Obamacare 2022 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 | 2022 |

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 2022.

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

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

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.

Obamacare Providers, Plans and 2022 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.

Obamacare Rates and Providers for Other Years

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

You may also be interested in:

How To Sign Up for Obamacare in Florida

For 2022 health plans, Florida open enrollment has ended. However, you may still be able to purchase health insurance for this year if you qualify for a special enrollment period. For example, if you’ve recently lost your job or income due to the COVID-19 crisis or for any other reason, you might qualify for a 60-day special enrollment period that will allow you to sign up for a new health insurance plan. (See What Happens If I Missed the Enrollment Deadline for 2022?)

To get covered, you can go directly to the online health insurance marketplace for Florida. If you need personalized help, you can reach out to an enrollment assistant. Most enrollment helpers are working remotely during the COVID crisis.

Where's the Florida Health Care Exchange?

You can find the health insurance exchange for Florida at Healthcare.gov. This is where you can learn about the various health insurance options available to you under the Affordable Care Act. If you see a plan you like, you'll be guided through the enrollment process online.

more...  

Florida Medicaid Expansion: Do I Qualify for Medicaid Under the ACA?

The Affordable Care Act (Obamacare) expanded Medicaid eligibility to include more people who couldn’t otherwise obtain health insurance. As written, the ACA would extend Medicaid to all adults with incomes at or below 138% of the federal poverty level. (For a single person in Florida in 2021, that’s $17,609. For a family of four, it’s $36,156.)

However, the U.S. Supreme Court later ruled that it was up to individual states to decide whether to expand Medicaid. As of October 2021, 12 states have not expanded their programs.

Florida Has Not Expanded Medicaid

Florida may put Medicaid expansion on the ballot in 2022. For now, because Florida has not yet expanded Medicaid eligibility, you may have fewer options for health coverage than people in states where Medicaid is more inclusive.

The Medicaid Coverage Gap

The Affordable Care Act assumed that Medicaid would be expanded to cover all Americans with incomes at or below 138% of the federal poverty level. And it created health plan subsidies for people with incomes between 100% - 400% of the poverty level.

That means Florida residents with incomes below the poverty level may fall into a coverage gap where they can get neither Medicaid nor ACA subsidies.

more...  

Get Help Finding a Health Insurance Plan in Florida

Get Help From Florida's Health Insurance Exchange

The following links and telephone numbers take you to the official help resources for Healthcare.gov, the health insurance marketplace for Florida.

Help by phone: 800-318-2596 (TTY: 855-889-4325)

In-person help: Go to Find Local Help, where you can enter your city and state or zip code to find an application assister, insurance agent, or health insurance broker in your area.

Get Help From a Licensed Insurance Broker

To directly connect with a Florida insurance broker who can help you evaluate insurance plans and choose a plan that's appropriate for your situation, call 800-943-6832. (We receive advertising income from the licensed brokers who offer their services through this telephone number.)

More Information

For more detailed information, see How Do I Sign Up for Obamacare in Florida?

  • Seminole County, FL Obamacare Rates
  • General Info
  • Rates
Obamacare Basics for Florida - (Basics)
Obamacare Rates for Seminole County - (Rates)
Obamacare Enrollment - (How to Enroll)
Obamacare Financial Assistance - (Financial Help)
Obamacare for Different Life Situations - (Life Situations)
Using Your Obamacare Health Insurance Plan - (Using Your Plan)
Obamacare News - (News)

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Bright Health

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

Toc - Plan #1 Bright Health
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$343,72
Toc - Plan #2 Bright Health
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$291,65
Toc - Plan #3 Bright Health
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$302,47
Toc - Plan #4 Bright Health
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$316,49
Toc - Plan #5 Bright Health
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$219,17
Toc - Plan #6 Bright Health
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$228,18
Toc - Plan #7 Bright Health
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$259,99
Toc - Plan #8 Bright Health
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$179,56
Toc - Plan #9 Bright Health
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$302,43
Toc - Plan #10 Bright Health
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$228,07
Toc - Plan #11 Bright Health
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$250,01

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Florida Blue (BlueCross BlueShield FL)

