Obamacare 2023 Rates for Steele County

Obamacare > Rates > North Dakota > Steele 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 Steele County, ND.

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, 40 Plans and 2023 Rates for Steele County, North Dakota

Below, you’ll find a summary of the 40 plans for Steele County, North Dakota 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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Steele County Resources

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Blue Cross Blue Shield of North Dakota

Local: 1-844-363-8457 | Toll Free: 1-844-363-8457

Toc - Plan #1 Blue Cross Blue Shield of North Dakota
Silver

(PPO) BlueCare 60 Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-363-8457

Annual Out of Pocket Expenses:

Individual Family
$2,500 $5,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$422.99
$480.09
$540.58
$755.46
$1,147.99 		$746.58
$803.68
$864.17
$1,079.05 		$1,070.17
$1,127.27
$1,187.76
$1,402.64 		$1,393.76
$1,450.86
$1,511.35
$1,726.23 		$323.59
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$845.98
$960.18
$1,081.16
$1,510.92
$2,295.98 		$1,169.57
$1,283.77
$1,404.75
$1,834.51 		$1,493.16
$1,607.36
$1,728.34
$2,158.10 		$1,816.75
$1,930.95
$2,051.93
$2,481.69 		$323.59
Toc - Plan #2 Blue Cross Blue Shield of North Dakota
Gold

(PPO) BlueCare 70 Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-363-8457

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 		$393.32
$446.42
$502.66
$702.47
$1,067.47 		$694.21
$747.31
$803.55
$1,003.36 		$995.10
$1,048.20
$1,104.44
$1,304.25 		$1,295.99
$1,349.09
$1,405.33
$1,605.14 		$300.89
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$786.64
$892.84
$1,005.32
$1,404.94
$2,134.94 		$1,087.53
$1,193.73
$1,306.21
$1,705.83 		$1,388.42
$1,494.62
$1,607.10
$2,006.72 		$1,689.31
$1,795.51
$1,907.99
$2,307.61 		$300.89
Toc - Plan #3 Blue Cross Blue Shield of North Dakota
Silver

(PPO) BlueDirect 80 Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-363-8457

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$429.18
$487.12
$548.49
$766.52
$1,164.79 		$757.50
$815.44
$876.81
$1,094.84 		$1,085.82
$1,143.76
$1,205.13
$1,423.16 		$1,414.14
$1,472.08
$1,533.45
$1,751.48 		$328.32
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$858.36
$974.24
$1,096.98
$1,533.04
$2,329.58 		$1,186.68
$1,302.56
$1,425.30
$1,861.36 		$1,515.00
$1,630.88
$1,753.62
$2,189.68 		$1,843.32
$1,959.20
$2,081.94
$2,518.00 		$328.32
Toc - Plan #4 Blue Cross Blue Shield of North Dakota
Expanded Bronze

(PPO) BlueDirect 100 Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-363-8457

Annual Out of Pocket Expenses:

Individual Family
$6,800 $13,600 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 		$277.32
$314.76
$354.41
$495.29
$752.65 		$489.47
$526.91
$566.56
$707.44 		$701.62
$739.06
$778.71
$919.59 		$913.77
$951.21
$990.86
$1,131.74 		$212.15
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$554.64
$629.52
$708.82
$990.58
$1,505.30 		$766.79
$841.67
$920.97
$1,202.73 		$978.94
$1,053.82
$1,133.12
$1,414.88 		$1,191.09
$1,265.97
$1,345.27
$1,627.03 		$212.15
Toc - Plan #5 Blue Cross Blue Shield of North Dakota
Catastrophic

(PPO) BlueEssential 100

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-363-8457

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 		$152.46
$173.04
$194.84
$272.29
$413.78 		$269.09
$289.67
$311.47
$388.92 		$385.72
$406.30
$428.10
$505.55 		$502.35
$522.93
$544.73
$622.18 		$116.63
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$304.92
$346.08
$389.68
$544.58
$827.56 		$421.55
$462.71
$506.31
$661.21 		$538.18
$579.34
$622.94
$777.84 		$654.81
$695.97
$739.57
$894.47 		$116.63
Toc - Plan #6 Blue Cross Blue Shield of North Dakota
Gold

(PPO) BlueDirect 90 Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-363-8457

Annual Out of Pocket Expenses:

