Georgia Obamacare

2017 Obamacare Rates for Forsyth County

Georgia 2017 Obamacare Rates for Forsyth County

 
Cumming, GA

Providers for Zip Code 30040

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Obamacare Providers, Plans and 2017 Rates for Forsyth County

The health insurance rates listed below are for calendar year 2017.

2017 Rates and Providers

(click here for 2014)

(click here for 2015)

(click here for 2016)

This page gives you an overview of the rates for individual and family health insurance plans available from HealthCare.gov, the marketplace for Forsyth County, Georgia.

Currently, there are 60 plans offered in Forsyth County.

Below, you’ll find a summary of plans and rates for each of these providers.‡ This chart is designed to give you a preview of your health insurance options. For detailed information on available subsidies to make your coverage affordable, you must complete an application at HealthCare.gov or contact the provider directly.

 

The table below shows premiums for the following scenarios:

  • Individual
  • Couple
  • Couple with 1 2 or 3 children
  • Individual with 1 2 or 3 children
  • A child alone

Each scenario is covered for age

  • Age 21, 30, 40, 50
  • Age 60 (Individual and Couple only)

 

Note: If you are over 65, you qualify for Medicare. Click here to see listings of 2017 Medicare Advantage plans for Forsyth County

 

For each plan, there are links that go to the insurance provider's website in a new window. You can find links to:

  • a summary of plan benefits and costs,
  • a plan brochure, and
  • a "Provider Directory" -- where you can find out which doctors and hospitals in the Cumming, GA area accept this insurance coverage as within the plan's "network".

‡Source: HealthCare.gov has released sample rates for all counties in those states served by HealthCare.gov. We have integrated that data into our tables and provide you that information for Forsyth County here.

Alliant Health Plans

Local: 1-800-811-4793 | Toll Free: 1-800-811-4793

Plan: (PPO) SoloCare Stdrd Gold PPO 40026

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-811-4793 - Provider Directory for This Plan: (Alliant Health Plans)

Deductible: Individual: $1,250 : Family: $2,500
Out of Pocket Maximum per year: Individual: $4,750 : Family: $9,500

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $472.64
$536.44
$604.03
$844.13
$1282.74		 $945.28
$1072.88
$1208.06
$1688.26
$2565.48		 $1245.41
$1373.01
$1508.19
$1988.39		 $1545.54
$1673.14
$1808.32
$2288.52		 $1845.67
$1973.27
$2108.45
$2588.65		 $772.77
$836.57
$904.16
$1144.26		 $1072.90
$1136.70
$1204.29
$1444.39		 $1373.03
$1436.83
$1504.42
$1744.52		 $300.13

Plan: (PPO) SoloCare Bronze HDHP 40031

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-811-4793 - Provider Directory for This Plan: (Alliant Health Plans)

Deductible: Individual: $6,500 : Family: $13,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $317.97
$360.89
$406.36
$567.89
$862.96		 $635.94
$721.78
$812.72
$1135.78
$1725.92		 $837.85
$923.69
$1014.63
$1337.69		 $1039.76
$1125.60
$1216.54
$1539.60		 $1241.67
$1327.51
$1418.45
$1741.51		 $519.88
$562.80
$608.27
$769.80		 $721.79
$764.71
$810.18
$971.71		 $923.70
$966.62
$1012.09
$1173.62		 $201.91

Kaiser Foundation Health Plan of Georgia

Local: 1-800-494-5314 | Toll Free: 1-800-494-5314

Plan: (HMO) KP GA Gold 500/20

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-494-5314 - Provider Directory for This Plan: (Kaiser Foundation Health Plan of Georgia)

Deductible: Individual: $500 : Family: $1,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $356.75
$404.91
$455.93
$637.16
$968.23		 $713.50
$809.82
$911.86
$1274.32
$1936.46		 $940.04
$1036.36
$1138.40
$1500.86		 $1166.58
$1262.90
$1364.94
$1727.40		 $1393.12
$1489.44
$1591.48
$1953.94		 $583.29
$631.45
$682.47
$863.70		 $809.83
$857.99
$909.01
$1090.24		 $1036.37
$1084.53
$1135.55
$1316.78		 $226.54

Plan: (HMO) KP GA Gold Std 1250/20

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-494-5314 - Provider Directory for This Plan: (Kaiser Foundation Health Plan of Georgia)

Deductible: Individual: $1,250 : Family: $2,500
Out of Pocket Maximum per year: Individual: $4,750 : Family: $9,500

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $364.61
$413.83
$465.97
$651.19
$989.55		 $729.22
$827.66
$931.94
$1302.38
$1979.10		 $960.75
$1059.19
$1163.47
$1533.91		 $1192.28
$1290.72
$1395.00
$1765.44		 $1423.81
$1522.25
$1626.53
$1996.97		 $596.14
$645.36
$697.50
$882.72		 $827.67
$876.89
$929.03
$1114.25		 $1059.20
$1108.42
$1160.56
$1345.78		 $231.53

Alliant Health Plans

Local: 1-800-811-4793 | Toll Free: 1-800-811-4793

Plan: (PPO) SoloCare Stdrd Bronze 40024

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-811-4793 - Provider Directory for This Plan: (Alliant Health Plans)

Deductible: Individual: $6,650 : Family: $13,300
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $340.53
$386.50
$435.19
$608.18
$924.19		 $681.06
$773.00
$870.38
$1216.36
$1848.38		 $897.30
$989.24
$1086.62
$1432.60		 $1113.54
$1205.48
$1302.86
$1648.84		 $1329.78
$1421.72
$1519.10
$1865.08		 $556.77
$602.74
$651.43
$824.42		 $773.01
$818.98
$867.67
$1040.66		 $989.25
$1035.22
$1083.91
$1256.90		 $216.24

Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.

