Obamacare 2023 Rates for Eaton County

Obamacare > Rates > Michigan > Eaton County

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

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

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

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

Obamacare Providers, 62 Plans and 2023 Rates for Eaton County, Michigan

Below, you’ll find a summary of the 62 plans for Eaton County, Michigan and rates for each of these providers.‡ This chart is designed to give you a preview of your health insurance options.

You may also be interested in:

Obamacare Rates and Providers for Other Years

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Eaton County Resources

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Blue Cross Blue Shield of Michigan Mutual Insurance Company

Local: 1-888-288-2738 | Toll Free: 1-888-288-2738 | TTY: 1-800-481-8704
Toc - Plan #1 Blue Cross Blue Shield of Michigan Mutual Insurance Company
Catastrophic

(PPO) Blue Cross® Premier PPO Value

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-288-2738

Annual Out of Pocket Expenses:

Individual Family
$9,100 $18,200 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$245.25
$278.36
$313.43
$438.02
$665.61 		$432.87
$465.98
$501.05
$625.64 		$620.49
$653.60
$688.67
$813.26 		$808.11
$841.22
$876.29
$1,000.88 		$187.62
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$490.50
$556.72
$626.86
$876.04
$1,331.22 		$678.12
$744.34
$814.48
$1,063.66 		$865.74
$931.96
$1,002.10
$1,251.28 		$1,053.36
$1,119.58
$1,189.72
$1,438.90 		$187.62
Toc - Plan #2 Blue Cross Blue Shield of Michigan Mutual Insurance Company
Expanded Bronze

(PPO) Blue Cross® Premier PPO Bronze HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-288-2738

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$326.63
$370.73
$417.43
$583.36
$886.47 		$576.50
$620.60
$667.30
$833.23 		$826.37
$870.47
$917.17
$1,083.10 		$1,076.24
$1,120.34
$1,167.04
$1,332.97 		$249.87
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$653.26
$741.46
$834.86
$1,166.72
$1,772.94 		$903.13
$991.33
$1,084.73
$1,416.59 		$1,153.00
$1,241.20
$1,334.60
$1,666.46 		$1,402.87
$1,491.07
$1,584.47
$1,916.33 		$249.87
Toc - Plan #3 Blue Cross Blue Shield of Michigan Mutual Insurance Company
Silver

(PPO) Blue Cross® Premier PPO Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-288-2738

Annual Out of Pocket Expenses:

Individual Family
$2,875 $5,750 Annual Deductible
$8,800 $17,600 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$442.05
$501.73
$564.94
$789.50
$1,199.72 		$780.22
$839.90
$903.11
$1,127.67 		$1,118.39
$1,178.07
$1,241.28
$1,465.84 		$1,456.56
$1,516.24
$1,579.45
$1,804.01 		$338.17
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$884.10
$1,003.46
$1,129.88
$1,579.00
$2,399.44 		$1,222.27
$1,341.63
$1,468.05
$1,917.17 		$1,560.44
$1,679.80
$1,806.22
$2,255.34 		$1,898.61
$2,017.97
$2,144.39
$2,593.51 		$338.17
Toc - Plan #4 Blue Cross Blue Shield of Michigan Mutual Insurance Company
Gold

(PPO) Blue Cross® Premier PPO Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-288-2738

Annual Out of Pocket Expenses:

Individual Family
$1,050 $2,100 Annual Deductible
$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$542.41
$615.64
$693.20
$968.74
$1,472.10 		$957.35
$1,030.58
$1,108.14
$1,383.68 		$1,372.29
$1,445.52
$1,523.08
$1,798.62 		$1,787.23
$1,860.46
$1,938.02
$2,213.56 		$414.94
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,084.82
$1,231.28
$1,386.40
$1,937.48
$2,944.20 		$1,499.76
$1,646.22
$1,801.34
$2,352.42 		$1,914.70
$2,061.16
$2,216.28
$2,767.36 		$2,329.64
$2,476.10
$2,631.22
$3,182.30 		$414.94
Toc - Plan #5 Blue Cross Blue Shield of Michigan Mutual Insurance Company
Bronze

(PPO) Blue Cross® Premier PPO Bronze Secure

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-288-2738

Annual Out of Pocket Expenses:

Individual Family
$9,100 $18,200 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$301.19
$341.85
$384.92
$537.93
$817.43 		$531.60
$572.26
$615.33
$768.34 		$762.01
$802.67
$845.74
$998.75 		$992.42
$1,033.08
$1,076.15
$1,229.16 		$230.41
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$602.38
$683.70
$769.84
$1,075.86
$1,634.86 		$832.79
$914.11
$1,000.25
$1,306.27 		$1,063.20
$1,144.52
$1,230.66
$1,536.68 		$1,293.61
$1,374.93
$1,461.07
$1,767.09 		$230.41
Toc - Plan #6 Blue Cross Blue Shield of Michigan Mutual Insurance Company
Silver

(PPO) Blue Cross® Premier PPO Silver Saver HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-288-2738

Annual Out of Pocket Expenses:

Individual Family
$3,400 $6,800 Annual Deductible
$7,050 $14,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$442.13
$501.82
$565.04
$789.64
$1,199.94 		$780.36
$840.05
$903.27
$1,127.87 		$1,118.59
$1,178.28
$1,241.50
$1,466.10 		$1,456.82
$1,516.51
$1,579.73
$1,804.33 		$338.23
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$884.26
$1,003.64
$1,130.08
$1,579.28
$2,399.88 		$1,222.49
$1,341.87
$1,468.31
$1,917.51 		$1,560.72
$1,680.10
$1,806.54
$2,255.74 		$1,898.95
$2,018.33
$2,144.77
$2,593.97 		$338.23
Toc - Plan #7 Blue Cross Blue Shield of Michigan Mutual Insurance Company
Expanded Bronze

