Home Page ObamacarebyZipCode Seminole County, FL
Basics Rates How to Enroll Financial Help Life Situations Using Your Plan
×

ADVERTISEMENT

Obamacare 2021 Rates and Health Insurance Providers for Seminole County , Florida

Obamacare > Rates > Florida > Seminole County

Obamacare Rates and Providers for Other Years

2014 | 2015 | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 |

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 Seminole County, FL.

The health insurance rates listed below are for calendar year 2021.

Obamacare Providers, Plans and 2021 Rates for Seminole County, Florida

Below, you’ll find a summary of the 180 plans for Seminole County, Florida and rates for each of these providers.‡ This chart is designed to give you a preview of your health insurance options.

  • Bright Health

    Local: 1-855-521-9335 | Toll Free: 1-855-521-9335

  • Florida Blue (BlueCross BlueShield FL)

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

  • AvMed

    Local: 1-800-477-8768 | Toll Free: 

  • Ambetter from Sunshine Health

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

  • Florida Blue HMO (a BlueCross BlueShield FL company)

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

  • Health First Commercial Plans, Inc.

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

  • Oscar Insurance Company of Florida

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

  • Cigna Healthcare

    Local: 1-877-900-1237 | Toll Free: 1-877-900-1237 | TTY: 1-800-676-3777

  • Molina Healthcare

    Local: 1-888-560-5716 | Toll Free: 1-888-560-5716 | TTY: 1-800-955-8771

  • Florida Health Care Plans

    Local: 1-386-676-7110 | Toll Free: 1-800-232-0578 | TTY: 1-800-955-8771

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

    The table below shows premiums for the following profiles at various ages:

    • Individuals
    • Couples
    • Couples with 1, 2, or 3 children
    • Individuals with 1, 2, or 3 children
    • A child alone

    Each plan links to the insurance provider's website. You can find the following:

    • Summary of plan benefits and costs
    • Plan brochure
    • Provider Directory where you can find out which doctors and hospitals in the Oviedo, FL area accept this insurance coverage as within the plan's network.

    2021 Obamacare Rates, Providers, and Plans for Seminole County

    ADVERTISEMENT

    Bright Health

    Local: 1-855-521-9335 | Toll Free: 1-855-521-9335

    Toc - Plan #1

    Gold

    (EPO) Gold 1000

    Annual Out of Pocket Expenses
    Individual Family
    $1,000 $2,000 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$449,30
    $509,96
    $574,21
    $802,46
    $1 219,41     		$898,60
    $1 019,92
    $1 148,42
    $1 604,92
    $2 438,82     		$1 242,32
    $1 363,64
    $1 492,14
    $1 948,64     		$1 586,04
    $1 707,36
    $1 835,86
    $2 292,36     		$1 929,76
    $2 051,08
    $2 179,58
    $2 636,08     		$793,02
    $853,68
    $917,93
    $1 146,18     		$1 136,74
    $1 197,40
    $1 261,65
    $1 489,90     		$1 480,46
    $1 541,12
    $1 605,37
    $1 833,62     		$343,72
    Toc - Plan #2

    Silver

    (EPO) Silver 5000

    Annual Out of Pocket Expenses
    Individual Family
    $5,000 $10,000 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$381,25
    $432,71
    $487,23
    $680,90
    $1 034,70     		$762,50
    $865,42
    $974,46
    $1 361,80
    $2 069,40     		$1 054,15
    $1 157,07
    $1 266,11
    $1 653,45     		$1 345,80
    $1 448,72
    $1 557,76
    $1 945,10     		$1 637,45
    $1 740,37
    $1 849,41
    $2 236,75     		$672,90
    $724,36
    $778,88
    $972,55     		$964,55
    $1 016,01
    $1 070,53
    $1 264,20     		$1 256,20
    $1 307,66
    $1 362,18
    $1 555,85     		$291,65
    Toc - Plan #3

    Silver

    (EPO) Silver 3000

    Annual Out of Pocket Expenses
    Individual Family
    $3,000 $6,000 Annual Deductible
    $7,500 $15,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$395,39
    $448,76
    $505,30
    $706,16
    $1 073,08     		$790,78
    $897,52
    $1 010,60
    $1 412,32
    $2 146,16     		$1 093,25
    $1 199,99
    $1 313,07
    $1 714,79     		$1 395,72
    $1 502,46
    $1 615,54
    $2 017,26     		$1 698,19
    $1 804,93
    $1 918,01
    $2 319,73     		$697,86
    $751,23
    $807,77
    $1 008,63     		$1 000,33
    $1 053,70
    $1 110,24
    $1 311,10     		$1 302,80
    $1 356,17
    $1 412,71
    $1 613,57     		$302,47
    Toc - Plan #4

    Silver

    (EPO) Silver $0 Deductible

    Annual Out of Pocket Expenses
    Individual Family
    $0 $0 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$413,71
    $469,57
    $528,73
    $738,89
    $1 122,82     		$827,42
    $939,14
    $1 057,46
    $1 477,78
    $2 245,64     		$1 143,91
    $1 255,63
    $1 373,95
    $1 794,27     		$1 460,40
    $1 572,12
    $1 690,44
    $2 110,76     		$1 776,89
    $1 888,61
    $2 006,93
    $2 427,25     		$730,20
    $786,06
    $845,22
    $1 055,38     		$1 046,69
    $1 102,55
    $1 161,71
    $1 371,87     		$1 363,18
    $1 419,04
    $1 478,20
    $1 688,36     		$316,49
    Toc - Plan #5

    Expanded Bronze

    (EPO) Bronze 8550

    Annual Out of Pocket Expenses
    Individual Family
    $8,550 $17,100 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$286,49
    $325,17
    $366,14
    $511,68
    $777,54     		$572,98
    $650,34
    $732,28
    $1 023,36
    $1 555,08     		$792,15
    $869,51
    $951,45
    $1 242,53     		$1 011,32
    $1 088,68
    $1 170,62
    $1 461,70     		$1 230,49
    $1 307,85
    $1 389,79
    $1 680,87     		$505,66
    $544,34
    $585,31
    $730,85     		$724,83
    $763,51
    $804,48
    $950,02     		$944,00
    $982,68
    $1 023,65
    $1 169,19     		$219,17
    Toc - Plan #6

    Expanded Bronze

    (EPO) Bronze 5900

    Annual Out of Pocket Expenses
    Individual Family
    $5,900 $11,800 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$298,28
    $338,54
    $381,20
    $532,72
    $809,52     		$596,56
    $677,08
    $762,40
    $1 065,44
    $1 619,04     		$824,74
    $905,26
    $990,58
    $1 293,62     		$1 052,92
    $1 133,44
    $1 218,76
    $1 521,80     		$1 281,10
    $1 361,62
    $1 446,94
    $1 749,98     		$526,46
    $566,72
    $609,38
    $760,90     		$754,64
    $794,90
    $837,56
    $989,08     		$982,82
    $1 023,08
    $1 065,74
    $1 217,26     		$228,18
    Toc - Plan #7

    Expanded Bronze

    (EPO) Bronze 7000 HSA

    Annual Out of Pocket Expenses
    Individual Family
    $7,000 $14,000 Annual Deductible
    $7,000 $14,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$339,86
    $385,74
    $434,34
    $606,99
    $922,38     		$679,72
    $771,48
    $868,68
    $1 213,98
    $1 844,76     		$939,71
    $1 031,47
    $1 128,67
    $1 473,97     		$1 199,70
    $1 291,46
    $1 388,66
    $1 733,96     		$1 459,69
    $1 551,45
    $1 648,65
    $1 993,95     		$599,85
    $645,73
    $694,33
    $866,98     		$859,84
    $905,72
    $954,32
    $1 126,97     		$1 119,83
    $1 165,71
    $1 214,31
    $1 386,96     		$259,99
    Toc - Plan #8

    Catastrophic

    (EPO) Catastrophic 3 $0 PCP Visits

    Annual Out of Pocket Expenses
    Individual Family
    $8,550 $17,100 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$234,72
    $266,41
    $299,97
    $419,21
    $637,03     		$469,44
    $532,82
    $599,94
    $838,42
    $1 274,06     		$649,00
    $712,38
    $779,50
    $1 017,98     		$828,56
    $891,94
    $959,06
    $1 197,54     		$1 008,12
    $1 071,50
    $1 138,62
    $1 377,10     		$414,28
    $445,97
    $479,53
    $598,77     		$593,84
    $625,53
    $659,09
    $778,33     		$773,40
    $805,09
    $838,65
    $957,89     		$179,56
    Toc - Plan #9

    Silver

    (EPO) Silver $0 Primary Care

    Annual Out of Pocket Expenses
    Individual Family
    $6,700 $13,400 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$395,33
    $448,70
    $505,23
    $706,06
    $1 072,93     		$790,66
    $897,40
    $1 010,46
    $1 412,12
    $2 145,86     		$1 093,09
    $1 199,83
    $1 312,89
    $1 714,55     		$1 395,52
    $1 502,26
    $1 615,32
    $2 016,98     		$1 697,95
    $1 804,69
    $1 917,75
    $2 319,41     		$697,76
    $751,13
    $807,66
    $1 008,49     		$1 000,19
    $1 053,56
    $1 110,09
    $1 310,92     		$1 302,62
    $1 355,99
    $1 412,52
    $1 613,35     		$302,43
    Toc - Plan #10

    Expanded Bronze

    (EPO) Bronze $0 Primary Care

    Annual Out of Pocket Expenses
    Individual Family
    $7,200 $14,400 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$298,13
    $338,38
    $381,01
    $532,46
    $809,13     		$596,26
    $676,76
    $762,02
    $1 064,92
    $1 618,26     		$824,33
    $904,83
    $990,09
    $1 292,99     		$1 052,40
    $1 132,90
    $1 218,16
    $1 521,06     		$1 280,47
    $1 360,97
    $1 446,23
    $1 749,13     		$526,20
    $566,45
    $609,08
    $760,53     		$754,27
    $794,52
    $837,15
    $988,60     		$982,34
    $1 022,59
    $1 065,22
    $1 216,67     		$228,07
    Toc - Plan #11

    Expanded Bronze

    (EPO) Bronze $0 Medical Deductible Direct

    Annual Out of Pocket Expenses
    Individual Family
    $0 $0 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$326,81
    $370,93
    $417,67
    $583,69
    $886,97     		$653,62
    $741,86
    $835,34
    $1 167,38
    $1 773,94     		$903,63
    $991,87
    $1 085,35
    $1 417,39     		$1 153,64
    $1 241,88
    $1 335,36
    $1 667,40     		$1 403,65
    $1 491,89
    $1 585,37
    $1 917,41     		$576,82
    $620,94
    $667,68
    $833,70     		$826,83
    $870,95
    $917,69
    $1 083,71     		$1 076,84
    $1 120,96
    $1 167,70
    $1 333,72     		$250,01
    ADVERTISEMENT

    Florida Blue (BlueCross BlueShield FL)

    Local: 1-800-352-2583 | Toll Free: 1-800-352-2583 | TTY: 1-800-955-8771
    Toc - Plan #12

    Silver

    (EPO) BlueOptions Silver 1423 ($0 Virtual Visits / $100+ in Rewards)

    Annual Out of Pocket Expenses
    Individual Family
    $5,950 $11,900 Annual Deductible
    $7,150 $14,300 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$733,79
    $832,85
    $937,78
    $1 310,55
    $1 991,51     		$1 467,58
    $1 665,70
    $1 875,56
    $2 621,10
    $3 983,02     		$2 028,93
    $2 227,05
    $2 436,91
    $3 182,45     		$2 590,28
    $2 788,40
    $2 998,26
    $3 743,80     		$3 151,63
    $3 349,75
    $3 559,61
    $4 305,15     		$1 295,14
    $1 394,20
    $1 499,13
    $1 871,90     		$1 856,49
    $1 955,55
    $2 060,48
    $2 433,25     		$2 417,84
    $2 516,90
    $2 621,83
    $2 994,60     		$561,35
    Toc - Plan #13

    Bronze

    (EPO) BlueOptions Bronze 1419 ($0 Virtual Visits / $100+ in Rewards)

    Annual Out of Pocket Expenses
    Individual Family
    $8,550 $17,100 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$453,68
    $514,93
    $579,80
    $810,27
    $1 231,29     		$907,36
    $1 029,86
    $1 159,60
    $1 620,54
    $2 462,58     		$1 254,43
    $1 376,93
    $1 506,67
    $1 967,61     		$1 601,50
    $1 724,00
    $1 853,74
    $2 314,68     		$1 948,57
    $2 071,07
    $2 200,81
    $2 661,75     		$800,75
    $862,00
    $926,87
    $1 157,34     		$1 147,82
    $1 209,07
    $1 273,94
    $1 504,41     		$1 494,89
    $1 556,14
    $1 621,01
    $1 851,48     		$347,07
    Toc - Plan #14

    Silver

    (EPO) BlueOptions Silver 1431 ($0 Virtual Visits / $100+ in Rewards)

    Annual Out of Pocket Expenses
    Individual Family
    $5,600 $11,200 Annual Deductible
    $7,800 $15,600 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$755,66
    $857,67
    $965,73
    $1 349,61
    $2 050,86     		$1 511,32
    $1 715,34
    $1 931,46
    $2 699,22
    $4 101,72     		$2 089,40
    $2 293,42
    $2 509,54
    $3 277,30     		$2 667,48
    $2 871,50
    $3 087,62
    $3 855,38     		$3 245,56
    $3 449,58
    $3 665,70
    $4 433,46     		$1 333,74
    $1 435,75
    $1 543,81
    $1 927,69     		$1 911,82
    $2 013,83
    $2 121,89
    $2 505,77     		$2 489,90
    $2 591,91
    $2 699,97
    $3 083,85     		$578,08
    Toc - Plan #15

    Platinum

    (EPO) BlueOptions Platinum 1418 ($0 Virtual Visits / $100+ in Rewards)

    Annual Out of Pocket Expenses
    Individual Family
    $1,250 $2,500 Annual Deductible
    $4,250 $8,500 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$884,49
    $1 003,90
    $1 130,38
    $1 579,70
    $2 400,51     		$1 768,98
    $2 007,80
    $2 260,76
    $3 159,40
    $4 801,02     		$2 445,61
    $2 684,43
    $2 937,39
    $3 836,03     		$3 122,24
    $3 361,06
    $3 614,02
    $4 512,66     		$3 798,87
    $4 037,69
    $4 290,65
    $5 189,29     		$1 561,12
    $1 680,53
    $1 807,01
    $2 256,33     		$2 237,75
    $2 357,16
    $2 483,64
    $2 932,96     		$2 914,38
    $3 033,79
    $3 160,27
    $3 609,59     		$676,63
    Toc - Plan #16

    Expanded Bronze

    (EPO) BlueOptions Bronze 1416 ($0 Virtual Visits / 3 PCP Visits for $20)

    Annual Out of Pocket Expenses
    Individual Family
    $8,500 $17,000 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$488,96
    $554,97
    $624,89
    $873,28
    $1 327,04     		$977,92
    $1 109,94
    $1 249,78
    $1 746,56
    $2 654,08     		$1 351,97
    $1 483,99
    $1 623,83
    $2 120,61     		$1 726,02
    $1 858,04
    $1 997,88
    $2 494,66     		$2 100,07
    $2 232,09
    $2 371,93
    $2 868,71     		$863,01
    $929,02
    $998,94
    $1 247,33     		$1 237,06
    $1 303,07
    $1 372,99
    $1 621,38     		$1 611,11
    $1 677,12
    $1 747,04
    $1 995,43     		$374,05
    Toc - Plan #17