Individual Family
$2,600 $5,200 Annual Deductible
$4,300 $8,600 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 		$397.99
$451.72
$508.63
$710.81
$1,080.14 		$702.45
$756.18
$813.09
$1,015.27 		$1,006.91
$1,060.64
$1,117.55
$1,319.73 		$1,311.37
$1,365.10
$1,422.01
$1,624.19 		$304.46
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$795.98
$903.44
$1,017.26
$1,421.62
$2,160.28 		$1,100.44
$1,207.90
$1,321.72
$1,726.08 		$1,404.90
$1,512.36
$1,626.18
$2,030.54 		$1,709.36
$1,816.82
$1,930.64
$2,335.00 		$304.46
Toc - Plan #7 Blue Cross Blue Shield of North Dakota
Expanded Bronze

(PPO) SimplyBlue 50

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-363-8457

Annual Out of Pocket Expenses:

Individual Family
$6,800 $13,600 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$246.30
$279.55
$314.77
$439.89
$668.46 		$434.72
$467.97
$503.19
$628.31 		$623.14
$656.39
$691.61
$816.73 		$811.56
$844.81
$880.03
$1,005.15 		$188.42
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$492.60
$559.10
$629.54
$879.78
$1,336.92 		$681.02
$747.52
$817.96
$1,068.20 		$869.44
$935.94
$1,006.38
$1,256.62 		$1,057.86
$1,124.36
$1,194.80
$1,445.04 		$188.42
Toc - Plan #8 Blue Cross Blue Shield of North Dakota
Gold

(PPO) BlueValue Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-363-8457

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 		$400.16
$454.18
$511.40
$714.69
$1,086.03 		$706.28
$760.30
$817.52
$1,020.81 		$1,012.40
$1,066.42
$1,123.64
$1,326.93 		$1,318.52
$1,372.54
$1,429.76
$1,633.05 		$306.12
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$800.32
$908.36
$1,022.80
$1,429.38
$2,172.06 		$1,106.44
$1,214.48
$1,328.92
$1,735.50 		$1,412.56
$1,520.60
$1,635.04
$2,041.62 		$1,718.68
$1,826.72
$1,941.16
$2,347.74 		$306.12
Toc - Plan #9 Blue Cross Blue Shield of North Dakota
Silver

(PPO) BlueValue Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-363-8457

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 		$416.67
$472.92
$532.50
$744.17
$1,130.84 		$735.42
$791.67
$851.25
$1,062.92 		$1,054.17
$1,110.42
$1,170.00
$1,381.67 		$1,372.92
$1,429.17
$1,488.75
$1,700.42 		$318.75
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$833.34
$945.84
$1,065.00
$1,488.34
$2,261.68 		$1,152.09
$1,264.59
$1,383.75
$1,807.09 		$1,470.84
$1,583.34
$1,702.50
$2,125.84 		$1,789.59
$1,902.09
$2,021.25
$2,444.59 		$318.75
Toc - Plan #10 Blue Cross Blue Shield of North Dakota
Expanded Bronze

(PPO) BlueValue Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-363-8457

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 		$268.85
$305.14
$343.59
$480.17
$729.66 		$474.52
$510.81
$549.26
$685.84 		$680.19
$716.48
$754.93
$891.51 		$885.86
$922.15
$960.60
$1,097.18 		$205.67
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$537.70
$610.28
$687.18
$960.34
$1,459.32 		$743.37
$815.95
$892.85
$1,166.01 		$949.04
$1,021.62
$1,098.52
$1,371.68 		$1,154.71
$1,227.29
$1,304.19
$1,577.35 		$205.67
Toc - Plan #11 Blue Cross Blue Shield of North Dakota
Gold

(PPO) BluePrime 70 Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-363-8457

Annual Out of Pocket Expenses:

Individual Family
$500 $1,000 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 		$391.69
$444.57
$500.58
$699.56
$1,063.05 		$691.33
$744.21
$800.22
$999.20 		$990.97
$1,043.85
$1,099.86
$1,298.84 		$1,290.61
$1,343.49
$1,399.50
$1,598.48 		$299.64
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$783.38
$889.14
$1,001.16
$1,399.12
$2,126.10 		$1,083.02
$1,188.78
$1,300.80
$1,698.76 		$1,382.66
$1,488.42
$1,600.44
$1,998.40 		$1,682.30
$1,788.06
$1,900.08
$2,298.04 		$299.64
Toc - Plan #12 Blue Cross Blue Shield of North Dakota
Gold

