Obamacare 2023 Rates for Walton County

Obamacare > Rates > Florida > Walton County

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 Walton County, FL.

The health insurance rates listed below are for calendar year 2023.

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

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

Obamacare Providers, 103 Plans and 2023 Rates for Walton County, Florida

Below, you’ll find a summary of the 103 plans for Walton County, Florida and rates for each of these providers.‡ This chart is designed to give you a preview of your health insurance options.

Florida Blue (BlueCross BlueShield FL)

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

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

Silver

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

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

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:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$713.71
$810.06
$912.12
$1,274.69
$1,937.01

$1,259.70
$1,356.05
$1,458.11
$1,820.68

$1,805.69
$1,902.04
$2,004.10
$2,366.67

$2,351.68
$2,448.03
$2,550.09
$2,912.66

$545.99

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,427.42
$1,620.12
$1,824.24
$2,549.38
$3,874.02

$1,973.41
$2,166.11
$2,370.23
$3,095.37

$2,519.40
$2,712.10
$2,916.22
$3,641.36

$3,065.39
$3,258.09
$3,462.21
$4,187.35

$545.99

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

Expanded Bronze

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

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$6,900 $13,800 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$461.75
$524.09
$590.12
$824.69
$1,253.19

$814.99
$877.33
$943.36
$1,177.93

$1,168.23
$1,230.57
$1,296.60
$1,531.17

$1,521.47
$1,583.81
$1,649.84
$1,884.41

$353.24

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$923.50
$1,048.18
$1,180.24
$1,649.38
$2,506.38

$1,276.74
$1,401.42
$1,533.48
$2,002.62

$1,629.98
$1,754.66
$1,886.72
$2,355.86

$1,983.22
$2,107.90
$2,239.96
$2,709.10

$353.24

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

Silver

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

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$6,000 $12,000 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$717.63
$814.51
$917.13
$1,281.69
$1,947.65

$1,266.62
$1,363.50
$1,466.12
$1,830.68

$1,815.61
$1,912.49
$2,015.11
$2,379.67

$2,364.60
$2,461.48
$2,564.10
$2,928.66

$548.99

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,435.26
$1,629.02
$1,834.26
$2,563.38
$3,895.30

$1,984.25
$2,178.01
$2,383.25
$3,112.37

$2,533.24
$2,727.00
$2,932.24
$3,661.36

$3,082.23
$3,275.99
$3,481.23
$4,210.35

$548.99

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

Platinum

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

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$1,000 $2,000 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$903.09
$1,025.01
$1,154.15
$1,612.92
$2,450.99

$1,593.95
$1,715.87
$1,845.01
$2,303.78

$2,284.81
$2,406.73
$2,535.87
$2,994.64

$2,975.67
$3,097.59
$3,226.73
$3,685.50

$690.86

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,806.18
$2,050.02
$2,308.30
$3,225.84
$4,901.98

$2,497.04
$2,740.88
$2,999.16
$3,916.70

$3,187.90
$3,431.74
$3,690.02
$4,607.56

$3,878.76
$4,122.60
$4,380.88
$5,298.42

$690.86

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

Expanded Bronze

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

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$7,400 $14,800 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$480.97
$545.90
$614.68
$859.01
$1,305.35

$848.91
$913.84
$982.62
$1,226.95

$1,216.85
$1,281.78
$1,350.56
$1,594.89

$1,584.79
$1,649.72
$1,718.50
$1,962.83

$367.94

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$961.94
$1,091.80
$1,229.36
$1,718.02
$2,610.70

$1,329.88
$1,459.74
$1,597.30
$2,085.96

$1,697.82
$1,827.68
$1,965.24
$2,453.90

$2,065.76
$2,195.62
$2,333.18
$2,821.84

$367.94

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

Platinum

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

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$946.28
$1,074.03
$1,209.35
$1,690.06
$2,568.20

$1,670.18
$1,797.93
$1,933.25
$2,413.96

$2,394.08
$2,521.83
$2,657.15
$3,137.86

$3,117.98
$3,245.73
$3,381.05
$3,861.76

$723.90

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,892.56
$2,148.06
$2,418.70
$3,380.12
$5,136.40

$2,616.46
$2,871.96
$3,142.60
$4,104.02

$3,340.36
$3,595.86
$3,866.50
$4,827.92

$4,064.26
$4,319.76
$4,590.40
$5,551.82

$723.90

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

Silver

(EPO) BlueOptions Silver 1410 ($0 Virtual Visits / $0 Lab / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$6,000 $12,000 Annual Deductible

$7,900 $15,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$669.93
$760.37
$856.17
$1,196.49
$1,818.19

$1,182.43
$1,272.87
$1,368.67
$1,708.99

$1,694.93
$1,785.37
$1,881.17
$2,221.49

$2,207.43
$2,297.87
$2,393.67
$2,733.99

$512.50

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,339.86
$1,520.74
$1,712.34
$2,392.98
$3,636.38

$1,852.36
$2,033.24
$2,224.84
$2,905.48

$2,364.86
$2,545.74
$2,737.34
$3,417.98

$2,877.36
$3,058.24
$3,249.84
$3,930.48

$512.50

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

Gold

(EPO) BlueOptions Gold 1505 ($0 Virtual Visits / $20 PCP Visits / $15 Generic Meds / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$775.59
$880.29
$991.20
$1,385.20
$2,104.95

$1,368.92
$1,473.62
$1,584.53
$1,978.53

$1,962.25
$2,066.95
$2,177.86
$2,571.86

$2,555.58
$2,660.28
$2,771.19
$3,165.19

$593.33

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,551.18
$1,760.58
$1,982.40
$2,770.40
$4,209.90

$2,144.51
$2,353.91
$2,575.73
$3,363.73

$2,737.84
$2,947.24
$3,169.06
$3,957.06

$3,331.17
$3,540.57
$3,762.39
$4,550.39

$593.33

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

Expanded Bronze

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

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$6,850 $13,700 Annual Deductible

$6,850 $13,700 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$467.57
$530.69
$597.55
$835.08
$1,268.98

$825.26
$888.38
$955.24
$1,192.77

$1,182.95
$1,246.07
$1,312.93
$1,550.46

$1,540.64
$1,603.76
$1,670.62
$1,908.15

$357.69

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$935.14
$1,061.38
$1,195.10
$1,670.16
$2,537.96

$1,292.83
$1,419.07
$1,552.79
$2,027.85

$1,650.52
$1,776.76
$1,910.48
$2,385.54

$2,008.21
$2,134.45
$2,268.17
$2,743.23

$357.69

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

Gold

(EPO) BlueOptions Gold 1805 ($0 Virtual Visits / $20 Labs / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$1,500 $3,000 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$750.37
$851.67
$958.97
$1,340.16
$2,036.50

$1,324.40
$1,425.70
$1,533.00
$1,914.19

$1,898.43
$1,999.73
$2,107.03
$2,488.22

$2,472.46
$2,573.76
$2,681.06
$3,062.25

$574.03

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,500.74
$1,703.34
$1,917.94
$2,680.32
$4,073.00

$2,074.77
$2,277.37
$2,491.97
$3,254.35

$2,648.80
$2,851.40
$3,066.00
$3,828.38

$3,222.83
$3,425.43
$3,640.03
$4,402.41

$574.03

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

Expanded Bronze

(EPO) BlueOptions Bronze 2119 ($0 Deductible / $0 Virtual Visits / $50 PCP Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$509.39
$578.16
$651.00
$909.77
$1,382.48

$899.07
$967.84
$1,040.68
$1,299.45

$1,288.75
$1,357.52
$1,430.36
$1,689.13

$1,678.43
$1,747.20
$1,820.04
$2,078.81

$389.68

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,018.78
$1,156.32
$1,302.00
$1,819.54
$2,764.96

$1,408.46
$1,546.00
$1,691.68
$2,209.22

$1,798.14
$1,935.68
$2,081.36
$2,598.90

$2,187.82
$2,325.36
$2,471.04
$2,988.58

$389.68

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

Bronze

(EPO) BlueOptions Bronze 2301S (Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$9,100 $18,200 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$441.34
$500.92
$564.03
$788.23
$1,197.80

$778.97
$838.55
$901.66
$1,125.86

$1,116.60
$1,176.18
$1,239.29
$1,463.49

$1,454.23
$1,513.81
$1,576.92
$1,801.12

$337.63

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$882.68
$1,001.84
$1,128.06
$1,576.46
$2,395.60

$1,220.31
$1,339.47
$1,465.69
$1,914.09

$1,557.94
$1,677.10
$1,803.32
$2,251.72

$1,895.57
$2,014.73
$2,140.95
$2,589.35

$337.63

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

Expanded Bronze

(EPO) BlueOptions Bronze 2302S (Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$474.44
$538.49
$606.33
$847.35
$1,287.63

$837.39
$901.44
$969.28
$1,210.30

$1,200.34
$1,264.39
$1,332.23
$1,573.25

$1,563.29
$1,627.34
$1,695.18
$1,936.20

$362.95

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$948.88
$1,076.98
$1,212.66
$1,694.70
$2,575.26

$1,311.83
$1,439.93
$1,575.61
$2,057.65

$1,674.78
$1,802.88
$1,938.56
$2,420.60

$2,037.73
$2,165.83
$2,301.51
$2,783.55

$362.95

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

Silver

(EPO) BlueOptions Silver 2303S ($40 PCP Visits / Multilingual Available/ Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$5,800 $11,600 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$706.42
$801.79
$902.80
$1,261.67
$1,917.22

$1,246.83
$1,342.20
$1,443.21
$1,802.08

$1,787.24
$1,882.61
$1,983.62
$2,342.49

$2,327.65
$2,423.02
$2,524.03
$2,882.90

$540.41

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,412.84
$1,603.58
$1,805.60
$2,523.34
$3,834.44

$1,953.25
$2,143.99
$2,346.01
$3,063.75

$2,493.66
$2,684.40
$2,886.42
$3,604.16

$3,034.07
$3,224.81
$3,426.83
$4,144.57

$540.41

Toc - Plan #15 Florida Blue (BlueCross BlueShield FL)

Gold

(EPO) BlueOptions Gold 2304S ($30 PCP Visits / Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$2,000 $4,000 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$721.01
$818.35
$921.45
$1,287.72
$1,956.82

$1,272.58
$1,369.92
$1,473.02
$1,839.29

$1,824.15
$1,921.49
$2,024.59
$2,390.86

$2,375.72
$2,473.06
$2,576.16
$2,942.43

$551.57

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,442.02
$1,636.70
$1,842.90
$2,575.44
$3,913.64

$1,993.59
$2,188.27
$2,394.47
$3,127.01

$2,545.16
$2,739.84
$2,946.04
$3,678.58

$3,096.73
$3,291.41
$3,497.61
$4,230.15

$551.57

Toc - Plan #16 Florida Blue (BlueCross BlueShield FL)

Platinum

(EPO) BlueOptions Platinum 2305S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$3,000 $6,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$943.90
$1,071.33
$1,206.30
$1,685.81
$2,561.74

$1,665.98
$1,793.41
$1,928.38
$2,407.89

$2,388.06
$2,515.49
$2,650.46
$3,129.97

$3,110.14
$3,237.57
$3,372.54
$3,852.05

$722.08

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,887.80
$2,142.66
$2,412.60
$3,371.62
$5,123.48

$2,609.88
$2,864.74
$3,134.68
$4,093.70

$3,331.96
$3,586.82
$3,856.76
$4,815.78

$4,054.04
$4,308.90
$4,578.84
$5,537.86

$722.08

Toc - Plan #17 Florida Blue (BlueCross BlueShield FL)

