Obamacare 2024 Rates for Volusia County, Florida

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

The health insurance rates listed below are for calendar year 2024.

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

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

Obamacare Providers, 149 Plans and 2024 Rates for Volusia County, Florida

Below, you’ll find a summary of the 149 plans for Volusia County, Florida and rates for each of these providers.‡ This chart is designed to give you a preview of your health insurance options.

Obamacare Rates and Providers for Other Years

2014 | 2015 | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 | 2022 | 2023 | 2024 |

Florida Blue (BlueCross BlueShield FL)

Local: 1-800-352-2583 | Toll Free: 1-800-352-2583 | TTY: 1-800-955-8771

Toc - Plan #1 Florida Blue (BlueCross BlueShield FL)

Silver

(PPO) BlueOptions Silver 24J01-03 ($0 Virtual Visits / $0 Labs / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$6,000 $12,000 Annual Deductible

$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$767.85
$871.51
$981.31
$1,371.38
$2,083.94

$1,355.26
$1,458.92
$1,568.72
$1,958.79

$1,942.67
$2,046.33
$2,156.13
$2,546.20

$2,530.08
$2,633.74
$2,743.54
$3,133.61

$587.41

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,535.70
$1,743.02
$1,962.62
$2,742.76
$4,167.88

$2,123.11
$2,330.43
$2,550.03
$3,330.17

$2,710.52
$2,917.84
$3,137.44
$3,917.58

$3,297.93
$3,505.25
$3,724.85
$4,504.99

$587.41

Toc - Plan #2 Florida Blue (BlueCross BlueShield FL)

Expanded Bronze

(PPO) BlueOptions Bronze 24J01-04 ($0 Virtual Visits / 3 PCP Visits for $0 then $40 / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$6,500 $13,000 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$548.81
$622.90
$701.38
$980.17
$1,489.47

$968.65
$1,042.74
$1,121.22
$1,400.01

$1,388.49
$1,462.58
$1,541.06
$1,819.85

$1,808.33
$1,882.42
$1,960.90
$2,239.69

$419.84

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,097.62
$1,245.80
$1,402.76
$1,960.34
$2,978.94

$1,517.46
$1,665.64
$1,822.60
$2,380.18

$1,937.30
$2,085.48
$2,242.44
$2,800.02

$2,357.14
$2,505.32
$2,662.28
$3,219.86

$419.84

Toc - Plan #3 Florida Blue (BlueCross BlueShield FL)

Platinum

(PPO) BlueOptions Platinum 24J01-05 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$1,000 $2,000 Annual Deductible

$4,000 $8,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$1,036.08
$1,175.95
$1,324.11
$1,850.44
$2,811.92

$1,828.68
$1,968.55
$2,116.71
$2,643.04

$2,621.28
$2,761.15
$2,909.31
$3,435.64

$3,413.88
$3,553.75
$3,701.91
$4,228.24

$792.60

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$2,072.16
$2,351.90
$2,648.22
$3,700.88
$5,623.84

$2,864.76
$3,144.50
$3,440.82
$4,493.48

$3,657.36
$3,937.10
$4,233.42
$5,286.08

$4,449.96
$4,729.70
$5,026.02
$6,078.68

$792.60

Toc - Plan #4 Florida Blue (BlueCross BlueShield FL)

Bronze

(PPO) BlueOptions Bronze 24J01-06 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$6,150 $12,300 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$513.47
$582.79
$656.21
$917.06
$1,393.56

$906.27
$975.59
$1,049.01
$1,309.86

$1,299.07
$1,368.39
$1,441.81
$1,702.66

$1,691.87
$1,761.19
$1,834.61
$2,095.46

$392.80

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,026.94
$1,165.58
$1,312.42
$1,834.12
$2,787.12

$1,419.74
$1,558.38
$1,705.22
$2,226.92

$1,812.54
$1,951.18
$2,098.02
$2,619.72

$2,205.34
$2,343.98
$2,490.82
$3,012.52

$392.80

Toc - Plan #5 Florida Blue (BlueCross BlueShield FL)

Silver

(PPO) BlueOptions Silver 24J01-07 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$2,800 $5,600 Annual Deductible

$7,150 $14,300 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$821.38
$932.27
$1,049.72
$1,466.98
$2,229.23

$1,449.74
$1,560.63
$1,678.08
$2,095.34

$2,078.10
$2,188.99
$2,306.44
$2,723.70

$2,706.46
$2,817.35
$2,934.80
$3,352.06

$628.36

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,642.76
$1,864.54
$2,099.44
$2,933.96
$4,458.46

$2,271.12
$2,492.90
$2,727.80
$3,562.32

$2,899.48
$3,121.26
$3,356.16
$4,190.68

$3,527.84
$3,749.62
$3,984.52
$4,819.04

$628.36

Toc - Plan #6 Florida Blue (BlueCross BlueShield FL)

Platinum

(PPO) BlueOptions Platinum 24J01-08 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$2,000 $4,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$1,077.63
$1,223.11
$1,377.21
$1,924.65
$2,924.69

$1,902.02
$2,047.50
$2,201.60
$2,749.04

$2,726.41
$2,871.89
$3,025.99
$3,573.43

$3,550.80
$3,696.28
$3,850.38
$4,397.82

$824.39

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$2,155.26
$2,446.22
$2,754.42
$3,849.30
$5,849.38

$2,979.65
$3,270.61
$3,578.81
$4,673.69

$3,804.04
$4,095.00
$4,403.20
$5,498.08

$4,628.43
$4,919.39
$5,227.59
$6,322.47

$824.39

Toc - Plan #7 Florida Blue (BlueCross BlueShield FL)

Gold

(PPO) BlueOptions Gold 24J01-09 ($0 Virtual Visits / $20 PCP Visits / $15 Generic Meds / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$6,250 $12,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$884.21
$1,003.58
$1,130.02
$1,579.20
$2,399.75

$1,560.63
$1,680.00
$1,806.44
$2,255.62

$2,237.05
$2,356.42
$2,482.86
$2,932.04

$2,913.47
$3,032.84
$3,159.28
$3,608.46

$676.42

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,768.42
$2,007.16
$2,260.04
$3,158.40
$4,799.50

$2,444.84
$2,683.58
$2,936.46
$3,834.82

$3,121.26
$3,360.00
$3,612.88
$4,511.24

$3,797.68
$4,036.42
$4,289.30
$5,187.66

$676.42

Toc - Plan #8 Florida Blue (BlueCross BlueShield FL)

Expanded Bronze

(PPO) BlueOptions Bronze (HSA) 24J01-10 (Rewards $$$ / $4 Condition Care Rx)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$7,050 $14,100 Annual Deductible

$7,050 $14,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$533.84
$605.91
$682.25
$953.44
$1,448.84

$942.23
$1,014.30
$1,090.64
$1,361.83

$1,350.62
$1,422.69
$1,499.03
$1,770.22

$1,759.01
$1,831.08
$1,907.42
$2,178.61

$408.39

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,067.68
$1,211.82
$1,364.50
$1,906.88
$2,897.68

$1,476.07
$1,620.21
$1,772.89
$2,315.27

$1,884.46
$2,028.60
$2,181.28
$2,723.66

$2,292.85
$2,436.99
$2,589.67
$3,132.05

$408.39

Toc - Plan #9 Florida Blue (BlueCross BlueShield FL)

Gold

(PPO) BlueOptions Gold 24J01-12 ($0 Virtual Visits / $20 Labs / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$1,500 $3,000 Annual Deductible

$5,900 $11,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$858.08
$973.92
$1,096.63
$1,532.53
$2,328.83

$1,514.51
$1,630.35
$1,753.06
$2,188.96

$2,170.94
$2,286.78
$2,409.49
$2,845.39

$2,827.37
$2,943.21
$3,065.92
$3,501.82

$656.43

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,716.16
$1,947.84
$2,193.26
$3,065.06
$4,657.66

$2,372.59
$2,604.27
$2,849.69
$3,721.49

$3,029.02
$3,260.70
$3,506.12
$4,377.92

$3,685.45
$3,917.13
$4,162.55
$5,034.35

$656.43

Toc - Plan #10 Florida Blue (BlueCross BlueShield FL)

Expanded Bronze

(PPO) BlueOptions Bronze 24J01-17 ($0 Virtual Visits / $50 PCP Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$574.65
$652.23
$734.40
$1,026.32
$1,559.60

$1,014.26
$1,091.84
$1,174.01
$1,465.93

$1,453.87
$1,531.45
$1,613.62
$1,905.54

$1,893.48
$1,971.06
$2,053.23
$2,345.15

$439.61

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,149.30
$1,304.46
$1,468.80
$2,052.64
$3,119.20

$1,588.91
$1,744.07
$1,908.41
$2,492.25

$2,028.52
$2,183.68
$2,348.02
$2,931.86

$2,468.13
$2,623.29
$2,787.63
$3,371.47

$439.61

Toc - Plan #11 Florida Blue (BlueCross BlueShield FL)

Expanded Bronze

(PPO) BlueOptions Bronze 24J01-18S (Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$537.95
$610.57
$687.50
$960.78
$1,460.00

$949.48
$1,022.10
$1,099.03
$1,372.31

$1,361.01
$1,433.63
$1,510.56
$1,783.84

$1,772.54
$1,845.16
$1,922.09
$2,195.37

$411.53

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,075.90
$1,221.14
$1,375.00
$1,921.56
$2,920.00

$1,487.43
$1,632.67
$1,786.53
$2,333.09

$1,898.96
$2,044.20
$2,198.06
$2,744.62

$2,310.49
$2,455.73
$2,609.59
$3,156.15

$411.53

Toc - Plan #12 Florida Blue (BlueCross BlueShield FL)

Silver

(PPO) BlueOptions Silver 24J01-19S ($40 PCP Visits / Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$5,900 $11,800 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$798.02
$905.75
$1,019.87
$1,425.26
$2,165.83

$1,408.51
$1,516.24
$1,630.36
$2,035.75

$2,019.00
$2,126.73
$2,240.85
$2,646.24

$2,629.49
$2,737.22
$2,851.34
$3,256.73

$610.49

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,596.04
$1,811.50
$2,039.74
$2,850.52
$4,331.66

$2,206.53
$2,421.99
$2,650.23
$3,461.01

$2,817.02
$3,032.48
$3,260.72
$4,071.50

$3,427.51
$3,642.97
$3,871.21
$4,681.99

$610.49

Toc - Plan #13 Florida Blue (BlueCross BlueShield FL)

Gold

(PPO) BlueOptions Gold 24J01-20S ($30 PCP Visits / Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$1,500 $3,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$836.88
$949.86
$1,069.53
$1,494.67
$2,271.29

$1,477.09
$1,590.07
$1,709.74
$2,134.88

$2,117.30
$2,230.28
$2,349.95
$2,775.09

$2,757.51
$2,870.49
$2,990.16
$3,415.30

$640.21

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,673.76
$1,899.72
$2,139.06
$2,989.34
$4,542.58

$2,313.97
$2,539.93
$2,779.27
$3,629.55

$2,954.18
$3,180.14
$3,419.48
$4,269.76

$3,594.39
$3,820.35
$4,059.69
$4,909.97

$640.21

Toc - Plan #14 Florida Blue (BlueCross BlueShield FL)

Platinum

(PPO) BlueOptions Platinum 24J01-21S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$3,200 $6,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$1,070.89
$1,215.46
$1,368.60
$1,912.61
$2,906.40

$1,890.12
$2,034.69
$2,187.83
$2,731.84

$2,709.35
$2,853.92
$3,007.06
$3,551.07

$3,528.58
$3,673.15
$3,826.29
$4,370.30

$819.23

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$2,141.78
$2,430.92
$2,737.20
$3,825.22
$5,812.80

$2,961.01
$3,250.15
$3,556.43
$4,644.45

$3,780.24
$4,069.38
$4,375.66
$5,463.68

$4,599.47
$4,888.61
$5,194.89
$6,282.91

$819.23

Aetna CVS Health

Local: 1-877-336-3915 | Toll Free: 1-877-336-3915

Toc - Plan #15 Aetna CVS Health

Silver

(HMO) Silver S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family

$5,900 $11,800 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$385.38
$437.40
$492.51
$688.28
$1,045.90

$680.19
$732.21
$787.32
$983.09

$975.00
$1,027.02
$1,082.13
$1,277.90

$1,269.81
$1,321.83
$1,376.94
$1,572.71

$294.81

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$770.76
$874.80
$985.02
$1,376.56
$2,091.80

$1,065.57
$1,169.61
$1,279.83
$1,671.37

$1,360.38
$1,464.42
$1,574.64
$1,966.18

$1,655.19
$1,759.23
$1,869.45
$2,260.99

$294.81

Toc - Plan #16 Aetna CVS Health

Expanded Bronze

(HMO) Bronze S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$307.74
$349.28
$393.29
$549.62
$835.20

$543.16
$584.70
$628.71
$785.04

$778.58
$820.12
$864.13
$1,020.46

$1,014.00
$1,055.54
$1,099.55
$1,255.88

$235.42

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$615.48
$698.56
$786.58
$1,099.24
$1,670.40

$850.90
$933.98
$1,022.00
$1,334.66

$1,086.32
$1,169.40
$1,257.42
$1,570.08

$1,321.74
$1,404.82
$1,492.84
$1,805.50

$235.42

Toc - Plan #17 Aetna CVS Health

Silver

(HMO) Silver 5: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family

$8,395 $16,790 Annual Deductible

$8,885 $17,770 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$385.13
$437.12
$492.19
$687.83
$1,045.22

$679.75
$731.74
$786.81
$982.45

$974.37
$1,026.36
$1,081.43
$1,277.07

$1,268.99
$1,320.98
$1,376.05
$1,571.69

$294.62

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$770.26
$874.24
$984.38
$1,375.66
$2,090.44

$1,064.88
$1,168.86
$1,279.00
$1,670.28

$1,359.50
$1,463.48
$1,573.62
$1,964.90

$1,654.12
$1,758.10
$1,868.24
$2,259.52

$294.62

Toc - Plan #18 Aetna CVS Health

Gold

(HMO) Gold S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family

$1,500 $3,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$411.89
$467.50
$526.40
$735.64
$1,117.87

$726.99
$782.60
$841.50
$1,050.74

$1,042.09
$1,097.70
$1,156.60
$1,365.84

$1,357.19
$1,412.80
$1,471.70
$1,680.94

$315.10

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$823.78
$935.00
$1,052.80
$1,471.28
$2,235.74

$1,138.88
$1,250.10
$1,367.90
$1,786.38

$1,453.98
$1,565.20
$1,683.00
$2,101.48

$1,769.08
$1,880.30
$1,998.10
$2,416.58

$315.10

Toc - Plan #19 Aetna CVS Health

Silver

(HMO) Silver 6: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family

$7,795 $15,590 Annual Deductible

$8,445 $16,890 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$393.25
$446.33
$502.57
$702.33
$1,067.26

$694.08
$747.16
$803.40
$1,003.16

$994.91
$1,047.99
$1,104.23
$1,303.99

$1,295.74
$1,348.82
$1,405.06
$1,604.82

$300.83

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$786.50
$892.66
$1,005.14
$1,404.66
$2,134.52

$1,087.33
$1,193.49
$1,305.97
$1,705.49

$1,388.16
$1,494.32
$1,606.80
$2,006.32

$1,688.99
$1,795.15
$1,907.63
$2,307.15

$300.83

Toc - Plan #20 Aetna CVS Health

Expanded Bronze

(HMO) Bronze 4: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$338.90
$384.66
$433.12
$605.28
$919.78

$598.16
$643.92
$692.38
$864.54

$857.42
$903.18
$951.64
$1,123.80

$1,116.68
$1,162.44
$1,210.90
$1,383.06

$259.26

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$677.80
$769.32
$866.24
$1,210.56
$1,839.56

$937.06
$1,028.58
$1,125.50
$1,469.82

$1,196.32
$1,287.84
$1,384.76
$1,729.08

$1,455.58
$1,547.10
$1,644.02
$1,988.34

$259.26

Toc - Plan #21 Aetna CVS Health

Gold

(HMO) Gold 3: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family

$795 $1,590 Annual Deductible

$9,195 $18,390 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$410.24
$465.62
$524.28
$732.68
$1,113.38

$724.07
$779.45
$838.11
$1,046.51

$1,037.90
$1,093.28
$1,151.94
$1,360.34

$1,351.73
$1,407.11
$1,465.77
$1,674.17

$313.83

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$820.48
$931.24
$1,048.56
$1,465.36
$2,226.76

$1,134.31
$1,245.07
$1,362.39
$1,779.19

$1,448.14
$1,558.90
$1,676.22
$2,093.02

$1,761.97
$1,872.73
$1,990.05
$2,406.85

$313.83

Toc - Plan #22 Aetna CVS Health

Gold

(HMO) Gold 4: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family

$3,500 $7,000 Annual Deductible

$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$415.70
$471.82
$531.27
$742.44
$1,128.21