    Platinum

    (EPO) BlueOptions Platinum 1424 ($0 Virtual Visits / $100+ in Rewards)

    Annual Out of Pocket Expenses
    Individual Family
    $0 $0 Annual Deductible
    $2,000 $4,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$937,25
    $1 063,78
    $1 197,81
    $1 673,93
    $2 543,70     		$1 874,50
    $2 127,56
    $2 395,62
    $3 347,86
    $5 087,40     		$2 591,50
    $2 844,56
    $3 112,62
    $4 064,86     		$3 308,50
    $3 561,56
    $3 829,62
    $4 781,86     		$4 025,50
    $4 278,56
    $4 546,62
    $5 498,86     		$1 654,25
    $1 780,78
    $1 914,81
    $2 390,93     		$2 371,25
    $2 497,78
    $2 631,81
    $3 107,93     		$3 088,25
    $3 214,78
    $3 348,81
    $3 824,93     		$717,00
    Toc - Plan #18

    Silver

    (EPO) BlueOptions Silver 1410 ($0 Virtual Visits / $100+ in Rewards)

    Annual Out of Pocket Expenses
    Individual Family
    $8,000 $16,000 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$668,92
    $759,22
    $854,88
    $1 194,69
    $1 815,45     		$1 337,84
    $1 518,44
    $1 709,76
    $2 389,38
    $3 630,90     		$1 849,56
    $2 030,16
    $2 221,48
    $2 901,10     		$2 361,28
    $2 541,88
    $2 733,20
    $3 412,82     		$2 873,00
    $3 053,60
    $3 244,92
    $3 924,54     		$1 180,64
    $1 270,94
    $1 366,60
    $1 706,41     		$1 692,36
    $1 782,66
    $1 878,32
    $2 218,13     		$2 204,08
    $2 294,38
    $2 390,04
    $2 729,85     		$511,72
    Toc - Plan #19

    Gold

    (EPO) BlueOptions Gold 1505 ($0 Virtual Visits / $100+ in Rewards)

    Annual Out of Pocket Expenses
    Individual Family
    $0 $0 Annual Deductible
    $5,000 $10,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$744,59
    $845,11
    $951,59
    $1 329,84
    $2 020,82     		$1 489,18
    $1 690,22
    $1 903,18
    $2 659,68
    $4 041,64     		$2 058,79
    $2 259,83
    $2 472,79
    $3 229,29     		$2 628,40
    $2 829,44
    $3 042,40
    $3 798,90     		$3 198,01
    $3 399,05
    $3 612,01
    $4 368,51     		$1 314,20
    $1 414,72
    $1 521,20
    $1 899,45     		$1 883,81
    $1 984,33
    $2 090,81
    $2 469,06     		$2 453,42
    $2 553,94
    $2 660,42
    $3 038,67     		$569,61
    Toc - Plan #20

    Expanded Bronze

    (EPO) BlueOptions Bronze (HSA) 1705 ($100+ in Rewards / $4 Condition Care Rx)

    Annual Out of Pocket Expenses
    Individual Family
    $6,850 $13,700 Annual Deductible
    $6,850 $13,700 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$473,81
    $537,77
    $605,53
    $846,22
    $1 285,92     		$947,62
    $1 075,54
    $1 211,06
    $1 692,44
    $2 571,84     		$1 310,08
    $1 438,00
    $1 573,52
    $2 054,90     		$1 672,54
    $1 800,46
    $1 935,98
    $2 417,36     		$2 035,00
    $2 162,92
    $2 298,44
    $2 779,82     		$836,27
    $900,23
    $967,99
    $1 208,68     		$1 198,73
    $1 262,69
    $1 330,45
    $1 571,14     		$1 561,19
    $1 625,15
    $1 692,91
    $1 933,60     		$362,46
    Toc - Plan #21

    Silver

    (EPO) BlueOptions Silver 1706S ($0 Virtual Visits / $100+ in Rewards)

    Annual Out of Pocket Expenses
    Individual Family
    $3,600 $7,200 Annual Deductible
    $8,150 $16,300 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$747,90
    $848,87
    $955,82
    $1 335,75
    $2 029,80     		$1 495,80
    $1 697,74
    $1 911,64
    $2 671,50
    $4 059,60     		$2 067,94
    $2 269,88
    $2 483,78
    $3 243,64     		$2 640,08
    $2 842,02
    $3 055,92
    $3 815,78     		$3 212,22
    $3 414,16
    $3 628,06
    $4 387,92     		$1 320,04
    $1 421,01
    $1 527,96
    $1 907,89     		$1 892,18
    $1 993,15
    $2 100,10
    $2 480,03     		$2 464,32
    $2 565,29
    $2 672,24
    $3 052,17     		$572,14
    Toc - Plan #22

    Expanded Bronze

    (EPO) BlueOptions Bronze 1707S ($0 Virtual Visits / $40 PCP Visits)

    Annual Out of Pocket Expenses
    Individual Family
    $8,150 $16,300 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$487,65
    $553,48
    $623,22
    $870,94
    $1 323,48     		$975,30
    $1 106,96
    $1 246,44
    $1 741,88
    $2 646,96     		$1 348,35
    $1 480,01
    $1 619,49
    $2 114,93     		$1 721,40
    $1 853,06
    $1 992,54
    $2 487,98     		$2 094,45
    $2 226,11
    $2 365,59
    $2 861,03     		$860,70
    $926,53
    $996,27
    $1 243,99     		$1 233,75
    $1 299,58
    $1 369,32
    $1 617,04     		$1 606,80
    $1 672,63
    $1 742,37
    $1 990,09     		$373,05
    Toc - Plan #23

    Gold

    (EPO) BlueOptions Gold 1805 ($0 Virtual Visits / $100+ in Rewards)

    Annual Out of Pocket Expenses
    Individual Family
    $1,500 $3,000 Annual Deductible
    $5,500 $11,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$721,04
    $818,38
    $921,49
    $1 287,78
    $1 956,90     		$1 442,08
    $1 636,76
    $1 842,98
    $2 575,56
    $3 913,80     		$1 993,68
    $2 188,36
    $2 394,58
    $3 127,16     		$2 545,28
    $2 739,96
    $2 946,18
    $3 678,76     		$3 096,88
    $3 291,56
    $3 497,78
    $4 230,36     		$1 272,64
    $1 369,98
    $1 473,09
    $1 839,38     		$1 824,24
    $1 921,58
    $2 024,69
    $2 390,98     		$2 375,84
    $2 473,18
    $2 576,29
    $2 942,58     		$551,60
    Toc - Plan #24

    Expanded Bronze

    (EPO) BlueOptions Bronze 2119 ($0 Deductible / $50 PCP Visits / $100+ in Rewards)

    Annual Out of Pocket Expenses
    Individual Family
    $0 $0 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$521,70
    $592,13
    $666,73
    $931,76
    $1 415,89     		$1 043,40
    $1 184,26
    $1 333,46
    $1 863,52
    $2 831,78     		$1 442,50
    $1 583,36
    $1 732,56
    $2 262,62     		$1 841,60
    $1 982,46
    $2 131,66
    $2 661,72     		$2 240,70
    $2 381,56
    $2 530,76
    $3 060,82     		$920,80
    $991,23
    $1 065,83
    $1 330,86     		$1 319,90
    $1 390,33
    $1 464,93
    $1 729,96     		$1 719,00
    $1 789,43
    $1 864,03
    $2 129,06     		$399,10
    Toc - Plan #25

    Silver

    (EPO) BlueSelect Silver 1456 ($0 Virtual Visits / $100+ in Rewards)

    Annual Out of Pocket Expenses
    Individual Family
    $5,950 $11,900 Annual Deductible
    $7,150 $14,300 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$477,65
    $542,13
    $610,44
    $853,08
    $1 296,34     		$955,30
    $1 084,26
    $1 220,88
    $1 706,16
    $2 592,68     		$1 320,70
    $1 449,66
    $1 586,28
    $2 071,56     		$1 686,10
    $1 815,06
    $1 951,68
    $2 436,96     		$2 051,50
    $2 180,46
    $2 317,08
    $2 802,36     		$843,05
    $907,53
    $975,84
    $1 218,48     		$1 208,45
    $1 272,93
    $1 341,24
    $1 583,88     		$1 573,85
    $1 638,33
    $1 706,64
    $1 949,28     		$365,40
    Toc - Plan #26

    Bronze

    (EPO) BlueSelect Bronze 1452 ($0 Virtual Visits / $100+ in Rewards)

    Annual Out of Pocket Expenses
    Individual Family
    $8,550 $17,100 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$340,51
    $386,48
    $435,17
    $608,15
    $924,14     		$681,02
    $772,96
    $870,34
    $1 216,30
    $1 848,28     		$941,51
    $1 033,45
    $1 130,83
    $1 476,79     		$1 202,00
    $1 293,94
    $1 391,32
    $1 737,28     		$1 462,49
    $1 554,43
    $1 651,81
    $1 997,77     		$601,00
    $646,97
    $695,66
    $868,64     		$861,49
    $907,46
    $956,15
    $1 129,13     		$1 121,98
    $1 167,95
    $1 216,64
    $1 389,62     		$260,49
    Toc - Plan #27

    Silver

    (EPO) BlueSelect Silver 1464 ($0 Virtual Visits / $100+ in Rewards)

    Annual Out of Pocket Expenses
    Individual Family
    $5,600 $11,200 Annual Deductible
    $7,800 $15,600 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$495,06
    $561,89
    $632,69
    $884,18
    $1 343,59     		$990,12
    $1 123,78
    $1 265,38
    $1 768,36
    $2 687,18     		$1 368,84
    $1 502,50
    $1 644,10
    $2 147,08     		$1 747,56
    $1 881,22
    $2 022,82
    $2 525,80     		$2 126,28
    $2 259,94
    $2 401,54
    $2 904,52     		$873,78
    $940,61
    $1 011,41
    $1 262,90     		$1 252,50
    $1 319,33
    $1 390,13
    $1 641,62     		$1 631,22
    $1 698,05
    $1 768,85
    $2 020,34     		$378,72
    Toc - Plan #28

    Platinum

    (EPO) BlueSelect Platinum 1451 ($0 Virtual Visits / $100+ in Rewards)

    Annual Out of Pocket Expenses
    Individual Family
    $1,250 $2,500 Annual Deductible
    $4,250 $8,500 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$584,96
    $663,93
    $747,58
    $1 044,74
    $1 587,58     		$1 169,92
    $1 327,86
    $1 495,16
    $2 089,48
    $3 175,16     		$1 617,41
    $1 775,35
    $1 942,65
    $2 536,97     		$2 064,90
    $2 222,84
    $2 390,14
    $2 984,46     		$2 512,39
    $2 670,33
    $2 837,63
    $3 431,95     		$1 032,45
    $1 111,42
    $1 195,07
    $1 492,23     		$1 479,94
    $1 558,91
    $1 642,56
    $1 939,72     		$1 927,43
    $2 006,40
    $2 090,05
    $2 387,21     		$447,49
    Toc - Plan #29

    Expanded Bronze

    (EPO) BlueSelect Bronze 1449 ($0 Virtual Visits / 3 PCP Visits for $20)

    Annual Out of Pocket Expenses
    Individual Family
    $8,500 $17,000 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$364,27
    $413,45
    $465,54
    $650,59
    $988,63     		$728,54
    $826,90
    $931,08
    $1 301,18
    $1 977,26     		$1 007,21
    $1 105,57
    $1 209,75
    $1 579,85     		$1 285,88
    $1 384,24
    $1 488,42
    $1 858,52     		$1 564,55
    $1 662,91
    $1 767,09
    $2 137,19     		$642,94
    $692,12
    $744,21
    $929,26     		$921,61
    $970,79
    $1 022,88
    $1 207,93     		$1 200,28
    $1 249,46
    $1 301,55
    $1 486,60     		$278,67
    Toc - Plan #30

    Platinum

    (EPO) BlueSelect Platinum 1457 ($0 Virtual Visits / $100+ in Rewards)

    Annual Out of Pocket Expenses
    Individual Family
    $0 $0 Annual Deductible
    $2,000 $4,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$627,96
    $712,73
    $802,53
    $1 121,54
    $1 704,28     		$1 255,92
    $1 425,46
    $1 605,06
    $2 243,08
    $3 408,56     		$1 736,31
    $1 905,85
    $2 085,45
    $2 723,47     		$2 216,70
    $2 386,24
    $2 565,84
    $3 203,86     		$2 697,09
    $2 866,63
    $3 046,23
    $3 684,25     		$1 108,35
    $1 193,12
    $1 282,92
    $1 601,93     		$1 588,74
    $1 673,51
    $1 763,31
    $2 082,32     		$2 069,13
    $2 153,90
    $2 243,70
    $2 562,71     		$480,39
    Toc - Plan #31

    Silver

    (EPO) BlueSelect Silver 1443 ($0 Labs / $0 Virtual Visits / $100+ in Rewards)

    Annual Out of Pocket Expenses
    Individual Family
    $8,000 $16,000 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$434,14
    $492,75
    $554,83
    $775,37
    $1 178,26     		$868,28
    $985,50
    $1 109,66
    $1 550,74
    $2 356,52     		$1 200,40
    $1 317,62
    $1 441,78
    $1 882,86     		$1 532,52
    $1 649,74
    $1 773,90
    $2 214,98     		$1 864,64
    $1 981,86
    $2 106,02
    $2 547,10     		$766,26
    $824,87
    $886,95
    $1 107,49     		$1 098,38
    $1 156,99
    $1 219,07
    $1 439,61     		$1 430,50
    $1 489,11
    $1 551,19
    $1 771,73     		$332,12
    Toc - Plan #32

    Gold

    (EPO) BlueSelect Gold 1535 ($0 Virtual Visits / $100+ in Rewards)

    Annual Out of Pocket Expenses
    Individual Family
    $0 $0 Annual Deductible
    $5,000 $10,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$509,53
    $578,32
    $651,18
    $910,02
    $1 382,86     		$1 019,06
    $1 156,64
    $1 302,36
    $1 820,04
    $2 765,72     		$1 408,85
    $1 546,43
    $1 692,15
    $2 209,83     		$1 798,64
    $1 936,22
    $2 081,94
    $2 599,62     		$2 188,43
    $2 326,01
    $2 471,73
    $2 989,41     		$899,32
    $968,11
    $1 040,97
    $1 299,81     		$1 289,11
    $1 357,90
    $1 430,76
    $1 689,60     		$1 678,90
    $1 747,69
    $1 820,55
    $2 079,39     		$389,79
    Toc - Plan #33

    Expanded Bronze

    (EPO) BlueSelect Bronze (HSA) 1735 ($100+ in Rewards / $4 Condition Care Rx)

    Annual Out of Pocket Expenses
    Individual Family
    $6,850 $13,700 Annual Deductible
    $6,850 $13,700 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$355,05
    $402,98
    $453,75
    $634,12
    $963,61     		$710,10
    $805,96
    $907,50
    $1 268,24
    $1 927,22     		$981,71
    $1 077,57
    $1 179,11
    $1 539,85     		$1 253,32
    $1 349,18
    $1 450,72
    $1 811,46     		$1 524,93
    $1 620,79
    $1 722,33
    $2 083,07     		$626,66
    $674,59
    $725,36
    $905,73     		$898,27
    $946,20
    $996,97
    $1 177,34     		$1 169,88
    $1 217,81
    $1 268,58
    $1 448,95     		$271,61
    Toc - Plan #34