(PPO) Blue Cross® Premier PPO Bronze Extra

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-288-2738

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$342.16
$388.35
$437.28
$611.10
$928.62 		$603.91
$650.10
$699.03
$872.85 		$865.66
$911.85
$960.78
$1,134.60 		$1,127.41
$1,173.60
$1,222.53
$1,396.35 		$261.75
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$684.32
$776.70
$874.56
$1,222.20
$1,857.24 		$946.07
$1,038.45
$1,136.31
$1,483.95 		$1,207.82
$1,300.20
$1,398.06
$1,745.70 		$1,469.57
$1,561.95
$1,659.81
$2,007.45 		$261.75
Toc - Plan #8 Blue Cross Blue Shield of Michigan Mutual Insurance Company
Silver

(PPO) Blue Cross® Premier PPO Silver Extra

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-288-2738

Annual Out of Pocket Expenses:

Individual Family
$5,800 $11,600 Annual Deductible
$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$469.96
$533.40
$600.61
$839.35
$1,275.47 		$829.48
$892.92
$960.13
$1,198.87 		$1,189.00
$1,252.44
$1,319.65
$1,558.39 		$1,548.52
$1,611.96
$1,679.17
$1,917.91 		$359.52
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$939.92
$1,066.80
$1,201.22
$1,678.70
$2,550.94 		$1,299.44
$1,426.32
$1,560.74
$2,038.22 		$1,658.96
$1,785.84
$1,920.26
$2,397.74 		$2,018.48
$2,145.36
$2,279.78
$2,757.26 		$359.52
Toc - Plan #9 Blue Cross Blue Shield of Michigan Mutual Insurance Company
Gold

(PPO) Blue Cross® Premier PPO Gold Extra

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-288-2738

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$590.51
$670.23
$754.67
$1,054.65
$1,602.64 		$1,042.25
$1,121.97
$1,206.41
$1,506.39 		$1,493.99
$1,573.71
$1,658.15
$1,958.13 		$1,945.73
$2,025.45
$2,109.89
$2,409.87 		$451.74
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,181.02
$1,340.46
$1,509.34
$2,109.30
$3,205.28 		$1,632.76
$1,792.20
$1,961.08
$2,561.04 		$2,084.50
$2,243.94
$2,412.82
$3,012.78 		$2,536.24
$2,695.68
$2,864.56
$3,464.52 		$451.74

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Priority Health

Local: 1-855-682-5217 | Toll Free: 1-855-682-5217 | TTY: 1-888-551-6761
Toc - Plan #10 Priority Health
Expanded Bronze

(HMO) MyPriority HSA Bronze 7100

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-682-5217

Annual Out of Pocket Expenses:

Individual Family
$7,100 $14,200 Annual Deductible
$7,100 $14,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$304.87
$346.03
$389.62
$544.50
$827.42 		$538.10
$579.26
$622.85
$777.73 		$771.33
$812.49
$856.08
$1,010.96 		$1,004.56
$1,045.72
$1,089.31
$1,244.19 		$233.23
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$609.74
$692.06
$779.24
$1,089.00
$1,654.84 		$842.97
$925.29
$1,012.47
$1,322.23 		$1,076.20
$1,158.52
$1,245.70
$1,555.46 		$1,309.43
$1,391.75
$1,478.93
$1,788.69 		$233.23
Toc - Plan #11 Priority Health
Expanded Bronze

(HMO) MyPriority Bronze 9100

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-682-5217

Annual Out of Pocket Expenses:

Individual Family
$9,100 $18,200 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$278.59
$316.20
$356.04
$497.56
$756.09 		$491.71
$529.32
$569.16
$710.68 		$704.83
$742.44
$782.28
$923.80 		$917.95
$955.56
$995.40
$1,136.92 		$213.12
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$557.18
$632.40
$712.08
$995.12
$1,512.18 		$770.30
$845.52
$925.20
$1,208.24 		$983.42
$1,058.64
$1,138.32
$1,421.36 		$1,196.54
$1,271.76
$1,351.44
$1,634.48 		$213.12
Toc - Plan #12 Priority Health
Expanded Bronze

(HMO) MyPriority Telehealth PCP Bronze 9100 - Virtual First

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-682-5217

Annual Out of Pocket Expenses:

Individual Family
$9,100 $18,200 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$263.27
$298.81
$336.46
$470.20
$714.51 		$464.67
$500.21
$537.86
$671.60 		$666.07
$701.61
$739.26
$873.00 		$867.47
$903.01
$940.66
$1,074.40 		$201.40
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$526.54
$597.62
$672.92
$940.40
$1,429.02 		$727.94
$799.02
$874.32
$1,141.80 		$929.34
$1,000.42
$1,075.72
$1,343.20 		$1,130.74
$1,201.82
$1,277.12
$1,544.60 		$201.40
Toc - Plan #13 Priority Health
Expanded Bronze

(HMO) MyPriority Travel Bronze 9100

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-682-5217

Annual Out of Pocket Expenses:

Individual Family
$9,100 $18,200 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$320.38
$363.63
$409.45
$572.20
$869.51 		$565.47
$608.72
$654.54
$817.29 		$810.56
$853.81
$899.63
$1,062.38 		$1,055.65
$1,098.90
$1,144.72
$1,307.47 		$245.09
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$640.76
$727.26
$818.90
$1,144.40
$1,739.02 		$885.85
$972.35
$1,063.99
$1,389.49 		$1,130.94
$1,217.44
$1,309.08
$1,634.58 		$1,376.03
$1,462.53
$1,554.17
$1,879.67 		$245.09
Toc - Plan #14 Priority Health
Silver

(HMO) MyPriority Silver 3600

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-682-5217

Annual Out of Pocket Expenses:

Individual Family
$3,600 $7,200 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$380.34
$431.69
$486.07
$679.29
$1,032.24 		$671.30
$722.65
$777.03
$970.25 		$962.26
$1,013.61
$1,067.99
$1,261.21 		$1,253.22
$1,304.57
$1,358.95
$1,552.17 		$290.96
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$760.68
$863.38
$972.14
$1,358.58
$2,064.48 		$1,051.64
$1,154.34
$1,263.10
$1,649.54 		$1,342.60
$1,445.30
$1,554.06
$1,940.50 		$1,633.56
$1,736.26
$1,845.02
$2,231.46 		$290.96
Toc - Plan #15 Priority Health
Silver

(HMO) MyPriority Silver 5500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-682-5217

Annual Out of Pocket Expenses:

Individual Family
$5,500 $11,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$367.70
$417.34
$469.92
$656.71
$997.94 		$648.99
$698.63
$751.21
$938.00 		$930.28
$979.92
$1,032.50
$1,219.29 		$1,211.57
$1,261.21
$1,313.79
$1,500.58 		$281.29
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$735.40
$834.68
$939.84
$1,313.42
$1,995.88 		$1,016.69
$1,115.97
$1,221.13
$1,594.71 		$1,297.98
$1,397.26
$1,502.42
$1,876.00 		$1,579.27
$1,678.55
$1,783.71
$2,157.29 		$281.29
Toc - Plan #16 Priority Health
Silver

(HMO) MyPriority Telehealth PCP Silver 5500 - Virtual First

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-682-5217

Annual Out of Pocket Expenses:

Individual Family
$5,500 $11,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$347.47
$394.38
$444.07
$620.58
$943.03 		$613.28
$660.19
$709.88
$886.39 		$879.09
$926.00
$975.69
$1,152.20 		$1,144.90
$1,191.81
$1,241.50
$1,418.01 		$265.81
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$694.94
$788.76
$888.14
$1,241.16
$1,886.06 		$960.75
$1,054.57
$1,153.95
$1,506.97 		$1,226.56
$1,320.38
$1,419.76
$1,772.78 		$1,492.37
$1,586.19
$1,685.57
$2,038.59 		$265.81
Toc - Plan #17 Priority Health
Silver

(HMO) MyPriority Travel Silver 5500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-682-5217

Annual Out of Pocket Expenses:

Individual Family
$5,500 $11,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$441.23
$500.80
$563.89
$788.04
$1,197.50 		$778.77
$838.34
$901.43
$1,125.58 		$1,116.31
$1,175.88
$1,238.97
$1,463.12 		$1,453.85
$1,513.42
$1,576.51
$1,800.66 		$337.54
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$882.46
$1,001.60
$1,127.78
$1,576.08
$2,395.00 		$1,220.00
$1,339.14
$1,465.32
$1,913.62 		$1,557.54
$1,676.68
$1,802.86
$2,251.16 		$1,895.08
$2,014.22
$2,140.40
$2,588.70 		$337.54
Toc - Plan #18 Priority Health
Expanded Bronze

(HMO) MyPriority Standard Bronze 7500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-682-5217

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$281.04
$318.98
$359.17
$501.94
$762.74 		$496.04
$533.98
$574.17
$716.94 		$711.04
$748.98
$789.17
$931.94 		$926.04
$963.98
$1,004.17
$1,146.94 		$215.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$562.08
$637.96
$718.34
$1,003.88
$1,525.48 		$777.08
$852.96
$933.34
$1,218.88 		$992.08
$1,067.96
$1,148.34
$1,433.88 		$1,207.08
$1,282.96
$1,363.34
$1,648.88 		$215.00
Toc - Plan #19 Priority Health
Silver

(HMO) MyPriority Standard Silver 5800

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-682-5217

Annual Out of Pocket Expenses:

Individual Family
$5,800 $11,600 Annual Deductible
$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$392.26
$445.22
$501.31
$700.58
$1,064.59 		$692.34
$745.30
$801.39
$1,000.66 		$992.42
$1,045.38
$1,101.47
$1,300.74 		$1,292.50
$1,345.46
$1,401.55
$1,600.82 		$300.08
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$784.52
$890.44
$1,002.62
$1,401.16
$2,129.18 		$1,084.60
$1,190.52
$1,302.70
$1,701.24 		$1,384.68
$1,490.60
$1,602.78
$2,001.32 		$1,684.76
$1,790.68
$1,902.86
$2,301.40 		$300.08
Toc - Plan #20 Priority Health
Gold

(HMO) MyPriority Standard Gold 2000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-682-5217

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$516.60
$586.34
$660.21
$922.65
$1,402.05 		$911.80
$981.54
$1,055.41
$1,317.85 		$1,307.00
$1,376.74
$1,450.61
$1,713.05 		$1,702.20
$1,771.94
$1,845.81
$2,108.25 		$395.20
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,033.20
$1,172.68
$1,320.42
$1,845.30
$2,804.10 		$1,428.40
$1,567.88
$1,715.62
$2,240.50 		$1,823.60
$1,963.08
$2,110.82
$2,635.70 		$2,218.80
$2,358.28
$2,506.02
$3,030.90 		$395.20

ADVERTISEMENT

Physicians Health Plan

Local: 1-517-364-8500 | Toll Free: 1-800-832-9186 | TTY: 1-800-649-3777
Toc - Plan #21 Physicians Health Plan
Silver

(HMO) Sparrow PHP Exclusive Silver 4000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-832-9186

Annual Out of Pocket Expenses:

Individual Family
$4,000 $8,000 Annual Deductible
$8,500 $17,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$330.98
$375.66
$422.99
$591.13
$898.28 		$584.18
$628.86
$676.19
$844.33 		$837.38
$882.06
$929.39
$1,097.53 		$1,090.58
$1,135.26
$1,182.59
$1,350.73 		$253.20
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$661.96
$751.32
$845.98
$1,182.26
$1,796.56 		$915.16
$1,004.52
$1,099.18
$1,435.46 		$1,168.36
$1,257.72
$1,352.38
$1,688.66 		$1,421.56
$1,510.92
$1,605.58
$1,941.86 		$253.20
Toc - Plan #22 Physicians Health Plan
Gold

(HMO) Sparrow PHP Exclusive Gold 1000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-832-9186

Annual Out of Pocket Expenses:

Individual Family
$1,000 $2,000 Annual Deductible
$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$360.84
$409.55
$461.15
$644.46
$979.32 		$636.88
$685.59
$737.19
$920.50 		$912.92
$961.63
$1,013.23
$1,196.54 		$1,188.96
$1,237.67
$1,289.27
$1,472.58 		$276.04
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$721.68
$819.10
$922.30
$1,288.92
$1,958.64 		$997.72
$1,095.14
$1,198.34
$1,564.96 		$1,273.76
$1,371.18
$1,474.38
$1,841.00 		$1,549.80
$1,647.22
$1,750.42
$2,117.04 		$276.04
Toc - Plan #23 Physicians Health Plan
Gold