$733.72
$789.84
$849.29
$1,060.46

$1,051.74
$1,107.86
$1,167.31
$1,378.48

$1,369.76
$1,425.88
$1,485.33
$1,696.50

$318.02

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$831.40
$943.64
$1,062.54
$1,484.88
$2,256.42

$1,149.42
$1,261.66
$1,380.56
$1,802.90

$1,467.44
$1,579.68
$1,698.58
$2,120.92

$1,785.46
$1,897.70
$2,016.60
$2,438.94

$318.02

Toc - Plan #23 Aetna CVS Health

Silver

(HMO) Silver 7: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family

$7,795 $15,590 Annual Deductible

$8,845 $17,690 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$393.43
$446.54
$502.80
$702.66
$1,067.75

$694.40
$747.51
$803.77
$1,003.63

$995.37
$1,048.48
$1,104.74
$1,304.60

$1,296.34
$1,349.45
$1,405.71
$1,605.57

$300.97

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$786.86
$893.08
$1,005.60
$1,405.32
$2,135.50

$1,087.83
$1,194.05
$1,306.57
$1,706.29

$1,388.80
$1,495.02
$1,607.54
$2,007.26

$1,689.77
$1,795.99
$1,908.51
$2,308.23

$300.97

Ambetter from Sunshine Health

Local: 1-877-687-1169 | Toll Free: 1-877-687-1169 | TTY: 1-800-955-8770

Toc - Plan #24 Ambetter from Sunshine Health

Gold

(EPO) Complete Gold

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$1,450 $2,900 Annual Deductible

$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$386.01
$438.10
$493.30
$689.39
$1,047.59

$681.30
$733.39
$788.59
$984.68

$976.59
$1,028.68
$1,083.88
$1,279.97

$1,271.88
$1,323.97
$1,379.17
$1,575.26

$295.29

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$772.02
$876.20
$986.60
$1,378.78
$2,095.18

$1,067.31
$1,171.49
$1,281.89
$1,674.07

$1,362.60
$1,466.78
$1,577.18
$1,969.36

$1,657.89
$1,762.07
$1,872.47
$2,264.65

$295.29

Toc - Plan #25 Ambetter from Sunshine Health

Expanded Bronze

(EPO) Choice Bronze HSA

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$7,250 $14,500 Annual Deductible

$7,250 $14,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$318.86
$361.90
$407.49
$569.47
$865.36

$562.78
$605.82
$651.41
$813.39

$806.70
$849.74
$895.33
$1,057.31

$1,050.62
$1,093.66
$1,139.25
$1,301.23

$243.92

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$637.72
$723.80
$814.98
$1,138.94
$1,730.72

$881.64
$967.72
$1,058.90
$1,382.86

$1,125.56
$1,211.64
$1,302.82
$1,626.78

$1,369.48
$1,455.56
$1,546.74
$1,870.70

$243.92

Toc - Plan #26 Ambetter from Sunshine Health

Silver

(EPO) Everyday Silver

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$6,500 $13,000 Annual Deductible

$8,400 $16,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$402.45
$456.77
$514.32
$718.76
$1,092.22

$710.32
$764.64
$822.19
$1,026.63

$1,018.19
$1,072.51
$1,130.06
$1,334.50

$1,326.06
$1,380.38
$1,437.93
$1,642.37

$307.87

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$804.90
$913.54
$1,028.64
$1,437.52
$2,184.44

$1,112.77
$1,221.41
$1,336.51
$1,745.39

$1,420.64
$1,529.28
$1,644.38
$2,053.26

$1,728.51
$1,837.15
$1,952.25
$2,361.13

$307.87

Toc - Plan #27 Ambetter from Sunshine Health

Expanded Bronze

(EPO) Everyday Bronze

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$8,450 $16,900 Annual Deductible

$9,250 $18,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$314.52
$356.97
$401.95
$561.72
$853.59

$555.12
$597.57
$642.55
$802.32

$795.72
$838.17
$883.15
$1,042.92

$1,036.32
$1,078.77
$1,123.75
$1,283.52

$240.60

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$629.04
$713.94
$803.90
$1,123.44
$1,707.18

$869.64
$954.54
$1,044.50
$1,364.04

$1,110.24
$1,195.14
$1,285.10
$1,604.64

$1,350.84
$1,435.74
$1,525.70
$1,845.24

$240.60

Toc - Plan #28 Ambetter from Sunshine Health

Expanded Bronze

(EPO) Elite Bronze

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$9,250 $18,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$361.12
$409.86
$461.50
$644.95
$980.06

$637.37
$686.11
$737.75
$921.20

$913.62
$962.36
$1,014.00
$1,197.45

$1,189.87
$1,238.61
$1,290.25
$1,473.70

$276.25

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$722.24
$819.72
$923.00
$1,289.90
$1,960.12

$998.49
$1,095.97
$1,199.25
$1,566.15

$1,274.74
$1,372.22
$1,475.50
$1,842.40

$1,550.99
$1,648.47
$1,751.75
$2,118.65

$276.25

Toc - Plan #29 Ambetter from Sunshine Health

Silver

(EPO) Clear Silver

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$5,400 $10,800 Annual Deductible

$5,400 $10,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$391.94
$444.84
$500.89
$699.99
$1,063.71

$691.77
$744.67
$800.72
$999.82

$991.60
$1,044.50
$1,100.55
$1,299.65

$1,291.43
$1,344.33
$1,400.38
$1,599.48

$299.83

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$783.88
$889.68
$1,001.78
$1,399.98
$2,127.42

$1,083.71
$1,189.51
$1,301.61
$1,699.81

$1,383.54
$1,489.34
$1,601.44
$1,999.64

$1,683.37
$1,789.17
$1,901.27
$2,299.47

$299.83

Toc - Plan #30 Ambetter from Sunshine Health

Silver

(EPO) Focused Silver

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$6,300 $12,600 Annual Deductible

$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$398.93
$452.78
$509.83
$712.48
$1,082.68

$704.11
$757.96
$815.01
$1,017.66

$1,009.29
$1,063.14
$1,120.19
$1,322.84

$1,314.47
$1,368.32
$1,425.37
$1,628.02

$305.18

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$797.86
$905.56
$1,019.66
$1,424.96
$2,165.36

$1,103.04
$1,210.74
$1,324.84
$1,730.14

$1,408.22
$1,515.92
$1,630.02
$2,035.32

$1,713.40
$1,821.10
$1,935.20
$2,340.50

$305.18

Toc - Plan #31 Ambetter from Sunshine Health

Gold

(EPO) Everyday Gold

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$750 $1,500 Annual Deductible

$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$368.98
$418.78
$471.54
$658.97
$1,001.37

$651.24
$701.04
$753.80
$941.23

$933.50
$983.30
$1,036.06
$1,223.49

$1,215.76
$1,265.56
$1,318.32
$1,505.75

$282.26

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$737.96
$837.56
$943.08
$1,317.94
$2,002.74

$1,020.22
$1,119.82
$1,225.34
$1,600.20

$1,302.48
$1,402.08
$1,507.60
$1,882.46

$1,584.74
$1,684.34
$1,789.86
$2,164.72

$282.26

Toc - Plan #32 Ambetter from Sunshine Health

Gold

(EPO) Elite Gold

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$5,500 $11,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$424.44
$481.73
$542.42
$758.03
$1,151.91

$749.13
$806.42
$867.11
$1,082.72

$1,073.82
$1,131.11
$1,191.80
$1,407.41

$1,398.51
$1,455.80
$1,516.49
$1,732.10

$324.69

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$848.88
$963.46
$1,084.84
$1,516.06
$2,303.82

$1,173.57
$1,288.15
$1,409.53
$1,840.75

$1,498.26
$1,612.84
$1,734.22
$2,165.44

$1,822.95
$1,937.53
$2,058.91
$2,490.13

$324.69

Toc - Plan #33 Ambetter from Sunshine Health

Expanded Bronze

(EPO) Standard Expanded Bronze

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$308.43
$350.06
$394.16
$550.84
$837.06

$544.37
$586.00
$630.10
$786.78

$780.31
$821.94
$866.04
$1,022.72

$1,016.25
$1,057.88
$1,101.98
$1,258.66

$235.94

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$616.86
$700.12
$788.32
$1,101.68
$1,674.12

$852.80
$936.06
$1,024.26
$1,337.62

$1,088.74
$1,172.00
$1,260.20
$1,573.56

$1,324.68
$1,407.94
$1,496.14
$1,809.50

$235.94

Toc - Plan #34 Ambetter from Sunshine Health

Silver

(EPO) Standard Silver

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$5,900 $11,800 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$390.61
$443.34
$499.19
$697.62
$1,060.10

$689.42
$742.15
$798.00
$996.43

$988.23
$1,040.96
$1,096.81
$1,295.24

$1,287.04
$1,339.77
$1,395.62
$1,594.05

$298.81

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$781.22
$886.68
$998.38
$1,395.24
$2,120.20

$1,080.03
$1,185.49
$1,297.19
$1,694.05

$1,378.84
$1,484.30
$1,596.00
$1,992.86

$1,677.65
$1,783.11
$1,894.81
$2,291.67

$298.81

Toc - Plan #35 Ambetter from Sunshine Health

Gold

(EPO) Standard Gold

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$1,500 $3,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$366.75
$416.25
$468.69
$655.00
$995.33

$647.31
$696.81
$749.25
$935.56

$927.87
$977.37
$1,029.81
$1,216.12

$1,208.43
$1,257.93
$1,310.37
$1,496.68

$280.56

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$733.50
$832.50
$937.38
$1,310.00
$1,990.66

$1,014.06
$1,113.06
$1,217.94
$1,590.56

$1,294.62
$1,393.62
$1,498.50
$1,871.12

$1,575.18
$1,674.18
$1,779.06
$2,151.68

$280.56

Toc - Plan #36 Ambetter from Sunshine Health

Silver

(EPO) Everyday Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$6,500 $13,000 Annual Deductible

$8,400 $16,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$416.30
$472.49
$532.02
$743.49
$1,129.81

$734.76
$790.95
$850.48
$1,061.95

$1,053.22
$1,109.41
$1,168.94
$1,380.41

$1,371.68
$1,427.87
$1,487.40
$1,698.87

$318.46

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$832.60
$944.98
$1,064.04
$1,486.98
$2,259.62

$1,151.06
$1,263.44
$1,382.50
$1,805.44

$1,469.52
$1,581.90
$1,700.96
$2,123.90

$1,787.98
$1,900.36
$2,019.42
$2,442.36

$318.46

Toc - Plan #37 Ambetter from Sunshine Health

Expanded Bronze

(EPO) Choice Bronze HSA + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$7,250 $14,500 Annual Deductible

$7,250 $14,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$329.83
$374.35
$421.52
$589.07
$895.14

$582.15
$626.67
$673.84
$841.39

$834.47
$878.99
$926.16
$1,093.71

$1,086.79
$1,131.31
$1,178.48
$1,346.03

$252.32

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$659.66
$748.70
$843.04
$1,178.14
$1,790.28

$911.98
$1,001.02
$1,095.36
$1,430.46

$1,164.30
$1,253.34
$1,347.68
$1,682.78

$1,416.62
$1,505.66
$1,600.00
$1,935.10

$252.32

Toc - Plan #38 Ambetter from Sunshine Health

Gold

(EPO) Complete Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$1,450 $2,900 Annual Deductible

$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$399.29
$453.18
$510.28
$713.11
$1,083.65

$704.74
$758.63
$815.73
$1,018.56

$1,010.19
$1,064.08
$1,121.18
$1,324.01

$1,315.64
$1,369.53
$1,426.63
$1,629.46

$305.45

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$798.58
$906.36
$1,020.56
$1,426.22
$2,167.30

$1,104.03
$1,211.81
$1,326.01
$1,731.67

$1,409.48
$1,517.26
$1,631.46
$2,037.12

$1,714.93
$1,822.71
$1,936.91
$2,342.57

$305.45

Toc - Plan #39 Ambetter from Sunshine Health

Silver

(EPO) Clear Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$5,400 $10,800 Annual Deductible

$5,400 $10,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$405.43
$460.15
$518.13
$724.08
$1,100.31

$715.58
$770.30
$828.28
$1,034.23

$1,025.73
$1,080.45
$1,138.43
$1,344.38

$1,335.88
$1,390.60
$1,448.58
$1,654.53

$310.15

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$810.86
$920.30
$1,036.26
$1,448.16
$2,200.62

$1,121.01
$1,230.45
$1,346.41
$1,758.31

$1,431.16
$1,540.60
$1,656.56
$2,068.46

$1,741.31
$1,850.75
$1,966.71
$2,378.61

$310.15

Toc - Plan #40 Ambetter from Sunshine Health

Gold

(EPO) Elite Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$5,500 $11,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$439.05
$498.31
$561.09
$784.12
$1,191.55

$774.91
$834.17
$896.95
$1,119.98

$1,110.77
$1,170.03
$1,232.81
$1,455.84

$1,446.63
$1,505.89
$1,568.67
$1,791.70

$335.86

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$878.10
$996.62
$1,122.18
$1,568.24
$2,383.10

$1,213.96
$1,332.48
$1,458.04
$1,904.10

$1,549.82
$1,668.34
$1,793.90
$2,239.96

$1,885.68
$2,004.20
$2,129.76
$2,575.82

$335.86

Toc - Plan #41 Ambetter from Sunshine Health

Expanded Bronze

(EPO) Standard Expanded Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$319.05
$362.11
$407.73
$569.80
$865.86

$563.11
$606.17
$651.79
$813.86

$807.17
$850.23
$895.85
$1,057.92

$1,051.23
$1,094.29
$1,139.91
$1,301.98

$244.06

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$638.10
$724.22
$815.46
$1,139.60
$1,731.72

$882.16
$968.28
$1,059.52
$1,383.66

$1,126.22
$1,212.34
$1,303.58
$1,627.72

$1,370.28
$1,456.40
$1,547.64
$1,871.78

$244.06

Toc - Plan #42 Ambetter from Sunshine Health

Silver

(EPO) Standard Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$5,900 $11,800 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$404.06
$458.59
$516.37
$721.63
$1,096.59

$713.16
$767.69
$825.47
$1,030.73

$1,022.26
$1,076.79
$1,134.57
$1,339.83

$1,331.36
$1,385.89
$1,443.67
$1,648.93

$309.10

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$808.12
$917.18
$1,032.74
$1,443.26
$2,193.18

$1,117.22
$1,226.28
$1,341.84
$1,752.36

$1,426.32
$1,535.38
$1,650.94
$2,061.46

$1,735.42
$1,844.48
$1,960.04
$2,370.56

$309.10

Toc - Plan #43 Ambetter from Sunshine Health

Gold

(EPO) Standard Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$1,500 $3,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$379.37
$430.57
$484.82
$677.54
$1,029.58

$669.58
$720.78
$775.03
$967.75

$959.79
$1,010.99
$1,065.24
$1,257.96

$1,250.00
$1,301.20
$1,355.45
$1,548.17

$290.21

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$758.74
$861.14
$969.64
$1,355.08
$2,059.16

$1,048.95
$1,151.35
$1,259.85
$1,645.29

$1,339.16
$1,441.56
$1,550.06
$1,935.50

$1,629.37
$1,731.77
$1,840.27
$2,225.71

$290.21

Toc - Plan #44 Ambetter from Sunshine Health

Expanded Bronze

(EPO) Everyday Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$8,450 $16,900 Annual Deductible

$9,250 $18,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$325.35
$369.26
$415.78
$581.06
$882.97

$574.23
$618.14
$664.66
$829.94

$823.11
$867.02
$913.54
$1,078.82

$1,071.99
$1,115.90
$1,162.42
$1,327.70

$248.88

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$650.70
$738.52
$831.56
$1,162.12
$1,765.94

$899.58
$987.40
$1,080.44
$1,411.00

$1,148.46
$1,236.28
$1,329.32
$1,659.88

$1,397.34
$1,485.16
$1,578.20
$1,908.76

$248.88

Toc - Plan #45 Ambetter from Sunshine Health

Expanded Bronze

(EPO) Elite Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$9,250 $18,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$373.55
$423.97
$477.39
$667.15
$1,013.79

$659.31
$709.73
$763.15
$952.91

$945.07
$995.49
$1,048.91
$1,238.67

$1,230.83
$1,281.25
$1,334.67
$1,524.43

$285.76

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$747.10
$847.94
$954.78
$1,334.30
$2,027.58

