Obamacare 2023 Rates for Iowa County
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Obamacare > Rates > Wisconsin > Iowa County
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QuartzLocal: 1-608-644-3430 | Toll Free: 1-800-362-3310 | TTY: 1-800-877-8973 |
Toc - Plan #1 Quartz | ||||||||||||||||||||
Silver
(HMO) QUARTZ ONE SILVER I303 with Dental & Vision |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$503.92 $571.94 $644.00 $899.99 $1,367.62 |
$889.41 $957.43 $1,029.49 $1,285.48 |
$1,274.90 $1,342.92 $1,414.98 $1,670.97 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$1,007.84 $1,143.88 $1,288.00 $1,799.98 $2,735.24 |
$1,393.33 $1,529.37 $1,673.49 $2,185.47 |
$1,778.82 $1,914.86 $2,058.98 $2,570.96 |
Toc - Plan #2 Quartz | ||||||||||||||||||||
Silver
(HMO) QUARTZ ONE SILVER I308 with Dental & Vision |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$528.70 $600.07 $675.68 $944.26 $1,434.89 |
$933.16 $1,004.53 $1,080.14 $1,348.72 |
$1,337.62 $1,408.99 $1,484.60 $1,753.18 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$1,057.40 $1,200.14 $1,351.36 $1,888.52 $2,869.78 |
$1,461.86 $1,604.60 $1,755.82 $2,292.98 |
$1,866.32 $2,009.06 $2,160.28 $2,697.44 |
Toc - Plan #3 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One Silver I309 Standard with Dental & Vision |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$553.74 $628.49 $707.67 $988.97 $1,502.83 |
$977.34 $1,052.09 $1,131.27 $1,412.57 |
$1,400.94 $1,475.69 $1,554.87 $1,836.17 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$1,107.48 $1,256.98 $1,415.34 $1,977.94 $3,005.66 |
$1,531.08 $1,680.58 $1,838.94 $2,401.54 |
$1,954.68 $2,104.18 $2,262.54 $2,825.14 |
Toc - Plan #4 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I201 with Dental & Vision |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$374.79 $425.38 $478.98 $669.37 $1,017.17 |
$661.50 $712.09 $765.69 $956.08 |
$948.21 $998.80 $1,052.40 $1,242.79 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$749.58 $850.76 $957.96 $1,338.74 $2,034.34 |
$1,036.29 $1,137.47 $1,244.67 $1,625.45 |
$1,323.00 $1,424.18 $1,531.38 $1,912.16 |
Toc - Plan #5 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I202 with Dental & Vision |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$378.50 $429.59 $483.72 $675.99 $1,027.24 |
$668.05 $719.14 $773.27 $965.54 |
$957.60 $1,008.69 $1,062.82 $1,255.09 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$757.00 $859.18 $967.44 $1,351.98 $2,054.48 |
$1,046.55 $1,148.73 $1,256.99 $1,641.53 |
$1,336.10 $1,438.28 $1,546.54 $1,931.08 |
Toc - Plan #6 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I204 with Dental & Vision |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$396.75 $450.30 $507.04 $708.58 $1,076.76 |
$700.26 $753.81 $810.55 $1,012.09 |
$1,003.77 $1,057.32 $1,114.06 $1,315.60 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$793.50 $900.60 $1,014.08 $1,417.16 $2,153.52 |
$1,097.01 $1,204.11 $1,317.59 $1,720.67 |
$1,400.52 $1,507.62 $1,621.10 $2,024.18 |
Toc - Plan #7 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I205 with Dental & Vision |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$392.69 $445.70 $501.86 $701.34 $1,065.76 |
$693.10 $746.11 $802.27 $1,001.75 |
$993.51 $1,046.52 $1,102.68 $1,302.16 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$785.38 $891.40 $1,003.72 $1,402.68 $2,131.52 |
$1,085.79 $1,191.81 $1,304.13 $1,703.09 |
$1,386.20 $1,492.22 $1,604.54 $2,003.50 |
Toc - Plan #8 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One Bronze I206 Standard with Dental & Vision |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$408.86 $464.05 $522.52 $730.21 $1,109.63 |
$721.63 $776.82 $835.29 $1,042.98 |
$1,034.40 $1,089.59 $1,148.06 $1,355.75 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$817.72 $928.10 $1,045.04 $1,460.42 $2,219.26 |
$1,130.49 $1,240.87 $1,357.81 $1,773.19 |
$1,443.26 $1,553.64 $1,670.58 $2,085.96 |
Toc - Plan #9 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I407 Maintenance with Dental & Vision |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$512.57 $581.77 $655.06 $915.45 $1,391.11 |
$904.68 $973.88 $1,047.17 $1,307.56 |
$1,296.79 $1,365.99 $1,439.28 $1,699.67 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,025.14 $1,163.54 $1,310.12 $1,830.90 $2,782.22 |
$1,417.25 $1,555.65 $1,702.23 $2,223.01 |
$1,809.36 $1,947.76 $2,094.34 $2,615.12 |
Toc - Plan #10 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I406 with Dental & Vision |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$448.58 $509.14 $573.28 $801.16 $1,217.44 |
$791.74 $852.30 $916.44 $1,144.32 |
$1,134.90 $1,195.46 $1,259.60 $1,487.48 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$897.16 $1,018.28 $1,146.56 $1,602.32 $2,434.88 |
$1,240.32 $1,361.44 $1,489.72 $1,945.48 |
$1,583.48 $1,704.60 $1,832.88 $2,288.64 |
Toc - Plan #11 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I409 with Dental & Vision |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$457.48 $519.24 $584.66 $817.05 $1,241.59 |
$807.45 $869.21 $934.63 $1,167.02 |
$1,157.42 $1,219.18 $1,284.60 $1,516.99 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$914.96 $1,038.48 $1,169.32 $1,634.10 $2,483.18 |
$1,264.93 $1,388.45 $1,519.29 $1,984.07 |
$1,614.90 $1,738.42 $1,869.26 $2,334.04 |
Toc - Plan #12 Quartz | ||||||||||||||||||||
Silver
(HMO) Tiered Choice Plus Silver I305 with Dental & Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$481.94 $547.00 $615.91 $860.74 $1,307.97 |
$850.62 $915.68 $984.59 $1,229.42 |
$1,219.30 $1,284.36 $1,353.27 $1,598.10 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$963.88 $1,094.00 $1,231.82 $1,721.48 $2,615.94 |
$1,332.56 $1,462.68 $1,600.50 $2,090.16 |
$1,701.24 $1,831.36 $1,969.18 $2,458.84 |
Toc - Plan #13 Quartz | ||||||||||||||||||||
Gold
