronze Simple- Standard (Choice) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone:
Annual Out of Pocket Expenses:
Monthly Premiums:
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$255.80 $290.32 $326.89 $456.83 $694.20 |
$451.48 $486.00 $522.57 $652.51 |
$647.16 $681.68 $718.25 $848.19 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$511.60 $580.64 $653.78 $913.66 $1,388.40 |
$707.28 $776.32 $849.46 $1,109.34 |
$902.96 $972.00 $1,045.14 $1,305.02 |
Toc - Plan #14 Oscar Health Plan, Inc. | ||||||||||||||||||||
Silver
(HMO) Silver Classic- Standard (Choice) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone:
Annual Out of Pocket Expenses:
Monthly Premiums:
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$345.41 $392.03 $441.42 $616.88 $937.41 |
$609.64 $656.26 $705.65 $881.11 |
$873.87 $920.49 $969.88 $1,145.34 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$690.82 $784.06 $882.84 $1,233.76 $1,874.82 |
$955.05 $1,048.29 $1,147.07 $1,497.99 |
$1,219.28 $1,312.52 $1,411.30 $1,762.22 |
Toc - Plan #15 Oscar Health Plan, Inc. | ||||||||||||||||||||
Gold
(HMO) Gold Classic- Standard (Choice) |
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Benefits & Coverage
Plan Brochure
Provider Directory
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Annual Out of Pocket Expenses:
Monthly Premiums:
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$373.50 $423.91 $477.31 $667.04 $1,013.64 |
$659.22 $709.63 $763.03 $952.76 |
$944.94 $995.35 $1,048.75 $1,238.48 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$747.00 $847.82 $954.62 $1,334.08 $2,027.28 |
$1,032.72 $1,133.54 $1,240.34 $1,619.80 |
$1,318.44 $1,419.26 $1,526.06 $1,905.52 |
Toc - Plan #16 Oscar Health Plan, Inc. | ||||||||||||||||||||
Expanded Bronze
(HMO) Bronze Classic (Select) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone:
Annual Out of Pocket Expenses:
Monthly Premiums:
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$236.40 $268.30 $302.10 $422.19 $641.56 |
$417.24 $449.14 $482.94 $603.03 |
$598.08 $629.98 $663.78 $783.87 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$472.80 $536.60 $604.20 $844.38 $1,283.12 |
$653.64 $717.44 $785.04 $1,025.22 |
$834.48 $898.28 $965.88 $1,206.06 |
Toc - Plan #17 Oscar Health Plan, Inc. | ||||||||||||||||||||
Expanded Bronze
(HMO) Bronze Elite- Deductible+PCP Saver Plus (Select) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone:
Annual Out of Pocket Expenses:
Monthly Premiums:
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$281.71 $319.73 $360.02 $503.12 $764.55 |
$497.21 $535.23 $575.52 $718.62 |
$712.71 $750.73 $791.02 $934.12 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$563.42 $639.46 $720.04 $1,006.24 $1,529.10 |
$778.92 $854.96 $935.54 $1,221.74 |
$994.42 $1,070.46 $1,151.04 $1,437.24 |
Toc - Plan #18 Oscar Health Plan, Inc. | ||||||||||||||||||||
Silver
(HMO) Silver Classic (Select) |
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Benefits & Coverage
Plan Brochure
Provider Directory
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Annual Out of Pocket Expenses:
Monthly Premiums:
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$313.56 $355.88 $400.72 $560.00 $850.98 |
$553.43 $595.75 $640.59 $799.87 |
$793.30 $835.62 $880.46 $1,039.74 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$627.12 $711.76 $801.44 $1,120.00 $1,701.96 |
$866.99 $951.63 $1,041.31 $1,359.87 |
$1,106.86 $1,191.50 $1,281.18 $1,599.74 |
Toc - Plan #19 Oscar Health Plan, Inc. | ||||||||||||||||||||
Expanded Bronze
(HMO) Bronze Simple- $5200 Ded (Select) |
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Benefits & Coverage
Plan Brochure
Provider Directory
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Annual Out of Pocket Expenses:
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$247.94 $281.40 $316.85 $442.80 $672.87 |
$437.60 $471.06 $506.51 $632.46 |
$627.26 $660.72 $696.17 $822.12 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$495.88 $562.80 $633.70 $885.60 $1,345.74 |
$685.54 $752.46 $823.36 $1,075.26 |
$875.20 $942.12 $1,013.02 $1,264.92 |
Toc - Plan #20 Oscar Health Plan, Inc. | ||||||||||||||||||||
Silver
(HMO) Silver Simple- Specialist Saver (Select) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone:
Annual Out of Pocket Expenses:
Monthly Premiums:
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$308.76 $350.43 $394.58 $551.42 $837.94 |
$544.95 $586.62 $630.77 $787.61 |
$781.14 $822.81 $866.96 $1,023.80 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$617.52 $700.86 $789.16 $1,102.84 $1,675.88 |
$853.71 $937.05 $1,025.35 $1,339.03 |
$1,089.90 $1,173.24 $1,261.54 $1,575.22 |
Toc - Plan #21 Oscar Health Plan, Inc. | ||||||||||||||||||||
Expanded Bronze
(HMO) Bronze Classic- PCP Saver Plus Rx Copay (Select) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone:
Annual Out of Pocket Expenses:
Monthly Premiums:
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$251.81 $285.80 $321.80 $449.72 $683.39 |
$444.44 $478.43 $514.43 $642.35 |
$637.07 $671.06 $707.06 $834.98 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$503.62 $571.60 $643.60 $899.44 $1,366.78 |
$696.25 $764.23 $836.23 $1,092.07 |
$888.88 $956.86 $1,028.86 $1,284.70 |
Toc - Plan #22 Oscar Health Plan, Inc. | ||||||||||||||||||||
Expanded Bronze
(HMO) Bronze Classic- Deductible Saver (Select) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone:
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$254.85 $289.24 $325.69 $455.14 $691.64 |
$449.80 $484.19 $520.64 $650.09 |
$644.75 $679.14 $715.59 $845.04 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$509.70 $578.48 $651.38 $910.28 $1,383.28 |
$704.65 $773.43 $846.33 $1,105.23 |
$899.60 $968.38 $1,041.28 $1,300.18 |
Toc - Plan #23 Oscar Health Plan, Inc. | ||||||||||||||||||||
Silver
(HMO) Silver Simple- PCP Saver (Select) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone:
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$300.91 $341.52 $384.55 $537.41 $816.65 |
$531.10 $571.71 $614.74 $767.60 |
$761.29 $801.90 $844.93 $997.79 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$601.82 $683.04 $769.10 $1,074.82 $1,633.30 |
$832.01 $913.23 $999.29 $1,305.01 |
$1,062.20 $1,143.42 $1,229.48 $1,535.20 |
Toc - Plan #24 Oscar Health Plan, Inc. | ||||||||||||||||||||
Silver
(HMO) Silver Elite- Deductible Saver Plus Rx Copay (Select) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone:
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$317.96 $360.87 $406.34 $567.86 $862.91 |
$561.19 $604.10 $649.57 $811.09 |
$804.42 $847.33 $892.80 $1,054.32 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$635.92 $721.74 $812.68 $1,135.72 $1,725.82 |
$879.15 $964.97 $1,055.91 $1,378.95 |
$1,122.38 $1,208.20 $1,299.14 $1,622.18 |
Toc - Plan #25 Oscar Health Plan, Inc. | ||||||||||||||||||||
Silver
(HMO) Silver Simple- For Diabetes (Select) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone:
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$310.57 $352.48 $396.89 $554.66 $842.86 |
$548.15 $590.06 $634.47 $792.24 |
$785.73 $827.64 $872.05 $1,029.82 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$621.14 $704.96 $793.78 $1,109.32 $1,685.72 |
$858.72 $942.54 $1,031.36 $1,346.90 |
$1,096.30 $1,180.12 $1,268.94 $1,584.48 |
Toc - Plan #26 Oscar Health Plan, Inc. | ||||||||||||||||||||
Expanded Bronze
(HMO) Bronze Classic- Standard (Select) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone:
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$249.49 $283.16 $318.83 $445.57 $677.08 |
$440.34 $474.01 $509.68 $636.42 |
$631.19 $664.86 $700.53 $827.27 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$498.98 $566.32 $637.66 $891.14 $1,354.16 |
$689.83 $757.17 $828.51 $1,081.99 |
$880.68 $948.02 $1,019.36 $1,272.84 |
Toc - Plan #27 Oscar Health Plan, Inc. | ||||||||||||||||||||
Bronze
(HMO) Bronze Simple- Standard (Select) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone:
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$225.03 $255.40 $287.58 $401.89 $610.71 |
$397.17 $427.54 $459.72 $574.03 |
$569.31 $599.68 $631.86 $746.17 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$450.06 $510.80 $575.16 $803.78 $1,221.42 |
$622.20 $682.94 $747.30 $975.92 |
$794.34 $855.08 $919.44 $1,148.06 |
Toc - Plan #28 Oscar Health Plan, Inc. | ||||||||||||||||||||
Silver