    Silver

    (EPO) BlueSelect Silver 1736S ($0 Virtual Visits / $100+ in Rewards)

    Annual Out of Pocket Expenses
    Individual Family
    $3,600 $7,200 Annual Deductible
    $8,150 $16,300 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$484,05
    $549,40
    $618,62
    $864,51
    $1 313,71     		$968,10
    $1 098,80
    $1 237,24
    $1 729,02
    $2 627,42     		$1 338,40
    $1 469,10
    $1 607,54
    $2 099,32     		$1 708,70
    $1 839,40
    $1 977,84
    $2 469,62     		$2 079,00
    $2 209,70
    $2 348,14
    $2 839,92     		$854,35
    $919,70
    $988,92
    $1 234,81     		$1 224,65
    $1 290,00
    $1 359,22
    $1 605,11     		$1 594,95
    $1 660,30
    $1 729,52
    $1 975,41     		$370,30
    Toc - Plan #35

    Expanded Bronze

    (EPO) BlueSelect Bronze 1737S ($0 Virtual Visits / $40 PCP Visits)

    Annual Out of Pocket Expenses
    Individual Family
    $8,150 $16,300 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$363,71
    $412,81
    $464,82
    $649,59
    $987,11     		$727,42
    $825,62
    $929,64
    $1 299,18
    $1 974,22     		$1 005,66
    $1 103,86
    $1 207,88
    $1 577,42     		$1 283,90
    $1 382,10
    $1 486,12
    $1 855,66     		$1 562,14
    $1 660,34
    $1 764,36
    $2 133,90     		$641,95
    $691,05
    $743,06
    $927,83     		$920,19
    $969,29
    $1 021,30
    $1 206,07     		$1 198,43
    $1 247,53
    $1 299,54
    $1 484,31     		$278,24
    Toc - Plan #36

    Gold

    (EPO) BlueSelect Gold 1835 ($0 Virtual Visits / $100+ in Rewards)

    Annual Out of Pocket Expenses
    Individual Family
    $1,500 $3,000 Annual Deductible
    $5,500 $11,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$486,77
    $552,48
    $622,09
    $869,37
    $1 321,09     		$973,54
    $1 104,96
    $1 244,18
    $1 738,74
    $2 642,18     		$1 345,92
    $1 477,34
    $1 616,56
    $2 111,12     		$1 718,30
    $1 849,72
    $1 988,94
    $2 483,50     		$2 090,68
    $2 222,10
    $2 361,32
    $2 855,88     		$859,15
    $924,86
    $994,47
    $1 241,75     		$1 231,53
    $1 297,24
    $1 366,85
    $1 614,13     		$1 603,91
    $1 669,62
    $1 739,23
    $1 986,51     		$372,38
    Toc - Plan #37

    Expanded Bronze

    (EPO) BlueSelect Bronze 2139 ($0 Deductible / $50 PCP Visits / $100+ in Rewards)

    Annual Out of Pocket Expenses
    Individual Family
    $0 $0 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$388,69
    $441,16
    $496,75
    $694,20
    $1 054,90     		$777,38
    $882,32
    $993,50
    $1 388,40
    $2 109,80     		$1 074,73
    $1 179,67
    $1 290,85
    $1 685,75     		$1 372,08
    $1 477,02
    $1 588,20
    $1 983,10     		$1 669,43
    $1 774,37
    $1 885,55
    $2 280,45     		$686,04
    $738,51
    $794,10
    $991,55     		$983,39
    $1 035,86
    $1 091,45
    $1 288,90     		$1 280,74
    $1 333,21
    $1 388,80
    $1 586,25     		$297,35
    ADVERTISEMENT

    AvMed

    Local: 1-800-477-8768 | Toll Free: 

    Toc - Plan #38

    Gold

    (HMO) AvMed Entrust Gold 125

    Annual Out of Pocket Expenses
    Individual Family
    $2,000 $4,000 Annual Deductible
    $4,700 $9,400 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$454,32
    $515,66
    $580,62
    $811,42
    $1 233,03     		$908,64
    $1 031,32
    $1 161,24
    $1 622,84
    $2 466,06     		$1 256,20
    $1 378,88
    $1 508,80
    $1 970,40     		$1 603,76
    $1 726,44
    $1 856,36
    $2 317,96     		$1 951,32
    $2 074,00
    $2 203,92
    $2 665,52     		$801,88
    $863,22
    $928,18
    $1 158,98     		$1 149,44
    $1 210,78
    $1 275,74
    $1 506,54     		$1 497,00
    $1 558,34
    $1 623,30
    $1 854,10     		$347,56
    Toc - Plan #39

    Silver

    (HMO) AvMed Entrust Silver 300

    Annual Out of Pocket Expenses
    Individual Family
    $3,000 $6,000 Annual Deductible
    $7,000 $14,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$441,64
    $501,27
    $564,42
    $788,78
    $1 198,62     		$883,28
    $1 002,54
    $1 128,84
    $1 577,56
    $2 397,24     		$1 221,14
    $1 340,40
    $1 466,70
    $1 915,42     		$1 559,00
    $1 678,26
    $1 804,56
    $2 253,28     		$1 896,86
    $2 016,12
    $2 142,42
    $2 591,14     		$779,50
    $839,13
    $902,28
    $1 126,64     		$1 117,36
    $1 176,99
    $1 240,14
    $1 464,50     		$1 455,22
    $1 514,85
    $1 578,00
    $1 802,36     		$337,86
    Toc - Plan #40

    Silver

    (HMO) AvMed Entrust Silver 350

    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:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$422,68
    $479,74
    $540,18
    $754,91
    $1 147,15     		$845,36
    $959,48
    $1 080,36
    $1 509,82
    $2 294,30     		$1 168,71
    $1 282,83
    $1 403,71
    $1 833,17     		$1 492,06
    $1 606,18
    $1 727,06
    $2 156,52     		$1 815,41
    $1 929,53
    $2 050,41
    $2 479,87     		$746,03
    $803,09
    $863,53
    $1 078,26     		$1 069,38
    $1 126,44
    $1 186,88
    $1 401,61     		$1 392,73
    $1 449,79
    $1 510,23
    $1 724,96     		$323,35
    Toc - Plan #41

    Silver

    (HMO) AvMed Entrust Silver 500

    Annual Out of Pocket Expenses
    Individual Family
    $5,500 $11,000 Annual Deductible
    $7,000 $14,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$421,62
    $478,54
    $538,83
    $753,01
    $1 144,27     		$843,24
    $957,08
    $1 077,66
    $1 506,02
    $2 288,54     		$1 165,78
    $1 279,62
    $1 400,20
    $1 828,56     		$1 488,32
    $1 602,16
    $1 722,74
    $2 151,10     		$1 810,86
    $1 924,70
    $2 045,28
    $2 473,64     		$744,16
    $801,08
    $861,37
    $1 075,55     		$1 066,70
    $1 123,62
    $1 183,91
    $1 398,09     		$1 389,24
    $1 446,16
    $1 506,45
    $1 720,63     		$322,54
    Toc - Plan #42

    Silver

    (HMO) AvMed Entrust Silver 550

    Annual Out of Pocket Expenses
    Individual Family
    $6,500 $13,000 Annual Deductible
    $7,000 $14,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$418,54
    $475,04
    $534,89
    $747,51
    $1 135,91     		$837,08
    $950,08
    $1 069,78
    $1 495,02
    $2 271,82     		$1 157,26
    $1 270,26
    $1 389,96
    $1 815,20     		$1 477,44
    $1 590,44
    $1 710,14
    $2 135,38     		$1 797,62
    $1 910,62
    $2 030,32
    $2 455,56     		$738,72
    $795,22
    $855,07
    $1 067,69     		$1 058,90
    $1 115,40
    $1 175,25
    $1 387,87     		$1 379,08
    $1 435,58
    $1 495,43
    $1 708,05     		$320,18
    Toc - Plan #43

    Expanded Bronze

    (HMO) AvMed Entrust Bronze 600

    Annual Out of Pocket Expenses
    Individual Family
    $6,500 $13,000 Annual Deductible
    $7,900 $15,800 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$348,16
    $395,16
    $444,95
    $621,81
    $944,91     		$696,32
    $790,32
    $889,90
    $1 243,62
    $1 889,82     		$962,66
    $1 056,66
    $1 156,24
    $1 509,96     		$1 229,00
    $1 323,00
    $1 422,58
    $1 776,30     		$1 495,34
    $1 589,34
    $1 688,92
    $2 042,64     		$614,50
    $661,50
    $711,29
    $888,15     		$880,84
    $927,84
    $977,63
    $1 154,49     		$1 147,18
    $1 194,18
    $1 243,97
    $1 420,83     		$266,34
    Toc - Plan #44

    Expanded Bronze

    (HMO) AvMed Entrust Bronze 650

    Annual Out of Pocket Expenses
    Individual Family
    $8,200 $16,400 Annual Deductible
    $8,200 $16,400 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$320,18
    $363,41
    $409,19
    $571,84
    $868,97     		$640,36
    $726,82
    $818,38
    $1 143,68
    $1 737,94     		$885,30
    $971,76
    $1 063,32
    $1 388,62     		$1 130,24
    $1 216,70
    $1 308,26
    $1 633,56     		$1 375,18
    $1 461,64
    $1 553,20
    $1 878,50     		$565,12
    $608,35
    $654,13
    $816,78     		$810,06
    $853,29
    $899,07
    $1 061,72     		$1 055,00
    $1 098,23
    $1 144,01
    $1 306,66     		$244,94
    Toc - Plan #45

    Catastrophic

    (HMO) AvMed Catastrophic 100

    Annual Out of Pocket Expenses
    Individual Family
    $8,550 $17,100 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$281,45
    $319,44
    $359,69
    $502,66
    $763,84     		$562,90
    $638,88
    $719,38
    $1 005,32
    $1 527,68     		$778,21
    $854,19
    $934,69
    $1 220,63     		$993,52
    $1 069,50
    $1 150,00
    $1 435,94     		$1 208,83
    $1 284,81
    $1 365,31
    $1 651,25     		$496,76
    $534,75
    $575,00
    $717,97     		$712,07
    $750,06
    $790,31
    $933,28     		$927,38
    $965,37
    $1 005,62
    $1 148,59     		$215,31
    Toc - Plan #46

    Gold

    (HMO) AvMed Entrust Gold 125 Adult Dental + Vision

    Annual Out of Pocket Expenses
    Individual Family
    $2,000 $4,000 Annual Deductible
    $4,700 $9,400 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$458,35
    $520,22
    $585,77
    $818,61
    $1 243,95     		$916,70
    $1 040,44
    $1 171,54
    $1 637,22
    $2 487,90     		$1 267,33
    $1 391,07
    $1 522,17
    $1 987,85     		$1 617,96
    $1 741,70
    $1 872,80
    $2 338,48     		$1 968,59
    $2 092,33
    $2 223,43
    $2 689,11     		$808,98
    $870,85
    $936,40
    $1 169,24     		$1 159,61
    $1 221,48
    $1 287,03
    $1 519,87     		$1 510,24
    $1 572,11
    $1 637,66
    $1 870,50     		$350,63
    Toc - Plan #47

    Silver

    (HMO) AvMed Entrust Silver 300 Adult Dental + Vision

    Annual Out of Pocket Expenses
    Individual Family
    $3,000 $6,000 Annual Deductible
    $7,000 $14,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$445,55
    $505,70
    $569,41
    $795,75
    $1 209,23     		$891,10
    $1 011,40
    $1 138,82
    $1 591,50
    $2 418,46     		$1 231,95
    $1 352,25
    $1 479,67
    $1 932,35     		$1 572,80
    $1 693,10
    $1 820,52
    $2 273,20     		$1 913,65
    $2 033,95
    $2 161,37
    $2 614,05     		$786,40
    $846,55
    $910,26
    $1 136,60     		$1 127,25
    $1 187,40
    $1 251,11
    $1 477,45     		$1 468,10
    $1 528,25
    $1 591,96
    $1 818,30     		$340,85
    Toc - Plan #48

    Silver

    (HMO) AvMed Entrust Silver 350 Adult Dental + Vision

    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:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$426,43
    $484,00
    $544,98
    $761,61
    $1 157,33     		$852,86
    $968,00
    $1 089,96
    $1 523,22
    $2 314,66     		$1 179,08
    $1 294,22
    $1 416,18
    $1 849,44     		$1 505,30
    $1 620,44
    $1 742,40
    $2 175,66     		$1 831,52
    $1 946,66
    $2 068,62
    $2 501,88     		$752,65
    $810,22
    $871,20
    $1 087,83     		$1 078,87
    $1 136,44
    $1 197,42
    $1 414,05     		$1 405,09
    $1 462,66
    $1 523,64
    $1 740,27     		$326,22
    Toc - Plan #49

    Silver

    (HMO) AvMed Entrust Silver 500 Adult Dental + Vision

    Annual Out of Pocket Expenses
    Individual Family
    $5,500 $11,000 Annual Deductible
    $7,000 $14,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$425,35
    $482,77
    $543,60
    $759,67
    $1 154,40     		$850,70
    $965,54
    $1 087,20
    $1 519,34
    $2 308,80     		$1 176,09
    $1 290,93
    $1 412,59
    $1 844,73     		$1 501,48
    $1 616,32
    $1 737,98
    $2 170,12     		$1 826,87
    $1 941,71
    $2 063,37
    $2 495,51     		$750,74
    $808,16
    $868,99
    $1 085,06     		$1 076,13
    $1 133,55
    $1 194,38
    $1 410,45     		$1 401,52
    $1 458,94
    $1 519,77
    $1 735,84     		$325,39
    ADVERTISEMENT

    Ambetter from Sunshine Health

    Local: 1-877-687-1169 | Toll Free: 1-877-687-1169 | TTY: 1-800-955-8770
    Toc - Plan #50

    Gold

    (EPO) Ambetter Secure Care 5 (2021)

    Annual Out of Pocket Expenses
    Individual Family
    $1,450 $2,900 Annual Deductible
    $6,300 $12,600 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$432,66
    $491,06
    $552,93
    $772,72
    $1 174,22     		$865,32
    $982,12
    $1 105,86
    $1 545,44
    $2 348,44     		$1 196,30
    $1 313,10
    $1 436,84
    $1 876,42     		$1 527,28
    $1 644,08
    $1 767,82
    $2 207,40     		$1 858,26
    $1 975,06
    $2 098,80
    $2 538,38     		$763,64
    $822,04
    $883,91
    $1 103,70     		$1 094,62
    $1 153,02
    $1 214,89
    $1 434,68     		$1 425,60
    $1 484,00
    $1 545,87
    $1 765,66     		$330,98
    Toc - Plan #51

    Bronze

    (EPO) Ambetter Essential Care 1 (2021)

    Annual Out of Pocket Expenses
    Individual Family
    $8,300 $16,600 Annual Deductible
    $8,300 $16,600 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$302,59
    $343,43
    $386,70
    $540,41
    $821,21     		$605,18
    $686,86
    $773,40
    $1 080,82
    $1 642,42     		$836,66
    $918,34
    $1 004,88
    $1 312,30     		$1 068,14
    $1 149,82
    $1 236,36
    $1 543,78     		$1 299,62
    $1 381,30
    $1 467,84
    $1 775,26     		$534,07
    $574,91
    $618,18
    $771,89     		$765,55
    $806,39
    $849,66
    $1 003,37     		$997,03
    $1 037,87
    $1 081,14
    $1 234,85     		$231,48
    Toc - Plan #52

    Expanded Bronze

    (EPO) Ambetter Essential Care 2 HSA (2021)