$1,032.86
$1,133.70
$1,240.54
$1,620.06

$1,318.62
$1,419.46
$1,526.30
$1,905.82

$1,604.38
$1,705.22
$1,812.06
$2,191.58

$285.76

Toc - Plan #46 Ambetter from Sunshine Health

Silver

(EPO) Focused Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$6,300 $12,600 Annual Deductible

$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$412.66
$468.36
$527.37
$737.00
$1,119.94

$728.34
$784.04
$843.05
$1,052.68

$1,044.02
$1,099.72
$1,158.73
$1,368.36

$1,359.70
$1,415.40
$1,474.41
$1,684.04

$315.68

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$825.32
$936.72
$1,054.74
$1,474.00
$2,239.88

$1,141.00
$1,252.40
$1,370.42
$1,789.68

$1,456.68
$1,568.08
$1,686.10
$2,105.36

$1,772.36
$1,883.76
$2,001.78
$2,421.04

$315.68

Toc - Plan #47 Ambetter from Sunshine Health

Gold

(EPO) Everyday Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$750 $1,500 Annual Deductible

$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$381.67
$433.19
$487.77
$681.65
$1,035.84

$673.64
$725.16
$779.74
$973.62

$965.61
$1,017.13
$1,071.71
$1,265.59

$1,257.58
$1,309.10
$1,363.68
$1,557.56

$291.97

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$763.34
$866.38
$975.54
$1,363.30
$2,071.68

$1,055.31
$1,158.35
$1,267.51
$1,655.27

$1,347.28
$1,450.32
$1,559.48
$1,947.24

$1,639.25
$1,742.29
$1,851.45
$2,239.21

$291.97

Florida Blue HMO (a BlueCross BlueShield FL company)

Local: 1-800-352-2583 | Toll Free: 1-800-352-2583 | TTY: 1-800-955-8771

Toc - Plan #48 Florida Blue HMO (a BlueCross BlueShield FL company)

Silver

(POS) BlueCare Silver 24K01-02 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$6,000 $12,000 Annual Deductible

$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$613.06
$695.82
$783.49
$1,094.93
$1,663.84

$1,082.05
$1,164.81
$1,252.48
$1,563.92

$1,551.04
$1,633.80
$1,721.47
$2,032.91

$2,020.03
$2,102.79
$2,190.46
$2,501.90

$468.99

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,226.12
$1,391.64
$1,566.98
$2,189.86
$3,327.68

$1,695.11
$1,860.63
$2,035.97
$2,658.85

$2,164.10
$2,329.62
$2,504.96
$3,127.84

$2,633.09
$2,798.61
$2,973.95
$3,596.83

$468.99

Toc - Plan #49 Florida Blue HMO (a BlueCross BlueShield FL company)

Expanded Bronze

(POS) BlueCare Bronze 24K01-03 ($0 Virtual Visits / 3 PCP Visits for $0 then $40 / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$6,500 $13,000 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$517.27
$587.10
$661.07
$923.84
$1,403.87

$912.98
$982.81
$1,056.78
$1,319.55

$1,308.69
$1,378.52
$1,452.49
$1,715.26

$1,704.40
$1,774.23
$1,848.20
$2,110.97

$395.71

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,034.54
$1,174.20
$1,322.14
$1,847.68
$2,807.74

$1,430.25
$1,569.91
$1,717.85
$2,243.39

$1,825.96
$1,965.62
$2,113.56
$2,639.10

$2,221.67
$2,361.33
$2,509.27
$3,034.81

$395.71

Toc - Plan #50 Florida Blue HMO (a BlueCross BlueShield FL company)

Platinum

(POS) BlueCare Platinum 24K01-04 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$1,000 $2,000 Annual Deductible

$4,000 $8,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$837.86
$950.97
$1,070.79
$1,496.42
$2,273.95

$1,478.82
$1,591.93
$1,711.75
$2,137.38

$2,119.78
$2,232.89
$2,352.71
$2,778.34

$2,760.74
$2,873.85
$2,993.67
$3,419.30

$640.96

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,675.72
$1,901.94
$2,141.58
$2,992.84
$4,547.90

$2,316.68
$2,542.90
$2,782.54
$3,633.80

$2,957.64
$3,183.86
$3,423.50
$4,274.76

$3,598.60
$3,824.82
$4,064.46
$4,915.72

$640.96

Toc - Plan #51 Florida Blue HMO (a BlueCross BlueShield FL company)

Bronze

(POS) BlueCare Bronze 24K01-05 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$6,150 $12,300 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$471.31
$534.94
$602.33
$841.76
$1,279.14

$831.86
$895.49
$962.88
$1,202.31

$1,192.41
$1,256.04
$1,323.43
$1,562.86

$1,552.96
$1,616.59
$1,683.98
$1,923.41

$360.55

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$942.62
$1,069.88
$1,204.66
$1,683.52
$2,558.28

$1,303.17
$1,430.43
$1,565.21
$2,044.07

$1,663.72
$1,790.98
$1,925.76
$2,404.62

$2,024.27
$2,151.53
$2,286.31
$2,765.17

$360.55

Toc - Plan #52 Florida Blue HMO (a BlueCross BlueShield FL company)

Silver

(POS) BlueCare Silver 24K01-06 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$2,800 $5,600 Annual Deductible

$7,150 $14,300 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$674.74
$765.83
$862.32
$1,205.09
$1,831.24

$1,190.92
$1,282.01
$1,378.50
$1,721.27

$1,707.10
$1,798.19
$1,894.68
$2,237.45

$2,223.28
$2,314.37
$2,410.86
$2,753.63

$516.18

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,349.48
$1,531.66
$1,724.64
$2,410.18
$3,662.48

$1,865.66
$2,047.84
$2,240.82
$2,926.36

$2,381.84
$2,564.02
$2,757.00
$3,442.54

$2,898.02
$3,080.20
$3,273.18
$3,958.72

$516.18

Toc - Plan #53 Florida Blue HMO (a BlueCross BlueShield FL company)

Platinum

(POS) BlueCare Platinum 24K01-07 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$2,000 $4,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$881.10
$1,000.05
$1,126.05
$1,573.64
$2,391.31

$1,555.14
$1,674.09
$1,800.09
$2,247.68

$2,229.18
$2,348.13
$2,474.13
$2,921.72

$2,903.22
$3,022.17
$3,148.17
$3,595.76

$674.04

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,762.20
$2,000.10
$2,252.10
$3,147.28
$4,782.62

$2,436.24
$2,674.14
$2,926.14
$3,821.32

$3,110.28
$3,348.18
$3,600.18
$4,495.36

$3,784.32
$4,022.22
$4,274.22
$5,169.40

$674.04

Toc - Plan #54 Florida Blue HMO (a BlueCross BlueShield FL company)

Gold

(POS) BlueCare Gold 24K01-08 ($0 Virtual Visits / $20 PCP Visit / $15 Generic Meds / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$6,250 $12,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$762.23
$865.13
$974.13
$1,361.34
$2,068.69

$1,345.34
$1,448.24
$1,557.24
$1,944.45

$1,928.45
$2,031.35
$2,140.35
$2,527.56

$2,511.56
$2,614.46
$2,723.46
$3,110.67

$583.11

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,524.46
$1,730.26
$1,948.26
$2,722.68
$4,137.38

$2,107.57
$2,313.37
$2,531.37
$3,305.79

$2,690.68
$2,896.48
$3,114.48
$3,888.90

$3,273.79
$3,479.59
$3,697.59
$4,472.01

$583.11

Toc - Plan #55 Florida Blue HMO (a BlueCross BlueShield FL company)

Expanded Bronze

(POS) BlueCare Bronze (HSA) 24K01-09 (Rewards $$$ / $4 Condition Care Rx)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$7,050 $14,100 Annual Deductible

$7,050 $14,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$495.34
$562.21
$633.04
$884.68
$1,344.35

$874.28
$941.15
$1,011.98
$1,263.62

$1,253.22
$1,320.09
$1,390.92
$1,642.56

$1,632.16
$1,699.03
$1,769.86
$2,021.50

$378.94

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$990.68
$1,124.42
$1,266.08
$1,769.36
$2,688.70

$1,369.62
$1,503.36
$1,645.02
$2,148.30

$1,748.56
$1,882.30
$2,023.96
$2,527.24

$2,127.50
$2,261.24
$2,402.90
$2,906.18

$378.94

Toc - Plan #56 Florida Blue HMO (a BlueCross BlueShield FL company)

Gold

(POS) BlueCare Gold 24K01-10 ($0 Virtual Visits / $20 Labs / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$1,500 $3,000 Annual Deductible

$5,900 $11,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$731.23
$829.95
$934.51
$1,305.98
$1,984.56

$1,290.62
$1,389.34
$1,493.90
$1,865.37

$1,850.01
$1,948.73
$2,053.29
$2,424.76

$2,409.40
$2,508.12
$2,612.68
$2,984.15

$559.39

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,462.46
$1,659.90
$1,869.02
$2,611.96
$3,969.12

$2,021.85
$2,219.29
$2,428.41
$3,171.35

$2,581.24
$2,778.68
$2,987.80
$3,730.74

$3,140.63
$3,338.07
$3,547.19
$4,290.13

$559.39

Toc - Plan #57 Florida Blue HMO (a BlueCross BlueShield FL company)

Expanded Bronze

(POS) BlueCare Bronze 24K01-25 ($0 Virtual Visits / $50 PCP Visit / $30 Generic Meds / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$551.90
$626.41
$705.33
$985.69
$1,497.86

$974.10
$1,048.61
$1,127.53
$1,407.89

$1,396.30
$1,470.81
$1,549.73
$1,830.09

$1,818.50
$1,893.01
$1,971.93
$2,252.29

$422.20

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,103.80
$1,252.82
$1,410.66
$1,971.38
$2,995.72

$1,526.00
$1,675.02
$1,832.86
$2,393.58

$1,948.20
$2,097.22
$2,255.06
$2,815.78

$2,370.40
$2,519.42
$2,677.26
$3,237.98

$422.20

Toc - Plan #58 Florida Blue HMO (a BlueCross BlueShield FL company)

Expanded Bronze

(POS) BlueCare Bronze 24K01-31S (Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$503.95
$571.98
$644.05
$900.05
$1,367.72

$889.47
$957.50
$1,029.57
$1,285.57

$1,274.99
$1,343.02
$1,415.09
$1,671.09

$1,660.51
$1,728.54
$1,800.61
$2,056.61

$385.52

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,007.90
$1,143.96
$1,288.10
$1,800.10
$2,735.44

$1,393.42
$1,529.48
$1,673.62
$2,185.62

$1,778.94
$1,915.00
$2,059.14
$2,571.14

$2,164.46
$2,300.52
$2,444.66
$2,956.66

$385.52

Toc - Plan #59 Florida Blue HMO (a BlueCross BlueShield FL company)

Silver

(POS) BlueCare Silver 24K01-32S ($40 PCP Visits / Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$5,900 $11,800 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$649.24
$736.89
$829.73
$1,159.54
$1,762.04

$1,145.91
$1,233.56
$1,326.40
$1,656.21

$1,642.58
$1,730.23
$1,823.07
$2,152.88

$2,139.25
$2,226.90
$2,319.74
$2,649.55

$496.67

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,298.48
$1,473.78
$1,659.46
$2,319.08
$3,524.08

$1,795.15
$1,970.45
$2,156.13
$2,815.75

$2,291.82
$2,467.12
$2,652.80
$3,312.42

$2,788.49
$2,963.79
$3,149.47
$3,809.09

$496.67

Toc - Plan #60 Florida Blue HMO (a BlueCross BlueShield FL company)

Gold

(POS) BlueCare Gold 24K01-33S ($30 PCP Visit / Multilingual Available/ Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$1,500 $3,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$708.69
$804.36
$905.71
$1,265.72
$1,923.38

$1,250.84
$1,346.51
$1,447.86
$1,807.87

$1,792.99
$1,888.66
$1,990.01
$2,350.02

$2,335.14
$2,430.81
$2,532.16
$2,892.17

$542.15

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,417.38
$1,608.72
$1,811.42
$2,531.44
$3,846.76

$1,959.53
$2,150.87
$2,353.57
$3,073.59

$2,501.68
$2,693.02
$2,895.72
$3,615.74

$3,043.83
$3,235.17
$3,437.87
$4,157.89

$542.15

Toc - Plan #61 Florida Blue HMO (a BlueCross BlueShield FL company)

Platinum

(POS) BlueCare Platinum 24K01-34S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$3,200 $6,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$878.31
$996.88
$1,122.48
$1,568.66
$2,383.73

$1,550.22
$1,668.79
$1,794.39
$2,240.57

$2,222.13
$2,340.70
$2,466.30
$2,912.48

$2,894.04
$3,012.61
$3,138.21
$3,584.39

$671.91

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,756.62
$1,993.76
$2,244.96
$3,137.32
$4,767.46

$2,428.53
$2,665.67
$2,916.87
$3,809.23

$3,100.44
$3,337.58
$3,588.78
$4,481.14

$3,772.35
$4,009.49
$4,260.69
$5,153.05

$671.91

Health First Commercial Plans, Inc.

Local: 1-855-443-4735 | Toll Free: 1-855-443-4735 | TTY: 1-800-955-8771

Toc - Plan #62 Health First Commercial Plans, Inc.

Silver

(HMO) Silver Gym Access 1664 (Primary Care & Specialist Copays, Open Access, Fitness Center Included)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-443-4735

Annual Out of Pocket Expenses:

Individual Family

$5,750 $11,500 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$408.39
$463.53
$521.93
$729.39
$1,108.38

$720.81
$775.95
$834.35
$1,041.81

$1,033.23
$1,088.37
$1,146.77
$1,354.23

$1,345.65
$1,400.79
$1,459.19
$1,666.65

$312.42

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$816.78
$927.06
$1,043.86
$1,458.78
$2,216.76

$1,129.20
$1,239.48
$1,356.28
$1,771.20

$1,441.62
$1,551.90
$1,668.70
$2,083.62

$1,754.04
$1,864.32
$1,981.12
$2,396.04

$312.42

Toc - Plan #63 Health First Commercial Plans, Inc.

Silver

(HMO) Silver Gym Access 1688 (Open Access, Fitness Center Included)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-443-4735

Annual Out of Pocket Expenses:

Individual Family

$3,850 $7,700 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$402.23
$456.54
$514.06
$718.39
$1,091.66

$709.94
$764.25
$821.77
$1,026.10

$1,017.65
$1,071.96
$1,129.48
$1,333.81

$1,325.36
$1,379.67
$1,437.19
$1,641.52

$307.71

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$804.46
$913.08
$1,028.12
$1,436.78
$2,183.32

$1,112.17
$1,220.79
$1,335.83
$1,744.49

$1,419.88
$1,528.50
$1,643.54
$2,052.20

$1,727.59
$1,836.21
$1,951.25
$2,359.91

$307.71

Toc - Plan #64 Health First Commercial Plans, Inc.

Gold

(HMO) Gold Gym Access 1736 (Primary Care & Urgent Care Copay, 0% Coinsurance, Open Access)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-443-4735

Annual Out of Pocket Expenses:

Individual Family

$2,650 $5,300 Annual Deductible

$8,150 $16,300 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$425.48
$482.92
$543.77
$759.91
$1,154.76

$750.98
$808.42
$869.27
$1,085.41

$1,076.48
$1,133.92
$1,194.77
$1,410.91

$1,401.98
$1,459.42
$1,520.27
$1,736.41

$325.50

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$850.96
$965.84
$1,087.54
$1,519.82
$2,309.52

$1,176.46
$1,291.34
$1,413.04
$1,845.32

$1,501.96
$1,616.84
$1,738.54
$2,170.82

$1,827.46
$1,942.34
$2,064.04
$2,496.32

$325.50

Toc - Plan #65 Health First Commercial Plans, Inc.

Gold

(HMO) Gold Gym Access 1742 (Emergency Room & Inpatient Hospitalization Copay, $0 Outpatient Labs, $0 MRI, Open Access)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-443-4735

Annual Out of Pocket Expenses:

Individual Family

$1,500 $3,000 Annual Deductible

$7,750 $15,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$433.29
$491.79
$553.75
$773.86
$1,175.96

$764.76
$823.26
$885.22
$1,105.33

$1,096.23
$1,154.73
$1,216.69
$1,436.80

$1,427.70
$1,486.20
$1,548.16
$1,768.27

$331.47

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$866.58
$983.58
$1,107.50
$1,547.72
$2,351.92

$1,198.05
$1,315.05
$1,438.97
$1,879.19

$1,529.52
$1,646.52
$1,770.44
$2,210.66

$1,860.99
$1,977.99
$2,101.91
$2,542.13

$331.47

Toc - Plan #66 Health First Commercial Plans, Inc.