(HMO) Quartz One Gold I410 Standard with Dental & Vision |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$505.82 $574.09 $646.43 $903.38 $1,372.77 |
$892.77 $961.04 $1,033.38 $1,290.33 |
$1,279.72 $1,347.99 $1,420.33 $1,677.28 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,011.64 $1,148.18 $1,292.86 $1,806.76 $2,745.54 |
$1,398.59 $1,535.13 $1,679.81 $2,193.71 |
$1,785.54 $1,922.08 $2,066.76 $2,580.66 |
Toc - Plan #14 Quartz | ||||||||||||||||||||
Silver
(HMO) QUARTZ ONE SILVER I303 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$481.58 $546.59 $615.45 $860.09 $1,306.99 |
$849.98 $914.99 $983.85 $1,228.49 |
$1,218.38 $1,283.39 $1,352.25 $1,596.89 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$963.16 $1,093.18 $1,230.90 $1,720.18 $2,613.98 |
$1,331.56 $1,461.58 $1,599.30 $2,088.58 |
$1,699.96 $1,829.98 $1,967.70 $2,456.98 |
Toc - Plan #15 Quartz | ||||||||||||||||||||
Silver
(HMO) QUARTZ ONE SILVER I308 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$505.26 $573.47 $645.72 $902.39 $1,371.27 |
$891.78 $959.99 $1,032.24 $1,288.91 |
$1,278.30 $1,346.51 $1,418.76 $1,675.43 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$1,010.52 $1,146.94 $1,291.44 $1,804.78 $2,742.54 |
$1,397.04 $1,533.46 $1,677.96 $2,191.30 |
$1,783.56 $1,919.98 $2,064.48 $2,577.82 |
Toc - Plan #16 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One Silver I309 Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$529.19 $600.62 $676.29 $945.12 $1,436.20 |
$934.01 $1,005.44 $1,081.11 $1,349.94 |
$1,338.83 $1,410.26 $1,485.93 $1,754.76 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$1,058.38 $1,201.24 $1,352.58 $1,890.24 $2,872.40 |
$1,463.20 $1,606.06 $1,757.40 $2,295.06 |
$1,868.02 $2,010.88 $2,162.22 $2,699.88 |
Toc - Plan #17 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I201 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$358.18 $406.52 $457.74 $639.69 $972.07 |
$632.18 $680.52 $731.74 $913.69 |
$906.18 $954.52 $1,005.74 $1,187.69 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$716.36 $813.04 $915.48 $1,279.38 $1,944.14 |
$990.36 $1,087.04 $1,189.48 $1,553.38 |
$1,264.36 $1,361.04 $1,463.48 $1,827.38 |
Toc - Plan #18 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I202 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$361.72 $410.55 $462.27 $646.02 $981.69 |
$638.43 $687.26 $738.98 $922.73 |
$915.14 $963.97 $1,015.69 $1,199.44 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$723.44 $821.10 $924.54 $1,292.04 $1,963.38 |
$1,000.15 $1,097.81 $1,201.25 $1,568.75 |
$1,276.86 $1,374.52 $1,477.96 $1,845.46 |
Toc - Plan #19 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I204 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$379.16 $430.34 $484.56 $677.17 $1,029.02 |
$669.21 $720.39 $774.61 $967.22 |
$959.26 $1,010.44 $1,064.66 $1,257.27 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$758.32 $860.68 $969.12 $1,354.34 $2,058.04 |
$1,048.37 $1,150.73 $1,259.17 $1,644.39 |
$1,338.42 $1,440.78 $1,549.22 $1,934.44 |
Toc - Plan #20 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I205 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$375.28 $425.94 $479.61 $670.25 $1,018.50 |
$662.37 $713.03 $766.70 $957.34 |
$949.46 $1,000.12 $1,053.79 $1,244.43 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$750.56 $851.88 $959.22 $1,340.50 $2,037.00 |
$1,037.65 $1,138.97 $1,246.31 $1,627.59 |
$1,324.74 $1,426.06 $1,533.40 $1,914.68 |
Toc - Plan #21 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One Bronze I206 Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$390.73 $443.48 $499.35 $697.84 $1,060.43 |
$689.64 $742.39 $798.26 $996.75 |
$988.55 $1,041.30 $1,097.17 $1,295.66 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$781.46 $886.96 $998.70 $1,395.68 $2,120.86 |
$1,080.37 $1,185.87 $1,297.61 $1,694.59 |
$1,379.28 $1,484.78 $1,596.52 $1,993.50 |
Toc - Plan #22 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I407 Maintenance |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$489.85 $555.97 $626.02 $874.86 $1,329.43 |
$864.58 $930.70 $1,000.75 $1,249.59 |
$1,239.31 $1,305.43 $1,375.48 $1,624.32 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$979.70 $1,111.94 $1,252.04 $1,749.72 $2,658.86 |
$1,354.43 $1,486.67 $1,626.77 $2,124.45 |
$1,729.16 $1,861.40 $2,001.50 $2,499.18 |
Toc - Plan #23 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I406 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$428.69 $486.56 $547.86 $765.64 $1,163.46 |
$756.64 $814.51 $875.81 $1,093.59 |
$1,084.59 $1,142.46 $1,203.76 $1,421.54 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$857.38 $973.12 $1,095.72 $1,531.28 $2,326.92 |
$1,185.33 $1,301.07 $1,423.67 $1,859.23 |
$1,513.28 $1,629.02 $1,751.62 $2,187.18 |
Toc - Plan #24 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I409 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$437.20 $496.22 $558.73 $780.83 $1,186.55 |
$771.65 $830.67 $893.18 $1,115.28 |
$1,106.10 $1,165.12 $1,227.63 $1,449.73 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$874.40 $992.44 $1,117.46 $1,561.66 $2,373.10 |
$1,208.85 $1,326.89 $1,451.91 $1,896.11 |
$1,543.30 $1,661.34 $1,786.36 $2,230.56 |
Toc - Plan #25 Quartz | ||||||||||||||||||||
Silver
(HMO) Tiered Choice Plus Silver I305 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$460.57 $522.74 $588.61 $822.57 $1,249.98 |
$812.90 $875.07 $940.94 $1,174.90 |
$1,165.23 $1,227.40 $1,293.27 $1,527.23 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$921.14 $1,045.48 $1,177.22 $1,645.14 $2,499.96 |
$1,273.47 $1,397.81 $1,529.55 $1,997.47 |
$1,625.80 $1,750.14 $1,881.88 $2,349.80 |
Toc - Plan #26 Quartz | ||||||||||||||||||||
Gold
(HMO) Quartz One Gold I410 Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$483.39 $548.64 $617.77 $863.33 $1,311.91 |
$853.18 $918.43 $987.56 $1,233.12 |