Expanded Bronze

(EPO) BlueOptions Bronze 2319 ($0 Deductible / $0 Virtual Visits / Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$499.36
$566.77
$638.18
$891.86
$1,355.26

$881.37
$948.78
$1,020.19
$1,273.87

$1,263.38
$1,330.79
$1,402.20
$1,655.88

$1,645.39
$1,712.80
$1,784.21
$2,037.89

$382.01

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$998.72
$1,133.54
$1,276.36
$1,783.72
$2,710.52

$1,380.73
$1,515.55
$1,658.37
$2,165.73

$1,762.74
$1,897.56
$2,040.38
$2,547.74

$2,144.75
$2,279.57
$2,422.39
$2,929.75

$382.01

Toc - Plan #18 Florida Blue (BlueCross BlueShield FL)

Silver

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

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

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:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$466.70
$529.70
$596.44
$833.53
$1,266.62

$823.73
$886.73
$953.47
$1,190.56

$1,180.76
$1,243.76
$1,310.50
$1,547.59

$1,537.79
$1,600.79
$1,667.53
$1,904.62

$357.03

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$933.40
$1,059.40
$1,192.88
$1,667.06
$2,533.24

$1,290.43
$1,416.43
$1,549.91
$2,024.09

$1,647.46
$1,773.46
$1,906.94
$2,381.12

$2,004.49
$2,130.49
$2,263.97
$2,738.15

$357.03

Toc - Plan #19 Florida Blue (BlueCross BlueShield FL)

Expanded Bronze

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

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$6,900 $13,800 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$351.40
$398.84
$449.09
$627.60
$953.70

$620.22
$667.66
$717.91
$896.42

$889.04
$936.48
$986.73
$1,165.24

$1,157.86
$1,205.30
$1,255.55
$1,434.06

$268.82

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$702.80
$797.68
$898.18
$1,255.20
$1,907.40

$971.62
$1,066.50
$1,167.00
$1,524.02

$1,240.44
$1,335.32
$1,435.82
$1,792.84

$1,509.26
$1,604.14
$1,704.64
$2,061.66

$268.82

Toc - Plan #20 Florida Blue (BlueCross BlueShield FL)

Silver

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

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$6,000 $12,000 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$465.25
$528.06
$594.59
$830.94
$1,262.69

$821.17
$883.98
$950.51
$1,186.86

$1,177.09
$1,239.90
$1,306.43
$1,542.78

$1,533.01
$1,595.82
$1,662.35
$1,898.70

$355.92

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$930.50
$1,056.12
$1,189.18
$1,661.88
$2,525.38

$1,286.42
$1,412.04
$1,545.10
$2,017.80

$1,642.34
$1,767.96
$1,901.02
$2,373.72

$1,998.26
$2,123.88
$2,256.94
$2,729.64

$355.92

Toc - Plan #21 Florida Blue (BlueCross BlueShield FL)

Platinum

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

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$1,000 $2,000 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$590.35
$670.05
$754.47
$1,054.37
$1,602.21

$1,041.97
$1,121.67
$1,206.09
$1,505.99

$1,493.59
$1,573.29
$1,657.71
$1,957.61

$1,945.21
$2,024.91
$2,109.33
$2,409.23

$451.62

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,180.70
$1,340.10
$1,508.94
$2,108.74
$3,204.42

$1,632.32
$1,791.72
$1,960.56
$2,560.36

$2,083.94
$2,243.34
$2,412.18
$3,011.98

$2,535.56
$2,694.96
$2,863.80
$3,463.60

$451.62

Toc - Plan #22 Florida Blue (BlueCross BlueShield FL)

Expanded Bronze

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

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$7,400 $14,800 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$362.98
$411.98
$463.89
$648.28
$985.13

$640.66
$689.66
$741.57
$925.96

$918.34
$967.34
$1,019.25
$1,203.64

$1,196.02
$1,245.02
$1,296.93
$1,481.32

$277.68

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$725.96
$823.96
$927.78
$1,296.56
$1,970.26

$1,003.64
$1,101.64
$1,205.46
$1,574.24

$1,281.32
$1,379.32
$1,483.14
$1,851.92

$1,559.00
$1,657.00
$1,760.82
$2,129.60

$277.68

Toc - Plan #23 Florida Blue (BlueCross BlueShield FL)

Platinum

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

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$617.79
$701.19
$789.54
$1,103.37
$1,676.68

$1,090.40
$1,173.80
$1,262.15
$1,575.98

$1,563.01
$1,646.41
$1,734.76
$2,048.59

$2,035.62
$2,119.02
$2,207.37
$2,521.20

$472.61

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,235.58
$1,402.38
$1,579.08
$2,206.74
$3,353.36

$1,708.19
$1,874.99
$2,051.69
$2,679.35

$2,180.80
$2,347.60
$2,524.30
$3,151.96

$2,653.41
$2,820.21
$2,996.91
$3,624.57

$472.61

Toc - Plan #24 Florida Blue (BlueCross BlueShield FL)

Silver

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

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$6,000 $12,000 Annual Deductible

$7,900 $15,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$436.74
$495.70
$558.15
$780.02
$1,185.31

$770.85
$829.81
$892.26
$1,114.13

$1,104.96
$1,163.92
$1,226.37
$1,448.24

$1,439.07
$1,498.03
$1,560.48
$1,782.35

$334.11

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$873.48
$991.40
$1,116.30
$1,560.04
$2,370.62

$1,207.59
$1,325.51
$1,450.41
$1,894.15

$1,541.70
$1,659.62
$1,784.52
$2,228.26

$1,875.81
$1,993.73
$2,118.63
$2,562.37

$334.11

Toc - Plan #25 Florida Blue (BlueCross BlueShield FL)

Gold

(EPO) BlueSelect Gold 1535 ($0 Virtual Visits / $20 PCP Visit / $15 Generic Meds / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$515.32
$584.89
$658.58
$920.36
$1,398.58

$909.54
$979.11
$1,052.80
$1,314.58

$1,303.76
$1,373.33
$1,447.02
$1,708.80

$1,697.98
$1,767.55
$1,841.24
$2,103.02

$394.22

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,030.64
$1,169.78
$1,317.16
$1,840.72
$2,797.16

$1,424.86
$1,564.00
$1,711.38
$2,234.94

$1,819.08
$1,958.22
$2,105.60
$2,629.16

$2,213.30
$2,352.44
$2,499.82
$3,023.38

$394.22

Toc - Plan #26 Florida Blue (BlueCross BlueShield FL)

Expanded Bronze

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

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$6,850 $13,700 Annual Deductible

$6,850 $13,700 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$355.19
$403.14
$453.93
$634.37
$963.99

$626.91
$674.86
$725.65
$906.09

$898.63
$946.58
$997.37
$1,177.81

$1,170.35
$1,218.30
$1,269.09
$1,449.53

$271.72

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$710.38
$806.28
$907.86
$1,268.74
$1,927.98

$982.10
$1,078.00
$1,179.58
$1,540.46

$1,253.82
$1,349.72
$1,451.30
$1,812.18

$1,525.54
$1,621.44
$1,723.02
$2,083.90

$271.72

Toc - Plan #27 Florida Blue (BlueCross BlueShield FL)

Gold

(EPO) BlueSelect Gold 1835 ($0 Virtual Visits / $20 Labs / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$1,500 $3,000 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$498.52
$565.82
$637.11
$890.36
$1,352.98

$879.89
$947.19
$1,018.48
$1,271.73

$1,261.26
$1,328.56
$1,399.85
$1,653.10

$1,642.63
$1,709.93
$1,781.22
$2,034.47

$381.37

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$997.04
$1,131.64
$1,274.22
$1,780.72
$2,705.96

$1,378.41
$1,513.01
$1,655.59
$2,162.09

$1,759.78
$1,894.38
$2,036.96
$2,543.46

$2,141.15
$2,275.75
$2,418.33
$2,924.83

$381.37

Toc - Plan #28 Florida Blue (BlueCross BlueShield FL)

Expanded Bronze

(EPO) BlueSelect Bronze 2139 ($0 Deductible / $0 Virtual Visits / $50 PCP Visit / $30 Generic Meds / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$384.59
$436.51
$491.51
$686.88
$1,043.78

$678.80
$730.72
$785.72
$981.09

$973.01
$1,024.93
$1,079.93
$1,275.30

$1,267.22
$1,319.14
$1,374.14
$1,569.51

$294.21

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$769.18
$873.02
$983.02
$1,373.76
$2,087.56

$1,063.39
$1,167.23
$1,277.23
$1,667.97

$1,357.60
$1,461.44
$1,571.44
$1,962.18

$1,651.81
$1,755.65
$1,865.65
$2,256.39

$294.21

Toc - Plan #29 Florida Blue (BlueCross BlueShield FL)

Bronze

(EPO) BlueSelect Bronze 2341S (Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$9,100 $18,200 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$333.33
$378.33
$426.00
$595.33
$904.66

$588.33
$633.33
$681.00
$850.33

$843.33
$888.33
$936.00
$1,105.33

$1,098.33
$1,143.33
$1,191.00
$1,360.33

$255.00

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$666.66
$756.66
$852.00
$1,190.66
$1,809.32

$921.66
$1,011.66
$1,107.00
$1,445.66

$1,176.66
$1,266.66
$1,362.00
$1,700.66

$1,431.66
$1,521.66
$1,617.00
$1,955.66

$255.00

Toc - Plan #30 Florida Blue (BlueCross BlueShield FL)

Expanded Bronze

(EPO) BlueSelect Bronze 2342S (Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$358.38
$406.76
$458.01
$640.07
$972.64

$632.54
$680.92
$732.17
$914.23

$906.70
$955.08
$1,006.33
$1,188.39

$1,180.86
$1,229.24
$1,280.49
$1,462.55

$274.16

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$716.76
$813.52
$916.02
$1,280.14
$1,945.28

$990.92
$1,087.68
$1,190.18
$1,554.30

$1,265.08
$1,361.84
$1,464.34
$1,828.46

$1,539.24
$1,636.00
$1,738.50
$2,102.62

$274.16

Toc - Plan #31 Florida Blue (BlueCross BlueShield FL)

Silver

(EPO) BlueSelect Silver 2343S ($40 PCP Visits / Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$5,800 $11,600 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$460.56
$522.74
$588.60
$822.56
$1,249.96

$812.89
$875.07
$940.93
$1,174.89

$1,165.22
$1,227.40
$1,293.26
$1,527.22

$1,517.55
$1,579.73
$1,645.59
$1,879.55

$352.33

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$921.12
$1,045.48
$1,177.20
$1,645.12
$2,499.92

$1,273.45
$1,397.81
$1,529.53
$1,997.45

$1,625.78
$1,750.14
$1,881.86
$2,349.78

$1,978.11
$2,102.47
$2,234.19
$2,702.11

$352.33

Toc - Plan #32 Florida Blue (BlueCross BlueShield FL)

Gold

(EPO) BlueSelect Gold 2344S ($30 PCP Visits / Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$2,000 $4,000 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$479.10
$543.78
$612.29
$855.67
$1,300.28

$845.61
$910.29
$978.80
$1,222.18

$1,212.12
$1,276.80
$1,345.31
$1,588.69

$1,578.63
$1,643.31
$1,711.82
$1,955.20

$366.51

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$958.20
$1,087.56
$1,224.58
$1,711.34
$2,600.56