    Annual Out of Pocket Expenses
    Individual Family
    $6,900 $13,800 Annual Deductible
    $6,900 $13,800 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$309,52
    $351,29
    $395,55
    $552,78
    $840,00     		$619,04
    $702,58
    $791,10
    $1 105,56
    $1 680,00     		$855,81
    $939,35
    $1 027,87
    $1 342,33     		$1 092,58
    $1 176,12
    $1 264,64
    $1 579,10     		$1 329,35
    $1 412,89
    $1 501,41
    $1 815,87     		$546,29
    $588,06
    $632,32
    $789,55     		$783,06
    $824,83
    $869,09
    $1 026,32     		$1 019,83
    $1 061,60
    $1 105,86
    $1 263,09     		$236,77
    Toc - Plan #53

    Expanded Bronze

    (EPO) Ambetter Essential Care 10 (2021)

    Annual Out of Pocket Expenses
    Individual Family
    $7,200 $14,400 Annual Deductible
    $8,400 $16,800 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$310,08
    $351,93
    $396,27
    $553,78
    $841,53     		$620,16
    $703,86
    $792,54
    $1 107,56
    $1 683,06     		$857,36
    $941,06
    $1 029,74
    $1 344,76     		$1 094,56
    $1 178,26
    $1 266,94
    $1 581,96     		$1 331,76
    $1 415,46
    $1 504,14
    $1 819,16     		$547,28
    $589,13
    $633,47
    $790,98     		$784,48
    $826,33
    $870,67
    $1 028,18     		$1 021,68
    $1 063,53
    $1 107,87
    $1 265,38     		$237,20
    Toc - Plan #54

    Silver

    (EPO) Ambetter Balanced Care 4 (2021)

    Annual Out of Pocket Expenses
    Individual Family
    $7,200 $14,400 Annual Deductible
    $7,200 $14,400 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$432,71
    $491,11
    $552,98
    $772,79
    $1 174,34     		$865,42
    $982,22
    $1 105,96
    $1 545,58
    $2 348,68     		$1 196,43
    $1 313,23
    $1 436,97
    $1 876,59     		$1 527,44
    $1 644,24
    $1 767,98
    $2 207,60     		$1 858,45
    $1 975,25
    $2 098,99
    $2 538,61     		$763,72
    $822,12
    $883,99
    $1 103,80     		$1 094,73
    $1 153,13
    $1 215,00
    $1 434,81     		$1 425,74
    $1 484,14
    $1 546,01
    $1 765,82     		$331,01
    Toc - Plan #55

    Silver

    (EPO) Ambetter Balanced Care 11 (2021)

    Annual Out of Pocket Expenses
    Individual Family
    $6,000 $12,000 Annual Deductible
    $8,500 $17,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$421,97
    $478,93
    $539,27
    $753,63
    $1 145,21     		$843,94
    $957,86
    $1 078,54
    $1 507,26
    $2 290,42     		$1 166,74
    $1 280,66
    $1 401,34
    $1 830,06     		$1 489,54
    $1 603,46
    $1 724,14
    $2 152,86     		$1 812,34
    $1 926,26
    $2 046,94
    $2 475,66     		$744,77
    $801,73
    $862,07
    $1 076,43     		$1 067,57
    $1 124,53
    $1 184,87
    $1 399,23     		$1 390,37
    $1 447,33
    $1 507,67
    $1 722,03     		$322,80
    Toc - Plan #56

    Silver

    (EPO) Ambetter Balanced Care 12 (2021)

    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:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$412,71
    $468,42
    $527,44
    $737,09
    $1 120,08     		$825,42
    $936,84
    $1 054,88
    $1 474,18
    $2 240,16     		$1 141,14
    $1 252,56
    $1 370,60
    $1 789,90     		$1 456,86
    $1 568,28
    $1 686,32
    $2 105,62     		$1 772,58
    $1 884,00
    $2 002,04
    $2 421,34     		$728,43
    $784,14
    $843,16
    $1 052,81     		$1 044,15
    $1 099,86
    $1 158,88
    $1 368,53     		$1 359,87
    $1 415,58
    $1 474,60
    $1 684,25     		$315,72
    Toc - Plan #57

    Silver

    (EPO) Ambetter Balanced Care 24 (2021)

    Annual Out of Pocket Expenses
    Individual Family
    $7,450 $14,900 Annual Deductible
    $7,450 $14,900 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$427,86
    $485,61
    $546,79
    $764,14
    $1 161,18     		$855,72
    $971,22
    $1 093,58
    $1 528,28
    $2 322,36     		$1 183,02
    $1 298,52
    $1 420,88
    $1 855,58     		$1 510,32
    $1 625,82
    $1 748,18
    $2 182,88     		$1 837,62
    $1 953,12
    $2 075,48
    $2 510,18     		$755,16
    $812,91
    $874,09
    $1 091,44     		$1 082,46
    $1 140,21
    $1 201,39
    $1 418,74     		$1 409,76
    $1 467,51
    $1 528,69
    $1 746,04     		$327,30
    Toc - Plan #58

    Silver

    (EPO) Ambetter Balanced Care 29 (2021)

    Annual Out of Pocket Expenses
    Individual Family
    $5,450 $10,900 Annual Deductible
    $8,400 $16,800 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$408,99
    $464,20
    $522,68
    $730,44
    $1 109,98     		$817,98
    $928,40
    $1 045,36
    $1 460,88
    $2 219,96     		$1 130,85
    $1 241,27
    $1 358,23
    $1 773,75     		$1 443,72
    $1 554,14
    $1 671,10
    $2 086,62     		$1 756,59
    $1 867,01
    $1 983,97
    $2 399,49     		$721,86
    $777,07
    $835,55
    $1 043,31     		$1 034,73
    $1 089,94
    $1 148,42
    $1 356,18     		$1 347,60
    $1 402,81
    $1 461,29
    $1 669,05     		$312,87
    Toc - Plan #59

    Silver

    (EPO) Ambetter Balanced Care 25 HSA (2021)

    Annual Out of Pocket Expenses
    Individual Family
    $4,800 $9,600 Annual Deductible
    $4,800 $9,600 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$426,73
    $484,33
    $545,35
    $762,13
    $1 158,13     		$853,46
    $968,66
    $1 090,70
    $1 524,26
    $2 316,26     		$1 179,90
    $1 295,10
    $1 417,14
    $1 850,70     		$1 506,34
    $1 621,54
    $1 743,58
    $2 177,14     		$1 832,78
    $1 947,98
    $2 070,02
    $2 503,58     		$753,17
    $810,77
    $871,79
    $1 088,57     		$1 079,61
    $1 137,21
    $1 198,23
    $1 415,01     		$1 406,05
    $1 463,65
    $1 524,67
    $1 741,45     		$326,44
    Toc - Plan #60

    Silver

    (EPO) Ambetter Balanced Care 26 (2021)

    Annual Out of Pocket Expenses
    Individual Family
    $5,450 $10,900 Annual Deductible
    $8,100 $16,200 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$435,09
    $493,81
    $556,03
    $777,04
    $1 180,79     		$870,18
    $987,62
    $1 112,06
    $1 554,08
    $2 361,58     		$1 203,01
    $1 320,45
    $1 444,89
    $1 886,91     		$1 535,84
    $1 653,28
    $1 777,72
    $2 219,74     		$1 868,67
    $1 986,11
    $2 110,55
    $2 552,57     		$767,92
    $826,64
    $888,86
    $1 109,87     		$1 100,75
    $1 159,47
    $1 221,69
    $1 442,70     		$1 433,58
    $1 492,30
    $1 554,52
    $1 775,53     		$332,83
    Toc - Plan #61

    Silver

    (EPO) Ambetter Balanced Care 27 (2021)

    Annual Out of Pocket Expenses
    Individual Family
    $2,750 $5,500 Annual Deductible
    $6,500 $13,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$454,43
    $515,76
    $580,74
    $811,59
    $1 233,29     		$908,86
    $1 031,52
    $1 161,48
    $1 623,18
    $2 466,58     		$1 256,49
    $1 379,15
    $1 509,11
    $1 970,81     		$1 604,12
    $1 726,78
    $1 856,74
    $2 318,44     		$1 951,75
    $2 074,41
    $2 204,37
    $2 666,07     		$802,06
    $863,39
    $928,37
    $1 159,22     		$1 149,69
    $1 211,02
    $1 276,00
    $1 506,85     		$1 497,32
    $1 558,65
    $1 623,63
    $1 854,48     		$347,63
    Toc - Plan #62

    Silver

    (EPO) Ambetter Balanced Care 28 (2021)

    Annual Out of Pocket Expenses
    Individual Family
    $0 $0 Annual Deductible
    $8,200 $16,400 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$462,91
    $525,39
    $591,58
    $826,73
    $1 256,30     		$925,82
    $1 050,78
    $1 183,16
    $1 653,46
    $2 512,60     		$1 279,94
    $1 404,90
    $1 537,28
    $2 007,58     		$1 634,06
    $1 759,02
    $1 891,40
    $2 361,70     		$1 988,18
    $2 113,14
    $2 245,52
    $2 715,82     		$817,03
    $879,51
    $945,70
    $1 180,85     		$1 171,15
    $1 233,63
    $1 299,82
    $1 534,97     		$1 525,27
    $1 587,75
    $1 653,94
    $1 889,09     		$354,12
    Toc - Plan #63

    Silver

    (EPO) Ambetter Balanced Care 12 (2021) + Vision + Adult Dental

    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:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$428,96
    $486,86
    $548,20
    $766,10
    $1 164,17     		$857,92
    $973,72
    $1 096,40
    $1 532,20
    $2 328,34     		$1 186,07
    $1 301,87
    $1 424,55
    $1 860,35     		$1 514,22
    $1 630,02
    $1 752,70
    $2 188,50     		$1 842,37
    $1 958,17
    $2 080,85
    $2 516,65     		$757,11
    $815,01
    $876,35
    $1 094,25     		$1 085,26
    $1 143,16
    $1 204,50
    $1 422,40     		$1 413,41
    $1 471,31
    $1 532,65
    $1 750,55     		$328,15
    Toc - Plan #64

    Expanded Bronze

    (EPO) Ambetter Essential Care 2 HSA (2021) + Vision + Adult Dental

    Annual Out of Pocket Expenses
    Individual Family
    $6,900 $13,800 Annual Deductible
    $6,900 $13,800 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$321,70
    $365,12
    $411,12
    $574,54
    $873,06     		$643,40
    $730,24
    $822,24
    $1 149,08
    $1 746,12     		$889,49
    $976,33
    $1 068,33
    $1 395,17     		$1 135,58
    $1 222,42
    $1 314,42
    $1 641,26     		$1 381,67
    $1 468,51
    $1 560,51
    $1 887,35     		$567,79
    $611,21
    $657,21
    $820,63     		$813,88
    $857,30
    $903,30
    $1 066,72     		$1 059,97
    $1 103,39
    $1 149,39
    $1 312,81     		$246,09
    Toc - Plan #65

    Gold

    (EPO) Ambetter Secure Care 5 (2021) + Vision + Adult Dental

    Annual Out of Pocket Expenses
    Individual Family
    $1,450 $2,900 Annual Deductible
    $6,300 $12,600 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$449,69
    $510,39
    $574,69
    $803,13
    $1 220,44     		$899,38
    $1 020,78
    $1 149,38
    $1 606,26
    $2 440,88     		$1 243,39
    $1 364,79
    $1 493,39
    $1 950,27     		$1 587,40
    $1 708,80
    $1 837,40
    $2 294,28     		$1 931,41
    $2 052,81
    $2 181,41
    $2 638,29     		$793,70
    $854,40
    $918,70
    $1 147,14     		$1 137,71
    $1 198,41
    $1 262,71
    $1 491,15     		$1 481,72
    $1 542,42
    $1 606,72
    $1 835,16     		$344,01
    Toc - Plan #66

    Bronze

    (EPO) Ambetter Essential Care 1 (2021) + Vision + Adult Dental

    Annual Out of Pocket Expenses
    Individual Family
    $8,300 $16,600 Annual Deductible
    $8,300 $16,600 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$314,50
    $356,95
    $401,92
    $561,69
    $853,54     		$629,00
    $713,90
    $803,84
    $1 123,38
    $1 707,08     		$869,59
    $954,49
    $1 044,43
    $1 363,97     		$1 110,18
    $1 195,08
    $1 285,02
    $1 604,56     		$1 350,77
    $1 435,67
    $1 525,61
    $1 845,15     		$555,09
    $597,54
    $642,51
    $802,28     		$795,68
    $838,13
    $883,10
    $1 042,87     		$1 036,27
    $1 078,72
    $1 123,69
    $1 283,46     		$240,59
    Toc - Plan #67

    Expanded Bronze

    (EPO) Ambetter Essential Care 10 (2021) + Vision + Adult Dental

    Annual Out of Pocket Expenses
    Individual Family
    $7,200 $14,400 Annual Deductible
    $8,400 $16,800 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$322,28
    $365,78
    $411,87
    $575,58
    $874,65     		$644,56
    $731,56
    $823,74
    $1 151,16
    $1 749,30     		$891,10
    $978,10
    $1 070,28
    $1 397,70     		$1 137,64
    $1 224,64
    $1 316,82
    $1 644,24     		$1 384,18
    $1 471,18
    $1 563,36
    $1 890,78     		$568,82
    $612,32
    $658,41
    $822,12     		$815,36
    $858,86
    $904,95
    $1 068,66     		$1 061,90
    $1 105,40
    $1 151,49
    $1 315,20     		$246,54
    Toc - Plan #68

    Silver

    (EPO) Ambetter Balanced Care 4 (2021) + Vision + Adult Dental

    Annual Out of Pocket Expenses
    Individual Family
    $7,200 $14,400 Annual Deductible
    $7,200 $14,400 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$449,74
    $510,44
    $574,75
    $803,21
    $1 220,56     		$899,48
    $1 020,88
    $1 149,50
    $1 606,42
    $2 441,12     		$1 243,52
    $1 364,92
    $1 493,54
    $1 950,46     		$1 587,56
    $1 708,96
    $1 837,58
    $2 294,50     		$1 931,60
    $2 053,00
    $2 181,62
    $2 638,54     		$793,78
    $854,48
    $918,79
    $1 147,25     		$1 137,82
    $1 198,52
    $1 262,83
    $1 491,29     		$1 481,86
    $1 542,56
    $1 606,87
    $1 835,33     		$344,04
    Toc - Plan #69

    Silver

    (EPO) Ambetter Balanced Care 11 (2021) + Vision + Adult Dental

    Annual Out of Pocket Expenses
    Individual Family
    $6,000 $12,000 Annual Deductible
    $8,500 $17,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$438,58
    $497,78
    $560,50
    $783,29
    $1 190,29     		$877,16
    $995,56
    $1 121,00
    $1 566,58
    $2 380,58     		$1 212,67
    $1 331,07
    $1 456,51
    $1 902,09     		$1 548,18
    $1 666,58
    $1 792,02
    $2 237,60     		$1 883,69
    $2 002,09
    $2 127,53
    $2 573,11     		$774,09
    $833,29
    $896,01
    $1 118,80     		$1 109,60
    $1 168,80
    $1 231,52
    $1 454,31     		$1 445,11
    $1 504,31
    $1 567,03
    $1 789,82     		$335,51
    Toc - Plan #70

