justice fist holding scales LegalConsumer.com
Empowering Consumers Since 2006
Obamacare
☰
Obamacare by State
Obamacare Guide
Search
Help
You are viewing information for Boone County, IL

Obamacare 2023 Rates for Boone County

Obamacare > Rates > Illinois > Boone 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 Boone County, IL.

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, 46 Plans and 2023 Rates for Boone County, Illinois

Below, you’ll find a summary of the 46 plans for Boone County, Illinois and rates for each of these providers.‡ This chart is designed to give you a preview of your health insurance options.

You may also be interested in:

Obamacare Rates and Providers for Other Years

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

ADVERTISEMENT

ADVERTISEMENT

Blue Cross and Blue Shield of Illinois

Local: 1-800-538-8833 | Toll Free: 1-800-538-8833 | TTY: 1-800-526-0844
Toc - Plan #1 Blue Cross and Blue Shield of Illinois
Gold

(HMO) Blue Precision Gold HMO? 207

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-8833

Annual Out of Pocket Expenses:

Individual Family
$750 $2,250 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 		$521.81
$592.26
$666.88
$931.96
$1,416.20 		$921.00
$991.45
$1,066.07
$1,331.15 		$1,320.19
$1,390.64
$1,465.26
$1,730.34 		$1,719.38
$1,789.83
$1,864.45
$2,129.53 		$399.19
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,043.62
$1,184.52
$1,333.76
$1,863.92
$2,832.40 		$1,442.81
$1,583.71
$1,732.95
$2,263.11 		$1,842.00
$1,982.90
$2,132.14
$2,662.30 		$2,241.19
$2,382.09
$2,531.33
$3,061.49 		$399.19
Toc - Plan #2 Blue Cross and Blue Shield of Illinois
Silver

(HMO) Blue Precision Silver HMO? 206

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-8833

Annual Out of Pocket Expenses:

Individual Family
$4,600 $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 		$430.47
$488.58
$550.14
$768.82
$1,168.29 		$759.78
$817.89
$879.45
$1,098.13 		$1,089.09
$1,147.20
$1,208.76
$1,427.44 		$1,418.40
$1,476.51
$1,538.07
$1,756.75 		$329.31
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$860.94
$977.16
$1,100.28
$1,537.64
$2,336.58 		$1,190.25
$1,306.47
$1,429.59
$1,866.95 		$1,519.56
$1,635.78
$1,758.90
$2,196.26 		$1,848.87
$1,965.09
$2,088.21
$2,525.57 		$329.31
Toc - Plan #3 Blue Cross and Blue Shield of Illinois
Expanded Bronze

(HMO) Blue Precision Bronze HMO? 205

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-8833

Annual Out of Pocket Expenses:

Individual Family
$7,400 $17,400 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 		$377.92
$428.94
$482.99
$674.97
$1,025.68 		$667.03
$718.05
$772.10
$964.08 		$956.14
$1,007.16
$1,061.21
$1,253.19 		$1,245.25
$1,296.27
$1,350.32
$1,542.30 		$289.11
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$755.84
$857.88
$965.98
$1,349.94
$2,051.36 		$1,044.95
$1,146.99
$1,255.09
$1,639.05 		$1,334.06
$1,436.10
$1,544.20
$1,928.16 		$1,623.17
$1,725.21
$1,833.31
$2,217.27 		$289.11
Toc - Plan #4 Blue Cross and Blue Shield of Illinois
Gold

(HMO) Blue Precision Gold HMO? 703 - Rx Copays

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-8833

Annual Out of Pocket Expenses:

Individual Family
$950 $2,850 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 		$553.85
$628.62
$707.82
$989.18
$1,503.15 		$977.54
$1,052.31
$1,131.51
$1,412.87 		$1,401.23
$1,476.00
$1,555.20
$1,836.56 		$1,824.92
$1,899.69
$1,978.89
$2,260.25 		$423.69
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,107.70
$1,257.24
$1,415.64
$1,978.36
$3,006.30 		$1,531.39
$1,680.93
$1,839.33
$2,402.05 		$1,955.08
$2,104.62
$2,263.02
$2,825.74 		$2,378.77
$2,528.31
$2,686.71
$3,249.43 		$423.69
Toc - Plan #5 Blue Cross and Blue Shield of Illinois
Silver