$1,222.97 $1,288.22 $1,357.35 $1,602.91 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$966.78 $1,097.28 $1,235.54 $1,726.66 $2,623.82 |
$1,336.57 $1,467.07 $1,605.33 $2,096.45 |
$1,706.36 $1,836.86 $1,975.12 $2,466.24 |
Toc - Plan #27 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I408 HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$453.88 $515.15 $580.05 $810.62 $1,231.81 |
$801.09 $862.36 $927.26 $1,157.83 |
$1,148.30 $1,209.57 $1,274.47 $1,505.04 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$907.76 $1,030.30 $1,160.10 $1,621.24 $2,463.62 |
$1,254.97 $1,377.51 $1,507.31 $1,968.45 |
$1,602.18 $1,724.72 $1,854.52 $2,315.66 |
Toc - Plan #28 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I203 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$376.40 $427.21 $481.04 $672.25 $1,021.55 |
$664.35 $715.16 $768.99 $960.20 |
$952.30 $1,003.11 $1,056.94 $1,248.15 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$752.80 $854.42 $962.08 $1,344.50 $2,043.10 |
$1,040.75 $1,142.37 $1,250.03 $1,632.45 |
$1,328.70 $1,430.32 $1,537.98 $1,920.40 |
Toc - Plan #29 Quartz | ||||||||||||||||||||
Catastrophic
(HMO) QUARTZ ONE CATASTROPHIC I101 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$277.48 $314.93 $354.61 $495.57 $753.06 |
$489.75 $527.20 $566.88 $707.84 |
$702.02 $739.47 $779.15 $920.11 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$554.96 $629.86 $709.22 $991.14 $1,506.12 |
$767.23 $842.13 $921.49 $1,203.41 |
$979.50 $1,054.40 $1,133.76 $1,415.68 |
Toc - Plan #30 Quartz | ||||||||||||||||||||
Silver
(HMO) Tiered Choice Plus Silver I310 HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$506.49 $574.86 $647.29 $904.58 $1,374.60 |
$893.95 $962.32 $1,034.75 $1,292.04 |
$1,281.41 $1,349.78 $1,422.21 $1,679.50 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,012.98 $1,149.72 $1,294.58 $1,809.16 $2,749.20 |
$1,400.44 $1,537.18 $1,682.04 $2,196.62 |
$1,787.90 $1,924.64 $2,069.50 $2,584.08 |
Toc - Plan #31 Quartz | ||||||||||||||||||||
Silver
(HMO) Tiered Choice Plus Silver I311 HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$496.51 $563.53 $634.53 $886.76 $1,347.51 |
$876.34 $943.36 $1,014.36 $1,266.59 |
$1,256.17 $1,323.19 $1,394.19 $1,646.42 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$993.02 $1,127.06 $1,269.06 $1,773.52 $2,695.02 |
$1,372.85 $1,506.89 $1,648.89 $2,153.35 |
$1,752.68 $1,886.72 $2,028.72 $2,533.18 |
Toc - Plan #32 Quartz | ||||||||||||||||||||
Silver
(HMO) QUARTZ ONE SILVER I303 with Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$487.17 $552.93 $622.60 $870.08 $1,322.17 |
$859.85 $925.61 $995.28 $1,242.76 |
$1,232.53 $1,298.29 $1,367.96 $1,615.44 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$974.34 $1,105.86 $1,245.20 $1,740.16 $2,644.34 |
$1,347.02 $1,478.54 $1,617.88 $2,112.84 |
$1,719.70 $1,851.22 $1,990.56 $2,485.52 |
Toc - Plan #33 Quartz | ||||||||||||||||||||
Silver
(HMO) QUARTZ ONE SILVER I308 with Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$511.13 $580.13 $653.22 $912.88 $1,387.20 |
$902.14 $971.14 $1,044.23 $1,303.89 |
$1,293.15 $1,362.15 $1,435.24 $1,694.90 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,022.26 $1,160.26 $1,306.44 $1,825.76 $2,774.40 |
$1,413.27 $1,551.27 $1,697.45 $2,216.77 |
$1,804.28 $1,942.28 $2,088.46 $2,607.78 |
Toc - Plan #34 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One Silver I309 Standard with Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$535.33 $607.60 $684.15 $956.10 $1,452.88 |
$944.86 $1,017.13 $1,093.68 $1,365.63 |
$1,354.39 $1,426.66 $1,503.21 $1,775.16 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,070.66 $1,215.20 $1,368.30 $1,912.20 $2,905.76 |
$1,480.19 $1,624.73 $1,777.83 $2,321.73 |
$1,889.72 $2,034.26 $2,187.36 $2,731.26 |
Toc - Plan #35 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I201 with Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$362.34 $411.25 $463.06 $647.12 $983.37 |
$639.52 $688.43 $740.24 $924.30 |
$916.70 $965.61 $1,017.42 $1,201.48 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$724.68 $822.50 $926.12 $1,294.24 $1,966.74 |
$1,001.86 $1,099.68 $1,203.30 $1,571.42 |
$1,279.04 $1,376.86 $1,480.48 $1,848.60 |
Toc - Plan #36 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I202 with Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$365.92 $415.32 $467.64 $653.53 $993.10 |
$645.85 $695.25 $747.57 $933.46 |
$925.78 $975.18 $1,027.50 $1,213.39 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$731.84 $830.64 $935.28 $1,307.06 $1,986.20 |
$1,011.77 $1,110.57 $1,215.21 $1,586.99 |
$1,291.70 $1,390.50 $1,495.14 $1,866.92 |
Toc - Plan #37 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I204 with Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$383.56 $435.34 $490.19 $685.03 $1,040.97 |
$676.98 $728.76 $783.61 $978.45 |
$970.40 $1,022.18 $1,077.03 $1,271.87 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$767.12 $870.68 $980.38 $1,370.06 $2,081.94 |
$1,060.54 $1,164.10 $1,273.80 $1,663.48 |
$1,353.96 $1,457.52 $1,567.22 $1,956.90 |
Toc - Plan #38 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I205 with Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$379.64 $430.89 $485.18 $678.03 $1,030.34 |
$670.06 $721.31 $775.60 $968.45 |
$960.48 $1,011.73 $1,066.02 $1,258.87 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$759.28 $861.78 $970.36 $1,356.06 $2,060.68 |
$1,049.70 $1,152.20 $1,260.78 $1,646.48 |
$1,340.12 $1,442.62 $1,551.20 $1,936.90 |
Toc - Plan #39 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One Bronze I206 Standard with Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$395.27 $448.63 $505.15 $705.95 $1,072.75 |
$697.65 $751.01 $807.53 $1,008.33 |
$1,000.03 $1,053.39 $1,109.91 $1,310.71 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$790.54 $897.26 $1,010.30 $1,411.90 $2,145.50 |
$1,092.92 $1,199.64 $1,312.68 $1,714.28 |
$1,395.30 $1,502.02 $1,615.06 $2,016.66 |