(HMO) Sparrow PHP Exclusive Gold 2000 30%

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-832-9186

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$6,800 $13,600 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$338.84
$384.58
$433.04
$605.17
$919.61 		$598.05
$643.79
$692.25
$864.38 		$857.26
$903.00
$951.46
$1,123.59 		$1,116.47
$1,162.21
$1,210.67
$1,382.80 		$259.21
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$677.68
$769.16
$866.08
$1,210.34
$1,839.22 		$936.89
$1,028.37
$1,125.29
$1,469.55 		$1,196.10
$1,287.58
$1,384.50
$1,728.76 		$1,455.31
$1,546.79
$1,643.71
$1,987.97 		$259.21
Toc - Plan #24 Physicians Health Plan
Silver

(HMO) Sparrow PHP Exclusive Silver 7000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-832-9186

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 Annual Deductible
$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$332.64
$377.54
$425.11
$594.09
$902.78 		$587.11
$632.01
$679.58
$848.56 		$841.58
$886.48
$934.05
$1,103.03 		$1,096.05
$1,140.95
$1,188.52
$1,357.50 		$254.47
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$665.28
$755.08
$850.22
$1,188.18
$1,805.56 		$919.75
$1,009.55
$1,104.69
$1,442.65 		$1,174.22
$1,264.02
$1,359.16
$1,697.12 		$1,428.69
$1,518.49
$1,613.63
$1,951.59 		$254.47
Toc - Plan #25 Physicians Health Plan
Silver

(HMO) Sparrow PHP Exclusive Silver 2500 Basic

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-832-9186

Annual Out of Pocket Expenses:

Individual Family
$2,500 $5,000 Annual Deductible
$8,500 $17,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$321.89
$365.34
$411.37
$574.89
$873.60 		$568.13
$611.58
$657.61
$821.13 		$814.37
$857.82
$903.85
$1,067.37 		$1,060.61
$1,104.06
$1,150.09
$1,313.61 		$246.24
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$643.78
$730.68
$822.74
$1,149.78
$1,747.20 		$890.02
$976.92
$1,068.98
$1,396.02 		$1,136.26
$1,223.16
$1,315.22
$1,642.26 		$1,382.50
$1,469.40
$1,561.46
$1,888.50 		$246.24
Toc - Plan #26 Physicians Health Plan
Catastrophic

(HMO) Sparrow PHP Exclusive Healthy

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-832-9186

Annual Out of Pocket Expenses:

Individual Family
$9,100 $18,200 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$208.40
$236.54
$266.34
$372.20
$565.60 		$367.83
$395.97
$425.77
$531.63 		$527.26
$555.40
$585.20
$691.06 		$686.69
$714.83
$744.63
$850.49 		$159.43
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$416.80
$473.08
$532.68
$744.40
$1,131.20 		$576.23
$632.51
$692.11
$903.83 		$735.66
$791.94
$851.54
$1,063.26 		$895.09
$951.37
$1,010.97
$1,222.69 		$159.43
Toc - Plan #27 Physicians Health Plan
Gold

(HMO) Sparrow PHP Exclusive Gold 1400

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-832-9186

Annual Out of Pocket Expenses:

Individual Family
$1,400 $2,800 Annual Deductible
$6,750 $13,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$353.27
$400.96
$451.47
$630.93
$958.76 		$623.52
$671.21
$721.72
$901.18 		$893.77
$941.46
$991.97
$1,171.43 		$1,164.02
$1,211.71
$1,262.22
$1,441.68 		$270.25
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$706.54
$801.92
$902.94
$1,261.86
$1,917.52 		$976.79
$1,072.17
$1,173.19
$1,532.11 		$1,247.04
$1,342.42
$1,443.44
$1,802.36 		$1,517.29
$1,612.67
$1,713.69
$2,072.61 		$270.25
Toc - Plan #28 Physicians Health Plan
Bronze

(HMO) Sparrow PHP Exclusive Bronze 6500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-832-9186

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 Annual Deductible
$8,500 $17,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$230.89
$262.06
$295.08
$412.37
$626.63 		$407.52
$438.69
$471.71
$589.00 		$584.15
$615.32
$648.34
$765.63 		$760.78
$791.95
$824.97
$942.26 		$176.63
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$461.78
$524.12
$590.16
$824.74
$1,253.26 		$638.41
$700.75
$766.79
$1,001.37 		$815.04
$877.38
$943.42
$1,178.00 		$991.67
$1,054.01
$1,120.05
$1,354.63 		$176.63
Toc - Plan #29 Physicians Health Plan
Expanded Bronze

(HMO) Sparrow PHP Exclusive Bronze 8500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-832-9186

Annual Out of Pocket Expenses:

Individual Family
$8,500 $17,000 Annual Deductible
$8,500 $17,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$237.13
$269.13
$303.04
$423.50
$643.55 		$418.53
$450.53
$484.44
$604.90 		$599.93
$631.93
$665.84
$786.30 		$781.33
$813.33
$847.24
$967.70 		$181.40
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$474.26
$538.26
$606.08
$847.00
$1,287.10 		$655.66
$719.66
$787.48
$1,028.40 		$837.06
$901.06
$968.88
$1,209.80 		$1,018.46
$1,082.46
$1,150.28
$1,391.20 		$181.40
Toc - Plan #30 Physicians Health Plan
Gold

(HMO) Sparrow PHP Exclusive Gold 2000 25%

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-832-9186

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$342.45
$388.68
$437.65
$611.61
$929.40 		$604.42
$650.65
$699.62
$873.58 		$866.39
$912.62
$961.59
$1,135.55 		$1,128.36
$1,174.59
$1,223.56
$1,397.52 		$261.97
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$684.90
$777.36
$875.30
$1,223.22
$1,858.80 		$946.87
$1,039.33
$1,137.27
$1,485.19 		$1,208.84
$1,301.30
$1,399.24
$1,747.16 		$1,470.81
$1,563.27
$1,661.21
$2,009.13 		$261.97
Toc - Plan #31 Physicians Health Plan
Silver

(HMO) Sparrow PHP Exclusive Silver 5800

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-832-9186

Annual Out of Pocket Expenses:

Individual Family
$5,800 $11,600 Annual Deductible
$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$315.69
$358.30
$403.44
$563.81
$856.77 		$557.19
$599.80
$644.94
$805.31 		$798.69
$841.30
$886.44
$1,046.81 		$1,040.19
$1,082.80
$1,127.94
$1,288.31 		$241.50
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$631.38
$716.60
$806.88
$1,127.62
$1,713.54 		$872.88
$958.10
$1,048.38
$1,369.12 		$1,114.38
$1,199.60
$1,289.88
$1,610.62 		$1,355.88
$1,441.10
$1,531.38
$1,852.12 		$241.50
Toc - Plan #32 Physicians Health Plan
Expanded Bronze

(HMO) Sparrow PHP Exclusive Bronze 7500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-832-9186

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$223.68
$253.87
$285.86
$399.49
$607.06 		$394.79
$424.98
$456.97
$570.60 		$565.90
$596.09
$628.08
$741.71 		$737.01
$767.20
$799.19
$912.82 		$171.11
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$447.36
$507.74
$571.72
$798.98
$1,214.12 		$618.47
$678.85
$742.83
$970.09 		$789.58
$849.96
$913.94
$1,141.20 		$960.69
$1,021.07
$1,085.05
$1,312.31 		$171.11
Toc - Plan #33 Physicians Health Plan
Expanded Bronze

(HMO) Sparrow PHP Exclusive Bronze 6900 HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-832-9186

Annual Out of Pocket Expenses:

Individual Family
$6,900 $13,800 Annual Deductible
$6,900 $13,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$242.57
$275.31
$310.00
$433.23
$658.33 		$428.13
$460.87
$495.56
$618.79 		$613.69
$646.43
$681.12
$804.35 		$799.25
$831.99
$866.68
$989.91 		$185.56
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$485.14
$550.62
$620.00
$866.46
$1,316.66 		$670.70
$736.18
$805.56
$1,052.02 		$856.26
$921.74
$991.12
$1,237.58 		$1,041.82
$1,107.30
$1,176.68
$1,423.14 		$185.56

ADVERTISEMENT

McLaren Health Plan Community

Local: 1-888-327-0671 | Toll Free: 1-888-327-0671 | TTY: 1-800-356-3232
Toc - Plan #34 McLaren Health Plan Community
Catastrophic

(HMO) McLaren Young Adult/Catastrophic

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-327-0671

Annual Out of Pocket Expenses:

Individual Family
$9,100 $18,200 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$202.59
$229.93
$258.90
$361.82
$549.82 		$357.57
$384.91
$413.88
$516.80 		$512.55
$539.89
$568.86
$671.78 		$667.53
$694.87
$723.84
$826.76 		$154.98
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$405.18
$459.86
$517.80
$723.64
$1,099.64 		$560.16
$614.84
$672.78
$878.62 		$715.14
$769.82
$827.76
$1,033.60 		$870.12
$924.80
$982.74
$1,188.58 		$154.98
Toc - Plan #35 McLaren Health Plan Community
Silver

(HMO) McLaren Silver Exchange

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-327-0671

Annual Out of Pocket Expenses:

Individual Family
$3,800 $7,600 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$358.47
$406.86
$458.12
$640.22
$972.88 		$632.70
$681.09
$732.35
$914.45 		$906.93
$955.32
$1,006.58
$1,188.68 		$1,181.16
$1,229.55
$1,280.81
$1,462.91 		$274.23
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$716.94
$813.72
$916.24
$1,280.44
$1,945.76 		$991.17
$1,087.95
$1,190.47
$1,554.67 		$1,265.40
$1,362.18
$1,464.70
$1,828.90 		$1,539.63
$1,636.41
$1,738.93
$2,103.13 		$274.23
Toc - Plan #36 McLaren Health Plan Community
Gold

(HMO) McLaren Gold 1400

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-327-0671

Annual Out of Pocket Expenses:

Individual Family
$1,400 $2,800 Annual Deductible
$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$347.95
$394.92
$444.68
$621.44
$944.34 		$614.13
$661.10
$710.86
$887.62 		$880.31
$927.28
$977.04
$1,153.80 		$1,146.49
$1,193.46
$1,243.22
$1,419.98 		$266.18
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$695.90
$789.84
$889.36
$1,242.88
$1,888.68 		$962.08
$1,056.02
$1,155.54
$1,509.06 		$1,228.26
$1,322.20
$1,421.72
$1,775.24 		$1,494.44
$1,588.38
$1,687.90
$2,041.42 		$266.18
Toc - Plan #37 McLaren Health Plan Community
Bronze

(HMO) McLaren Bronze 6500

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-327-0671

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$224.04
$254.29
$286.33
$400.14
$608.05 		$395.43
$425.68
$457.72
$571.53 		$566.82
$597.07
$629.11
$742.92 		$738.21
$768.46
$800.50
$914.31 		$171.39
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$448.08
$508.58
$572.66
$800.28
$1,216.10 		$619.47
$679.97
$744.05
$971.67 		$790.86
$851.36
$915.44
$1,143.06 		$962.25
$1,022.75
$1,086.83
$1,314.45 		$171.39
Toc - Plan #38 McLaren Health Plan Community
Expanded Bronze

(HMO) McLaren Bronze Saver

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-327-0671

Annual Out of Pocket Expenses:

Individual Family
$7,100 $14,200 Annual Deductible
$7,100 $14,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$246.76
$280.08
$315.36
$440.72
$669.71 		$435.53
$468.85
$504.13
$629.49 		$624.30
$657.62
$692.90
$818.26 		$813.07
$846.39
$881.67
$1,007.03 		$188.77
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$493.52
$560.16
$630.72
$881.44
$1,339.42 		$682.29
$748.93
$819.49
$1,070.21 		$871.06
$937.70
$1,008.26
$1,258.98 		$1,059.83
$1,126.47
$1,197.03
$1,447.75 		$188.77
Toc - Plan #39 McLaren Health Plan Community
Silver