(HMO) Blue Precision Silver HMO 704? - Rx Copays

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-8833

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 		$466.60
$529.60
$596.32
$833.35
$1,266.36 		$823.55
$886.55
$953.27
$1,190.30 		$1,180.50
$1,243.50
$1,310.22
$1,547.25 		$1,537.45
$1,600.45
$1,667.17
$1,904.20 		$356.95
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$933.20
$1,059.20
$1,192.64
$1,666.70
$2,532.72 		$1,290.15
$1,416.15
$1,549.59
$2,023.65 		$1,647.10
$1,773.10
$1,906.54
$2,380.60 		$2,004.05
$2,130.05
$2,263.49
$2,737.55 		$356.95
Toc - Plan #6 Blue Cross and Blue Shield of Illinois
Expanded Bronze

(HMO) Blue Precision Bronze HMO? 701 - Rx Copays

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-8833

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 		$370.22
$420.20
$473.15
$661.22
$1,004.79 		$653.44
$703.42
$756.37
$944.44 		$936.66
$986.64
$1,039.59
$1,227.66 		$1,219.88
$1,269.86
$1,322.81
$1,510.88 		$283.22
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$740.44
$840.40
$946.30
$1,322.44
$2,009.58 		$1,023.66
$1,123.62
$1,229.52
$1,605.66 		$1,306.88
$1,406.84
$1,512.74
$1,888.88 		$1,590.10
$1,690.06
$1,795.96
$2,172.10 		$283.22
Toc - Plan #7 Blue Cross and Blue Shield of Illinois
Gold

(HMO) Blue Precision Gold HMO? 707

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-8833

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 		$558.94
$634.40
$714.33
$998.27
$1,516.98 		$986.53
$1,061.99
$1,141.92
$1,425.86 		$1,414.12
$1,489.58
$1,569.51
$1,853.45 		$1,841.71
$1,917.17
$1,997.10
$2,281.04 		$427.59
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,117.88
$1,268.80
$1,428.66
$1,996.54
$3,033.96 		$1,545.47
$1,696.39
$1,856.25
$2,424.13 		$1,973.06
$2,123.98
$2,283.84
$2,851.72 		$2,400.65
$2,551.57
$2,711.43
$3,279.31 		$427.59
Toc - Plan #8 Blue Cross and Blue Shield of Illinois
Silver

(HMO) Blue Precision Silver HMO? 706

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-8833

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 		$508.33
$576.96
$649.65
$907.89
$1,379.62 		$897.21
$965.84
$1,038.53
$1,296.77 		$1,286.09
$1,354.72
$1,427.41
$1,685.65 		$1,674.97
$1,743.60
$1,816.29
$2,074.53 		$388.88
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,016.66
$1,153.92
$1,299.30
$1,815.78
$2,759.24 		$1,405.54
$1,542.80
$1,688.18
$2,204.66 		$1,794.42
$1,931.68
$2,077.06
$2,593.54 		$2,183.30
$2,320.56
$2,465.94
$2,982.42 		$388.88
Toc - Plan #9 Blue Cross and Blue Shield of Illinois
Expanded Bronze

(HMO) Blue Precision Bronze HMO? 708

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-8833

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 		$431.59
$489.86
$551.58
$770.83
$1,171.34 		$761.76
$820.03
$881.75
$1,101.00 		$1,091.93
$1,150.20
$1,211.92
$1,431.17 		$1,422.10
$1,480.37
$1,542.09
$1,761.34 		$330.17
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$863.18
$979.72
$1,103.16
$1,541.66
$2,342.68 		$1,193.35
$1,309.89
$1,433.33
$1,871.83 		$1,523.52
$1,640.06
$1,763.50
$2,202.00 		$1,853.69
$1,970.23
$2,093.67
$2,532.17 		$330.17
Toc - Plan #10 Blue Cross and Blue Shield of Illinois
Gold

(PPO) Blue Choice Preferred Gold PPO? 204

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-8833

Annual Out of Pocket Expenses:

Individual Family
$750 $2,250 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 		$635.93
$721.78
$812.72
$1,135.78
$1,725.92 		$1,122.42
$1,208.27
$1,299.21
$1,622.27 		$1,608.91
$1,694.76
$1,785.70
$2,108.76 		$2,095.40
$2,181.25
$2,272.19
$2,595.25 		$486.49
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,271.86
$1,443.56
$1,625.44
$2,271.56
$3,451.84 		$1,758.35
$1,930.05
$2,111.93
$2,758.05 		$2,244.84
$2,416.54
$2,598.42
$3,244.54 		$2,731.33
$2,903.03
$3,084.91
$3,731.03 		$486.49
Toc - Plan #11 Blue Cross and Blue Shield of Illinois
Silver

(PPO) Blue Choice Preferred Silver PPO? 203

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-8833

Annual Out of Pocket Expenses:

Individual Family
$2,250 $6,750 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 		$539.04
$611.82
$688.90
$962.73
$1,462.97 		$951.41
$1,024.19
$1,101.27
$1,375.10 		$1,363.78
$1,436.56
$1,513.64
$1,787.47 		$1,776.15
$1,848.93
$1,926.01
$2,199.84 		$412.37
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,078.08
$1,223.64
$1,377.80
$1,925.46
$2,925.94 		$1,490.45
$1,636.01
$1,790.17
$2,337.83 		$1,902.82
$2,048.38
$2,202.54
$2,750.20 		$2,315.19
$2,460.75
$2,614.91
$3,162.57 		$412.37
Toc - Plan #12 Blue Cross and Blue Shield of Illinois
Expanded Bronze

(PPO) Blue Choice Preferred Bronze PPO? 202

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-8833

Annual Out of Pocket Expenses:

Individual Family
$4,500 $13,500 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$476.45
$540.78
$608.91
$850.95
$1,293.10 		$840.94
$905.27
$973.40
$1,215.44 		$1,205.43
$1,269.76
$1,337.89
$1,579.93 		$1,569.92
$1,634.25
$1,702.38
$1,944.42 		$364.49
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$952.90
$1,081.56
$1,217.82
$1,701.90
$2,586.20 		$1,317.39
$1,446.05
$1,582.31
$2,066.39 		$1,681.88
$1,810.54
$1,946.80
$2,430.88 		$2,046.37
$2,175.03
$2,311.29
$2,795.37 		$364.49
Toc - Plan #13 Blue Cross and Blue Shield of Illinois
Catastrophic

(PPO) Blue Choice Preferred Security PPO? 200

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-8833

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 		$395.76
$449.19
$505.79
$706.83
$1,074.10 		$698.52
$751.95
$808.55
$1,009.59 		$1,001.28
$1,054.71
$1,111.31
$1,312.35 		$1,304.04
$1,357.47
$1,414.07
$1,615.11 		$302.76
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$791.52
$898.38
$1,011.58
$1,413.66
$2,148.20 		$1,094.28
$1,201.14
$1,314.34
$1,716.42 		$1,397.04
$1,503.90
$1,617.10
$2,019.18 		$1,699.80
$1,806.66
$1,919.86
$2,321.94 		$302.76
Toc - Plan #14 Blue Cross and Blue Shield of Illinois
Expanded Bronze

(PPO) Blue Choice Preferred Bronze PPO? 201

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-8833

Annual Out of Pocket Expenses:

Individual Family
$7,000 $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 		$429.35
$487.32
$548.71
$766.82
$1,165.26 		$757.81
$815.78
$877.17
$1,095.28 		$1,086.27
$1,144.24
$1,205.63
$1,423.74 		$1,414.73
$1,472.70
$1,534.09
$1,752.20 		$328.46
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$858.70
$974.64
$1,097.42
$1,533.64
$2,330.52 		$1,187.16
$1,303.10
$1,425.88
$1,862.10 		$1,515.62
$1,631.56
$1,754.34
$2,190.56 		$1,844.08
$1,960.02
$2,082.80
$2,519.02 		$328.46
Toc - Plan #15 Blue Cross and Blue Shield of Illinois
Bronze

(PPO) Blue Choice Preferred Bronze PPO? 601

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-8833

Annual Out of Pocket Expenses:

Individual Family
$7,000 $17,400 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 		$419.67
$476.33
$536.34
$749.54
$1,138.99 		$740.72
$797.38
$857.39
$1,070.59 		$1,061.77
$1,118.43
$1,178.44
$1,391.64 		$1,382.82
$1,439.48
$1,499.49
$1,712.69 		$321.05
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$839.34
$952.66
$1,072.68
$1,499.08
$2,277.98 		$1,160.39
$1,273.71
$1,393.73
$1,820.13 		$1,481.44
$1,594.76
$1,714.78
$2,141.18 		$1,802.49
$1,915.81
$2,035.83
$2,462.23 		$321.05
Toc - Plan #16 Blue Cross and Blue Shield of Illinois
Bronze

(PPO) Blue Choice Preferred Bronze PPO? 701

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-8833

Annual Out of Pocket Expenses:

Individual Family
$8,600 $17,400 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 		$398.71
$452.54
$509.55
$712.10
$1,082.11 		$703.72
$757.55
$814.56
$1,017.11 		$1,008.73
$1,062.56
$1,119.57
$1,322.12 		$1,313.74
$1,367.57
$1,424.58
$1,627.13 		$305.01
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$797.42
$905.08
$1,019.10
$1,424.20
$2,164.22 		$1,102.43
$1,210.09
$1,324.11
$1,729.21 		$1,407.44
$1,515.10
$1,629.12
$2,034.22 		$1,712.45
$1,820.11
$1,934.13
$2,339.23 		$305.01
Toc - Plan #17 Blue Cross and Blue Shield of Illinois
Gold

(PPO) Blue Choice Preferred Gold PPO? 707

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-8833

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 		$620.91
$704.73
$793.52
$1,108.94
$1,685.14 		$1,095.90
$1,179.72
$1,268.51
$1,583.93 		$1,570.89
$1,654.71
$1,743.50
$2,058.92 		$2,045.88
$2,129.70
$2,218.49
$2,533.91 		$474.99
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,241.82
$1,409.46
$1,587.04
$2,217.88
$3,370.28 		$1,716.81
$1,884.45
$2,062.03
$2,692.87 		$2,191.80
$2,359.44
$2,537.02
$3,167.86 		$2,666.79
$2,834.43
$3,012.01
$3,642.85 		$474.99
Toc - Plan #18 Blue Cross and Blue Shield of Illinois
Silver

(PPO) Blue Choice Preferred Silver PPO? 706

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-8833

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 		$543.02
$616.32
$693.98
$969.83
$1,473.75 		$958.43
$1,031.73
$1,109.39
$1,385.24 		$1,373.84
$1,447.14
$1,524.80
$1,800.65 		$1,789.25
$1,862.55
$1,940.21
$2,216.06 		$415.41
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,086.04
$1,232.64
$1,387.96
$1,939.66
$2,947.50 		$1,501.45
$1,648.05
$1,803.37
$2,355.07 		$1,916.86
$2,063.46
$2,218.78
$2,770.48 		$2,332.27
$2,478.87
$2,634.19
$3,185.89 		$415.41
Toc - Plan #19 Blue Cross and Blue Shield of Illinois
Expanded Bronze

(PPO) Blue Choice Preferred Bronze PPO? 708

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-8833

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 		$478.43
$543.02
$611.43
$854.48
$1,298.46 		$844.43
$909.02
$977.43
$1,220.48 		$1,210.43
$1,275.02
$1,343.43
$1,586.48 		$1,576.43
$1,641.02
$1,709.43
$1,952.48 		$366.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$956.86
$1,086.04
$1,222.86
$1,708.96
$2,596.92 		$1,322.86
$1,452.04
$1,588.86
$2,074.96 		$1,688.86
$1,818.04
$1,954.86
$2,440.96 		$2,054.86
$2,184.04
$2,320.86
$2,806.96 		$366.00
Toc - Plan #20 Blue Cross and Blue Shield of Illinois
Bronze

(PPO) Blue Choice Preferred Bronze PPO? 705

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-538-8833

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 		$414.90
$470.91
$530.24
$741.01
$1,126.03 		$732.30
$788.31
$847.64
$1,058.41 		$1,049.70
$1,105.71
$1,165.04
$1,375.81 		$1,367.10
$1,423.11
$1,482.44
$1,693.21 		$317.40
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$829.80
$941.82
$1,060.48
$1,482.02
$2,252.06 		$1,147.20
$1,259.22
$1,377.88
$1,799.42 		$1,464.60
$1,576.62
$1,695.28
$2,116.82 		$1,782.00
$1,894.02
$2,012.68
$2,434.22 		$317.40

ADVERTISEMENT

MercyCare Health Plans

Local: 1-877-908-6027 | Toll Free: 

Toc - Plan #21 MercyCare Health Plans
Gold

(HMO) MercyCare HMO Gold HDHP

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$3,000 $6,000 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 		$414.90
$470.91
$530.24
$741.01
$1,126.04 		$732.30
$788.31
$847.64
$1,058.41 		$1,049.70
$1,105.71
$1,165.04
$1,375.81 		$1,367.10
$1,423.11
$1,482.44
$1,693.21 		$317.40
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$829.80
$941.82
$1,060.48
$1,482.02
$2,252.08 		$1,147.20
$1,259.22
$1,377.88
$1,799.42 		$1,464.60
$1,576.62
$1,695.28
$2,116.82 		$1,782.00
$1,894.02
$2,012.68
$2,434.22 		$317.40
Toc - Plan #22 MercyCare Health Plans
Silver

