Obamacare 2023 Rates for Washington County
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Obamacare > Rates > Wisconsin > Washington County
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Together with CCHPLocal: 1-844-201-4672 | Toll Free: 1-844-201-4672 | TTY: 1-844-531-4856 |
Toc - Plan #1 Together with CCHP | ||||||||||||||||||||
Expanded Bronze
(EPO) Chorus Bronze |
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Benefits & Coverage
Plan Brochure
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Customer Service Phone: 1-844-201-4672
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 |
$325.57 $369.51 $416.06 $581.44 $883.56 |
$574.62 $618.56 $665.11 $830.49 |
$823.67 $867.61 $914.16 $1,079.54 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$651.14 $739.02 $832.12 $1,162.88 $1,767.12 |
$900.19 $988.07 $1,081.17 $1,411.93 |
$1,149.24 $1,237.12 $1,330.22 $1,660.98 |
Toc - Plan #2 Together with CCHP | ||||||||||||||||||||
Silver
(EPO) Chorus Standard Silver |
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Benefits & Coverage
Plan Brochure
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Customer Service Phone: 1-844-201-4672
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 |
$425.57 $483.01 $543.87 $760.06 $1,154.98 |
$751.13 $808.57 $869.43 $1,085.62 |
$1,076.69 $1,134.13 $1,194.99 $1,411.18 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$851.14 $966.02 $1,087.74 $1,520.12 $2,309.96 |
$1,176.70 $1,291.58 $1,413.30 $1,845.68 |
$1,502.26 $1,617.14 $1,738.86 $2,171.24 |
Toc - Plan #3 Together with CCHP | ||||||||||||||||||||
Silver
(EPO) Chorus Silver |
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Benefits & Coverage
Plan Brochure
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Customer Service Phone: 1-844-201-4672
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 |
$388.12 $440.51 $496.01 $693.17 $1,053.34 |
$685.03 $737.42 $792.92 $990.08 |
$981.94 $1,034.33 $1,089.83 $1,286.99 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$776.24 $881.02 $992.02 $1,386.34 $2,106.68 |
$1,073.15 $1,177.93 $1,288.93 $1,683.25 |
$1,370.06 $1,474.84 $1,585.84 $1,980.16 |
Toc - Plan #4 Together with CCHP | ||||||||||||||||||||
Gold
(EPO) Chorus Gold |
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Benefits & Coverage
Plan Brochure
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Customer Service Phone: 1-844-201-4672
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 |
$459.62 $521.65 $587.38 $820.86 $1,247.38 |
$811.22 $873.25 $938.98 $1,172.46 |
$1,162.82 $1,224.85 $1,290.58 $1,524.06 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$919.24 $1,043.30 $1,174.76 $1,641.72 $2,494.76 |
$1,270.84 $1,394.90 $1,526.36 $1,993.32 |
$1,622.44 $1,746.50 $1,877.96 $2,344.92 |
Toc - Plan #5 Together with CCHP | ||||||||||||||||||||
Expanded Bronze
(EPO) Chorus Bronze HDHP |
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Benefits & Coverage
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Customer Service Phone: 1-844-201-4672
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 |
$358.33 $406.70 $457.94 $639.97 $972.49 |
$632.45 $680.82 $732.06 $914.09 |
$906.57 $954.94 $1,006.18 $1,188.21 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$716.66 $813.40 $915.88 $1,279.94 $1,944.98 |
$990.78 $1,087.52 $1,190.00 $1,554.06 |
$1,264.90 $1,361.64 $1,464.12 $1,828.18 |
Toc - Plan #6 Together with CCHP | ||||||||||||||||||||
Silver
(EPO) Chorus Silver Select |
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Benefits & Coverage
Plan Brochure
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Customer Service Phone: 1-844-201-4672
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 |
$411.95 $467.56 $526.47 $735.73 $1,118.02 |
$727.09 $782.70 $841.61 $1,050.87 |
$1,042.23 $1,097.84 $1,156.75 $1,366.01 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$823.90 $935.12 $1,052.94 $1,471.46 $2,236.04 |
$1,139.04 $1,250.26 $1,368.08 $1,786.60 |
$1,454.18 $1,565.40 $1,683.22 $2,101.74 |
Toc - Plan #7 Together with CCHP | ||||||||||||||||||||
Catastrophic
(EPO) Chorus Catastrophic |
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Benefits & Coverage
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Customer Service Phone: 1-844-201-4672
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 |
$270.67 $307.20 $345.90 $483.40 $734.57 |
$477.72 $514.25 $552.95 $690.45 |
$684.77 $721.30 $760.00 $897.50 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$541.34 $614.40 $691.80 $966.80 $1,469.14 |
$748.39 $821.45 $898.85 $1,173.85 |
$955.44 $1,028.50 $1,105.90 $1,380.90 |
Toc - Plan #8 Together with CCHP | ||||||||||||||||||||
Expanded Bronze
(EPO) Chorus Bronze Copay |
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Benefits & Coverage
Plan Brochure
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Customer Service Phone: 1-844-201-4672
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 |
$362.59 $411.53 $463.38 $647.57 $984.04 |
$639.96 $688.90 $740.75 $924.94 |
$917.33 $966.27 $1,018.12 $1,202.31 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$725.18 $823.06 $926.76 $1,295.14 $1,968.08 |
$1,002.55 $1,100.43 $1,204.13 $1,572.51 |
$1,279.92 $1,377.80 $1,481.50 $1,849.88 |
Toc - Plan #9 Together with CCHP | ||||||||||||||||||||
Silver
(EPO) Chorus Silver Copay |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-201-4672
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 |
$459.62 $521.65 $587.38 $820.86 $1,247.38 |
$811.22 $873.25 $938.98 $1,172.46 |
$1,162.82 $1,224.85 $1,290.58 $1,524.06 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$919.24 $1,043.30 $1,174.76 $1,641.72 $2,494.76 |
$1,270.84 $1,394.90 $1,526.36 $1,993.32 |
$1,622.44 $1,746.50 $1,877.96 $2,344.92 |
Toc - Plan #10 Together with CCHP | ||||||||||||||||||||
Bronze
(EPO) Chorus Core Bronze |
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Benefits & Coverage
Plan Brochure
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Customer Service Phone: 1-844-201-4672
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 |
$305.56 $346.80 $390.50 $545.72 $829.27 |
$539.31 $580.55 $624.25 $779.47 |
$773.06 $814.30 $858.00 $1,013.22 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$611.12 $693.60 $781.00 $1,091.44 $1,658.54 |
$844.87 $927.35 $1,014.75 $1,325.19 |
$1,078.62 $1,161.10 $1,248.50 $1,558.94 |
Toc - Plan #11 Together with CCHP | ||||||||||||||||||||
Silver
(EPO) Chorus Core Silver |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-201-4672
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 |
$386.42 $438.58 $493.83 $690.13 $1,048.72 |
$682.02 $734.18 $789.43 $985.73 |
$977.62 $1,029.78 $1,085.03 $1,281.33 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$772.84 $877.16 $987.66 $1,380.26 $2,097.44 |
$1,068.44 $1,172.76 $1,283.26 $1,675.86 |
$1,364.04 $1,468.36 $1,578.86 $1,971.46 |
Toc - Plan #12 Together with CCHP | ||||||||||||||||||||
Gold
(EPO) Chorus Core Gold |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-201-4672
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 |
$441.32 $500.89 $563.99 $788.18 $1,197.71 |
$778.92 $838.49 $901.59 $1,125.78 |
$1,116.52 $1,176.09 $1,239.19 $1,463.38 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$882.64 $1,001.78 $1,127.98 $1,576.36 $2,395.42 |
$1,220.24 $1,339.38 $1,465.58 $1,913.96 |
$1,557.84 $1,676.98 $1,803.18 $2,251.56 |
ADVERTISEMENT
QuartzLocal: 1-608-644-3430 | Toll Free: 1-800-362-3310 | TTY: 1-800-877-8973 |
Toc - Plan #13 Quartz | ||||||||||||||||||||
Gold
(HMO) QUARTZ ONE WITH AURORA HEALTH CARE GOLD I401 with Dental & Vision |
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Benefits & Coverage
Plan Brochure
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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 |
$407.67 $462.70 $520.99 $728.08 $1,106.39 |
$719.53 $774.56 $832.85 $1,039.94 |
$1,031.39 $1,086.42 $1,144.71 $1,351.80 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$815.34 $925.40 $1,041.98 $1,456.16 $2,212.78 |
$1,127.20 $1,237.26 $1,353.84 $1,768.02 |
$1,439.06 $1,549.12 $1,665.70 $2,079.88 |
Toc - Plan #14 Quartz | ||||||||||||||||||||
Gold
(HMO) QUARTZ ONE WITH AURORA HEALTH CARE GOLD I402 Maintenance with Dental & Vision |
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Benefits & Coverage
Plan Brochure
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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 |