(PPO) DakotaBlue Altru Gold 70

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-363-8457

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 		$334.33
$379.46
$427.27
$597.11
$907.37 		$590.09
$635.22
$683.03
$852.87 		$845.85
$890.98
$938.79
$1,108.63 		$1,101.61
$1,146.74
$1,194.55
$1,364.39 		$255.76
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$668.66
$758.92
$854.54
$1,194.22
$1,814.74 		$924.42
$1,014.68
$1,110.30
$1,449.98 		$1,180.18
$1,270.44
$1,366.06
$1,705.74 		$1,435.94
$1,526.20
$1,621.82
$1,961.50 		$255.76
Toc - Plan #13 Blue Cross Blue Shield of North Dakota
Silver

(PPO) DakotaBlue Altru Silver 60

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-363-8457

Annual Out of Pocket Expenses:

Individual Family
$2,500 $5,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$359.54
$408.08
$459.49
$642.14
$975.79 		$634.59
$683.13
$734.54
$917.19 		$909.64
$958.18
$1,009.59
$1,192.24 		$1,184.69
$1,233.23
$1,284.64
$1,467.29 		$275.05
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$719.08
$816.16
$918.98
$1,284.28
$1,951.58 		$994.13
$1,091.21
$1,194.03
$1,559.33 		$1,269.18
$1,366.26
$1,469.08
$1,834.38 		$1,544.23
$1,641.31
$1,744.13
$2,109.43 		$275.05

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Medica

Local: 1-888-592-8211 | Toll Free: 1-888-592-8211 | TTY: 1-800-269-7477
Toc - Plan #14 Medica
Expanded Bronze

(HMO) Altru Prime by Medica Bronze HSA ($0 Virtual Care after Deductible with Designated Providers)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$5,400 $10,800 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 		$333.56
$378.58
$426.27
$595.72
$905.25 		$588.72
$633.74
$681.43
$850.88 		$843.88
$888.90
$936.59
$1,106.04 		$1,099.04
$1,144.06
$1,191.75
$1,361.20 		$255.16
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$667.12
$757.16
$852.54
$1,191.44
$1,810.50 		$922.28
$1,012.32
$1,107.70
$1,446.60 		$1,177.44
$1,267.48
$1,362.86
$1,701.76 		$1,432.60
$1,522.64
$1,618.02
$1,956.92 		$255.16
Toc - Plan #15 Medica
Catastrophic

(HMO) Altru Prime by Medica Catastrophic ($0 Virtual Care with Designated Providers)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$200.87
$227.97
$256.70
$358.73
$545.13 		$354.53
$381.63
$410.36
$512.39 		$508.19
$535.29
$564.02
$666.05 		$661.85
$688.95
$717.68
$819.71 		$153.66
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$401.74
$455.94
$513.40
$717.46
$1,090.26 		$555.40
$609.60
$667.06
$871.12 		$709.06
$763.26
$820.72
$1,024.78 		$862.72
$916.92
$974.38
$1,178.44 		$153.66
Toc - Plan #16 Medica
Expanded Bronze

(HMO) Altru Prime by Medica Bronze Share Plus ($0 Virtual Care with Designated Providers)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$2,500 $5,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$291.82
$331.20
$372.93
$521.16
$791.96 		$515.05
$554.43
$596.16
$744.39 		$738.28
$777.66
$819.39
$967.62 		$961.51
$1,000.89
$1,042.62
$1,190.85 		$223.23
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$583.64
$662.40
$745.86
$1,042.32
$1,583.92 		$806.87
$885.63
$969.09
$1,265.55 		$1,030.10
$1,108.86
$1,192.32
$1,488.78 		$1,253.33
$1,332.09
$1,415.55
$1,712.01 		$223.23
Toc - Plan #17 Medica
Expanded Bronze

(HMO) Altru Prime by Medica Bronze Copay $0 PCP ($0 Virtual Care with Designated Providers)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$284.79
$323.22
$363.94
$508.61
$772.88 		$502.64
$541.07
$581.79
$726.46 		$720.49
$758.92
$799.64
$944.31 		$938.34
$976.77
$1,017.49
$1,162.16 		$217.85
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$569.58
$646.44
$727.88
$1,017.22
$1,545.76 		$787.43
$864.29
$945.73
$1,235.07 		$1,005.28
$1,082.14
$1,163.58
$1,452.92 		$1,223.13
$1,299.99
$1,381.43
$1,670.77 		$217.85
Toc - Plan #18 Medica
Gold