    Silver

    (EPO) Ambetter Balanced Care 24 (2021) + Vision + Adult Dental

    Annual Out of Pocket Expenses
    Individual Family
    $7,450 $14,900 Annual Deductible
    $7,450 $14,900 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$444,70
    $504,72
    $568,31
    $794,22
    $1 206,89     		$889,40
    $1 009,44
    $1 136,62
    $1 588,44
    $2 413,78     		$1 229,59
    $1 349,63
    $1 476,81
    $1 928,63     		$1 569,78
    $1 689,82
    $1 817,00
    $2 268,82     		$1 909,97
    $2 030,01
    $2 157,19
    $2 609,01     		$784,89
    $844,91
    $908,50
    $1 134,41     		$1 125,08
    $1 185,10
    $1 248,69
    $1 474,60     		$1 465,27
    $1 525,29
    $1 588,88
    $1 814,79     		$340,19
    Toc - Plan #71

    Silver

    (EPO) Ambetter Balanced Care 25 HSA (2021) + Vision + Adult Dental

    Annual Out of Pocket Expenses
    Individual Family
    $4,800 $9,600 Annual Deductible
    $4,800 $9,600 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$443,53
    $503,40
    $566,82
    $792,13
    $1 203,71     		$887,06
    $1 006,80
    $1 133,64
    $1 584,26
    $2 407,42     		$1 226,35
    $1 346,09
    $1 472,93
    $1 923,55     		$1 565,64
    $1 685,38
    $1 812,22
    $2 262,84     		$1 904,93
    $2 024,67
    $2 151,51
    $2 602,13     		$782,82
    $842,69
    $906,11
    $1 131,42     		$1 122,11
    $1 181,98
    $1 245,40
    $1 470,71     		$1 461,40
    $1 521,27
    $1 584,69
    $1 810,00     		$339,29
    Toc - Plan #72

    Silver

    (EPO) Ambetter Balanced Care 26 (2021) + Vision + Adult Dental

    Annual Out of Pocket Expenses
    Individual Family
    $5,450 $10,900 Annual Deductible
    $8,100 $16,200 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$452,21
    $513,25
    $577,91
    $807,63
    $1 227,27     		$904,42
    $1 026,50
    $1 155,82
    $1 615,26
    $2 454,54     		$1 250,35
    $1 372,43
    $1 501,75
    $1 961,19     		$1 596,28
    $1 718,36
    $1 847,68
    $2 307,12     		$1 942,21
    $2 064,29
    $2 193,61
    $2 653,05     		$798,14
    $859,18
    $923,84
    $1 153,56     		$1 144,07
    $1 205,11
    $1 269,77
    $1 499,49     		$1 490,00
    $1 551,04
    $1 615,70
    $1 845,42     		$345,93
    Toc - Plan #73

    Silver

    (EPO) Ambetter Balanced Care 27 (2021) + Vision + Adult Dental

    Annual Out of Pocket Expenses
    Individual Family
    $2,750 $5,500 Annual Deductible
    $6,500 $13,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$472,31
    $536,06
    $603,60
    $843,53
    $1 281,83     		$944,62
    $1 072,12
    $1 207,20
    $1 687,06
    $2 563,66     		$1 305,93
    $1 433,43
    $1 568,51
    $2 048,37     		$1 667,24
    $1 794,74
    $1 929,82
    $2 409,68     		$2 028,55
    $2 156,05
    $2 291,13
    $2 770,99     		$833,62
    $897,37
    $964,91
    $1 204,84     		$1 194,93
    $1 258,68
    $1 326,22
    $1 566,15     		$1 556,24
    $1 619,99
    $1 687,53
    $1 927,46     		$361,31
    Toc - Plan #74

    Silver

    (EPO) Ambetter Balanced Care 28 (2021) + Vision + Adult Dental

    Annual Out of Pocket Expenses
    Individual Family
    $0 $0 Annual Deductible
    $8,200 $16,400 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$481,13
    $546,07
    $614,87
    $859,28
    $1 305,75     		$962,26
    $1 092,14
    $1 229,74
    $1 718,56
    $2 611,50     		$1 330,31
    $1 460,19
    $1 597,79
    $2 086,61     		$1 698,36
    $1 828,24
    $1 965,84
    $2 454,66     		$2 066,41
    $2 196,29
    $2 333,89
    $2 822,71     		$849,18
    $914,12
    $982,92
    $1 227,33     		$1 217,23
    $1 282,17
    $1 350,97
    $1 595,38     		$1 585,28
    $1 650,22
    $1 719,02
    $1 963,43     		$368,05
    ADVERTISEMENT

    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 #75

    Platinum

    (HMO) BlueCare Platinum 2151 ($0 Virtual Visits / $100+ in Rewards)

    Annual Out of Pocket Expenses
    Individual Family
    $0 $0 Annual Deductible
    $2,000 $4,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$782,01
    $887,58
    $999,41
    $1 396,67
    $2 122,38     		$1 564,02
    $1 775,16
    $1 998,82
    $2 793,34
    $4 244,76     		$2 162,26
    $2 373,40
    $2 597,06
    $3 391,58     		$2 760,50
    $2 971,64
    $3 195,30
    $3 989,82     		$3 358,74
    $3 569,88
    $3 793,54
    $4 588,06     		$1 380,25
    $1 485,82
    $1 597,65
    $1 994,91     		$1 978,49
    $2 084,06
    $2 195,89
    $2 593,15     		$2 576,73
    $2 682,30
    $2 794,13
    $3 191,39     		$598,24
    Toc - Plan #76

    Expanded Bronze

    (HMO) BlueCare Bronze 2153 ($0 Virtual Visits / 3 PCP Visits for $20)

    Annual Out of Pocket Expenses
    Individual Family
    $8,500 $17,000 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$468,37
    $531,60
    $598,58
    $836,51
    $1 271,16     		$936,74
    $1 063,20
    $1 197,16
    $1 673,02
    $2 542,32     		$1 295,04
    $1 421,50
    $1 555,46
    $2 031,32     		$1 653,34
    $1 779,80
    $1 913,76
    $2 389,62     		$2 011,64
    $2 138,10
    $2 272,06
    $2 747,92     		$826,67
    $889,90
    $956,88
    $1 194,81     		$1 184,97
    $1 248,20
    $1 315,18
    $1 553,11     		$1 543,27
    $1 606,50
    $1 673,48
    $1 911,41     		$358,30
    Toc - Plan #77

    Bronze

    (HMO) BlueCare Bronze 2154 ($0 Virtual Visits / $100+ in Rewards)

    Annual Out of Pocket Expenses
    Individual Family
    $8,550 $17,100 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$421,78
    $478,72
    $539,03
    $753,30
    $1 144,71     		$843,56
    $957,44
    $1 078,06
    $1 506,60
    $2 289,42     		$1 166,22
    $1 280,10
    $1 400,72
    $1 829,26     		$1 488,88
    $1 602,76
    $1 723,38
    $2 151,92     		$1 811,54
    $1 925,42
    $2 046,04
    $2 474,58     		$744,44
    $801,38
    $861,69
    $1 075,96     		$1 067,10
    $1 124,04
    $1 184,35
    $1 398,62     		$1 389,76
    $1 446,70
    $1 507,01
    $1 721,28     		$322,66
    Toc - Plan #78

    Gold

    (HMO) BlueCare Gold 2156 ($0 Virtual Visits / $100+ in Rewards)

    Annual Out of Pocket Expenses
    Individual Family
    $0 $0 Annual Deductible
    $5,000 $10,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$668,85
    $759,14
    $854,79
    $1 194,57
    $1 815,26     		$1 337,70
    $1 518,28
    $1 709,58
    $2 389,14
    $3 630,52     		$1 849,37
    $2 029,95
    $2 221,25
    $2 900,81     		$2 361,04
    $2 541,62
    $2 732,92
    $3 412,48     		$2 872,71
    $3 053,29
    $3 244,59
    $3 924,15     		$1 180,52
    $1 270,81
    $1 366,46
    $1 706,24     		$1 692,19
    $1 782,48
    $1 878,13
    $2 217,91     		$2 203,86
    $2 294,15
    $2 389,80
    $2 729,58     		$511,67
    Toc - Plan #79

    Silver

    (HMO) BlueCare Silver 2157 ($0 Virtual Visits / $100+ in Rewards)

    Annual Out of Pocket Expenses
    Individual Family
    $8,000 $16,000 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$563,08
    $639,10
    $719,62
    $1 005,66
    $1 528,20     		$1 126,16
    $1 278,20
    $1 439,24
    $2 011,32
    $3 056,40     		$1 556,92
    $1 708,96
    $1 870,00
    $2 442,08     		$1 987,68
    $2 139,72
    $2 300,76
    $2 872,84     		$2 418,44
    $2 570,48
    $2 731,52
    $3 303,60     		$993,84
    $1 069,86
    $1 150,38
    $1 436,42     		$1 424,60
    $1 500,62
    $1 581,14
    $1 867,18     		$1 855,36
    $1 931,38
    $2 011,90
    $2 297,94     		$430,76
    Toc - Plan #80

    Expanded Bronze

    (HMO) BlueCare Bronze 2159 ($0 Deductible / $50 PCP Visits / $100+ in Rewards)

    Annual Out of Pocket Expenses
    Individual Family
    $0 $0 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$510,97
    $579,95
    $653,02
    $912,59
    $1 386,77     		$1 021,94
    $1 159,90
    $1 306,04
    $1 825,18
    $2 773,54     		$1 412,83
    $1 550,79
    $1 696,93
    $2 216,07     		$1 803,72
    $1 941,68
    $2 087,82
    $2 606,96     		$2 194,61
    $2 332,57
    $2 478,71
    $2 997,85     		$901,86
    $970,84
    $1 043,91
    $1 303,48     		$1 292,75
    $1 361,73
    $1 434,80
    $1 694,37     		$1 683,64
    $1 752,62
    $1 825,69
    $2 085,26     		$390,89
    Toc - Plan #81

    Expanded Bronze

    (HMO) myBlue Bronze 1601 ($0 Virtual Visits / 2 PCP Visits for $50)

    Annual Out of Pocket Expenses
    Individual Family
    $8,500 $17,000 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$318,68
    $361,70
    $407,27
    $569,16
    $864,90     		$637,36
    $723,40
    $814,54
    $1 138,32
    $1 729,80     		$881,15
    $967,19
    $1 058,33
    $1 382,11     		$1 124,94
    $1 210,98
    $1 302,12
    $1 625,90     		$1 368,73
    $1 454,77
    $1 545,91
    $1 869,69     		$562,47
    $605,49
    $651,06
    $812,95     		$806,26
    $849,28
    $894,85
    $1 056,74     		$1 050,05
    $1 093,07
    $1 138,64
    $1 300,53     		$243,79
    Toc - Plan #82

    Expanded Bronze

    (HMO) myBlue Bronze 1602 ($0 Labs / $0 Virtual Visits / $100+ in Rewards)

    Annual Out of Pocket Expenses
    Individual Family
    $8,550 $17,100 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$285,12
    $323,61
    $364,38
    $509,22
    $773,82     		$570,24
    $647,22
    $728,76
    $1 018,44
    $1 547,64     		$788,36
    $865,34
    $946,88
    $1 236,56     		$1 006,48
    $1 083,46
    $1 165,00
    $1 454,68     		$1 224,60
    $1 301,58
    $1 383,12
    $1 672,80     		$503,24
    $541,73
    $582,50
    $727,34     		$721,36
    $759,85
    $800,62
    $945,46     		$939,48
    $977,97
    $1 018,74
    $1 163,58     		$218,12
    Toc - Plan #83

    Silver

    (HMO) myBlue Silver 1603 ($0 Virtual Visits / $100+ in Rewards)

    Annual Out of Pocket Expenses
    Individual Family
    $5,900 $11,800 Annual Deductible
    $7,200 $14,400 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$413,67
    $469,52
    $528,67
    $738,81
    $1 122,70     		$827,34
    $939,04
    $1 057,34
    $1 477,62
    $2 245,40     		$1 143,80
    $1 255,50
    $1 373,80
    $1 794,08     		$1 460,26
    $1 571,96
    $1 690,26
    $2 110,54     		$1 776,72
    $1 888,42
    $2 006,72
    $2 427,00     		$730,13
    $785,98
    $845,13
    $1 055,27     		$1 046,59
    $1 102,44
    $1 161,59
    $1 371,73     		$1 363,05
    $1 418,90
    $1 478,05
    $1 688,19     		$316,46
    Toc - Plan #84

    Silver

    (HMO) myBlue Silver 1604 ($0 Labs / $0 Virtual Visits / $100+ in Rewards)

    Annual Out of Pocket Expenses
    Individual Family
    $5,800 $11,600 Annual Deductible
    $7,750 $15,500 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$378,77
    $429,90
    $484,07
    $676,48
    $1 027,98     		$757,54
    $859,80
    $968,14
    $1 352,96
    $2 055,96     		$1 047,30
    $1 149,56
    $1 257,90
    $1 642,72     		$1 337,06
    $1 439,32
    $1 547,66
    $1 932,48     		$1 626,82
    $1 729,08
    $1 837,42
    $2 222,24     		$668,53
    $719,66
    $773,83
    $966,24     		$958,29
    $1 009,42
    $1 063,59
    $1 256,00     		$1 248,05
    $1 299,18
    $1 353,35
    $1 545,76     		$289,76
    Toc - Plan #85

    Gold

    (HMO) myBlue Gold 1605 ($0 Labs / $0 Virtual Visits / $100+ in Rewards)

    Annual Out of Pocket Expenses
    Individual Family
    $940 $1,880 Annual Deductible
    $4,700 $9,400 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$429,08
    $487,01
    $548,36
    $766,34
    $1 164,52     		$858,16
    $974,02
    $1 096,72
    $1 532,68
    $2 329,04     		$1 186,41
    $1 302,27
    $1 424,97
    $1 860,93     		$1 514,66
    $1 630,52
    $1 753,22
    $2 189,18     		$1 842,91
    $1 958,77
    $2 081,47
    $2 517,43     		$757,33
    $815,26
    $876,61
    $1 094,59     		$1 085,58
    $1 143,51
    $1 204,86
    $1 422,84     		$1 413,83
    $1 471,76
    $1 533,11
    $1 751,09     		$328,25
    Toc - Plan #86

    Silver

    (HMO) myBlue Silver 1710 ($0 Virtual Visits / $100+ in Rewards)

    Annual Out of Pocket Expenses
    Individual Family
    $6,200 $12,400 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$430,79
    $488,95
    $550,55
    $769,39
    $1 169,16     		$861,58
    $977,90
    $1 101,10
    $1 538,78
    $2 338,32     		$1 191,13
    $1 307,45
    $1 430,65
    $1 868,33     		$1 520,68
    $1 637,00
    $1 760,20
    $2 197,88     		$1 850,23
    $1 966,55
    $2 089,75
    $2 527,43     		$760,34
    $818,50
    $880,10
    $1 098,94     		$1 089,89
    $1 148,05
    $1 209,65
    $1 428,49     		$1 419,44
    $1 477,60
    $1 539,20
    $1 758,04     		$329,55
    Toc - Plan #87

    Expanded Bronze

    (HMO) myBlue Bronze 1711S ($0 Virtual Visits / $55 PCP Visits / $100+ in Rewards)

    Annual Out of Pocket Expenses
    Individual Family
    $8,500 $17,000 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$316,77
    $359,53
    $404,83
    $565,75
    $859,71     		$633,54
    $719,06
    $809,66
    $1 131,50
    $1 719,42     		$875,87
    $961,39
    $1 051,99
    $1 373,83     		$1 118,20
    $1 203,72
    $1 294,32
    $1 616,16     		$1 360,53
    $1 446,05
    $1 536,65
    $1 858,49     		$559,10
    $601,86
    $647,16
    $808,08     		$801,43
    $844,19
    $889,49
    $1 050,41     		$1 043,76
    $1 086,52
    $1 131,82
    $1 292,74     		$242,33
    Toc - Plan #88