Catastrophic

(HMO) Catastrophic Gym Access 1746 (Primary Care Copay Visits 1-3, Open Access)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-443-4735

Annual Out of Pocket Expenses:

Individual Family

$9,450 $18,900 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$190.47
$216.19
$243.42
$340.18
$516.94

$336.18
$361.90
$389.13
$485.89

$481.89
$507.61
$534.84
$631.60

$627.60
$653.32
$680.55
$777.31

$145.71

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$380.94
$432.38
$486.84
$680.36
$1,033.88

$526.65
$578.09
$632.55
$826.07

$672.36
$723.80
$778.26
$971.78

$818.07
$869.51
$923.97
$1,117.49

$145.71

Toc - Plan #67 Health First Commercial Plans, Inc.

Expanded Bronze

(HMO) Bronze 1750 (Unlimited Primary Care, Specialist & Urgent Care Copay Visits, Open Access)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-443-4735

Annual Out of Pocket Expenses:

Individual Family

$8,500 $17,000 Annual Deductible

$9,350 $18,700 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$333.40
$378.41
$426.09
$595.46
$904.85

$588.45
$633.46
$681.14
$850.51

$843.50
$888.51
$936.19
$1,105.56

$1,098.55
$1,143.56
$1,191.24
$1,360.61

$255.05

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$666.80
$756.82
$852.18
$1,190.92
$1,809.70

$921.85
$1,011.87
$1,107.23
$1,445.97

$1,176.90
$1,266.92
$1,362.28
$1,701.02

$1,431.95
$1,521.97
$1,617.33
$1,956.07

$255.05

Toc - Plan #68 Health First Commercial Plans, Inc.

Gold

(HMO) Gold 1770 (Low Primary Care, Specialist & Urgent Care Copay, Open Access)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-443-4735

Annual Out of Pocket Expenses:

Individual Family

$1,600 $3,200 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$412.17
$467.82
$526.76
$736.14
$1,118.64

$727.48
$783.13
$842.07
$1,051.45

$1,042.79
$1,098.44
$1,157.38
$1,366.76

$1,358.10
$1,413.75
$1,472.69
$1,682.07

$315.31

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$824.34
$935.64
$1,053.52
$1,472.28
$2,237.28

$1,139.65
$1,250.95
$1,368.83
$1,787.59

$1,454.96
$1,566.26
$1,684.14
$2,102.90

$1,770.27
$1,881.57
$1,999.45
$2,418.21

$315.31

Toc - Plan #69 Health First Commercial Plans, Inc.

Expanded Bronze

(HMO) Bronze HSA 1794 (HSA Qualified, Open Access)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-443-4735

Annual Out of Pocket Expenses:

Individual Family

$7,050 $14,100 Annual Deductible

$7,050 $14,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$341.92
$388.08
$436.98
$610.67
$927.98

$603.49
$649.65
$698.55
$872.24

$865.06
$911.22
$960.12
$1,133.81

$1,126.63
$1,172.79
$1,221.69
$1,395.38

$261.57

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$683.84
$776.16
$873.96
$1,221.34
$1,855.96

$945.41
$1,037.73
$1,135.53
$1,482.91

$1,206.98
$1,299.30
$1,397.10
$1,744.48

$1,468.55
$1,560.87
$1,658.67
$2,006.05

$261.57

Toc - Plan #70 Health First Commercial Plans, Inc.

Silver

(HMO) Silver 1806 ($2,100 Deductible, Open Access)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-443-4735

Annual Out of Pocket Expenses:

Individual Family

$2,100 $4,200 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$392.19
$445.14
$501.23
$700.46
$1,064.42

$692.22
$745.17
$801.26
$1,000.49

$992.25
$1,045.20
$1,101.29
$1,300.52

$1,292.28
$1,345.23
$1,401.32
$1,600.55

$300.03

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$784.38
$890.28
$1,002.46
$1,400.92
$2,128.84

$1,084.41
$1,190.31
$1,302.49
$1,700.95

$1,384.44
$1,490.34
$1,602.52
$2,000.98

$1,684.47
$1,790.37
$1,902.55
$2,301.01

$300.03

Toc - Plan #71 Health First Commercial Plans, Inc.

Expanded Bronze

(HMO) Bronze 1826 ($0 Medical Deductible, $0 Primary Care Copay- Visits 1 & 2, Specialist & Urgent Care Copay, Open Access)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-443-4735

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$368.01
$417.69
$470.32
$657.27
$998.79

$649.54
$699.22
$751.85
$938.80

$931.07
$980.75
$1,033.38
$1,220.33

$1,212.60
$1,262.28
$1,314.91
$1,501.86

$281.53

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$736.02
$835.38
$940.64
$1,314.54
$1,997.58

$1,017.55
$1,116.91
$1,222.17
$1,596.07

$1,299.08
$1,398.44
$1,503.70
$1,877.60

$1,580.61
$1,679.97
$1,785.23
$2,159.13

$281.53

Toc - Plan #72 Health First Commercial Plans, Inc.

Expanded Bronze

(HMO) Bronze Standard 1828

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-443-4735

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$333.02
$377.97
$425.59
$594.77
$903.81

$587.78
$632.73
$680.35
$849.53

$842.54
$887.49
$935.11
$1,104.29

$1,097.30
$1,142.25
$1,189.87
$1,359.05

$254.76

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$666.04
$755.94
$851.18
$1,189.54
$1,807.62

$920.80
$1,010.70
$1,105.94
$1,444.30

$1,175.56
$1,265.46
$1,360.70
$1,699.06

$1,430.32
$1,520.22
$1,615.46
$1,953.82

$254.76

Toc - Plan #73 Health First Commercial Plans, Inc.

Silver

(HMO) Silver Standard 1829

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-443-4735

Annual Out of Pocket Expenses:

Individual Family

$5,900 $11,800 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$390.84
$443.60
$499.49
$698.04
$1,060.74

$689.83
$742.59
$798.48
$997.03

$988.82
$1,041.58
$1,097.47
$1,296.02

$1,287.81
$1,340.57
$1,396.46
$1,595.01

$298.99

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$781.68
$887.20
$998.98
$1,396.08
$2,121.48

$1,080.67
$1,186.19
$1,297.97
$1,695.07

$1,379.66
$1,485.18
$1,596.96
$1,994.06

$1,678.65
$1,784.17
$1,895.95
$2,293.05

$298.99

Toc - Plan #74 Health First Commercial Plans, Inc.

Gold

(HMO) Gold Standard 1833

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-443-4735

Annual Out of Pocket Expenses:

Individual Family

$1,500 $3,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$409.99
$465.34
$523.97
$732.25
$1,112.72

$723.63
$778.98
$837.61
$1,045.89

$1,037.27
$1,092.62
$1,151.25
$1,359.53

$1,350.91
$1,406.26
$1,464.89
$1,673.17

$313.64

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$819.98
$930.68
$1,047.94
$1,464.50
$2,225.44

$1,133.62
$1,244.32
$1,361.58
$1,778.14

$1,447.26
$1,557.96
$1,675.22
$2,091.78

$1,760.90
$1,871.60
$1,988.86
$2,405.42

$313.64

Toc - Plan #75 Health First Commercial Plans, Inc.

Expanded Bronze

(HMO) Bronze Savings 1820 (Primary Care Copay Visits 1-5, Open Access)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-443-4735

Annual Out of Pocket Expenses:

Individual Family

$8,300 $16,600 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$310.95
$352.93
$397.39
$555.35
$843.92

$548.83
$590.81
$635.27
$793.23

$786.71
$828.69
$873.15
$1,031.11

$1,024.59
$1,066.57
$1,111.03
$1,268.99

$237.88

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$621.90
$705.86
$794.78
$1,110.70
$1,687.84

$859.78
$943.74
$1,032.66
$1,348.58

$1,097.66
$1,181.62
$1,270.54
$1,586.46

$1,335.54
$1,419.50
$1,508.42
$1,824.34

$237.88

Toc - Plan #76 Health First Commercial Plans, Inc.

Silver

(HMO) Silver Savings 1821 (Primary Care Copay, Open Access)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-443-4735

Annual Out of Pocket Expenses:

Individual Family

$4,500 $9,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$380.59
$431.97
$486.40
$679.74
$1,032.93

$671.74
$723.12
$777.55
$970.89

$962.89
$1,014.27
$1,068.70
$1,262.04

$1,254.04
$1,305.42
$1,359.85
$1,553.19

$291.15

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$761.18
$863.94
$972.80
$1,359.48
$2,065.86

$1,052.33
$1,155.09
$1,263.95
$1,650.63

$1,343.48
$1,446.24
$1,555.10
$1,941.78

$1,634.63
$1,737.39
$1,846.25
$2,232.93

$291.15

Toc - Plan #77 Health First Commercial Plans, Inc.

Gold

(HMO) Gold Savings 1825 ($25 Primary Care Copay, $50 Specialist Copay, Open Access)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-443-4735

Annual Out of Pocket Expenses:

Individual Family

$2,400 $4,800 Annual Deductible

$7,700 $15,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$383.99
$435.83
$490.74
$685.81
$1,042.16

$677.74
$729.58
$784.49
$979.56

$971.49
$1,023.33
$1,078.24
$1,273.31

$1,265.24
$1,317.08
$1,371.99
$1,567.06

$293.75

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$767.98
$871.66
$981.48
$1,371.62
$2,084.32

$1,061.73
$1,165.41
$1,275.23
$1,665.37

$1,355.48
$1,459.16
$1,568.98
$1,959.12

$1,649.23
$1,752.91
$1,862.73
$2,252.87

$293.75

Oscar Insurance Company of Florida

Local: 1-855-672-2755 | Toll Free: 1-855-672-2755

Toc - Plan #78 Oscar Insurance Company of Florida

Expanded Bronze

(EPO) Bronze Elite + PCP Saver Plus

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$366.12
$415.53
$467.89
$653.87
$993.62

$646.19
$695.60
$747.96
$933.94

$926.26
$975.67
$1,028.03
$1,214.01

$1,206.33
$1,255.74
$1,308.10
$1,494.08

$280.07

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$732.24
$831.06
$935.78
$1,307.74
$1,987.24

$1,012.31
$1,111.13
$1,215.85
$1,587.81

$1,292.38
$1,391.20
$1,495.92
$1,867.88

$1,572.45
$1,671.27
$1,775.99
$2,147.95

$280.07

Toc - Plan #79 Oscar Insurance Company of Florida

Silver

(EPO) Silver Classic

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family

$5,400 $10,800 Annual Deductible

$8,650 $17,300 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$403.46
$457.92
$515.61
$720.57
$1,094.97

$712.10
$766.56
$824.25
$1,029.21

$1,020.74
$1,075.20
$1,132.89
$1,337.85

$1,329.38
$1,383.84
$1,441.53
$1,646.49

$308.64

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$806.92
$915.84
$1,031.22
$1,441.14
$2,189.94

$1,115.56
$1,224.48
$1,339.86
$1,749.78

$1,424.20
$1,533.12
$1,648.50
$2,058.42

$1,732.84
$1,841.76
$1,957.14
$2,367.06

$308.64

Toc - Plan #80 Oscar Insurance Company of Florida

Catastrophic

(EPO) Secure

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family

$9,450 $18,900 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$243.95
$276.88
$311.76
$435.68
$662.06

$430.57
$463.50
$498.38
$622.30

$617.19
$650.12
$685.00
$808.92

$803.81
$836.74
$871.62
$995.54

$186.62

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$487.90
$553.76
$623.52
$871.36
$1,324.12

$674.52
$740.38
$810.14
$1,057.98

$861.14
$927.00
$996.76
$1,244.60

$1,047.76
$1,113.62
$1,183.38
$1,431.22

$186.62

Toc - Plan #81 Oscar Insurance Company of Florida

Expanded Bronze

(EPO) Bronze Elite + Specialist Saver Plus

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$368.34
$418.05
$470.72
$657.83
$999.64

$650.11
$699.82
$752.49
$939.60

$931.88
$981.59
$1,034.26
$1,221.37

$1,213.65
$1,263.36
$1,316.03
$1,503.14

$281.77

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$736.68
$836.10
$941.44
$1,315.66
$1,999.28

$1,018.45
$1,117.87
$1,223.21
$1,597.43

$1,300.22
$1,399.64
$1,504.98
$1,879.20

$1,581.99
$1,681.41
$1,786.75
$2,160.97

$281.77

Toc - Plan #82 Oscar Insurance Company of Florida

Gold

(EPO) Gold Classic

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family

$3,500 $7,000 Annual Deductible

$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$428.23
$486.03
$547.27
$764.80
$1,162.19

$755.82
$813.62
$874.86
$1,092.39

$1,083.41
$1,141.21
$1,202.45
$1,419.98

$1,411.00
$1,468.80
$1,530.04
$1,747.57

$327.59

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$856.46
$972.06
$1,094.54
$1,529.60
$2,324.38

$1,184.05
$1,299.65
$1,422.13
$1,857.19

$1,511.64
$1,627.24
$1,749.72
$2,184.78

$1,839.23
$1,954.83
$2,077.31
$2,512.37

$327.59

Toc - Plan #83 Oscar Insurance Company of Florida

Silver

(EPO) Silver Simple

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family

$4,500 $9,000 Annual Deductible

$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$402.42
$456.74
$514.29
$718.71
$1,092.15

$710.27
$764.59
$822.14
$1,026.56

$1,018.12
$1,072.44
$1,129.99
$1,334.41

$1,325.97
$1,380.29
$1,437.84
$1,642.26

$307.85

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$804.84
$913.48
$1,028.58
$1,437.42
$2,184.30

$1,112.69
$1,221.33
$1,336.43
$1,745.27

$1,420.54
$1,529.18
$1,644.28
$2,053.12

$1,728.39
$1,837.03
$1,952.13
$2,360.97

$307.85

Toc - Plan #84 Oscar Insurance Company of Florida

Silver

(EPO) Silver Elite

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family

$5,000 $10,000 Annual Deductible

$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$410.69
$466.12
$524.85
$733.47
$1,114.58

$724.86
$780.29
$839.02
$1,047.64

$1,039.03
$1,094.46
$1,153.19
$1,361.81

$1,353.20
$1,408.63
$1,467.36
$1,675.98

$314.17

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$821.38
$932.24
$1,049.70
$1,466.94
$2,229.16

$1,135.55
$1,246.41
$1,363.87
$1,781.11

$1,449.72
$1,560.58
$1,678.04
$2,095.28

$1,763.89
$1,874.75
$1,992.21
$2,409.45

$314.17

Toc - Plan #85 Oscar Insurance Company of Florida

Expanded Bronze

(EPO) Bronze Classic 4700

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family

$4,700 $9,400 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$331.42
$376.15
$423.54
$591.90
$899.44

$584.95
$629.68
$677.07
$845.43

$838.48
$883.21
$930.60
$1,098.96

$1,092.01
$1,136.74
$1,184.13
$1,352.49

$253.53

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$662.84
$752.30
$847.08
$1,183.80
$1,798.88

$916.37
$1,005.83
$1,100.61
$1,437.33

$1,169.90
$1,259.36
$1,354.14
$1,690.86

$1,423.43
$1,512.89
$1,607.67
$1,944.39

$253.53

Toc - Plan #86 Oscar Insurance Company of Florida

Silver

(EPO) Silver Simple PCP Saver

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family

$5,500 $11,000 Annual Deductible

$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$399.49
$453.41
$510.54
$713.47
$1,084.19

$705.09
$759.01
$816.14
$1,019.07

$1,010.69
$1,064.61
$1,121.74
$1,324.67

$1,316.29
$1,370.21
$1,427.34
$1,630.27

$305.60

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$798.98
$906.82
$1,021.08
$1,426.94
$2,168.38

$1,104.58
$1,212.42
$1,326.68
$1,732.54

$1,410.18
$1,518.02
$1,632.28
$2,038.14

$1,715.78
$1,823.62
$1,937.88
$2,343.74

$305.60

Toc - Plan #87 Oscar Insurance Company of Florida

Gold

(EPO) Gold Elite Saver Plus

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$467.57
$530.68
$597.54
$835.06
$1,268.96

$825.25
$888.36
$955.22
$1,192.74

$1,182.93
$1,246.04
$1,312.90
$1,550.42

$1,540.61
$1,603.72
$1,670.58
$1,908.10

$357.68

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$935.14
$1,061.36
$1,195.08
$1,670.12
$2,537.92

$1,292.82
$1,419.04
$1,552.76
$2,027.80

$1,650.50
$1,776.72
$1,910.44
$2,385.48

$2,008.18
$2,134.40
$2,268.12
$2,743.16

$357.68

Toc - Plan #88 Oscar Insurance Company of Florida

Gold

(EPO) Gold Elite

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family

$500 $1,000 Annual Deductible

$5,500 $11,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$443.98
$503.90
$567.39
$792.92
$1,204.92

