Illinois

Obamacare 2018 Rates

Obamacare 2018 Rates and Health Insurance Providers for Knox County,Galesburg,IL


The health insurance rates listed below are for calendar year 2018.

2018 Rates and Providers

(click here for 2014)

(click here for 2015)

(click here for 2016)

(click here for 2017)

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

Obamacare Providers, Plans and 2018 Rates for Knox County

Knox County is in “Rating Area 7” of Illinois.

Currently, there are 44 plans offered in Rating Area 7.

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 either

  • contact a licensed health insurance agent (by contacting one of the advertisers you see on this website)
  • complete an application at HealthCare.gov, or
  • contact the provider directly.

The table below shows premiums for the following scenarios for:

  • 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)

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 Galesburg, IL area accept this insurance coverage as within the plan's "network".

2018 Obamacare Rates Providers, Plans for Knox County

Health Alliance Medical Plans, Inc.

Local: 1-866-247-3296 | Toll Free: 1-866-247-3296

TTY: 1-800-526-0844

Expanded Bronze

Plan: (HMO) HMO HSA 6000 Methodist Bronze

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)
Customer Service Phone: 1-866-247-3296

Deductible: Individual: $6,000 : Family: $12,000
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
0-14
Expanded Bronze 21
30
40
50
60
$329.07
$373.49
$420.55
$587.72
$893.10
$658.14
$746.98
$841.10
$1,175.44
$1,786.20
$909.88
$998.72
$1,092.84
$1,427.18
$1,161.62
$1,250.46
$1,344.58
$1,678.92
$1,413.36
$1,502.20
$1,596.32
$1,930.66
$580.81
$625.23
$672.29
$839.46
$832.55
$876.97
$924.03
$1,091.20
$1,084.29
$1,128.71
$1,175.77
$1,342.94
$251.74

Silver

Plan: (HMO) HMO HSA 3250 Methodist Silver

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)
Customer Service Phone: 1-866-247-3296

Deductible: Individual: $3,250 : Family: $6,500
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
0-14
Silver 21
30
40
50
60
$478.92
$543.57
$612.06
$855.35
$1,299.79
$957.84
$1,087.14
$1,224.12
$1,710.70
$2,599.58
$1,324.21
$1,453.51
$1,590.49
$2,077.07
$1,690.58
$1,819.88
$1,956.86
$2,443.44
$2,056.95
$2,186.25
$2,323.23
$2,809.81
$845.29
$909.94
$978.43
$1,221.72
$1,211.66
$1,276.31
$1,344.80
$1,588.09
$1,578.03
$1,642.68
$1,711.17
$1,954.46
$366.37

Silver

Plan: (HMO) HMO HSA 3250 OSF Silver

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)
Customer Service Phone: 1-866-247-3296

Deductible: Individual: $3,250 : Family: $6,500
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
0-14
Silver 21
30
40
50
60
$478.92
$543.57
$612.06
$855.35
$1,299.79
$957.84
$1,087.14
$1,224.12
$1,710.70
$2,599.58
$1,324.21
$1,453.51
$1,590.49
$2,077.07
$1,690.58
$1,819.88
$1,956.86
$2,443.44
$2,056.95
$2,186.25
$2,323.23
$2,809.81
$845.29
$909.94
$978.43
$1,221.72
$1,211.66
$1,276.31
$1,344.80
$1,588.09
$1,578.03
$1,642.68
$1,711.17
$1,954.46
$366.37

Bronze

Plan: (HMO) HMO 3700 Methodist Bronze

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)
Customer Service Phone: 1-866-247-3296

Deductible: Individual: $3,700 : Family: $7,150
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
0-14
Bronze 21
30
40
50
60
$322.61
$366.16
$412.30
$576.18
$875.56
$645.22
$732.32
$824.60
$1,152.36
$1,751.12
$892.02
$979.12
$1,071.40
$1,399.16
$1,138.82
$1,225.92
$1,318.20
$1,645.96
$1,385.62
$1,472.72
$1,565.00
$1,892.76
$569.41
$612.96
$659.10
$822.98
$816.21
$859.76
$905.90
$1,069.78
$1,063.01
$1,106.56
$1,152.70
$1,316.58
$246.80