$403.84 $458.36 $516.10 $721.25 $1,096.02 |
$712.78 $767.30 $825.04 $1,030.19 |
$1,021.72 $1,076.24 $1,133.98 $1,339.13 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$807.68 $916.72 $1,032.20 $1,442.50 $2,192.04 |
$1,116.62 $1,225.66 $1,341.14 $1,751.44 |
$1,425.56 $1,534.60 $1,650.08 $2,060.38 |
Toc - Plan #15 Quartz | ||||||||||||||||||||
Gold
(HMO) QUARTZ ONE WITH AURORA HEALTH CARE GOLD I405 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 |
$407.20 $462.17 $520.39 $727.25 $1,105.13 |
$718.70 $773.67 $831.89 $1,038.75 |
$1,030.20 $1,085.17 $1,143.39 $1,350.25 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$814.40 $924.34 $1,040.78 $1,454.50 $2,210.26 |
$1,125.90 $1,235.84 $1,352.28 $1,766.00 |
$1,437.40 $1,547.34 $1,663.78 $2,077.50 |
Toc - Plan #16 Quartz | ||||||||||||||||||||
Gold
(HMO) Quartz One with Aurora Health Care Gold I410 Standard with Dental & Vision |
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Benefits & Coverage
Plan Brochure
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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 |
$417.63 $474.00 $533.72 $745.87 $1,133.43 |
$737.11 $793.48 $853.20 $1,065.35 |
$1,056.59 $1,112.96 $1,172.68 $1,384.83 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$835.26 $948.00 $1,067.44 $1,491.74 $2,266.86 |
$1,154.74 $1,267.48 $1,386.92 $1,811.22 |
$1,474.22 $1,586.96 $1,706.40 $2,130.70 |
Toc - Plan #17 Quartz | ||||||||||||||||||||
Silver
(HMO) QUARTZ ONE WITH AURORA HEALTH CARE SILVER I301 with Dental & Vision |
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Benefits & Coverage
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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 |
$419.61 $476.26 $536.26 $749.42 $1,138.82 |
$740.61 $797.26 $857.26 $1,070.42 |
$1,061.61 $1,118.26 $1,178.26 $1,391.42 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$839.22 $952.52 $1,072.52 $1,498.84 $2,277.64 |
$1,160.22 $1,273.52 $1,393.52 $1,819.84 |
$1,481.22 $1,594.52 $1,714.52 $2,140.84 |
Toc - Plan #18 Quartz | ||||||||||||||||||||
Silver
(HMO) QUARTZ ONE WITH AURORA HEALTH CARE SILVER I303 with Dental & Vision |
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Benefits & Coverage
Plan Brochure
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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 |
$416.06 $472.22 $531.72 $743.08 $1,129.18 |
$734.34 $790.50 $850.00 $1,061.36 |
$1,052.62 $1,108.78 $1,168.28 $1,379.64 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$832.12 $944.44 $1,063.44 $1,486.16 $2,258.36 |
$1,150.40 $1,262.72 $1,381.72 $1,804.44 |
$1,468.68 $1,581.00 $1,700.00 $2,122.72 |
Toc - Plan #19 Quartz | ||||||||||||||||||||
Silver
(HMO) QUARTZ ONE WITH AURORA HEALTH CARE SILVER I308 with Dental & Vision |
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Benefits & Coverage
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Customer Service Phone: 1-800-362-3310
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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 |
$436.53 $495.45 $557.87 $779.63 $1,184.72 |
$770.47 $829.39 $891.81 $1,113.57 |
$1,104.41 $1,163.33 $1,225.75 $1,447.51 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$873.06 $990.90 $1,115.74 $1,559.26 $2,369.44 |
$1,207.00 $1,324.84 $1,449.68 $1,893.20 |
$1,540.94 $1,658.78 $1,783.62 $2,227.14 |
Toc - Plan #20 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One with Aurora Health Care Silver I309 Standard with Dental & Vision |
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Benefits & Coverage
Plan Brochure
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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 |
$457.19 $518.91 $584.29 $816.54 $1,240.81 |
$806.94 $868.66 $934.04 $1,166.29 |
$1,156.69 $1,218.41 $1,283.79 $1,516.04 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$914.38 $1,037.82 $1,168.58 $1,633.08 $2,481.62 |
$1,264.13 $1,387.57 $1,518.33 $1,982.83 |
$1,613.88 $1,737.32 $1,868.08 $2,332.58 |
Toc - Plan #21 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE WITH AURORA HEALTH CARE BRONZE I201 with Dental & Vision |
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Benefits & Coverage
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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 |
$309.45 $351.22 $395.47 $552.67 $839.83 |
$546.17 $587.94 $632.19 $789.39 |
$782.89 $824.66 $868.91 $1,026.11 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$618.90 $702.44 $790.94 $1,105.34 $1,679.66 |
$855.62 $939.16 $1,027.66 $1,342.06 |
$1,092.34 $1,175.88 $1,264.38 $1,578.78 |
Toc - Plan #22 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE WITH AURORA HEALTH CARE BRONZE I202 with Dental & Vision |
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Benefits & Coverage
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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 |
$312.51 $354.69 $399.38 $558.13 $848.14 |
$551.58 $593.76 $638.45 $797.20 |
$790.65 $832.83 $877.52 $1,036.27 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$625.02 $709.38 $798.76 $1,116.26 $1,696.28 |
$864.09 $948.45 $1,037.83 $1,355.33 |
$1,103.16 $1,187.52 $1,276.90 $1,594.40 |
Toc - Plan #23 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE WITH AURORA HEALTH CARE BRONZE I204 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]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$327.58 $371.79 $418.64 $585.04 $889.03 |
$578.17 $622.38 $669.23 $835.63 |
$828.76 $872.97 $919.82 $1,086.22 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$655.16 $743.58 $837.28 $1,170.08 $1,778.06 |
$905.75 $994.17 $1,087.87 $1,420.67 |
$1,156.34 $1,244.76 $1,338.46 $1,671.26 |
Toc - Plan #24 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE WITH AURORA HEALTH CARE BRONZE I205 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]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$324.23 $367.99 $414.36 $579.06 $879.94 |
$572.26 $616.02 $662.39 $827.09 |
$820.29 $864.05 $910.42 $1,075.12 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$648.46 $735.98 $828.72 $1,158.12 $1,759.88 |
$896.49 $984.01 $1,076.75 $1,406.15 |
$1,144.52 $1,232.04 $1,324.78 $1,654.18 |
Toc - Plan #25 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One with Aurora Health Care Bronze I206 Standard 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]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$337.58 $383.14 $431.42 $602.90 $916.17 |
$595.82 $641.38 $689.66 $861.14 |
$854.06 $899.62 $947.90 $1,119.38 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$675.16 $766.28 $862.84 $1,205.80 $1,832.34 |
$933.40 $1,024.52 $1,121.08 $1,464.04 |
$1,191.64 $1,282.76 $1,379.32 $1,722.28 |
Toc - Plan #26 Quartz | ||||||||||||||||||||
Gold
(HMO) QUARTZ ONE WITH AURORA HEALTH CARE GOLD I401 |
||||||||||||||||||||
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 |
$389.59 $442.18 $497.89 $695.80 $1,057.34 |
$687.62 $740.21 $795.92 $993.83 |
$985.65 $1,038.24 $1,093.95 $1,291.86 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$779.18 $884.36 $995.78 $1,391.60 $2,114.68 |
$1,077.21 $1,182.39 $1,293.81 $1,689.63 |
$1,375.24 $1,480.42 $1,591.84 $1,987.66 |
Toc - Plan #27 Quartz | ||||||||||||||||||||
Gold
(HMO) QUARTZ ONE WITH AURORA HEALTH CARE GOLD I402 Maintenance |
||||||||||||||||||||
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 |
$385.94 $438.03 $493.22 $689.28 $1,047.42 |
$681.18 $733.27 $788.46 $984.52 |
$976.42 $1,028.51 $1,083.70 $1,279.76 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$771.88 $876.06 $986.44 $1,378.56 $2,094.84 |
$1,067.12 $1,171.30 $1,281.68 $1,673.80 |
$1,362.36 $1,466.54 $1,576.92 $1,969.04 |
Toc - Plan #28 Quartz | ||||||||||||||||||||
Gold
(HMO) QUARTZ ONE WITH AURORA HEALTH CARE GOLD I405 |
||||||||||||||||||||
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 |
$389.15 $441.68 $497.32 $695.01 $1,056.13 |
$686.84 $739.37 $795.01 $992.70 |
$984.53 $1,037.06 $1,092.70 $1,290.39 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$778.30 $883.36 $994.64 $1,390.02 $2,112.26 |
$1,075.99 $1,181.05 $1,292.33 $1,687.71 |
$1,373.68 $1,478.74 $1,590.02 $1,985.40 |
Toc - Plan #29 Quartz | ||||||||||||||||||||
Gold
(HMO) Quartz One with Aurora Health Care 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 |
$399.11 $452.99 $510.06 $712.80 $1,083.18 |