$783.61
$843.53
$907.02
$1,132.55

$1,123.24
$1,183.16
$1,246.65
$1,472.18

$1,462.87
$1,522.79
$1,586.28
$1,811.81

$339.63

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$887.96
$1,007.80
$1,134.78
$1,585.84
$2,409.84

$1,227.59
$1,347.43
$1,474.41
$1,925.47

$1,567.22
$1,687.06
$1,814.04
$2,265.10

$1,906.85
$2,026.69
$2,153.67
$2,604.73

$339.63

Toc - Plan #89 Oscar Insurance Company of Florida

Expanded Bronze

(EPO) Bronze Elite Saver Plus

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$359.57
$408.10
$459.52
$642.17
$975.84

$634.63
$683.16
$734.58
$917.23

$909.69
$958.22
$1,009.64
$1,192.29

$1,184.75
$1,233.28
$1,284.70
$1,467.35

$275.06

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$719.14
$816.20
$919.04
$1,284.34
$1,951.68

$994.20
$1,091.26
$1,194.10
$1,559.40

$1,269.26
$1,366.32
$1,469.16
$1,834.46

$1,544.32
$1,641.38
$1,744.22
$2,109.52

$275.06

Toc - Plan #90 Oscar Insurance Company of Florida

Expanded Bronze

(EPO) Bronze Classic Standard

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$328.48
$372.82
$419.79
$586.65
$891.48

$579.76
$624.10
$671.07
$837.93

$831.04
$875.38
$922.35
$1,089.21

$1,082.32
$1,126.66
$1,173.63
$1,340.49

$251.28

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$656.96
$745.64
$839.58
$1,173.30
$1,782.96

$908.24
$996.92
$1,090.86
$1,424.58

$1,159.52
$1,248.20
$1,342.14
$1,675.86

$1,410.80
$1,499.48
$1,593.42
$1,927.14

$251.28

Toc - Plan #91 Oscar Insurance Company of Florida

Silver

(EPO) Silver Classic Standard

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family

$5,900 $11,800 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$400.31
$454.35
$511.59
$714.94
$1,086.43

$706.54
$760.58
$817.82
$1,021.17

$1,012.77
$1,066.81
$1,124.05
$1,327.40

$1,319.00
$1,373.04
$1,430.28
$1,633.63

$306.23

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$800.62
$908.70
$1,023.18
$1,429.88
$2,172.86

$1,106.85
$1,214.93
$1,329.41
$1,736.11

$1,413.08
$1,521.16
$1,635.64
$2,042.34

$1,719.31
$1,827.39
$1,941.87
$2,348.57

$306.23

Toc - Plan #92 Oscar Insurance Company of Florida

Gold

(EPO) Gold Classic Standard

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family

$1,500 $3,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$413.91
$469.78
$528.96
$739.22
$1,123.32

$730.54
$786.41
$845.59
$1,055.85

$1,047.17
$1,103.04
$1,162.22
$1,372.48

$1,363.80
$1,419.67
$1,478.85
$1,689.11

$316.63

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$827.82
$939.56
$1,057.92
$1,478.44
$2,246.64

$1,144.45
$1,256.19
$1,374.55
$1,795.07

$1,461.08
$1,572.82
$1,691.18
$2,111.70

$1,777.71
$1,889.45
$2,007.81
$2,428.33

$316.63

Florida Health Care Plans

Local: 1-386-676-7110 | Toll Free: 1-800-232-0578 | TTY: 1-800-955-8771

Toc - Plan #93 Florida Health Care Plans

Catastrophic

(HMO) Gym Access IND Essential Plus Catastrophic HMO 36

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-232-0578

Annual Out of Pocket Expenses:

Individual Family

$9,450 $18,900 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$240.32
$272.76
$307.13
$429.21
$652.23

$424.16
$456.60
$490.97
$613.05

$608.00
$640.44
$674.81
$796.89

$791.84
$824.28
$858.65
$980.73

$183.84

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$480.64
$545.52
$614.26
$858.42
$1,304.46

$664.48
$729.36
$798.10
$1,042.26

$848.32
$913.20
$981.94
$1,226.10

$1,032.16
$1,097.04
$1,165.78
$1,409.94

$183.84

Toc - Plan #94 Florida Health Care Plans

Catastrophic

(POS) Gym Access IND Essential Plus Catastrophic POS 37

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-232-0578

Annual Out of Pocket Expenses:

Individual Family

$9,450 $18,900 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$259.55
$294.59
$331.70
$463.56
$704.42

$458.11
$493.15
$530.26
$662.12

$656.67
$691.71
$728.82
$860.68

$855.23
$890.27
$927.38
$1,059.24

$198.56

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$519.10
$589.18
$663.40
$927.12
$1,408.84

$717.66
$787.74
$861.96
$1,125.68

$916.22
$986.30
$1,060.52
$1,324.24

$1,114.78
$1,184.86
$1,259.08
$1,522.80

$198.56

Toc - Plan #95 Florida Health Care Plans

Silver

(HMO) Gym Access IND Essential Plus Silver HMO 53

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-232-0578

Annual Out of Pocket Expenses:

Individual Family

$4,000 $8,000 Annual Deductible

$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$407.70
$462.74
$521.04
$728.15
$1,106.50

$719.59
$774.63
$832.93
$1,040.04

$1,031.48
$1,086.52
$1,144.82
$1,351.93

$1,343.37
$1,398.41
$1,456.71
$1,663.82

$311.89

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$815.40
$925.48
$1,042.08
$1,456.30
$2,213.00

$1,127.29
$1,237.37
$1,353.97
$1,768.19

$1,439.18
$1,549.26
$1,665.86
$2,080.08

$1,751.07
$1,861.15
$1,977.75
$2,391.97

$311.89

Toc - Plan #96 Florida Health Care Plans

Silver

(POS) Gym Access IND Essential Plus Silver POS 54

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-232-0578

Annual Out of Pocket Expenses:

Individual Family

$4,000 $8,000 Annual Deductible

$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$431.85
$490.15
$551.90
$771.28
$1,172.04

$762.22
$820.52
$882.27
$1,101.65

$1,092.59
$1,150.89
$1,212.64
$1,432.02

$1,422.96
$1,481.26
$1,543.01
$1,762.39

$330.37

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$863.70
$980.30
$1,103.80
$1,542.56
$2,344.08

$1,194.07
$1,310.67
$1,434.17
$1,872.93

$1,524.44
$1,641.04
$1,764.54
$2,203.30

$1,854.81
$1,971.41
$2,094.91
$2,533.67

$330.37

Toc - Plan #97 Florida Health Care Plans

Platinum

(POS) Gym Access IND Platinum POS 4000

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-232-0578

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$4,000 $8,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$593.23
$673.32
$758.15
$1,059.51
$1,610.03

$1,047.05
$1,127.14
$1,211.97
$1,513.33

$1,500.87
$1,580.96
$1,665.79
$1,967.15

$1,954.69
$2,034.78
$2,119.61
$2,420.97

$453.82

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,186.46
$1,346.64
$1,516.30
$2,119.02
$3,220.06

$1,640.28
$1,800.46
$1,970.12
$2,572.84

$2,094.10
$2,254.28
$2,423.94
$3,026.66

$2,547.92
$2,708.10
$2,877.76
$3,480.48

$453.82

Toc - Plan #98 Florida Health Care Plans

Gold

(HMO) Gym Access IND Gold HMO 55001

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-232-0578

Annual Out of Pocket Expenses:

Individual Family

$2,800 $5,600 Annual Deductible

$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$422.95
$480.05
$540.53
$755.39
$1,147.89

$746.51
$803.61
$864.09
$1,078.95

$1,070.07
$1,127.17
$1,187.65
$1,402.51

$1,393.63
$1,450.73
$1,511.21
$1,726.07

$323.56

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$845.90
$960.10
$1,081.06
$1,510.78
$2,295.78

$1,169.46
$1,283.66
$1,404.62
$1,834.34

$1,493.02
$1,607.22
$1,728.18
$2,157.90

$1,816.58
$1,930.78
$2,051.74
$2,481.46

$323.56

Toc - Plan #99 Florida Health Care Plans

Gold

(POS) Gym Access IND Gold POS 55001

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-232-0578

Annual Out of Pocket Expenses:

Individual Family

$2,800 $5,600 Annual Deductible

$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$457.47
$519.23
$584.65
$817.04
$1,241.57

$807.43
$869.19
$934.61
$1,167.00

$1,157.39
$1,219.15
$1,284.57
$1,516.96

$1,507.35
$1,569.11
$1,634.53
$1,866.92

$349.96

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$914.94
$1,038.46
$1,169.30
$1,634.08
$2,483.14

$1,264.90
$1,388.42
$1,519.26
$1,984.04

$1,614.86
$1,738.38
$1,869.22
$2,334.00

$1,964.82
$2,088.34
$2,219.18
$2,683.96

$349.96

Toc - Plan #100 Florida Health Care Plans

Gold

(HMO) Gym Access IND Gold HMO 4500

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-232-0578

Annual Out of Pocket Expenses:

Individual Family

$2,550 $5,100 Annual Deductible

$5,000 $10,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$421.68
$478.61
$538.91
$753.12
$1,144.44

$744.27
$801.20
$861.50
$1,075.71

$1,066.86
$1,123.79
$1,184.09
$1,398.30

$1,389.45
$1,446.38
$1,506.68
$1,720.89

$322.59

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$843.36
$957.22
$1,077.82
$1,506.24
$2,288.88

$1,165.95
$1,279.81
$1,400.41
$1,828.83

$1,488.54
$1,602.40
$1,723.00
$2,151.42

$1,811.13
$1,924.99
$2,045.59
$2,474.01

$322.59

Toc - Plan #101 Florida Health Care Plans

Expanded Bronze

(HMO) Gym Access IND Bronze HMO HSA 5065

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-232-0578

Annual Out of Pocket Expenses:

Individual Family

$6,300 $12,600 Annual Deductible

$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$331.75
$376.54
$423.98
$592.51
$900.37

$585.54
$630.33
$677.77
$846.30

$839.33
$884.12
$931.56
$1,100.09

$1,093.12
$1,137.91
$1,185.35
$1,353.88

$253.79

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$663.50
$753.08
$847.96
$1,185.02
$1,800.74

$917.29
$1,006.87
$1,101.75
$1,438.81

$1,171.08
$1,260.66
$1,355.54
$1,692.60

$1,424.87
$1,514.45
$1,609.33
$1,946.39

$253.79

Toc - Plan #102 Florida Health Care Plans

Expanded Bronze

(POS) Gym Access IND Bronze POS BC 3841

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-232-0578

Annual Out of Pocket Expenses:

Individual Family

$8,000 $16,000 Annual Deductible

$9,300 $18,600 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$365.29
$414.60
$466.84
$652.41
$991.40

$644.74
$694.05
$746.29
$931.86

$924.19
$973.50
$1,025.74
$1,211.31

$1,203.64
$1,252.95
$1,305.19
$1,490.76

$279.45

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$730.58
$829.20
$933.68
$1,304.82
$1,982.80

$1,010.03
$1,108.65
$1,213.13
$1,584.27

$1,289.48
$1,388.10
$1,492.58
$1,863.72

$1,568.93
$1,667.55
$1,772.03
$2,143.17

$279.45

Toc - Plan #103 Florida Health Care Plans

Silver

(HMO) Gym Access IND Silver HMO BC 0941

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-232-0578

Annual Out of Pocket Expenses:

Individual Family

$5,000 $10,000 Annual Deductible

$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$405.15
$459.85
$517.78
$723.60
$1,099.58

$715.09
$769.79
$827.72
$1,033.54

$1,025.03
$1,079.73
$1,137.66
$1,343.48

$1,334.97
$1,389.67
$1,447.60
$1,653.42

$309.94

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$810.30
$919.70
$1,035.56
$1,447.20
$2,199.16

$1,120.24
$1,229.64
$1,345.50
$1,757.14

$1,430.18
$1,539.58
$1,655.44
$2,067.08

$1,740.12
$1,849.52
$1,965.38
$2,377.02

$309.94

Toc - Plan #104 Florida Health Care Plans

Silver

(POS) Gym Access IND Silver POS BC 0941

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-232-0578

Annual Out of Pocket Expenses:

Individual Family

$5,000 $10,000 Annual Deductible

$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$437.56
$496.63
$559.20
$781.48
$1,187.54

$772.29
$831.36
$893.93
$1,116.21

$1,107.02
$1,166.09
$1,228.66
$1,450.94

$1,441.75
$1,500.82
$1,563.39
$1,785.67

$334.73

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$875.12
$993.26
$1,118.40
$1,562.96
$2,375.08

$1,209.85
$1,327.99
$1,453.13
$1,897.69

$1,544.58
$1,662.72
$1,787.86
$2,232.42

$1,879.31
$1,997.45
$2,122.59
$2,567.15

$334.73

Toc - Plan #105 Florida Health Care Plans

Silver

(HMO) Gym Access IND Silver HMO BC 7741

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-232-0578

Annual Out of Pocket Expenses:

Individual Family

$6,000 $12,000 Annual Deductible

$8,450 $16,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$400.10
$454.11
$511.33
$714.58
$1,085.87

$706.18
$760.19
$817.41
$1,020.66

$1,012.26
$1,066.27
$1,123.49
$1,326.74

$1,318.34
$1,372.35
$1,429.57
$1,632.82

$306.08

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$800.20
$908.22
$1,022.66
$1,429.16
$2,171.74

$1,106.28
$1,214.30
$1,328.74
$1,735.24

$1,412.36
$1,520.38
$1,634.82
$2,041.32

$1,718.44
$1,826.46
$1,940.90
$2,347.40

$306.08

Toc - Plan #106 Florida Health Care Plans

Silver

(POS) Gym Access IND Silver POS BC 7741

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-232-0578

Annual Out of Pocket Expenses:

Individual Family

$6,000 $12,000 Annual Deductible

$8,450 $16,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$432.11
$490.44
$552.24
$771.75
$1,172.75

$762.67
$821.00
$882.80
$1,102.31

$1,093.23
$1,151.56
$1,213.36
$1,432.87

$1,423.79
$1,482.12
$1,543.92
$1,763.43

$330.56

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$864.22
$980.88
$1,104.48
$1,543.50
$2,345.50

$1,194.78
$1,311.44
$1,435.04
$1,874.06

$1,525.34
$1,642.00
$1,765.60
$2,204.62

$1,855.90
$1,972.56
$2,096.16
$2,535.18

$330.56

Toc - Plan #107 Florida Health Care Plans

Gold

(HMO) Gym Access IND Gold HMO BC 5651

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-232-0578

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$6,800 $13,600 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$445.96
$506.16
$569.94
$796.48
$1,210.34

$787.12
$847.32
$911.10
$1,137.64

$1,128.28
$1,188.48
$1,252.26
$1,478.80

$1,469.44
$1,529.64
$1,593.42
$1,819.96

$341.16

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$891.92
$1,012.32
$1,139.88
$1,592.96
$2,420.68

$1,233.08
$1,353.48
$1,481.04
$1,934.12

$1,574.24
$1,694.64
$1,822.20
$2,275.28

$1,915.40
$2,035.80
$2,163.36
$2,616.44

$341.16

Toc - Plan #108 Florida Health Care Plans

Gold

(POS) Gym Access IND Gold POS BC 5651

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-232-0578

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$6,800 $13,600 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$482.20
$547.30
$616.25
$861.21
$1,308.69

$851.08
$916.18
$985.13
$1,230.09

$1,219.96
$1,285.06
$1,354.01
$1,598.97

$1,588.84
$1,653.94
$1,722.89
$1,967.85

$368.88

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$964.40
$1,094.60
$1,232.50
$1,722.42
$2,617.38

$1,333.28
$1,463.48
$1,601.38
$2,091.30

$1,702.16
$1,832.36
$1,970.26
$2,460.18

$2,071.04
$2,201.24
$2,339.14
$2,829.06

$368.88

Toc - Plan #109 Florida Health Care Plans

Platinum

(POS) Gym Access IND Platinum POS BC 5841

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-232-0578

Annual Out of Pocket Expenses:

Individual Family

$800 $1,600 Annual Deductible

$2,500 $5,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$578.85
$656.99
$739.77
$1,033.83
$1,571.00

$1,021.67
$1,099.81
$1,182.59
$1,476.65

$1,464.49
$1,542.63
$1,625.41
$1,919.47

$1,907.31
$1,985.45
$2,068.23
$2,362.29

$442.82

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,157.70
$1,313.98
$1,479.54
$2,067.66
$3,142.00