(HMO) Silver Classic- Standard (Select) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone:
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$303.39 $344.33 $387.72 $541.83 $823.37 |
$535.47 $576.41 $619.80 $773.91 |
$767.55 $808.49 $851.88 $1,005.99 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$606.78 $688.66 $775.44 $1,083.66 $1,646.74 |
$838.86 $920.74 $1,007.52 $1,315.74 |
$1,070.94 $1,152.82 $1,239.60 $1,547.82 |
Toc - Plan #29 Oscar Health Plan, Inc. | ||||||||||||||||||||
Gold
(HMO) Gold Classic- Standard (Select) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone:
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$327.95 $372.21 $419.10 $585.70 $890.02 |
$578.82 $623.08 $669.97 $836.57 |
$829.69 $873.95 $920.84 $1,087.44 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$655.90 $744.42 $838.20 $1,171.40 $1,780.04 |
$906.77 $995.29 $1,089.07 $1,422.27 |
$1,157.64 $1,246.16 $1,339.94 $1,673.14 |
ADVERTISEMENT
Ambetter of IllinoisLocal: 1-855-745-5507 | Toll Free: 1-855-745-5507 | TTY: 1-844-517-3431 |
Toc - Plan #30 Ambetter of Illinois | ||||||||||||||||||||
Silver
(HMO) Premier Silver |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-745-5507
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$310.03 $351.87 $396.20 $553.69 $841.39 |
$547.19 $589.03 $633.36 $790.85 |
$784.35 $826.19 $870.52 $1,028.01 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$620.06 $703.74 $792.40 $1,107.38 $1,682.78 |
$857.22 $940.90 $1,029.56 $1,344.54 |
$1,094.38 $1,178.06 $1,266.72 $1,581.70 |
Toc - Plan #31 Ambetter of Illinois | ||||||||||||||||||||
Gold
(HMO) Complete Gold |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-745-5507
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$362.21 $411.09 $462.89 $646.88 $983.00 |
$639.29 $688.17 $739.97 $923.96 |
$916.37 $965.25 $1,017.05 $1,201.04 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$724.42 $822.18 $925.78 $1,293.76 $1,966.00 |
$1,001.50 $1,099.26 $1,202.86 $1,570.84 |
$1,278.58 $1,376.34 $1,479.94 $1,847.92 |
Toc - Plan #32 Ambetter of Illinois | ||||||||||||||||||||
Silver
(HMO) Complete Silver |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-745-5507
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$309.60 $351.38 $395.65 $552.92 $840.21 |
$546.43 $588.21 $632.48 $789.75 |
$783.26 $825.04 $869.31 $1,026.58 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$619.20 $702.76 $791.30 $1,105.84 $1,680.42 |
$856.03 $939.59 $1,028.13 $1,342.67 |
$1,092.86 $1,176.42 $1,264.96 $1,579.50 |
Toc - Plan #33 Ambetter of Illinois | ||||||||||||||||||||
Expanded Bronze
(HMO) Everyday Bronze |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-745-5507
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$257.64 $292.41 $329.25 $460.12 $699.20 |
$454.72 $489.49 $526.33 $657.20 |
$651.80 $686.57 $723.41 $854.28 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$515.28 $584.82 $658.50 $920.24 $1,398.40 |
$712.36 $781.90 $855.58 $1,117.32 |
$909.44 $978.98 $1,052.66 $1,314.40 |
Toc - Plan #34 Ambetter of Illinois | ||||||||||||||||||||
Silver
(HMO) Everyday Silver |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-745-5507
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$304.79 $345.93 $389.51 $544.34 $827.17 |
$537.95 $579.09 $622.67 $777.50 |
$771.11 $812.25 $855.83 $1,010.66 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$609.58 $691.86 $779.02 $1,088.68 $1,654.34 |
$842.74 $925.02 $1,012.18 $1,321.84 |
$1,075.90 $1,158.18 $1,245.34 $1,555.00 |
Toc - Plan #35 Ambetter of Illinois | ||||||||||||||||||||
Silver
(HMO) Elite Silver |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-745-5507
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$326.58 $370.66 $417.36 $583.26 $886.32 |
$576.41 $620.49 $667.19 $833.09 |
$826.24 $870.32 $917.02 $1,082.92 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$653.16 $741.32 $834.72 $1,166.52 $1,772.64 |
$902.99 $991.15 $1,084.55 $1,416.35 |
$1,152.82 $1,240.98 $1,334.38 $1,666.18 |
Toc - Plan #36 Ambetter of Illinois | ||||||||||||||||||||
Expanded Bronze
(HMO) Choice Bronze HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-745-5507
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$249.92 $283.64 $319.38 $446.33 $678.25 |
$441.10 $474.82 $510.56 $637.51 |
$632.28 $666.00 $701.74 $828.69 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$499.84 $567.28 $638.76 $892.66 $1,356.50 |
$691.02 $758.46 $829.94 $1,083.84 |
$882.20 $949.64 $1,021.12 $1,275.02 |
Toc - Plan #37 Ambetter of Illinois | ||||||||||||||||||||
Expanded Bronze
(HMO) Elite Bronze |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-745-5507
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$299.27 $339.66 $382.46 $534.48 $812.20 |
$528.21 $568.60 $611.40 $763.42 |
$757.15 $797.54 $840.34 $992.36 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$598.54 $679.32 $764.92 $1,068.96 $1,624.40 |
$827.48 $908.26 $993.86 $1,297.90 |
$1,056.42 $1,137.20 $1,222.80 $1,526.84 |
Toc - Plan #38 Ambetter of Illinois | ||||||||||||||||||||
Silver
(HMO) Clear Silver |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-745-5507
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$295.55 $335.44 $377.70 $527.84 $802.10 |
$521.64 $561.53 $603.79 $753.93 |
$747.73 $787.62 $829.88 $980.02 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$591.10 $670.88 $755.40 $1,055.68 $1,604.20 |
$817.19 $896.97 $981.49 $1,281.77 |
$1,043.28 $1,123.06 $1,207.58 $1,507.86 |
Toc - Plan #39 Ambetter of Illinois | ||||||||||||||||||||
Silver
(HMO) Focused Silver |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-745-5507
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$300.88 $341.49 $384.52 $537.36 $816.57 |
$531.05 $571.66 $614.69 $767.53 |
$761.22 $801.83 $844.86 $997.70 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$601.76 $682.98 $769.04 $1,074.72 $1,633.14 |
$831.93 $913.15 $999.21 $1,304.89 |
$1,062.10 $1,143.32 $1,229.38 $1,535.06 |
Toc - Plan #40 Ambetter of Illinois | ||||||||||||||||||||
Gold
(HMO) Everyday Gold |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-745-5507
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$343.36 $389.70 $438.80 $613.22 $931.84 |
$606.02 $652.36 $701.46 $875.88 |
$868.68 $915.02 $964.12 $1,138.54 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$686.72 $779.40 $877.60 $1,226.44 $1,863.68 |
$949.38 $1,042.06 $1,140.26 $1,489.10 |
$1,212.04 $1,304.72 $1,402.92 $1,751.76 |
Toc - Plan #41 Ambetter of Illinois | ||||||||||||||||||||
Bronze
(HMO) Clear Bronze |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-745-5507
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$229.86 $260.88 $293.75 $410.51 $623.81 |
$405.69 $436.71 $469.58 $586.34 |
$581.52 $612.54 $645.41 $762.17 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$459.72 $521.76 $587.50 $821.02 $1,247.62 |
$635.55 $697.59 $763.33 $996.85 |
$811.38 $873.42 $939.16 $1,172.68 |
Toc - Plan #42 Ambetter of Illinois | ||||||||||||||||||||
Gold
(HMO) Elite Gold |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-745-5507
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$406.38 $461.23 $519.34 $725.78 $1,102.90 |
$717.26 $772.11 $830.22 $1,036.66 |
$1,028.14 $1,082.99 $1,141.10 $1,347.54 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$812.76 $922.46 $1,038.68 $1,451.56 $2,205.80 |
$1,123.64 $1,233.34 $1,349.56 $1,762.44 |
$1,434.52 $1,544.22 $1,660.44 $2,073.32 |
Toc - Plan #43 Ambetter of Illinois | ||||||||||||||||||||
Expanded Bronze
(HMO) Central Bronze |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-745-5507
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$254.54 $288.89 $325.28 $454.58 $690.78 |
$449.25 $483.60 $519.99 $649.29 |
$643.96 $678.31 $714.70 $844.00 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$509.08 $577.78 $650.56 $909.16 $1,381.56 |
$703.79 $772.49 $845.27 $1,103.87 |
$898.50 $967.20 $1,039.98 $1,298.58 |
Toc - Plan #44 Ambetter of Illinois | ||||||||||||||||||||
Silver
(HMO) Central Silver |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-745-5507
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$318.12 $361.06 $406.55 $568.15 $863.35 |
$561.47 $604.41 $649.90 $811.50 |
$804.82 $847.76 $893.25 $1,054.85 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$636.24 $722.12 $813.10 $1,136.30 $1,726.70 |
$879.59 $965.47 $1,056.45 $1,379.65 |
$1,122.94 $1,208.82 $1,299.80 $1,623.00 |