Local: 1-855-738-6652 | Toll Free: 1-855-738-6652

Plan: (HMO) BCBSHP Catastrophic Pathway HMO 7150

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-738-6652 - Provider Directory for This Plan: (Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.)

Deductible: Individual: $7,150 : Family: $14,300
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Catastrophic 21
30
40
50
60		 $180.92
$205.34
$231.22
$323.12
$491.02		 $361.84
$410.68
$462.44
$646.24
$982.04		 $476.72
$525.56
$577.32
$761.12		 $591.60
$640.44
$692.20
$876.00		 $706.48
$755.32
$807.08
$990.88		 $295.80
$320.22
$346.10
$438.00		 $410.68
$435.10
$460.98
$552.88		 $525.56
$549.98
$575.86
$667.76		 $114.88

Plan: (HMO) BCBSHP Bronze Pathway HMO 0 for HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-738-6652 - Provider Directory for This Plan: (Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.)

Deductible: Individual: $6,550 : Family: $13,100
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $269.32
$305.68
$344.19
$481.01
$730.93		 $538.64
$611.36
$688.38
$962.02
$1461.86		 $709.66
$782.38
$859.40
$1133.04		 $880.68
$953.40
$1030.42
$1304.06		 $1051.70
$1124.42
$1201.44
$1475.08		 $440.34
$476.70
$515.21
$652.03		 $611.36
$647.72
$686.23
$823.05		 $782.38
$818.74
$857.25
$994.07		 $171.02

Plan: (HMO) BCBSHP Bronze Pathway HMO 5200

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-738-6652 - Provider Directory for This Plan: (Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.)

Deductible: Individual: $5,200 : Family: $10,400
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $266.25
$302.19
$340.27
$475.52
$722.60		 $532.50
$604.38
$680.54
$951.04
$1445.20		 $701.57
$773.45
$849.61
$1120.11		 $870.64
$942.52
$1018.68
$1289.18		 $1039.71
$1111.59
$1187.75
$1458.25		 $435.32
$471.26
$509.34
$644.59		 $604.39
$640.33
$678.41
$813.66		 $773.46
$809.40
$847.48
$982.73		 $169.07

Plan: (HMO) BCBSHP Silver Pathway HMO 10 for HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-738-6652 - Provider Directory for This Plan: (Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.)

Deductible: Individual: $3,200 : Family: $6,400
Out of Pocket Maximum per year: Individual: $5,000 : Family: $10,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $306.58
$347.97
$391.81
$547.55
$832.06		 $613.16
$695.94
$783.62
$1095.10
$1664.12		 $807.84
$890.62
$978.30
$1289.78		 $1002.52
$1085.30
$1172.98
$1484.46		 $1197.20
$1279.98
$1367.66
$1679.14		 $501.26
$542.65
$586.49
$742.23		 $695.94
$737.33
$781.17
$936.91		 $890.62
$932.01
$975.85
$1131.59		 $194.68

Plan: (HMO) BCBSHP Silver Pathway HMO 3000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-738-6652 - Provider Directory for This Plan: (Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.)

Deductible: Individual: $3,000 : Family: $6,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $302.45
$343.28
$386.53
$540.18
$820.85		 $604.90
$686.56
$773.06
$1080.36
$1641.70		 $796.96
$878.62
$965.12
$1272.42		 $989.02
$1070.68
$1157.18
$1464.48		 $1181.08
$1262.74
$1349.24
$1656.54		 $494.51
$535.34
$578.59
$732.24		 $686.57
$727.40
$770.65
$924.30		 $878.63
$919.46
$962.71
$1116.36		 $192.06

Plan: (HMO) BCBSHP Bronze Pathway HMO 30 for HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-738-6652 - Provider Directory for This Plan: (Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.)

Deductible: Individual: $5,400 : Family: $10,800
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $270.32
$306.81
$345.47
$482.79
$733.65		 $540.64
$613.62
$690.94
$965.58
$1467.30		 $712.29
$785.27
$862.59
$1137.23		 $883.94
$956.92
$1034.24
$1308.88		 $1055.59
$1128.57
$1205.89
$1480.53		 $441.97
$478.46
$517.12
$654.44		 $613.62
$650.11
$688.77
$826.09		 $785.27
$821.76
$860.42
$997.74		 $171.65

Plan: (HMO) BCBSHP Bronze Pathway HMO 5500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-738-6652 - Provider Directory for This Plan: (Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.)

Deductible: Individual: $5,500 : Family: $11,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $260.22
$295.35
$332.56
$464.75
$706.24		 $520.44
$590.70
$665.12
$929.50
$1412.48		 $685.68
$755.94
$830.36
$1094.74		 $850.92
$921.18
$995.60
$1259.98		 $1016.16
$1086.42
$1160.84
$1425.22		 $425.46
$460.59
$497.80
$629.99		 $590.70
$625.83
$663.04
$795.23		 $755.94
$791.07
$828.28
$960.47		 $165.24

Plan: (HMO) BCBSHP Silver Pathway HMO 2000 25

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-738-6652 - Provider Directory for This Plan: (Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.)