Toc - Plan #40 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I203 with Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$380.78 $432.18 $486.63 $680.06 $1,033.41 |
$672.07 $723.47 $777.92 $971.35 |
$963.36 $1,014.76 $1,069.21 $1,262.64 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$761.56 $864.36 $973.26 $1,360.12 $2,066.82 |
$1,052.85 $1,155.65 $1,264.55 $1,651.41 |
$1,344.14 $1,446.94 $1,555.84 $1,942.70 |
Toc - Plan #41 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I407 Maintenance with Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$495.54 $562.43 $633.29 $885.02 $1,344.88 |
$874.62 $941.51 $1,012.37 $1,264.10 |
$1,253.70 $1,320.59 $1,391.45 $1,643.18 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$991.08 $1,124.86 $1,266.58 $1,770.04 $2,689.76 |
$1,370.16 $1,503.94 $1,645.66 $2,149.12 |
$1,749.24 $1,883.02 $2,024.74 $2,528.20 |
Toc - Plan #42 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I406 with Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$433.67 $492.21 $554.23 $774.53 $1,176.98 |
$765.43 $823.97 $885.99 $1,106.29 |
$1,097.19 $1,155.73 $1,217.75 $1,438.05 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$867.34 $984.42 $1,108.46 $1,549.06 $2,353.96 |
$1,199.10 $1,316.18 $1,440.22 $1,880.82 |
$1,530.86 $1,647.94 $1,771.98 $2,212.58 |
Toc - Plan #43 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I409 with Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$442.28 $501.98 $565.23 $789.90 $1,200.33 |
$780.62 $840.32 $903.57 $1,128.24 |
$1,118.96 $1,178.66 $1,241.91 $1,466.58 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$884.56 $1,003.96 $1,130.46 $1,579.80 $2,400.66 |
$1,222.90 $1,342.30 $1,468.80 $1,918.14 |
$1,561.24 $1,680.64 $1,807.14 $2,256.48 |
Toc - Plan #44 Quartz | ||||||||||||||||||||
Silver
(HMO) Tiered Choice Plus Silver I305 with Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$465.92 $528.82 $595.44 $832.13 $1,264.50 |
$822.35 $885.25 $951.87 $1,188.56 |
$1,178.78 $1,241.68 $1,308.30 $1,544.99 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$931.84 $1,057.64 $1,190.88 $1,664.26 $2,529.00 |
$1,288.27 $1,414.07 $1,547.31 $2,020.69 |
$1,644.70 $1,770.50 $1,903.74 $2,377.12 |
Toc - Plan #45 Quartz | ||||||||||||||||||||
Gold
(HMO) Tiered Choice Plus Gold I408 HSA with Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$459.15 $521.13 $586.79 $820.03 $1,246.12 |
$810.40 $872.38 $938.04 $1,171.28 |
$1,161.65 $1,223.63 $1,289.29 $1,522.53 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$918.30 $1,042.26 $1,173.58 $1,640.06 $2,492.24 |
$1,269.55 $1,393.51 $1,524.83 $1,991.31 |
$1,620.80 $1,744.76 $1,876.08 $2,342.56 |
Toc - Plan #46 Quartz | ||||||||||||||||||||
Silver
(HMO) Tiered Choice Plus Silver I310 HSA with Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$512.37 $581.54 $654.81 $915.09 $1,390.57 |
$904.33 $973.50 $1,046.77 $1,307.05 |
$1,296.29 $1,365.46 $1,438.73 $1,699.01 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,024.74 $1,163.08 $1,309.62 $1,830.18 $2,781.14 |
$1,416.70 $1,555.04 $1,701.58 $2,222.14 |
$1,808.66 $1,947.00 $2,093.54 $2,614.10 |
Toc - Plan #47 Quartz | ||||||||||||||||||||
Silver
(HMO) Tiered Choice Plus Silver I311 HSA with Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$502.28 $570.08 $641.90 $897.06 $1,363.17 |
$886.52 $954.32 $1,026.14 $1,281.30 |
$1,270.76 $1,338.56 $1,410.38 $1,665.54 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,004.56 $1,140.16 $1,283.80 $1,794.12 $2,726.34 |
$1,388.80 $1,524.40 $1,668.04 $2,178.36 |
$1,773.04 $1,908.64 $2,052.28 $2,562.60 |
Toc - Plan #48 Quartz | ||||||||||||||||||||
Gold
(HMO) Quartz One Gold I410 Standard with Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$489.00 $555.01 $624.94 $873.35 $1,327.15 |
$863.08 $929.09 $999.02 $1,247.43 |
$1,237.16 $1,303.17 $1,373.10 $1,621.51 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$978.00 $1,110.02 $1,249.88 $1,746.70 $2,654.30 |
$1,352.08 $1,484.10 $1,623.96 $2,120.78 |
$1,726.16 $1,858.18 $1,998.04 $2,494.86 |
ADVERTISEMENT
Dean Health PlanLocal: 1-800-279-1302 | Toll Free: 1-800-279-1302 | TTY: 1-800-279-1302 |
Toc - Plan #49 Dean Health Plan | ||||||||||||||||||||
Catastrophic
(HMO) Dean Catastrophic Safety Net (Free Transportation) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$201.57 $228.78 $257.61 $360.01 $547.06 |
$355.77 $382.98 $411.81 $514.21 |
$509.97 $537.18 $566.01 $668.41 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$403.14 $457.56 $515.22 $720.02 $1,094.12 |
$557.34 $611.76 $669.42 $874.22 |
$711.54 $765.96 $823.62 $1,028.42 |
Toc - Plan #50 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Dean Silver Copay Plus 4800X (Free Virtual Visits & Transportation) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$397.92 $451.64 $508.54 $710.68 $1,079.95 |
$702.33 $756.05 $812.95 $1,015.09 |
$1,006.74 $1,060.46 $1,117.36 $1,319.50 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$795.84 $903.28 $1,017.08 $1,421.36 $2,159.90 |
$1,100.25 $1,207.69 $1,321.49 $1,725.77 |
$1,404.66 $1,512.10 $1,625.90 $2,030.18 |
Toc - Plan #51 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Dean Silver Value Copay 4100X (Free Virtual Visits & Transportation) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$394.84 $448.14 $504.61 $705.19 $1,071.60 |
$696.89 $750.19 $806.66 $1,007.24 |
$998.94 $1,052.24 $1,108.71 $1,309.29 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$789.68 $896.28 $1,009.22 $1,410.38 $2,143.20 |
$1,091.73 $1,198.33 $1,311.27 $1,712.43 |
$1,393.78 $1,500.38 $1,613.32 $2,014.48 |
Toc - Plan #52 Dean Health Plan | ||||||||||||||||||||
Gold
(HMO) Dean Gold Value Copay 4000X (Free Virtual Visits & Transportation) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$379.13 $430.31 $484.53 $677.12 $1,028.96 |
$669.16 $720.34 $774.56 $967.15 |