Bronze

Plan: (HMO) HMO 3700 OSF Bronze

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)
Customer Service Phone: 1-866-247-3296

Deductible: Individual: $3,700 : Family: $7,150
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
0-14
Bronze 21
30
40
50
60
$322.61
$366.16
$412.30
$576.18
$875.56
$645.22
$732.32
$824.60
$1,152.36
$1,751.12
$892.02
$979.12
$1,071.40
$1,399.16
$1,138.82
$1,225.92
$1,318.20
$1,645.96
$1,385.62
$1,472.72
$1,565.00
$1,892.76
$569.41
$612.96
$659.10
$822.98
$816.21
$859.76
$905.90
$1,069.78
$1,063.01
$1,106.56
$1,152.70
$1,316.58
$246.80

Expanded Bronze

Plan: (HMO) HMO HSA 6000 OSF Bronze

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)
Customer Service Phone: 1-866-247-3296

Deductible: Individual: $6,000 : Family: $12,000
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
0-14
Expanded Bronze 21
30
40
50
60
$329.07
$373.49
$420.55
$587.72
$893.10
$658.14
$746.98
$841.10
$1,175.44
$1,786.20
$909.88
$998.72
$1,092.84
$1,427.18
$1,161.62
$1,250.46
$1,344.58
$1,678.92
$1,413.36
$1,502.20
$1,596.32
$1,930.66
$580.81
$625.23
$672.29
$839.46
$832.55
$876.97
$924.03
$1,091.20
$1,084.29
$1,128.71
$1,175.77
$1,342.94
$251.74

Expanded Bronze

Plan: (POS) POS HSA 6000 Methodist Bronze

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)
Customer Service Phone: 1-866-247-3296

Deductible: Individual: $6,000 : Family: $12,000
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
0-14
Expanded Bronze 21
30
40
50
60
$342.36
$388.58
$437.54
$611.45
$929.17
$684.72
$777.16
$875.08
$1,222.90
$1,858.34
$946.63
$1,039.07
$1,136.99
$1,484.81
$1,208.54
$1,300.98
$1,398.90
$1,746.72
$1,470.45
$1,562.89
$1,660.81
$2,008.63
$604.27
$650.49
$699.45
$873.36
$866.18
$912.40
$961.36
$1,135.27
$1,128.09
$1,174.31
$1,223.27
$1,397.18
$261.91

Expanded Bronze

Plan: (POS) POS HSA 6000 OSF Bronze

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)
Customer Service Phone: 1-866-247-3296

Deductible: Individual: $6,000 : Family: $12,000
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
0-14
Expanded Bronze 21
30
40
50
60
$342.36
$388.58
$437.54
$611.45
$929.17
$684.72
$777.16
$875.08
$1,222.90
$1,858.34
$946.63
$1,039.07
$1,136.99
$1,484.81
$1,208.54
$1,300.98
$1,398.90
$1,746.72
$1,470.45
$1,562.89
$1,660.81
$2,008.63
$604.27
$650.49
$699.45
$873.36
$866.18
$912.40
$961.36
$1,135.27
$1,128.09
$1,174.31
$1,223.27
$1,397.18
$261.91

Bronze

Plan: (POS) POS HSA 6550 Methodist Bronze

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)
Customer Service Phone: 1-866-247-3296

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
0-14
Bronze 21
30
40
50
60
$331.80
$376.59
$424.04
$592.59
$900.51
$663.60
$753.18
$848.08
$1,185.18
$1,801.02
$917.43
$1,007.01
$1,101.91
$1,439.01
$1,171.26
$1,260.84
$1,355.74
$1,692.84
$1,425.09
$1,514.67
$1,609.57
$1,946.67
$585.63
$630.42
$677.87
$846.42
$839.46
$884.25
$931.70
$1,100.25
$1,093.29
$1,138.08
$1,185.53
$1,354.08
$253.83

Bronze

Plan: (POS) POS HSA 6550 OSF Bronze

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)
Customer Service Phone: 1-866-247-3296