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $313.39
$355.70
$400.51
$559.71
$850.54		 $626.78
$711.40
$801.02
$1119.42
$1701.08		 $825.78
$910.40
$1000.02
$1318.42		 $1024.78
$1109.40
$1199.02
$1517.42		 $1223.78
$1308.40
$1398.02
$1716.42		 $512.39
$554.70
$599.51
$758.71		 $711.39
$753.70
$798.51
$957.71		 $910.39
$952.70
$997.51
$1156.71		 $199.00

Plan: (HMO) BCBSHP Silver Pathway HMO 3500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-738-6652 - Provider Directory for This Plan: (Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $4,850 : Family: $9,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $303.94
$344.97
$388.44
$542.84
$824.89		 $607.88
$689.94
$776.88
$1085.68
$1649.78		 $800.88
$882.94
$969.88
$1278.68		 $993.88
$1075.94
$1162.88
$1471.68		 $1186.88
$1268.94
$1355.88
$1664.68		 $496.94
$537.97
$581.44
$735.84		 $689.94
$730.97
$774.44
$928.84		 $882.94
$923.97
$967.44
$1121.84		 $193.00

Plan: (HMO) BCBSHP Bronze Pathway HMO 5850

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-738-6652 - Provider Directory for This Plan: (Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.)

Deductible: Individual: $5,850 : Family: $11,700
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $259.04
$294.01
$331.05
$462.65
$703.03		 $518.08
$588.02
$662.10
$925.30
$1406.06		 $682.57
$752.51
$826.59
$1089.79		 $847.06
$917.00
$991.08
$1254.28		 $1011.55
$1081.49
$1155.57
$1418.77		 $423.53
$458.50
$495.54
$627.14		 $588.02
$622.99
$660.03
$791.63		 $752.51
$787.48
$824.52
$956.12		 $164.49

Plan: (HMO) BCBSHP Silver Core Pathway HMO 5300

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-738-6652 - Provider Directory for This Plan: (Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.)

Deductible: Individual: $5,300 : Family: $10,600
Out of Pocket Maximum per year: Individual: $6,700 : Family: $13,400

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $279.34
$317.05
$357.00
$498.90
$758.13		 $558.68
$634.10
$714.00
$997.80
$1516.26		 $736.06
$811.48
$891.38
$1175.18		 $913.44
$988.86
$1068.76
$1352.56		 $1090.82
$1166.24
$1246.14
$1529.94		 $456.72
$494.43
$534.38
$676.28		 $634.10
$671.81
$711.76
$853.66		 $811.48
$849.19
$889.14
$1031.04		 $177.38

Plan: (HMO) Blue Cross and Blue Shield Healthcare Plan of Georgia Silver DirectAccess, a Multi-State Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-738-6652 - Provider Directory for This Plan: (Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.)

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $329.52
$374.01
$421.13
$588.52
$894.32		 $659.04
$748.02
$842.26
$1177.04
$1788.64		 $868.29
$957.27
$1051.51
$1386.29		 $1077.54
$1166.52
$1260.76
$1595.54		 $1286.79
$1375.77
$1470.01
$1804.79		 $538.77
$583.26
$630.38
$797.77		 $748.02
$792.51
$839.63
$1007.02		 $957.27
$1001.76
$1048.88
$1216.27		 $209.25

Plan: (HMO) Blue Cross and Blue Shield Healthcare Plan of Georgia Gold DirectAccess, a Multi-State Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-738-6652 - Provider Directory for This Plan: (Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.)

Deductible: Individual: $1,150 : Family: $3,450
Out of Pocket Maximum per year: Individual: $4,900 : Family: $9,800

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $429.51
$487.49
$548.91
$767.10
$1165.69		 $859.02
$974.98
$1097.82
$1534.20
$2331.38		 $1131.76
$1247.72
$1370.56
$1806.94		 $1404.50
$1520.46
$1643.30
$2079.68		 $1677.24
$1793.20
$1916.04
$2352.42		 $702.25
$760.23
$821.65
$1039.84		 $974.99
$1032.97
$1094.39
$1312.58		 $1247.73
$1305.71
$1367.13
$1585.32		 $272.74
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Ambetter of Peach State Inc.

Local: 1-877-687-1180 | Toll Free: 1-877-687-1180

TTY: 1-877-941-9231

Plan: (HMO) Ambetter Secure Care 1 (2017) with 3 Free PCP Visits

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1180 - Provider Directory for This Plan: (Ambetter of Peach State Inc.)

Deductible: Individual: $1,000 : Family: $2,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $283.41
$321.66
$362.18
$506.15
$769.15		 $566.82
$643.32
$724.36
$1012.30
$1538.30		 $746.78
$823.28
$904.32
$1192.26		 $926.74
$1003.24
$1084.28
$1372.22		 $1106.70
$1183.20
$1264.24
$1552.18		 $463.37
$501.62
$542.14
$686.11		 $643.33
$681.58
$722.10
$866.07		 $823.29
$861.54
$902.06
$1046.03		 $179.96
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Alliant Health Plans

Local: 1-800-811-4793 | Toll Free: 1-800-811-4793

Plan: (PPO) SoloCare Bronze HDHP 40032

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-811-4793 - Provider Directory for This Plan: (Alliant Health Plans)

Deductible: Individual: $5,500 : Family: $11,000
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $315.83
$358.47
$403.63
$564.08
$857.17		 $631.66
$716.94
$807.26
$1128.16
$1714.34		 $832.21
$917.49
$1007.81
$1328.71		 $1032.76
$1118.04
$1208.36
$1529.26		 $1233.31
$1318.59
$1408.91
$1729.81		 $516.38
$559.02
$604.18
$764.63		 $716.93
$759.57
$804.73
$965.18		 $917.48
$960.12
$1005.28
$1165.73		 $200.55
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Ambetter of Peach State Inc.

Local: 1-877-687-1180 | Toll Free: 1-877-687-1180

TTY: 1-877-941-9231

Plan: (HMO) Ambetter Balanced Care 1 (2017)

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1180 - Provider Directory for This Plan: (Ambetter of Peach State Inc.)