$959.19 $1,010.37 $1,064.59 $1,257.18 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$758.26 $860.62 $969.06 $1,354.24 $2,057.92 |
$1,048.29 $1,150.65 $1,259.09 $1,644.27 |
$1,338.32 $1,440.68 $1,549.12 $1,934.30 |
Toc - Plan #53 Dean Health Plan | ||||||||||||||||||||
Bronze
(HMO) Dean Bronze Value Copay 9050X (Free Virtual Visits & Transportation) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$250.99 $284.87 $320.76 $448.27 $681.18 |
$443.00 $476.88 $512.77 $640.28 |
$635.01 $668.89 $704.78 $832.29 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$501.98 $569.74 $641.52 $896.54 $1,362.36 |
$693.99 $761.75 $833.53 $1,088.55 |
$886.00 $953.76 $1,025.54 $1,280.56 |
Toc - Plan #54 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Dean Silver HSA-E HDHP 3550X (Free Transportation) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$378.67 $429.79 $483.93 $676.30 $1,027.70 |
$668.35 $719.47 $773.61 $965.98 |
$958.03 $1,009.15 $1,063.29 $1,255.66 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$757.34 $859.58 $967.86 $1,352.60 $2,055.40 |
$1,047.02 $1,149.26 $1,257.54 $1,642.28 |
$1,336.70 $1,438.94 $1,547.22 $1,931.96 |
Toc - Plan #55 Dean Health Plan | ||||||||||||||||||||
Gold
(HMO) Dean Gold Copay Plus 1500X (Free Virtual Visits & Transportation) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$399.01 $452.87 $509.93 $712.63 $1,082.91 |
$704.25 $758.11 $815.17 $1,017.87 |
$1,009.49 $1,063.35 $1,120.41 $1,323.11 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$798.02 $905.74 $1,019.86 $1,425.26 $2,165.82 |
$1,103.26 $1,210.98 $1,325.10 $1,730.50 |
$1,408.50 $1,516.22 $1,630.34 $2,035.74 |
Toc - Plan #56 Dean Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) Dean Bronze HSA-E HDHP 7000X (Free Transportation) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$270.21 $306.68 $345.32 $482.59 $733.34 |
$476.92 $513.39 $552.03 $689.30 |
$683.63 $720.10 $758.74 $896.01 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$540.42 $613.36 $690.64 $965.18 $1,466.68 |
$747.13 $820.07 $897.35 $1,171.89 |
$953.84 $1,026.78 $1,104.06 $1,378.60 |
Toc - Plan #57 Dean Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) Dean Bronze Copay Plus 9050X (Free Virtual Visits & Transportation) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$262.80 $298.27 $335.85 $469.36 $713.23 |
$463.84 $499.31 $536.89 $670.40 |
$664.88 $700.35 $737.93 $871.44 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$525.60 $596.54 $671.70 $938.72 $1,426.46 |
$726.64 $797.58 $872.74 $1,139.76 |
$927.68 $998.62 $1,073.78 $1,340.80 |
Toc - Plan #58 Dean Health Plan | ||||||||||||||||||||
Gold
(HMO) Dean Gold Copay Elite 1500X (Free Virtual Visits & Transportation) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$377.31 $428.25 $482.20 $673.88 $1,024.02 |
$665.95 $716.89 $770.84 $962.52 |
$954.59 $1,005.53 $1,059.48 $1,251.16 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$754.62 $856.50 $964.40 $1,347.76 $2,048.04 |
$1,043.26 $1,145.14 $1,253.04 $1,636.40 |
$1,331.90 $1,433.78 $1,541.68 $1,925.04 |
Toc - Plan #59 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Dean Silver Copay Elite 4800X (Free Virtual Visits & Transportation) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$338.34 $384.02 $432.40 $604.28 $918.27 |
$597.17 $642.85 $691.23 $863.11 |
$856.00 $901.68 $950.06 $1,121.94 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$676.68 $768.04 $864.80 $1,208.56 $1,836.54 |
$935.51 $1,026.87 $1,123.63 $1,467.39 |
$1,194.34 $1,285.70 $1,382.46 $1,726.22 |
Toc - Plan #60 Dean Health Plan | ||||||||||||||||||||
Gold
(HMO) Dean Gold HSA HDHP 2000X (Free Transportation) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$355.81 $403.84 $454.72 $635.48 $965.67 |
$628.00 $676.03 $726.91 $907.67 |
$900.19 $948.22 $999.10 $1,179.86 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$711.62 $807.68 $909.44 $1,270.96 $1,931.34 |
$983.81 $1,079.87 $1,181.63 $1,543.15 |
$1,256.00 $1,352.06 $1,453.82 $1,815.34 |
Toc - Plan #61 Dean Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) Dean Bronze Copay PCP 8000X (Free Virtual Visits & Transportation) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$251.91 $285.92 $321.95 $449.92 $683.70 |
$444.62 $478.63 $514.66 $642.63 |
$637.33 $671.34 $707.37 $835.34 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$503.82 $571.84 $643.90 $899.84 $1,367.40 |
$696.53 $764.55 $836.61 $1,092.55 |
$889.24 $957.26 $1,029.32 $1,285.26 |
Toc - Plan #62 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Dean Silver Copay PCP 4500X (Free Virtual Visits & Transportation) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$369.57 $419.46 $472.31 $660.05 $1,003.01 |
$652.29 $702.18 $755.03 $942.77 |
$935.01 $984.90 $1,037.75 $1,225.49 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$739.14 $838.92 $944.62 $1,320.10 $2,006.02 |
$1,021.86 $1,121.64 $1,227.34 $1,602.82 |
$1,304.58 $1,404.36 $1,510.06 $1,885.54 |
Toc - Plan #63 Dean Health Plan | ||||||||||||||||||||
Gold
(HMO) Dean Gold Copay PCP 2000X (Free Virtual Visits & Transportation) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$366.79 $416.31 $468.76 $655.09 $995.47 |
$647.39 $696.91 $749.36 $935.69 |
$927.99 $977.51 $1,029.96 $1,216.29 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$733.58 $832.62 $937.52 $1,310.18 $1,990.94 |
$1,014.18 $1,113.22 $1,218.12 $1,590.78 |
$1,294.78 $1,393.82 $1,498.72 $1,871.38 |
Toc - Plan #64 Dean Health Plan | ||||||||||||||||||||
Gold
(HMO) Dean Gold Standard 2000X (Free Virtual Visits & Transportation) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$382.27 $433.88 $488.54 $682.74 $1,037.48 |
$674.71 $726.32 $780.98 $975.18 |
$967.15 $1,018.76 $1,073.42 $1,267.62 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$764.54 $867.76 $977.08 $1,365.48 $2,074.96 |
$1,056.98 $1,160.20 $1,269.52 $1,657.92 |
$1,349.42 $1,452.64 $1,561.96 $1,950.36 |