(HMO) McLaren Silver Exchange Rewards

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-327-0671

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$8,250 $16,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$349.10
$396.23
$446.15
$623.49
$947.46 		$616.16
$663.29
$713.21
$890.55 		$883.22
$930.35
$980.27
$1,157.61 		$1,150.28
$1,197.41
$1,247.33
$1,424.67 		$267.06
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$698.20
$792.46
$892.30
$1,246.98
$1,894.92 		$965.26
$1,059.52
$1,159.36
$1,514.04 		$1,232.32
$1,326.58
$1,426.42
$1,781.10 		$1,499.38
$1,593.64
$1,693.48
$2,048.16 		$267.06
Toc - Plan #40 McLaren Health Plan Community
Gold

(HMO) McLaren Gold Standard

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-327-0671

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$346.20
$392.94
$442.45
$618.32
$939.59 		$611.04
$657.78
$707.29
$883.16 		$875.88
$922.62
$972.13
$1,148.00 		$1,140.72
$1,187.46
$1,236.97
$1,412.84 		$264.84
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$692.40
$785.88
$884.90
$1,236.64
$1,879.18 		$957.24
$1,050.72
$1,149.74
$1,501.48 		$1,222.08
$1,315.56
$1,414.58
$1,766.32 		$1,486.92
$1,580.40
$1,679.42
$2,031.16 		$264.84
Toc - Plan #41 McLaren Health Plan Community
Silver

(HMO) McLaren Silver Standard

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-327-0671

Annual Out of Pocket Expenses:

Individual Family
$5,800 $11,600 Annual Deductible
$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$357.17
$405.39
$456.46
$637.90
$969.36 		$630.40
$678.62
$729.69
$911.13 		$903.63
$951.85
$1,002.92
$1,184.36 		$1,176.86
$1,225.08
$1,276.15
$1,457.59 		$273.23
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$714.34
$810.78
$912.92
$1,275.80
$1,938.72 		$987.57
$1,084.01
$1,186.15
$1,549.03 		$1,260.80
$1,357.24
$1,459.38
$1,822.26 		$1,534.03
$1,630.47
$1,732.61
$2,095.49 		$273.23
Toc - Plan #42 McLaren Health Plan Community
Bronze

(HMO) McLaren Bronze Standard

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-327-0671

Annual Out of Pocket Expenses:

Individual Family
$9,100 $18,200 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$224.53
$254.84
$286.95
$401.01
$609.38 		$396.30
$426.61
$458.72
$572.78 		$568.07
$598.38
$630.49
$744.55 		$739.84
$770.15
$802.26
$916.32 		$171.77
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$449.06
$509.68
$573.90
$802.02
$1,218.76 		$620.83
$681.45
$745.67
$973.79 		$792.60
$853.22
$917.44
$1,145.56 		$964.37
$1,024.99
$1,089.21
$1,317.33 		$171.77
Toc - Plan #43 McLaren Health Plan Community
Expanded Bronze

(HMO) McLaren Expanded Bronze Standard

Benefits & Coverage Provider Directory
Customer Service Phone: 1-888-327-0671

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$239.48
$271.81
$306.06
$427.71
$649.95 		$422.68
$455.01
$489.26
$610.91 		$605.88
$638.21
$672.46
$794.11 		$789.08
$821.41
$855.66
$977.31 		$183.20
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$478.96
$543.62
$612.12
$855.42
$1,299.90 		$662.16
$726.82
$795.32
$1,038.62 		$845.36
$910.02
$978.52
$1,221.82 		$1,028.56
$1,093.22
$1,161.72
$1,405.02 		$183.20

ADVERTISEMENT

Blue Care Network of Michigan

Local: 1-888-227-2345 | Toll Free: 1-888-227-2345 | TTY: 1-800-257-9980
Toc - Plan #44 Blue Care Network of Michigan
Catastrophic

(HMO) Blue Cross® Select HMO Value

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-227-2345

Annual Out of Pocket Expenses:

Individual Family
$9,100 $18,200 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$226.95
$257.59
$290.04
$405.33
$615.94 		$400.57
$431.21
$463.66
$578.95 		$574.19
$604.83
$637.28
$752.57 		$747.81
$778.45
$810.90
$926.19 		$173.62
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$453.90
$515.18
$580.08
$810.66
$1,231.88 		$627.52
$688.80
$753.70
$984.28 		$801.14
$862.42
$927.32
$1,157.90 		$974.76
$1,036.04
$1,100.94
$1,331.52 		$173.62
Toc - Plan #45 Blue Care Network of Michigan
Silver

(HMO) Blue Cross® Select HMO Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-227-2345

Annual Out of Pocket Expenses:

Individual Family
$4,650 $9,300 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$393.48
$446.60
$502.87
$702.76
$1,067.90 		$694.49
$747.61
$803.88
$1,003.77 		$995.50
$1,048.62
$1,104.89
$1,304.78 		$1,296.51
$1,349.63
$1,405.90
$1,605.79 		$301.01
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$786.96
$893.20
$1,005.74
$1,405.52
$2,135.80 		$1,087.97
$1,194.21
$1,306.75
$1,706.53 		$1,388.98
$1,495.22
$1,607.76
$2,007.54 		$1,689.99
$1,796.23
$1,908.77
$2,308.55 		$301.01
Toc - Plan #46 Blue Care Network of Michigan
Silver

(HMO) Blue Cross® Preferred HMO Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-227-2345

Annual Out of Pocket Expenses:

Individual Family
$4,650 $9,300 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$432.34
$490.71
$552.53
$772.16
$1,173.37 		$763.08
$821.45
$883.27
$1,102.90 		$1,093.82
$1,152.19
$1,214.01
$1,433.64 		$1,424.56
$1,482.93
$1,544.75
$1,764.38 		$330.74
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$864.68
$981.42
$1,105.06
$1,544.32
$2,346.74 		$1,195.42
$1,312.16
$1,435.80
$1,875.06 		$1,526.16
$1,642.90
$1,766.54
$2,205.80 		$1,856.90
$1,973.64
$2,097.28
$2,536.54 		$330.74
Toc - Plan #47 Blue Care Network of Michigan
Gold

(HMO) Blue Cross® Preferred HMO Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-227-2345

Annual Out of Pocket Expenses:

Individual Family
$1,600 $3,200 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$486.43
$552.10
$621.66
$868.76
$1,320.17 		$858.55
$924.22
$993.78
$1,240.88 		$1,230.67
$1,296.34
$1,365.90
$1,613.00 		$1,602.79
$1,668.46
$1,738.02
$1,985.12 		$372.12
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$972.86
$1,104.20
$1,243.32
$1,737.52
$2,640.34 		$1,344.98
$1,476.32
$1,615.44
$2,109.64 		$1,717.10
$1,848.44
$1,987.56
$2,481.76 		$2,089.22
$2,220.56
$2,359.68
$2,853.88 		$372.12
Toc - Plan #48 Blue Care Network of Michigan
Silver

(HMO) Blue Cross® Select HMO Silver Saver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-227-2345

Annual Out of Pocket Expenses:

Individual Family
$5,500 $11,000 Annual Deductible
$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$352.63
$400.24
$450.66
$629.80
$957.04 		$622.39
$670.00
$720.42
$899.56 		$892.15
$939.76
$990.18
$1,169.32 		$1,161.91
$1,209.52
$1,259.94
$1,439.08 		$269.76
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$705.26
$800.48
$901.32
$1,259.60
$1,914.08 		$975.02
$1,070.24
$1,171.08
$1,529.36 		$1,244.78
$1,340.00
$1,440.84
$1,799.12 		$1,514.54
$1,609.76
$1,710.60
$2,068.88 		$269.76
Toc - Plan #49 Blue Care Network of Michigan
Silver

(HMO) Blue Cross® Preferred HMO Silver Saver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-227-2345

Annual Out of Pocket Expenses:

Individual Family
$5,500 $11,000 Annual Deductible
$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$387.45
$439.76
$495.16
$691.99
$1,051.54 		$683.85
$736.16
$791.56
$988.39 		$980.25
$1,032.56
$1,087.96
$1,284.79 		$1,276.65
$1,328.96
$1,384.36
$1,581.19 		$296.40
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$774.90
$879.52
$990.32
$1,383.98
$2,103.08 		$1,071.30
$1,175.92
$1,286.72
$1,680.38 		$1,367.70
$1,472.32
$1,583.12
$1,976.78 		$1,664.10
$1,768.72
$1,879.52
$2,273.18 		$296.40
Toc - Plan #50 Blue Care Network of Michigan
Expanded Bronze

(HMO) Blue Cross® Select HMO Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-227-2345

Annual Out of Pocket Expenses:

Individual Family
$9,100 $18,200 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$276.66
$314.01
$353.57
$494.11
$750.86 		$488.30
$525.65
$565.21
$705.75 		$699.94
$737.29
$776.85
$917.39 		$911.58
$948.93
$988.49
$1,129.03 		$211.64
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$553.32
$628.02
$707.14
$988.22
$1,501.72 		$764.96
$839.66
$918.78
$1,199.86 		$976.60
$1,051.30
$1,130.42
$1,411.50 		$1,188.24
$1,262.94
$1,342.06
$1,623.14 		$211.64
Toc - Plan #51 Blue Care Network of Michigan
Expanded Bronze

(HMO) Blue Cross® Select HMO Bronze Saver HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-227-2345

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$281.12
$319.07
$359.27
$502.08
$762.96 		$496.18
$534.13
$574.33
$717.14 		$711.24
$749.19
$789.39
$932.20 		$926.30
$964.25
$1,004.45
$1,147.26 		$215.06
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$562.24
$638.14
$718.54
$1,004.16
$1,525.92 		$777.30
$853.20
$933.60
$1,219.22 		$992.36
$1,068.26
$1,148.66
$1,434.28 		$1,207.42
$1,283.32
$1,363.72
$1,649.34 		$215.06
Toc - Plan #52 Blue Care Network of Michigan
Expanded Bronze

(HMO) Blue Cross® Preferred HMO Bronze Saver HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-227-2345

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$308.87
$350.57
$394.74
$551.64
$838.27 		$545.16
$586.86
$631.03
$787.93 		$781.45
$823.15
$867.32
$1,024.22 		$1,017.74
$1,059.44
$1,103.61
$1,260.51 		$236.29
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$617.74
$701.14
$789.48
$1,103.28
$1,676.54 		$854.03
$937.43
$1,025.77
$1,339.57 		$1,090.32
$1,173.72
$1,262.06
$1,575.86 		$1,326.61
$1,410.01
$1,498.35
$1,812.15 		$236.29
Toc - Plan #53 Blue Care Network of Michigan
Expanded Bronze

(HMO) Blue Cross® Preferred HMO Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-227-2345

Annual Out of Pocket Expenses:

Individual Family
$9,100 $18,200 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$303.98
$345.02
$388.49
$542.91
$825.00 		$536.52
$577.56
$621.03
$775.45 		$769.06
$810.10
$853.57
$1,007.99 		$1,001.60
$1,042.64
$1,086.11
$1,240.53 		$232.54
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$607.96
$690.04
$776.98
$1,085.82
$1,650.00 		$840.50
$922.58
$1,009.52
$1,318.36 		$1,073.04
$1,155.12
$1,242.06
$1,550.90 		$1,305.58
$1,387.66
$1,474.60
$1,783.44 		$232.54
Toc - Plan #54 Blue Care Network of Michigan
Silver

(HMO) Blue Cross® Select HMO Silver Extra

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-227-2345

Annual Out of Pocket Expenses:

Individual Family
$5,800 $11,600 Annual Deductible
$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$413.26
$469.05
$528.15
$738.08
$1,121.59 		$729.40
$785.19
$844.29
$1,054.22 		$1,045.54
$1,101.33
$1,160.43
$1,370.36 		$1,361.68
$1,417.47
$1,476.57
$1,686.50 		$316.14
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$826.52
$938.10
$1,056.30
$1,476.16
$2,243.18 		$1,142.66
$1,254.24
$1,372.44
$1,792.30 		$1,458.80
$1,570.38
$1,688.58
$2,108.44 		$1,774.94
$1,886.52
$2,004.72
$2,424.58 		$316.14
Toc - Plan #55 Blue Care Network of Michigan
Silver