Deductible: Individual: $5,500 : Family: $11,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $217.04
$246.33
$277.37
$387.62
$589.02		 $434.08
$492.66
$554.74
$775.24
$1178.04		 $571.89
$630.47
$692.55
$913.05		 $709.70
$768.28
$830.36
$1050.86		 $847.51
$906.09
$968.17
$1188.67		 $354.85
$384.14
$415.18
$525.43		 $492.66
$521.95
$552.99
$663.24		 $630.47
$659.76
$690.80
$801.05		 $137.81

Plan: (HMO) Ambetter Balanced Care 2 (2017)

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1180 - Provider Directory for This Plan: (Ambetter of Peach State Inc.)

Deductible: Individual: $6,500 : Family: $13,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $213.41
$242.21
$272.73
$381.14
$579.18		 $426.82
$484.42
$545.46
$762.28
$1158.36		 $562.33
$619.93
$680.97
$897.79		 $697.84
$755.44
$816.48
$1033.30		 $833.35
$890.95
$951.99
$1168.81		 $348.92
$377.72
$408.24
$516.65		 $484.43
$513.23
$543.75
$652.16		 $619.94
$648.74
$679.26
$787.67		 $135.51

Plan: (HMO) Ambetter Balanced Care 10 (2017)

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1180 - Provider Directory for This Plan: (Ambetter of Peach State Inc.)

Deductible: Individual: $4,500 : Family: $9,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $224.72
$255.05
$287.18
$401.34
$609.87		 $449.44
$510.10
$574.36
$802.68
$1219.74		 $592.13
$652.79
$717.05
$945.37		 $734.82
$795.48
$859.74
$1088.06		 $877.51
$938.17
$1002.43
$1230.75		 $367.41
$397.74
$429.87
$544.03		 $510.10
$540.43
$572.56
$686.72		 $652.79
$683.12
$715.25
$829.41		 $142.69

Plan: (HMO) Ambetter Essential Care 1 (2017)

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1180 - Provider Directory for This Plan: (Ambetter of Peach State Inc.)

Deductible: Individual: $6,800 : Family: $13,600
Out of Pocket Maximum per year: Individual: $6,800 : Family: $13,600

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $189.51
$215.09
$242.18
$338.45
$514.31		 $379.02
$430.18
$484.36
$676.90
$1028.62		 $499.35
$550.51
$604.69
$797.23		 $619.68
$670.84
$725.02
$917.56		 $740.01
$791.17
$845.35
$1037.89		 $309.84
$335.42
$362.51
$458.78		 $430.17
$455.75
$482.84
$579.11		 $550.50
$576.08
$603.17
$699.44		 $120.33

Plan: (HMO) Ambetter Balanced Care 3 (2017)

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1180 - Provider Directory for This Plan: (Ambetter of Peach State Inc.)

Deductible: Individual: $3,000 : Family: $6,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $225.79
$256.26
$288.55
$403.24
$612.77		 $451.58
$512.52
$577.10
$806.48
$1225.54		 $594.95
$655.89
$720.47
$949.85		 $738.32
$799.26
$863.84
$1093.22		 $881.69
$942.63
$1007.21
$1236.59		 $369.16
$399.63
$431.92
$546.61		 $512.53
$543.00
$575.29
$689.98		 $655.90
$686.37
$718.66
$833.35		 $143.37

Plan: (HMO) Ambetter Balanced Care 4 (2017)

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1180 - Provider Directory for This Plan: (Ambetter of Peach State Inc.)

Deductible: Individual: $7,050 : Family: $14,100
Out of Pocket Maximum per year: Individual: $7,050 : Family: $14,100

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $206.80
$234.70
$264.27
$369.32
$561.22		 $413.60
$469.40
$528.54
$738.64
$1122.44		 $544.91
$600.71
$659.85
$869.95		 $676.22
$732.02
$791.16
$1001.26		 $807.53
$863.33
$922.47
$1132.57		 $338.11
$366.01
$395.58
$500.63		 $469.42
$497.32
$526.89
$631.94		 $600.73
$628.63
$658.20
$763.25		 $131.31

Plan: (HMO) Ambetter Balanced Care 12 (2017)

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1180 - Provider Directory for This Plan: (Ambetter of Peach State Inc.)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $231.98
$263.29
$296.46
$414.30
$629.57		 $463.96
$526.58
$592.92
$828.60
$1259.14		 $611.26
$673.88
$740.22
$975.90		 $758.56
$821.18
$887.52
$1123.20		 $905.86
$968.48
$1034.82
$1270.50		 $379.28
$410.59
$443.76
$561.60		 $526.58
$557.89
$591.06
$708.90		 $673.88
$705.19
$738.36
$856.20		 $147.30

Plan: (HMO) Ambetter Balanced Care 1 (2017) + Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1180 - Provider Directory for This Plan: (Ambetter of Peach State Inc.)

Deductible: Individual: $5,500 : Family: $11,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $221.79
$251.72
$283.44
$396.10
$601.92		 $443.58
$503.44
$566.88
$792.20
$1203.84		 $584.41
$644.27
$707.71
$933.03		 $725.24
$785.10
$848.54
$1073.86		 $866.07
$925.93
$989.37
$1214.69		 $362.62
$392.55
$424.27
$536.93		 $503.45
$533.38
$565.10
$677.76		 $644.28
$674.21
$705.93
$818.59		 $140.83

Plan: (HMO) Ambetter Balanced Care 2 (2017) + Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1180 - Provider Directory for This Plan: (Ambetter of Peach State Inc.)

Deductible: Individual: $6,500 : Family: $13,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $218.09
$247.52
$278.70
$389.48
$591.86		 $436.18
$495.04
$557.40
$778.96
$1183.72		 $574.66
$633.52
$695.88
$917.44		 $713.14
$772.00
$834.36
$1055.92		 $851.62
$910.48
$972.84
$1194.40		 $356.57
$386.00
$417.18
$527.96		 $495.05
$524.48
$555.66
$666.44		 $633.53
$662.96
$694.14
$804.92		 $138.48

Plan: (HMO) Ambetter Balanced Care 10 (2017) + Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1180 - Provider Directory for This Plan: (Ambetter of Peach State Inc.)