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
0-14
Bronze 21
30
40
50
60
$331.80
$376.59
$424.04
$592.59
$900.51
$663.60
$753.18
$848.08
$1,185.18
$1,801.02
$917.43
$1,007.01
$1,101.91
$1,439.01
$1,171.26
$1,260.84
$1,355.74
$1,692.84
$1,425.09
$1,514.67
$1,609.57
$1,946.67
$585.63
$630.42
$677.87
$846.42
$839.46
$884.25
$931.70
$1,100.25
$1,093.29
$1,138.08
$1,185.53
$1,354.08
$253.83

Catastrophic

Plan: (HMO) HMO 7350 Elite Catastrophic

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)
Customer Service Phone: 1-866-247-3296

Deductible: Individual: $7,350 : Family: $14,700
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

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
0-14
Catastrophic 21
30
40
50
60
$269.22
$305.56
$344.06
$480.83
$730.66
$538.44
$611.12
$688.12
$961.66
$1,461.32
$744.39
$817.07
$894.07
$1,167.61
$950.34
$1,023.02
$1,100.02
$1,373.56
$1,156.29
$1,228.97
$1,305.97
$1,579.51
$475.17
$511.51
$550.01
$686.78
$681.12
$717.46
$755.96
$892.73
$887.07
$923.41
$961.91
$1,098.68
$205.95

Gold

Plan: (HMO) HMO 2000 Methodist Gold

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)
Customer Service Phone: 1-866-247-3296

Deductible: Individual: $2,000 : Family: $4,000
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
0-14
Gold 21
30
40
50
60
$535.36
$607.63
$684.19
$956.15
$1,452.97
$1,070.72
$1,215.26
$1,368.38
$1,912.30
$2,905.94
$1,480.27
$1,624.81
$1,777.93
$2,321.85
$1,889.82
$2,034.36
$2,187.48
$2,731.40
$2,299.37
$2,443.91
$2,597.03
$3,140.95
$944.91
$1,017.18
$1,093.74
$1,365.70
$1,354.46
$1,426.73
$1,503.29
$1,775.25
$1,764.01
$1,836.28
$1,912.84
$2,184.80
$409.55

Gold

Plan: (HMO) HMO 2000 OSF Gold

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)
Customer Service Phone: 1-866-247-3296

Deductible: Individual: $2,000 : Family: $4,000
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
0-14
Gold 21
30
40
50
60
$535.36
$607.63
$684.19
$956.15
$1,452.97
$1,070.72
$1,215.26
$1,368.38
$1,912.30
$2,905.94
$1,480.27
$1,624.81
$1,777.93
$2,321.85
$1,889.82
$2,034.36
$2,187.48
$2,731.40
$2,299.37
$2,443.91
$2,597.03
$3,140.95
$944.91
$1,017.18
$1,093.74
$1,365.70
$1,354.46
$1,426.73
$1,503.29
$1,775.25
$1,764.01
$1,836.28
$1,912.84
$2,184.80
$409.55

Silver

Plan: (HMO) HMO 3100 Methodist Silver

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)
Customer Service Phone: 1-866-247-3296

Deductible: Individual: $3,100 : Family: $6,200
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

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
0-14
Silver 21
30
40
50
60
$482.52
$547.66
$616.66
$861.78
$1,309.56
$965.04
$1,095.32
$1,233.32
$1,723.56
$2,619.12
$1,334.17
$1,464.45
$1,602.45
$2,092.69
$1,703.30
$1,833.58
$1,971.58
$2,461.82
$2,072.43
$2,202.71
$2,340.71
$2,830.95
$851.65
$916.79
$985.79
$1,230.91
$1,220.78
$1,285.92
$1,354.92
$1,600.04
$1,589.91
$1,655.05
$1,724.05
$1,969.17
$369.13

Silver

Plan: (HMO) HMO 3100 OSF Silver

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)
Customer Service Phone: 1-866-247-3296

Deductible: Individual: $3,100 : Family: $6,200
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

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
0-14
Silver 21
30
40
50
60
$482.52
$547.66
$616.66
$861.78
$1,309.56
$965.04
$1,095.32
$1,233.32
$1,723.56
$2,619.12
$1,334.17
$1,464.45
$1,602.45
$2,092.69
$1,703.30
$1,833.58
$1,971.58
$2,461.82
$2,072.43
$2,202.71
$2,340.71
$2,830.95
$851.65
$916.79
$985.79
$1,230.91
$1,220.78
$1,285.92
$1,354.92
$1,600.04
$1,589.91
$1,655.05
$1,724.05
$1,969.17
$369.13