$1,324.71
$1,454.07
$1,591.09
$2,077.85

$1,691.22
$1,820.58
$1,957.60
$2,444.36

$2,057.73
$2,187.09
$2,324.11
$2,810.87

$366.51

Toc - Plan #33 Florida Blue (BlueCross BlueShield FL)

Platinum

(EPO) BlueSelect Platinum 2345S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$3,000 $6,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$616.21
$699.40
$787.52
$1,100.55
$1,672.39

$1,087.61
$1,170.80
$1,258.92
$1,571.95

$1,559.01
$1,642.20
$1,730.32
$2,043.35

$2,030.41
$2,113.60
$2,201.72
$2,514.75

$471.40

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,232.42
$1,398.80
$1,575.04
$2,201.10
$3,344.78

$1,703.82
$1,870.20
$2,046.44
$2,672.50

$2,175.22
$2,341.60
$2,517.84
$3,143.90

$2,646.62
$2,813.00
$2,989.24
$3,615.30

$471.40

Toc - Plan #34 Florida Blue (BlueCross BlueShield FL)

Expanded Bronze

(EPO) BlueSelect Bronze 2339 ($0 Deductible / $0 Virtual Visits / Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$377.17
$428.09
$482.02
$673.63
$1,023.64

$665.71
$716.63
$770.56
$962.17

$954.25
$1,005.17
$1,059.10
$1,250.71

$1,242.79
$1,293.71
$1,347.64
$1,539.25

$288.54

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$754.34
$856.18
$964.04
$1,347.26
$2,047.28

$1,042.88
$1,144.72
$1,252.58
$1,635.80

$1,331.42
$1,433.26
$1,541.12
$1,924.34

$1,619.96
$1,721.80
$1,829.66
$2,212.88

$288.54

Ambetter from Sunshine Health

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

Toc - Plan #35 Ambetter from Sunshine Health

Gold

(EPO) Complete Gold

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$1,450 $2,900 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$397.03
$450.62
$507.39
$709.07
$1,077.51

$700.75
$754.34
$811.11
$1,012.79

$1,004.47
$1,058.06
$1,114.83
$1,316.51

$1,308.19
$1,361.78
$1,418.55
$1,620.23

$303.72

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$794.06
$901.24
$1,014.78
$1,418.14
$2,155.02

$1,097.78
$1,204.96
$1,318.50
$1,721.86

$1,401.50
$1,508.68
$1,622.22
$2,025.58

$1,705.22
$1,812.40
$1,925.94
$2,329.30

$303.72

Toc - Plan #36 Ambetter from Sunshine Health

Bronze

(EPO) Clear Bronze

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$8,600 $17,200 Annual Deductible

$8,600 $17,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$296.03
$335.99
$378.32
$528.70
$803.41

$522.49
$562.45
$604.78
$755.16

$748.95
$788.91
$831.24
$981.62

$975.41
$1,015.37
$1,057.70
$1,208.08

$226.46

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$592.06
$671.98
$756.64
$1,057.40
$1,606.82

$818.52
$898.44
$983.10
$1,283.86

$1,044.98
$1,124.90
$1,209.56
$1,510.32

$1,271.44
$1,351.36
$1,436.02
$1,736.78

$226.46

Toc - Plan #37 Ambetter from Sunshine Health

Expanded Bronze

(EPO) Choice Bronze HSA

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$6,900 $13,800 Annual Deductible

$6,900 $13,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$326.02
$370.02
$416.64
$582.26
$884.79

$575.42
$619.42
$666.04
$831.66

$824.82
$868.82
$915.44
$1,081.06

$1,074.22
$1,118.22
$1,164.84
$1,330.46

$249.40

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$652.04
$740.04
$833.28
$1,164.52
$1,769.58

$901.44
$989.44
$1,082.68
$1,413.92

$1,150.84
$1,238.84
$1,332.08
$1,663.32

$1,400.24
$1,488.24
$1,581.48
$1,912.72

$249.40

Toc - Plan #38 Ambetter from Sunshine Health

Silver

(EPO) Everyday Silver

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$6,500 $13,000 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$401.27
$455.43
$512.81
$716.64
$1,089.01

$708.23
$762.39
$819.77
$1,023.60

$1,015.19
$1,069.35
$1,126.73
$1,330.56

$1,322.15
$1,376.31
$1,433.69
$1,637.52

$306.96

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$802.54
$910.86
$1,025.62
$1,433.28
$2,178.02

$1,109.50
$1,217.82
$1,332.58
$1,740.24

$1,416.46
$1,524.78
$1,639.54
$2,047.20

$1,723.42
$1,831.74
$1,946.50
$2,354.16

$306.96

Toc - Plan #39 Ambetter from Sunshine Health

Expanded Bronze

(EPO) Everyday Bronze

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$8,300 $16,600 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$318.30
$361.26
$406.78
$568.47
$863.85

$561.80
$604.76
$650.28
$811.97

$805.30
$848.26
$893.78
$1,055.47

$1,048.80
$1,091.76
$1,137.28
$1,298.97

$243.50

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$636.60
$722.52
$813.56
$1,136.94
$1,727.70

$880.10
$966.02
$1,057.06
$1,380.44

$1,123.60
$1,209.52
$1,300.56
$1,623.94

$1,367.10
$1,453.02
$1,544.06
$1,867.44

$243.50

Toc - Plan #40 Ambetter from Sunshine Health

Expanded Bronze

(EPO) Elite Bronze

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$364.80
$414.04
$466.21
$651.52
$990.05

$643.87
$693.11
$745.28
$930.59

$922.94
$972.18
$1,024.35
$1,209.66

$1,202.01
$1,251.25
$1,303.42
$1,488.73

$279.07

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$729.60
$828.08
$932.42
$1,303.04
$1,980.10

$1,008.67
$1,107.15
$1,211.49
$1,582.11

$1,287.74
$1,386.22
$1,490.56
$1,861.18

$1,566.81
$1,665.29
$1,769.63
$2,140.25

$279.07

Toc - Plan #41 Ambetter from Sunshine Health

Silver

(EPO) Clear Silver

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$5,400 $10,800 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$396.47
$449.98
$506.67
$708.07
$1,075.99

$699.76
$753.27
$809.96
$1,011.36

$1,003.05
$1,056.56
$1,113.25
$1,314.65

$1,306.34
$1,359.85
$1,416.54
$1,617.94

$303.29

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$792.94
$899.96
$1,013.34
$1,416.14
$2,151.98

$1,096.23
$1,203.25
$1,316.63
$1,719.43

$1,399.52
$1,506.54
$1,619.92
$2,022.72

$1,702.81
$1,809.83
$1,923.21
$2,326.01

$303.29

Toc - Plan #42 Ambetter from Sunshine Health

Silver

(EPO) Focused Silver

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$6,100 $12,200 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$399.83
$453.79
$510.97
$714.07
$1,085.10

$705.69
$759.65
$816.83
$1,019.93

$1,011.55
$1,065.51
$1,122.69
$1,325.79

$1,317.41
$1,371.37
$1,428.55
$1,631.65

$305.86

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$799.66
$907.58
$1,021.94
$1,428.14
$2,170.20

$1,105.52
$1,213.44
$1,327.80
$1,734.00

$1,411.38
$1,519.30
$1,633.66
$2,039.86

$1,717.24
$1,825.16
$1,939.52
$2,345.72

$305.86

Toc - Plan #43 Ambetter from Sunshine Health

Gold

(EPO) Everyday Gold

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$750 $1,500 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$378.88
$430.01
$484.19
$676.66
$1,028.24

$668.71
$719.84
$774.02
$966.49

$958.54
$1,009.67
$1,063.85
$1,256.32

$1,248.37
$1,299.50
$1,353.68
$1,546.15

$289.83

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$757.76
$860.02
$968.38
$1,353.32
$2,056.48

$1,047.59
$1,149.85
$1,258.21
$1,643.15

$1,337.42
$1,439.68
$1,548.04
$1,932.98

$1,627.25
$1,729.51
$1,837.87
$2,222.81

$289.83

Toc - Plan #44 Ambetter from Sunshine Health

Silver

(EPO) Enhanced Silver

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$3,850 $7,700 Annual Deductible

$8,600 $17,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$402.19
$456.47
$513.98
$718.29
$1,091.51

$709.85
$764.13
$821.64
$1,025.95

$1,017.51
$1,071.79
$1,129.30
$1,333.61

$1,325.17
$1,379.45
$1,436.96
$1,641.27

$307.66

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$804.38
$912.94
$1,027.96
$1,436.58
$2,183.02

$1,112.04
$1,220.60
$1,335.62
$1,744.24

$1,419.70
$1,528.26
$1,643.28
$2,051.90

$1,727.36
$1,835.92
$1,950.94
$2,359.56

$307.66

Toc - Plan #45 Ambetter from Sunshine Health

Gold

(EPO) Elite Gold

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$5,000 $10,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$440.85
$500.35
$563.39
$787.34
$1,196.43

$778.09
$837.59
$900.63
$1,124.58

$1,115.33
$1,174.83
$1,237.87
$1,461.82

$1,452.57
$1,512.07
$1,575.11
$1,799.06

$337.24

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$881.70
$1,000.70
$1,126.78
$1,574.68
$2,392.86

$1,218.94
$1,337.94
$1,464.02
$1,911.92

$1,556.18
$1,675.18
$1,801.26
$2,249.16

$1,893.42
$2,012.42
$2,138.50
$2,586.40

$337.24

Toc - Plan #46 Ambetter from Sunshine Health

Expanded Bronze

(EPO) CMS Standard Expanded Bronze

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$312.35
$354.50
$399.17
$557.83
$847.68

$551.29
$593.44
$638.11
$796.77

$790.23
$832.38
$877.05
$1,035.71

$1,029.17
$1,071.32
$1,115.99
$1,274.65

$238.94

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$624.70
$709.00
$798.34
$1,115.66
$1,695.36

$863.64
$947.94
$1,037.28
$1,354.60

$1,102.58
$1,186.88
$1,276.22
$1,593.54

$1,341.52
$1,425.82
$1,515.16
$1,832.48

$238.94

Toc - Plan #47 Ambetter from Sunshine Health

Silver

(EPO) CMS Standard Silver

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$5,800 $11,600 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$396.23
$449.71
$506.37
$707.65
$1,075.34

$699.34
$752.82
$809.48
$1,010.76

$1,002.45
$1,055.93
$1,112.59
$1,313.87

$1,305.56
$1,359.04
$1,415.70
$1,616.98

$303.11

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$792.46
$899.42
$1,012.74
$1,415.30
$2,150.68

$1,095.57
$1,202.53
$1,315.85
$1,718.41

$1,398.68
$1,505.64
$1,618.96
$2,021.52

$1,701.79
$1,808.75
$1,922.07
$2,324.63

$303.11

Toc - Plan #48 Ambetter from Sunshine Health

Gold

(EPO) CMS Standard Gold

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$2,000 $4,000 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$371.04
$421.12
$474.18
$662.66
$1,006.98

$654.88
$704.96
$758.02
$946.50

$938.72
$988.80
$1,041.86
$1,230.34

$1,222.56
$1,272.64
$1,325.70
$1,514.18

$283.84

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$742.08
$842.24
$948.36
$1,325.32
$2,013.96

$1,025.92
$1,126.08
$1,232.20
$1,609.16

$1,309.76
$1,409.92
$1,516.04
$1,893.00

$1,593.60
$1,693.76
$1,799.88
$2,176.84

$283.84

Toc - Plan #49 Ambetter from Sunshine Health

Silver

(EPO) Everyday Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$6,500 $13,000 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$416.15
$472.32
$531.83
$743.23
$1,129.41