$704.43 $758.31 $815.38 $1,018.12 |
$1,009.75 $1,063.63 $1,120.70 $1,323.44 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$798.22 $905.98 $1,020.12 $1,425.60 $2,166.36 |
$1,103.54 $1,211.30 $1,325.44 $1,730.92 |
$1,408.86 $1,516.62 $1,630.76 $2,036.24 |
Toc - Plan #30 Quartz | ||||||||||||||||||||
Silver
(HMO) QUARTZ ONE WITH AURORA HEALTH CARE SILVER I301 |
||||||||||||||||||||
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 |
$401.01 $455.14 $512.48 $716.19 $1,088.33 |
$707.78 $761.91 $819.25 $1,022.96 |
$1,014.55 $1,068.68 $1,126.02 $1,329.73 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$802.02 $910.28 $1,024.96 $1,432.38 $2,176.66 |
$1,108.79 $1,217.05 $1,331.73 $1,739.15 |
$1,415.56 $1,523.82 $1,638.50 $2,045.92 |
Toc - Plan #31 Quartz | ||||||||||||||||||||
Silver
(HMO) QUARTZ ONE WITH AURORA HEALTH CARE SILVER I303 |
||||||||||||||||||||
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 |
$397.62 $451.29 $508.15 $710.13 $1,079.12 |
$701.79 $755.46 $812.32 $1,014.30 |
$1,005.96 $1,059.63 $1,116.49 $1,318.47 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$795.24 $902.58 $1,016.30 $1,420.26 $2,158.24 |
$1,099.41 $1,206.75 $1,320.47 $1,724.43 |
$1,403.58 $1,510.92 $1,624.64 $2,028.60 |
Toc - Plan #32 Quartz | ||||||||||||||||||||
Silver
(HMO) QUARTZ ONE WITH AURORA HEALTH CARE SILVER I308 |
||||||||||||||||||||
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 |
$417.17 $473.48 $533.14 $745.06 $1,132.19 |
$736.30 $792.61 $852.27 $1,064.19 |
$1,055.43 $1,111.74 $1,171.40 $1,383.32 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$834.34 $946.96 $1,066.28 $1,490.12 $2,264.38 |
$1,153.47 $1,266.09 $1,385.41 $1,809.25 |
$1,472.60 $1,585.22 $1,704.54 $2,128.38 |
Toc - Plan #33 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One with Aurora Health Care 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]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$436.92 $495.90 $558.38 $780.34 $1,185.80 |
$771.16 $830.14 $892.62 $1,114.58 |
$1,105.40 $1,164.38 $1,226.86 $1,448.82 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$873.84 $991.80 $1,116.76 $1,560.68 $2,371.60 |
$1,208.08 $1,326.04 $1,451.00 $1,894.92 |
$1,542.32 $1,660.28 $1,785.24 $2,229.16 |
Toc - Plan #34 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE WITH AURORA HEALTH CARE BRONZE I201 |
||||||||||||||||||||
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 |
$295.73 $335.65 $377.93 $528.16 $802.59 |
$521.96 $561.88 $604.16 $754.39 |
$748.19 $788.11 $830.39 $980.62 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$591.46 $671.30 $755.86 $1,056.32 $1,605.18 |
$817.69 $897.53 $982.09 $1,282.55 |
$1,043.92 $1,123.76 $1,208.32 $1,508.78 |
Toc - Plan #35 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE WITH AURORA HEALTH CARE BRONZE I202 |
||||||||||||||||||||
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 |
$298.66 $338.97 $381.67 $533.39 $810.54 |
$527.13 $567.44 $610.14 $761.86 |
$755.60 $795.91 $838.61 $990.33 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$597.32 $677.94 $763.34 $1,066.78 $1,621.08 |
$825.79 $906.41 $991.81 $1,295.25 |
$1,054.26 $1,134.88 $1,220.28 $1,523.72 |
Toc - Plan #36 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE WITH AURORA HEALTH CARE BRONZE I204 |
||||||||||||||||||||
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 |
$313.05 $355.31 $400.08 $559.10 $849.61 |
$552.53 $594.79 $639.56 $798.58 |
$792.01 $834.27 $879.04 $1,038.06 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$626.10 $710.62 $800.16 $1,118.20 $1,699.22 |
$865.58 $950.10 $1,039.64 $1,357.68 |
$1,105.06 $1,189.58 $1,279.12 $1,597.16 |
Toc - Plan #37 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE WITH AURORA HEALTH CARE BRONZE I205 |
||||||||||||||||||||
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 |
$309.85 $351.68 $395.99 $553.39 $840.93 |
$546.88 $588.71 $633.02 $790.42 |
$783.91 $825.74 $870.05 $1,027.45 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$619.70 $703.36 $791.98 $1,106.78 $1,681.86 |
$856.73 $940.39 $1,029.01 $1,343.81 |
$1,093.76 $1,177.42 $1,266.04 $1,580.84 |
Toc - Plan #38 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One with Aurora Health Care 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]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$322.61 $366.16 $412.29 $576.17 $875.55 |
$569.40 $612.95 $659.08 $822.96 |
$816.19 $859.74 $905.87 $1,069.75 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$645.22 $732.32 $824.58 $1,152.34 $1,751.10 |
$892.01 $979.11 $1,071.37 $1,399.13 |
$1,138.80 $1,225.90 $1,318.16 $1,645.92 |
Toc - Plan #39 Quartz | ||||||||||||||||||||
Gold
(HMO) QUARTZ ONE WITH AURORA HEALTH CARE GOLD I403 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 |
$413.47 $469.28 $528.41 $738.44 $1,122.14 |
$729.77 $785.58 $844.71 $1,054.74 |
$1,046.07 $1,101.88 $1,161.01 $1,371.04 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$826.94 $938.56 $1,056.82 $1,476.88 $2,244.28 |
$1,143.24 $1,254.86 $1,373.12 $1,793.18 |
$1,459.54 $1,571.16 $1,689.42 $2,109.48 |
Toc - Plan #40 Quartz | ||||||||||||||||||||
Silver
(HMO) QUARTZ ONE WITH AURORA HEALTH CARE SILVER I304 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 |
$439.29 $498.59 $561.40 $784.56 $1,192.21 |
$775.34 $834.64 $897.45 $1,120.61 |
$1,111.39 $1,170.69 $1,233.50 $1,456.66 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$878.58 $997.18 $1,122.80 $1,569.12 $2,384.42 |
$1,214.63 $1,333.23 $1,458.85 $1,905.17 |
$1,550.68 $1,669.28 $1,794.90 $2,241.22 |
Toc - Plan #41 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE WITH AURORA HEALTH CARE 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 |
$310.78 $352.73 $397.17 $555.04 $843.44 |
$548.52 $590.47 $634.91 $792.78 |
$786.26 $828.21 $872.65 $1,030.52 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$621.56 $705.46 $794.34 $1,110.08 $1,686.88 |
$859.30 $943.20 $1,032.08 $1,347.82 |
$1,097.04 $1,180.94 $1,269.82 $1,585.56 |
Toc - Plan #42 Quartz | ||||||||||||||||||||
Catastrophic
(HMO) QUARTZ ONE WITH AURORA HEALTH CARE 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 |
$229.10 $260.02 $292.79 $409.17 $621.77 |
$404.36 $435.28 $468.05 $584.43 |
$579.62 $610.54 $643.31 $759.69 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$458.20 $520.04 $585.58 $818.34 $1,243.54 |
$633.46 $695.30 $760.84 $993.60 |
$808.72 $870.56 $936.10 $1,168.86 |
Toc - Plan #43 Quartz | ||||||||||||||||||||
Silver
(HMO) QUARTZ ONE WITH AURORA HEALTH CARE SILVER I307 |
||||||||||||||||||||
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 |
$441.20 $500.76 $563.85 $787.98 $1,197.41 |
$778.72 $838.28 $901.37 $1,125.50 |
$1,116.24 $1,175.80 $1,238.89 $1,463.02 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$882.40 $1,001.52 $1,127.70 $1,575.96 $2,394.82 |
$1,219.92 $1,339.04 $1,465.22 $1,913.48 |
$1,557.44 $1,676.56 $1,802.74 $2,251.00 |
Toc - Plan #44 Quartz | ||||||||||||||||||||
Gold
(HMO) QUARTZ ONE WITH AURORA HEALTH CARE GOLD I401 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 |
$394.12 $447.32 $503.68 $703.88 $1,069.62 |
$695.62 $748.82 $805.18 $1,005.38 |
$997.12 $1,050.32 $1,106.68 $1,306.88 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$788.24 $894.64 $1,007.36 $1,407.76 $2,139.24 |
$1,089.74 $1,196.14 $1,308.86 $1,709.26 |
$1,391.24 $1,497.64 $1,610.36 $2,010.76 |
Toc - Plan #45 Quartz | ||||||||||||||||||||
Gold
(HMO) QUARTZ ONE WITH AURORA HEALTH CARE GOLD I402 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 |
$390.42 $443.12 $498.95 $697.28 $1,059.59 |
$689.09 $741.79 $797.62 $995.95 |
$987.76 $1,040.46 $1,096.29 $1,294.62 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$780.84 $886.24 $997.90 $1,394.56 $2,119.18 |
$1,079.51 $1,184.91 $1,296.57 $1,693.23 |
$1,378.18 $1,483.58 $1,595.24 $1,991.90 |
Toc - Plan #46 Quartz | ||||||||||||||||||||
Gold
(HMO) QUARTZ ONE WITH AURORA HEALTH CARE GOLD I405 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 |
$393.67 $446.81 $503.10 $703.08 $1,068.40 |
$694.82 $747.96 $804.25 $1,004.23 |
$995.97 $1,049.11 $1,105.40 $1,305.38 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$787.34 $893.62 $1,006.20 $1,406.16 $2,136.80 |
$1,088.49 $1,194.77 $1,307.35 $1,707.31 |
$1,389.64 $1,495.92 $1,608.50 $2,008.46 |
Toc - Plan #47 Quartz | ||||||||||||||||||||
Gold
(HMO) Quartz One with Aurora Health Care 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 |