Silver

Plan: (HMO) HMO 3500a Methodist Silver

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)
Customer Service Phone: 1-866-247-3296

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

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
0-14
Silver 21
30
40
50
60
$456.21
$517.80
$583.04
$814.79
$1,238.15
$912.42
$1,035.60
$1,166.08
$1,629.58
$2,476.30
$1,261.42
$1,384.60
$1,515.08
$1,978.58
$1,610.42
$1,733.60
$1,864.08
$2,327.58
$1,959.42
$2,082.60
$2,213.08
$2,676.58
$805.21
$866.80
$932.04
$1,163.79
$1,154.21
$1,215.80
$1,281.04
$1,512.79
$1,503.21
$1,564.80
$1,630.04
$1,861.79
$349.00

Silver

Plan: (HMO) HMO 3500a OSF Silver

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)
Customer Service Phone: 1-866-247-3296

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

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
0-14
Silver 21
30
40
50
60
$456.21
$517.80
$583.04
$814.79
$1,238.15
$912.42
$1,035.60
$1,166.08
$1,629.58
$2,476.30
$1,261.42
$1,384.60
$1,515.08
$1,978.58
$1,610.42
$1,733.60
$1,864.08
$2,327.58
$1,959.42
$2,082.60
$2,213.08
$2,676.58
$805.21
$866.80
$932.04
$1,163.79
$1,154.21
$1,215.80
$1,281.04
$1,512.79
$1,503.21
$1,564.80
$1,630.04
$1,861.79
$349.00

Bronze

Plan: (HMO) HMO 3800 Methodist Bronze

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)
Customer Service Phone: 1-866-247-3296

Deductible: Individual: $3,800 : Family: $7,150
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
0-14
Bronze 21
30
40
50
60
$327.00
$371.15
$417.91
$584.02
$887.48
$654.00
$742.30
$835.82
$1,168.04
$1,774.96
$904.16
$992.46
$1,085.98
$1,418.20
$1,154.32
$1,242.62
$1,336.14
$1,668.36
$1,404.48
$1,492.78
$1,586.30
$1,918.52
$577.16
$621.31
$668.07
$834.18
$827.32
$871.47
$918.23
$1,084.34
$1,077.48
$1,121.63
$1,168.39
$1,334.50
$250.16

Bronze

Plan: (HMO) HMO 3800 OSF Bronze

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)
Customer Service Phone: 1-866-247-3296

Deductible: Individual: $3,800 : Family: $7,150
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
0-14
Bronze 21
30
40
50
60
$327.00
$371.15
$417.91
$584.02
$887.48
$654.00
$742.30
$835.82
$1,168.04
$1,774.96
$904.16
$992.46
$1,085.98
$1,418.20
$1,154.32
$1,242.62
$1,336.14
$1,668.36
$1,404.48
$1,492.78
$1,586.30
$1,918.52
$577.16
$621.31
$668.07
$834.18
$827.32
$871.47
$918.23
$1,084.34
$1,077.48
$1,121.63
$1,168.39
$1,334.50
$250.16

Bronze

Plan: (POS) POS 3750c OSF Bronze

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)
Customer Service Phone: 1-866-247-3296

Deductible: Individual: $3,750 : Family: $7,500
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
0-14
Bronze 21
30
40
50
60
$338.70
$384.42
$432.86
$604.92
$919.23
$677.40
$768.84
$865.72
$1,209.84
$1,838.46
$936.51
$1,027.95
$1,124.83
$1,468.95
$1,195.62
$1,287.06
$1,383.94
$1,728.06
$1,454.73
$1,546.17
$1,643.05
$1,987.17
$597.81
$643.53
$691.97
$864.03
$856.92
$902.64
$951.08
$1,123.14
$1,116.03
$1,161.75
$1,210.19
$1,382.25
$259.11

Silver

Plan: (HMO) HMO 4000b Methodist Silver

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)
Customer Service Phone: 1-866-247-3296