Deductible: Individual: $4,500 : Family: $9,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $229.64
$260.63
$293.47
$410.13
$623.23		 $459.28
$521.26
$586.94
$820.26
$1246.46		 $605.10
$667.08
$732.76
$966.08		 $750.92
$812.90
$878.58
$1111.90		 $896.74
$958.72
$1024.40
$1257.72		 $375.46
$406.45
$439.29
$555.95		 $521.28
$552.27
$585.11
$701.77		 $667.10
$698.09
$730.93
$847.59		 $145.82

Plan: (HMO) Ambetter Essential Care 1 (2017) + Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1180 - Provider Directory for This Plan: (Ambetter of Peach State Inc.)

Deductible: Individual: $6,800 : Family: $13,600
Out of Pocket Maximum per year: Individual: $6,800 : Family: $13,600

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $193.66
$219.79
$247.49
$345.86
$525.57		 $387.32
$439.58
$494.98
$691.72
$1051.14		 $510.29
$562.55
$617.95
$814.69		 $633.26
$685.52
$740.92
$937.66		 $756.23
$808.49
$863.89
$1060.63		 $316.63
$342.76
$370.46
$468.83		 $439.60
$465.73
$493.43
$591.80		 $562.57
$588.70
$616.40
$714.77		 $122.97

Plan: (HMO) Ambetter Balanced Care 3 (2017) + Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1180 - Provider Directory for This Plan: (Ambetter of Peach State Inc.)

Deductible: Individual: $3,000 : Family: $6,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $230.73
$261.87
$294.87
$412.07
$626.19		 $461.46
$523.74
$589.74
$824.14
$1252.38		 $607.97
$670.25
$736.25
$970.65		 $754.48
$816.76
$882.76
$1117.16		 $900.99
$963.27
$1029.27
$1263.67		 $377.24
$408.38
$441.38
$558.58		 $523.75
$554.89
$587.89
$705.09		 $670.26
$701.40
$734.40
$851.60		 $146.51

Plan: (HMO) Ambetter Balanced Care 1 (2017) + Vision + Adult Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1180 - Provider Directory for This Plan: (Ambetter of Peach State Inc.)

Deductible: Individual: $5,500 : Family: $11,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $234.47
$266.11
$299.64
$418.75
$636.33		 $468.94
$532.22
$599.28
$837.50
$1272.66		 $617.82
$681.10
$748.16
$986.38		 $766.70
$829.98
$897.04
$1135.26		 $915.58
$978.86
$1045.92
$1284.14		 $383.35
$414.99
$448.52
$567.63		 $532.23
$563.87
$597.40
$716.51		 $681.11
$712.75
$746.28
$865.39		 $148.88

Plan: (HMO) Ambetter Balanced Care 2 (2017) + Vision + Adult Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1180 - Provider Directory for This Plan: (Ambetter of Peach State Inc.)

Deductible: Individual: $6,500 : Family: $13,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $230.55
$261.67
$294.63
$411.75
$625.69		 $461.10
$523.34
$589.26
$823.50
$1251.38		 $607.49
$669.73
$735.65
$969.89		 $753.88
$816.12
$882.04
$1116.28		 $900.27
$962.51
$1028.43
$1262.67		 $376.94
$408.06
$441.02
$558.14		 $523.33
$554.45
$587.41
$704.53		 $669.72
$700.84
$733.80
$850.92		 $146.39

Plan: (HMO) Ambetter Balanced Care 10 (2017) + Vision + Adult Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1180 - Provider Directory for This Plan: (Ambetter of Peach State Inc.)

Deductible: Individual: $4,500 : Family: $9,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $242.77
$275.53
$310.25
$433.57
$658.85		 $485.54
$551.06
$620.50
$867.14
$1317.70		 $639.69
$705.21
$774.65
$1021.29		 $793.84
$859.36
$928.80
$1175.44		 $947.99
$1013.51
$1082.95
$1329.59		 $396.92
$429.68
$464.40
$587.72		 $551.07
$583.83
$618.55
$741.87		 $705.22
$737.98
$772.70
$896.02		 $154.15

Plan: (HMO) Ambetter Essential Care 1 (2017) + Vision + Adult Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1180 - Provider Directory for This Plan: (Ambetter of Peach State Inc.)

Deductible: Individual: $6,800 : Family: $13,600
Out of Pocket Maximum per year: Individual: $6,800 : Family: $13,600

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $204.73
$232.36
$261.63
$365.63
$555.61		 $409.46
$464.72
$523.26
$731.26
$1111.22		 $539.46
$594.72
$653.26
$861.26		 $669.46
$724.72
$783.26
$991.26		 $799.46
$854.72
$913.26
$1121.26		 $334.73
$362.36
$391.63
$495.63		 $464.73
$492.36
$521.63
$625.63		 $594.73
$622.36
$651.63
$755.63		 $130.00

Plan: (HMO) Ambetter Balanced Care 3 (2017) + Vision + Adult Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1180 - Provider Directory for This Plan: (Ambetter of Peach State Inc.)