$734.50
$790.67
$850.18
$1,061.58

$1,052.85
$1,109.02
$1,168.53
$1,379.93

$1,371.20
$1,427.37
$1,486.88
$1,698.28

$318.35

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$832.30
$944.64
$1,063.66
$1,486.46
$2,258.82

$1,150.65
$1,262.99
$1,382.01
$1,804.81

$1,469.00
$1,581.34
$1,700.36
$2,123.16

$1,787.35
$1,899.69
$2,018.71
$2,441.51

$318.35

Toc - Plan #50 Ambetter from Sunshine Health

Expanded Bronze

(EPO) Choice Bronze HSA + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$6,900 $13,800 Annual Deductible

$6,900 $13,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$338.11
$383.75
$432.10
$603.85
$917.61

$596.76
$642.40
$690.75
$862.50

$855.41
$901.05
$949.40
$1,121.15

$1,114.06
$1,159.70
$1,208.05
$1,379.80

$258.65

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$676.22
$767.50
$864.20
$1,207.70
$1,835.22

$934.87
$1,026.15
$1,122.85
$1,466.35

$1,193.52
$1,284.80
$1,381.50
$1,725.00

$1,452.17
$1,543.45
$1,640.15
$1,983.65

$258.65

Toc - Plan #51 Ambetter from Sunshine Health

Gold

(EPO) Complete Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$1,450 $2,900 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$411.76
$467.33
$526.21
$735.38
$1,117.48

$726.75
$782.32
$841.20
$1,050.37

$1,041.74
$1,097.31
$1,156.19
$1,365.36

$1,356.73
$1,412.30
$1,471.18
$1,680.35

$314.99

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$823.52
$934.66
$1,052.42
$1,470.76
$2,234.96

$1,138.51
$1,249.65
$1,367.41
$1,785.75

$1,453.50
$1,564.64
$1,682.40
$2,100.74

$1,768.49
$1,879.63
$1,997.39
$2,415.73

$314.99

Toc - Plan #52 Ambetter from Sunshine Health

Bronze

(EPO) Clear Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$8,600 $17,200 Annual Deductible

$8,600 $17,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$307.02
$348.45
$392.35
$548.31
$833.21

$541.88
$583.31
$627.21
$783.17

$776.74
$818.17
$862.07
$1,018.03

$1,011.60
$1,053.03
$1,096.93
$1,252.89

$234.86

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$614.04
$696.90
$784.70
$1,096.62
$1,666.42

$848.90
$931.76
$1,019.56
$1,331.48

$1,083.76
$1,166.62
$1,254.42
$1,566.34

$1,318.62
$1,401.48
$1,489.28
$1,801.20

$234.86

Toc - Plan #53 Ambetter from Sunshine Health

Silver

(EPO) Clear Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$5,400 $10,800 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$411.18
$466.67
$525.47
$734.34
$1,115.90

$725.72
$781.21
$840.01
$1,048.88

$1,040.26
$1,095.75
$1,154.55
$1,363.42

$1,354.80
$1,410.29
$1,469.09
$1,677.96

$314.54

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$822.36
$933.34
$1,050.94
$1,468.68
$2,231.80

$1,136.90
$1,247.88
$1,365.48
$1,783.22

$1,451.44
$1,562.42
$1,680.02
$2,097.76

$1,765.98
$1,876.96
$1,994.56
$2,412.30

$314.54

Toc - Plan #54 Ambetter from Sunshine Health

Silver

(EPO) Enhanced Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$3,850 $7,700 Annual Deductible

$8,600 $17,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$417.10
$473.40
$533.05
$744.93
$1,131.99

$736.18
$792.48
$852.13
$1,064.01

$1,055.26
$1,111.56
$1,171.21
$1,383.09

$1,374.34
$1,430.64
$1,490.29
$1,702.17

$319.08

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$834.20
$946.80
$1,066.10
$1,489.86
$2,263.98

$1,153.28
$1,265.88
$1,385.18
$1,808.94

$1,472.36
$1,584.96
$1,704.26
$2,128.02

$1,791.44
$1,904.04
$2,023.34
$2,447.10

$319.08

Toc - Plan #55 Ambetter from Sunshine Health

Gold

(EPO) Elite Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$5,000 $10,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$457.20
$518.91
$584.29
$816.54
$1,240.82

$806.95
$868.66
$934.04
$1,166.29

$1,156.70
$1,218.41
$1,283.79
$1,516.04

$1,506.45
$1,568.16
$1,633.54
$1,865.79

$349.75

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$914.40
$1,037.82
$1,168.58
$1,633.08
$2,481.64

$1,264.15
$1,387.57
$1,518.33
$1,982.83

$1,613.90
$1,737.32
$1,868.08
$2,332.58

$1,963.65
$2,087.07
$2,217.83
$2,682.33

$349.75

Toc - Plan #56 Ambetter from Sunshine Health

Expanded Bronze

(EPO) Everyday Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$8,300 $16,600 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$330.11
$374.67
$421.87
$589.56
$895.90

$582.64
$627.20
$674.40
$842.09

$835.17
$879.73
$926.93
$1,094.62

$1,087.70
$1,132.26
$1,179.46
$1,347.15

$252.53

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$660.22
$749.34
$843.74
$1,179.12
$1,791.80

$912.75
$1,001.87
$1,096.27
$1,431.65

$1,165.28
$1,254.40
$1,348.80
$1,684.18

$1,417.81
$1,506.93
$1,601.33
$1,936.71

$252.53

Toc - Plan #57 Ambetter from Sunshine Health

Expanded Bronze

(EPO) Elite Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$378.33
$429.40
$483.50
$675.69
$1,026.77

$667.75
$718.82
$772.92
$965.11

$957.17
$1,008.24
$1,062.34
$1,254.53

$1,246.59
$1,297.66
$1,351.76
$1,543.95

$289.42

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$756.66
$858.80
$967.00
$1,351.38
$2,053.54

$1,046.08
$1,148.22
$1,256.42
$1,640.80

$1,335.50
$1,437.64
$1,545.84
$1,930.22

$1,624.92
$1,727.06
$1,835.26
$2,219.64

$289.42

Toc - Plan #58 Ambetter from Sunshine Health

Silver

(EPO) Focused Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$6,100 $12,200 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$414.66
$470.63
$529.92
$740.56
$1,125.35

$731.87
$787.84
$847.13
$1,057.77

$1,049.08
$1,105.05
$1,164.34
$1,374.98

$1,366.29
$1,422.26
$1,481.55
$1,692.19

$317.21

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$829.32
$941.26
$1,059.84
$1,481.12
$2,250.70

$1,146.53
$1,258.47
$1,377.05
$1,798.33

$1,463.74
$1,575.68
$1,694.26
$2,115.54

$1,780.95
$1,892.89
$2,011.47
$2,432.75

$317.21

Toc - Plan #59 Ambetter from Sunshine Health

Gold

(EPO) Everyday Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$750 $1,500 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$392.93
$445.96
$502.15
$701.76
$1,066.39

$693.51
$746.54
$802.73
$1,002.34

$994.09
$1,047.12
$1,103.31
$1,302.92

$1,294.67
$1,347.70
$1,403.89
$1,603.50

$300.58

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$785.86
$891.92
$1,004.30
$1,403.52
$2,132.78

$1,086.44
$1,192.50
$1,304.88
$1,704.10

$1,387.02
$1,493.08
$1,605.46
$2,004.68

$1,687.60
$1,793.66
$1,906.04
$2,305.26

$300.58

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

Silver

(HMO) BlueCare Silver 1490 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$5,950 $11,900 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$491.50
$557.85
$628.14
$877.82
$1,333.93

$867.50
$933.85
$1,004.14
$1,253.82

$1,243.50
$1,309.85
$1,380.14
$1,629.82

$1,619.50
$1,685.85
$1,756.14
$2,005.82

$376.00

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$983.00
$1,115.70
$1,256.28
$1,755.64
$2,667.86

$1,359.00
$1,491.70
$1,632.28
$2,131.64

$1,735.00
$1,867.70
$2,008.28
$2,507.64

$2,111.00
$2,243.70
$2,384.28
$2,883.64

$376.00

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

Expanded Bronze

(HMO) BlueCare Bronze 1486 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$6,900 $13,800 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$347.64
$394.57
$444.28
$620.89
$943.49

$613.58
$660.51
$710.22
$886.83

$879.52
$926.45
$976.16
$1,152.77

$1,145.46
$1,192.39
$1,242.10
$1,418.71

$265.94

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$695.28
$789.14
$888.56
$1,241.78
$1,886.98

$961.22
$1,055.08
$1,154.50
$1,507.72

$1,227.16
$1,321.02
$1,420.44
$1,773.66

$1,493.10
$1,586.96
$1,686.38
$2,039.60

$265.94

Toc - Plan #62 Florida Blue HMO (a BlueCross BlueShield FL company)

Silver

(HMO) BlueCare Silver 1498 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$6,000 $12,000 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$503.07
$570.98
$642.92
$898.48
$1,365.33

$887.92
$955.83
$1,027.77
$1,283.33

$1,272.77
$1,340.68
$1,412.62
$1,668.18

$1,657.62
$1,725.53
$1,797.47
$2,053.03

$384.85

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,006.14
$1,141.96
$1,285.84
$1,796.96
$2,730.66

$1,390.99
$1,526.81
$1,670.69
$2,181.81

$1,775.84
$1,911.66
$2,055.54
$2,566.66

$2,160.69
$2,296.51
$2,440.39
$2,951.51

$384.85

Toc - Plan #63 Florida Blue HMO (a BlueCross BlueShield FL company)

Platinum

(HMO) BlueCare Platinum 1485 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$1,000 $2,000 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$589.58
$669.17
$753.48
$1,052.99
$1,600.12

$1,040.61
$1,120.20
$1,204.51
$1,504.02

$1,491.64
$1,571.23
$1,655.54
$1,955.05

$1,942.67
$2,022.26
$2,106.57
$2,406.08

$451.03

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,179.16
$1,338.34
$1,506.96
$2,105.98
$3,200.24

$1,630.19
$1,789.37
$1,957.99
$2,557.01

$2,081.22
$2,240.40
$2,409.02
$3,008.04

$2,532.25
$2,691.43
$2,860.05
$3,459.07

$451.03

Toc - Plan #64 Florida Blue HMO (a BlueCross BlueShield FL company)

Expanded Bronze

(HMO) BlueCare Bronze 1483 ($0 Virtual Visits / 3 PCP Visits for $0 / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$7,400 $14,800 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$368.47
$418.21
$470.90
$658.09
$1,000.03

$650.35
$700.09
$752.78
$939.97

$932.23
$981.97
$1,034.66
$1,221.85

$1,214.11
$1,263.85
$1,316.54
$1,503.73

$281.88

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$736.94
$836.42
$941.80
$1,316.18
$2,000.06

$1,018.82
$1,118.30
$1,223.68
$1,598.06

$1,300.70
$1,400.18
$1,505.56
$1,879.94

$1,582.58
$1,682.06
$1,787.44
$2,161.82

$281.88

Toc - Plan #65 Florida Blue HMO (a BlueCross BlueShield FL company)

Platinum

(HMO) BlueCare Platinum 1491 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$626.77
$711.38
$801.01
$1,119.41
$1,701.05