$403.75 $458.25 $515.98 $721.08 $1,095.76 |
$712.61 $767.11 $824.84 $1,029.94 |
$1,021.47 $1,075.97 $1,133.70 $1,338.80 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$807.50 $916.50 $1,031.96 $1,442.16 $2,191.52 |
$1,116.36 $1,225.36 $1,340.82 $1,751.02 |
$1,425.22 $1,534.22 $1,649.68 $2,059.88 |
Toc - Plan #48 Quartz | ||||||||||||||||||||
Silver
(HMO) QUARTZ ONE WITH AURORA HEALTH CARE SILVER I301 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 |
$405.67 $460.43 $518.44 $724.51 $1,100.97 |
$716.00 $770.76 $828.77 $1,034.84 |
$1,026.33 $1,081.09 $1,139.10 $1,345.17 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$811.34 $920.86 $1,036.88 $1,449.02 $2,201.94 |
$1,121.67 $1,231.19 $1,347.21 $1,759.35 |
$1,432.00 $1,541.52 $1,657.54 $2,069.68 |
Toc - Plan #49 Quartz | ||||||||||||||||||||
Silver
(HMO) QUARTZ ONE WITH AURORA HEALTH CARE 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 |
$402.23 $456.53 $514.05 $718.38 $1,091.65 |
$709.94 $764.24 $821.76 $1,026.09 |
$1,017.65 $1,071.95 $1,129.47 $1,333.80 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$804.46 $913.06 $1,028.10 $1,436.76 $2,183.30 |
$1,112.17 $1,220.77 $1,335.81 $1,744.47 |
$1,419.88 $1,528.48 $1,643.52 $2,052.18 |
Toc - Plan #50 Quartz | ||||||||||||||||||||
Silver
(HMO) QUARTZ ONE WITH AURORA HEALTH CARE 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 |
$422.02 $478.98 $539.33 $753.72 $1,145.34 |
$744.86 $801.82 $862.17 $1,076.56 |
$1,067.70 $1,124.66 $1,185.01 $1,399.40 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$844.04 $957.96 $1,078.66 $1,507.44 $2,290.68 |
$1,166.88 $1,280.80 $1,401.50 $1,830.28 |
$1,489.72 $1,603.64 $1,724.34 $2,153.12 |
Toc - Plan #51 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One with Aurora Health Care 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 |
$442.00 $501.66 $564.87 $789.40 $1,199.57 |
$780.13 $839.79 $903.00 $1,127.53 |
$1,118.26 $1,177.92 $1,241.13 $1,465.66 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$884.00 $1,003.32 $1,129.74 $1,578.80 $2,399.14 |
$1,222.13 $1,341.45 $1,467.87 $1,916.93 |
$1,560.26 $1,679.58 $1,806.00 $2,255.06 |
Toc - Plan #52 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE WITH AURORA HEALTH CARE 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 |
$299.16 $339.55 $382.32 $534.30 $811.92 |
$528.02 $568.41 $611.18 $763.16 |
$756.88 $797.27 $840.04 $992.02 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$598.32 $679.10 $764.64 $1,068.60 $1,623.84 |
$827.18 $907.96 $993.50 $1,297.46 |
$1,056.04 $1,136.82 $1,222.36 $1,526.32 |
Toc - Plan #53 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE WITH AURORA HEALTH CARE 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 |
$302.12 $342.91 $386.11 $539.58 $819.95 |
$533.24 $574.03 $617.23 $770.70 |
$764.36 $805.15 $848.35 $1,001.82 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$604.24 $685.82 $772.22 $1,079.16 $1,639.90 |
$835.36 $916.94 $1,003.34 $1,310.28 |
$1,066.48 $1,148.06 $1,234.46 $1,541.40 |
Toc - Plan #54 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE WITH AURORA HEALTH CARE 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 |
$316.69 $359.44 $404.72 $565.60 $859.48 |
$558.95 $601.70 $646.98 $807.86 |
$801.21 $843.96 $889.24 $1,050.12 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$633.38 $718.88 $809.44 $1,131.20 $1,718.96 |
$875.64 $961.14 $1,051.70 $1,373.46 |
$1,117.90 $1,203.40 $1,293.96 $1,615.72 |
Toc - Plan #55 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE WITH AURORA HEALTH CARE 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 |
$313.45 $355.76 $400.59 $559.82 $850.70 |
$553.24 $595.55 $640.38 $799.61 |
$793.03 $835.34 $880.17 $1,039.40 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$626.90 $711.52 $801.18 $1,119.64 $1,701.40 |
$866.69 $951.31 $1,040.97 $1,359.43 |
$1,106.48 $1,191.10 $1,280.76 $1,599.22 |
Toc - Plan #56 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One with Aurora Health Care 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 |
$326.36 $370.41 $417.08 $582.86 $885.72 |
$576.02 $620.07 $666.74 $832.52 |
$825.68 $869.73 $916.40 $1,082.18 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$652.72 $740.82 $834.16 $1,165.72 $1,771.44 |
$902.38 $990.48 $1,083.82 $1,415.38 |
$1,152.04 $1,240.14 $1,333.48 $1,665.04 |
Toc - Plan #57 Quartz | ||||||||||||||||||||
Gold
(HMO) QUARTZ ONE WITH AURORA HEALTH CARE GOLD I403 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 |
$418.27 $474.73 $534.54 $747.02 $1,135.17 |
$738.24 $794.70 $854.51 $1,066.99 |
$1,058.21 $1,114.67 $1,174.48 $1,386.96 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$836.54 $949.46 $1,069.08 $1,494.04 $2,270.34 |
$1,156.51 $1,269.43 $1,389.05 $1,814.01 |
$1,476.48 $1,589.40 $1,709.02 $2,133.98 |
Toc - Plan #58 Quartz | ||||||||||||||||||||
Silver
(HMO) QUARTZ ONE WITH AURORA HEALTH CARE SILVER I304 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 |
$444.39 $504.38 $567.92 $793.67 $1,206.06 |
$784.34 $844.33 $907.87 $1,133.62 |
$1,124.29 $1,184.28 $1,247.82 $1,473.57 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$888.78 $1,008.76 $1,135.84 $1,587.34 $2,412.12 |
$1,228.73 $1,348.71 $1,475.79 $1,927.29 |
$1,568.68 $1,688.66 $1,815.74 $2,267.24 |
Toc - Plan #59 Quartz | ||||||||||||||||||||
Silver
(HMO) QUARTZ ONE WITH AURORA HEALTH CARE SILVER I307 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 |
$446.33 $506.58 $570.40 $797.13 $1,211.32 |
$787.77 $848.02 $911.84 $1,138.57 |
$1,129.21 $1,189.46 $1,253.28 $1,480.01 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$892.66 $1,013.16 $1,140.80 $1,594.26 $2,422.64 |
$1,234.10 $1,354.60 $1,482.24 $1,935.70 |
$1,575.54 $1,696.04 $1,823.68 $2,277.14 |
Toc - Plan #60 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE WITH AURORA HEALTH CARE 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 |
$314.39 $356.83 $401.78 $561.49 $853.24 |
$554.89 $597.33 $642.28 $801.99 |
$795.39 $837.83 $882.78 $1,042.49 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$628.78 $713.66 $803.56 $1,122.98 $1,706.48 |
$869.28 $954.16 $1,044.06 $1,363.48 |
$1,109.78 $1,194.66 $1,284.56 $1,603.98 |
ADVERTISEMENT
Molina HealthcareLocal: 1-888-560-2043 | Toll Free: 1-888-560-2043 |
Toc - Plan #61 Molina Healthcare | ||||||||||||||||||||
Gold
(HMO) Confident Care Gold 1 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$533.62 $605.66 $681.96 $953.04 $1,448.24 |
$941.84 $1,013.88 $1,090.18 $1,361.26 |
$1,350.06 $1,422.10 $1,498.40 $1,769.48 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,067.24 $1,211.32 $1,363.92 $1,906.08 $2,896.48 |
$1,475.46 $1,619.54 $1,772.14 $2,314.30 |
$1,883.68 $2,027.76 $2,180.36 $2,722.52 |
Toc - Plan #62 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Constant Care Silver 1 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$447.94 $508.41 $572.47 $800.02 $1,215.71 |
$790.61 $851.08 $915.14 $1,142.69 |
$1,133.28 $1,193.75 $1,257.81 $1,485.36 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$895.88 $1,016.82 $1,144.94 $1,600.04 $2,431.42 |
$1,238.55 $1,359.49 $1,487.61 $1,942.71 |
$1,581.22 $1,702.16 $1,830.28 $2,285.38 |
Toc - Plan #63 Molina Healthcare | ||||||||||||||||||||
Gold
(HMO) Confident Care Gold 8 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$545.11 $618.70 $696.65 $973.57 $1,479.43 |
$962.12 $1,035.71 $1,113.66 $1,390.58 |
$1,379.13 $1,452.72 $1,530.67 $1,807.59 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,090.22 $1,237.40 $1,393.30 $1,947.14 $2,958.86 |
$1,507.23 $1,654.41 $1,810.31 $2,364.15 |
$1,924.24 $2,071.42 $2,227.32 $2,781.16 |
Toc - Plan #64 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Constant Care Silver 8 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$460.67 $522.86 $588.74 $822.76 $1,250.26 |
$813.08 $875.27 $941.15 $1,175.17 |
$1,165.49 $1,227.68 $1,293.56 $1,527.58 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$921.34 $1,045.72 $1,177.48 $1,645.52 $2,500.52 |
$1,273.75 $1,398.13 $1,529.89 $1,997.93 |
$1,626.16 $1,750.54 $1,882.30 $2,350.34 |
Toc - Plan #65 Molina Healthcare | ||||||||||||||||||||
Gold
(HMO) Confident Care Gold 1 + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$538.66 $611.38 $688.41 $962.04 $1,461.92 |
$950.73 $1,023.45 $1,100.48 $1,374.11 |
$1,362.80 $1,435.52 $1,512.55 $1,786.18 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,077.32 $1,222.76 $1,376.82 $1,924.08 $2,923.84 |