Toc - Plan #65 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Dean Silver Standard 5800X (Free Virtual Visits & Transportation) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$379.82 $431.10 $485.41 $678.36 $1,030.84 |
$670.39 $721.67 $775.98 $968.93 |
$960.96 $1,012.24 $1,066.55 $1,259.50 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$759.64 $862.20 $970.82 $1,356.72 $2,061.68 |
$1,050.21 $1,152.77 $1,261.39 $1,647.29 |
$1,340.78 $1,443.34 $1,551.96 $1,937.86 |
Toc - Plan #66 Dean Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) Dean Bronze Standard 7500X (Free Virtual Visits & Transportation) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$259.39 $294.41 $331.50 $463.27 $703.98 |
$457.82 $492.84 $529.93 $661.70 |
$656.25 $691.27 $728.36 $860.13 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$518.78 $588.82 $663.00 $926.54 $1,407.96 |
$717.21 $787.25 $861.43 $1,124.97 |
$915.64 $985.68 $1,059.86 $1,323.40 |
Toc - Plan #67 Dean Health Plan | ||||||||||||||||||||
Bronze
(HMO) Dean Bronze Standard 9100X (Free Virtual Visits & Transportation) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$231.94 $263.25 $296.41 $414.24 $629.47 |
$409.37 $440.68 $473.84 $591.67 |
$586.80 $618.11 $651.27 $769.10 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$463.88 $526.50 $592.82 $828.48 $1,258.94 |
$641.31 $703.93 $770.25 $1,005.91 |
$818.74 $881.36 $947.68 $1,183.34 |
ADVERTISEMENT
Anthem Blue Cross and Blue ShieldLocal: 1-855-748-1813 | Toll Free: 1-855-748-1813 |
Toc - Plan #68 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(HMO) Anthem Bronze Blue Preferred/Broad 0 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$370.87 $420.94 $473.97 $662.37 $1,006.54 |
$654.59 $704.66 $757.69 $946.09 |
$938.31 $988.38 $1,041.41 $1,229.81 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$741.74 $841.88 $947.94 $1,324.74 $2,013.08 |
$1,025.46 $1,125.60 $1,231.66 $1,608.46 |
$1,309.18 $1,409.32 $1,515.38 $1,892.18 |
Toc - Plan #69 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(HMO) Anthem Bronze Blue Preferred/Broad 5000 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$359.59 $408.13 $459.56 $642.23 $975.93 |
$634.68 $683.22 $734.65 $917.32 |
$909.77 $958.31 $1,009.74 $1,192.41 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$719.18 $816.26 $919.12 $1,284.46 $1,951.86 |
$994.27 $1,091.35 $1,194.21 $1,559.55 |
$1,269.36 $1,366.44 $1,469.30 $1,834.64 |
Toc - Plan #70 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(HMO) Anthem Bronze Blue Preferred/Broad 6550 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$353.15 $400.83 $451.33 $630.73 $958.45 |
$623.31 $670.99 $721.49 $900.89 |
$893.47 $941.15 $991.65 $1,171.05 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$706.30 $801.66 $902.66 $1,261.46 $1,916.90 |
$976.46 $1,071.82 $1,172.82 $1,531.62 |
$1,246.62 $1,341.98 $1,442.98 $1,801.78 |
Toc - Plan #71 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Bronze
(HMO) Anthem Bronze Blue Preferred/Broad 9100 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$334.74 $379.93 $427.80 $597.85 $908.48 |
$590.82 $636.01 $683.88 $853.93 |
$846.90 $892.09 $939.96 $1,110.01 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$669.48 $759.86 $855.60 $1,195.70 $1,816.96 |
$925.56 $1,015.94 $1,111.68 $1,451.78 |
$1,181.64 $1,272.02 $1,367.76 $1,707.86 |
Toc - Plan #72 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(HMO) Anthem Bronze Blue Preferred/Broad 0% for HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$352.42 $400.00 $450.39 $629.42 $956.47 |
$622.02 $669.60 $719.99 $899.02 |
$891.62 $939.20 $989.59 $1,168.62 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$704.84 $800.00 $900.78 $1,258.84 $1,912.94 |
$974.44 $1,069.60 $1,170.38 $1,528.44 |
$1,244.04 $1,339.20 $1,439.98 $1,798.04 |
Toc - Plan #73 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Gold
(HMO) Anthem Gold Blue Preferred/Broad 1000 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$457.15 $518.87 $584.24 $816.47 $1,240.71 |
$806.87 $868.59 $933.96 $1,166.19 |
$1,156.59 $1,218.31 $1,283.68 $1,515.91 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$914.30 $1,037.74 $1,168.48 $1,632.94 $2,481.42 |
$1,264.02 $1,387.46 $1,518.20 $1,982.66 |
$1,613.74 $1,737.18 $1,867.92 $2,332.38 |
Toc - Plan #74 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(HMO) Anthem Silver Blue Preferred/Broad 4000 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$441.38 $500.97 $564.08 $788.30 $1,197.91 |
$779.04 $838.63 $901.74 $1,125.96 |
$1,116.70 $1,176.29 $1,239.40 $1,463.62 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$882.76 $1,001.94 $1,128.16 $1,576.60 $2,395.82 |
$1,220.42 $1,339.60 $1,465.82 $1,914.26 |
$1,558.08 $1,677.26 $1,803.48 $2,251.92 |
Toc - Plan #75 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(HMO) Anthem Silver Blue Preferred/Broad 4100 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$446.68 $506.98 $570.86 $797.77 $1,212.29 |
$788.39 $848.69 $912.57 $1,139.48 |
$1,130.10 $1,190.40 $1,254.28 $1,481.19 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$893.36 $1,013.96 $1,141.72 $1,595.54 $2,424.58 |
$1,235.07 $1,355.67 $1,483.43 $1,937.25 |
$1,576.78 $1,697.38 $1,825.14 $2,278.96 |
Toc - Plan #76 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(HMO) Anthem Silver Blue Preferred/Broad 5300 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$438.78 $498.02 $560.76 $783.66 $1,190.85 |
$774.45 $833.69 $896.43 $1,119.33 |
$1,110.12 $1,169.36 $1,232.10 $1,455.00 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$877.56 $996.04 $1,121.52 $1,567.32 $2,381.70 |
$1,213.23 $1,331.71 $1,457.19 $1,902.99 |
$1,548.90 $1,667.38 $1,792.86 $2,238.66 |
Toc - Plan #77 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Bronze