$1,600.52
$1,756.80
$1,922.36
$2,510.48

$2,043.34
$2,199.62
$2,365.18
$2,953.30

$2,486.16
$2,642.44
$2,808.00
$3,396.12

$442.82

Toc - Plan #110 Florida Health Care Plans

Platinum

(POS) Gym Access IND Platinum POS BC 1941

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-232-0578

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$2,100 $4,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$601.33
$682.51
$768.50
$1,073.98
$1,632.01

$1,061.35
$1,142.53
$1,228.52
$1,534.00

$1,521.37
$1,602.55
$1,688.54
$1,994.02

$1,981.39
$2,062.57
$2,148.56
$2,454.04

$460.02

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,202.66
$1,365.02
$1,537.00
$2,147.96
$3,264.02

$1,662.68
$1,825.04
$1,997.02
$2,607.98

$2,122.70
$2,285.06
$2,457.04
$3,068.00

$2,582.72
$2,745.08
$2,917.06
$3,528.02

$460.02

Toc - Plan #111 Florida Health Care Plans

Expanded Bronze

(HMO) Gym Access IND Bronze Standardized HMO

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-232-0578

Annual Out of Pocket Expenses:

Individual Family

$7,150 $14,300 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$334.73
$379.92
$427.78
$597.83
$908.46

$590.80
$635.99
$683.85
$853.90

$846.87
$892.06
$939.92
$1,109.97

$1,102.94
$1,148.13
$1,195.99
$1,366.04

$256.07

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$669.46
$759.84
$855.56
$1,195.66
$1,816.92

$925.53
$1,015.91
$1,111.63
$1,451.73

$1,181.60
$1,271.98
$1,367.70
$1,707.80

$1,437.67
$1,528.05
$1,623.77
$1,963.87

$256.07

Toc - Plan #112 Florida Health Care Plans

Expanded Bronze

(HMO) Gym Access IND Bronze HMO 1340

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-232-0578

Annual Out of Pocket Expenses:

Individual Family

$9,400 $18,800 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$323.54
$367.22
$413.48
$577.84
$878.09

$571.05
$614.73
$660.99
$825.35

$818.56
$862.24
$908.50
$1,072.86

$1,066.07
$1,109.75
$1,156.01
$1,320.37

$247.51

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$647.08
$734.44
$826.96
$1,155.68
$1,756.18

$894.59
$981.95
$1,074.47
$1,403.19

$1,142.10
$1,229.46
$1,321.98
$1,650.70

$1,389.61
$1,476.97
$1,569.49
$1,898.21

$247.51

Toc - Plan #113 Florida Health Care Plans

Expanded Bronze

(POS) Gym Access IND Bronze POS 1042

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-232-0578

Annual Out of Pocket Expenses:

Individual Family

$5,500 $11,000 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$365.08
$414.37
$466.57
$652.03
$990.83

$644.37
$693.66
$745.86
$931.32

$923.66
$972.95
$1,025.15
$1,210.61

$1,202.95
$1,252.24
$1,304.44
$1,489.90

$279.29

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$730.16
$828.74
$933.14
$1,304.06
$1,981.66

$1,009.45
$1,108.03
$1,212.43
$1,583.35

$1,288.74
$1,387.32
$1,491.72
$1,862.64

$1,568.03
$1,666.61
$1,771.01
$2,141.93

$279.29

Toc - Plan #114 Florida Health Care Plans

Gold

(HMO) Gym Access IND Gold HMO H.S.A 9010

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-232-0578

Annual Out of Pocket Expenses:

Individual Family

$1,750 $3,500 Annual Deductible

$4,900 $9,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$392.31
$445.27
$501.37
$700.67
$1,064.73

$692.43
$745.39
$801.49
$1,000.79

$992.55
$1,045.51
$1,101.61
$1,300.91

$1,292.67
$1,345.63
$1,401.73
$1,601.03

$300.12

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$784.62
$890.54
$1,002.74
$1,401.34
$2,129.46

$1,084.74
$1,190.66
$1,302.86
$1,701.46

$1,384.86
$1,490.78
$1,602.98
$2,001.58

$1,684.98
$1,790.90
$1,903.10
$2,301.70

$300.12

Toc - Plan #115 Florida Health Care Plans

Expanded Bronze

(HMO) Gym Access IND Bronze HMO OA 1211

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-232-0578

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$364.46
$413.66
$465.78
$650.93
$989.14

$643.27
$692.47
$744.59
$929.74

$922.08
$971.28
$1,023.40
$1,208.55

$1,200.89
$1,250.09
$1,302.21
$1,487.36

$278.81

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$728.92
$827.32
$931.56
$1,301.86
$1,978.28

$1,007.73
$1,106.13
$1,210.37
$1,580.67

$1,286.54
$1,384.94
$1,489.18
$1,859.48

$1,565.35
$1,663.75
$1,767.99
$2,138.29

$278.81

Toc - Plan #116 Florida Health Care Plans

Silver

(HMO) Gym Access IND Silver HMO OA 1009

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-232-0578

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$7,900 $15,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$421.18
$478.04
$538.27
$752.23
$1,143.08

$743.38
$800.24
$860.47
$1,074.43

$1,065.58
$1,122.44
$1,182.67
$1,396.63

$1,387.78
$1,444.64
$1,504.87
$1,718.83

$322.20

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$842.36
$956.08
$1,076.54
$1,504.46
$2,286.16

$1,164.56
$1,278.28
$1,398.74
$1,826.66

$1,486.76
$1,600.48
$1,720.94
$2,148.86

$1,808.96
$1,922.68
$2,043.14
$2,471.06

$322.20

Toc - Plan #117 Florida Health Care Plans

Expanded Bronze

(HMO) Gym Access IND Bronze HMO OA Standard 2450

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-232-0578

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$342.25
$388.45
$437.40
$611.26
$928.87

$604.07
$650.27
$699.22
$873.08

$865.89
$912.09
$961.04
$1,134.90

$1,127.71
$1,173.91
$1,222.86
$1,396.72

$261.82

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$684.50
$776.90
$874.80
$1,222.52
$1,857.74

$946.32
$1,038.72
$1,136.62
$1,484.34

$1,208.14
$1,300.54
$1,398.44
$1,746.16

$1,469.96
$1,562.36
$1,660.26
$2,007.98

$261.82

Toc - Plan #118 Florida Health Care Plans

Silver

(HMO) Gym Access IND Silver HMO OA Standard 1440

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-232-0578

Annual Out of Pocket Expenses:

Individual Family

$5,900 $11,800 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$397.26
$450.89
$507.70
$709.51
$1,078.16

$701.16
$754.79
$811.60
$1,013.41

$1,005.06
$1,058.69
$1,115.50
$1,317.31

$1,308.96
$1,362.59
$1,419.40
$1,621.21

$303.90

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$794.52
$901.78
$1,015.40
$1,419.02
$2,156.32

$1,098.42
$1,205.68
$1,319.30
$1,722.92

$1,402.32
$1,509.58
$1,623.20
$2,026.82

$1,706.22
$1,813.48
$1,927.10
$2,330.72

$303.90

Toc - Plan #119 Florida Health Care Plans

Gold

(HMO) Gym Access IND Gold HMO OA Standard 3450

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-232-0578

Annual Out of Pocket Expenses:

Individual Family

$1,500 $3,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$399.74
$453.70
$510.87
$713.94
$1,084.89

$705.54
$759.50
$816.67
$1,019.74

$1,011.34
$1,065.30
$1,122.47
$1,325.54

$1,317.14
$1,371.10
$1,428.27
$1,631.34

$305.80

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$799.48
$907.40
$1,021.74
$1,427.88
$2,169.78

$1,105.28
$1,213.20
$1,327.54
$1,733.68

$1,411.08
$1,519.00
$1,633.34
$2,039.48

$1,716.88
$1,824.80
$1,939.14
$2,345.28

$305.80

Toc - Plan #120 Florida Health Care Plans

Expanded Bronze

(POS) Gym Access IND Bronze POS OA Standard 2450

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-232-0578

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$369.63
$419.53
$472.39
$660.16
$1,003.18

$652.40
$702.30
$755.16
$942.93

$935.17
$985.07
$1,037.93
$1,225.70

$1,217.94
$1,267.84
$1,320.70
$1,508.47

$282.77

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$739.26
$839.06
$944.78
$1,320.32
$2,006.36

$1,022.03
$1,121.83
$1,227.55
$1,603.09

$1,304.80
$1,404.60
$1,510.32
$1,885.86

$1,587.57
$1,687.37
$1,793.09
$2,168.63

$282.77

Toc - Plan #121 Florida Health Care Plans

Silver

(POS) Gym Access IND Silver POS OA Standard 1440

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-232-0578

Annual Out of Pocket Expenses:

Individual Family

$5,900 $11,800 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$429.04
$486.96
$548.31
$766.27
$1,164.41

$757.26
$815.18
$876.53
$1,094.49

$1,085.48
$1,143.40
$1,204.75
$1,422.71

$1,413.70
$1,471.62
$1,532.97
$1,750.93

$328.22

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$858.08
$973.92
$1,096.62
$1,532.54
$2,328.82

$1,186.30
$1,302.14
$1,424.84
$1,860.76

$1,514.52
$1,630.36
$1,753.06
$2,188.98

$1,842.74
$1,958.58
$2,081.28
$2,517.20

$328.22

Toc - Plan #122 Florida Health Care Plans

Gold

(POS) Gym Access IND Gold POS OA Standard 3450

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-232-0578

Annual Out of Pocket Expenses:

Individual Family

$1,500 $3,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$431.72
$490.00
$551.74
$771.05
$1,171.69

$761.99
$820.27
$882.01
$1,101.32

$1,092.26
$1,150.54
$1,212.28
$1,431.59

$1,422.53
$1,480.81
$1,542.55
$1,761.86

$330.27

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$863.44
$980.00
$1,103.48
$1,542.10
$2,343.38

$1,193.71
$1,310.27
$1,433.75
$1,872.37

$1,523.98
$1,640.54
$1,764.02
$2,202.64

$1,854.25
$1,970.81
$2,094.29
$2,532.91

$330.27

Toc - Plan #123 Florida Health Care Plans

Platinum

(POS) Gym Access IND Platinum POS OA Standard 4450

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-232-0578

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$3,200 $6,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$602.43
$683.76
$769.91
$1,075.94
$1,635.00

$1,063.29
$1,144.62
$1,230.77
$1,536.80

$1,524.15
$1,605.48
$1,691.63
$1,997.66

$1,985.01
$2,066.34
$2,152.49
$2,458.52

$460.86

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,204.86
$1,367.52
$1,539.82
$2,151.88
$3,270.00

$1,665.72
$1,828.38
$2,000.68
$2,612.74

$2,126.58
$2,289.24
$2,461.54
$3,073.60

$2,587.44
$2,750.10
$2,922.40
$3,534.46

$460.86

Toc - Plan #124 Florida Health Care Plans

Expanded Bronze

(POS) Gym Access IND Bronze POS OA 1211

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-232-0578

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$393.61
$446.75
$503.03
$702.99
$1,068.26

$694.72
$747.86
$804.14
$1,004.10

$995.83
$1,048.97
$1,105.25
$1,305.21

$1,296.94
$1,350.08
$1,406.36
$1,606.32

$301.11

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$787.22
$893.50
$1,006.06
$1,405.98
$2,136.52

$1,088.33
$1,194.61
$1,307.17
$1,707.09

$1,389.44
$1,495.72
$1,608.28
$2,008.20

$1,690.55
$1,796.83
$1,909.39
$2,309.31

$301.11

Toc - Plan #125 Florida Health Care Plans

Gold

(POS) Gym Access IND Gold POS 4500

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-232-0578

Annual Out of Pocket Expenses:

Individual Family

$2,550 $5,100 Annual Deductible

$5,000 $10,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$457.01
$518.71
$584.06
$816.22
$1,240.33

$806.62
$868.32
$933.67
$1,165.83

$1,156.23
$1,217.93
$1,283.28
$1,515.44

$1,505.84
$1,567.54
$1,632.89
$1,865.05

$349.61

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$914.02
$1,037.42
$1,168.12
$1,632.44
$2,480.66

$1,263.63
$1,387.03
$1,517.73
$1,982.05

$1,613.24
$1,736.64
$1,867.34
$2,331.66

$1,962.85
$2,086.25
$2,216.95
$2,681.27

$349.61

Toc - Plan #126 Florida Health Care Plans

Platinum

(POS) Gym Access IND Essential Plus Platinum POS 65

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-232-0578

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$2,000 $4,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$592.12
$672.06
$756.73
$1,057.53
$1,607.01

$1,045.09
$1,125.03
$1,209.70
$1,510.50

$1,498.06
$1,578.00
$1,662.67
$1,963.47

$1,951.03
$2,030.97
$2,115.64
$2,416.44

$452.97

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,184.24
$1,344.12
$1,513.46
$2,115.06
$3,214.02

$1,637.21
$1,797.09
$1,966.43
$2,568.03

$2,090.18
$2,250.06
$2,419.40
$3,021.00

$2,543.15
$2,703.03
$2,872.37
$3,473.97

$452.97

Toc - Plan #127 Florida Health Care Plans

Silver

(POS) Gym Access IND Silver POS OA 1009

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-232-0578

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$7,900 $15,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$454.88
$516.29
$581.34
$812.42
$1,234.54

$802.86
$864.27
$929.32
$1,160.40

$1,150.84
$1,212.25
$1,277.30
$1,508.38

$1,498.82
$1,560.23
$1,625.28
$1,856.36

$347.98

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$909.76
$1,032.58
$1,162.68
$1,624.84
$2,469.08

$1,257.74
$1,380.56
$1,510.66
$1,972.82

$1,605.72
$1,728.54
$1,858.64
$2,320.80

$1,953.70
$2,076.52
$2,206.62
$2,668.78

$347.98

UnitedHealthcare

Local: 1-888-200-0405 | Toll Free: 1-888-200-0405 | TTY: 1-888-200-0405

Toc - Plan #128 UnitedHealthcare

Silver

(HMO) UHC Silver Virtual First (Unlimited $0 App-based Care, $3 Tier 2 Rx) (Disponible en espanol)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family

$3,900 $7,800 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$446.15
$506.38
$570.18
$796.83
$1,210.86

$787.46
$847.69
$911.49
$1,138.14

$1,128.77
$1,189.00
$1,252.80
$1,479.45

$1,470.08
$1,530.31
$1,594.11
$1,820.76

$341.31

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$892.30
$1,012.76
$1,140.36
$1,593.66
$2,421.72

$1,233.61
$1,354.07
$1,481.67
$1,934.97

$1,574.92
$1,695.38
$1,822.98
$2,276.28

$1,916.23
$2,036.69
$2,164.29
$2,617.59

$341.31

Toc - Plan #129 UnitedHealthcare

Expanded Bronze

(HMO) UHC Bronze Value ($0 Virtual Urgent Care + $0 PCP Visits, $3 Tier 2 Rx)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family

$8,250 $16,500 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$357.56
$405.83
$456.96
$638.60
$970.42

$631.09
$679.36
$730.49
$912.13

$904.62
$952.89
$1,004.02
$1,185.66

$1,178.15
$1,226.42
$1,277.55
$1,459.19

$273.53

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$715.12
$811.66
$913.92
$1,277.20
$1,940.84

$988.65
$1,085.19
$1,187.45
$1,550.73

$1,262.18
$1,358.72
$1,460.98
$1,824.26

$1,535.71
$1,632.25
$1,734.51
$2,097.79

$273.53

Toc - Plan #130 UnitedHealthcare

Expanded Bronze

(HMO) UHC Bronze Virtual First (Unlimited $0 App-based Care, $3 Tier 2 Rx) (Disponible en espanol)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family

$7,250 $14,500 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$358.11
$406.45
$457.66
$639.58
$971.91

$632.06
$680.40
$731.61
$913.53

$906.01
$954.35
$1,005.56
$1,187.48

$1,179.96
$1,228.30
$1,279.51
$1,461.43

$273.95

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$716.22
$812.90
$915.32
$1,279.16
$1,943.82

$990.17
$1,086.85
$1,189.27
$1,553.11

$1,264.12
$1,360.80
$1,463.22
$1,827.06

$1,538.07
$1,634.75
$1,737.17
$2,101.01

$273.95

Toc - Plan #131 UnitedHealthcare

Gold

(HMO) UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $3 Tier 2 Rx)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$7,750 $15,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$512.80
$582.02
$655.35
$915.85
$1,391.73

$905.09
$974.31
$1,047.64
$1,308.14

$1,297.38
$1,366.60
$1,439.93
$1,700.43

$1,689.67
$1,758.89
$1,832.22
$2,092.72

$392.29

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,025.60
$1,164.04
$1,310.70
$1,831.70
$2,783.46