Toc - Plan #45 Ambetter of Illinois | ||||||||||||||||||||
Gold
(HMO) Central Gold |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-745-5507
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$350.89 $398.25 $448.42 $626.67 $952.29 |
$619.31 $666.67 $716.84 $895.09 |
$887.73 $935.09 $985.26 $1,163.51 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$701.78 $796.50 $896.84 $1,253.34 $1,904.58 |
$970.20 $1,064.92 $1,165.26 $1,521.76 |
$1,238.62 $1,333.34 $1,433.68 $1,790.18 |
Toc - Plan #46 Ambetter of Illinois | ||||||||||||||||||||
Bronze
(HMO) CMS Standard Bronze |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-745-5507
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$215.75 $244.87 $275.72 $385.32 $585.52 |
$380.79 $409.91 $440.76 $550.36 |
$545.83 $574.95 $605.80 $715.40 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$431.50 $489.74 $551.44 $770.64 $1,171.04 |
$596.54 $654.78 $716.48 $935.68 |
$761.58 $819.82 $881.52 $1,100.72 |
Toc - Plan #47 Ambetter of Illinois | ||||||||||||||||||||
Expanded Bronze
(HMO) CMS Standard Expanded Bronze |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-745-5507
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$250.13 $283.89 $319.66 $446.72 $678.84 |
$441.47 $475.23 $511.00 $638.06 |
$632.81 $666.57 $702.34 $829.40 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$500.26 $567.78 $639.32 $893.44 $1,357.68 |
$691.60 $759.12 $830.66 $1,084.78 |
$882.94 $950.46 $1,022.00 $1,276.12 |
Toc - Plan #48 Ambetter of Illinois | ||||||||||||||||||||
Silver
(HMO) CMS Standard Silver |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-745-5507
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$298.68 $338.99 $381.70 $533.43 $810.60 |
$527.16 $567.47 $610.18 $761.91 |
$755.64 $795.95 $838.66 $990.39 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$597.36 $677.98 $763.40 $1,066.86 $1,621.20 |
$825.84 $906.46 $991.88 $1,295.34 |
$1,054.32 $1,134.94 $1,220.36 $1,523.82 |
Toc - Plan #49 Ambetter of Illinois | ||||||||||||||||||||
Gold
(HMO) CMS Standard Gold |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-745-5507
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$334.95 $380.16 $428.06 $598.21 $909.04 |
$591.18 $636.39 $684.29 $854.44 |
$847.41 $892.62 $940.52 $1,110.67 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$669.90 $760.32 $856.12 $1,196.42 $1,818.08 |
$926.13 $1,016.55 $1,112.35 $1,452.65 |
$1,182.36 $1,272.78 $1,368.58 $1,708.88 |
Toc - Plan #50 Ambetter of Illinois | ||||||||||||||||||||
Silver
(HMO) Premier Silver + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-745-5507
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$321.96 $365.41 $411.45 $575.00 $873.76 |
$568.25 $611.70 $657.74 $821.29 |
$814.54 $857.99 $904.03 $1,067.58 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$643.92 $730.82 $822.90 $1,150.00 $1,747.52 |
$890.21 $977.11 $1,069.19 $1,396.29 |
$1,136.50 $1,223.40 $1,315.48 $1,642.58 |
Toc - Plan #51 Ambetter of Illinois | ||||||||||||||||||||
Gold
(HMO) Complete Gold + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-745-5507
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$376.14 $426.91 $480.69 $671.77 $1,020.82 |
$663.88 $714.65 $768.43 $959.51 |
$951.62 $1,002.39 $1,056.17 $1,247.25 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$752.28 $853.82 $961.38 $1,343.54 $2,041.64 |
$1,040.02 $1,141.56 $1,249.12 $1,631.28 |
$1,327.76 $1,429.30 $1,536.86 $1,919.02 |
Toc - Plan #52 Ambetter of Illinois | ||||||||||||||||||||
Silver
(HMO) Complete Silver + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-745-5507
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$321.51 $364.90 $410.87 $574.19 $872.54 |
$567.45 $610.84 $656.81 $820.13 |
$813.39 $856.78 $902.75 $1,066.07 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$643.02 $729.80 $821.74 $1,148.38 $1,745.08 |
$888.96 $975.74 $1,067.68 $1,394.32 |
$1,134.90 $1,221.68 $1,313.62 $1,640.26 |
Toc - Plan #53 Ambetter of Illinois | ||||||||||||||||||||
Expanded Bronze
(HMO) Everyday Bronze + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-745-5507
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$267.55 $303.65 $341.91 $477.82 $726.10 |
$472.22 $508.32 $546.58 $682.49 |
$676.89 $712.99 $751.25 $887.16 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$535.10 $607.30 $683.82 $955.64 $1,452.20 |
$739.77 $811.97 $888.49 $1,160.31 |
$944.44 $1,016.64 $1,093.16 $1,364.98 |
Toc - Plan #54 Ambetter of Illinois | ||||||||||||||||||||
Silver
(HMO) Elite Silver + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-745-5507
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$339.15 $384.92 $433.42 $605.70 $920.42 |
$598.59 $644.36 $692.86 $865.14 |
$858.03 $903.80 $952.30 $1,124.58 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$678.30 $769.84 $866.84 $1,211.40 $1,840.84 |
$937.74 $1,029.28 $1,126.28 $1,470.84 |
$1,197.18 $1,288.72 $1,385.72 $1,730.28 |
Toc - Plan #55 Ambetter of Illinois | ||||||||||||||||||||
Expanded Bronze
(HMO) Choice Bronze HSA + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-745-5507
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$259.53 $294.56 $331.67 $463.50 $704.34 |
$458.06 $493.09 $530.20 $662.03 |
$656.59 $691.62 $728.73 $860.56 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$519.06 $589.12 $663.34 $927.00 $1,408.68 |
$717.59 $787.65 $861.87 $1,125.53 |
$916.12 $986.18 $1,060.40 $1,324.06 |
Toc - Plan #56 Ambetter of Illinois | ||||||||||||||||||||
Expanded Bronze
(HMO) Elite Bronze + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-745-5507
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$310.78 $352.73 $397.17 $555.04 $843.44 |
$548.52 $590.47 $634.91 $792.78 |
$786.26 $828.21 $872.65 $1,030.52 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$621.56 $705.46 $794.34 $1,110.08 $1,686.88 |
$859.30 $943.20 $1,032.08 $1,347.82 |
$1,097.04 $1,180.94 $1,269.82 $1,585.56 |
Toc - Plan #57 Ambetter of Illinois | ||||||||||||||||||||
Silver
(HMO) Focused Silver + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-745-5507
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$312.46 $354.63 $399.31 $558.03 $847.99 |
$551.48 $593.65 $638.33 $797.05 |
$790.50 $832.67 $877.35 $1,036.07 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$624.92 $709.26 $798.62 $1,116.06 $1,695.98 |
$863.94 $948.28 $1,037.64 $1,355.08 |
$1,102.96 $1,187.30 $1,276.66 $1,594.10 |
Toc - Plan #58 Ambetter of Illinois | ||||||||||||||||||||
Gold
(HMO) Everyday Gold + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-745-5507
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$356.57 $404.69 $455.68 $636.81 $967.69 |
$629.34 $677.46 $728.45 $909.58 |
$902.11 $950.23 $1,001.22 $1,182.35 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$713.14 $809.38 $911.36 $1,273.62 $1,935.38 |
$985.91 $1,082.15 $1,184.13 $1,546.39 |
$1,258.68 $1,354.92 $1,456.90 $1,819.16 |
Toc - Plan #59 Ambetter of Illinois | ||||||||||||||||||||
Silver
(HMO) Everyday Silver + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-745-5507
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$316.52 $359.23 $404.49 $565.28 $859.00 |
$558.65 $601.36 $646.62 $807.41 |
$800.78 $843.49 $888.75 $1,049.54 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$633.04 $718.46 $808.98 $1,130.56 $1,718.00 |
$875.17 $960.59 $1,051.11 $1,372.69 |
$1,117.30 $1,202.72 $1,293.24 $1,614.82 |
Toc - Plan #60 Ambetter of Illinois | ||||||||||||||||||||
Silver
(HMO) Clear Silver + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-745-5507
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$306.92 $348.34 $392.23 $548.14 $832.96 |
$541.71 $583.13 $627.02 $782.93 |
$776.50 $817.92 $861.81 $1,017.72 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$613.84 $696.68 $784.46 $1,096.28 $1,665.92 |
$848.63 $931.47 $1,019.25 $1,331.07 |
$1,083.42 $1,166.26 $1,254.04 $1,565.86 |
Toc - Plan #61 Ambetter of Illinois | ||||||||||||||||||||
Bronze
(HMO) Clear Bronze + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-745-5507
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$238.70 $270.91 $305.05 $426.30 $647.81 |
$421.30 $453.51 $487.65 $608.90 |
$603.90 $636.11 $670.25 $791.50 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$477.40 $541.82 $610.10 $852.60 $1,295.62 |
$660.00 $724.42 $792.70 $1,035.20 |
$842.60 $907.02 $975.30 $1,217.80 |