(HMO) Altru Prime by Medica Gold Copay $0 PCP ($0 Virtual Care with Designated Providers)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$850 $1,700 Annual Deductible
$8,150 $16,300 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$431.98
$490.28
$552.05
$771.49
$1,172.36 		$762.43
$820.73
$882.50
$1,101.94 		$1,092.88
$1,151.18
$1,212.95
$1,432.39 		$1,423.33
$1,481.63
$1,543.40
$1,762.84 		$330.45
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$863.96
$980.56
$1,104.10
$1,542.98
$2,344.72 		$1,194.41
$1,311.01
$1,434.55
$1,873.43 		$1,524.86
$1,641.46
$1,765.00
$2,203.88 		$1,855.31
$1,971.91
$2,095.45
$2,534.33 		$330.45
Toc - Plan #19 Medica
Silver

(HMO) Altru Prime by Medica Silver Copay $0 PCP ($0 Virtual Care with Designated Providers)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$4,600 $9,200 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$402.72
$457.08
$514.67
$719.24
$1,092.96 		$710.79
$765.15
$822.74
$1,027.31 		$1,018.86
$1,073.22
$1,130.81
$1,335.38 		$1,326.93
$1,381.29
$1,438.88
$1,643.45 		$308.07
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$805.44
$914.16
$1,029.34
$1,438.48
$2,185.92 		$1,113.51
$1,222.23
$1,337.41
$1,746.55 		$1,421.58
$1,530.30
$1,645.48
$2,054.62 		$1,729.65
$1,838.37
$1,953.55
$2,362.69 		$308.07
Toc - Plan #20 Medica
Gold

(HMO) Altru Prime by Medica Gold Standard ($0 Virtual Care with Designated Providers)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$395.08
$448.41
$504.90
$705.60
$1,072.22 		$697.31
$750.64
$807.13
$1,007.83 		$999.54
$1,052.87
$1,109.36
$1,310.06 		$1,301.77
$1,355.10
$1,411.59
$1,612.29 		$302.23
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$790.16
$896.82
$1,009.80
$1,411.20
$2,144.44 		$1,092.39
$1,199.05
$1,312.03
$1,713.43 		$1,394.62
$1,501.28
$1,614.26
$2,015.66 		$1,696.85
$1,803.51
$1,916.49
$2,317.89 		$302.23
Toc - Plan #21 Medica
Silver

(HMO) Altru Prime by Medica Silver Standard ($0 Virtual Care with Designated Providers)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

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 		$394.51
$447.76
$504.17
$704.58
$1,070.68 		$696.30
$749.55
$805.96
$1,006.37 		$998.09
$1,051.34
$1,107.75
$1,308.16 		$1,299.88
$1,353.13
$1,409.54
$1,609.95 		$301.79
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$789.02
$895.52
$1,008.34
$1,409.16
$2,141.36 		$1,090.81
$1,197.31
$1,310.13
$1,710.95 		$1,392.60
$1,499.10
$1,611.92
$2,012.74 		$1,694.39
$1,800.89
$1,913.71
$2,314.53 		$301.79
Toc - Plan #22 Medica
Bronze

(HMO) Altru Prime by Medica Bronze Standard ($0 Virtual Care with Designated Providers)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

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 		$267.54
$303.64
$341.90
$477.81
$726.07 		$472.20
$508.30
$546.56
$682.47 		$676.86
$712.96
$751.22
$887.13 		$881.52
$917.62
$955.88
$1,091.79 		$204.66
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$535.08
$607.28
$683.80
$955.62
$1,452.14 		$739.74
$811.94
$888.46
$1,160.28 		$944.40
$1,016.60
$1,093.12
$1,364.94 		$1,149.06
$1,221.26
$1,297.78
$1,569.60 		$204.66
Toc - Plan #23 Medica
Expanded Bronze

(HMO) Medica Individual Choice Bronze HSA ($0 Virtual Care after Deductible with Designated Providers)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$5,400 $10,800 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 		$421.92
$478.86
$539.20
$753.53
$1,145.06 		$744.68
$801.62
$861.96
$1,076.29 		$1,067.44
$1,124.38
$1,184.72
$1,399.05 		$1,390.20
$1,447.14
$1,507.48
$1,721.81 		$322.76
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$843.84
$957.72
$1,078.40
$1,507.06
$2,290.12 		$1,166.60
$1,280.48
$1,401.16
$1,829.82 		$1,489.36
$1,603.24
$1,723.92
$2,152.58 		$1,812.12
$1,926.00
$2,046.68
$2,475.34 		$322.76
Toc - Plan #24 Medica
Catastrophic