    Silver

    (HMO) myBlue Silver 1712S ($0 Virtual Visits / $100+ in Rewards)

    Annual Out of Pocket Expenses
    Individual Family
    $3,950 $7,900 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$422,56
    $479,61
    $540,03
    $754,69
    $1 146,83     		$845,12
    $959,22
    $1 080,06
    $1 509,38
    $2 293,66     		$1 168,38
    $1 282,48
    $1 403,32
    $1 832,64     		$1 491,64
    $1 605,74
    $1 726,58
    $2 155,90     		$1 814,90
    $1 929,00
    $2 049,84
    $2 479,16     		$745,82
    $802,87
    $863,29
    $1 077,95     		$1 069,08
    $1 126,13
    $1 186,55
    $1 401,21     		$1 392,34
    $1 449,39
    $1 509,81
    $1 724,47     		$323,26
    Toc - Plan #89

    Silver

    (HMO) myBlue Silver 2017 ($0 Labs / $0 Virtual Visits / $100+ in Rewards)

    Annual Out of Pocket Expenses
    Individual Family
    $7,700 $15,400 Annual Deductible
    $8,150 $16,300 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$370,99
    $421,07
    $474,13
    $662,59
    $1 006,87     		$741,98
    $842,14
    $948,26
    $1 325,18
    $2 013,74     		$1 025,79
    $1 125,95
    $1 232,07
    $1 608,99     		$1 309,60
    $1 409,76
    $1 515,88
    $1 892,80     		$1 593,41
    $1 693,57
    $1 799,69
    $2 176,61     		$654,80
    $704,88
    $757,94
    $946,40     		$938,61
    $988,69
    $1 041,75
    $1 230,21     		$1 222,42
    $1 272,50
    $1 325,56
    $1 514,02     		$283,81
    Toc - Plan #90

    Silver

    (HMO) myBlue Silver 2127 ($0 Labs / $0 Virtual Visits / $100+ in Rewards)

    Annual Out of Pocket Expenses
    Individual Family
    $8,450 $16,900 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$359,24
    $407,74
    $459,11
    $641,60
    $974,98     		$718,48
    $815,48
    $918,22
    $1 283,20
    $1 949,96     		$993,30
    $1 090,30
    $1 193,04
    $1 558,02     		$1 268,12
    $1 365,12
    $1 467,86
    $1 832,84     		$1 542,94
    $1 639,94
    $1 742,68
    $2 107,66     		$634,06
    $682,56
    $733,93
    $916,42     		$908,88
    $957,38
    $1 008,75
    $1 191,24     		$1 183,70
    $1 232,20
    $1 283,57
    $1 466,06     		$274,82
    Toc - Plan #91

    Expanded Bronze

    (HMO) myBlue Bronze 2129 ($0 Deductible / $50 PCP Visits / $75 Specialist Visits)

    Annual Out of Pocket Expenses
    Individual Family
    $0 $0 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$350,56
    $397,89
    $448,02
    $626,10
    $951,42     		$701,12
    $795,78
    $896,04
    $1 252,20
    $1 902,84     		$969,30
    $1 063,96
    $1 164,22
    $1 520,38     		$1 237,48
    $1 332,14
    $1 432,40
    $1 788,56     		$1 505,66
    $1 600,32
    $1 700,58
    $2 056,74     		$618,74
    $666,07
    $716,20
    $894,28     		$886,92
    $934,25
    $984,38
    $1 162,46     		$1 155,10
    $1 202,43
    $1 252,56
    $1 430,64     		$268,18
    Toc - Plan #92

    Expanded Bronze

    (HMO) myBlue Bronze 2126 (3 PCP Visits for $0 / $0 Virtual Visits)

    Annual Out of Pocket Expenses
    Individual Family
    $8,500 $17,000 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$316,56
    $359,30
    $404,56
    $565,38
    $859,14     		$633,12
    $718,60
    $809,12
    $1 130,76
    $1 718,28     		$875,29
    $960,77
    $1 051,29
    $1 372,93     		$1 117,46
    $1 202,94
    $1 293,46
    $1 615,10     		$1 359,63
    $1 445,11
    $1 535,63
    $1 857,27     		$558,73
    $601,47
    $646,73
    $807,55     		$800,90
    $843,64
    $888,90
    $1 049,72     		$1 043,07
    $1 085,81
    $1 131,07
    $1 291,89     		$242,17
    ADVERTISEMENT

    Health First Commercial Plans, Inc.

    Local: 1-855-443-4735 | Toll Free: 1-855-443-4735 | TTY: 1-800-955-8771
    Toc - Plan #93

    Gold

    (HMO) AdventHealth GYM ACCESS Gold HMO 90 HSA 1745

    Annual Out of Pocket Expenses
    Individual Family
    $1,700 $3,400 Annual Deductible
    $4,000 $8,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$447,05
    $507,41
    $571,33
    $798,44
    $1 213,30     		$894,10
    $1 014,82
    $1 142,66
    $1 596,88
    $2 426,60     		$1 236,10
    $1 356,82
    $1 484,66
    $1 938,88     		$1 578,10
    $1 698,82
    $1 826,66
    $2 280,88     		$1 920,10
    $2 040,82
    $2 168,66
    $2 622,88     		$789,05
    $849,41
    $913,33
    $1 140,44     		$1 131,05
    $1 191,41
    $1 255,33
    $1 482,44     		$1 473,05
    $1 533,41
    $1 597,33
    $1 824,44     		$342,00
    Toc - Plan #94

    Silver

    (HMO) AdventHealth GYM ACCESS Silver HMO 80 1696

    Annual Out of Pocket Expenses
    Individual Family
    $4,950 $9,900 Annual Deductible
    $7,900 $15,800 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$422,64
    $479,70
    $540,13
    $754,84
    $1 147,05     		$845,28
    $959,40
    $1 080,26
    $1 509,68
    $2 294,10     		$1 168,60
    $1 282,72
    $1 403,58
    $1 833,00     		$1 491,92
    $1 606,04
    $1 726,90
    $2 156,32     		$1 815,24
    $1 929,36
    $2 050,22
    $2 479,64     		$745,96
    $803,02
    $863,45
    $1 078,16     		$1 069,28
    $1 126,34
    $1 186,77
    $1 401,48     		$1 392,60
    $1 449,66
    $1 510,09
    $1 724,80     		$323,32
    Toc - Plan #95

    Catastrophic

    (HMO) AdventHealth GYM ACCESS Catastrophic HMO 1748

    Annual Out of Pocket Expenses
    Individual Family
    $8,550 $17,100 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$172,62
    $195,92
    $220,60
    $308,29
    $468,48     		$345,24
    $391,84
    $441,20
    $616,58
    $936,96     		$477,29
    $523,89
    $573,25
    $748,63     		$609,34
    $655,94
    $705,30
    $880,68     		$741,39
    $787,99
    $837,35
    $1 012,73     		$304,67
    $327,97
    $352,65
    $440,34     		$436,72
    $460,02
    $484,70
    $572,39     		$568,77
    $592,07
    $616,75
    $704,44     		$132,05
    Toc - Plan #96

    Gold

    (HMO) AdventHealth GYM ACCESS Gold HMO 70 1743

    Annual Out of Pocket Expenses
    Individual Family
    $1,500 $3,000 Annual Deductible
    $5,150 $10,300 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$448,28
    $508,79
    $572,90
    $800,62
    $1 216,62     		$896,56
    $1 017,58
    $1 145,80
    $1 601,24
    $2 433,24     		$1 239,49
    $1 360,51
    $1 488,73
    $1 944,17     		$1 582,42
    $1 703,44
    $1 831,66
    $2 287,10     		$1 925,35
    $2 046,37
    $2 174,59
    $2 630,03     		$791,21
    $851,72
    $915,83
    $1 143,55     		$1 134,14
    $1 194,65
    $1 258,76
    $1 486,48     		$1 477,07
    $1 537,58
    $1 601,69
    $1 829,41     		$342,93
    Toc - Plan #97

    Gold

    (HMO) AdventHealth GYM ACCESS Gold HMO 100 1738

    Annual Out of Pocket Expenses
    Individual Family
    $2,650 $5,300 Annual Deductible
    $6,800 $13,600 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$438,08
    $497,22
    $559,86
    $782,41
    $1 188,94     		$876,16
    $994,44
    $1 119,72
    $1 564,82
    $2 377,88     		$1 211,29
    $1 329,57
    $1 454,85
    $1 899,95     		$1 546,42
    $1 664,70
    $1 789,98
    $2 235,08     		$1 881,55
    $1 999,83
    $2 125,11
    $2 570,21     		$773,21
    $832,35
    $894,99
    $1 117,54     		$1 108,34
    $1 167,48
    $1 230,12
    $1 452,67     		$1 443,47
    $1 502,61
    $1 565,25
    $1 787,80     		$335,13
    Toc - Plan #98

    Gold

    (HMO) AdventHealth GYM ACCESS Gold HMO 80 1741

    Annual Out of Pocket Expenses
    Individual Family
    $2,900 $5,800 Annual Deductible
    $7,900 $15,800 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$426,50
    $484,08
    $545,07
    $761,73
    $1 157,52     		$853,00
    $968,16
    $1 090,14
    $1 523,46
    $2 315,04     		$1 179,27
    $1 294,43
    $1 416,41
    $1 849,73     		$1 505,54
    $1 620,70
    $1 742,68
    $2 176,00     		$1 831,81
    $1 946,97
    $2 068,95
    $2 502,27     		$752,77
    $810,35
    $871,34
    $1 088,00     		$1 079,04
    $1 136,62
    $1 197,61
    $1 414,27     		$1 405,31
    $1 462,89
    $1 523,88
    $1 740,54     		$326,27
    Toc - Plan #99

    Silver

    (HMO) AdventHealth GYM ACCESS Silver HMO 100 1668

    Annual Out of Pocket Expenses
    Individual Family
    $5,750 $11,500 Annual Deductible
    $8,150 $16,300 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$431,61
    $489,87
    $551,59
    $770,85
    $1 171,38     		$863,22
    $979,74
    $1 103,18
    $1 541,70
    $2 342,76     		$1 193,40
    $1 309,92
    $1 433,36
    $1 871,88     		$1 523,58
    $1 640,10
    $1 763,54
    $2 202,06     		$1 853,76
    $1 970,28
    $2 093,72
    $2 532,24     		$761,79
    $820,05
    $881,77
    $1 101,03     		$1 091,97
    $1 150,23
    $1 211,95
    $1 431,21     		$1 422,15
    $1 480,41
    $1 542,13
    $1 761,39     		$330,18
    Toc - Plan #100

    Expanded Bronze

    (HMO) AdventHealth GYM ACCESS Bronze HMO 100 HSA 1660

    Annual Out of Pocket Expenses
    Individual Family
    $6,900 $13,800 Annual Deductible
    $6,900 $13,800 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$324,29
    $368,07
    $414,45
    $579,19
    $880,13     		$648,58
    $736,14
    $828,90
    $1 158,38
    $1 760,26     		$896,66
    $984,22
    $1 076,98
    $1 406,46     		$1 144,74
    $1 232,30
    $1 325,06
    $1 654,54     		$1 392,82
    $1 480,38
    $1 573,14
    $1 902,62     		$572,37
    $616,15
    $662,53
    $827,27     		$820,45
    $864,23
    $910,61
    $1 075,35     		$1 068,53
    $1 112,31
    $1 158,69
    $1 323,43     		$248,08
    Toc - Plan #101

    Expanded Bronze

    (HMO) AdventHealthGYM ACCESS Bronze HMO 50 1797

    Annual Out of Pocket Expenses
    Individual Family
    $6,900 $13,800 Annual Deductible
    $8,200 $16,400 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$314,97
    $357,49
    $402,53
    $562,53
    $854,82     		$629,94
    $714,98
    $805,06
    $1 125,06
    $1 709,64     		$870,89
    $955,93
    $1 046,01
    $1 366,01     		$1 111,84
    $1 196,88
    $1 286,96
    $1 606,96     		$1 352,79
    $1 437,83
    $1 527,91
    $1 847,91     		$555,92
    $598,44
    $643,48
    $803,48     		$796,87
    $839,39
    $884,43
    $1 044,43     		$1 037,82
    $1 080,34
    $1 125,38
    $1 285,38     		$240,95
    Toc - Plan #102

    Expanded Bronze

    (HMO) AdventHealth GYM ACCESS Bronze HMO 60 1657

    Annual Out of Pocket Expenses
    Individual Family
    $7,550 $15,100 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$319,91
    $363,10
    $408,84
    $571,36
    $868,23     		$639,82
    $726,20
    $817,68
    $1 142,72
    $1 736,46     		$884,55
    $970,93
    $1 062,41
    $1 387,45     		$1 129,28
    $1 215,66
    $1 307,14
    $1 632,18     		$1 374,01
    $1 460,39
    $1 551,87
    $1 876,91     		$564,64
    $607,83
    $653,57
    $816,09     		$809,37
    $852,56
    $898,30
    $1 060,82     		$1 054,10
    $1 097,29
    $1 143,03
    $1 305,55     		$244,73
    Toc - Plan #103

    Expanded Bronze

    (HMO) AdventHealth Bronze HMO 60 1752

    Annual Out of Pocket Expenses
    Individual Family
    $8,500 $17,000 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$314,97
    $357,49
    $402,53
    $562,53
    $854,82     		$629,94
    $714,98
    $805,06
    $1 125,06
    $1 709,64     		$870,89
    $955,93
    $1 046,01
    $1 366,01     		$1 111,84
    $1 196,88
    $1 286,96
    $1 606,96     		$1 352,79
    $1 437,83
    $1 527,91
    $1 847,91     		$555,92
    $598,44
    $643,48
    $803,48     		$796,87
    $839,39
    $884,43
    $1 044,43     		$1 037,82
    $1 080,34
    $1 125,38
    $1 285,38     		$240,95
    Toc - Plan #104

    Gold

    (HMO) AdventHealth Gold HMO 80 1772

    Annual Out of Pocket Expenses
    Individual Family
    $1,600 $3,200 Annual Deductible
    $6,900 $13,800 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$428,54
    $486,40
    $547,68
    $765,38
    $1 163,07     		$857,08
    $972,80
    $1 095,36
    $1 530,76
    $2 326,14     		$1 184,92
    $1 300,64
    $1 423,20
    $1 858,60     		$1 512,76
    $1 628,48
    $1 751,04
    $2 186,44     		$1 840,60
    $1 956,32
    $2 078,88
    $2 514,28     		$756,38
    $814,24
    $875,52
    $1 093,22     		$1 084,22
    $1 142,08
    $1 203,36
    $1 421,06     		$1 412,06
    $1 469,92
    $1 531,20
    $1 748,90     		$327,84
    Toc - Plan #105

    Bronze

    (HMO) AdventHealth Bronze HMO 100 1776

    Annual Out of Pocket Expenses
    Individual Family
    $8,250 $16,500 Annual Deductible
    $8,250 $16,500 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$309,09
    $350,82
    $395,02
    $552,04
    $838,88     		$618,18
    $701,64
    $790,04
    $1 104,08
    $1 677,76     		$854,64
    $938,10
    $1 026,50
    $1 340,54     		$1 091,10
    $1 174,56
    $1 262,96
    $1 577,00     		$1 327,56
    $1 411,02
    $1 499,42
    $1 813,46     		$545,55
    $587,28
    $631,48
    $788,50     		$782,01
    $823,74
    $867,94
    $1 024,96     		$1 018,47
    $1 060,20
    $1 104,40
    $1 261,42     		$236,46
    Toc - Plan #106