Toc - Plan #62 Ambetter of Illinois | ||||||||||||||||||||
Gold
(HMO) Elite Gold + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-745-5507
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$422.02 $478.98 $539.33 $753.71 $1,145.33 |
$744.86 $801.82 $862.17 $1,076.55 |
$1,067.70 $1,124.66 $1,185.01 $1,399.39 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$844.04 $957.96 $1,078.66 $1,507.42 $2,290.66 |
$1,166.88 $1,280.80 $1,401.50 $1,830.26 |
$1,489.72 $1,603.64 $1,724.34 $2,153.10 |
Toc - Plan #63 Ambetter of Illinois | ||||||||||||||||||||
Expanded Bronze
(HMO) Central Bronze + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-745-5507
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$264.33 $300.00 $337.80 $472.07 $717.36 |
$466.53 $502.20 $540.00 $674.27 |
$668.73 $704.40 $742.20 $876.47 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$528.66 $600.00 $675.60 $944.14 $1,434.72 |
$730.86 $802.20 $877.80 $1,146.34 |
$933.06 $1,004.40 $1,080.00 $1,348.54 |
Toc - Plan #64 Ambetter of Illinois | ||||||||||||||||||||
Silver
(HMO) Central Silver + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-745-5507
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$330.36 $374.95 $422.19 $590.00 $896.57 |
$583.08 $627.67 $674.91 $842.72 |
$835.80 $880.39 $927.63 $1,095.44 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$660.72 $749.90 $844.38 $1,180.00 $1,793.14 |
$913.44 $1,002.62 $1,097.10 $1,432.72 |
$1,166.16 $1,255.34 $1,349.82 $1,685.44 |
Toc - Plan #65 Ambetter of Illinois | ||||||||||||||||||||
Gold
(HMO) Central Gold + Vision + Adult Dental |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-745-5507
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$364.39 $413.57 $465.68 $650.78 $988.92 |
$643.14 $692.32 $744.43 $929.53 |
$921.89 $971.07 $1,023.18 $1,208.28 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$728.78 $827.14 $931.36 $1,301.56 $1,977.84 |
$1,007.53 $1,105.89 $1,210.11 $1,580.31 |
$1,286.28 $1,384.64 $1,488.86 $1,859.06 |
ADVERTISEMENT
Molina HealthcareLocal: 1-833-644-1623 | Toll Free: 1-833-644-1623 | TTY: 1-800-877-8339 |
Toc - Plan #66 Molina Healthcare | ||||||||||||||||||||
Gold
(HMO) Confident Care Gold 1 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-833-644-1623
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$325.22 $369.13 $415.64 $580.85 $882.66 |
$574.02 $617.93 $664.44 $829.65 |
$822.82 $866.73 $913.24 $1,078.45 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$650.44 $738.26 $831.28 $1,161.70 $1,765.32 |
$899.24 $987.06 $1,080.08 $1,410.50 |
$1,148.04 $1,235.86 $1,328.88 $1,659.30 |
Toc - Plan #67 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Constant Care Silver 1 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-833-644-1623
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$313.69 $356.04 $400.90 $560.26 $851.37 |
$553.67 $596.02 $640.88 $800.24 |
$793.65 $836.00 $880.86 $1,040.22 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$627.38 $712.08 $801.80 $1,120.52 $1,702.74 |
$867.36 $952.06 $1,041.78 $1,360.50 |
$1,107.34 $1,192.04 $1,281.76 $1,600.48 |
Toc - Plan #68 Molina Healthcare | ||||||||||||||||||||
Gold
(HMO) Confident Care Gold 8 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-833-644-1623
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$334.94 $380.16 $428.06 $598.21 $909.04 |
$591.17 $636.39 $684.29 $854.44 |
$847.40 $892.62 $940.52 $1,110.67 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$669.88 $760.32 $856.12 $1,196.42 $1,818.08 |
$926.11 $1,016.55 $1,112.35 $1,452.65 |
$1,182.34 $1,272.78 $1,368.58 $1,708.88 |
Toc - Plan #69 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Constant Care Silver 8 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-833-644-1623
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$317.19 $360.01 $405.37 $566.50 $860.86 |
$559.84 $602.66 $648.02 $809.15 |
$802.49 $845.31 $890.67 $1,051.80 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$634.38 $720.02 $810.74 $1,133.00 $1,721.72 |
$877.03 $962.67 $1,053.39 $1,375.65 |
$1,119.68 $1,205.32 $1,296.04 $1,618.30 |
Toc - Plan #70 Molina Healthcare | ||||||||||||||||||||
Gold
(HMO) Confident Care Gold 1 + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-833-644-1623
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$323.38 $367.03 $413.27 $577.55 $877.64 |
$570.76 $614.41 $660.65 $824.93 |
$818.14 $861.79 $908.03 $1,072.31 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$646.76 $734.06 $826.54 $1,155.10 $1,755.28 |
$894.14 $981.44 $1,073.92 $1,402.48 |
$1,141.52 $1,228.82 $1,321.30 $1,649.86 |
Toc - Plan #71 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Constant Care Silver 1 with RX Copay + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-833-644-1623
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$329.83 $374.36 $421.52 $589.08 $895.16 |
$582.15 $626.68 $673.84 $841.40 |
$834.47 $879.00 $926.16 $1,093.72 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$659.66 $748.72 $843.04 $1,178.16 $1,790.32 |
$911.98 $1,001.04 $1,095.36 $1,430.48 |
$1,164.30 $1,253.36 $1,347.68 $1,682.80 |
ADVERTISEMENT
Blue Cross and Blue Shield of IllinoisLocal: 1-800-538-8833 | Toll Free: 1-800-538-8833 | TTY: 1-800-526-0844 |
Toc - Plan #72 Blue Cross and Blue Shield of Illinois | ||||||||||||||||||||
Gold
(HMO) Blue Precision Gold HMO? 207 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-538-8833
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$450.46 $511.28 $575.69 $804.53 $1,222.56 |
$795.06 $855.88 $920.29 $1,149.13 |
$1,139.66 $1,200.48 $1,264.89 $1,493.73 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$900.92 $1,022.56 $1,151.38 $1,609.06 $2,445.12 |
$1,245.52 $1,367.16 $1,495.98 $1,953.66 |
$1,590.12 $1,711.76 $1,840.58 $2,298.26 |
Toc - Plan #73 Blue Cross and Blue Shield of Illinois | ||||||||||||||||||||
Silver
(HMO) Blue Precision Silver HMO? 206 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-538-8833
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$370.40 $420.41 $473.38 $661.54 $1,005.27 |
$653.76 $703.77 $756.74 $944.90 |
$937.12 $987.13 $1,040.10 $1,228.26 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$740.80 $840.82 $946.76 $1,323.08 $2,010.54 |
$1,024.16 $1,124.18 $1,230.12 $1,606.44 |
$1,307.52 $1,407.54 $1,513.48 $1,889.80 |
Toc - Plan #74 Blue Cross and Blue Shield of Illinois | ||||||||||||||||||||
Expanded Bronze
(HMO) Blue Precision Bronze HMO? 205 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-538-8833
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$322.58 $366.13 $412.26 $576.13 $875.48 |
$569.35 $612.90 $659.03 $822.90 |
$816.12 $859.67 $905.80 $1,069.67 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$645.16 $732.26 $824.52 $1,152.26 $1,750.96 |
$891.93 $979.03 $1,071.29 $1,399.03 |
$1,138.70 $1,225.80 $1,318.06 $1,645.80 |
Toc - Plan #75 Blue Cross and Blue Shield of Illinois | ||||||||||||||||||||
Gold
(HMO) Blue Precision Gold HMO? 703 - Rx Copays |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-538-8833
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$480.39 $545.25 $613.94 $857.98 $1,303.79 |
$847.89 $912.75 $981.44 $1,225.48 |
$1,215.39 $1,280.25 $1,348.94 $1,592.98 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$960.78 $1,090.50 $1,227.88 $1,715.96 $2,607.58 |
$1,328.28 $1,458.00 $1,595.38 $2,083.46 |
$1,695.78 $1,825.50 $1,962.88 $2,450.96 |
Toc - Plan #76 Blue Cross and Blue Shield of Illinois | ||||||||||||||||||||
Silver
(HMO) Blue Precision Silver HMO 704? - Rx Copays |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-538-8833
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$404.52 $459.13 $516.97 $722.47 $1,097.86 |
$713.98 $768.59 $826.43 $1,031.93 |
$1,023.44 $1,078.05 $1,135.89 $1,341.39 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$809.04 $918.26 $1,033.94 $1,444.94 $2,195.72 |
$1,118.50 $1,227.72 $1,343.40 $1,754.40 |
$1,427.96 $1,537.18 $1,652.86 $2,063.86 |
Toc - Plan #77 Blue Cross and Blue Shield of Illinois | ||||||||||||||||||||
Expanded Bronze
(HMO) Blue Precision Bronze HMO? 701 - Rx Copays |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-538-8833
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$317.30 $360.14 $405.51 $566.70 $861.16 |
$560.04 $602.88 $648.25 $809.44 |
$802.78 $845.62 $890.99 $1,052.18 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$634.60 $720.28 $811.02 $1,133.40 $1,722.32 |