(HMO) Anthem Bronze Blue Preferred/Broad 9100/0% Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$335.21 $380.46 $428.40 $598.69 $909.76 |
$591.65 $636.90 $684.84 $855.13 |
$848.09 $893.34 $941.28 $1,111.57 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$670.42 $760.92 $856.80 $1,197.38 $1,819.52 |
$926.86 $1,017.36 $1,113.24 $1,453.82 |
$1,183.30 $1,273.80 $1,369.68 $1,710.26 |
Toc - Plan #78 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(HMO) Anthem Bronze Blue Preferred/Broad 7500/50% Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$364.35 $413.54 $465.64 $650.73 $988.85 |
$643.08 $692.27 $744.37 $929.46 |
$921.81 $971.00 $1,023.10 $1,208.19 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$728.70 $827.08 $931.28 $1,301.46 $1,977.70 |
$1,007.43 $1,105.81 $1,210.01 $1,580.19 |
$1,286.16 $1,384.54 $1,488.74 $1,858.92 |
Toc - Plan #79 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(HMO) Anthem Silver Blue Preferred/Broad 5800/40% Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$435.04 $493.77 $555.98 $776.98 $1,180.70 |
$767.85 $826.58 $888.79 $1,109.79 |
$1,100.66 $1,159.39 $1,221.60 $1,442.60 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$870.08 $987.54 $1,111.96 $1,553.96 $2,361.40 |
$1,202.89 $1,320.35 $1,444.77 $1,886.77 |
$1,535.70 $1,653.16 $1,777.58 $2,219.58 |
Toc - Plan #80 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Gold
(HMO) Anthem Gold Blue Preferred/Broad 2000/25% Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$457.48 $519.24 $584.66 $817.06 $1,241.60 |
$807.45 $869.21 $934.63 $1,167.03 |
$1,157.42 $1,219.18 $1,284.60 $1,517.00 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$914.96 $1,038.48 $1,169.32 $1,634.12 $2,483.20 |
$1,264.93 $1,388.45 $1,519.29 $1,984.09 |
$1,614.90 $1,738.42 $1,869.26 $2,334.06 |
ADVERTISEMENT
Group Health Cooperative-SCWLocal: 1-608-828-4831 | Toll Free: 1-855-344-2729 | TTY: 1-608-828-4815 |
Toc - Plan #81 Group Health Cooperative-SCW | ||||||||||||||||||||
Platinum
(HMO) Platinum 500 Ded/1500 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$442.35 $502.07 $565.32 $790.04 $1,200.53 |
$780.75 $840.47 $903.72 $1,128.44 |
$1,119.15 $1,178.87 $1,242.12 $1,466.84 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$884.70 $1,004.14 $1,130.64 $1,580.08 $2,401.06 |
$1,223.10 $1,342.54 $1,469.04 $1,918.48 |
$1,561.50 $1,680.94 $1,807.44 $2,256.88 |
Toc - Plan #82 Group Health Cooperative-SCW | ||||||||||||||||||||
Gold
(HMO) Gold 2600 Ded/2600 MOOP HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$368.82 $418.61 $471.36 $658.71 $1,000.98 |
$650.97 $700.76 $753.51 $940.86 |
$933.12 $982.91 $1,035.66 $1,223.01 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$737.64 $837.22 $942.72 $1,317.42 $2,001.96 |
$1,019.79 $1,119.37 $1,224.87 $1,599.57 |
$1,301.94 $1,401.52 $1,507.02 $1,881.72 |
Toc - Plan #83 Group Health Cooperative-SCW | ||||||||||||||||||||
Silver
(HMO) Silver 5400 Ded/5400 MOOP HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$431.83 $490.13 $551.88 $771.25 $1,171.99 |
$762.18 $820.48 $882.23 $1,101.60 |
$1,092.53 $1,150.83 $1,212.58 $1,431.95 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$863.66 $980.26 $1,103.76 $1,542.50 $2,343.98 |
$1,194.01 $1,310.61 $1,434.11 $1,872.85 |
$1,524.36 $1,640.96 $1,764.46 $2,203.20 |
Toc - Plan #84 Group Health Cooperative-SCW | ||||||||||||||||||||
Expanded Bronze
(HMO) Bronze 4000 Ded/8500 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$300.81 $341.42 $384.44 $537.24 $816.39 |
$530.93 $571.54 $614.56 $767.36 |
$761.05 $801.66 $844.68 $997.48 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$601.62 $682.84 $768.88 $1,074.48 $1,632.78 |
$831.74 $912.96 $999.00 $1,304.60 |
$1,061.86 $1,143.08 $1,229.12 $1,534.72 |
Toc - Plan #85 Group Health Cooperative-SCW | ||||||||||||||||||||
Expanded Bronze
(HMO) Bronze 7500 Ded/7500 MOOP HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$292.53 $332.02 $373.85 $522.45 $793.91 |
$516.31 $555.80 $597.63 $746.23 |
$740.09 $779.58 $821.41 $970.01 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$585.06 $664.04 $747.70 $1,044.90 $1,587.82 |
$808.84 $887.82 $971.48 $1,268.68 |
$1,032.62 $1,111.60 $1,195.26 $1,492.46 |
Toc - Plan #86 Group Health Cooperative-SCW | ||||||||||||||||||||
Gold
(HMO) Gold 2500 Ded/6500 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$369.03 $418.85 $471.62 $659.08 $1,001.53 |
$651.34 $701.16 $753.93 $941.39 |
$933.65 $983.47 $1,036.24 $1,223.70 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$738.06 $837.70 $943.24 $1,318.16 $2,003.06 |
$1,020.37 $1,120.01 $1,225.55 $1,600.47 |
$1,302.68 $1,402.32 $1,507.86 $1,882.78 |
Toc - Plan #87 Group Health Cooperative-SCW | ||||||||||||||||||||
Gold
(HMO) Gold 1800 Ded/5600 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$375.10 $425.74 $479.38 $669.93 $1,018.02 |
$662.06 $712.70 $766.34 $956.89 |
$949.02 $999.66 $1,053.30 $1,243.85 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$750.20 $851.48 $958.76 $1,339.86 $2,036.04 |
$1,037.16 $1,138.44 $1,245.72 $1,626.82 |
$1,324.12 $1,425.40 $1,532.68 $1,913.78 |
Toc - Plan #88 Group Health Cooperative-SCW | ||||||||||||||||||||
Expanded Bronze
(HMO) Bronze 6850 Ded/8200 MOOP |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$309.35 $351.11 $395.35 $552.49 $839.57 |
$546.00 $587.76 $632.00 $789.14 |
$782.65 $824.41 $868.65 $1,025.79 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$618.70 $702.22 $790.70 $1,104.98 $1,679.14 |
$855.35 $938.87 $1,027.35 $1,341.63 |
$1,092.00 $1,175.52 $1,264.00 $1,578.28 |
Toc - Plan #89 Group Health Cooperative-SCW | ||||||||||||||||||||
Platinum
(HMO) Platinum No Ded/2200 MOOP |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$441.96 $501.62 $564.82 $789.33 $1,199.46 |
$780.06 $839.72 $902.92 $1,127.43 |
$1,118.16 $1,177.82 $1,241.02 $1,465.53 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$883.92 $1,003.24 $1,129.64 $1,578.66 $2,398.92 |