$1,106.25
$1,190.86
$1,280.49
$1,598.89

$1,585.73
$1,670.34
$1,759.97
$2,078.37

$2,065.21
$2,149.82
$2,239.45
$2,557.85

$479.48

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,253.54
$1,422.76
$1,602.02
$2,238.82
$3,402.10

$1,733.02
$1,902.24
$2,081.50
$2,718.30

$2,212.50
$2,381.72
$2,560.98
$3,197.78

$2,691.98
$2,861.20
$3,040.46
$3,677.26

$479.48

Toc - Plan #66 Florida Blue HMO (a BlueCross BlueShield FL company)

Silver

(HMO) BlueCare Silver 1477 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$6,000 $12,000 Annual Deductible

$7,900 $15,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$453.32
$514.52
$579.34
$809.63
$1,230.31

$800.11
$861.31
$926.13
$1,156.42

$1,146.90
$1,208.10
$1,272.92
$1,503.21

$1,493.69
$1,554.89
$1,619.71
$1,850.00

$346.79

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$906.64
$1,029.04
$1,158.68
$1,619.26
$2,460.62

$1,253.43
$1,375.83
$1,505.47
$1,966.05

$1,600.22
$1,722.62
$1,852.26
$2,312.84

$1,947.01
$2,069.41
$2,199.05
$2,659.63

$346.79

Toc - Plan #67 Florida Blue HMO (a BlueCross BlueShield FL company)

Gold

(HMO) BlueCare Gold 1565 ($0 Virtual Visits / $20 PCP Visit / $15 Generic Meds / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$553.01
$627.67
$706.75
$987.68
$1,500.87

$976.06
$1,050.72
$1,129.80
$1,410.73

$1,399.11
$1,473.77
$1,552.85
$1,833.78

$1,822.16
$1,896.82
$1,975.90
$2,256.83

$423.05

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,106.02
$1,255.34
$1,413.50
$1,975.36
$3,001.74

$1,529.07
$1,678.39
$1,836.55
$2,398.41

$1,952.12
$2,101.44
$2,259.60
$2,821.46

$2,375.17
$2,524.49
$2,682.65
$3,244.51

$423.05

Toc - Plan #68 Florida Blue HMO (a BlueCross BlueShield FL company)

Expanded Bronze

(HMO) BlueCare Bronze (HSA) 1765 (Rewards $$$ / $4 Condition Care Rx)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$6,850 $13,700 Annual Deductible

$6,850 $13,700 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$351.75
$399.24
$449.54
$628.23
$954.65

$620.84
$668.33
$718.63
$897.32

$889.93
$937.42
$987.72
$1,166.41

$1,159.02
$1,206.51
$1,256.81
$1,435.50

$269.09

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$703.50
$798.48
$899.08
$1,256.46
$1,909.30

$972.59
$1,067.57
$1,168.17
$1,525.55

$1,241.68
$1,336.66
$1,437.26
$1,794.64

$1,510.77
$1,605.75
$1,706.35
$2,063.73

$269.09

Toc - Plan #69 Florida Blue HMO (a BlueCross BlueShield FL company)

Gold

(HMO) BlueCare Gold 1865 ($0 Virtual Visits / $20 Labs / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$1,500 $3,000 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$529.26
$600.71
$676.39
$945.26
$1,436.41

$934.14
$1,005.59
$1,081.27
$1,350.14

$1,339.02
$1,410.47
$1,486.15
$1,755.02

$1,743.90
$1,815.35
$1,891.03
$2,159.90

$404.88

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,058.52
$1,201.42
$1,352.78
$1,890.52
$2,872.82

$1,463.40
$1,606.30
$1,757.66
$2,295.40

$1,868.28
$2,011.18
$2,162.54
$2,700.28

$2,273.16
$2,416.06
$2,567.42
$3,105.16

$404.88

Toc - Plan #70 Florida Blue HMO (a BlueCross BlueShield FL company)

Expanded Bronze

(HMO) BlueCare Bronze 2179 ($0 Deductible / $0 Virtual Visits / $50 PCP Visit / $30 Generic Meds / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$399.88
$453.86
$511.05
$714.19
$1,085.27

$705.79
$759.77
$816.96
$1,020.10

$1,011.70
$1,065.68
$1,122.87
$1,326.01

$1,317.61
$1,371.59
$1,428.78
$1,631.92

$305.91

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$799.76
$907.72
$1,022.10
$1,428.38
$2,170.54

$1,105.67
$1,213.63
$1,328.01
$1,734.29

$1,411.58
$1,519.54
$1,633.92
$2,040.20

$1,717.49
$1,825.45
$1,939.83
$2,346.11

$305.91

Toc - Plan #71 Florida Blue HMO (a BlueCross BlueShield FL company)

Bronze

(HMO) BlueCare Bronze 2361S (Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$9,100 $18,200 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$328.26
$372.58
$419.52
$586.27
$890.90

$579.38
$623.70
$670.64
$837.39

$830.50
$874.82
$921.76
$1,088.51

$1,081.62
$1,125.94
$1,172.88
$1,339.63

$251.12

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$656.52
$745.16
$839.04
$1,172.54
$1,781.80

$907.64
$996.28
$1,090.16
$1,423.66

$1,158.76
$1,247.40
$1,341.28
$1,674.78

$1,409.88
$1,498.52
$1,592.40
$1,925.90

$251.12

Toc - Plan #72 Florida Blue HMO (a BlueCross BlueShield FL company)

Expanded Bronze

(HMO) BlueCare Bronze 2362S (Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$361.65
$410.47
$462.19
$645.91
$981.52

$638.31
$687.13
$738.85
$922.57

$914.97
$963.79
$1,015.51
$1,199.23

$1,191.63
$1,240.45
$1,292.17
$1,475.89

$276.66

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$723.30
$820.94
$924.38
$1,291.82
$1,963.04

$999.96
$1,097.60
$1,201.04
$1,568.48

$1,276.62
$1,374.26
$1,477.70
$1,845.14

$1,553.28
$1,650.92
$1,754.36
$2,121.80

$276.66

Toc - Plan #73 Florida Blue HMO (a BlueCross BlueShield FL company)

Silver

(HMO) BlueCare Silver 2363S ($40 PCP Visits / Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$5,800 $11,600 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$486.19
$551.83
$621.35
$868.34
$1,319.52

$858.13
$923.77
$993.29
$1,240.28

$1,230.07
$1,295.71
$1,365.23
$1,612.22

$1,602.01
$1,667.65
$1,737.17
$1,984.16

$371.94

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$972.38
$1,103.66
$1,242.70
$1,736.68
$2,639.04

$1,344.32
$1,475.60
$1,614.64
$2,108.62

$1,716.26
$1,847.54
$1,986.58
$2,480.56

$2,088.20
$2,219.48
$2,358.52
$2,852.50

$371.94

Toc - Plan #74 Florida Blue HMO (a BlueCross BlueShield FL company)

Gold

(HMO) BlueCare Gold 2364S ($30 PCP Visit / Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$2,000 $4,000 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$501.24
$568.91
$640.58
$895.21
$1,360.37

$884.69
$952.36
$1,024.03
$1,278.66

$1,268.14
$1,335.81
$1,407.48
$1,662.11

$1,651.59
$1,719.26
$1,790.93
$2,045.56

$383.45

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,002.48
$1,137.82
$1,281.16
$1,790.42
$2,720.74

$1,385.93
$1,521.27
$1,664.61
$2,173.87

$1,769.38
$1,904.72
$2,048.06
$2,557.32

$2,152.83
$2,288.17
$2,431.51
$2,940.77

$383.45

Toc - Plan #75 Florida Blue HMO (a BlueCross BlueShield FL company)

Platinum

(HMO) BlueCare Platinum 2365S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$3,000 $6,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$625.05
$709.43
$798.81
$1,116.34
$1,696.39

$1,103.21
$1,187.59
$1,276.97
$1,594.50

$1,581.37
$1,665.75
$1,755.13
$2,072.66

$2,059.53
$2,143.91
$2,233.29
$2,550.82

$478.16

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,250.10
$1,418.86
$1,597.62
$2,232.68
$3,392.78

$1,728.26
$1,897.02
$2,075.78
$2,710.84

$2,206.42
$2,375.18
$2,553.94
$3,189.00

$2,684.58
$2,853.34
$3,032.10
$3,667.16

$478.16

Toc - Plan #76 Florida Blue HMO (a BlueCross BlueShield FL company)

Expanded Bronze

(HMO) BlueCare Bronze 2379 ($0 Deductible / $0 Virtual Visits / Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$0 Not Applicable Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$386.70
$438.90
$494.20
$690.65
$1,049.50

$682.53
$734.73
$790.03
$986.48

$978.36
$1,030.56
$1,085.86
$1,282.31

$1,274.19
$1,326.39
$1,381.69
$1,578.14

$295.83

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$773.40
$877.80
$988.40
$1,381.30
$2,099.00

$1,069.23
$1,173.63
$1,284.23
$1,677.13

$1,365.06
$1,469.46
$1,580.06
$1,972.96

$1,660.89
$1,765.29
$1,875.89
$2,268.79

$295.83

Toc - Plan #77 Florida Blue HMO (a BlueCross BlueShield FL company)

Expanded Bronze

(HMO) myBlue Bronze 1601 ($0 Virtual Visits / 3 PCP Visits for $0 / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$8,000 $16,000 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$346.87
$393.70
$443.30
$619.51
$941.41

$612.23
$659.06
$708.66
$884.87

$877.59
$924.42
$974.02
$1,150.23

$1,142.95
$1,189.78
$1,239.38
$1,415.59

$265.36

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$693.74
$787.40
$886.60
$1,239.02
$1,882.82

$959.10
$1,052.76
$1,151.96
$1,504.38

$1,224.46
$1,318.12
$1,417.32
$1,769.74

$1,489.82
$1,583.48
$1,682.68
$2,035.10

$265.36

Toc - Plan #78 Florida Blue HMO (a BlueCross BlueShield FL company)

Expanded Bronze

(HMO) myBlue Bronze 1602 ($0 Virtual Visits / $20 Labs / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$326.53
$370.61
$417.31
$583.18
$886.20

$576.33
$620.41
$667.11
$832.98

$826.13
$870.21
$916.91
$1,082.78

$1,075.93
$1,120.01
$1,166.71
$1,332.58

$249.80

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$653.06
$741.22
$834.62
$1,166.36
$1,772.40

$902.86
$991.02
$1,084.42
$1,416.16

$1,152.66
$1,240.82
$1,334.22
$1,665.96

$1,402.46
$1,490.62
$1,584.02
$1,915.76

$249.80

Toc - Plan #79 Florida Blue HMO (a BlueCross BlueShield FL company)

Silver

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

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$5,900 $11,800 Annual Deductible

$7,200 $14,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$427.18
$484.85
$545.94
$762.94
$1,159.37

$753.97
$811.64
$872.73
$1,089.73

$1,080.76
$1,138.43
$1,199.52
$1,416.52

$1,407.55
$1,465.22
$1,526.31
$1,743.31

$326.79

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$854.36
$969.70
$1,091.88
$1,525.88
$2,318.74

$1,181.15
$1,296.49
$1,418.67
$1,852.67

$1,507.94
$1,623.28
$1,745.46
$2,179.46

$1,834.73
$1,950.07
$2,072.25
$2,506.25

$326.79

Toc - Plan #80 Florida Blue HMO (a BlueCross BlueShield FL company)

Silver

(HMO) myBlue Silver 1604 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$5,500 $11,000 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$407.20
$462.17
$520.40
$727.26
$1,105.14