(HMO) MercyCare HMO Silver Option A

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 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 		$428.04
$485.82
$547.03
$764.47
$1,161.69 		$755.49
$813.27
$874.48
$1,091.92 		$1,082.94
$1,140.72
$1,201.93
$1,419.37 		$1,410.39
$1,468.17
$1,529.38
$1,746.82 		$327.45
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$856.08
$971.64
$1,094.06
$1,528.94
$2,323.38 		$1,183.53
$1,299.09
$1,421.51
$1,856.39 		$1,510.98
$1,626.54
$1,748.96
$2,183.84 		$1,838.43
$1,953.99
$2,076.41
$2,511.29 		$327.45
Toc - Plan #23 MercyCare Health Plans
Silver

(HMO) MercyCare HMO Silver HDHP

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

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 		$429.21
$487.16
$548.53
$766.57
$1,164.88 		$757.56
$815.51
$876.88
$1,094.92 		$1,085.91
$1,143.86
$1,205.23
$1,423.27 		$1,414.26
$1,472.21
$1,533.58
$1,751.62 		$328.35
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$858.42
$974.32
$1,097.06
$1,533.14
$2,329.76 		$1,186.77
$1,302.67
$1,425.41
$1,861.49 		$1,515.12
$1,631.02
$1,753.76
$2,189.84 		$1,843.47
$1,959.37
$2,082.11
$2,518.19 		$328.35
Toc - Plan #24 MercyCare Health Plans
Bronze

(HMO) MercyCare HMO Bronze Option A

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$316.61
$359.35
$404.63
$565.47
$859.28 		$558.82
$601.56
$646.84
$807.68 		$801.03
$843.77
$889.05
$1,049.89 		$1,043.24
$1,085.98
$1,131.26
$1,292.10 		$242.21
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$633.22
$718.70
$809.26
$1,130.94
$1,718.56 		$875.43
$960.91
$1,051.47
$1,373.15 		$1,117.64
$1,203.12
$1,293.68
$1,615.36 		$1,359.85
$1,445.33
$1,535.89
$1,857.57 		$242.21
Toc - Plan #25 MercyCare Health Plans
Gold

(HMO) MercyCare HMO Gold Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

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 		$390.17
$442.85
$498.64
$696.85
$1,058.92 		$688.65
$741.33
$797.12
$995.33 		$987.13
$1,039.81
$1,095.60
$1,293.81 		$1,285.61
$1,338.29
$1,394.08
$1,592.29 		$298.48
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$780.34
$885.70
$997.28
$1,393.70
$2,117.84 		$1,078.82
$1,184.18
$1,295.76
$1,692.18 		$1,377.30
$1,482.66
$1,594.24
$1,990.66 		$1,675.78
$1,781.14
$1,892.72
$2,289.14 		$298.48
Toc - Plan #26 MercyCare Health Plans
Silver

(HMO) MercyCare HMO Silver Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

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 		$420.11
$476.83
$536.90
$750.32
$1,140.17 		$741.50
$798.22
$858.29
$1,071.71 		$1,062.89
$1,119.61
$1,179.68
$1,393.10 		$1,384.28
$1,441.00
$1,501.07
$1,714.49 		$321.39
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$840.22
$953.66
$1,073.80
$1,500.64
$2,280.34 		$1,161.61
$1,275.05
$1,395.19
$1,822.03 		$1,483.00
$1,596.44
$1,716.58
$2,143.42 		$1,804.39
$1,917.83
$2,037.97
$2,464.81 		$321.39
Toc - Plan #27 MercyCare Health Plans
Expanded Bronze

(HMO) MercyCare HMO Bronze Standard Expanded

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

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 		$330.92
$375.60
$422.92
$591.02
$898.12 		$584.08
$628.76
$676.08
$844.18 		$837.24
$881.92
$929.24
$1,097.34 		$1,090.40
$1,135.08
$1,182.40
$1,350.50 		$253.16
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$661.84
$751.20
$845.84
$1,182.04
$1,796.24 		$915.00
$1,004.36
$1,099.00
$1,435.20 		$1,168.16
$1,257.52
$1,352.16
$1,688.36 		$1,421.32
$1,510.68
$1,605.32
$1,941.52 		$253.16
Toc - Plan #28 MercyCare Health Plans
Bronze

(HMO) MercyCare HMO Bronze Standard HDHP

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

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 		$293.76
$333.42
$375.42
$524.65
$797.26 		$518.49
$558.15
$600.15
$749.38 		$743.22
$782.88
$824.88
$974.11 		$967.95
$1,007.61
$1,049.61
$1,198.84 		$224.73
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$587.52
$666.84
$750.84
$1,049.30
$1,594.52 		$812.25
$891.57
$975.57
$1,274.03 		$1,036.98
$1,116.30
$1,200.30
$1,498.76 		$1,261.71
$1,341.03
$1,425.03
$1,723.49 		$224.73