$877.34 $963.02 $1,053.76 $1,376.14 |
$1,120.08 $1,205.76 $1,296.50 $1,618.88 |
Toc - Plan #78 Blue Cross and Blue Shield of Illinois | ||||||||||||||||||||
Gold
(HMO) Blue Precision Gold HMO? 707 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-538-8833
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$485.77 $551.35 $620.81 $867.58 $1,318.37 |
$857.38 $922.96 $992.42 $1,239.19 |
$1,228.99 $1,294.57 $1,364.03 $1,610.80 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$971.54 $1,102.70 $1,241.62 $1,735.16 $2,636.74 |
$1,343.15 $1,474.31 $1,613.23 $2,106.77 |
$1,714.76 $1,845.92 $1,984.84 $2,478.38 |
Toc - Plan #79 Blue Cross and Blue Shield of Illinois | ||||||||||||||||||||
Silver
(HMO) Blue Precision Silver HMO? 706 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-538-8833
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$442.95 $502.75 $566.09 $791.11 $1,202.17 |
$781.81 $841.61 $904.95 $1,129.97 |
$1,120.67 $1,180.47 $1,243.81 $1,468.83 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$885.90 $1,005.50 $1,132.18 $1,582.22 $2,404.34 |
$1,224.76 $1,344.36 $1,471.04 $1,921.08 |
$1,563.62 $1,683.22 $1,809.90 $2,259.94 |
Toc - Plan #80 Blue Cross and Blue Shield of Illinois | ||||||||||||||||||||
Expanded Bronze
(HMO) Blue Precision Bronze HMO? 708 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-538-8833
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$375.31 $425.98 $479.65 $670.31 $1,018.60 |
$662.43 $713.10 $766.77 $957.43 |
$949.55 $1,000.22 $1,053.89 $1,244.55 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$750.62 $851.96 $959.30 $1,340.62 $2,037.20 |
$1,037.74 $1,139.08 $1,246.42 $1,627.74 |
$1,324.86 $1,426.20 $1,533.54 $1,914.86 |
Toc - Plan #81 Blue Cross and Blue Shield of Illinois | ||||||||||||||||||||
Silver
(HMO) BlueCare Direct Silver? 212 with Advocate |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-538-8833
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$327.69 $371.93 $418.79 $585.26 $889.36 |
$578.37 $622.61 $669.47 $835.94 |
$829.05 $873.29 $920.15 $1,086.62 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$655.38 $743.86 $837.58 $1,170.52 $1,778.72 |
$906.06 $994.54 $1,088.26 $1,421.20 |
$1,156.74 $1,245.22 $1,338.94 $1,671.88 |
Toc - Plan #82 Blue Cross and Blue Shield of Illinois | ||||||||||||||||||||
Gold
(HMO) BlueCare Direct Gold? 409 with Advocate |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-538-8833
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$394.45 $447.70 $504.10 $704.48 $1,070.53 |
$696.20 $749.45 $805.85 $1,006.23 |
$997.95 $1,051.20 $1,107.60 $1,307.98 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$788.90 $895.40 $1,008.20 $1,408.96 $2,141.06 |
$1,090.65 $1,197.15 $1,309.95 $1,710.71 |
$1,392.40 $1,498.90 $1,611.70 $2,012.46 |
Toc - Plan #83 Blue Cross and Blue Shield of Illinois | ||||||||||||||||||||
Expanded Bronze
(HMO) BlueCare Direct Bronze? 401 with Advocate |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-538-8833
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$280.54 $318.41 $358.53 $501.04 $761.38 |
$495.15 $533.02 $573.14 $715.65 |
$709.76 $747.63 $787.75 $930.26 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$561.08 $636.82 $717.06 $1,002.08 $1,522.76 |
$775.69 $851.43 $931.67 $1,216.69 |
$990.30 $1,066.04 $1,146.28 $1,431.30 |
Toc - Plan #84 Blue Cross and Blue Shield of Illinois | ||||||||||||||||||||
Gold
(PPO) Blue Choice Preferred Gold PPO? 204 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-538-8833
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$573.74 $651.19 $733.24 $1,024.70 $1,557.13 |
$1,012.65 $1,090.10 $1,172.15 $1,463.61 |
$1,451.56 $1,529.01 $1,611.06 $1,902.52 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,147.48 $1,302.38 $1,466.48 $2,049.40 $3,114.26 |
$1,586.39 $1,741.29 $1,905.39 $2,488.31 |
$2,025.30 $2,180.20 $2,344.30 $2,927.22 |
Toc - Plan #85 Blue Cross and Blue Shield of Illinois | ||||||||||||||||||||
Silver
(PPO) Blue Choice Preferred Silver PPO? 203 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-538-8833
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$476.95 $541.34 $609.55 $851.84 $1,294.45 |
$841.82 $906.21 $974.42 $1,216.71 |
$1,206.69 $1,271.08 $1,339.29 $1,581.58 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$953.90 $1,082.68 $1,219.10 $1,703.68 $2,588.90 |
$1,318.77 $1,447.55 $1,583.97 $2,068.55 |
$1,683.64 $1,812.42 $1,948.84 $2,433.42 |
Toc - Plan #86 Blue Cross and Blue Shield of Illinois | ||||||||||||||||||||
Expanded Bronze
(PPO) Blue Choice Preferred Bronze PPO? 202 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-538-8833
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$416.63 $472.88 $532.46 $744.11 $1,130.74 |
$735.35 $791.60 $851.18 $1,062.83 |
$1,054.07 $1,110.32 $1,169.90 $1,381.55 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$833.26 $945.76 $1,064.92 $1,488.22 $2,261.48 |
$1,151.98 $1,264.48 $1,383.64 $1,806.94 |
$1,470.70 $1,583.20 $1,702.36 $2,125.66 |
Toc - Plan #87 Blue Cross and Blue Shield of Illinois | ||||||||||||||||||||
Catastrophic
(PPO) Blue Choice Preferred Security PPO? 200 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-538-8833
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$341.55 $387.66 $436.50 $610.01 $926.96 |
$602.83 $648.94 $697.78 $871.29 |
$864.11 $910.22 $959.06 $1,132.57 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$683.10 $775.32 $873.00 $1,220.02 $1,853.92 |
$944.38 $1,036.60 $1,134.28 $1,481.30 |
$1,205.66 $1,297.88 $1,395.56 $1,742.58 |
Toc - Plan #88 Blue Cross and Blue Shield of Illinois | ||||||||||||||||||||
Expanded Bronze
(PPO) Blue Choice Preferred Bronze PPO? 201 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-538-8833
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$374.06 $424.56 $478.05 $668.07 $1,015.19 |
$660.21 $710.71 $764.20 $954.22 |
$946.36 $996.86 $1,050.35 $1,240.37 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$748.12 $849.12 $956.10 $1,336.14 $2,030.38 |
$1,034.27 $1,135.27 $1,242.25 $1,622.29 |
$1,320.42 $1,421.42 $1,528.40 $1,908.44 |
Toc - Plan #89 Blue Cross and Blue Shield of Illinois | ||||||||||||||||||||
Bronze
(PPO) Blue Choice Preferred Bronze PPO? 601 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-538-8833
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$365.90 $415.29 $467.62 $653.49 $993.05 |
$645.81 $695.20 $747.53 $933.40 |
$925.72 $975.11 $1,027.44 $1,213.31 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$731.80 $830.58 $935.24 $1,306.98 $1,986.10 |
$1,011.71 $1,110.49 $1,215.15 $1,586.89 |
$1,291.62 $1,390.40 $1,495.06 $1,866.80 |
Toc - Plan #90 Blue Cross and Blue Shield of Illinois | ||||||||||||||||||||
Bronze
(PPO) Blue Choice Preferred Bronze PPO? 701 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-538-8833
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$342.96 $389.26 $438.30 $612.53 $930.79 |
$605.32 $651.62 $700.66 $874.89 |
$867.68 $913.98 $963.02 $1,137.25 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$685.92 $778.52 $876.60 $1,225.06 $1,861.58 |
$948.28 $1,040.88 $1,138.96 $1,487.42 |
$1,210.64 $1,303.24 $1,401.32 $1,749.78 |
Toc - Plan #91 Blue Cross and Blue Shield of Illinois | ||||||||||||||||||||
Gold
(PPO) Blue Choice Preferred Gold PPO? 707 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-538-8833
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$560.26 $635.89 $716.01 $1,000.62 $1,520.54 |
$988.86 $1,064.49 $1,144.61 $1,429.22 |
$1,417.46 $1,493.09 $1,573.21 $1,857.82 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,120.52 $1,271.78 $1,432.02 $2,001.24 $3,041.08 |
$1,549.12 $1,700.38 $1,860.62 $2,429.84 |
$1,977.72 $2,128.98 $2,289.22 $2,858.44 |
Toc - Plan #92 Blue Cross and Blue Shield of Illinois | ||||||||||||||||||||
Silver
(PPO) Blue Choice Preferred Silver PPO? 706 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-538-8833
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$484.48 $549.89 $619.17 $865.29 $1,314.88 |
$855.11 $920.52 $989.80 $1,235.92 |
$1,225.74 $1,291.15 $1,360.43 $1,606.55 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$968.96 $1,099.78 $1,238.34 $1,730.58 $2,629.76 |
$1,339.59 $1,470.41 $1,608.97 $2,101.21 |
$1,710.22 $1,841.04 $1,979.60 $2,471.84 |
Toc - Plan #93 Blue Cross and Blue Shield of Illinois | ||||||||||||||||||||