Deductible: Individual: $3,000 : Family: $6,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $243.92
$276.84
$311.72
$435.63
$661.98		 $487.84
$553.68
$623.44
$871.26
$1323.96		 $642.73
$708.57
$778.33
$1026.15		 $797.62
$863.46
$933.22
$1181.04		 $952.51
$1018.35
$1088.11
$1335.93		 $398.81
$431.73
$466.61
$590.52		 $553.70
$586.62
$621.50
$745.41		 $708.59
$741.51
$776.39
$900.30		 $154.89
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Alliant Health Plans

Local: 1-800-811-4793 | Toll Free: 1-800-811-4793

Plan: (PPO) SoloCare Gold PPO 40002

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-811-4793 - Provider Directory for This Plan: (Alliant Health Plans)

Deductible: Individual: $1,500 : Family: $3,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $468.21
$531.42
$598.37
$836.23
$1270.73		 $936.42
$1062.84
$1196.74
$1672.46
$2541.46		 $1233.73
$1360.15
$1494.05
$1969.77		 $1531.04
$1657.46
$1791.36
$2267.08		 $1828.35
$1954.77
$2088.67
$2564.39		 $765.52
$828.73
$895.68
$1133.54		 $1062.83
$1126.04
$1192.99
$1430.85		 $1360.14
$1423.35
$1490.30
$1728.16		 $297.31

Plan: (PPO) SoloCare Gold PPO 40003

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-811-4793 - Provider Directory for This Plan: (Alliant Health Plans)

Deductible: Individual: $1,000 : Family: $2,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $460.78
$522.98
$588.88
$822.95
$1250.55		 $921.56
$1045.96
$1177.76
$1645.90
$2501.10		 $1214.15
$1338.55
$1470.35
$1938.49		 $1506.74
$1631.14
$1762.94
$2231.08		 $1799.33
$1923.73
$2055.53
$2523.67		 $753.37
$815.57
$881.47
$1115.54		 $1045.96
$1108.16
$1174.06
$1408.13		 $1338.55
$1400.75
$1466.65
$1700.72		 $292.59

Plan: (PPO) SoloCare Silver PPO 40007

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-811-4793 - Provider Directory for This Plan: (Alliant Health Plans)

Deductible: Individual: $1,750 : Family: $3,500
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $368.10
$417.79
$470.43
$657.42
$999.02		 $736.20
$835.58
$940.86
$1314.84
$1998.04		 $969.94
$1069.32
$1174.60
$1548.58		 $1203.68
$1303.06
$1408.34
$1782.32		 $1437.42
$1536.80
$1642.08
$2016.06		 $601.84
$651.53
$704.17
$891.16		 $835.58
$885.27
$937.91
$1124.90		 $1069.32
$1119.01
$1171.65
$1358.64		 $233.74

Plan: (PPO) SoloCare Stdrd Silver PPO 40025

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-811-4793 - Provider Directory for This Plan: (Alliant Health Plans)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $384.39
$436.29
$491.25
$686.53
$1043.24		 $768.78
$872.58
$982.50
$1373.06
$2086.48		 $1012.87
$1116.67
$1226.59
$1617.15		 $1256.96
$1360.76
$1470.68
$1861.24		 $1501.05
$1604.85
$1714.77
$2105.33		 $628.48
$680.38
$735.34
$930.62		 $872.57
$924.47
$979.43
$1174.71		 $1116.66
$1168.56
$1223.52
$1418.80		 $244.09

Plan: (PPO) SoloCare Silver PPO 40010

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-811-4793 - Provider Directory for This Plan: (Alliant Health Plans)

Deductible: Individual: $2,500 : Family: $5,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $372.73
$423.04
$476.34
$665.69
$1011.58		 $745.46
$846.08
$952.68
$1331.38
$2023.16		 $982.14
$1082.76
$1189.36
$1568.06		 $1218.82
$1319.44
$1426.04
$1804.74		 $1455.50
$1556.12
$1662.72
$2041.42		 $609.41
$659.72
$713.02
$902.37		 $846.09
$896.40
$949.70
$1139.05		 $1082.77
$1133.08
$1186.38
$1375.73		 $236.68

Plan: (PPO) SoloCare Silver PPO 40017

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-811-4793 - Provider Directory for This Plan: (Alliant Health Plans)

Deductible: Individual: $4,750 : Family: $9,500
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $382.01
$433.59
$488.21
$682.28
$1036.79		 $764.02
$867.18
$976.42
$1364.56
$2073.58		 $1006.60
$1109.76
$1219.00
$1607.14		 $1249.18
$1352.34
$1461.58
$1849.72		 $1491.76
$1594.92
$1704.16
$2092.30		 $624.59
$676.17
$730.79
$924.86		 $867.17
$918.75
$973.37
$1167.44		 $1109.75
$1161.33
$1215.95
$1410.02		 $242.58

Plan: (PPO) SoloCare Bronze PPO 40021

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-811-4793 - Provider Directory for This Plan: (Alliant Health Plans)

Deductible: Individual: $7,150 : Family: $14,300
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $341.35
$387.43
$436.24
$609.65
$926.42		 $682.70
$774.86
$872.48
$1219.30
$1852.84		 $899.46
$991.62
$1089.24
$1436.06		 $1116.22
$1208.38
$1306.00
$1652.82		 $1332.98
$1425.14
$1522.76
$1869.58		 $558.11
$604.19
$653.00
$826.41		 $774.87
$820.95
$869.76
$1043.17		 $991.63
$1037.71
$1086.52
$1259.93		 $216.76

Plan: (PPO) SoloCare Platinum PPO 40022

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-811-4793 - Provider Directory for This Plan: (Alliant Health Plans)

Deductible: Individual: $500 : Family: $1,000
Out of Pocket Maximum per year: Individual: $1,500 : Family: $3,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Platinum 21
30
40
50
60		 $550.66
$625.00
$703.75
$983.48
$1494.50		 $1101.32
$1250.00
$1407.50
$1966.96
$2989.00		 $1450.99
$1599.67
$1757.17
$2316.63		 $1800.66
$1949.34
$2106.84
$2666.30		 $2150.33
$2299.01
$2456.51
$3015.97		 $900.33
$974.67
$1053.42
$1333.15		 $1250.00
$1324.34
$1403.09
$1682.82		 $1599.67
$1674.01
$1752.76
$2032.49		 $349.67