ADVERTISEMENT

Quartz

Local: 1-608-644-3430 | Toll Free: 1-800-362-3310 | TTY: 1-800-877-8973
Toc - Plan #29 Quartz
Gold

(HMO) Quartz One Gold I403 HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 Annual Deductible
$3,500 $7,000 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 		$537.88
$610.49
$687.41
$960.65
$1,459.80 		$949.36
$1,021.97
$1,098.89
$1,372.13 		$1,360.84
$1,433.45
$1,510.37
$1,783.61 		$1,772.32
$1,844.93
$1,921.85
$2,195.09 		$411.48
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,075.76
$1,220.98
$1,374.82
$1,921.30
$2,919.60 		$1,487.24
$1,632.46
$1,786.30
$2,332.78 		$1,898.72
$2,043.94
$2,197.78
$2,744.26 		$2,310.20
$2,455.42
$2,609.26
$3,155.74 		$411.48
Toc - Plan #30 Quartz
Silver

(HMO) Quartz One Silver I304 HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 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 		$556.71
$631.86
$711.47
$994.27
$1,510.89 		$982.59
$1,057.74
$1,137.35
$1,420.15 		$1,408.47
$1,483.62
$1,563.23
$1,846.03 		$1,834.35
$1,909.50
$1,989.11
$2,271.91 		$425.88
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,113.42
$1,263.72
$1,422.94
$1,988.54
$3,021.78 		$1,539.30
$1,689.60
$1,848.82
$2,414.42 		$1,965.18
$2,115.48
$2,274.70
$2,840.30 		$2,391.06
$2,541.36
$2,700.58
$3,266.18 		$425.88
Toc - Plan #31 Quartz
Expanded Bronze

(HMO) Quartz One Bronze I203 HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

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 		$416.05
$472.22
$531.71
$743.06
$1,129.16 		$734.33
$790.50
$849.99
$1,061.34 		$1,052.61
$1,108.78
$1,168.27
$1,379.62 		$1,370.89
$1,427.06
$1,486.55
$1,697.90 		$318.28
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$832.10
$944.44
$1,063.42
$1,486.12
$2,258.32 		$1,150.38
$1,262.72
$1,381.70
$1,804.40 		$1,468.66
$1,581.00
$1,699.98
$2,122.68 		$1,786.94
$1,899.28
$2,018.26
$2,440.96 		$318.28
Toc - Plan #32 Quartz
Catastrophic

(HMO) Quartz One Catastrophic I101

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

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 		$302.94
$343.83
$387.15
$541.04
$822.16 		$534.69
$575.58
$618.90
$772.79 		$766.44
$807.33
$850.65
$1,004.54 		$998.19
$1,039.08
$1,082.40
$1,236.29 		$231.75
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$605.88
$687.66
$774.30
$1,082.08
$1,644.32 		$837.63
$919.41
$1,006.05
$1,313.83 		$1,069.38
$1,151.16
$1,237.80
$1,545.58 		$1,301.13
$1,382.91
$1,469.55
$1,777.33 		$231.75
Toc - Plan #33 Quartz
Gold

(HMO) Quartz One Gold I401

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$506.84
$575.26
$647.74
$905.21
$1,375.55 		$894.57
$962.99
$1,035.47
$1,292.94 		$1,282.30
$1,350.72
$1,423.20
$1,680.67 		$1,670.03
$1,738.45
$1,810.93
$2,068.40 		$387.73
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,013.68
$1,150.52
$1,295.48
$1,810.42
$2,751.10 		$1,401.41
$1,538.25
$1,683.21
$2,198.15 		$1,789.14
$1,925.98
$2,070.94
$2,585.88 		$2,176.87
$2,313.71
$2,458.67
$2,973.61 		$387.73
Toc - Plan #34 Quartz
Gold

(HMO) Quartz One Gold I402 Maintenance

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$502.10
$569.87
$641.67
$896.73
$1,362.67 		$886.20
$953.97
$1,025.77
$1,280.83 		$1,270.30
$1,338.07
$1,409.87
$1,664.93 		$1,654.40
$1,722.17
$1,793.97
$2,049.03 		$384.10
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,004.20
$1,139.74
$1,283.34
$1,793.46
$2,725.34 		$1,388.30
$1,523.84
$1,667.44
$2,177.56 		$1,772.40
$1,907.94
$2,051.54
$2,561.66 		$2,156.50
$2,292.04
$2,435.64
$2,945.76 		$384.10
Toc - Plan #35 Quartz
Gold