$1,489.39 $1,634.83 $1,788.89 $2,336.15 |
$1,901.46 $2,046.90 $2,200.96 $2,748.22 |
Toc - Plan #66 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Constant Care Silver 1 + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$460.17 $522.29 $588.09 $821.86 $1,248.90 |
$812.20 $874.32 $940.12 $1,173.89 |
$1,164.23 $1,226.35 $1,292.15 $1,525.92 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$920.34 $1,044.58 $1,176.18 $1,643.72 $2,497.80 |
$1,272.37 $1,396.61 $1,528.21 $1,995.75 |
$1,624.40 $1,748.64 $1,880.24 $2,347.78 |
ADVERTISEMENT
Anthem Blue Cross and Blue ShieldLocal: 1-855-748-1813 | Toll Free: 1-855-748-1813 |
Toc - Plan #67 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 |
$388.80 $441.29 $496.89 $694.40 $1,055.20 |
$686.23 $738.72 $794.32 $991.83 |
$983.66 $1,036.15 $1,091.75 $1,289.26 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$777.60 $882.58 $993.78 $1,388.80 $2,110.40 |
$1,075.03 $1,180.01 $1,291.21 $1,686.23 |
$1,372.46 $1,477.44 $1,588.64 $1,983.66 |
Toc - Plan #68 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 |
$376.98 $427.87 $481.78 $673.29 $1,023.12 |
$665.37 $716.26 $770.17 $961.68 |
$953.76 $1,004.65 $1,058.56 $1,250.07 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$753.96 $855.74 $963.56 $1,346.58 $2,046.24 |
$1,042.35 $1,144.13 $1,251.95 $1,634.97 |
$1,330.74 $1,432.52 $1,540.34 $1,923.36 |
Toc - Plan #69 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 |
$370.22 $420.20 $473.14 $661.21 $1,004.78 |
$653.44 $703.42 $756.36 $944.43 |
$936.66 $986.64 $1,039.58 $1,227.65 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$740.44 $840.40 $946.28 $1,322.42 $2,009.56 |
$1,023.66 $1,123.62 $1,229.50 $1,605.64 |
$1,306.88 $1,406.84 $1,512.72 $1,888.86 |
Toc - Plan #70 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 |
$350.92 $398.29 $448.48 $626.74 $952.40 |
$619.37 $666.74 $716.93 $895.19 |
$887.82 $935.19 $985.38 $1,163.64 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$701.84 $796.58 $896.96 $1,253.48 $1,904.80 |
$970.29 $1,065.03 $1,165.41 $1,521.93 |
$1,238.74 $1,333.48 $1,433.86 $1,790.38 |
Toc - Plan #71 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 |
$369.45 $419.33 $472.16 $659.84 $1,002.69 |
$652.08 $701.96 $754.79 $942.47 |
$934.71 $984.59 $1,037.42 $1,225.10 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$738.90 $838.66 $944.32 $1,319.68 $2,005.38 |
$1,021.53 $1,121.29 $1,226.95 $1,602.31 |
$1,304.16 $1,403.92 $1,509.58 $1,884.94 |
Toc - Plan #72 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 |
$479.25 $543.95 $612.48 $855.94 $1,300.68 |
$845.88 $910.58 $979.11 $1,222.57 |
$1,212.51 $1,277.21 $1,345.74 $1,589.20 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$958.50 $1,087.90 $1,224.96 $1,711.88 $2,601.36 |
$1,325.13 $1,454.53 $1,591.59 $2,078.51 |
$1,691.76 $1,821.16 $1,958.22 $2,445.14 |
Toc - Plan #73 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 |
$462.71 $525.18 $591.34 $826.40 $1,255.79 |
$816.68 $879.15 $945.31 $1,180.37 |
$1,170.65 $1,233.12 $1,299.28 $1,534.34 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$925.42 $1,050.36 $1,182.68 $1,652.80 $2,511.58 |
$1,279.39 $1,404.33 $1,536.65 $2,006.77 |
$1,633.36 $1,758.30 $1,890.62 $2,360.74 |
Toc - Plan #74 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 |
$468.27 $531.49 $598.45 $836.33 $1,270.88 |
$826.50 $889.72 $956.68 $1,194.56 |
$1,184.73 $1,247.95 $1,314.91 $1,552.79 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$936.54 $1,062.98 $1,196.90 $1,672.66 $2,541.76 |
$1,294.77 $1,421.21 $1,555.13 $2,030.89 |
$1,653.00 $1,779.44 $1,913.36 $2,389.12 |
Toc - Plan #75 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 |
$459.98 $522.08 $587.85 $821.52 $1,248.39 |
$811.86 $873.96 $939.73 $1,173.40 |
$1,163.74 $1,225.84 $1,291.61 $1,525.28 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$919.96 $1,044.16 $1,175.70 $1,643.04 $2,496.78 |
$1,271.84 $1,396.04 $1,527.58 $1,994.92 |
$1,623.72 $1,747.92 $1,879.46 $2,346.80 |
Toc - Plan #76 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(HMO) Anthem Bronze Pathway/Lean 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 |
$293.01 $332.57 $374.47 $523.32 $795.23 |
$517.16 $556.72 $598.62 $747.47 |
$741.31 $780.87 $822.77 $971.62 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$586.02 $665.14 $748.94 $1,046.64 $1,590.46 |
$810.17 $889.29 $973.09 $1,270.79 |
$1,034.32 $1,113.44 $1,197.24 $1,494.94 |
Toc - Plan #77 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(HMO) Anthem Bronze Pathway/Lean 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 |
$298.92 $339.27 $382.02 $533.87 $811.27 |
$527.59 $567.94 $610.69 $762.54 |
$756.26 $796.61 $839.36 $991.21 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$597.84 $678.54 $764.04 $1,067.74 $1,622.54 |
$826.51 $907.21 $992.71 $1,296.41 |
$1,055.18 $1,135.88 $1,221.38 $1,525.08 |
Toc - Plan #78 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(HMO) Anthem Bronze Pathway/Lean 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 |
$293.62 $333.26 $375.25 $524.41 $796.88 |
$518.24 $557.88 $599.87 $749.03 |
$742.86 $782.50 $824.49 $973.65 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$587.24 $666.52 $750.50 $1,048.82 $1,593.76 |
$811.86 $891.14 $975.12 $1,273.44 |
$1,036.48 $1,115.76 $1,199.74 $1,498.06 |
Toc - Plan #79 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Bronze
(HMO) Anthem Bronze Pathway/Lean 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 |
$278.31 $315.88 $355.68 $497.06 $755.33 |
$491.22 $528.79 $568.59 $709.97 |
$704.13 $741.70 $781.50 $922.88 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$556.62 $631.76 $711.36 $994.12 $1,510.66 |
$769.53 $844.67 $924.27 $1,207.03 |
$982.44 $1,057.58 $1,137.18 $1,419.94 |
Toc - Plan #80 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(HMO) Anthem Silver Pathway/Lean 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 |
$338.64 $384.36 $432.78 $604.81 $919.07 |
$597.70 $643.42 $691.84 $863.87 |
$856.76 $902.48 $950.90 $1,122.93 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$677.28 $768.72 $865.56 $1,209.62 $1,838.14 |
$936.34 $1,027.78 $1,124.62 $1,468.68 |
$1,195.40 $1,286.84 $1,383.68 $1,727.74 |
Toc - Plan #81 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(HMO) Anthem Silver Pathway/Lean 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 |
$342.70 $388.96 $437.97 $612.06 $930.09 |
$604.87 $651.13 $700.14 $874.23 |
$867.04 $913.30 $962.31 $1,136.40 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$685.40 $777.92 $875.94 $1,224.12 $1,860.18 |
$947.57 $1,040.09 $1,138.11 $1,486.29 |
$1,209.74 $1,302.26 $1,400.28 $1,748.46 |
Toc - Plan #82 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(HMO) Anthem Silver Pathway/Lean 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 |
$336.64 $382.09 $430.23 $601.24 $913.64 |
$594.17 $639.62 $687.76 $858.77 |
$851.70 $897.15 $945.29 $1,116.30 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$673.28 $764.18 $860.46 $1,202.48 $1,827.28 |
$930.81 $1,021.71 $1,117.99 $1,460.01 |
$1,188.34 $1,279.24 $1,375.52 $1,717.54 |
Toc - Plan #83 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Gold
(HMO) Anthem Gold Pathway/Lean 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 |
$350.73 $398.08 $448.23 $626.40 $951.88 |
$619.04 $666.39 $716.54 $894.71 |
$887.35 $934.70 $984.85 $1,163.02 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$701.46 $796.16 $896.46 $1,252.80 $1,903.76 |
$969.77 $1,064.47 $1,164.77 $1,521.11 |
$1,238.08 $1,332.78 $1,433.08 $1,789.42 |
Toc - Plan #84 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(HMO) Anthem Bronze Pathway/Lean 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 |
$299.15 $339.54 $382.31 $534.28 $811.89 |
$528.00 $568.39 $611.16 $763.13 |
$756.85 $797.24 $840.01 $991.98 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$598.30 $679.08 $764.62 $1,068.56 $1,623.78 |
$827.15 $907.93 $993.47 $1,297.41 |
$1,056.00 $1,136.78 $1,222.32 $1,526.26 |
Toc - Plan #85 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 |
$351.42 $398.86 $449.11 $627.64 $953.75 |
$620.26 $667.70 $717.95 $896.48 |
$889.10 $936.54 $986.79 $1,165.32 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$702.84 $797.72 $898.22 $1,255.28 $1,907.50 |
$971.68 $1,066.56 $1,167.06 $1,524.12 |
$1,240.52 $1,335.40 $1,435.90 $1,792.96 |
Toc - Plan #86 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 |