$718.71
$773.68
$831.91
$1,038.77

$1,030.22
$1,085.19
$1,143.42
$1,350.28

$1,341.73
$1,396.70
$1,454.93
$1,661.79

$311.51

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$814.40
$924.34
$1,040.80
$1,454.52
$2,210.28

$1,125.91
$1,235.85
$1,352.31
$1,766.03

$1,437.42
$1,547.36
$1,663.82
$2,077.54

$1,748.93
$1,858.87
$1,975.33
$2,389.05

$311.51

Toc - Plan #81 Florida Blue HMO (a BlueCross BlueShield FL company)

Gold

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

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$940 $1,880 Annual Deductible

$4,700 $9,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$483.61
$548.90
$618.05
$863.73
$1,312.52

$853.57
$918.86
$988.01
$1,233.69

$1,223.53
$1,288.82
$1,357.97
$1,603.65

$1,593.49
$1,658.78
$1,727.93
$1,973.61

$369.96

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$967.22
$1,097.80
$1,236.10
$1,727.46
$2,625.04

$1,337.18
$1,467.76
$1,606.06
$2,097.42

$1,707.14
$1,837.72
$1,976.02
$2,467.38

$2,077.10
$2,207.68
$2,345.98
$2,837.34

$369.96

Toc - Plan #82 Florida Blue HMO (a BlueCross BlueShield FL company)

Silver

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

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$6,700 $13,400 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$434.00
$492.59
$554.65
$775.12
$1,177.88

$766.01
$824.60
$886.66
$1,107.13

$1,098.02
$1,156.61
$1,218.67
$1,439.14

$1,430.03
$1,488.62
$1,550.68
$1,771.15

$332.01

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$868.00
$985.18
$1,109.30
$1,550.24
$2,355.76

$1,200.01
$1,317.19
$1,441.31
$1,882.25

$1,532.02
$1,649.20
$1,773.32
$2,214.26

$1,864.03
$1,981.21
$2,105.33
$2,546.27

$332.01

Toc - Plan #83 Florida Blue HMO (a BlueCross BlueShield FL company)

Silver

(HMO) myBlue Silver 2017 ($0 Virtual Visits / $20 Labs / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$6,000 $12,000 Annual Deductible

$7,400 $14,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$403.92
$458.45
$516.21
$721.40
$1,096.24

$712.92
$767.45
$825.21
$1,030.40

$1,021.92
$1,076.45
$1,134.21
$1,339.40

$1,330.92
$1,385.45
$1,443.21
$1,648.40

$309.00

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$807.84
$916.90
$1,032.42
$1,442.80
$2,192.48

$1,116.84
$1,225.90
$1,341.42
$1,751.80

$1,425.84
$1,534.90
$1,650.42
$2,060.80

$1,734.84
$1,843.90
$1,959.42
$2,369.80

$309.00

Toc - Plan #84 Florida Blue HMO (a BlueCross BlueShield FL company)

Silver

(HMO) myBlue Silver 2127 ($0 Virtual Visits / $25 Generic Meds / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$5,800 $11,600 Annual Deductible

$7,600 $15,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$402.39
$456.71
$514.25
$718.67
$1,092.09

$710.22
$764.54
$822.08
$1,026.50

$1,018.05
$1,072.37
$1,129.91
$1,334.33

$1,325.88
$1,380.20
$1,437.74
$1,642.16

$307.83

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$804.78
$913.42
$1,028.50
$1,437.34
$2,184.18

$1,112.61
$1,221.25
$1,336.33
$1,745.17

$1,420.44
$1,529.08
$1,644.16
$2,053.00

$1,728.27
$1,836.91
$1,951.99
$2,360.83

$307.83

Toc - Plan #85 Florida Blue HMO (a BlueCross BlueShield FL company)

Expanded Bronze

(HMO) myBlue Bronze 2129 ($0 Deductible / $0 Virtual Visits / $35 PCP Visit / $80 Specialist Visits / $25 Generic Meds / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$375.24
$425.90
$479.56
$670.18
$1,018.40

$662.30
$712.96
$766.62
$957.24

$949.36
$1,000.02
$1,053.68
$1,244.30

$1,236.42
$1,287.08
$1,340.74
$1,531.36

$287.06

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$750.48
$851.80
$959.12
$1,340.36
$2,036.80

$1,037.54
$1,138.86
$1,246.18
$1,627.42

$1,324.60
$1,425.92
$1,533.24
$1,914.48

$1,611.66
$1,712.98
$1,820.30
$2,201.54

$287.06

Toc - Plan #86 Florida Blue HMO (a BlueCross BlueShield FL company)

Expanded Bronze

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

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$8,200 $16,400 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$347.27
$394.15
$443.81
$620.22
$942.49

$612.93
$659.81
$709.47
$885.88

$878.59
$925.47
$975.13
$1,151.54

$1,144.25
$1,191.13
$1,240.79
$1,417.20

$265.66

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$694.54
$788.30
$887.62
$1,240.44
$1,884.98

$960.20
$1,053.96
$1,153.28
$1,506.10

$1,225.86
$1,319.62
$1,418.94
$1,771.76

$1,491.52
$1,585.28
$1,684.60
$2,037.42

$265.66

Toc - Plan #87 Florida Blue HMO (a BlueCross BlueShield FL company)

Silver

(HMO) myBlue Silver 2237 ($0 Virtual Visits / $80 PCP Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$4,100 $8,200 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$395.35
$448.72
$505.26
$706.10
$1,072.98

$697.79
$751.16
$807.70
$1,008.54

$1,000.23
$1,053.60
$1,110.14
$1,310.98

$1,302.67
$1,356.04
$1,412.58
$1,613.42

$302.44

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$790.70
$897.44
$1,010.52
$1,412.20
$2,145.96

$1,093.14
$1,199.88
$1,312.96
$1,714.64

$1,395.58
$1,502.32
$1,615.40
$2,017.08

$1,698.02
$1,804.76
$1,917.84
$2,319.52

$302.44

Toc - Plan #88 Florida Blue HMO (a BlueCross BlueShield FL company)

Expanded Bronze

(HMO) myBlue Bronze 2219 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$2,400 $4,800 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$339.41
$385.23
$433.77
$606.19
$921.16

$599.06
$644.88
$693.42
$865.84

$858.71
$904.53
$953.07
$1,125.49

$1,118.36
$1,164.18
$1,212.72
$1,385.14

$259.65

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$678.82
$770.46
$867.54
$1,212.38
$1,842.32

$938.47
$1,030.11
$1,127.19
$1,472.03

$1,198.12
$1,289.76
$1,386.84
$1,731.68

$1,457.77
$1,549.41
$1,646.49
$1,991.33

$259.65

Toc - Plan #89 Florida Blue HMO (a BlueCross BlueShield FL company)

Expanded Bronze

(HMO) myBlue Bronze 2266 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$2,700 $5,400 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$340.13
$386.05
$434.69
$607.47
$923.11

$600.33
$646.25
$694.89
$867.67

$860.53
$906.45
$955.09
$1,127.87

$1,120.73
$1,166.65
$1,215.29
$1,388.07

$260.20

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$680.26
$772.10
$869.38
$1,214.94
$1,846.22

$940.46
$1,032.30
$1,129.58
$1,475.14

$1,200.66
$1,292.50
$1,389.78
$1,735.34

$1,460.86
$1,552.70
$1,649.98
$1,995.54

$260.20

Toc - Plan #90 Florida Blue HMO (a BlueCross BlueShield FL company)

Bronze

(HMO) myBlue Bronze 2311S (Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$9,100 $18,200 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$309.03
$350.75
$394.94
$551.93
$838.71

$545.44
$587.16
$631.35
$788.34

$781.85
$823.57
$867.76
$1,024.75

$1,018.26
$1,059.98
$1,104.17
$1,261.16

$236.41

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$618.06
$701.50
$789.88
$1,103.86
$1,677.42

$854.47
$937.91
$1,026.29
$1,340.27

$1,090.88
$1,174.32
$1,262.70
$1,576.68

$1,327.29
$1,410.73
$1,499.11
$1,813.09

$236.41

Toc - Plan #91 Florida Blue HMO (a BlueCross BlueShield FL company)

Expanded Bronze

(HMO) myBlue Bronze 2312S (Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$331.52
$376.28
$423.68
$592.09
$899.75

$585.13
$629.89
$677.29
$845.70

$838.74
$883.50
$930.90
$1,099.31

$1,092.35
$1,137.11
$1,184.51
$1,352.92

$253.61

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$663.04
$752.56
$847.36
$1,184.18
$1,799.50

$916.65
$1,006.17
$1,100.97
$1,437.79

$1,170.26
$1,259.78
$1,354.58
$1,691.40

$1,423.87
$1,513.39
$1,608.19
$1,945.01

$253.61

Toc - Plan #92 Florida Blue HMO (a BlueCross BlueShield FL company)

Expanded Bronze

(HMO) myBlue Bronze 2329 ($0 Deductible / $0 Virtual Visits / Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$363.34
$412.39
$464.35
$648.93
$986.10

$641.30
$690.35
$742.31
$926.89

$919.26
$968.31
$1,020.27
$1,204.85

$1,197.22
$1,246.27
$1,298.23
$1,482.81

$277.96

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$726.68
$824.78
$928.70
$1,297.86
$1,972.20

$1,004.64
$1,102.74
$1,206.66
$1,575.82

$1,282.60
$1,380.70
$1,484.62
$1,853.78

$1,560.56
$1,658.66
$1,762.58
$2,131.74

$277.96

Toc - Plan #93 Florida Blue HMO (a BlueCross BlueShield FL company)

Silver

(HMO) myBlue Silver 2337 ($0 Virtual Visits / $20 Labs / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$4,500 $9,000 Annual Deductible

$8,300 $16,600 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$382.69
$434.35
$489.08
$683.48
$1,038.62

$675.45
$727.11
$781.84
$976.24

$968.21
$1,019.87
$1,074.60
$1,269.00

$1,260.97
$1,312.63
$1,367.36
$1,561.76

$292.76

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$765.38
$868.70
$978.16
$1,366.96
$2,077.24

$1,058.14
$1,161.46
$1,270.92
$1,659.72

$1,350.90
$1,454.22
$1,563.68
$1,952.48

$1,643.66
$1,746.98
$1,856.44
$2,245.24

$292.76

Toc - Plan #94 Florida Blue HMO (a BlueCross BlueShield FL company)

Silver

(HMO) myBlue Silver 2313S ($40 PCP Visits / Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$5,800 $11,600 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$397.95
$451.67
$508.58
$710.74
$1,080.04

$702.38
$756.10
$813.01
$1,015.17

$1,006.81
$1,060.53
$1,117.44
$1,319.60

$1,311.24
$1,364.96
$1,421.87
$1,624.03

$304.43

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$795.90
$903.34
$1,017.16
$1,421.48
$2,160.08

$1,100.33
$1,207.77
$1,321.59
$1,725.91

$1,404.76
$1,512.20
$1,626.02
$2,030.34

$1,709.19
$1,816.63
$1,930.45
$2,334.77

$304.43

Toc - Plan #95 Florida Blue HMO (a BlueCross BlueShield FL company)

Gold

(HMO) myBlue Gold 2314S ($30 PCP Visits / Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$2,000 $4,000 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$457.75
$519.55
$585.00
$817.54
$1,242.33