    Expanded Bronze

    (HMO) AdventHealth Bronze HMO 100 HSA 1795

    Annual Out of Pocket Expenses
    Individual Family
    $6,900 $13,800 Annual Deductible
    $6,900 $13,800 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$320,61
    $363,89
    $409,74
    $572,61
    $870,13     		$641,22
    $727,78
    $819,48
    $1 145,22
    $1 740,26     		$886,49
    $973,05
    $1 064,75
    $1 390,49     		$1 131,76
    $1 218,32
    $1 310,02
    $1 635,76     		$1 377,03
    $1 463,59
    $1 555,29
    $1 881,03     		$565,88
    $609,16
    $655,01
    $817,88     		$811,15
    $854,43
    $900,28
    $1 063,15     		$1 056,42
    $1 099,70
    $1 145,55
    $1 308,42     		$245,27
    Toc - Plan #107

    Silver

    (HMO) AdventHealth Silver HMO 65 1810

    Annual Out of Pocket Expenses
    Individual Family
    $2,900 $5,800 Annual Deductible
    $8,150 $16,300 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$415,53
    $471,62
    $531,04
    $742,13
    $1 127,74     		$831,06
    $943,24
    $1 062,08
    $1 484,26
    $2 255,48     		$1 148,94
    $1 261,12
    $1 379,96
    $1 802,14     		$1 466,82
    $1 579,00
    $1 697,84
    $2 120,02     		$1 784,70
    $1 896,88
    $2 015,72
    $2 437,90     		$733,41
    $789,50
    $848,92
    $1 060,01     		$1 051,29
    $1 107,38
    $1 166,80
    $1 377,89     		$1 369,17
    $1 425,26
    $1 484,68
    $1 695,77     		$317,88
    Toc - Plan #108

    Expanded Bronze

    (HMO) AdventHealth Bronze VALUE RX 50 1820

    Annual Out of Pocket Expenses
    Individual Family
    $8,300 $16,600 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$293,54
    $333,17
    $375,15
    $524,27
    $796,67     		$587,08
    $666,34
    $750,30
    $1 048,54
    $1 593,34     		$811,64
    $890,90
    $974,86
    $1 273,10     		$1 036,20
    $1 115,46
    $1 199,42
    $1 497,66     		$1 260,76
    $1 340,02
    $1 423,98
    $1 722,22     		$518,10
    $557,73
    $599,71
    $748,83     		$742,66
    $782,29
    $824,27
    $973,39     		$967,22
    $1 006,85
    $1 048,83
    $1 197,95     		$224,56
    Toc - Plan #109

    Silver

    (HMO) AdventHealth Silver VALUE RX 80 1821

    Annual Out of Pocket Expenses
    Individual Family
    $7,100 $14,200 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$394,90
    $448,21
    $504,68
    $705,28
    $1 071,75     		$789,80
    $896,42
    $1 009,36
    $1 410,56
    $2 143,50     		$1 091,90
    $1 198,52
    $1 311,46
    $1 712,66     		$1 394,00
    $1 500,62
    $1 613,56
    $2 014,76     		$1 696,10
    $1 802,72
    $1 915,66
    $2 316,86     		$697,00
    $750,31
    $806,78
    $1 007,38     		$999,10
    $1 052,41
    $1 108,88
    $1 309,48     		$1 301,20
    $1 354,51
    $1 410,98
    $1 611,58     		$302,10
    Toc - Plan #110

    Gold

    (HMO) AdventHealth Gold VALUE RX 75 1825

    Annual Out of Pocket Expenses
    Individual Family
    $4,000 $8,000 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$411,76
    $467,35
    $526,23
    $735,40
    $1 117,52     		$823,52
    $934,70
    $1 052,46
    $1 470,80
    $2 235,04     		$1 138,52
    $1 249,70
    $1 367,46
    $1 785,80     		$1 453,52
    $1 564,70
    $1 682,46
    $2 100,80     		$1 768,52
    $1 879,70
    $1 997,46
    $2 415,80     		$726,76
    $782,35
    $841,23
    $1 050,40     		$1 041,76
    $1 097,35
    $1 156,23
    $1 365,40     		$1 356,76
    $1 412,35
    $1 471,23
    $1 680,40     		$315,00
    ADVERTISEMENT

    Oscar Insurance Company of Florida

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

    Toc - Plan #111

    Expanded Bronze

    (EPO) Oscar Bronze Simple

    Annual Out of Pocket Expenses
    Individual Family
    $7,300 $14,600 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$275,20
    $312,34
    $351,70
    $491,49
    $746,87     		$550,40
    $624,68
    $703,40
    $982,98
    $1 493,74     		$760,92
    $835,20
    $913,92
    $1 193,50     		$971,44
    $1 045,72
    $1 124,44
    $1 404,02     		$1 181,96
    $1 256,24
    $1 334,96
    $1 614,54     		$485,72
    $522,86
    $562,22
    $702,01     		$696,24
    $733,38
    $772,74
    $912,53     		$906,76
    $943,90
    $983,26
    $1 123,05     		$210,52
    Toc - Plan #112

    Expanded Bronze

    (EPO) Oscar Bronze Classic PCP Copay

    Annual Out of Pocket Expenses
    Individual Family
    $6,000 $12,000 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$287,37
    $326,15
    $367,25
    $513,23
    $779,90     		$574,74
    $652,30
    $734,50
    $1 026,46
    $1 559,80     		$794,57
    $872,13
    $954,33
    $1 246,29     		$1 014,40
    $1 091,96
    $1 174,16
    $1 466,12     		$1 234,23
    $1 311,79
    $1 393,99
    $1 685,95     		$507,20
    $545,98
    $587,08
    $733,06     		$727,03
    $765,81
    $806,91
    $952,89     		$946,86
    $985,64
    $1 026,74
    $1 172,72     		$219,83
    Toc - Plan #113

    Expanded Bronze

    (EPO) Oscar Bronze Classic

    Annual Out of Pocket Expenses
    Individual Family
    $6,000 $12,000 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$277,98
    $315,49
    $355,24
    $496,45
    $754,40     		$555,96
    $630,98
    $710,48
    $992,90
    $1 508,80     		$768,61
    $843,63
    $923,13
    $1 205,55     		$981,26
    $1 056,28
    $1 135,78
    $1 418,20     		$1 193,91
    $1 268,93
    $1 348,43
    $1 630,85     		$490,63
    $528,14
    $567,89
    $709,10     		$703,28
    $740,79
    $780,54
    $921,75     		$915,93
    $953,44
    $993,19
    $1 134,40     		$212,65
    Toc - Plan #114

    Expanded Bronze

    (EPO) Oscar Bronze Classic Next

    Annual Out of Pocket Expenses
    Individual Family
    $0 $0 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$327,44
    $371,63
    $418,45
    $584,78
    $888,63     		$654,88
    $743,26
    $836,90
    $1 169,56
    $1 777,26     		$905,36
    $993,74
    $1 087,38
    $1 420,04     		$1 155,84
    $1 244,22
    $1 337,86
    $1 670,52     		$1 406,32
    $1 494,70
    $1 588,34
    $1 921,00     		$577,92
    $622,11
    $668,93
    $835,26     		$828,40
    $872,59
    $919,41
    $1 085,74     		$1 078,88
    $1 123,07
    $1 169,89
    $1 336,22     		$250,48
    Toc - Plan #115

    Silver

    (EPO) Oscar Silver Classic

    Annual Out of Pocket Expenses
    Individual Family
    $5,000 $10,000 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$363,21
    $412,23
    $464,17
    $648,68
    $985,73     		$726,42
    $824,46
    $928,34
    $1 297,36
    $1 971,46     		$1 004,27
    $1 102,31
    $1 206,19
    $1 575,21     		$1 282,12
    $1 380,16
    $1 484,04
    $1 853,06     		$1 559,97
    $1 658,01
    $1 761,89
    $2 130,91     		$641,06
    $690,08
    $742,02
    $926,53     		$918,91
    $967,93
    $1 019,87
    $1 204,38     		$1 196,76
    $1 245,78
    $1 297,72
    $1 482,23     		$277,85
    Toc - Plan #116

    Silver

    (EPO) Oscar Silver Saver 2

    Annual Out of Pocket Expenses
    Individual Family
    $6,200 $12,400 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$359,31
    $407,80
    $459,18
    $641,71
    $975,13     		$718,62
    $815,60
    $918,36
    $1 283,42
    $1 950,26     		$993,48
    $1 090,46
    $1 193,22
    $1 558,28     		$1 268,34
    $1 365,32
    $1 468,08
    $1 833,14     		$1 543,20
    $1 640,18
    $1 742,94
    $2 108,00     		$634,17
    $682,66
    $734,04
    $916,57     		$909,03
    $957,52
    $1 008,90
    $1 191,43     		$1 183,89
    $1 232,38
    $1 283,76
    $1 466,29     		$274,86
    Toc - Plan #117

    Silver

    (EPO) Oscar Silver Classic Next

    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:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$362,03
    $410,89
    $462,66
    $646,57
    $982,52     		$724,06
    $821,78
    $925,32
    $1 293,14
    $1 965,04     		$1 001,01
    $1 098,73
    $1 202,27
    $1 570,09     		$1 277,96
    $1 375,68
    $1 479,22
    $1 847,04     		$1 554,91
    $1 652,63
    $1 756,17
    $2 123,99     		$638,98
    $687,84
    $739,61
    $923,52     		$915,93
    $964,79
    $1 016,56
    $1 200,47     		$1 192,88
    $1 241,74
    $1 293,51
    $1 477,42     		$276,95
    Toc - Plan #118

    Catastrophic

    (EPO) Oscar Secure

    Annual Out of Pocket Expenses
    Individual Family
    $8,550 $17,100 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$226,04
    $256,55
    $288,87
    $403,70
    $613,46     		$452,08
    $513,10
    $577,74
    $807,40
    $1 226,92     		$625,00
    $686,02
    $750,66
    $980,32     		$797,92
    $858,94
    $923,58
    $1 153,24     		$970,84
    $1 031,86
    $1 096,50
    $1 326,16     		$398,96
    $429,47
    $461,79
    $576,62     		$571,88
    $602,39
    $634,71
    $749,54     		$744,80
    $775,31
    $807,63
    $922,46     		$172,92
    Toc - Plan #119

    Expanded Bronze

    (EPO) Oscar Bronze Classic Next 2

    Annual Out of Pocket Expenses
    Individual Family
    $0 $0 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$328,06
    $372,34
    $419,25
    $585,90
    $890,34     		$656,12
    $744,68
    $838,50
    $1 171,80
    $1 780,68     		$907,08
    $995,64
    $1 089,46
    $1 422,76     		$1 158,04
    $1 246,60
    $1 340,42
    $1 673,72     		$1 409,00
    $1 497,56
    $1 591,38
    $1 924,68     		$579,02
    $623,30
    $670,21
    $836,86     		$829,98
    $874,26
    $921,17
    $1 087,82     		$1 080,94
    $1 125,22
    $1 172,13
    $1 338,78     		$250,96
    Toc - Plan #120

    Gold

    (EPO) Oscar Gold Classic

    Annual Out of Pocket Expenses
    Individual Family
    $2,500 $5,000 Annual Deductible
    $6,000 $12,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$382,43
    $434,05
    $488,73
    $683,00
    $1 037,89     		$764,86
    $868,10
    $977,46
    $1 366,00
    $2 075,78     		$1 057,41
    $1 160,65
    $1 270,01
    $1 658,55     		$1 349,96
    $1 453,20
    $1 562,56
    $1 951,10     		$1 642,51
    $1 745,75
    $1 855,11
    $2 243,65     		$674,98
    $726,60
    $781,28
    $975,55     		$967,53
    $1 019,15
    $1 073,83
    $1 268,10     		$1 260,08
    $1 311,70
    $1 366,38
    $1 560,65     		$292,55
    Toc - Plan #121

    Expanded Bronze

    (EPO) Oscar Bronze HDHP

    Annual Out of Pocket Expenses
    Individual Family
    $5,200 $10,400 Annual Deductible
    $7,000 $14,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$292,66
    $332,15
    $374,00
    $522,67
    $794,24     		$585,32
    $664,30
    $748,00
    $1 045,34
    $1 588,48     		$809,19
    $888,17
    $971,87
    $1 269,21     		$1 033,06
    $1 112,04
    $1 195,74
    $1 493,08     		$1 256,93
    $1 335,91
    $1 419,61
    $1 716,95     		$516,53
    $556,02
    $597,87
    $746,54     		$740,40
    $779,89
    $821,74
    $970,41     		$964,27
    $1 003,76
    $1 045,61
    $1 194,28     		$223,87
    Toc - Plan #122

    Silver

    (EPO) Oscar Silver Saver

    Annual Out of Pocket Expenses
    Individual Family
    $4,200 $8,400 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$358,53
    $406,91
    $458,18
    $640,31
    $973,01     		$717,06
    $813,82
    $916,36
    $1 280,62
    $1 946,02     		$991,32
    $1 088,08
    $1 190,62
    $1 554,88     		$1 265,58
    $1 362,34
    $1 464,88
    $1 829,14     		$1 539,84
    $1 636,60
    $1 739,14
    $2 103,40     		$632,79
    $681,17
    $732,44
    $914,57     		$907,05
    $955,43
    $1 006,70
    $1 188,83     		$1 181,31
    $1 229,69
    $1 280,96
    $1 463,09     		$274,26
    Toc - Plan #123

    Silver

    (EPO) Oscar Silver Classic Copay

    Annual Out of Pocket Expenses
    Individual Family
    $7,000 $14,000 Annual Deductible
    $8,200 $16,400 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$368,73
    $418,50
    $471,23
    $658,54
    $1 000,71     		$737,46
    $837,00
    $942,46
    $1 317,08
    $2 001,42     		$1 019,53
    $1 119,07
    $1 224,53
    $1 599,15     		$1 301,60
    $1 401,14
    $1 506,60
    $1 881,22     		$1 583,67
    $1 683,21
    $1 788,67
    $2 163,29     		$650,80
    $700,57
    $753,30
    $940,61     		$932,87
    $982,64
    $1 035,37
    $1 222,68     		$1 214,94
    $1 264,71
    $1 317,44
    $1 504,75     		$282,07
    Toc - Plan #124

    Silver

    (EPO) Oscar Silver Classic $0 Ded

    Annual Out of Pocket Expenses
    Individual Family
    $0 $0 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$371,39
    $421,52
    $474,62
    $663,28
    $1 007,92     		$742,78
    $843,04
    $949,24
    $1 326,56
    $2 015,84     		$1 026,89
    $1 127,15
    $1 233,35
    $1 610,67     		$1 311,00
    $1 411,26
    $1 517,46
    $1 894,78     		$1 595,11
    $1 695,37
    $1 801,57
    $2 178,89     		$655,50
    $705,63
    $758,73
    $947,39     		$939,61
    $989,74
    $1 042,84
    $1 231,50     		$1 223,72
    $1 273,85
    $1 326,95
    $1 515,61     		$284,11
    ADVERTISEMENT

    Cigna Healthcare

    Local: 1-877-900-1237 | Toll Free: 1-877-900-1237 | TTY: 1-800-676-3777
    Toc - Plan #125