(HMO) Quartz One Gold I405

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$6,000 $12,000 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 		$506.30
$574.64
$647.04
$904.24
$1,374.08 		$893.61
$961.95
$1,034.35
$1,291.55 		$1,280.92
$1,349.26
$1,421.66
$1,678.86 		$1,668.23
$1,736.57
$1,808.97
$2,066.17 		$387.31
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,012.60
$1,149.28
$1,294.08
$1,808.48
$2,748.16 		$1,399.91
$1,536.59
$1,681.39
$2,195.79 		$1,787.22
$1,923.90
$2,068.70
$2,583.10 		$2,174.53
$2,311.21
$2,456.01
$2,970.41 		$387.31
Toc - Plan #36 Quartz
Gold

(HMO) Quartz One Gold I410 Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

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 		$519.21
$589.30
$663.54
$927.30
$1,409.12 		$916.40
$986.49
$1,060.73
$1,324.49 		$1,313.59
$1,383.68
$1,457.92
$1,721.68 		$1,710.78
$1,780.87
$1,855.11
$2,118.87 		$397.19
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,038.42
$1,178.60
$1,327.08
$1,854.60
$2,818.24 		$1,435.61
$1,575.79
$1,724.27
$2,251.79 		$1,832.80
$1,972.98
$2,121.46
$2,648.98 		$2,229.99
$2,370.17
$2,518.65
$3,046.17 		$397.19
Toc - Plan #37 Quartz
Silver

(HMO) Quartz One Silver I301

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 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 		$505.36
$573.58
$645.85
$902.57
$1,371.54 		$891.96
$960.18
$1,032.45
$1,289.17 		$1,278.56
$1,346.78
$1,419.05
$1,675.77 		$1,665.16
$1,733.38
$1,805.65
$2,062.37 		$386.60
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,010.72
$1,147.16
$1,291.70
$1,805.14
$2,743.08 		$1,397.32
$1,533.76
$1,678.30
$2,191.74 		$1,783.92
$1,920.36
$2,064.90
$2,578.34 		$2,170.52
$2,306.96
$2,451.50
$2,964.94 		$386.60
Toc - Plan #38 Quartz
Silver

(HMO) Quartz One Silver I303

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$8,000 $16,000 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 		$500.77
$568.37
$639.98
$894.37
$1,359.08 		$883.86
$951.46
$1,023.07
$1,277.46 		$1,266.95
$1,334.55
$1,406.16
$1,660.55 		$1,650.04
$1,717.64
$1,789.25
$2,043.64 		$383.09
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,001.54
$1,136.74
$1,279.96
$1,788.74
$2,718.16 		$1,384.63
$1,519.83
$1,663.05
$2,171.83 		$1,767.72
$1,902.92
$2,046.14
$2,554.92 		$2,150.81
$2,286.01
$2,429.23
$2,938.01 		$383.09
Toc - Plan #39 Quartz
Silver

(HMO) Quartz One Silver I308

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$0 $0 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 		$527.07
$598.22
$673.59
$941.33
$1,430.45 		$930.27
$1,001.42
$1,076.79
$1,344.53 		$1,333.47
$1,404.62
$1,479.99
$1,747.73 		$1,736.67
$1,807.82
$1,883.19
$2,150.93 		$403.20
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,054.14
$1,196.44
$1,347.18
$1,882.66
$2,860.90 		$1,457.34
$1,599.64
$1,750.38
$2,285.86 		$1,860.54
$2,002.84
$2,153.58
$2,689.06 		$2,263.74
$2,406.04
$2,556.78
$3,092.26 		$403.20
Toc - Plan #40 Quartz
Silver

(HMO) Quartz One Silver I309 Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

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 		$533.06
$605.02
$681.24
$952.03
$1,446.71 		$940.85
$1,012.81
$1,089.03
$1,359.82 		$1,348.64
$1,420.60
$1,496.82
$1,767.61 		$1,756.43
$1,828.39
$1,904.61
$2,175.40 		$407.79
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,066.12
$1,210.04
$1,362.48
$1,904.06
$2,893.42 		$1,473.91
$1,617.83
$1,770.27
$2,311.85 		$1,881.70
$2,025.62
$2,178.06
$2,719.64 		$2,289.49
$2,433.41
$2,585.85
$3,127.43 		$407.79
Toc - Plan #41 Quartz
Expanded Bronze