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

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
0-14
Silver 21
30
40
50
60
$526.86
$597.99
$673.33
$940.97
$1,429.90
$1,053.72
$1,195.98
$1,346.66
$1,881.94
$2,859.80
$1,456.77
$1,599.03
$1,749.71
$2,284.99
$1,859.82
$2,002.08
$2,152.76
$2,688.04
$2,262.87
$2,405.13
$2,555.81
$3,091.09
$929.91
$1,001.04
$1,076.38
$1,344.02
$1,332.96
$1,404.09
$1,479.43
$1,747.07
$1,736.01
$1,807.14
$1,882.48
$2,150.12
$403.05

Silver

Plan: (HMO) HMO 4000b OSF Silver

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)
Customer Service Phone: 1-866-247-3296

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

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
0-14
Silver 21
30
40
50
60
$526.86
$597.99
$673.33
$940.97
$1,429.90
$1,053.72
$1,195.98
$1,346.66
$1,881.94
$2,859.80
$1,456.77
$1,599.03
$1,749.71
$2,284.99
$1,859.82
$2,002.08
$2,152.76
$2,688.04
$2,262.87
$2,405.13
$2,555.81
$3,091.09
$929.91
$1,001.04
$1,076.38
$1,344.02
$1,332.96
$1,404.09
$1,479.43
$1,747.07
$1,736.01
$1,807.14
$1,882.48
$2,150.12
$403.05

Bronze

Plan: (HMO) HMO 4000d Methodist Bronze

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)
Customer Service Phone: 1-866-247-3296

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

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
0-14
Bronze 21
30
40
50
60
$325.27
$369.18
$415.70
$580.93
$882.78
$650.54
$738.36
$831.40
$1,161.86
$1,765.56
$899.37
$987.19
$1,080.23
$1,410.69
$1,148.20
$1,236.02
$1,329.06
$1,659.52
$1,397.03
$1,484.85
$1,577.89
$1,908.35
$574.10
$618.01
$664.53
$829.76
$822.93
$866.84
$913.36
$1,078.59
$1,071.76
$1,115.67
$1,162.19
$1,327.42
$248.83

Bronze

Plan: (HMO) HMO 4000d OSF Bronze

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)
Customer Service Phone: 1-866-247-3296

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

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
0-14
Bronze 21
30
40
50
60
$325.27
$369.18
$415.70
$580.93
$882.78
$650.54
$738.36
$831.40
$1,161.86
$1,765.56
$899.37
$987.19
$1,080.23
$1,410.69
$1,148.20
$1,236.02
$1,329.06
$1,659.52
$1,397.03
$1,484.85
$1,577.89
$1,908.35
$574.10
$618.01
$664.53
$829.76
$822.93
$866.84
$913.36
$1,078.59
$1,071.76
$1,115.67
$1,162.19
$1,327.42
$248.83

Bronze

Plan: (POS) POS 5000a OSF Bronze

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)
Customer Service Phone: 1-866-247-3296

Deductible: Individual: $5,000 : Family: $12,700
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
0-14
Bronze 21
30
40
50
60
$338.45
$384.14
$432.54
$604.47
$918.55
$676.90
$768.28
$865.08
$1,208.94
$1,837.10
$935.81
$1,027.19
$1,123.99
$1,467.85
$1,194.72
$1,286.10
$1,382.90
$1,726.76
$1,453.63
$1,545.01
$1,641.81
$1,985.67
$597.36
$643.05
$691.45
$863.38
$856.27
$901.96
$950.36
$1,122.29
$1,115.18
$1,160.87
$1,209.27
$1,381.20
$258.91

Silver

Plan: (HMO) HMO 5000c Methodist Silver

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)
Customer Service Phone: 1-866-247-3296

Deductible: Individual: $5,000 : Family: $10,000
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
0-14
Silver 21
30
40
50
60
$477.34
$541.78
$610.04
$852.53
$1,295.50
$954.68
$1,083.56
$1,220.08
$1,705.06
$2,591.00
$1,319.85
$1,448.73
$1,585.25
$2,070.23
$1,685.02
$1,813.90
$1,950.42
$2,435.40
$2,050.19
$2,179.07
$2,315.59
$2,800.57
$842.51
$906.95
$975.21
$1,217.70
$1,207.68
$1,272.12
$1,340.38
$1,582.87
$1,572.85
$1,637.29
$1,705.55
$1,948.04
$365.17

Silver

Plan: (HMO) HMO 5000c OSF Silver

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)
Customer Service Phone: 1-866-247-3296