    Bronze

    (EPO) Cigna Connect 8550

    Annual Out of Pocket Expenses
    Individual Family
    $8,550 $17,100 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$309,47
    $351,24
    $395,50
    $552,71
    $839,89     		$618,94
    $702,48
    $791,00
    $1 105,42
    $1 679,78     		$855,68
    $939,22
    $1 027,74
    $1 342,16     		$1 092,42
    $1 175,96
    $1 264,48
    $1 578,90     		$1 329,16
    $1 412,70
    $1 501,22
    $1 815,64     		$546,21
    $587,98
    $632,24
    $789,45     		$782,95
    $824,72
    $868,98
    $1 026,19     		$1 019,69
    $1 061,46
    $1 105,72
    $1 262,93     		$236,74
    Toc - Plan #126

    Expanded Bronze

    (EPO) Cigna Connect 6500

    Annual Out of Pocket Expenses
    Individual Family
    $6,500 $13,000 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$324,69
    $368,52
    $414,95
    $579,90
    $881,21     		$649,38
    $737,04
    $829,90
    $1 159,80
    $1 762,42     		$897,77
    $985,43
    $1 078,29
    $1 408,19     		$1 146,16
    $1 233,82
    $1 326,68
    $1 656,58     		$1 394,55
    $1 482,21
    $1 575,07
    $1 904,97     		$573,08
    $616,91
    $663,34
    $828,29     		$821,47
    $865,30
    $911,73
    $1 076,68     		$1 069,86
    $1 113,69
    $1 160,12
    $1 325,07     		$248,39
    Toc - Plan #127

    Expanded Bronze

    (EPO) Cigna Connect 7000

    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:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$321,71
    $365,14
    $411,14
    $574,57
    $873,11     		$643,42
    $730,28
    $822,28
    $1 149,14
    $1 746,22     		$889,53
    $976,39
    $1 068,39
    $1 395,25     		$1 135,64
    $1 222,50
    $1 314,50
    $1 641,36     		$1 381,75
    $1 468,61
    $1 560,61
    $1 887,47     		$567,82
    $611,25
    $657,25
    $820,68     		$813,93
    $857,36
    $903,36
    $1 066,79     		$1 060,04
    $1 103,47
    $1 149,47
    $1 312,90     		$246,11
    Toc - Plan #128

    Silver

    (EPO) Cigna Connect 6000

    Annual Out of Pocket Expenses
    Individual Family
    $6,000 $12,000 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$394,07
    $447,27
    $503,62
    $703,80
    $1 069,50     		$788,14
    $894,54
    $1 007,24
    $1 407,60
    $2 139,00     		$1 089,60
    $1 196,00
    $1 308,70
    $1 709,06     		$1 391,06
    $1 497,46
    $1 610,16
    $2 010,52     		$1 692,52
    $1 798,92
    $1 911,62
    $2 311,98     		$695,53
    $748,73
    $805,08
    $1 005,26     		$996,99
    $1 050,19
    $1 106,54
    $1 306,72     		$1 298,45
    $1 351,65
    $1 408,00
    $1 608,18     		$301,46
    Toc - Plan #129

    Silver

    (EPO) Cigna Connect 4500

    Annual Out of Pocket Expenses
    Individual Family
    $4,500 $9,000 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$397,40
    $451,05
    $507,87
    $709,75
    $1 078,54     		$794,80
    $902,10
    $1 015,74
    $1 419,50
    $2 157,08     		$1 098,81
    $1 206,11
    $1 319,75
    $1 723,51     		$1 402,82
    $1 510,12
    $1 623,76
    $2 027,52     		$1 706,83
    $1 814,13
    $1 927,77
    $2 331,53     		$701,41
    $755,06
    $811,88
    $1 013,76     		$1 005,42
    $1 059,07
    $1 115,89
    $1 317,77     		$1 309,43
    $1 363,08
    $1 419,90
    $1 621,78     		$304,01
    Toc - Plan #130

    Silver

    (EPO) Cigna Connect 7200

    Annual Out of Pocket Expenses
    Individual Family
    $7,200 $14,400 Annual Deductible
    $7,200 $14,400 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$400,21
    $454,24
    $511,47
    $714,77
    $1 086,17     		$800,42
    $908,48
    $1 022,94
    $1 429,54
    $2 172,34     		$1 106,58
    $1 214,64
    $1 329,10
    $1 735,70     		$1 412,74
    $1 520,80
    $1 635,26
    $2 041,86     		$1 718,90
    $1 826,96
    $1 941,42
    $2 348,02     		$706,37
    $760,40
    $817,63
    $1 020,93     		$1 012,53
    $1 066,56
    $1 123,79
    $1 327,09     		$1 318,69
    $1 372,72
    $1 429,95
    $1 633,25     		$306,16
    Toc - Plan #131

    Silver

    (EPO) Cigna Connect 3500

    Annual Out of Pocket Expenses
    Individual Family
    $3,500 $7,000 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$409,81
    $465,13
    $523,74
    $731,92
    $1 112,23     		$819,62
    $930,26
    $1 047,48
    $1 463,84
    $2 224,46     		$1 133,12
    $1 243,76
    $1 360,98
    $1 777,34     		$1 446,62
    $1 557,26
    $1 674,48
    $2 090,84     		$1 760,12
    $1 870,76
    $1 987,98
    $2 404,34     		$723,31
    $778,63
    $837,24
    $1 045,42     		$1 036,81
    $1 092,13
    $1 150,74
    $1 358,92     		$1 350,31
    $1 405,63
    $1 464,24
    $1 672,42     		$313,50
    Toc - Plan #132

    Gold

    (EPO) Cigna Connect 2000

    Annual Out of Pocket Expenses
    Individual Family
    $2,000 $4,000 Annual Deductible
    $8,000 $16,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$446,75
    $507,06
    $570,94
    $797,89
    $1 212,47     		$893,50
    $1 014,12
    $1 141,88
    $1 595,78
    $2 424,94     		$1 235,26
    $1 355,88
    $1 483,64
    $1 937,54     		$1 577,02
    $1 697,64
    $1 825,40
    $2 279,30     		$1 918,78
    $2 039,40
    $2 167,16
    $2 621,06     		$788,51
    $848,82
    $912,70
    $1 139,65     		$1 130,27
    $1 190,58
    $1 254,46
    $1 481,41     		$1 472,03
    $1 532,34
    $1 596,22
    $1 823,17     		$341,76
    Toc - Plan #133

    Expanded Bronze

    (EPO) Cigna Connect 5500

    Annual Out of Pocket Expenses
    Individual Family
    $5,500 $11,000 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$326,72
    $370,83
    $417,55
    $583,53
    $886,73     		$653,44
    $741,66
    $835,10
    $1 167,06
    $1 773,46     		$903,38
    $991,60
    $1 085,04
    $1 417,00     		$1 153,32
    $1 241,54
    $1 334,98
    $1 666,94     		$1 403,26
    $1 491,48
    $1 584,92
    $1 916,88     		$576,66
    $620,77
    $667,49
    $833,47     		$826,60
    $870,71
    $917,43
    $1 083,41     		$1 076,54
    $1 120,65
    $1 167,37
    $1 333,35     		$249,94
    Toc - Plan #134

    Silver

    (EPO) Cigna Connect 3500 Diabetes Care

    Annual Out of Pocket Expenses
    Individual Family
    $3,500 $7,000 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$413,66
    $469,50
    $528,66
    $738,80
    $1 122,67     		$827,32
    $939,00
    $1 057,32
    $1 477,60
    $2 245,34     		$1 143,77
    $1 255,45
    $1 373,77
    $1 794,05     		$1 460,22
    $1 571,90
    $1 690,22
    $2 110,50     		$1 776,67
    $1 888,35
    $2 006,67
    $2 426,95     		$730,11
    $785,95
    $845,11
    $1 055,25     		$1 046,56
    $1 102,40
    $1 161,56
    $1 371,70     		$1 363,01
    $1 418,85
    $1 478,01
    $1 688,15     		$316,45
    ADVERTISEMENT

    Molina Healthcare

    Local: 1-888-560-5716 | Toll Free: 1-888-560-5716 | TTY: 1-800-955-8771
    Toc - Plan #135

    Gold

    (HMO) Confident Care Gold 1

    Annual Out of Pocket Expenses
    Individual Family
    $2,925 $5,850 Annual Deductible
    $6,500 $13,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$439,84
    $499,22
    $562,12
    $785,56
    $1 193,74     		$879,68
    $998,44
    $1 124,24
    $1 571,12
    $2 387,48     		$1 216,16
    $1 334,92
    $1 460,72
    $1 907,60     		$1 552,64
    $1 671,40
    $1 797,20
    $2 244,08     		$1 889,12
    $2 007,88
    $2 133,68
    $2 580,56     		$776,32
    $835,70
    $898,60
    $1 122,04     		$1 112,80
    $1 172,18
    $1 235,08
    $1 458,52     		$1 449,28
    $1 508,66
    $1 571,56
    $1 795,00     		$336,48
    Toc - Plan #136

    Silver

    (HMO) Constant Care Silver 1

    Annual Out of Pocket Expenses
    Individual Family
    $0 $0 Annual Deductible
    $8,500 $17,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$419,06
    $475,63
    $535,56
    $748,44
    $1 137,33     		$838,12
    $951,26
    $1 071,12
    $1 496,88
    $2 274,66     		$1 158,70
    $1 271,84
    $1 391,70
    $1 817,46     		$1 479,28
    $1 592,42
    $1 712,28
    $2 138,04     		$1 799,86
    $1 913,00
    $2 032,86
    $2 458,62     		$739,64
    $796,21
    $856,14
    $1 069,02     		$1 060,22
    $1 116,79
    $1 176,72
    $1 389,60     		$1 380,80
    $1 437,37
    $1 497,30
    $1 710,18     		$320,58
    Toc - Plan #137

    Bronze

    (HMO) Core Care Bronze 1

    Annual Out of Pocket Expenses
    Individual Family
    $6,100 $12,200 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$292,08
    $331,51
    $373,28
    $521,66
    $792,71     		$584,16
    $663,02
    $746,56
    $1 043,32
    $1 585,42     		$807,60
    $886,46
    $970,00
    $1 266,76     		$1 031,04
    $1 109,90
    $1 193,44
    $1 490,20     		$1 254,48
    $1 333,34
    $1 416,88
    $1 713,64     		$515,52
    $554,95
    $596,72
    $745,10     		$738,96
    $778,39
    $820,16
    $968,54     		$962,40
    $1 001,83
    $1 043,60
    $1 191,98     		$223,44
    Toc - Plan #138

    Silver

    (HMO) Constant Care Silver 4

    Annual Out of Pocket Expenses
    Individual Family
    $7,450 $14,900 Annual Deductible
    $7,450 $14,900 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$414,45
    $470,40
    $529,67
    $740,20
    $1 124,81     		$828,90
    $940,80
    $1 059,34
    $1 480,40
    $2 249,62     		$1 145,95
    $1 257,85
    $1 376,39
    $1 797,45     		$1 463,00
    $1 574,90
    $1 693,44
    $2 114,50     		$1 780,05
    $1 891,95
    $2 010,49
    $2 431,55     		$731,50
    $787,45
    $846,72
    $1 057,25     		$1 048,55
    $1 104,50
    $1 163,77
    $1 374,30     		$1 365,60
    $1 421,55
    $1 480,82
    $1 691,35     		$317,05
    Toc - Plan #139

    Expanded Bronze

    (HMO) Core Care Bronze 4

    Annual Out of Pocket Expenses
    Individual Family
    $0 $0 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$305,61
    $346,86
    $390,56
    $545,81
    $829,41     		$611,22
    $693,72
    $781,12
    $1 091,62
    $1 658,82     		$845,01
    $927,51
    $1 014,91
    $1 325,41     		$1 078,80
    $1 161,30
    $1 248,70
    $1 559,20     		$1 312,59
    $1 395,09
    $1 482,49
    $1 792,99     		$539,40
    $580,65
    $624,35
    $779,60     		$773,19
    $814,44
    $858,14
    $1 013,39     		$1 006,98
    $1 048,23
    $1 091,93
    $1 247,18     		$233,79
    Toc - Plan #140

    Expanded Bronze

    (HMO) Core Care Bronze 5

    Annual Out of Pocket Expenses
    Individual Family
    $0 $0 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$297,34
    $337,48
    $380,00
    $531,05
    $806,98     		$594,68
    $674,96
    $760,00
    $1 062,10
    $1 613,96     		$822,14
    $902,42
    $987,46
    $1 289,56     		$1 049,60
    $1 129,88
    $1 214,92
    $1 517,02     		$1 277,06
    $1 357,34
    $1 442,38
    $1 744,48     		$524,80
    $564,94
    $607,46
    $758,51     		$752,26
    $792,40
    $834,92
    $985,97     		$979,72
    $1 019,86
    $1 062,38
    $1 213,43     		$227,46
    Toc - Plan #141

    Gold

    (HMO) Confident Care Gold 1 + Vision

    Annual Out of Pocket Expenses
    Individual Family
    $2,925 $5,850 Annual Deductible
    $6,500 $13,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$443,39
    $503,24
    $566,65
    $791,89
    $1 203,35     		$886,78
    $1 006,48
    $1 133,30
    $1 583,78
    $2 406,70     		$1 225,97
    $1 345,67
    $1 472,49
    $1 922,97     		$1 565,16
    $1 684,86
    $1 811,68
    $2 262,16     		$1 904,35
    $2 024,05
    $2 150,87
    $2 601,35     		$782,58
    $842,43
    $905,84
    $1 131,08     		$1 121,77
    $1 181,62
    $1 245,03
    $1 470,27     		$1 460,96
    $1 520,81
    $1 584,22
    $1 809,46     		$339,19
    Toc - Plan #142

    Silver

    (HMO) Confident Care Silver 1 + Vision

    Annual Out of Pocket Expenses
    Individual Family
    $0 $0 Annual Deductible
    $8,500 $17,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$422,60
    $479,66
    $540,09
    $754,77
    $1 146,95     		$845,20
    $959,32
    $1 080,18
    $1 509,54
    $2 293,90     		$1 168,49
    $1 282,61
    $1 403,47
    $1 832,83     		$1 491,78
    $1 605,90
    $1 726,76
    $2 156,12     		$1 815,07
    $1 929,19
    $2 050,05
    $2 479,41     		$745,89
    $802,95
    $863,38
    $1 078,06     		$1 069,18
    $1 126,24
    $1 186,67
    $1 401,35     		$1 392,47
    $1 449,53
    $1 509,96
    $1 724,64     		$323,29
    Toc - Plan #143

    Bronze

    (HMO) Core Care Bronze 1 + Vision

    Annual Out of Pocket Expenses
    Individual Family
    $6,100 $12,200 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    		 Couple
    		Couple
    1 Child
    		 Couple
    2 Chidren
    		 Couple
    3+ Children
    		 Individual
    1 Child
    		 Individual
    2 Children
    		 Individual
    3+ Children
    		 Child
    0-14
    21
    30
    40
    50
    60     		$295,63
    $335,53
    $377,81
    $527,99
    $802,33     		$591,26
    $671,06
    $755,62
    $1 055,98
    $1 604,66     		$817,41
    $897,21
    $981,77
    $1 282,13     		$1 043,56
    $1 123,36
    $1 207,92
    $1 508,28     		$1 269,71
    $1 349,51
    $1 434,07
    $1 734,43     		$521,78
    $561,68
    $603,96
    $754,14     		$747,93
    $787,83
    $830,11
    $980,29     		$974,08
    $1 013,98
    $1 056,26
    $1 206,44     		$226,15
    Toc - Plan #144