Plan: (PPO) SoloCare Platinum PPO 40023

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-811-4793 - Provider Directory for This Plan: (Alliant Health Plans)

Deductible: Individual: $750 : Family: $1,500
Out of Pocket Maximum per year: Individual: $2,000 : Family: $4,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Platinum 21
30
40
50
60		 $548.88
$622.97
$701.46
$980.29
$1489.65		 $1097.76
$1245.94
$1402.92
$1960.58
$2979.30		 $1446.30
$1594.48
$1751.46
$2309.12		 $1794.84
$1943.02
$2100.00
$2657.66		 $2143.38
$2291.56
$2448.54
$3006.20		 $897.42
$971.51
$1050.00
$1328.83		 $1245.96
$1320.05
$1398.54
$1677.37		 $1594.50
$1668.59
$1747.08
$2025.91		 $348.54
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Kaiser Foundation Health Plan of Georgia

Local: 1-800-494-5314 | Toll Free: 1-800-494-5314

Plan: (HMO) KP GA Silver 2000/30

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-494-5314 - Provider Directory for This Plan: (Kaiser Foundation Health Plan of Georgia)

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $306.59
$347.98
$391.82
$547.57
$832.08		 $613.18
$695.96
$783.64
$1095.14
$1664.16		 $807.86
$890.64
$978.32
$1289.82		 $1002.54
$1085.32
$1173.00
$1484.50		 $1197.22
$1280.00
$1367.68
$1679.18		 $501.27
$542.66
$586.50
$742.25		 $695.95
$737.34
$781.18
$936.93		 $890.63
$932.02
$975.86
$1131.61		 $194.68

Plan: (HMO) KP GA Silver 3000/30

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-494-5314 - Provider Directory for This Plan: (Kaiser Foundation Health Plan of Georgia)

Deductible: Individual: $3,000 : Family: $6,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $293.11
$332.68
$374.60
$523.50
$795.51		 $586.22
$665.36
$749.20
$1047.00
$1591.02		 $772.35
$851.49
$935.33
$1233.13		 $958.48
$1037.62
$1121.46
$1419.26		 $1144.61
$1223.75
$1307.59
$1605.39		 $479.24
$518.81
$560.73
$709.63		 $665.37
$704.94
$746.86
$895.76		 $851.50
$891.07
$932.99
$1081.89		 $186.13

Plan: (HMO) KP GA Silver 2750/20% HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-494-5314 - Provider Directory for This Plan: (Kaiser Foundation Health Plan of Georgia)

Deductible: Individual: $2,750 : Family: $5,500
Out of Pocket Maximum per year: Individual: $6,000 : Family: $12,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $290.87
$330.14
$371.73
$519.49
$789.42		 $581.74
$660.28
$743.46
$1038.98
$1578.84		 $766.44
$844.98
$928.16
$1223.68		 $951.14
$1029.68
$1112.86
$1408.38		 $1135.84
$1214.38
$1297.56
$1593.08		 $475.57
$514.84
$556.43
$704.19		 $660.27
$699.54
$741.13
$888.89		 $844.97
$884.24
$925.83
$1073.59		 $184.70

Plan: (HMO) KP GA Bronze 4500/20

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-494-5314 - Provider Directory for This Plan: (Kaiser Foundation Health Plan of Georgia)

Deductible: Individual: $4,500 : Family: $9,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $253.06
$287.22
$323.41
$451.96
$686.80		 $506.12
$574.44
$646.82
$903.92
$1373.60		 $666.81
$735.13
$807.51
$1064.61		 $827.50
$895.82
$968.20
$1225.30		 $988.19
$1056.51
$1128.89
$1385.99		 $413.75
$447.91
$484.10
$612.65		 $574.44
$608.60
$644.79
$773.34		 $735.13
$769.29
$805.48
$934.03		 $160.69

Plan: (HMO) KP GA Bronze 6200/40%/HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-494-5314 - Provider Directory for This Plan: (Kaiser Foundation Health Plan of Georgia)

Deductible: Individual: $6,200 : Family: $12,400
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $234.34
$265.98
$299.49
$418.53
$636.00		 $468.68
$531.96
$598.98
$837.06
$1272.00		 $617.49
$680.77
$747.79
$985.87		 $766.30
$829.58
$896.60
$1134.68		 $915.11
$978.39
$1045.41
$1283.49		 $383.15
$414.79
$448.30
$567.34		 $531.96
$563.60
$597.11
$716.15		 $680.77
$712.41
$745.92
$864.96		 $148.81

Plan: (HMO) KP GA Catastrophic 7150/0

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-494-5314 - Provider Directory for This Plan: (Kaiser Foundation Health Plan of Georgia)

Deductible: Individual: $7,150 : Family: $14,300
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Catastrophic 21
30
40
50
60		 $199.35
$226.26
$254.77
$356.03
$541.03		 $398.70
$452.52
$509.54
$712.06
$1082.06		 $525.29
$579.11
$636.13
$838.65		 $651.88
$705.70
$762.72
$965.24		 $778.47
$832.29
$889.31
$1091.83		 $325.94
$352.85
$381.36
$482.62		 $452.53
$479.44
$507.95
$609.21		 $579.12
$606.03
$634.54
$735.80		 $126.59

Plan: (HMO) KP GA Gold 1500/20

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-494-5314 - Provider Directory for This Plan: (Kaiser Foundation Health Plan of Georgia)