$1,417.89
$1,556.33
$1,702.99
$2,223.99

$1,810.18
$1,948.62
$2,095.28
$2,616.28

$2,202.47
$2,340.91
$2,487.57
$3,008.57

$392.29

Toc - Plan #132 UnitedHealthcare

Gold

(HMO) UHC Gold Standard

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family

$1,500 $3,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$504.07
$572.12
$644.21
$900.27
$1,368.05

$889.69
$957.74
$1,029.83
$1,285.89

$1,275.31
$1,343.36
$1,415.45
$1,671.51

$1,660.93
$1,728.98
$1,801.07
$2,057.13

$385.62

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,008.14
$1,144.24
$1,288.42
$1,800.54
$2,736.10

$1,393.76
$1,529.86
$1,674.04
$2,186.16

$1,779.38
$1,915.48
$2,059.66
$2,571.78

$2,165.00
$2,301.10
$2,445.28
$2,957.40

$385.62

Toc - Plan #133 UnitedHealthcare

Silver

(HMO) UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$464.10
$526.75
$593.12
$828.88
$1,259.57

$819.14
$881.79
$948.16
$1,183.92

$1,174.18
$1,236.83
$1,303.20
$1,538.96

$1,529.22
$1,591.87
$1,658.24
$1,894.00

$355.04

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$928.20
$1,053.50
$1,186.24
$1,657.76
$2,519.14

$1,283.24
$1,408.54
$1,541.28
$2,012.80

$1,638.28
$1,763.58
$1,896.32
$2,367.84

$1,993.32
$2,118.62
$2,251.36
$2,722.88

$355.04

Toc - Plan #134 UnitedHealthcare

Silver

(HMO) UHC Silver Standard

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family

$5,900 $11,800 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$441.20
$500.76
$563.86
$787.99
$1,197.42

$778.72
$838.28
$901.38
$1,125.51

$1,116.24
$1,175.80
$1,238.90
$1,463.03

$1,453.76
$1,513.32
$1,576.42
$1,800.55

$337.52

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$882.40
$1,001.52
$1,127.72
$1,575.98
$2,394.84

$1,219.92
$1,339.04
$1,465.24
$1,913.50

$1,557.44
$1,676.56
$1,802.76
$2,251.02

$1,894.96
$2,014.08
$2,140.28
$2,588.54

$337.52

Toc - Plan #135 UnitedHealthcare

Bronze

(HMO) UHC Bronze Essential ($0 Virtual Urgent Care, $3 Tier 2 Rx)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family

$6,350 $12,700 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$352.32
$399.88
$450.26
$629.24
$956.19

$621.84
$669.40
$719.78
$898.76

$891.36
$938.92
$989.30
$1,168.28

$1,160.88
$1,208.44
$1,258.82
$1,437.80

$269.52

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$704.64
$799.76
$900.52
$1,258.48
$1,912.38

$974.16
$1,069.28
$1,170.04
$1,528.00

$1,243.68
$1,338.80
$1,439.56
$1,797.52

$1,513.20
$1,608.32
$1,709.08
$2,067.04

$269.52

Toc - Plan #136 UnitedHealthcare

Expanded Bronze

(HMO) UHC Bronze Standard

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$358.63
$407.05
$458.33
$640.52
$973.33

$632.99
$681.41
$732.69
$914.88

$907.35
$955.77
$1,007.05
$1,189.24

$1,181.71
$1,230.13
$1,281.41
$1,463.60

$274.36

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$717.26
$814.10
$916.66
$1,281.04
$1,946.66

$991.62
$1,088.46
$1,191.02
$1,555.40

$1,265.98
$1,362.82
$1,465.38
$1,829.76

$1,540.34
$1,637.18
$1,739.74
$2,104.12

$274.36

Toc - Plan #137 UnitedHealthcare

Expanded Bronze

(HMO) UHC Bronze Copay Focus $0 Indiv Med Ded

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$376.08
$426.85
$480.63
$671.68
$1,020.68

$663.78
$714.55
$768.33
$959.38

$951.48
$1,002.25
$1,056.03
$1,247.08

$1,239.18
$1,289.95
$1,343.73
$1,534.78

$287.70

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$752.16
$853.70
$961.26
$1,343.36
$2,041.36

$1,039.86
$1,141.40
$1,248.96
$1,631.06

$1,327.56
$1,429.10
$1,536.66
$1,918.76

$1,615.26
$1,716.80
$1,824.36
$2,206.46

$287.70

Toc - Plan #138 UnitedHealthcare

Silver

(HMO) UHC Silver Value ($0 Virtual Urgent Care, $3 Tier 2 Rx)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family

$3,500 $7,000 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$445.17
$505.27
$568.93
$795.07
$1,208.19

$785.73
$845.83
$909.49
$1,135.63

$1,126.29
$1,186.39
$1,250.05
$1,476.19

$1,466.85
$1,526.95
$1,590.61
$1,816.75

$340.56

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$890.34
$1,010.54
$1,137.86
$1,590.14
$2,416.38

$1,230.90
$1,351.10
$1,478.42
$1,930.70

$1,571.46
$1,691.66
$1,818.98
$2,271.26

$1,912.02
$2,032.22
$2,159.54
$2,611.82

$340.56

Toc - Plan #139 UnitedHealthcare

Silver

(HMO) UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, $0 Insulin)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family

$2,750 $5,500 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$450.20
$510.97
$575.35
$804.05
$1,221.83

$794.60
$855.37
$919.75
$1,148.45

$1,139.00
$1,199.77
$1,264.15
$1,492.85

$1,483.40
$1,544.17
$1,608.55
$1,837.25

$344.40

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$900.40
$1,021.94
$1,150.70
$1,608.10
$2,443.66

$1,244.80
$1,366.34
$1,495.10
$1,952.50

$1,589.20
$1,710.74
$1,839.50
$2,296.90

$1,933.60
$2,055.14
$2,183.90
$2,641.30

$344.40

Toc - Plan #140 UnitedHealthcare

Gold

(HMO) UHC Gold Value ($0 Virtual Urgent Care, $3 Tier 2 Rx)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family

$1,500 $3,000 Annual Deductible

$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$501.25
$568.92
$640.60
$895.24
$1,360.40

$884.71
$952.38
$1,024.06
$1,278.70

$1,268.17
$1,335.84
$1,407.52
$1,662.16

$1,651.63
$1,719.30
$1,790.98
$2,045.62

$383.46

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,002.50
$1,137.84
$1,281.20
$1,790.48
$2,720.80

$1,385.96
$1,521.30
$1,664.66
$2,173.94

$1,769.42
$1,904.76
$2,048.12
$2,557.40

$2,152.88
$2,288.22
$2,431.58
$2,940.86

$383.46

Toc - Plan #141 UnitedHealthcare

Gold

(HMO) UHC Gold Virtual First (Unlimited $0 App-based Care, $3 Tier 2 Rx) (Disponible en espanol)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family

$1,000 $2,000 Annual Deductible

$8,400 $16,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$502.61
$570.46
$642.33
$897.65
$1,364.07

$887.10
$954.95
$1,026.82
$1,282.14

$1,271.59
$1,339.44
$1,411.31
$1,666.63

$1,656.08
$1,723.93
$1,795.80
$2,051.12

$384.49

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,005.22
$1,140.92
$1,284.66
$1,795.30
$2,728.14

$1,389.71
$1,525.41
$1,669.15
$2,179.79

$1,774.20
$1,909.90
$2,053.64
$2,564.28

$2,158.69
$2,294.39
$2,438.13
$2,948.77

$384.49

Toc - Plan #142 UnitedHealthcare

Gold

(HMO) UHC Gold Advantage+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family

$500 $1,000 Annual Deductible

$7,750 $15,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$531.40
$603.14
$679.13
$949.08
$1,442.22

$937.92
$1,009.66
$1,085.65
$1,355.60

$1,344.44
$1,416.18
$1,492.17
$1,762.12

$1,750.96
$1,822.70
$1,898.69
$2,168.64

$406.52

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,062.80
$1,206.28
$1,358.26
$1,898.16
$2,884.44

$1,469.32
$1,612.80
$1,764.78
$2,304.68

$1,875.84
$2,019.32
$2,171.30
$2,711.20

$2,282.36
$2,425.84
$2,577.82
$3,117.72

$406.52

Toc - Plan #143 UnitedHealthcare

Silver

(HMO) UHC Silver Advantage+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, $0 Insulin)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0405

Annual Out of Pocket Expenses:

Individual Family

$2,750 $5,500 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$469.98
$533.43
$600.63
$839.38
$1,275.53

$829.51
$892.96
$960.16
$1,198.91

$1,189.04
$1,252.49
$1,319.69
$1,558.44

$1,548.57
$1,612.02
$1,679.22
$1,917.97

$359.53

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$939.96
$1,066.86
$1,201.26
$1,678.76
$2,551.06

$1,299.49
$1,426.39
$1,560.79
$2,038.29

$1,659.02
$1,785.92
$1,920.32
$2,397.82

$2,018.55
$2,145.45
$2,279.85
$2,757.35

$359.53

Ambetter from Sunshine Health

Local: 1-877-687-1169 | Toll Free: 1-877-687-1169 | TTY: 1-800-955-8770

Toc - Plan #144 Ambetter from Sunshine Health

Expanded Bronze

(HMO) Ambetter Virtual Access Bronze (Virtual PCP selection required)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$7,000 $14,000 Annual Deductible

$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$326.93
$371.06
$417.80
$583.88
$887.26

$577.02
$621.15
$667.89
$833.97

$827.11
$871.24
$917.98
$1,084.06

$1,077.20
$1,121.33
$1,168.07
$1,334.15

$250.09

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$653.86
$742.12
$835.60
$1,167.76
$1,774.52

$903.95
$992.21
$1,085.69
$1,417.85

$1,154.04
$1,242.30
$1,335.78
$1,667.94

$1,404.13
$1,492.39
$1,585.87
$1,918.03

$250.09

Toc - Plan #145 Ambetter from Sunshine Health

Silver

(HMO) Ambetter Virtual Access Silver (Virtual PCP selection required)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$5,700 $11,400 Annual Deductible

$7,400 $14,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$408.96
$464.15
$522.63
$730.38
$1,109.88

$721.80
$776.99
$835.47
$1,043.22

$1,034.64
$1,089.83
$1,148.31
$1,356.06

$1,347.48
$1,402.67
$1,461.15
$1,668.90

$312.84

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$817.92
$928.30
$1,045.26
$1,460.76
$2,219.76

$1,130.76
$1,241.14
$1,358.10
$1,773.60

$1,443.60
$1,553.98
$1,670.94
$2,086.44

$1,756.44
$1,866.82
$1,983.78
$2,399.28

$312.84

Toc - Plan #146 Ambetter from Sunshine Health

Gold

(HMO) Ambetter Virtual Access Gold (Virtual PCP selection required)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$950 $1,900 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$390.60
$443.32
$499.18
$697.60
$1,060.07

$689.40
$742.12
$797.98
$996.40

$988.20
$1,040.92
$1,096.78
$1,295.20

$1,287.00
$1,339.72
$1,395.58
$1,594.00

$298.80

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$781.20
$886.64
$998.36
$1,395.20
$2,120.14

$1,080.00
$1,185.44
$1,297.16
$1,694.00

$1,378.80
$1,484.24
$1,595.96
$1,992.80

$1,677.60
$1,783.04
$1,894.76
$2,291.60

$298.80

Toc - Plan #147 Ambetter from Sunshine Health

Expanded Bronze

(HMO) Standard Ambetter Virtual Access Expanded Bronze (Virtual PCP selection required)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$322.67
$366.22
$412.36
$576.27
$875.69

$569.50
$613.05
$659.19
$823.10

$816.33
$859.88
$906.02
$1,069.93

$1,063.16
$1,106.71
$1,152.85
$1,316.76

$246.83

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$645.34
$732.44
$824.72
$1,152.54
$1,751.38

$892.17
$979.27
$1,071.55
$1,399.37

$1,139.00
$1,226.10
$1,318.38
$1,646.20

$1,385.83
$1,472.93
$1,565.21
$1,893.03

$246.83

Toc - Plan #148 Ambetter from Sunshine Health

Silver

(HMO) Standard Ambetter Virtual Access Silver (Virtual PCP selection required)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$5,900 $11,800 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$408.67
$463.83
$522.27
$729.87
$1,109.11

$721.30
$776.46
$834.90
$1,042.50

$1,033.93
$1,089.09
$1,147.53
$1,355.13

$1,346.56
$1,401.72
$1,460.16
$1,667.76

$312.63

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$817.34
$927.66
$1,044.54
$1,459.74
$2,218.22

$1,129.97
$1,240.29
$1,357.17
$1,772.37

$1,442.60
$1,552.92
$1,669.80
$2,085.00

$1,755.23
$1,865.55
$1,982.43
$2,397.63

$312.63

Toc - Plan #149 Ambetter from Sunshine Health

Gold

(HMO) Standard Ambetter Virtual Access Gold (Virtual PCP selection required)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$1,500 $3,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$383.70
$435.49
$490.35
$685.27
$1,041.33

$677.22
$729.01
$783.87
$978.79

$970.74
$1,022.53
$1,077.39
$1,272.31

$1,264.26
$1,316.05
$1,370.91
$1,565.83

$293.52

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$767.40
$870.98
$980.70
$1,370.54
$2,082.66

$1,060.92
$1,164.50
$1,274.22
$1,664.06

$1,354.44
$1,458.02
$1,567.74
$1,957.58

$1,647.96
$1,751.54
$1,861.26
$2,251.10

$293.52

‡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 Volusia County here.

Volusia County is in “Rating Area 64” of Florida.

Currently, there are 149 plans offered in Rating Area 64.

Top

2024 Obamacare Plans for Volusia County, FL

Plan Browser: 149 Plans

Florida Blue (BlueCross BlueShield FL)

Local: 1-800-352-2583 | Toll Free: 1-800-352-2583 | TTY: 1-800-955-8771

1. Silver BlueOptions Silver 24J01-03 ($0 Virtual Visits / $0 Labs / Rewards $$$)

2. Expanded Bronze BlueOptions Bronze 24J01-04 ($0 Virtual Visits / 3 PCP Visits for $0 then $40 / Rewards $$$)

3. Platinum BlueOptions Platinum 24J01-05 ($0 Virtual Visits / Rewards $$$)

4. Bronze BlueOptions Bronze 24J01-06 ($0 Virtual Visits / Rewards $$$)

5. Silver BlueOptions Silver 24J01-07 ($0 Virtual Visits / Rewards $$$)

6. Platinum BlueOptions Platinum 24J01-08 ($0 Virtual Visits / Rewards $$$)

7. Gold BlueOptions Gold 24J01-09 ($0 Virtual Visits / $20 PCP Visits / $15 Generic Meds / Rewards $$$)

8. Expanded Bronze BlueOptions Bronze (HSA) 24J01-10 (Rewards $$$ / $4 Condition Care Rx)

9. Gold BlueOptions Gold 24J01-12 ($0 Virtual Visits / $20 Labs / Rewards $$$)

10. Expanded Bronze BlueOptions Bronze 24J01-17 ($0 Virtual Visits / $50 PCP Visits / Rewards $$$)

11. Expanded Bronze BlueOptions Bronze 24J01-18S (Multilingual Available / Rewards $$$)

12. Silver BlueOptions Silver 24J01-19S ($40 PCP Visits / Multilingual Available / Rewards $$$)

13. Gold BlueOptions Gold 24J01-20S ($30 PCP Visits / Multilingual Available / Rewards $$$)

14. Platinum BlueOptions Platinum 24J01-21S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Multilingual Available / Rewards $$$)

Aetna CVS Health

Local: 1-877-336-3915 | Toll Free: 1-877-336-3915

15. Silver Silver S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

16. Expanded Bronze Bronze S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

17. Silver Silver 5: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

18. Gold Gold S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

19. Silver Silver 6: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

20. Expanded Bronze Bronze 4: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

21. Gold Gold 3: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

22. Gold Gold 4: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

23. Silver Silver 7: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Ambetter from Sunshine Health

Local: 1-877-687-1169 | Toll Free: 1-877-687-1169 | TTY: 1-800-955-8770

24. Gold Complete Gold

25. Expanded Bronze Choice Bronze HSA

26. Silver Everyday Silver

27. Expanded Bronze Everyday Bronze

28. Expanded Bronze Elite Bronze

29. Silver Clear Silver

30. Silver Focused Silver

31. Gold Everyday Gold

32. Gold Elite Gold

33. Expanded Bronze Standard Expanded Bronze

34. Silver Standard Silver

35. Gold Standard Gold

36. Silver Everyday Silver + Vision + Adult Dental

37. Expanded Bronze Choice Bronze HSA + Vision + Adult Dental

38. Gold Complete Gold + Vision + Adult Dental

39. Silver Clear Silver + Vision + Adult Dental

40. Gold Elite Gold + Vision + Adult Dental

41. Expanded Bronze Standard Expanded Bronze + Vision + Adult Dental

42. Silver Standard Silver + Vision + Adult Dental

43. Gold Standard Gold + Vision + Adult Dental

44. Expanded Bronze Everyday Bronze + Vision + Adult Dental

45. Expanded Bronze Elite Bronze + Vision + Adult Dental

46. Silver Focused Silver + Vision + Adult Dental

47. Gold Everyday Gold + Vision + Adult Dental

Florida Blue HMO (a BlueCross BlueShield FL company)

Local: 1-800-352-2583 | Toll Free: 1-800-352-2583 | TTY: 1-800-955-8771

48. Silver BlueCare Silver 24K01-02 ($0 Virtual Visits / Rewards $$$)

49. Expanded Bronze BlueCare Bronze 24K01-03 ($0 Virtual Visits / 3 PCP Visits for $0 then $40 / Rewards $$$)

50. Platinum BlueCare Platinum 24K01-04 ($0 Virtual Visits / Rewards $$$)

51. Bronze BlueCare Bronze 24K01-05 ($0 Virtual Visits / Rewards $$$)

52. Silver BlueCare Silver 24K01-06 ($0 Virtual Visits / Rewards $$$)

53. Platinum BlueCare Platinum 24K01-07 ($0 Virtual Visits / Rewards $$$)

54. Gold BlueCare Gold 24K01-08 ($0 Virtual Visits / $20 PCP Visit / $15 Generic Meds / Rewards $$$)

55. Expanded Bronze BlueCare Bronze (HSA) 24K01-09 (Rewards $$$ / $4 Condition Care Rx)

56. Gold BlueCare Gold 24K01-10 ($0 Virtual Visits / $20 Labs / Rewards $$$)

57. Expanded Bronze BlueCare Bronze 24K01-25 ($0 Virtual Visits / $50 PCP Visit / $30 Generic Meds / Rewards $$$)

58. Expanded Bronze BlueCare Bronze 24K01-31S (Multilingual Available / Rewards $$$)

59. Silver BlueCare Silver 24K01-32S ($40 PCP Visits / Multilingual Available / Rewards $$$)

60. Gold BlueCare Gold 24K01-33S ($30 PCP Visit / Multilingual Available/ Rewards $$$)

61. Platinum BlueCare Platinum 24K01-34S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Multilingual Available / Rewards $$$)

Health First Commercial Plans, Inc.