(HMO) Medica Individual Choice Catastrophic ($0 Virtual Care with Designated Providers)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

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 		$254.08
$288.36
$324.70
$453.76
$689.53 		$448.44
$482.72
$519.06
$648.12 		$642.80
$677.08
$713.42
$842.48 		$837.16
$871.44
$907.78
$1,036.84 		$194.36
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$508.16
$576.72
$649.40
$907.52
$1,379.06 		$702.52
$771.08
$843.76
$1,101.88 		$896.88
$965.44
$1,038.12
$1,296.24 		$1,091.24
$1,159.80
$1,232.48
$1,490.60 		$194.36
Toc - Plan #25 Medica
Expanded Bronze

(HMO) Medica Individual Choice Bronze Share Plus ($0 Virtual Care with Designated Providers)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$2,500 $5,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$369.12
$418.94
$471.72
$659.22
$1,001.76 		$651.49
$701.31
$754.09
$941.59 		$933.86
$983.68
$1,036.46
$1,223.96 		$1,216.23
$1,266.05
$1,318.83
$1,506.33 		$282.37
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$738.24
$837.88
$943.44
$1,318.44
$2,003.52 		$1,020.61
$1,120.25
$1,225.81
$1,600.81 		$1,302.98
$1,402.62
$1,508.18
$1,883.18 		$1,585.35
$1,684.99
$1,790.55
$2,165.55 		$282.37
Toc - Plan #26 Medica
Expanded Bronze

(HMO) Medica Individual Choice Bronze Copay $0 PCP ($0 Virtual Care with Designated Providers)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$360.22
$408.84
$460.35
$643.34
$977.62 		$635.78
$684.40
$735.91
$918.90 		$911.34
$959.96
$1,011.47
$1,194.46 		$1,186.90
$1,235.52
$1,287.03
$1,470.02 		$275.56
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$720.44
$817.68
$920.70
$1,286.68
$1,955.24 		$996.00
$1,093.24
$1,196.26
$1,562.24 		$1,271.56
$1,368.80
$1,471.82
$1,837.80 		$1,547.12
$1,644.36
$1,747.38
$2,113.36 		$275.56
Toc - Plan #27 Medica
Silver

(HMO) Medica Individual Choice Silver Standard ($0 Virtual Care with Designated Providers)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

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 		$499.02
$566.38
$637.73
$891.23
$1,354.31 		$880.76
$948.12
$1,019.47
$1,272.97 		$1,262.50
$1,329.86
$1,401.21
$1,654.71 		$1,644.24
$1,711.60
$1,782.95
$2,036.45 		$381.74
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$998.04
$1,132.76
$1,275.46
$1,782.46
$2,708.62 		$1,379.78
$1,514.50
$1,657.20
$2,164.20 		$1,761.52
$1,896.24
$2,038.94
$2,545.94 		$2,143.26
$2,277.98
$2,420.68
$2,927.68 		$381.74
Toc - Plan #28 Medica
Bronze

(HMO) Medica Individual Choice Bronze Standard ($0 Virtual Care with Designated Providers)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

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 		$338.41
$384.08
$432.47
$604.38
$918.41 		$597.28
$642.95
$691.34
$863.25 		$856.15
$901.82
$950.21
$1,122.12 		$1,115.02
$1,160.69
$1,209.08
$1,380.99 		$258.87
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$676.82
$768.16
$864.94
$1,208.76
$1,836.82 		$935.69
$1,027.03
$1,123.81
$1,467.63 		$1,194.56
$1,285.90
$1,382.68
$1,726.50 		$1,453.43
$1,544.77
$1,641.55
$1,985.37 		$258.87

ADVERTISEMENT

Sanford Health Plan

Local: 1-605-328-6800 | Toll Free: 1-800-752-5863 | TTY: 1-877-652-1844
Toc - Plan #29 Sanford Health Plan
Gold

(PPO) Sanford Simplicity $1,750

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-752-5863

Annual Out of Pocket Expenses:

Individual Family
$1,750 $3,500 Annual Deductible
$8,450 $16,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$399.29
$453.19
$510.29
$713.12
$1,083.65 		$704.74
$758.64
$815.74
$1,018.57 		$1,010.19
$1,064.09
$1,121.19
$1,324.02 		$1,315.64
$1,369.54
$1,426.64
$1,629.47 		$305.45
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$798.58
$906.38
$1,020.58
$1,426.24
$2,167.30 		$1,104.03
$1,211.83
$1,326.03
$1,731.69 		$1,409.48
$1,517.28
$1,631.48
$2,037.14 		$1,714.93
$1,822.73
$1,936.93
$2,342.59 		$305.45
Toc - Plan #30 Sanford Health Plan
Silver

(PPO) Sanford Simplicity $3,500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-752-5863

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$458.56
$520.46
$586.03
$818.98
$1,244.51 		$809.36
$871.26
$936.83
$1,169.78 		$1,160.16
$1,222.06
$1,287.63
$1,520.58 		$1,510.96
$1,572.86
$1,638.43
$1,871.38 		$350.80
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$917.12
$1,040.92
$1,172.06
$1,637.96
$2,489.02 		$1,267.92
$1,391.72
$1,522.86
$1,988.76 		$1,618.72
$1,742.52
$1,873.66
$2,339.56 		$1,969.52
$2,093.32
$2,224.46
$2,690.36 		$350.80
Toc - Plan #31 Sanford Health Plan
Silver

(PPO) Sanford Simplicity $4,750

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-752-5863

Annual Out of Pocket Expenses:

Individual Family
$4,750 $9,500 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$396.54
$450.08
$506.78
$708.22
$1,076.21 		$699.90
$753.44
$810.14
$1,011.58 		$1,003.26
$1,056.80
$1,113.50
$1,314.94 		$1,306.62
$1,360.16
$1,416.86
$1,618.30 		$303.36
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$793.08
$900.16
$1,013.56
$1,416.44
$2,152.42 		$1,096.44
$1,203.52
$1,316.92
$1,719.80 		$1,399.80
$1,506.88
$1,620.28
$2,023.16 		$1,703.16
$1,810.24
$1,923.64
$2,326.52 		$303.36
Toc - Plan #32 Sanford Health Plan
Expanded Bronze

(PPO) Sanford Simplicity $6,900 HSA/HDHP

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-752-5863

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 		$268.07
$304.26
$342.60
$478.77
$727.54 		$473.15
$509.34
$547.68
$683.85 		$678.23
$714.42
$752.76
$888.93 		$883.31
$919.50
$957.84
$1,094.01 		$205.08
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$536.14
$608.52
$685.20
$957.54
$1,455.08 		$741.22
$813.60
$890.28
$1,162.62 		$946.30
$1,018.68
$1,095.36
$1,367.70 		$1,151.38
$1,223.76
$1,300.44
$1,572.78 		$205.08
Toc - Plan #33 Sanford Health Plan
Expanded Bronze

(PPO) Sanford Simplicity $6,000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-752-5863

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$256.42
$291.03
$327.70
$457.96
$695.90 		$452.58
$487.19
$523.86
$654.12 		$648.74
$683.35
$720.02
$850.28 		$844.90
$879.51
$916.18
$1,046.44 		$196.16
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$512.84
$582.06
$655.40
$915.92
$1,391.80 		$709.00
$778.22
$851.56
$1,112.08 		$905.16
$974.38
$1,047.72
$1,308.24 		$1,101.32
$1,170.54
$1,243.88
$1,504.40 		$196.16
Toc - Plan #34 Sanford Health Plan
Expanded Bronze

(PPO) Sanford Simplicity $7,000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-752-5863

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$254.33
$288.66
$325.03
$454.23
$690.24 		$448.89
$483.22
$519.59
$648.79 		$643.45
$677.78
$714.15
$843.35 		$838.01
$872.34
$908.71
$1,037.91 		$194.56
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$508.66
$577.32
$650.06
$908.46
$1,380.48 		$703.22
$771.88
$844.62
$1,103.02 		$897.78
$966.44
$1,039.18
$1,297.58 		$1,092.34
$1,161.00
$1,233.74
$1,492.14 		$194.56
Toc - Plan #35 Sanford Health Plan
Catastrophic