Local: 1-800-352-2583 | Toll Free: 1-800-352-2583 | TTY: 1-800-955-8771
Toc - Plan #12 Florida Blue (BlueCross BlueShield FL)
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
 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 		$1 295,14
$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$561,35
Toc - Plan #13 Florida Blue (BlueCross BlueShield FL)
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$347,07
Toc - Plan #14 Florida Blue (BlueCross BlueShield FL)
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
 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 		$1 333,74
$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$578,08
Toc - Plan #15 Florida Blue (BlueCross BlueShield FL)
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
 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 		$1 561,12
$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$676,63
Toc - Plan #16 Florida Blue (BlueCross BlueShield FL)
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$374,05
Toc - Plan #17 Florida Blue (BlueCross BlueShield FL)
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
 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 		$1 654,25
$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$717,00
Toc - Plan #18 Florida Blue (BlueCross BlueShield FL)
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
 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 		$1 180,64
$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$511,72
Toc - Plan #19 Florida Blue (BlueCross BlueShield FL)
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
 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 		$1 314,20
$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$569,61
Toc - Plan #20 Florida Blue (BlueCross BlueShield FL)
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$362,46
Toc - Plan #21 Florida Blue (BlueCross BlueShield FL)
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
 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 		$1 320,04
$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$572,14
Toc - Plan #22 Florida Blue (BlueCross BlueShield FL)
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$373,05
Toc - Plan #23 Florida Blue (BlueCross BlueShield FL)
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
 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 		$1 272,64
$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$551,60
Toc - Plan #24 Florida Blue (BlueCross BlueShield FL)
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$399,10
Toc - Plan #25 Florida Blue (BlueCross BlueShield FL)
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$365,40
Toc - Plan #26 Florida Blue (BlueCross BlueShield FL)
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$260,49
Toc - Plan #27 Florida Blue (BlueCross BlueShield FL)
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$378,72
Toc - Plan #28 Florida Blue (BlueCross BlueShield FL)
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
 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 		$1 032,45
$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$447,49
Toc - Plan #29 Florida Blue (BlueCross BlueShield FL)
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$278,67
Toc - Plan #30 Florida Blue (BlueCross BlueShield FL)
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
 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 		$1 108,35
$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$480,39
Toc - Plan #31 Florida Blue (BlueCross BlueShield FL)
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$332,12
Toc - Plan #32 Florida Blue (BlueCross BlueShield FL)
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$389,79
Toc - Plan #33 Florida Blue (BlueCross BlueShield FL)
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$271,61
Toc - Plan #34 Florida Blue (BlueCross BlueShield FL)
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$370,30
Toc - Plan #35 Florida Blue (BlueCross BlueShield FL)
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$278,24
Toc - Plan #36 Florida Blue (BlueCross BlueShield FL)
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$372,38
Toc - Plan #37 Florida Blue (BlueCross BlueShield FL)
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$297,35

ADVERTISEMENT

AvMed

Local: 1-800-477-8768 | Toll Free: 