$807.93
$869.73
$935.18
$1,167.72

$1,158.11
$1,219.91
$1,285.36
$1,517.90

$1,508.29
$1,570.09
$1,635.54
$1,868.08

$350.18

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$915.50
$1,039.10
$1,170.00
$1,635.08
$2,484.66

$1,265.68
$1,389.28
$1,520.18
$1,985.26

$1,615.86
$1,739.46
$1,870.36
$2,335.44

$1,966.04
$2,089.64
$2,220.54
$2,685.62

$350.18

Toc - Plan #96 Florida Blue HMO (a BlueCross BlueShield FL company)

Silver

(HMO) myBlue Silver 2237D ($0 Virtual Visits / $80 PCP Visits / Adult Dental / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$4,100 $8,200 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$403.39
$457.85
$515.53
$720.45
$1,094.80

$711.98
$766.44
$824.12
$1,029.04

$1,020.57
$1,075.03
$1,132.71
$1,337.63

$1,329.16
$1,383.62
$1,441.30
$1,646.22

$308.59

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$806.78
$915.70
$1,031.06
$1,440.90
$2,189.60

$1,115.37
$1,224.29
$1,339.65
$1,749.49

$1,423.96
$1,532.88
$1,648.24
$2,058.08

$1,732.55
$1,841.47
$1,956.83
$2,366.67

$308.59

Toc - Plan #97 Florida Blue HMO (a BlueCross BlueShield FL company)

Silver

(HMO) myBlue Silver 2337D ($0 Virtual Visits / Adult Dental / $20 Labs / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family

$4,500 $9,000 Annual Deductible

$8,300 $16,600 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$390.70
$443.44
$499.31
$697.79
$1,060.36

$689.59
$742.33
$798.20
$996.68

$988.48
$1,041.22
$1,097.09
$1,295.57

$1,287.37
$1,340.11
$1,395.98
$1,594.46

$298.89

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$781.40
$886.88
$998.62
$1,395.58
$2,120.72

$1,080.29
$1,185.77
$1,297.51
$1,694.47

$1,379.18
$1,484.66
$1,596.40
$1,993.36

$1,678.07
$1,783.55
$1,895.29
$2,292.25

$298.89

Ambetter from Sunshine Health

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

Toc - Plan #98 Ambetter from Sunshine Health

Expanded Bronze

(HMO) Ambetter Virtual Access Bronze - Virtual PCP selection required

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$7,000 $14,000 Annual Deductible

$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$318.34
$361.31
$406.83
$568.54
$863.96

$561.87
$604.84
$650.36
$812.07

$805.40
$848.37
$893.89
$1,055.60

$1,048.93
$1,091.90
$1,137.42
$1,299.13

$243.53

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$636.68
$722.62
$813.66
$1,137.08
$1,727.92

$880.21
$966.15
$1,057.19
$1,380.61

$1,123.74
$1,209.68
$1,300.72
$1,624.14

$1,367.27
$1,453.21
$1,544.25
$1,867.67

$243.53

Toc - Plan #99 Ambetter from Sunshine Health

Silver

(HMO) Ambetter Virtual Access Silver - Virtual PCP selection required

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$5,700 $11,400 Annual Deductible

$7,400 $14,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$401.55
$455.74
$513.16
$717.14
$1,089.77

$708.73
$762.92
$820.34
$1,024.32

$1,015.91
$1,070.10
$1,127.52
$1,331.50

$1,323.09
$1,377.28
$1,434.70
$1,638.68

$307.18

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$803.10
$911.48
$1,026.32
$1,434.28
$2,179.54

$1,110.28
$1,218.66
$1,333.50
$1,741.46

$1,417.46
$1,525.84
$1,640.68
$2,048.64

$1,724.64
$1,833.02
$1,947.86
$2,355.82

$307.18

Toc - Plan #100 Ambetter from Sunshine Health

Gold

(HMO) Ambetter Virtual Access Gold - Virtual PCP selection required

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$950 $1,900 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$395.76
$449.18
$505.77
$706.82
$1,074.08

$698.51
$751.93
$808.52
$1,009.57

$1,001.26
$1,054.68
$1,111.27
$1,312.32

$1,304.01
$1,357.43
$1,414.02
$1,615.07

$302.75

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$791.52
$898.36
$1,011.54
$1,413.64
$2,148.16

$1,094.27
$1,201.11
$1,314.29
$1,716.39

$1,397.02
$1,503.86
$1,617.04
$2,019.14

$1,699.77
$1,806.61
$1,919.79
$2,321.89

$302.75

Toc - Plan #101 Ambetter from Sunshine Health

Expanded Bronze

(HMO) CMS Standard Virtual Access Basic Bronze - Virtual PCP Selection Required

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$328.85
$373.23
$420.25
$587.30
$892.46

$580.41
$624.79
$671.81
$838.86

$831.97
$876.35
$923.37
$1,090.42

$1,083.53
$1,127.91
$1,174.93
$1,341.98

$251.56

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$657.70
$746.46
$840.50
$1,174.60
$1,784.92

$909.26
$998.02
$1,092.06
$1,426.16

$1,160.82
$1,249.58
$1,343.62
$1,677.72

$1,412.38
$1,501.14
$1,595.18
$1,929.28

$251.56

Toc - Plan #102 Ambetter from Sunshine Health

Silver

(HMO) CMS Standard Virtual Access Basic Silver - Virtual PCP Selection Required

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$5,800 $11,600 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$417.16
$473.47
$533.12
$745.04
$1,132.16

$736.28
$792.59
$852.24
$1,064.16

$1,055.40
$1,111.71
$1,171.36
$1,383.28

$1,374.52
$1,430.83
$1,490.48
$1,702.40

$319.12

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$834.32
$946.94
$1,066.24
$1,490.08
$2,264.32

$1,153.44
$1,266.06
$1,385.36
$1,809.20

$1,472.56
$1,585.18
$1,704.48
$2,128.32

$1,791.68
$1,904.30
$2,023.60
$2,447.44

$319.12

Toc - Plan #103 Ambetter from Sunshine Health

Gold

(HMO) CMS Standard Virtual Access Basic Gold - Virtual PCP Selection Required

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family

$2,000 $4,000 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$390.65
$443.38
$499.24
$697.68
$1,060.20

$689.49
$742.22
$798.08
$996.52

$988.33
$1,041.06
$1,096.92
$1,295.36

$1,287.17
$1,339.90
$1,395.76
$1,594.20

$298.84

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$781.30
$886.76
$998.48
$1,395.36
$2,120.40

$1,080.14
$1,185.60
$1,297.32
$1,694.20

$1,378.98
$1,484.44
$1,596.16
$1,993.04

$1,677.82
$1,783.28
$1,895.00
$2,291.88

$298.84

‡Source: HealthCare.gov has released sample rates for all counties in the 36 states served by HealthCare.gov. We have integrated that data into our tables and provide you that information for Walton County here.

Walton County is in “Rating Area 66” of Florida.

Currently, there are 103 plans offered in Rating Area 66.

Top

2023 Obamacare Plans for Walton County, FL

Plan Browser: 103 Plans

Florida Blue (BlueCross BlueShield FL)

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

1. Silver BlueOptions Silver 1423 ($0 Virtual Visits / Rewards $$$)

2. Expanded Bronze BlueOptions Bronze 1419 ($0 Virtual Visits / Rewards $$$)

3. Silver BlueOptions Silver 1431 ($0 Virtual Visits / Rewards $$$)

4. Platinum BlueOptions Platinum 1418 ($0 Virtual Visits / Rewards $$$)

5. Expanded Bronze BlueOptions Bronze 1416 ($0 Virtual Visits / 3 PCP Visits for $0 / Rewards $$$)

6. Platinum BlueOptions Platinum 1424 ($0 Virtual Visits / Rewards $$$)

7. Silver BlueOptions Silver 1410 ($0 Virtual Visits / $0 Lab / Rewards $$$)

8. Gold BlueOptions Gold 1505 ($0 Virtual Visits / $20 PCP Visits / $15 Generic Meds / Rewards $$$)

9. Expanded Bronze BlueOptions Bronze (HSA) 1705 (Rewards $$$ / $4 Condition Care Rx)

10. Gold BlueOptions Gold 1805 ($0 Virtual Visits / $20 Labs / Rewards $$$)

11. Expanded Bronze BlueOptions Bronze 2119 ($0 Deductible / $0 Virtual Visits / $50 PCP Visits / Rewards $$$)

12. Bronze BlueOptions Bronze 2301S (Multilingual Available / Rewards $$$)

13. Expanded Bronze BlueOptions Bronze 2302S (Multilingual Available / Rewards $$$)

14. Silver BlueOptions Silver 2303S ($40 PCP Visits / Multilingual Available/ Rewards $$$)

15. Gold BlueOptions Gold 2304S ($30 PCP Visits / Multilingual Available / Rewards $$$)

16. Platinum BlueOptions Platinum 2305S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Multilingual Available / Rewards $$$)

17. Expanded Bronze BlueOptions Bronze 2319 ($0 Deductible / $0 Virtual Visits / Multilingual Available / Rewards $$$)

18. Silver BlueSelect Silver 1456 ($0 Virtual Visits / Rewards $$$)

19. Expanded Bronze BlueSelect Bronze 1452 ($0 Virtual Visits / Rewards $$$)

20. Silver BlueSelect Silver 1464 ($0 Virtual Visits / Rewards $$$)

21. Platinum BlueSelect Platinum 1451 ($0 Virtual Visits / Rewards $$$)

22. Expanded Bronze BlueSelect Bronze 1449 ($0 Virtual Visits / 3 PCP Visits for $0 / Rewards $$$)

23. Platinum BlueSelect Platinum 1457 ($0 Virtual Visits / Rewards $$$)

24. Silver BlueSelect Silver 1443 ($0 Virtual Visits / $0 Labs / Rewards $$$)

25. Gold BlueSelect Gold 1535 ($0 Virtual Visits / $20 PCP Visit / $15 Generic Meds / Rewards $$$)

26. Expanded Bronze BlueSelect Bronze (HSA) 1735 (Rewards $$$ / $4 Condition Care Rx)

27. Gold BlueSelect Gold 1835 ($0 Virtual Visits / $20 Labs / Rewards $$$)

28. Expanded Bronze BlueSelect Bronze 2139 ($0 Deductible / $0 Virtual Visits / $50 PCP Visit / $30 Generic Meds / Rewards $$$)

29. Bronze BlueSelect Bronze 2341S (Multilingual Available / Rewards $$$)

30. Expanded Bronze BlueSelect Bronze 2342S (Multilingual Available / Rewards $$$)

31. Silver BlueSelect Silver 2343S ($40 PCP Visits / Multilingual Available / Rewards $$$)

32. Gold BlueSelect Gold 2344S ($30 PCP Visits / Multilingual Available / Rewards $$$)

33. Platinum BlueSelect Platinum 2345S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Multilingual Available / Rewards $$$)