(PPO) Sanford Simplicity $9,100

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-752-5863

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 		$160.23
$181.86
$204.77
$286.16
$434.85 		$282.81
$304.44
$327.35
$408.74 		$405.39
$427.02
$449.93
$531.32 		$527.97
$549.60
$572.51
$653.90 		$122.58
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$320.46
$363.72
$409.54
$572.32
$869.70 		$443.04
$486.30
$532.12
$694.90 		$565.62
$608.88
$654.70
$817.48 		$688.20
$731.46
$777.28
$940.06 		$122.58
Toc - Plan #36 Sanford Health Plan
Silver

(PPO) Sanford Simplicity Enhanced - Diabetes & Asthma/COPD Care Plan $3,700

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-752-5863

Annual Out of Pocket Expenses:

Individual Family
$3,700 $7,400 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 		$406.64
$461.53
$519.68
$726.25
$1,103.61 		$717.72
$772.61
$830.76
$1,037.33 		$1,028.80
$1,083.69
$1,141.84
$1,348.41 		$1,339.88
$1,394.77
$1,452.92
$1,659.49 		$311.08
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$813.28
$923.06
$1,039.36
$1,452.50
$2,207.22 		$1,124.36
$1,234.14
$1,350.44
$1,763.58 		$1,435.44
$1,545.22
$1,661.52
$2,074.66 		$1,746.52
$1,856.30
$1,972.60
$2,385.74 		$311.08
Toc - Plan #37 Sanford Health Plan
Gold

(PPO) Sanford Simplicity Enhanced - Diabetes & Asthma/COPD Care Plan $1,250

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-752-5863

Annual Out of Pocket Expenses:

Individual Family
$1,250 $2,500 Annual Deductible
$5,500 $11,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$403.45
$457.92
$515.61
$720.56
$1,094.96 		$712.09
$766.56
$824.25
$1,029.20 		$1,020.73
$1,075.20
$1,132.89
$1,337.84 		$1,329.37
$1,383.84
$1,441.53
$1,646.48 		$308.64
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$806.90
$915.84
$1,031.22
$1,441.12
$2,189.92 		$1,115.54
$1,224.48
$1,339.86
$1,749.76 		$1,424.18
$1,533.12
$1,648.50
$2,058.40 		$1,732.82
$1,841.76
$1,957.14
$2,367.04 		$308.64
Toc - Plan #38 Sanford Health Plan
Expanded Bronze

(PPO) Sanford Simplicity - Standardized $7,500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-752-5863

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 		$280.84
$318.75
$358.91
$501.57
$762.19 		$495.68
$533.59
$573.75
$716.41 		$710.52
$748.43
$788.59
$931.25 		$925.36
$963.27
$1,003.43
$1,146.09 		$214.84
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$561.68
$637.50
$717.82
$1,003.14
$1,524.38 		$776.52
$852.34
$932.66
$1,217.98 		$991.36
$1,067.18
$1,147.50
$1,432.82 		$1,206.20
$1,282.02
$1,362.34
$1,647.66 		$214.84
Toc - Plan #39 Sanford Health Plan
Silver

(PPO) Sanford Simplicity - Standardized $5,800

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-752-5863

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 		$398.97
$452.83
$509.88
$712.55
$1,082.79 		$704.18
$758.04
$815.09
$1,017.76 		$1,009.39
$1,063.25
$1,120.30
$1,322.97 		$1,314.60
$1,368.46
$1,425.51
$1,628.18 		$305.21
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$797.94
$905.66
$1,019.76
$1,425.10
$2,165.58 		$1,103.15
$1,210.87
$1,324.97
$1,730.31 		$1,408.36
$1,516.08
$1,630.18
$2,035.52 		$1,713.57
$1,821.29
$1,935.39
$2,340.73 		$305.21
Toc - Plan #40 Sanford Health Plan
Gold

(PPO) Sanford Simplicity - Standardized $2,000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-752-5863

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 		$391.03
$443.82
$499.74
$698.38
$1,061.26 		$690.17
$742.96
$798.88
$997.52 		$989.31
$1,042.10
$1,098.02
$1,296.66 		$1,288.45
$1,341.24
$1,397.16
$1,595.80 		$299.14
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$782.06
$887.64
$999.48
$1,396.76
$2,122.52 		$1,081.20
$1,186.78
$1,298.62
$1,695.90 		$1,380.34
$1,485.92
$1,597.76
$1,995.04 		$1,679.48
$1,785.06
$1,896.90
$2,294.18 		$299.14

‡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 Steele County here.

Steele County is in “Rating Area 4” of North Dakota.

Currently, there are 40 plans offered in Rating Area 4.

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2023 Obamacare Plans for Steele County, ND

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