Toc - Plan #38 AvMed
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$347,56
Toc - Plan #39 AvMed
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$337,86
Toc - Plan #40 AvMed
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$323,35
Toc - Plan #41 AvMed
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$322,54
Toc - Plan #42 AvMed
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$320,18
Toc - Plan #43 AvMed
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$266,34
Toc - Plan #44 AvMed
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$244,94
Toc - Plan #45 AvMed
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$215,31
Toc - Plan #46 AvMed
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$350,63
Toc - Plan #47 AvMed
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$340,85
Toc - Plan #48 AvMed
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$326,22
Toc - Plan #49 AvMed
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$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 Ambetter from Sunshine Health
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$330,98
Toc - Plan #51 Ambetter from Sunshine Health
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$231,48
Toc - Plan #52 Ambetter from Sunshine Health
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$236,77
Toc - Plan #53 Ambetter from Sunshine Health
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$237,20
Toc - Plan #54 Ambetter from Sunshine Health
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$331,01
Toc - Plan #55 Ambetter from Sunshine Health
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$322,80
Toc - Plan #56 Ambetter from Sunshine Health
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$315,72
Toc - Plan #57 Ambetter from Sunshine Health
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$327,30
Toc - Plan #58 Ambetter from Sunshine Health
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$312,87
Toc - Plan #59 Ambetter from Sunshine Health
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$326,44
Toc - Plan #60 Ambetter from Sunshine Health
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$332,83
Toc - Plan #61 Ambetter from Sunshine Health
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$347,63
Toc - Plan #62 Ambetter from Sunshine Health
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$354,12
Toc - Plan #63 Ambetter from Sunshine Health
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$328,15
Toc - Plan #64 Ambetter from Sunshine Health
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$246,09
Toc - Plan #65 Ambetter from Sunshine Health
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$344,01
Toc - Plan #66 Ambetter from Sunshine Health
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$240,59
Toc - Plan #67 Ambetter from Sunshine Health
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$246,54
Toc - Plan #68 Ambetter from Sunshine Health
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$344,04
Toc - Plan #69 Ambetter from Sunshine Health
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$335,51
Toc - Plan #70 Ambetter from Sunshine Health
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$340,19
Toc - Plan #71 Ambetter from Sunshine Health
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$339,29
Toc - Plan #72 Ambetter from Sunshine Health
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$345,93
Toc - Plan #73 Ambetter from Sunshine Health
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$361,31
Toc - Plan #74 Ambetter from Sunshine Health
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$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 Florida Blue HMO (a BlueCross BlueShield FL company)
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
 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 		$1 380,25
$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$598,24
Toc - Plan #76 Florida Blue HMO (a BlueCross BlueShield FL company)
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$358,30
Toc - Plan #77 Florida Blue HMO (a BlueCross BlueShield FL company)
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$322,66
Toc - Plan #78 Florida Blue HMO (a BlueCross BlueShield FL company)
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
 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 		$1 180,52
$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$511,67
Toc - Plan #79 Florida Blue HMO (a BlueCross BlueShield FL company)
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$430,76
Toc - Plan #80 Florida Blue HMO (a BlueCross BlueShield FL company)
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$390,89
Toc - Plan #81 Florida Blue HMO (a BlueCross BlueShield FL company)
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$243,79
Toc - Plan #82 Florida Blue HMO (a BlueCross BlueShield FL company)
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$218,12
Toc - Plan #83 Florida Blue HMO (a BlueCross BlueShield FL company)
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$316,46
Toc - Plan #84 Florida Blue HMO (a BlueCross BlueShield FL company)
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$289,76
Toc - Plan #85 Florida Blue HMO (a BlueCross BlueShield FL company)
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$328,25
Toc - Plan #86 Florida Blue HMO (a BlueCross BlueShield FL company)
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$329,55
Toc - Plan #87 Florida Blue HMO (a BlueCross BlueShield FL company)
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$242,33
Toc - Plan #88 Florida Blue HMO (a BlueCross BlueShield FL company)
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$323,26
Toc - Plan #89 Florida Blue HMO (a BlueCross BlueShield FL company)
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$283,81
Toc - Plan #90 Florida Blue HMO (a BlueCross BlueShield FL company)
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$274,82
Toc - Plan #91 Florida Blue HMO (a BlueCross BlueShield FL company)
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$268,18
Toc - Plan #92 Florida Blue HMO (a BlueCross BlueShield FL company)
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$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 Health First Commercial Plans, Inc.
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$342,00
Toc - Plan #94 Health First Commercial Plans, Inc.
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$323,32
Toc - Plan #95 Health First Commercial Plans, Inc.
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$132,05
Toc - Plan #96 Health First Commercial Plans, Inc.
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$342,93
Toc - Plan #97 Health First Commercial Plans, Inc.
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$335,13
Toc - Plan #98 Health First Commercial Plans, Inc.
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$326,27
Toc - Plan #99 Health First Commercial Plans, Inc.
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$330,18
Toc - Plan #100 Health First Commercial Plans, Inc.
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$248,08
Toc - Plan #101 Health First Commercial Plans, Inc.
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$240,95
Toc - Plan #102 Health First Commercial Plans, Inc.
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$244,73
Toc - Plan #103 Health First Commercial Plans, Inc.
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$240,95
Toc - Plan #104 Health First Commercial Plans, Inc.
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$327,84
Toc - Plan #105 Health First Commercial Plans, Inc.
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$236,46
Toc - Plan #106 Health First Commercial Plans, Inc.
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$245,27
Toc - Plan #107 Health First Commercial Plans, Inc.
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$317,88
Toc - Plan #108 Health First Commercial Plans, Inc.
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$224,56
Toc - Plan #109 Health First Commercial Plans, Inc.
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$302,10
Toc - Plan #110 Health First Commercial Plans, Inc.
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$315,00

ADVERTISEMENT

Oscar Insurance Company of Florida

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

Toc - Plan #111 Oscar Insurance Company of Florida
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$210,52
Toc - Plan #112 Oscar Insurance Company of Florida
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$219,83
Toc - Plan #113 Oscar Insurance Company of Florida
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$212,65
Toc - Plan #114 Oscar Insurance Company of Florida
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$250,48
Toc - Plan #115 Oscar Insurance Company of Florida
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$277,85
Toc - Plan #116 Oscar Insurance Company of Florida
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$274,86
Toc - Plan #117 Oscar Insurance Company of Florida
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$276,95
Toc - Plan #118 Oscar Insurance Company of Florida
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$172,92
Toc - Plan #119 Oscar Insurance Company of Florida
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$250,96
Toc - Plan #120 Oscar Insurance Company of Florida
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$292,55
Toc - Plan #121 Oscar Insurance Company of Florida
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$223,87
Toc - Plan #122 Oscar Insurance Company of Florida
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$274,26
Toc - Plan #123 Oscar Insurance Company of Florida
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$282,07
Toc - Plan #124 Oscar Insurance Company of Florida
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$284,11

ADVERTISEMENT

Cigna Healthcare

Local: 1-877-900-1237 | Toll Free: 1-877-900-1237 | TTY: 1-800-676-3777
Toc - Plan #125 Cigna Healthcare
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$236,74
Toc - Plan #126 Cigna Healthcare
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$248,39
Toc - Plan #127 Cigna Healthcare
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$246,11
Toc - Plan #128 Cigna Healthcare
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$301,46
Toc - Plan #129 Cigna Healthcare
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$304,01
Toc - Plan #130 Cigna Healthcare
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$306,16
Toc - Plan #131 Cigna Healthcare
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$313,50
Toc - Plan #132 Cigna Healthcare
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
 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 		$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
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$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 		$341,76
Toc - Plan #133 Cigna Healthcare
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