(HMO) Blue Cross® Preferred HMO Silver Extra

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-227-2345

Annual Out of Pocket Expenses:

Individual Family
$5,800 $11,600 Annual Deductible
$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$454.08
$515.38
$580.31
$810.99
$1,232.37 		$801.45
$862.75
$927.68
$1,158.36 		$1,148.82
$1,210.12
$1,275.05
$1,505.73 		$1,496.19
$1,557.49
$1,622.42
$1,853.10 		$347.37
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$908.16
$1,030.76
$1,160.62
$1,621.98
$2,464.74 		$1,255.53
$1,378.13
$1,507.99
$1,969.35 		$1,602.90
$1,725.50
$1,855.36
$2,316.72 		$1,950.27
$2,072.87
$2,202.73
$2,664.09 		$347.37
Toc - Plan #56 Blue Care Network of Michigan
Gold

(HMO) Blue Cross® Preferred HMO Gold Extra

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-227-2345

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$489.70
$555.81
$625.84
$874.60
$1,329.05 		$864.32
$930.43
$1,000.46
$1,249.22 		$1,238.94
$1,305.05
$1,375.08
$1,623.84 		$1,613.56
$1,679.67
$1,749.70
$1,998.46 		$374.62
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$979.40
$1,111.62
$1,251.68
$1,749.20
$2,658.10 		$1,354.02
$1,486.24
$1,626.30
$2,123.82 		$1,728.64
$1,860.86
$2,000.92
$2,498.44 		$2,103.26
$2,235.48
$2,375.54
$2,873.06 		$374.62
Toc - Plan #57 Blue Care Network of Michigan
Expanded Bronze

(HMO) Blue Cross® Select HMO Bronze Extra

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-227-2345

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$266.25
$302.19
$340.27
$475.52
$722.60 		$469.93
$505.87
$543.95
$679.20 		$673.61
$709.55
$747.63
$882.88 		$877.29
$913.23
$951.31
$1,086.56 		$203.68
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$532.50
$604.38
$680.54
$951.04
$1,445.20 		$736.18
$808.06
$884.22
$1,154.72 		$939.86
$1,011.74
$1,087.90
$1,358.40 		$1,143.54
$1,215.42
$1,291.58
$1,562.08 		$203.68
Toc - Plan #58 Blue Care Network of Michigan
Expanded Bronze

(HMO) Blue Cross® Preferred HMO Bronze Extra

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-227-2345

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$292.53
$332.02
$373.85
$522.46
$793.93 		$516.32
$555.81
$597.64
$746.25 		$740.11
$779.60
$821.43
$970.04 		$963.90
$1,003.39
$1,045.22
$1,193.83 		$223.79
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$585.06
$664.04
$747.70
$1,044.92
$1,587.86 		$808.85
$887.83
$971.49
$1,268.71 		$1,032.64
$1,111.62
$1,195.28
$1,492.50 		$1,256.43
$1,335.41
$1,419.07
$1,716.29 		$223.79
Toc - Plan #59 Blue Care Network of Michigan
Bronze

(HMO) Blue Cross® Select HMO Bronze Secure

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-227-2345

Annual Out of Pocket Expenses:

Individual Family
$9,100 $18,200 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$236.91
$268.89
$302.77
$423.12
$642.97 		$418.15
$450.13
$484.01
$604.36 		$599.39
$631.37
$665.25
$785.60 		$780.63
$812.61
$846.49
$966.84 		$181.24
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$473.82
$537.78
$605.54
$846.24
$1,285.94 		$655.06
$719.02
$786.78
$1,027.48 		$836.30
$900.26
$968.02
$1,208.72 		$1,017.54
$1,081.50
$1,149.26
$1,389.96 		$181.24
Toc - Plan #60 Blue Care Network of Michigan
Bronze

(HMO) Blue Cross® Preferred HMO Bronze Secure

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-227-2345

Annual Out of Pocket Expenses:

Individual Family
$9,100 $18,200 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$260.30
$295.44
$332.66
$464.90
$706.45 		$459.43
$494.57
$531.79
$664.03 		$658.56
$693.70
$730.92
$863.16 		$857.69
$892.83
$930.05
$1,062.29 		$199.13
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$520.60
$590.88
$665.32
$929.80
$1,412.90 		$719.73
$790.01
$864.45
$1,128.93 		$918.86
$989.14
$1,063.58
$1,328.06 		$1,117.99
$1,188.27
$1,262.71
$1,527.19 		$199.13
Toc - Plan #61 Blue Care Network of Michigan
Expanded Bronze

(HMO) Blue Cross® Preferred HMO Virtual Primary Care Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-227-2345

Annual Out of Pocket Expenses:

Individual Family
$9,000 $18,000 Annual Deductible
$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$280.36
$318.21
$358.30
$500.72
$760.90 		$494.84
$532.69
$572.78
$715.20 		$709.32
$747.17
$787.26
$929.68 		$923.80
$961.65
$1,001.74
$1,144.16 		$214.48
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$560.72
$636.42
$716.60
$1,001.44
$1,521.80 		$775.20
$850.90
$931.08
$1,215.92 		$989.68
$1,065.38
$1,145.56
$1,430.40 		$1,204.16
$1,279.86
$1,360.04
$1,644.88 		$214.48
Toc - Plan #62 Blue Care Network of Michigan
Silver

(HMO) Blue Cross® Preferred HMO Virtual Primary Care Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-227-2345

Annual Out of Pocket Expenses:

Individual Family
$6,050 $12,100 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$393.47
$446.59
$502.85
$702.74
$1,067.88 		$694.47
$747.59
$803.85
$1,003.74 		$995.47
$1,048.59
$1,104.85
$1,304.74 		$1,296.47
$1,349.59
$1,405.85
$1,605.74 		$301.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$786.94
$893.18
$1,005.70
$1,405.48
$2,135.76 		$1,087.94
$1,194.18
$1,306.70
$1,706.48 		$1,388.94
$1,495.18
$1,607.70
$2,007.48 		$1,689.94
$1,796.18
$1,908.70
$2,308.48 		$301.00

‡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 Eaton County here.

Eaton County is in “Rating Area 10” of Michigan.

Currently, there are 62 plans offered in Rating Area 10.

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