Local: 1-855-443-4735 | Toll Free: 1-855-443-4735 | TTY: 1-800-955-8771

62. Silver Silver Gym Access 1664 (Primary Care & Specialist Copays, Open Access, Fitness Center Included)

63. Silver Silver Gym Access 1688 (Open Access, Fitness Center Included)

64. Gold Gold Gym Access 1736 (Primary Care & Urgent Care Copay, 0% Coinsurance, Open Access)

65. Gold Gold Gym Access 1742 (Emergency Room & Inpatient Hospitalization Copay, $0 Outpatient Labs, $0 MRI, Open Access)

66. Catastrophic Catastrophic Gym Access 1746 (Primary Care Copay Visits 1-3, Open Access)

67. Expanded Bronze Bronze 1750 (Unlimited Primary Care, Specialist & Urgent Care Copay Visits, Open Access)

68. Gold Gold 1770 (Low Primary Care, Specialist & Urgent Care Copay, Open Access)

69. Expanded Bronze Bronze HSA 1794 (HSA Qualified, Open Access)

70. Silver Silver 1806 ($2,100 Deductible, Open Access)

71. Expanded Bronze Bronze 1826 ($0 Medical Deductible, $0 Primary Care Copay- Visits 1 & 2, Specialist & Urgent Care Copay, Open Access)

72. Expanded Bronze Bronze Standard 1828

73. Silver Silver Standard 1829

74. Gold Gold Standard 1833

75. Expanded Bronze Bronze Savings 1820 (Primary Care Copay Visits 1-5, Open Access)

76. Silver Silver Savings 1821 (Primary Care Copay, Open Access)

77. Gold Gold Savings 1825 ($25 Primary Care Copay, $50 Specialist Copay, Open Access)

Oscar Insurance Company of Florida

Local: 1-855-672-2755 | Toll Free: 1-855-672-2755

78. Expanded Bronze Bronze Elite + PCP Saver Plus

79. Silver Silver Classic

80. Catastrophic Secure

81. Expanded Bronze Bronze Elite + Specialist Saver Plus

82. Gold Gold Classic

83. Silver Silver Simple

84. Silver Silver Elite

85. Expanded Bronze Bronze Classic 4700

86. Silver Silver Simple PCP Saver

87. Gold Gold Elite Saver Plus

88. Gold Gold Elite

89. Expanded Bronze Bronze Elite Saver Plus

90. Expanded Bronze Bronze Classic Standard

91. Silver Silver Classic Standard

92. Gold Gold Classic Standard

Florida Health Care Plans

Local: 1-386-676-7110 | Toll Free: 1-800-232-0578 | TTY: 1-800-955-8771

93. Catastrophic Gym Access IND Essential Plus Catastrophic HMO 36

94. Catastrophic Gym Access IND Essential Plus Catastrophic POS 37

95. Silver Gym Access IND Essential Plus Silver HMO 53

96. Silver Gym Access IND Essential Plus Silver POS 54

97. Platinum Gym Access IND Platinum POS 4000

98. Gold Gym Access IND Gold HMO 55001

99. Gold Gym Access IND Gold POS 55001

100. Gold Gym Access IND Gold HMO 4500

101. Expanded Bronze Gym Access IND Bronze HMO HSA 5065

102. Expanded Bronze Gym Access IND Bronze POS BC 3841

103. Silver Gym Access IND Silver HMO BC 0941

104. Silver Gym Access IND Silver POS BC 0941

105. Silver Gym Access IND Silver HMO BC 7741

106. Silver Gym Access IND Silver POS BC 7741

107. Gold Gym Access IND Gold HMO BC 5651

108. Gold Gym Access IND Gold POS BC 5651

109. Platinum Gym Access IND Platinum POS BC 5841

110. Platinum Gym Access IND Platinum POS BC 1941

111. Expanded Bronze Gym Access IND Bronze Standardized HMO

112. Expanded Bronze Gym Access IND Bronze HMO 1340

113. Expanded Bronze Gym Access IND Bronze POS 1042

114. Gold Gym Access IND Gold HMO H.S.A 9010

115. Expanded Bronze Gym Access IND Bronze HMO OA 1211

116. Silver Gym Access IND Silver HMO OA 1009

117. Expanded Bronze Gym Access IND Bronze HMO OA Standard 2450

118. Silver Gym Access IND Silver HMO OA Standard 1440

119. Gold Gym Access IND Gold HMO OA Standard 3450

120. Expanded Bronze Gym Access IND Bronze POS OA Standard 2450

121. Silver Gym Access IND Silver POS OA Standard 1440

122. Gold Gym Access IND Gold POS OA Standard 3450

123. Platinum Gym Access IND Platinum POS OA Standard 4450

124. Expanded Bronze Gym Access IND Bronze POS OA 1211

125. Gold Gym Access IND Gold POS 4500

126. Platinum Gym Access IND Essential Plus Platinum POS 65

127. Silver Gym Access IND Silver POS OA 1009

UnitedHealthcare

Local: 1-888-200-0405 | Toll Free: 1-888-200-0405 | TTY: 1-888-200-0405

128. Silver UHC Silver Virtual First (Unlimited $0 App-based Care, $3 Tier 2 Rx) (Disponible en espanol)

129. Expanded Bronze UHC Bronze Value ($0 Virtual Urgent Care + $0 PCP Visits, $3 Tier 2 Rx)

130. Expanded Bronze UHC Bronze Virtual First (Unlimited $0 App-based Care, $3 Tier 2 Rx) (Disponible en espanol)

131. Gold UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $3 Tier 2 Rx)

132. Gold UHC Gold Standard

133. Silver UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx)

134. Silver UHC Silver Standard

135. Bronze UHC Bronze Essential ($0 Virtual Urgent Care, $3 Tier 2 Rx)

136. Expanded Bronze UHC Bronze Standard

137. Expanded Bronze UHC Bronze Copay Focus $0 Indiv Med Ded

138. Silver UHC Silver Value ($0 Virtual Urgent Care, $3 Tier 2 Rx)

139. Silver UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, $0 Insulin)

140. Gold UHC Gold Value ($0 Virtual Urgent Care, $3 Tier 2 Rx)

141. Gold UHC Gold Virtual First (Unlimited $0 App-based Care, $3 Tier 2 Rx) (Disponible en espanol)

142. Gold UHC Gold Advantage+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision)

143. Silver UHC Silver Advantage+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, $0 Insulin)

Ambetter from Sunshine Health

Local: 1-877-687-1169 | Toll Free: 1-877-687-1169 | TTY: 1-800-955-8770

144. Expanded Bronze Ambetter Virtual Access Bronze (Virtual PCP selection required)

145. Silver Ambetter Virtual Access Silver (Virtual PCP selection required)

146. Gold Ambetter Virtual Access Gold (Virtual PCP selection required)

147. Expanded Bronze Standard Ambetter Virtual Access Expanded Bronze (Virtual PCP selection required)

148. Silver Standard Ambetter Virtual Access Silver (Virtual PCP selection required)

149. Gold Standard Ambetter Virtual Access Gold (Virtual PCP selection required)

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

Obamacare Providers, 149 Plans and 2024 Rates for Volusia County, Florida

Obamacare Rates and Providers for Other Years

How To Sign Up for Obamacare in Florida for 2024

Where's the Florida Health Care Exchange?

Florida Medicaid Expansion: Do I Qualify for Medicaid Under the ACA?

Florida Has Not Expanded Medicaid

The Medicaid Coverage Gap

Get Help Finding a Health Insurance Plan in Florida

Get Help From Florida's Health Insurance Exchange

Get Help From a Licensed Insurance Broker

More Information

Florida Blue (BlueCross BlueShield FL)

(PPO) BlueOptions Silver 24J01-03 ($0 Virtual Visits / $0 Labs / Rewards $$$)

Annual Out of Pocket Expenses:

Individual Family $6,000 $12,000 Annual Deductible $8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

(PPO) BlueOptions Bronze 24J01-04 ($0 Virtual Visits / 3 PCP Visits for $0 then $40 / Rewards $$$)

Annual Out of Pocket Expenses:

Individual Family $6,500 $13,000 Annual Deductible $9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

(PPO) BlueOptions Platinum 24J01-05 ($0 Virtual Visits / Rewards $$$)

Annual Out of Pocket Expenses:

Individual Family $1,000 $2,000 Annual Deductible $4,000 $8,000 Maximum Out of Pocket Per Year

Monthly Premiums:

(PPO) BlueOptions Bronze 24J01-06 ($0 Virtual Visits / Rewards $$$)

Annual Out of Pocket Expenses:

Individual Family $6,150 $12,300 Annual Deductible $9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

(PPO) BlueOptions Silver 24J01-07 ($0 Virtual Visits / Rewards $$$)

Annual Out of Pocket Expenses:

Individual Family $2,800 $5,600 Annual Deductible $7,150 $14,300 Maximum Out of Pocket Per Year

Monthly Premiums:

(PPO) BlueOptions Platinum 24J01-08 ($0 Virtual Visits / Rewards $$$)

Annual Out of Pocket Expenses:

Individual Family $0 $0 Annual Deductible $2,000 $4,000 Maximum Out of Pocket Per Year

Monthly Premiums:

(PPO) BlueOptions Gold 24J01-09 ($0 Virtual Visits / $20 PCP Visits / $15 Generic Meds / Rewards $$$)

Annual Out of Pocket Expenses:

Individual Family $0 $0 Annual Deductible $6,250 $12,500 Maximum Out of Pocket Per Year

Monthly Premiums:

(PPO) BlueOptions Bronze (HSA) 24J01-10 (Rewards $$$ / $4 Condition Care Rx)

Annual Out of Pocket Expenses:

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

Monthly Premiums:

(PPO) BlueOptions Gold 24J01-12 ($0 Virtual Visits / $20 Labs / Rewards $$$)

Annual Out of Pocket Expenses:

Individual Family $1,500 $3,000 Annual Deductible $5,900 $11,800 Maximum Out of Pocket Per Year

Monthly Premiums:

(PPO) BlueOptions Bronze 24J01-17 ($0 Virtual Visits / $50 PCP Visits / Rewards $$$)

Annual Out of Pocket Expenses:

Individual Family $0 $0 Annual Deductible $9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

(PPO) BlueOptions Bronze 24J01-18S (Multilingual Available / Rewards $$$)

Annual Out of Pocket Expenses:

Individual Family $7,500 $15,000 Annual Deductible $9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

(PPO) BlueOptions Silver 24J01-19S ($40 PCP Visits / Multilingual Available / Rewards $$$)

Annual Out of Pocket Expenses:

Individual Family $5,900 $11,800 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

(PPO) BlueOptions Gold 24J01-20S ($30 PCP Visits / Multilingual Available / Rewards $$$)

Annual Out of Pocket Expenses:

Individual Family $1,500 $3,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

(PPO) BlueOptions Platinum 24J01-21S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Multilingual Available / Rewards $$$)

Annual Out of Pocket Expenses:

Individual Family $0 $0 Annual Deductible $3,200 $6,400 Maximum Out of Pocket Per Year

Monthly Premiums:

Aetna CVS Health

(HMO) Silver S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Annual Out of Pocket Expenses:

Individual Family $5,900 $11,800 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

(HMO) Bronze S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Annual Out of Pocket Expenses:

Individual Family $7,500 $15,000 Annual Deductible $9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

(HMO) Silver 5: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Annual Out of Pocket Expenses:

Individual Family

$6,000 $12,000 Annual Deductible

$8,000 $16,000 Maximum Out of Pocket Per Year

Individual Family

$6,500 $13,000 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Individual Family

$1,000 $2,000 Annual Deductible

$4,000 $8,000 Maximum Out of Pocket Per Year

Individual Family

$6,150 $12,300 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Individual Family

$2,800 $5,600 Annual Deductible

$7,150 $14,300 Maximum Out of Pocket Per Year

Individual Family

$0 $0 Annual Deductible

$2,000 $4,000 Maximum Out of Pocket Per Year

Individual Family

$0 $0 Annual Deductible

$6,250 $12,500 Maximum Out of Pocket Per Year

Individual Family

$7,050 $14,100 Annual Deductible

$7,050 $14,100 Maximum Out of Pocket Per Year

Individual Family

$1,500 $3,000 Annual Deductible

$5,900 $11,800 Maximum Out of Pocket Per Year

Individual Family

$0 $0 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Individual Family

$7,500 $15,000 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Individual Family

$5,900 $11,800 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Individual Family

$1,500 $3,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Individual Family

$0 $0 Annual Deductible

$3,200 $6,400 Maximum Out of Pocket Per Year

Individual Family

$5,900 $11,800 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Individual Family

$7,500 $15,000 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Individual Family

$8,395 $16,790 Annual Deductible

$8,885 $17,770 Maximum Out of Pocket Per Year

Individual Family

$1,500 $3,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Individual Family

$7,795 $15,590 Annual Deductible

$8,445 $16,890 Maximum Out of Pocket Per Year

Individual Family

$0 $0 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Individual Family

$795 $1,590 Annual Deductible

$9,195 $18,390 Maximum Out of Pocket Per Year

Individual Family

$3,500 $7,000 Annual Deductible

$9,000 $18,000 Maximum Out of Pocket Per Year

Individual Family

$7,795 $15,590 Annual Deductible

$8,845 $17,690 Maximum Out of Pocket Per Year

Individual Family

$1,450 $2,900 Annual Deductible

$7,500 $15,000 Maximum Out of Pocket Per Year

Individual Family

$7,250 $14,500 Annual Deductible

$7,250 $14,500 Maximum Out of Pocket Per Year

Individual Family

$6,500 $13,000 Annual Deductible

$8,400 $16,800 Maximum Out of Pocket Per Year

Individual Family

$8,450 $16,900 Annual Deductible

$9,250 $18,500 Maximum Out of Pocket Per Year

Individual Family

$0 $0 Annual Deductible

$9,250 $18,500 Maximum Out of Pocket Per Year

Individual Family

$5,400 $10,800 Annual Deductible

$5,400 $10,800 Maximum Out of Pocket Per Year

Individual Family

$6,300 $12,600 Annual Deductible

$8,000 $16,000 Maximum Out of Pocket Per Year

Individual Family

$750 $1,500 Annual Deductible

$7,500 $15,000 Maximum Out of Pocket Per Year

Individual Family

$0 $0 Annual Deductible

$5,500 $11,000 Maximum Out of Pocket Per Year