(HMO) Quartz One Bronze I201

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$9,000 $18,000 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 		$392.33
$445.28
$501.39
$700.69
$1,064.76 		$692.46
$745.41
$801.52
$1,000.82 		$992.59
$1,045.54
$1,101.65
$1,300.95 		$1,292.72
$1,345.67
$1,401.78
$1,601.08 		$300.13
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$784.66
$890.56
$1,002.78
$1,401.38
$2,129.52 		$1,084.79
$1,190.69
$1,302.91
$1,701.51 		$1,384.92
$1,490.82
$1,603.04
$2,001.64 		$1,685.05
$1,790.95
$1,903.17
$2,301.77 		$300.13
Toc - Plan #42 Quartz
Expanded Bronze

(HMO) Quartz One Bronze I202

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$8,000 $16,000 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 		$399.79
$453.76
$510.93
$714.02
$1,085.03 		$705.63
$759.60
$816.77
$1,019.86 		$1,011.47
$1,065.44
$1,122.61
$1,325.70 		$1,317.31
$1,371.28
$1,428.45
$1,631.54 		$305.84
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$799.58
$907.52
$1,021.86
$1,428.04
$2,170.06 		$1,105.42
$1,213.36
$1,327.70
$1,733.88 		$1,411.26
$1,519.20
$1,633.54
$2,039.72 		$1,717.10
$1,825.04
$1,939.38
$2,345.56 		$305.84
Toc - Plan #43 Quartz
Expanded Bronze

(HMO) Quartz One Bronze I204

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$3,000 $6,000 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 		$419.01
$475.57
$535.49
$748.34
$1,137.18 		$739.55
$796.11
$856.03
$1,068.88 		$1,060.09
$1,116.65
$1,176.57
$1,389.42 		$1,380.63
$1,437.19
$1,497.11
$1,709.96 		$320.54
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$838.02
$951.14
$1,070.98
$1,496.68
$2,274.36 		$1,158.56
$1,271.68
$1,391.52
$1,817.22 		$1,479.10
$1,592.22
$1,712.06
$2,137.76 		$1,799.64
$1,912.76
$2,032.60
$2,458.30 		$320.54
Toc - Plan #44 Quartz
Expanded Bronze

(HMO) Quartz One Bronze I205

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

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 		$414.73
$470.71
$530.02
$740.70
$1,125.57 		$732.00
$787.98
$847.29
$1,057.97 		$1,049.27
$1,105.25
$1,164.56
$1,375.24 		$1,366.54
$1,422.52
$1,481.83
$1,692.51 		$317.27
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$829.46
$941.42
$1,060.04
$1,481.40
$2,251.14 		$1,146.73
$1,258.69
$1,377.31
$1,798.67 		$1,464.00
$1,575.96
$1,694.58
$2,115.94 		$1,781.27
$1,893.23
$2,011.85
$2,433.21 		$317.27
Toc - Plan #45 Quartz
Expanded Bronze

(HMO) Quartz One Bronze I206 Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

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 		$427.96
$485.73
$546.92
$764.32
$1,161.46 		$755.34
$813.11
$874.30
$1,091.70 		$1,082.72
$1,140.49
$1,201.68
$1,419.08 		$1,410.10
$1,467.87
$1,529.06
$1,746.46 		$327.38
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$855.92
$971.46
$1,093.84
$1,528.64
$2,322.92 		$1,183.30
$1,298.84
$1,421.22
$1,856.02 		$1,510.68
$1,626.22
$1,748.60
$2,183.40 		$1,838.06
$1,953.60
$2,075.98
$2,510.78 		$327.38
Toc - Plan #46 Quartz
Silver

(HMO) Quartz One Silver I307 HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family
$3,000 $6,000 Annual Deductible
$6,000 $12,000 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 		$559.28
$634.77
$714.75
$998.86
$1,517.86 		$987.12
$1,062.61
$1,142.59
$1,426.70 		$1,414.96
$1,490.45
$1,570.43
$1,854.54 		$1,842.80
$1,918.29
$1,998.27
$2,282.38 		$427.84
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,118.56
$1,269.54
$1,429.50
$1,997.72
$3,035.72 		$1,546.40
$1,697.38
$1,857.34
$2,425.56 		$1,974.24
$2,125.22
$2,285.18
$2,853.40 		$2,402.08
$2,553.06
$2,713.02
$3,281.24 		$427.84

‡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 Boone County here.

Boone County is in “Rating Area 5” of Illinois.

Currently, there are 46 plans offered in Rating Area 5.

Top

2023 Obamacare Plans for Boone County, IL

Plan Browser: 46 Plans
scroll down for more