Bronze
(PPO) Blue Choice Preferred Bronze PPO? 705 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-538-8833
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$357.60 $405.87 $457.01 $638.67 $970.52 |
$631.16 $679.43 $730.57 $912.23 |
$904.72 $952.99 $1,004.13 $1,185.79 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$715.20 $811.74 $914.02 $1,277.34 $1,941.04 |
$988.76 $1,085.30 $1,187.58 $1,550.90 |
$1,262.32 $1,358.86 $1,461.14 $1,824.46 |
Toc - Plan #94 Blue Cross and Blue Shield of Illinois | ||||||||||||||||||||
Expanded Bronze
(PPO) Blue Choice Preferred Bronze PPO? 708 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-538-8833
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$425.14 $482.54 $543.33 $759.31 $1,153.84 |
$750.37 $807.77 $868.56 $1,084.54 |
$1,075.60 $1,133.00 $1,193.79 $1,409.77 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$850.28 $965.08 $1,086.66 $1,518.62 $2,307.68 |
$1,175.51 $1,290.31 $1,411.89 $1,843.85 |
$1,500.74 $1,615.54 $1,737.12 $2,169.08 |
Toc - Plan #95 Blue Cross and Blue Shield of Illinois | ||||||||||||||||||||
Gold
(HMO) Blue FocusCare Gold? 211 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-538-8833
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$352.39 $399.97 $450.36 $629.37 $956.40 |
$621.97 $669.55 $719.94 $898.95 |
$891.55 $939.13 $989.52 $1,168.53 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$704.78 $799.94 $900.72 $1,258.74 $1,912.80 |
$974.36 $1,069.52 $1,170.30 $1,528.32 |
$1,243.94 $1,339.10 $1,439.88 $1,797.90 |
Toc - Plan #96 Blue Cross and Blue Shield of Illinois | ||||||||||||||||||||
Silver
(HMO) Blue FocusCare Silver? 210 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-538-8833
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$293.67 $333.32 $375.32 $524.50 $797.03 |
$518.33 $557.98 $599.98 $749.16 |
$742.99 $782.64 $824.64 $973.82 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$587.34 $666.64 $750.64 $1,049.00 $1,594.06 |
$812.00 $891.30 $975.30 $1,273.66 |
$1,036.66 $1,115.96 $1,199.96 $1,498.32 |
Toc - Plan #97 Blue Cross and Blue Shield of Illinois | ||||||||||||||||||||
Expanded Bronze
(HMO) Blue FocusCare Bronze? 209 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-538-8833
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$230.43 $261.53 $294.48 $411.54 $625.37 |
$406.71 $437.81 $470.76 $587.82 |
$582.99 $614.09 $647.04 $764.10 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$460.86 $523.06 $588.96 $823.08 $1,250.74 |
$637.14 $699.34 $765.24 $999.36 |
$813.42 $875.62 $941.52 $1,175.64 |
ADVERTISEMENT
UnitedHealthcareLocal: 1-888-200-0325 | Toll Free: 1-888-200-0325 | TTY: 1-888-200-0325 |
Toc - Plan #98 UnitedHealthcare | ||||||||||||||||||||
Expanded Bronze
(HMO) UHC Bronze Virtual First (Unlimited App-based Care, Preferred Rx) (Disponible en español) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-200-0325
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$270.17 $306.65 $345.28 $482.53 $733.25 |
$476.85 $513.33 $551.96 $689.21 |
$683.53 $720.01 $758.64 $895.89 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$540.34 $613.30 $690.56 $965.06 $1,466.50 |
$747.02 $819.98 $897.24 $1,171.74 |
$953.70 $1,026.66 $1,103.92 $1,378.42 |
Toc - Plan #99 UnitedHealthcare | ||||||||||||||||||||
Silver
(HMO) UHC Silver Value 1 (Unlimited Virtual Urgent Care + Primary Care Visits, Preferred Rx) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-200-0325
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$326.92 $371.05 $417.80 $583.87 $887.25 |
$577.01 $621.14 $667.89 $833.96 |
$827.10 $871.23 $917.98 $1,084.05 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$653.84 $742.10 $835.60 $1,167.74 $1,774.50 |
$903.93 $992.19 $1,085.69 $1,417.83 |
$1,154.02 $1,242.28 $1,335.78 $1,667.92 |
Toc - Plan #100 UnitedHealthcare | ||||||||||||||||||||
Silver
(HMO) UHC Silver Virtual First (Unlimited App-based Care, Preferred Rx) (Disponible en español) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-200-0325
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$322.08 $365.56 $411.62 $575.24 $874.14 |
$568.47 $611.95 $658.01 $821.63 |
$814.86 $858.34 $904.40 $1,068.02 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$644.16 $731.12 $823.24 $1,150.48 $1,748.28 |
$890.55 $977.51 $1,069.63 $1,396.87 |
$1,136.94 $1,223.90 $1,316.02 $1,643.26 |
Toc - Plan #101 UnitedHealthcare | ||||||||||||||||||||
Gold
(HMO) UHC Gold Value (Unlimited Virtual Urgent Care + Primary Care Visits, Preferred Rx) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-200-0325
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$382.11 $433.69 $488.33 $682.44 $1,037.04 |
$674.42 $726.00 $780.64 $974.75 |
$966.73 $1,018.31 $1,072.95 $1,267.06 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$764.22 $867.38 $976.66 $1,364.88 $2,074.08 |
$1,056.53 $1,159.69 $1,268.97 $1,657.19 |
$1,348.84 $1,452.00 $1,561.28 $1,949.50 |
Toc - Plan #102 UnitedHealthcare | ||||||||||||||||||||
Gold
(HMO) UHC Gold Advantage (Unlimited Virtual Urgent Care + Primary Care Visits, Preferred Rx) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-200-0325
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$399.89 $453.87 $511.06 $714.20 $1,085.29 |
$705.80 $759.78 $816.97 $1,020.11 |
$1,011.71 $1,065.69 $1,122.88 $1,326.02 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$799.78 $907.74 $1,022.12 $1,428.40 $2,170.58 |
$1,105.69 $1,213.65 $1,328.03 $1,734.31 |
$1,411.60 $1,519.56 $1,633.94 $2,040.22 |
Toc - Plan #103 UnitedHealthcare | ||||||||||||||||||||
Gold
(HMO) UHC Gold Advantage+ (Unlimited Virtual Urgent Care + Primary Care Visits, Preferred Rx, Dental + Vision) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-200-0325
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$417.77 $474.17 $533.92 $746.15 $1,133.84 |
$737.37 $793.77 $853.52 $1,065.75 |
$1,056.97 $1,113.37 $1,173.12 $1,385.35 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$835.54 $948.34 $1,067.84 $1,492.30 $2,267.68 |
$1,155.14 $1,267.94 $1,387.44 $1,811.90 |
$1,474.74 $1,587.54 $1,707.04 $2,131.50 |
Toc - Plan #104 UnitedHealthcare | ||||||||||||||||||||
Gold
(HMO) UHC Gold Standard (Rx Copay) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-200-0325
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$388.70 $441.18 $496.76 $694.23 $1,054.94 |
$686.06 $738.54 $794.12 $991.59 |
$983.42 $1,035.90 $1,091.48 $1,288.95 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$777.40 $882.36 $993.52 $1,388.46 $2,109.88 |
$1,074.76 $1,179.72 $1,290.88 $1,685.82 |
$1,372.12 $1,477.08 $1,588.24 $1,983.18 |
Toc - Plan #105 UnitedHealthcare | ||||||||||||||||||||
Silver
(HMO) UHC Silver Advantage 1 (Unlimited Virtual Urgent Care + Primary Care Visits, Preferred Rx) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-200-0325
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$332.97 $377.92 $425.53 $594.68 $903.67 |
$587.69 $632.64 $680.25 $849.40 |
$842.41 $887.36 $934.97 $1,104.12 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$665.94 $755.84 $851.06 $1,189.36 $1,807.34 |
$920.66 $1,010.56 $1,105.78 $1,444.08 |
$1,175.38 $1,265.28 $1,360.50 $1,698.80 |
Toc - Plan #106 UnitedHealthcare | ||||||||||||||||||||
Silver
(HMO) UHC Silver Advantage+ (Unlimited Virtual Urgent Care + Primary Care Visits, Preferred Rx, Dental + Vision) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-200-0325
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$341.50 $387.60 $436.44 $609.92 $926.83 |
$602.75 $648.85 $697.69 $871.17 |
$864.00 $910.10 $958.94 $1,132.42 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$683.00 $775.20 $872.88 $1,219.84 $1,853.66 |
$944.25 $1,036.45 $1,134.13 $1,481.09 |
$1,205.50 $1,297.70 $1,395.38 $1,742.34 |
Toc - Plan #107 UnitedHealthcare | ||||||||||||||||||||
Silver
(HMO) UHC Silver Value (Unlimited Virtual Urgent Care + Primary Care Visits, Preferred Rx) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-200-0325
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$325.26 $369.17 $415.68 $580.91 $882.75 |
$574.08 $617.99 $664.50 $829.73 |
$822.90 $866.81 $913.32 $1,078.55 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$650.52 $738.34 $831.36 $1,161.82 $1,765.50 |
$899.34 $987.16 $1,080.18 $1,410.64 |
$1,148.16 $1,235.98 $1,329.00 $1,659.46 |
Toc - Plan #108 UnitedHealthcare | ||||||||||||||||||||
Silver