$381.96 $433.52 $488.14 $682.18 $1,036.64 |
$674.16 $725.72 $780.34 $974.38 |
$966.36 $1,017.92 $1,072.54 $1,266.58 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$763.92 $867.04 $976.28 $1,364.36 $2,073.28 |
$1,056.12 $1,159.24 $1,268.48 $1,656.56 |
$1,348.32 $1,451.44 $1,560.68 $1,948.76 |
Toc - Plan #87 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 |
$456.07 $517.64 $582.86 $814.54 $1,237.77 |
$804.96 $866.53 $931.75 $1,163.43 |
$1,153.85 $1,215.42 $1,280.64 $1,512.32 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$912.14 $1,035.28 $1,165.72 $1,629.08 $2,475.54 |
$1,261.03 $1,384.17 $1,514.61 $1,977.97 |
$1,609.92 $1,733.06 $1,863.50 $2,326.86 |
Toc - Plan #88 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 |
$479.59 $544.33 $612.92 $856.55 $1,301.61 |
$846.48 $911.22 $979.81 $1,223.44 |
$1,213.37 $1,278.11 $1,346.70 $1,590.33 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$959.18 $1,088.66 $1,225.84 $1,713.10 $2,603.22 |
$1,326.07 $1,455.55 $1,592.73 $2,079.99 |
$1,692.96 $1,822.44 $1,959.62 $2,446.88 |
Toc - Plan #89 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Bronze
(HMO) Anthem Bronze Pathway/Lean 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 |
$278.73 $316.36 $356.22 $497.81 $756.47 |
$491.96 $529.59 $569.45 $711.04 |
$705.19 $742.82 $782.68 $924.27 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$557.46 $632.72 $712.44 $995.62 $1,512.94 |
$770.69 $845.95 $925.67 $1,208.85 |
$983.92 $1,059.18 $1,138.90 $1,422.08 |
Toc - Plan #90 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Gold
(HMO) Anthem Gold Pathway/Lean 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 |
$350.99 $398.37 $448.57 $626.87 $952.59 |
$619.50 $666.88 $717.08 $895.38 |
$888.01 $935.39 $985.59 $1,163.89 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$701.98 $796.74 $897.14 $1,253.74 $1,905.18 |
$970.49 $1,065.25 $1,165.65 $1,522.25 |
$1,239.00 $1,333.76 $1,434.16 $1,790.76 |
Toc - Plan #91 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(HMO) Anthem Silver Pathway/Lean 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 |
$333.76 $378.82 $426.55 $596.10 $905.82 |
$589.09 $634.15 $681.88 $851.43 |
$844.42 $889.48 $937.21 $1,106.76 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$667.52 $757.64 $853.10 $1,192.20 $1,811.64 |
$922.85 $1,012.97 $1,108.43 $1,447.53 |
$1,178.18 $1,268.30 $1,363.76 $1,702.86 |
Toc - Plan #92 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(HMO) Anthem Bronze Pathway/Lean 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 |
$302.91 $343.80 $387.12 $541.00 $822.10 |
$534.64 $575.53 $618.85 $772.73 |
$766.37 $807.26 $850.58 $1,004.46 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$605.82 $687.60 $774.24 $1,082.00 $1,644.20 |
$837.55 $919.33 $1,005.97 $1,313.73 |
$1,069.28 $1,151.06 $1,237.70 $1,545.46 |
ADVERTISEMENT
Network HealthLocal: 1-920-720-1400x1400 | Toll Free: 1-855-275-1400 | TTY: 1-800-947-3529 |
Toc - Plan #93 Network Health | ||||||||||||||||||||
Expanded Bronze
(HMO) Prestige Bronze 20 HDHP + Dental + Vision + Fitness |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$382.96 $434.66 $489.42 $683.96 $1,039.34 |
$675.92 $727.62 $782.38 $976.92 |
$968.88 $1,020.58 $1,075.34 $1,269.88 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$765.92 $869.32 $978.84 $1,367.92 $2,078.68 |
$1,058.88 $1,162.28 $1,271.80 $1,660.88 |
$1,351.84 $1,455.24 $1,564.76 $1,953.84 |
Toc - Plan #94 Network Health | ||||||||||||||||||||
Expanded Bronze
(HMO) Prestige Bronze Essential + Dental + Vision + Fitness + 3 Free PCP Visits |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$370.60 $420.63 $473.63 $661.89 $1,005.81 |
$654.11 $704.14 $757.14 $945.40 |
$937.62 $987.65 $1,040.65 $1,228.91 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$741.20 $841.26 $947.26 $1,323.78 $2,011.62 |
$1,024.71 $1,124.77 $1,230.77 $1,607.29 |
$1,308.22 $1,408.28 $1,514.28 $1,890.80 |
Toc - Plan #95 Network Health | ||||||||||||||||||||
Silver
(HMO) Prestige Silver Essential + Dental + Vision + Fitness + 3 Free PCP Visits |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$571.44 $648.58 $730.30 $1,020.59 $1,550.88 |
$1,008.59 $1,085.73 $1,167.45 $1,457.74 |
$1,445.74 $1,522.88 $1,604.60 $1,894.89 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,142.88 $1,297.16 $1,460.60 $2,041.18 $3,101.76 |
$1,580.03 $1,734.31 $1,897.75 $2,478.33 |
$2,017.18 $2,171.46 $2,334.90 $2,915.48 |
Toc - Plan #96 Network Health | ||||||||||||||||||||
Gold
(HMO) Prestige Gold Essential + Dental + Vision + Fitness + 3 Free PCP Visits |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$525.15 $596.05 $671.15 $937.92 $1,425.26 |
$926.89 $997.79 $1,072.89 $1,339.66 |
$1,328.63 $1,399.53 $1,474.63 $1,741.40 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,050.30 $1,192.10 $1,342.30 $1,875.84 $2,850.52 |
$1,452.04 $1,593.84 $1,744.04 $2,277.58 |
$1,853.78 $1,995.58 $2,145.78 $2,679.32 |
Toc - Plan #97 Network Health | ||||||||||||||||||||
Gold
(HMO) Prestige Gold 50 + Dental + Vision + Fitness |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$541.35 $614.44 $691.85 $966.86 $1,469.23 |
$955.49 $1,028.58 $1,105.99 $1,381.00 |
$1,369.63 $1,442.72 $1,520.13 $1,795.14 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,082.70 $1,228.88 $1,383.70 $1,933.72 $2,938.46 |
$1,496.84 $1,643.02 $1,797.84 $2,347.86 |
$1,910.98 $2,057.16 $2,211.98 $2,762.00 |
Toc - Plan #98 Network Health | ||||||||||||||||||||
Expanded Bronze
(HMO) Signature Prestige Bronze Copay + Dental + Vision + Fitness |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$372.88 $423.22 $476.55 $665.97 $1,012.00 |
$658.14 $708.48 $761.81 $951.23 |
$943.40 $993.74 $1,047.07 $1,236.49 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$745.76 $846.44 $953.10 $1,331.94 $2,024.00 |
$1,031.02 $1,131.70 $1,238.36 $1,617.20 |
$1,316.28 $1,416.96 $1,523.62 $1,902.46 |
Toc - Plan #99 Network Health | ||||||||||||||||||||
Bronze
(HMO) Prestige Bronze |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$337.92 $383.54 $431.86 $603.52 $917.11 |
$596.43 $642.05 $690.37 $862.03 |
$854.94 $900.56 $948.88 $1,120.54 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$675.84 $767.08 $863.72 $1,207.04 $1,834.22 |
$934.35 $1,025.59 $1,122.23 $1,465.55 |
$1,192.86 $1,284.10 $1,380.74 $1,724.06 |
Toc - Plan #100 Network Health | ||||||||||||||||||||
Expanded Bronze
(HMO) Prestige Bronze Plus |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$362.35 $411.27 $463.08 $647.16 $983.41 |
$639.55 $688.47 $740.28 $924.36 |
$916.75 $965.67 $1,017.48 $1,201.56 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$724.70 $822.54 $926.16 $1,294.32 $1,966.82 |
$1,001.90 $1,099.74 $1,203.36 $1,571.52 |
$1,279.10 $1,376.94 $1,480.56 $1,848.72 |
Toc - Plan #101 Network Health | ||||||||||||||||||||
Silver
(HMO) Prestige Silver |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$586.46 $665.63 $749.50 $1,047.41 $1,591.65 |
$1,035.10 $1,114.27 $1,198.14 $1,496.05 |
$1,483.74 $1,562.91 $1,646.78 $1,944.69 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,172.92 $1,331.26 $1,499.00 $2,094.82 $3,183.30 |
$1,621.56 $1,779.90 $1,947.64 $2,543.46 |
$2,070.20 $2,228.54 $2,396.28 $2,992.10 |
Toc - Plan #102 Network Health | ||||||||||||||||||||
Gold
(HMO) Prestige Gold |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$524.52 $595.33 $670.33 $936.78 $1,423.53 |
$925.78 $996.59 $1,071.59 $1,338.04 |
$1,327.04 $1,397.85 $1,472.85 $1,739.30 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,049.04 $1,190.66 $1,340.66 $1,873.56 $2,847.06 |
$1,450.30 $1,591.92 $1,741.92 $2,274.82 |
$1,851.56 $1,993.18 $2,143.18 $2,676.08 |
ADVERTISEMENT
Common Ground Healthcare CooperativeLocal: 1-877-514-2442 | Toll Free: 1-877-514-2442 | TTY: 1-844-472-2442 |
Toc - Plan #103 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Copay Bronze $0 Ded - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$314.22 $356.62 $401.56 $561.17 $852.76 |
$554.59 $596.99 $641.93 $801.54 |
$794.96 $837.36 $882.30 $1,041.91 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$628.44 $713.24 $803.12 $1,122.34 $1,705.52 |
$868.81 $953.61 $1,043.49 $1,362.71 |
$1,109.18 $1,193.98 $1,283.86 $1,603.08 |
Toc - Plan #104 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Copay Silver $0 Ded - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$446.12 $506.33 $570.13 $796.75 $1,210.74 |