$1,222.02 $1,341.34 $1,467.74 $1,916.76 |
$1,560.12 $1,679.44 $1,805.84 $2,254.86 |
Toc - Plan #90 Group Health Cooperative-SCW | ||||||||||||||||||||
Bronze
(HMO) Bronze 9050 Ded/9050 MOOP |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$286.79 $325.50 $366.51 $512.20 $778.33 |
$506.18 $544.89 $585.90 $731.59 |
$725.57 $764.28 $805.29 $950.98 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$573.58 $651.00 $733.02 $1,024.40 $1,556.66 |
$792.97 $870.39 $952.41 $1,243.79 |
$1,012.36 $1,089.78 $1,171.80 $1,463.18 |
Toc - Plan #91 Group Health Cooperative-SCW | ||||||||||||||||||||
Silver
(HMO) Silver 4900 Ded/7900 MOOP |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$434.81 $493.50 $555.68 $776.56 $1,180.06 |
$767.44 $826.13 $888.31 $1,109.19 |
$1,100.07 $1,158.76 $1,220.94 $1,441.82 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$869.62 $987.00 $1,111.36 $1,553.12 $2,360.12 |
$1,202.25 $1,319.63 $1,443.99 $1,885.75 |
$1,534.88 $1,652.26 $1,776.62 $2,218.38 |
Toc - Plan #92 Group Health Cooperative-SCW | ||||||||||||||||||||
Gold
(HMO) Gold 1500 Ded/8550 MOOP |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$358.45 $406.84 $458.10 $640.19 $972.83 |
$632.67 $681.06 $732.32 $914.41 |
$906.89 $955.28 $1,006.54 $1,188.63 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$716.90 $813.68 $916.20 $1,280.38 $1,945.66 |
$991.12 $1,087.90 $1,190.42 $1,554.60 |
$1,265.34 $1,362.12 $1,464.64 $1,828.82 |
Toc - Plan #93 Group Health Cooperative-SCW | ||||||||||||||||||||
Catastrophic
(HMO) Catastrophic 9100 Ded/9100 MOOP |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$234.80 $266.50 $300.08 $419.36 $637.25 |
$414.43 $446.13 $479.71 $598.99 |
$594.06 $625.76 $659.34 $778.62 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$469.60 $533.00 $600.16 $838.72 $1,274.50 |
$649.23 $712.63 $779.79 $1,018.35 |
$828.86 $892.26 $959.42 $1,197.98 |
Toc - Plan #94 Group Health Cooperative-SCW | ||||||||||||||||||||
Platinum
(HMO) Platinum 1000 Ded/4000 MOOP Primary Care Preferred |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$416.74 $472.99 $532.59 $744.29 $1,131.01 |
$735.54 $791.79 $851.39 $1,063.09 |
$1,054.34 $1,110.59 $1,170.19 $1,381.89 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$833.48 $945.98 $1,065.18 $1,488.58 $2,262.02 |
$1,152.28 $1,264.78 $1,383.98 $1,807.38 |
$1,471.08 $1,583.58 $1,702.78 $2,126.18 |
Toc - Plan #95 Group Health Cooperative-SCW | ||||||||||||||||||||
Gold
(HMO) Gold 4450 Ded/7450 MOOP Primary Care Preferred |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$354.42 $402.27 $452.95 $633.00 $961.90 |
$625.56 $673.41 $724.09 $904.14 |
$896.70 $944.55 $995.23 $1,175.28 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$708.84 $804.54 $905.90 $1,266.00 $1,923.80 |
$979.98 $1,075.68 $1,177.04 $1,537.14 |
$1,251.12 $1,346.82 $1,448.18 $1,808.28 |
Toc - Plan #96 Group Health Cooperative-SCW | ||||||||||||||||||||
Silver
(HMO) Silver 9050 Ded/9050 MOOP Primary Care Preferred |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$425.05 $482.43 $543.22 $759.14 $1,153.58 |
$750.22 $807.60 $868.39 $1,084.31 |
$1,075.39 $1,132.77 $1,193.56 $1,409.48 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$850.10 $964.86 $1,086.44 $1,518.28 $2,307.16 |
$1,175.27 $1,290.03 $1,411.61 $1,843.45 |
$1,500.44 $1,615.20 $1,736.78 $2,168.62 |
Toc - Plan #97 Group Health Cooperative-SCW | ||||||||||||||||||||
Platinum
(HMO) Platinum No Ded/3000 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$458.24 $520.11 $585.63 $818.42 $1,243.67 |
$808.80 $870.67 $936.19 $1,168.98 |
$1,159.36 $1,221.23 $1,286.75 $1,519.54 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$916.48 $1,040.22 $1,171.26 $1,636.84 $2,487.34 |
$1,267.04 $1,390.78 $1,521.82 $1,987.40 |
$1,617.60 $1,741.34 $1,872.38 $2,337.96 |
Toc - Plan #98 Group Health Cooperative-SCW | ||||||||||||||||||||
Gold
(HMO) Gold 2000 Ded/8700 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$358.66 $407.07 $458.36 $640.56 $973.38 |
$633.03 $681.44 $732.73 $914.93 |
$907.40 $955.81 $1,007.10 $1,189.30 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$717.32 $814.14 $916.72 $1,281.12 $1,946.76 |
$991.69 $1,088.51 $1,191.09 $1,555.49 |
$1,266.06 $1,362.88 $1,465.46 $1,829.86 |
Toc - Plan #99 Group Health Cooperative-SCW | ||||||||||||||||||||
Silver
(HMO) Silver 5800 Ded/8900 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$418.31 $474.78 $534.60 $747.10 $1,135.28 |
$738.32 $794.79 $854.61 $1,067.11 |
$1,058.33 $1,114.80 $1,174.62 $1,387.12 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$836.62 $949.56 $1,069.20 $1,494.20 $2,270.56 |
$1,156.63 $1,269.57 $1,389.21 $1,814.21 |
$1,476.64 $1,589.58 $1,709.22 $2,134.22 |
Toc - Plan #100 Group Health Cooperative-SCW | ||||||||||||||||||||
Expanded Bronze
(HMO) Bronze 7500 Ded/9000 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$306.24 $347.58 $391.37 $546.94 $831.13 |
$540.51 $581.85 $625.64 $781.21 |
$774.78 $816.12 $859.91 $1,015.48 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$612.48 $695.16 $782.74 $1,093.88 $1,662.26 |
$846.75 $929.43 $1,017.01 $1,328.15 |
$1,081.02 $1,163.70 $1,251.28 $1,562.42 |
Toc - Plan #101 Group Health Cooperative-SCW | ||||||||||||||||||||
Bronze
(HMO) Bronze 9100 Ded/9100 MOOP |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-344-2729
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$272.62 $309.43 $348.41 $486.90 $739.89 |
$481.18 $517.99 $556.97 $695.46 |
$689.74 $726.55 $765.53 $904.02 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$545.24 $618.86 $696.82 $973.80 $1,479.78 |
$753.80 $827.42 $905.38 $1,182.36 |
$962.36 $1,035.98 $1,113.94 $1,390.92 |
‡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 Iowa County here.
Iowa County is in “Rating Area 7” of Wisconsin.
Currently, there are 101 plans offered in Rating Area 7.