34. Expanded Bronze BlueSelect Bronze 2339 ($0 Deductible / $0 Virtual Visits / Multilingual Available / Rewards $$$)

Ambetter from Sunshine Health

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

35. Gold Complete Gold

36. Bronze Clear Bronze

37. Expanded Bronze Choice Bronze HSA

38. Silver Everyday Silver

39. Expanded Bronze Everyday Bronze

40. Expanded Bronze Elite Bronze

41. Silver Clear Silver

42. Silver Focused Silver

43. Gold Everyday Gold

44. Silver Enhanced Silver

45. Gold Elite Gold

46. Expanded Bronze CMS Standard Expanded Bronze

47. Silver CMS Standard Silver

48. Gold CMS Standard Gold

49. Silver Everyday Silver + Vision + Adult Dental

50. Expanded Bronze Choice Bronze HSA + Vision + Adult Dental

51. Gold Complete Gold + Vision + Adult Dental

52. Bronze Clear Bronze + Vision + Adult Dental

53. Silver Clear Silver + Vision + Adult Dental

54. Silver Enhanced Silver + Vision + Adult Dental

55. Gold Elite Gold + Vision + Adult Dental

56. Expanded Bronze Everyday Bronze + Vision + Adult Dental

57. Expanded Bronze Elite Bronze + Vision + Adult Dental

58. Silver Focused Silver + Vision + Adult Dental

59. Gold Everyday Gold + Vision + Adult Dental

Florida Blue HMO (a BlueCross BlueShield FL company)

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

60. Silver BlueCare Silver 1490 ($0 Virtual Visits / Rewards $$$)

61. Expanded Bronze BlueCare Bronze 1486 ($0 Virtual Visits / Rewards $$$)

62. Silver BlueCare Silver 1498 ($0 Virtual Visits / Rewards $$$)

63. Platinum BlueCare Platinum 1485 ($0 Virtual Visits / Rewards $$$)

64. Expanded Bronze BlueCare Bronze 1483 ($0 Virtual Visits / 3 PCP Visits for $0 / Rewards $$$)

65. Platinum BlueCare Platinum 1491 ($0 Virtual Visits / Rewards $$$)

66. Silver BlueCare Silver 1477 ($0 Virtual Visits / Rewards $$$)

67. Gold BlueCare Gold 1565 ($0 Virtual Visits / $20 PCP Visit / $15 Generic Meds / Rewards $$$)

68. Expanded Bronze BlueCare Bronze (HSA) 1765 (Rewards $$$ / $4 Condition Care Rx)

69. Gold BlueCare Gold 1865 ($0 Virtual Visits / $20 Labs / Rewards $$$)

70. Expanded Bronze BlueCare Bronze 2179 ($0 Deductible / $0 Virtual Visits / $50 PCP Visit / $30 Generic Meds / Rewards $$$)

71. Bronze BlueCare Bronze 2361S (Multilingual Available / Rewards $$$)

72. Expanded Bronze BlueCare Bronze 2362S (Multilingual Available / Rewards $$$)

73. Silver BlueCare Silver 2363S ($40 PCP Visits / Multilingual Available / Rewards $$$)

74. Gold BlueCare Gold 2364S ($30 PCP Visit / Multilingual Available / Rewards $$$)

75. Platinum BlueCare Platinum 2365S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Multilingual Available / Rewards $$$)

76. Expanded Bronze BlueCare Bronze 2379 ($0 Deductible / $0 Virtual Visits / Multilingual Available / Rewards $$$)

77. Expanded Bronze myBlue Bronze 1601 ($0 Virtual Visits / 3 PCP Visits for $0 / Rewards $$$)

78. Expanded Bronze myBlue Bronze 1602 ($0 Virtual Visits / $20 Labs / Rewards $$$)

79. Silver myBlue Silver 1603 ($0 Virtual Visits / Rewards $$$)

80. Silver myBlue Silver 1604 ($0 Virtual Visits / Rewards $$$)

81. Gold myBlue Gold 1605 ($0 Virtual Visits / $0 Labs / Rewards $$$)

82. Silver myBlue Silver 1710 ($0 Virtual Visits / Rewards $$$)

83. Silver myBlue Silver 2017 ($0 Virtual Visits / $20 Labs / Rewards $$$)

84. Silver myBlue Silver 2127 ($0 Virtual Visits / $25 Generic Meds / Rewards $$$)

85. Expanded Bronze myBlue Bronze 2129 ($0 Deductible / $0 Virtual Visits / $35 PCP Visit / $80 Specialist Visits / $25 Generic Meds / Rewards $$$)

86. Expanded Bronze myBlue Bronze 2126 ($0 Virtual Visits / 3 PCP Visits for $0 / Rewards $$$)

87. Silver myBlue Silver 2237 ($0 Virtual Visits / $80 PCP Visits / Rewards $$$)

88. Expanded Bronze myBlue Bronze 2219 ($0 Virtual Visits / Rewards $$$)

89. Expanded Bronze myBlue Bronze 2266 ($0 Virtual Visits / Rewards $$$)

90. Bronze myBlue Bronze 2311S (Multilingual Available / Rewards $$$)

91. Expanded Bronze myBlue Bronze 2312S (Multilingual Available / Rewards $$$)

92. Expanded Bronze myBlue Bronze 2329 ($0 Deductible / $0 Virtual Visits / Multilingual Available / Rewards $$$)

93. Silver myBlue Silver 2337 ($0 Virtual Visits / $20 Labs / Rewards $$$)

94. Silver myBlue Silver 2313S ($40 PCP Visits / Multilingual Available / Rewards $$$)

95. Gold myBlue Gold 2314S ($30 PCP Visits / Multilingual Available / Rewards $$$)

96. Silver myBlue Silver 2237D ($0 Virtual Visits / $80 PCP Visits / Adult Dental / Rewards $$$)

97. Silver myBlue Silver 2337D ($0 Virtual Visits / Adult Dental / $20 Labs / Rewards $$$)

Ambetter from Sunshine Health

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

98. Expanded Bronze Ambetter Virtual Access Bronze - Virtual PCP selection required

99. Silver Ambetter Virtual Access Silver - Virtual PCP selection required

100. Gold Ambetter Virtual Access Gold - Virtual PCP selection required

101. Expanded Bronze CMS Standard Virtual Access Basic Bronze - Virtual PCP Selection Required

102. Silver CMS Standard Virtual Access Basic Silver - Virtual PCP Selection Required

103. Gold CMS Standard Virtual Access Basic Gold - Virtual PCP Selection Required

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

Obamacare Providers, 103 Plans and 2023 Rates for Walton County, Florida

You may also be interested in:

Do I Qualify For a Tax Credit to Pay My Premiums?

How do I sign up in Florida?

Using a Broker to Help You Sign Up

Obamacare Rates and Providers for Other Years

How To Sign Up for Obamacare in Florida for 2023

Where's the Florida Health Care Exchange?

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

Florida Has Not Expanded Medicaid

The Medicaid Coverage Gap

Get Help Finding a Health Insurance Plan in Florida

Get Help From Florida's Health Insurance Exchange

Get Help From a Licensed Insurance Broker

More Information

Florida Blue (BlueCross BlueShield FL)

(EPO) BlueOptions Silver 1423 ($0 Virtual Visits / 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:

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

Annual Out of Pocket Expenses:

Individual Family $6,900 $13,800 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

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

Annual Out of Pocket Expenses:

Individual Family $6,000 $12,000 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

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

Annual Out of Pocket Expenses:

Individual Family $1,000 $2,000 Annual Deductible $4,000 $8,000 Maximum Out of Pocket Per Year

Monthly Premiums:

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

Annual Out of Pocket Expenses:

Individual Family $7,400 $14,800 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

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

Annual Out of Pocket Expenses:

Individual Family $0 $0 Annual Deductible $2,000 $4,000 Maximum Out of Pocket Per Year

Monthly Premiums:

(EPO) BlueOptions Silver 1410 ($0 Virtual Visits / $0 Lab / Rewards $$$)

Annual Out of Pocket Expenses:

Individual Family $6,000 $12,000 Annual Deductible $7,900 $15,800 Maximum Out of Pocket Per Year

Monthly Premiums:

(EPO) BlueOptions Gold 1505 ($0 Virtual Visits / $20 PCP Visits / $15 Generic Meds / Rewards $$$)

Annual Out of Pocket Expenses:

Individual Family $0 $0 Annual Deductible $5,500 $11,000 Maximum Out of Pocket Per Year

Monthly Premiums:

(EPO) BlueOptions Bronze (HSA) 1705 (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:

(EPO) BlueOptions Gold 1805 ($0 Virtual Visits / $20 Labs / 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:

(EPO) BlueOptions Bronze 2119 ($0 Deductible / $0 Virtual Visits / $50 PCP Visits / Rewards $$$)

Annual Out of Pocket Expenses:

Individual Family $0 $0 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

(EPO) BlueOptions Bronze 2301S (Multilingual Available / Rewards $$$)

Annual Out of Pocket Expenses:

Individual Family $9,100 $18,200 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

(EPO) BlueOptions Bronze 2302S (Multilingual Available / Rewards $$$)

Annual Out of Pocket Expenses:

Individual Family $7,500 $15,000 Annual Deductible $9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

(EPO) BlueOptions Silver 2303S ($40 PCP Visits / Multilingual Available/ Rewards $$$)

Annual Out of Pocket Expenses:

Individual Family $5,800 $11,600 Annual Deductible $8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

(EPO) BlueOptions Gold 2304S ($30 PCP Visits / Multilingual Available / Rewards $$$)

Annual Out of Pocket Expenses:

Individual Family $2,000 $4,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

(EPO) BlueOptions Platinum 2305S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Multilingual Available / Rewards $$$)

Annual Out of Pocket Expenses:

Individual Family $0 $0 Annual Deductible $3,000 $6,000 Maximum Out of Pocket Per Year

Individual Family

$5,950 $11,900 Annual Deductible

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

Individual Family

$6,900 $13,800 Annual Deductible

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

Individual Family

$6,000 $12,000 Annual Deductible

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

Individual Family

$1,000 $2,000 Annual Deductible

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

Individual Family

$7,400 $14,800 Annual Deductible

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

Individual Family

$0 $0 Annual Deductible

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

Individual Family

$6,000 $12,000 Annual Deductible

$7,900 $15,800 Maximum Out of Pocket Per Year

Individual Family

$0 $0 Annual Deductible

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

Individual Family

$6,850 $13,700 Annual Deductible

$6,850 $13,700 Maximum Out of Pocket Per Year

Individual Family

$1,500 $3,000 Annual Deductible

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

Individual Family

$0 $0 Annual Deductible

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

Individual Family

$9,100 $18,200 Annual Deductible

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

Individual Family

$7,500 $15,000 Annual Deductible

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

Individual Family

$5,800 $11,600 Annual Deductible

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

Individual Family

$2,000 $4,000 Annual Deductible

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

Individual Family

$0 $0 Annual Deductible

$3,000 $6,000 Maximum Out of Pocket Per Year

Individual Family

$0 $0 Annual Deductible

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

Individual Family

$5,950 $11,900 Annual Deductible

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

Individual Family

$6,900 $13,800 Annual Deductible

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

Individual Family

$6,000 $12,000 Annual Deductible

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

Individual Family

$1,000 $2,000 Annual Deductible

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

Individual Family

$7,400 $14,800 Annual Deductible

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

Individual Family

$0 $0 Annual Deductible

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

Individual Family

$6,000 $12,000 Annual Deductible

$7,900 $15,800 Maximum Out of Pocket Per Year

Individual Family

$0 $0 Annual Deductible

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

Individual Family

$6,850 $13,700 Annual Deductible

$6,850 $13,700 Maximum Out of Pocket Per Year

Individual Family

$1,500 $3,000 Annual Deductible

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

Individual Family

$0 $0 Annual Deductible

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

Individual Family

$9,100 $18,200 Annual Deductible

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

Individual Family

$7,500 $15,000 Annual Deductible

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

Individual Family

$5,800 $11,600 Annual Deductible

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

Individual Family

$2,000 $4,000 Annual Deductible

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