(HMO) UHC Silver Advantage (Unlimited Virtual Urgent Care + Primary Care Visits, Rx Copay) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-200-0325
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$328.62 $372.98 $419.98 $586.92 $891.88 |
$580.02 $624.38 $671.38 $838.32 |
$831.42 $875.78 $922.78 $1,089.72 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$657.24 $745.96 $839.96 $1,173.84 $1,783.76 |
$908.64 $997.36 $1,091.36 $1,425.24 |
$1,160.04 $1,248.76 $1,342.76 $1,676.64 |
Toc - Plan #109 UnitedHealthcare | ||||||||||||||||||||
Silver
(HMO) UHC Silver Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-200-0325
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$329.12 $373.55 $420.62 $587.81 $893.24 |
$580.90 $625.33 $672.40 $839.59 |
$832.68 $877.11 $924.18 $1,091.37 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$658.24 $747.10 $841.24 $1,175.62 $1,786.48 |
$910.02 $998.88 $1,093.02 $1,427.40 |
$1,161.80 $1,250.66 $1,344.80 $1,679.18 |
Toc - Plan #110 UnitedHealthcare | ||||||||||||||||||||
Expanded Bronze
(HMO) UHC Bronze Value (Unlimited Virtual Urgent Care + Primary Care Visits, Rx Copay) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-200-0325
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$280.43 $318.28 $358.39 $500.84 $761.08 |
$494.96 $532.81 $572.92 $715.37 |
$709.49 $747.34 $787.45 $929.90 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$560.86 $636.56 $716.78 $1,001.68 $1,522.16 |
$775.39 $851.09 $931.31 $1,216.21 |
$989.92 $1,065.62 $1,145.84 $1,430.74 |
Toc - Plan #111 UnitedHealthcare | ||||||||||||||||||||
Bronze
(HMO) UHC Bronze Essential (Preferred Rx) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-200-0325
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$269.01 $305.32 $343.79 $480.45 $730.08 |
$474.80 $511.11 $549.58 $686.24 |
$680.59 $716.90 $755.37 $892.03 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$538.02 $610.64 $687.58 $960.90 $1,460.16 |
$743.81 $816.43 $893.37 $1,166.69 |
$949.60 $1,022.22 $1,099.16 $1,372.48 |
Toc - Plan #112 UnitedHealthcare | ||||||||||||||||||||
Expanded Bronze
(HMO) UHC Bronze Value HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-200-0325
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$277.53 $314.99 $354.68 $495.66 $753.21 |
$489.84 $527.30 $566.99 $707.97 |
$702.15 $739.61 $779.30 $920.28 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$555.06 $629.98 $709.36 $991.32 $1,506.42 |
$767.37 $842.29 $921.67 $1,203.63 |
$979.68 $1,054.60 $1,133.98 $1,415.94 |
Toc - Plan #113 UnitedHealthcare | ||||||||||||||||||||
Expanded Bronze
(HMO) UHC Bronze Standard 1 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-200-0325
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$278.59 $316.20 $356.04 $497.57 $756.10 |
$491.71 $529.32 $569.16 $710.69 |
$704.83 $742.44 $782.28 $923.81 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$557.18 $632.40 $712.08 $995.14 $1,512.20 |
$770.30 $845.52 $925.20 $1,208.26 |
$983.42 $1,058.64 $1,138.32 $1,421.38 |
Toc - Plan #114 UnitedHealthcare | ||||||||||||||||||||
Bronze
(HMO) UHC Bronze Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-200-0325
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$261.19 $296.45 $333.81 $466.49 $708.88 |
$461.00 $496.26 $533.62 $666.30 |
$660.81 $696.07 $733.43 $866.11 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$522.38 $592.90 $667.62 $932.98 $1,417.76 |
$722.19 $792.71 $867.43 $1,132.79 |
$922.00 $992.52 $1,067.24 $1,332.60 |
ADVERTISEMENT
Cigna HealthcareLocal: 1-877-900-1237 | Toll Free: 1-877-900-1237 | TTY: 1-800-676-3777 |
Toc - Plan #115 Cigna Healthcare | ||||||||||||||||||||
Expanded Bronze
(HMO) Cigna Connect 5000 Rx Copay |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-900-1237
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$293.88 $333.56 $375.58 $524.88 $797.60 |
$518.70 $558.38 $600.40 $749.70 |
$743.52 $783.20 $825.22 $974.52 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$587.76 $667.12 $751.16 $1,049.76 $1,595.20 |
$812.58 $891.94 $975.98 $1,274.58 |
$1,037.40 $1,116.76 $1,200.80 $1,499.40 |
Toc - Plan #116 Cigna Healthcare | ||||||||||||||||||||
Silver
(HMO) Cigna Connect 3000 Rx Copay |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-900-1237
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$335.25 $380.51 $428.45 $598.76 $909.87 |
$591.72 $636.98 $684.92 $855.23 |
$848.19 $893.45 $941.39 $1,111.70 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$670.50 $761.02 $856.90 $1,197.52 $1,819.74 |
$926.97 $1,017.49 $1,113.37 $1,453.99 |
$1,183.44 $1,273.96 $1,369.84 $1,710.46 |
Toc - Plan #117 Cigna Healthcare | ||||||||||||||||||||
Gold
(HMO) Cigna Connect 1000 Rx Copay |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-900-1237
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$398.94 $452.80 $509.84 $712.51 $1,082.72 |
$704.13 $757.99 $815.03 $1,017.70 |
$1,009.32 $1,063.18 $1,120.22 $1,322.89 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$797.88 $905.60 $1,019.68 $1,425.02 $2,165.44 |
$1,103.07 $1,210.79 $1,324.87 $1,730.21 |
$1,408.26 $1,515.98 $1,630.06 $2,035.40 |
Toc - Plan #118 Cigna Healthcare | ||||||||||||||||||||
Expanded Bronze
(HMO) Cigna Connect 0A |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-900-1237
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$313.21 $355.49 $400.28 $559.39 $850.05 |
$552.82 $595.10 $639.89 $799.00 |
$792.43 $834.71 $879.50 $1,038.61 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$626.42 $710.98 $800.56 $1,118.78 $1,700.10 |
$866.03 $950.59 $1,040.17 $1,358.39 |
$1,105.64 $1,190.20 $1,279.78 $1,598.00 |
Toc - Plan #119 Cigna Healthcare | ||||||||||||||||||||
Silver
(HMO) Cigna Connect 6000 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-900-1237
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$337.85 $383.46 $431.77 $603.39 $916.92 |
$596.30 $641.91 $690.22 $861.84 |
$854.75 $900.36 $948.67 $1,120.29 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$675.70 $766.92 $863.54 $1,206.78 $1,833.84 |
$934.15 $1,025.37 $1,121.99 $1,465.23 |
$1,192.60 $1,283.82 $1,380.44 $1,723.68 |
Toc - Plan #120 Cigna Healthcare | ||||||||||||||||||||
Silver
(HMO) Cigna Connect 8000 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-900-1237
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$340.96 $386.99 $435.75 $608.96 $925.37 |
$601.80 $647.83 $696.59 $869.80 |
$862.64 $908.67 $957.43 $1,130.64 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$681.92 $773.98 $871.50 $1,217.92 $1,850.74 |
$942.76 $1,034.82 $1,132.34 $1,478.76 |
$1,203.60 $1,295.66 $1,393.18 $1,739.60 |
Toc - Plan #121 Cigna Healthcare | ||||||||||||||||||||
Silver
(HMO) Cigna Connect 3800 Enhanced Diabetes Care |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-900-1237
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$341.52 $387.63 $436.46 $609.95 $926.89 |
$602.78 $648.89 $697.72 $871.21 |
$864.04 $910.15 $958.98 $1,132.47 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$683.04 $775.26 $872.92 $1,219.90 $1,853.78 |
$944.30 $1,036.52 $1,134.18 $1,481.16 |
$1,205.56 $1,297.78 $1,395.44 $1,742.42 |
Toc - Plan #122 Cigna Healthcare | ||||||||||||||||||||
Expanded Bronze
(HMO) Cigna Connect HSA 7050 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-900-1237
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$290.45 $329.66 $371.19 $518.74 $788.28 |
$512.64 $551.85 $593.38 $740.93 |
$734.83 $774.04 $815.57 $963.12 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$580.90 $659.32 $742.38 $1,037.48 $1,576.56 |
$803.09 $881.51 $964.57 $1,259.67 |
$1,025.28 $1,103.70 $1,186.76 $1,481.86 |
Toc - Plan #123 Cigna Healthcare | ||||||||||||||||||||
Expanded Bronze
(HMO) Cigna Connect 6800 Enhanced Diabetes Care |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-900-1237
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$289.13 $328.16 $369.51 $516.39 $784.70 |
$510.32 $549.35 $590.70 $737.58 |
$731.51 $770.54 $811.89 $958.77 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$578.26 $656.32 $739.02 $1,032.78 $1,569.40 |
$799.45 $877.51 $960.21 $1,253.97 |
$1,020.64 $1,098.70 $1,181.40 $1,475.16 |
Toc - Plan #124 Cigna Healthcare | ||||||||||||||||||||
Silver
(HMO) Cigna Connect 0B |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-900-1237
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$339.16 $384.95 $433.45 $605.75 $920.49 |