Deductible: Individual: $1,500 : Family: $3,000
Out of Pocket Maximum per year: Individual: $4,750 : Family: $9,500

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $347.39
$394.29
$443.97
$620.45
$942.83		 $694.78
$788.58
$887.94
$1240.90
$1885.66		 $915.37
$1009.17
$1108.53
$1461.49		 $1135.96
$1229.76
$1329.12
$1682.08		 $1356.55
$1450.35
$1549.71
$1902.67		 $567.98
$614.88
$664.56
$841.04		 $788.57
$835.47
$885.15
$1061.63		 $1009.16
$1056.06
$1105.74
$1282.22		 $220.59

Plan: (HMO) KP GA Bronze 5700/50

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-494-5314 - Provider Directory for This Plan: (Kaiser Foundation Health Plan of Georgia)

Deductible: Individual: $5,700 : Family: $11,400
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $241.83
$274.47
$309.06
$431.90
$656.32		 $483.66
$548.94
$618.12
$863.80
$1312.64		 $637.22
$702.50
$771.68
$1017.36		 $790.78
$856.06
$925.24
$1170.92		 $944.34
$1009.62
$1078.80
$1324.48		 $395.39
$428.03
$462.62
$585.46		 $548.95
$581.59
$616.18
$739.02		 $702.51
$735.15
$769.74
$892.58		 $153.56

Plan: (HMO) KP GA Silver Std 3500/30

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-494-5314 - Provider Directory for This Plan: (Kaiser Foundation Health Plan of Georgia)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $302.85
$343.73
$387.04
$540.89
$821.93		 $605.70
$687.46
$774.08
$1081.78
$1643.86		 $798.01
$879.77
$966.39
$1274.09		 $990.32
$1072.08
$1158.70
$1466.40		 $1182.63
$1264.39
$1351.01
$1658.71		 $495.16
$536.04
$579.35
$733.20		 $687.47
$728.35
$771.66
$925.51		 $879.78
$920.66
$963.97
$1117.82		 $192.31

Plan: (HMO) KP GA Bronze Std 6650/45

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-494-5314 - Provider Directory for This Plan: (Kaiser Foundation Health Plan of Georgia)

Deductible: Individual: $6,650 : Family: $13,300
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $245.94
$279.15
$314.32
$439.25
$667.49		 $491.88
$558.30
$628.64
$878.50
$1334.98		 $648.05
$714.47
$784.81
$1034.67		 $804.22
$870.64
$940.98
$1190.84		 $960.39
$1026.81
$1097.15
$1347.01		 $402.11
$435.32
$470.49
$595.42		 $558.28
$591.49
$626.66
$751.59		 $714.45
$747.66
$782.83
$907.76		 $156.17
ADVERTISEMENTS

Humana Employers Health Plan of Georgia, Inc.

Local: 1-877-720-4854 | Toll Free: 1-877-720-4854

TTY: 1-800-325-2028

Plan: (HMO) Humana Basic 7150/Atlanta HMOx

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana Employers Health Plan of Georgia, Inc.)

Deductible: Individual: $7,150 : Family: $14,300
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Catastrophic 21
30
40
50
60		 $253.23
$287.42
$323.63
$452.27
$687.27		 $506.46
$574.84
$647.26
$904.54
$1374.54		 $667.26
$735.64
$808.06
$1065.34		 $828.06
$896.44
$968.86
$1226.14		 $988.86
$1057.24
$1129.66
$1386.94		 $414.03
$448.22
$484.43
$613.07		 $574.83
$609.02
$645.23
$773.87		 $735.63
$769.82
$806.03
$934.67		 $160.80

Plan: (HMO) Humana Bronze 6550/Atlanta HMOx

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana Employers Health Plan of Georgia, Inc.)

Deductible: Individual: $6,550 : Family: $13,100
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $329.06
$373.48
$420.54
$587.70
$893.07		 $658.12
$746.96
$841.08
$1175.40
$1786.14		 $867.07
$955.91
$1050.03
$1384.35		 $1076.02
$1164.86
$1258.98
$1593.30		 $1284.97
$1373.81
$1467.93
$1802.25		 $538.01
$582.43
$629.49
$796.65		 $746.96
$791.38
$838.44
$1005.60		 $955.91
$1000.33
$1047.39
$1214.55		 $208.95

Plan: (HMO) Humana Bronze 6150/Atlanta HMOx

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana Employers Health Plan of Georgia, Inc.)

Deductible: Individual: $6,150 : Family: $12,300
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $358.61
$407.02
$458.30
$640.48
$973.27		 $717.22
$814.04
$916.60
$1280.96
$1946.54		 $944.94
$1041.76
$1144.32
$1508.68		 $1172.66
$1269.48
$1372.04
$1736.40		 $1400.38
$1497.20
$1599.76
$1964.12		 $586.33
$634.74
$686.02
$868.20		 $814.05
$862.46
$913.74
$1095.92		 $1041.77
$1090.18
$1141.46
$1323.64		 $227.72

Plan: (HMO) Humana Silver 3550/Atlanta HMOx

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana Employers Health Plan of Georgia, Inc.)

Deductible: Individual: $3,550 : Family: $7,100
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $421.03
$477.87
$538.08
$751.96
$1142.68		 $842.06
$955.74
$1076.16
$1503.92
$2285.36		 $1109.41
$1223.09
$1343.51
$1771.27		 $1376.76
$1490.44
$1610.86
$2038.62		 $1644.11
$1757.79
$1878.21
$2305.97		 $688.38
$745.22
$805.43
$1019.31		 $955.73
$1012.57
$1072.78
$1286.66		 $1223.08
$1279.92
$1340.13
$1554.01		 $267.35