$787.39 $847.60 $911.40 $1,138.02 |
$1,128.66 $1,188.87 $1,252.67 $1,479.29 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$892.24 $1,012.66 $1,140.26 $1,593.50 $2,421.48 |
$1,233.51 $1,353.93 $1,481.53 $1,934.77 |
$1,574.78 $1,695.20 $1,822.80 $2,276.04 |
Toc - Plan #105 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Copay Gold $0 Ded - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$480.80 $545.69 $614.45 $858.69 $1,304.86 |
$848.60 $913.49 $982.25 $1,226.49 |
$1,216.40 $1,281.29 $1,350.05 $1,594.29 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$961.60 $1,091.38 $1,228.90 $1,717.38 $2,609.72 |
$1,329.40 $1,459.18 $1,596.70 $2,085.18 |
$1,697.20 $1,826.98 $1,964.50 $2,452.98 |
Toc - Plan #106 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Gold $3000 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$414.73 $470.71 $530.01 $740.69 $1,125.56 |
$731.99 $787.97 $847.27 $1,057.95 |
$1,049.25 $1,105.23 $1,164.53 $1,375.21 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$829.46 $941.42 $1,060.02 $1,481.38 $2,251.12 |
$1,146.72 $1,258.68 $1,377.28 $1,798.64 |
$1,463.98 $1,575.94 $1,694.54 $2,115.90 |
Toc - Plan #107 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Gold $1800 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$454.26 $515.57 $580.53 $811.29 $1,232.83 |
$801.76 $863.07 $928.03 $1,158.79 |
$1,149.26 $1,210.57 $1,275.53 $1,506.29 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$908.52 $1,031.14 $1,161.06 $1,622.58 $2,465.66 |
$1,256.02 $1,378.64 $1,508.56 $1,970.08 |
$1,603.52 $1,726.14 $1,856.06 $2,317.58 |
Toc - Plan #108 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Silver $4000 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$409.25 $464.48 $523.00 $730.90 $1,110.67 |
$722.32 $777.55 $836.07 $1,043.97 |
$1,035.39 $1,090.62 $1,149.14 $1,357.04 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$818.50 $928.96 $1,046.00 $1,461.80 $2,221.34 |
$1,131.57 $1,242.03 $1,359.07 $1,774.87 |
$1,444.64 $1,555.10 $1,672.14 $2,087.94 |
Toc - Plan #109 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Silver $5000 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$350.11 $397.37 $447.43 $625.29 $950.18 |
$617.94 $665.20 $715.26 $893.12 |
$885.77 $933.03 $983.09 $1,160.95 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$700.22 $794.74 $894.86 $1,250.58 $1,900.36 |
$968.05 $1,062.57 $1,162.69 $1,518.41 |
$1,235.88 $1,330.40 $1,430.52 $1,786.24 |
Toc - Plan #110 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Catastrophic
(EPO) CGHC Catastrophic $9100 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$205.93 $233.72 $263.16 $367.77 $558.86 |
$363.46 $391.25 $420.69 $525.30 |
$520.99 $548.78 $578.22 $682.83 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$411.86 $467.44 $526.32 $735.54 $1,117.72 |
$569.39 $624.97 $683.85 $893.07 |
$726.92 $782.50 $841.38 $1,050.60 |
Toc - Plan #111 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Bronze $9100 ($35 PCP Copay) - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$294.36 $334.09 $376.18 $525.71 $798.86 |
$519.54 $559.27 $601.36 $750.89 |
$744.72 $784.45 $826.54 $976.07 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$588.72 $668.18 $752.36 $1,051.42 $1,597.72 |
$813.90 $893.36 $977.54 $1,276.60 |
$1,039.08 $1,118.54 $1,202.72 $1,501.78 |
Toc - Plan #112 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Bronze $8150 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$305.50 $346.73 $390.42 $545.60 $829.10 |
$539.20 $580.43 $624.12 $779.30 |
$772.90 $814.13 $857.82 $1,013.00 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$611.00 $693.46 $780.84 $1,091.20 $1,658.20 |
$844.70 $927.16 $1,014.54 $1,324.90 |
$1,078.40 $1,160.86 $1,248.24 $1,558.60 |
Toc - Plan #113 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC HSA Bronze $7500 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$303.89 $344.91 $388.36 $542.74 $824.74 |
$536.36 $577.38 $620.83 $775.21 |
$768.83 $809.85 $853.30 $1,007.68 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$607.78 $689.82 $776.72 $1,085.48 $1,649.48 |
$840.25 $922.29 $1,009.19 $1,317.95 |
$1,072.72 $1,154.76 $1,241.66 $1,550.42 |
Toc - Plan #114 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC HSA Gold $3000 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$482.93 $548.11 $617.17 $862.49 $1,310.64 |
$852.36 $917.54 $986.60 $1,231.92 |
$1,221.79 $1,286.97 $1,356.03 $1,601.35 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$965.86 $1,096.22 $1,234.34 $1,724.98 $2,621.28 |
$1,335.29 $1,465.65 $1,603.77 $2,094.41 |
$1,704.72 $1,835.08 $1,973.20 $2,463.84 |
Toc - Plan #115 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC HSA Silver $3000 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$468.33 $531.54 $598.51 $836.41 $1,271.01 |
$826.59 $889.80 $956.77 $1,194.67 |
$1,184.85 $1,248.06 $1,315.03 $1,552.93 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$936.66 $1,063.08 $1,197.02 $1,672.82 $2,542.02 |
$1,294.92 $1,421.34 $1,555.28 $2,031.08 |
$1,653.18 $1,779.60 $1,913.54 $2,389.34 |
Toc - Plan #116 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Bronze
(EPO) CGHC Bronze $6000 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$301.69 $342.41 $385.55 $538.80 $818.76 |
$532.48 $573.20 $616.34 $769.59 |
$763.27 $803.99 $847.13 $1,000.38 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$603.38 $684.82 $771.10 $1,077.60 $1,637.52 |
$834.17 $915.61 $1,001.89 $1,308.39 |
$1,064.96 $1,146.40 $1,232.68 $1,539.18 |
Toc - Plan #117 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Bronze
(EPO) Bronze Standard Plan - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$292.23 $331.67 $373.46 $521.90 $793.08 |
$515.78 $555.22 $597.01 $745.45 |
$739.33 $778.77 $820.56 $969.00 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$584.46 $663.34 $746.92 $1,043.80 $1,586.16 |
$808.01 $886.89 $970.47 $1,267.35 |
$1,031.56 $1,110.44 $1,194.02 $1,490.90 |
Toc - Plan #118 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) Silver Standard Plan - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$353.64 $401.37 $451.94 $631.58 $959.75 |
$624.17 $671.90 $722.47 $902.11 |
$894.70 $942.43 $993.00 $1,172.64 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$707.28 $802.74 $903.88 $1,263.16 $1,919.50 |
$977.81 $1,073.27 $1,174.41 $1,533.69 |
$1,248.34 $1,343.80 $1,444.94 $1,804.22 |
Toc - Plan #119 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) Gold Standard Plan - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$422.80 $479.87 $540.32 $755.10 $1,147.45 |
$746.23 $803.30 $863.75 $1,078.53 |
$1,069.66 $1,126.73 $1,187.18 $1,401.96 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$845.60 $959.74 $1,080.64 $1,510.20 $2,294.90 |
$1,169.03 $1,283.17 $1,404.07 $1,833.63 |
$1,492.46 $1,606.60 $1,727.50 $2,157.06 |
Toc - Plan #120 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Silver $5650 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$349.88 $397.11 $447.14 $624.87 $949.56 |
$617.53 $664.76 $714.79 $892.52 |
$885.18 $932.41 $982.44 $1,160.17 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$699.76 $794.22 $894.28 $1,249.74 $1,899.12 |
$967.41 $1,061.87 $1,161.93 $1,517.39 |
$1,235.06 $1,329.52 $1,429.58 $1,785.04 |
Toc - Plan #121 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Gold $1800 - Envision Network (Vision Exam + Allergy Test) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$457.49 $519.24 $584.66 $817.06 $1,241.60 |
$807.46 $869.21 $934.63 $1,167.03 |
$1,157.43 $1,219.18 $1,284.60 $1,517.00 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$914.98 $1,038.48 $1,169.32 $1,634.12 $2,483.20 |
$1,264.95 $1,388.45 $1,519.29 $1,984.09 |
$1,614.92 $1,738.42 $1,869.26 $2,334.06 |
Toc - Plan #122 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Gold $2000 - Envision Network (Vision Exam + Allergy Test) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$425.60 $483.04 $543.90 $760.10 $1,155.05 |
$751.18 $808.62 $869.48 $1,085.68 |
$1,076.76 $1,134.20 $1,195.06 $1,411.26 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$851.20 $966.08 $1,087.80 $1,520.20 $2,310.10 |
$1,176.78 $1,291.66 $1,413.38 $1,845.78 |
$1,502.36 $1,617.24 $1,738.96 $2,171.36 |
Toc - Plan #123 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Gold $3000 - Envision Network (Vision Exam + Allergy Test) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$417.93 $474.34 $534.10 $746.41 $1,134.24 |