$598.62 $644.41 $692.91 $865.21 |
$858.08 $903.87 $952.37 $1,124.67 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$678.32 $769.90 $866.90 $1,211.50 $1,840.98 |
$937.78 $1,029.36 $1,126.36 $1,470.96 |
$1,197.24 $1,288.82 $1,385.82 $1,730.42 |
Toc - Plan #125 Cigna Healthcare | ||||||||||||||||||||
Silver
(HMO) 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$340.16 $386.08 $434.73 $607.53 $923.20 |
$600.38 $646.30 $694.95 $867.75 |
$860.60 $906.52 $955.17 $1,127.97 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$680.32 $772.16 $869.46 $1,215.06 $1,846.40 |
$940.54 $1,032.38 $1,129.68 $1,475.28 |
$1,200.76 $1,292.60 $1,389.90 $1,735.50 |
Toc - Plan #126 Cigna Healthcare | ||||||||||||||||||||
Bronze
(HMO) Cigna Simple Choice 9100 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-900-1237
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$276.19 $313.48 $352.98 $493.28 $749.59 |
$487.48 $524.77 $564.27 $704.57 |
$698.77 $736.06 $775.56 $915.86 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$552.38 $626.96 $705.96 $986.56 $1,499.18 |
$763.67 $838.25 $917.25 $1,197.85 |
$974.96 $1,049.54 $1,128.54 $1,409.14 |
Toc - Plan #127 Cigna Healthcare | ||||||||||||||||||||
Expanded Bronze
(HMO) Cigna Simple Choice 7500 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-900-1237
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$286.98 $325.72 $366.76 $512.54 $778.85 |
$506.52 $545.26 $586.30 $732.08 |
$726.06 $764.80 $805.84 $951.62 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$573.96 $651.44 $733.52 $1,025.08 $1,557.70 |
$793.50 $870.98 $953.06 $1,244.62 |
$1,013.04 $1,090.52 $1,172.60 $1,464.16 |
Toc - Plan #128 Cigna Healthcare | ||||||||||||||||||||
Silver
(HMO) Cigna Simple Choice 5800 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-900-1237
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$334.25 $379.38 $427.18 $596.98 $907.16 |
$589.95 $635.08 $682.88 $852.68 |
$845.65 $890.78 $938.58 $1,108.38 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$668.50 $758.76 $854.36 $1,193.96 $1,814.32 |
$924.20 $1,014.46 $1,110.06 $1,449.66 |
$1,179.90 $1,270.16 $1,365.76 $1,705.36 |
Toc - Plan #129 Cigna Healthcare | ||||||||||||||||||||
Gold
(HMO) Cigna Simple Choice 2000 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-900-1237
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$391.87 $444.77 $500.81 $699.88 $1,063.54 |
$691.65 $744.55 $800.59 $999.66 |
$991.43 $1,044.33 $1,100.37 $1,299.44 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$783.74 $889.54 $1,001.62 $1,399.76 $2,127.08 |
$1,083.52 $1,189.32 $1,301.40 $1,699.54 |
$1,383.30 $1,489.10 $1,601.18 $1,999.32 |
Toc - Plan #130 Cigna Healthcare | ||||||||||||||||||||
Expanded Bronze
(HMO) 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$288.89 $327.89 $369.20 $515.96 $784.05 |
$509.89 $548.89 $590.20 $736.96 |
$730.89 $769.89 $811.20 $957.96 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$577.78 $655.78 $738.40 $1,031.92 $1,568.10 |
$798.78 $876.78 $959.40 $1,252.92 |
$1,019.78 $1,097.78 $1,180.40 $1,473.92 |
ADVERTISEMENT
Aetna CVS HealthLocal: 1-877-336-3915 | Toll Free: 1-877-336-3915 | TTY: 1-877-336-3915 |
Toc - Plan #131 Aetna CVS Health | ||||||||||||||||||||
Expanded Bronze
(HMO) Bronze: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 Telehealth 24/7 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-336-3915
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$282.73 $320.90 $361.33 $504.96 $767.34 |
$499.02 $537.19 $577.62 $721.25 |
$715.31 $753.48 $793.91 $937.54 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$565.46 $641.80 $722.66 $1,009.92 $1,534.68 |
$781.75 $858.09 $938.95 $1,226.21 |
$998.04 $1,074.38 $1,155.24 $1,442.50 |
Toc - Plan #132 Aetna CVS Health | ||||||||||||||||||||
Expanded Bronze
(HMO) Bronze: Aetna network of doctors & hospitals + Low-cost MinuteClinic + $0 Telehealth 24/7 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-336-3915
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$278.03 $315.57 $355.32 $496.56 $754.58 |
$490.72 $528.26 $568.01 $709.25 |
$703.41 $740.95 $780.70 $921.94 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$556.06 $631.14 $710.64 $993.12 $1,509.16 |
$768.75 $843.83 $923.33 $1,205.81 |
$981.44 $1,056.52 $1,136.02 $1,418.50 |
Toc - Plan #133 Aetna CVS Health | ||||||||||||||||||||
Expanded Bronze
(HMO) Bronze S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 Telehealth 24/7 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-336-3915
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$267.64 $303.77 $342.04 $478.00 $726.36 |
$472.38 $508.51 $546.78 $682.74 |
$677.12 $713.25 $751.52 $887.48 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$535.28 $607.54 $684.08 $956.00 $1,452.72 |
$740.02 $812.28 $888.82 $1,160.74 |
$944.76 $1,017.02 $1,093.56 $1,365.48 |
Toc - Plan #134 Aetna CVS Health | ||||||||||||||||||||
Gold
(HMO) Gold: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 Telehealth 24/7 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-336-3915
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$422.51 $479.55 $539.97 $754.61 $1,146.70 |
$745.73 $802.77 $863.19 $1,077.83 |
$1,068.95 $1,125.99 $1,186.41 $1,401.05 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$845.02 $959.10 $1,079.94 $1,509.22 $2,293.40 |
$1,168.24 $1,282.32 $1,403.16 $1,832.44 |
$1,491.46 $1,605.54 $1,726.38 $2,155.66 |
Toc - Plan #135 Aetna CVS Health | ||||||||||||||||||||
Gold
(HMO) Gold S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 Telehealth 24/7 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-336-3915
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$373.43 $423.85 $477.25 $666.95 $1,013.50 |
$659.11 $709.53 $762.93 $952.63 |
$944.79 $995.21 $1,048.61 $1,238.31 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$746.86 $847.70 $954.50 $1,333.90 $2,027.00 |
$1,032.54 $1,133.38 $1,240.18 $1,619.58 |
$1,318.22 $1,419.06 $1,525.86 $1,905.26 |
Toc - Plan #136 Aetna CVS Health | ||||||||||||||||||||
Silver
(HMO) Silver 1: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 Telehealth 24/7 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-336-3915
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$350.27 $397.56 $447.65 $625.59 $950.64 |
$618.23 $665.52 $715.61 $893.55 |
$886.19 $933.48 $983.57 $1,161.51 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$700.54 $795.12 $895.30 $1,251.18 $1,901.28 |
$968.50 $1,063.08 $1,163.26 $1,519.14 |
$1,236.46 $1,331.04 $1,431.22 $1,787.10 |
Toc - Plan #137 Aetna CVS Health | ||||||||||||||||||||
Silver
(HMO) Silver 2: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 Telehealth 24/7 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-336-3915
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$347.42 $394.32 $444.00 $620.49 $942.89 |
$613.19 $660.09 $709.77 $886.26 |
$878.96 $925.86 $975.54 $1,152.03 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$694.84 $788.64 $888.00 $1,240.98 $1,885.78 |
$960.61 $1,054.41 $1,153.77 $1,506.75 |
$1,226.38 $1,320.18 $1,419.54 $1,772.52 |
Toc - Plan #138 Aetna CVS Health | ||||||||||||||||||||
Silver
(HMO) Silver 3: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 Telehealth 24/7 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-336-3915
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$354.02 $401.82 $452.44 $632.29 $960.82 |
$624.85 $672.65 $723.27 $903.12 |
$895.68 $943.48 $994.10 $1,173.95 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$708.04 $803.64 $904.88 $1,264.58 $1,921.64 |
$978.87 $1,074.47 $1,175.71 $1,535.41 |
$1,249.70 $1,345.30 $1,446.54 $1,806.24 |
Toc - Plan #139 Aetna CVS Health | ||||||||||||||||||||
Silver
(HMO) Silver S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 Telehealth 24/7 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-336-3915
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$319.71 $362.87 $408.59 $571.00 $867.70 |
$564.29 $607.45 $653.17 $815.58 |
$808.87 $852.03 $897.75 $1,060.16 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$639.42 $725.74 $817.18 $1,142.00 $1,735.40 |
$884.00 $970.32 $1,061.76 $1,386.58 |
$1,128.58 $1,214.90 $1,306.34 $1,631.16 |
‡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 Cook County here.
Cook County is in “Rating Area 1” of Illinois.
Currently, there are 139 plans offered in Rating Area 1.