$737.64 $794.05 $853.81 $1,066.12 |
$1,057.35 $1,113.76 $1,173.52 $1,385.83 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$835.86 $948.68 $1,068.20 $1,492.82 $2,268.48 |
$1,155.57 $1,268.39 $1,387.91 $1,812.53 |
$1,475.28 $1,588.10 $1,707.62 $2,132.24 |
Toc - Plan #124 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Silver $4000 - Envision Network (Vision Exam + Allergy Test) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$412.45 $468.11 $527.09 $736.61 $1,119.35 |
$727.96 $783.62 $842.60 $1,052.12 |
$1,043.47 $1,099.13 $1,158.11 $1,367.63 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$824.90 $936.22 $1,054.18 $1,473.22 $2,238.70 |
$1,140.41 $1,251.73 $1,369.69 $1,788.73 |
$1,455.92 $1,567.24 $1,685.20 $2,104.24 |
Toc - Plan #125 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Silver $5650 (Vision Exam + Allergy Test) - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$353.04 $400.69 $451.17 $630.51 $958.12 |
$623.11 $670.76 $721.24 $900.58 |
$893.18 $940.83 $991.31 $1,170.65 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$706.08 $801.38 $902.34 $1,261.02 $1,916.24 |
$976.15 $1,071.45 $1,172.41 $1,531.09 |
$1,246.22 $1,341.52 $1,442.48 $1,801.16 |
Toc - Plan #126 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Silver $5000 - Envision Network (Vision Exam + Allergy Test) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$353.27 $400.95 $451.47 $630.92 $958.75 |
$623.51 $671.19 $721.71 $901.16 |
$893.75 $941.43 $991.95 $1,171.40 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$706.54 $801.90 $902.94 $1,261.84 $1,917.50 |
$976.78 $1,072.14 $1,173.18 $1,532.08 |
$1,247.02 $1,342.38 $1,443.42 $1,802.32 |
Toc - Plan #127 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Bronze
(EPO) CGHC Bronze $9100 - Envision Network (Vision Exam + Allergy Test) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$295.36 $335.22 $377.45 $527.49 $801.57 |
$521.30 $561.16 $603.39 $753.43 |
$747.24 $787.10 $829.33 $979.37 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$590.72 $670.44 $754.90 $1,054.98 $1,603.14 |
$816.66 $896.38 $980.84 $1,280.92 |
$1,042.60 $1,122.32 $1,206.78 $1,506.86 |
Toc - Plan #128 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Bronze $9100 ($35 PCP Copay) - Envision Network (Vision Exam + Allergy Test) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$297.49 $337.63 $380.17 $531.29 $807.35 |
$525.06 $565.20 $607.74 $758.86 |
$752.63 $792.77 $835.31 $986.43 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$594.98 $675.26 $760.34 $1,062.58 $1,614.70 |
$822.55 $902.83 $987.91 $1,290.15 |
$1,050.12 $1,130.40 $1,215.48 $1,517.72 |
Toc - Plan #129 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Bronze $8150 - Envision Network (Vision Exam + Allergy Test) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$308.64 $350.29 $394.42 $551.21 $837.61 |
$544.74 $586.39 $630.52 $787.31 |
$780.84 $822.49 $866.62 $1,023.41 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$617.28 $700.58 $788.84 $1,102.42 $1,675.22 |
$853.38 $936.68 $1,024.94 $1,338.52 |
$1,089.48 $1,172.78 $1,261.04 $1,574.62 |
Toc - Plan #130 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Bronze
(EPO) CGHC Bronze $6000 - Envision Network (Vision Exam + Allergy Test) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
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 |
$304.82 $345.96 $389.54 $544.39 $827.25 |
$538.00 $579.14 $622.72 $777.57 |
$771.18 $812.32 $855.90 $1,010.75 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$609.64 $691.92 $779.08 $1,088.78 $1,654.50 |
$842.82 $925.10 $1,012.26 $1,321.96 |
$1,076.00 $1,158.28 $1,245.44 $1,555.14 |
Toc - Plan #131 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC HSA Bronze $7500 - Envision Network (Vision Exam + Allergy Test) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
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 |
$307.02 $348.46 $392.36 $548.32 $833.23 |
$541.88 $583.32 $627.22 $783.18 |
$776.74 $818.18 $862.08 $1,018.04 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$614.04 $696.92 $784.72 $1,096.64 $1,666.46 |
$848.90 $931.78 $1,019.58 $1,331.50 |
$1,083.76 $1,166.64 $1,254.44 $1,566.36 |
Toc - Plan #132 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC HSA Silver $3000 - Envision Network (Vision Exam + Allergy Test) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
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 |
$471.57 $535.22 $602.65 $842.20 $1,279.81 |
$832.31 $895.96 $963.39 $1,202.94 |
$1,193.05 $1,256.70 $1,324.13 $1,563.68 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$943.14 $1,070.44 $1,205.30 $1,684.40 $2,559.62 |
$1,303.88 $1,431.18 $1,566.04 $2,045.14 |
$1,664.62 $1,791.92 $1,926.78 $2,405.88 |
Toc - Plan #133 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC HSA Gold $3000 - Envision Network (Vision Exam + Allergy Test) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$486.18 $551.80 $621.32 $868.30 $1,319.46 |
$858.10 $923.72 $993.24 $1,240.22 |
$1,230.02 $1,295.64 $1,365.16 $1,612.14 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$972.36 $1,103.60 $1,242.64 $1,736.60 $2,638.92 |
$1,344.28 $1,475.52 $1,614.56 $2,108.52 |
$1,716.20 $1,847.44 $1,986.48 $2,480.44 |
Toc - Plan #134 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Copay Bronze $0 Ded - Envision Network (Vision Exam + Allergy Test) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$317.35 $360.18 $405.56 $566.78 $861.27 |
$560.12 $602.95 $648.33 $809.55 |
$802.89 $845.72 $891.10 $1,052.32 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$634.70 $720.36 $811.12 $1,133.56 $1,722.54 |
$877.47 $963.13 $1,053.89 $1,376.33 |
$1,120.24 $1,205.90 $1,296.66 $1,619.10 |
Toc - Plan #135 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Copay Silver $0 Ded - Envision Network (Vision Exam + Allergy Test) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$449.34 $509.99 $574.24 $802.50 $1,219.48 |
$793.08 $853.73 $917.98 $1,146.24 |
$1,136.82 $1,197.47 $1,261.72 $1,489.98 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$898.68 $1,019.98 $1,148.48 $1,605.00 $2,438.96 |
$1,242.42 $1,363.72 $1,492.22 $1,948.74 |
$1,586.16 $1,707.46 $1,835.96 $2,292.48 |
Toc - Plan #136 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Copay Gold $0 Ded - Envision Network (Vision Exam + Allergy Test) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$484.04 $549.37 $618.59 $864.48 $1,313.66 |
$854.32 $919.65 $988.87 $1,234.76 |
$1,224.60 $1,289.93 $1,359.15 $1,605.04 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$968.08 $1,098.74 $1,237.18 $1,728.96 $2,627.32 |
$1,338.36 $1,469.02 $1,607.46 $2,099.24 |
$1,708.64 $1,839.30 $1,977.74 $2,469.52 |
Toc - Plan #137 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Silver $5650 - Envision Network (Dental/Vision Exam + Allergy Test) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$362.78 $411.74 $463.61 $647.90 $984.54 |
$640.30 $689.26 $741.13 $925.42 |
$917.82 $966.78 $1,018.65 $1,202.94 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$725.56 $823.48 $927.22 $1,295.80 $1,969.08 |
$1,003.08 $1,101.00 $1,204.74 $1,573.32 |
$1,280.60 $1,378.52 $1,482.26 $1,850.84 |
Toc - Plan #138 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Silver $5000 - Envision Network (Dental/Vision Exam + Allergy Test) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$363.01 $412.00 $463.91 $648.31 $985.17 |
$640.70 $689.69 $741.60 $926.00 |
$918.39 $967.38 $1,019.29 $1,203.69 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$726.02 $824.00 $927.82 $1,296.62 $1,970.34 |
$1,003.71 $1,101.69 $1,205.51 $1,574.31 |
$1,281.40 $1,379.38 $1,483.20 $1,852.00 |
Toc - Plan #139 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Copay Bronze $0 Ded - Envision Network (Dental/Vision Exam + Allergy Test) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$327.10 $371.25 $418.02 $584.18 $887.72 |
$577.32 $621.47 $668.24 $834.40 |
$827.54 $871.69 $918.46 $1,084.62 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$654.20 $742.50 $836.04 $1,168.36 $1,775.44 |
$904.42 $992.72 $1,086.26 $1,418.58 |
$1,154.64 $1,242.94 $1,336.48 $1,668.80 |
‡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 Washington County here.
Washington County is in “Rating Area 12” of Wisconsin.
Currently, there are 139 plans offered in Rating Area 12.