Deductible: Individual: $5,000 : Family: $10,000
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
0-14
Silver 21
30
40
50
60
$477.34
$541.78
$610.04
$852.53
$1,295.50
$954.68
$1,083.56
$1,220.08
$1,705.06
$2,591.00
$1,319.85
$1,448.73
$1,585.25
$2,070.23
$1,685.02
$1,813.90
$1,950.42
$2,435.40
$2,050.19
$2,179.07
$2,315.59
$2,800.57
$842.51
$906.95
$975.21
$1,217.70
$1,207.68
$1,272.12
$1,340.38
$1,582.87
$1,572.85
$1,637.29
$1,705.55
$1,948.04
$365.17

Expanded Bronze

Plan: (HMO) HMO 6650a Methodist Bronze

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)
Customer Service Phone: 1-866-247-3296

Deductible: Individual: $6,650 : Family: $13,300
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

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
0-14
Expanded Bronze 21
30
40
50
60
$328.66
$373.03
$420.03
$586.99
$891.98
$657.32
$746.06
$840.06
$1,173.98
$1,783.96
$908.74
$997.48
$1,091.48
$1,425.40
$1,160.16
$1,248.90
$1,342.90
$1,676.82
$1,411.58
$1,500.32
$1,594.32
$1,928.24
$580.08
$624.45
$671.45
$838.41
$831.50
$875.87
$922.87
$1,089.83
$1,082.92
$1,127.29
$1,174.29
$1,341.25
$251.42

Expanded Bronze

Plan: (HMO) HMO 6650a OSF Bronze

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)
Customer Service Phone: 1-866-247-3296

Deductible: Individual: $6,650 : Family: $13,300
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

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
0-14
Expanded Bronze 21
30
40
50
60
$328.66
$373.03
$420.03
$586.99
$891.98
$657.32
$746.06
$840.06
$1,173.98
$1,783.96
$908.74
$997.48
$1,091.48
$1,425.40
$1,160.16
$1,248.90
$1,342.90
$1,676.82
$1,411.58
$1,500.32
$1,594.32
$1,928.24
$580.08
$624.45
$671.45
$838.41
$831.50
$875.87
$922.87
$1,089.83
$1,082.92
$1,127.29
$1,174.29
$1,341.25
$251.42

Bronze

Plan: (POS) POS 5000a Methodist Bronze

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)
Customer Service Phone: 1-866-247-3296

Deductible: Individual: $5,000 : Family: $12,700
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
0-14
Bronze 21
30
40
50
60
$338.45
$384.14
$432.54
$604.47
$918.55
$676.90
$768.28
$865.08
$1,208.94
$1,837.10
$935.81
$1,027.19
$1,123.99
$1,467.85
$1,194.72
$1,286.10
$1,382.90
$1,726.76
$1,453.63
$1,545.01
$1,641.81
$1,985.67
$597.36
$643.05
$691.45
$863.38
$856.27
$901.96
$950.36
$1,122.29
$1,115.18
$1,160.87
$1,209.27
$1,381.20
$258.91

Silver

Plan: (POS) POS 6300 Methodist Silver

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)
Customer Service Phone: 1-866-247-3296

Deductible: Individual: $6,300 : Family: $12,600
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

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
0-14
Silver 21
30
40
50
60
$491.24
$557.56
$627.80
$877.35
$1,333.23
$982.48
$1,115.12
$1,255.60
$1,754.70
$2,666.46
$1,358.28
$1,490.92
$1,631.40
$2,130.50
$1,734.08
$1,866.72
$2,007.20
$2,506.30
$2,109.88
$2,242.52
$2,383.00
$2,882.10
$867.04
$933.36
$1,003.60
$1,253.15
$1,242.84
$1,309.16
$1,379.40
$1,628.95
$1,618.64
$1,684.96
$1,755.20
$2,004.75
$375.80

Silver

Plan: (POS) POS 3500a Methodist Silver

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)
Customer Service Phone: 1-866-247-3296

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

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
0-14
Silver 21
30
40
50
60
$474.64
$538.72
$606.59
$847.71
$1,288.17
$949.28
$1,077.44
$1,213.18
$1,695.42
$2,576.34
$1,312.38
$1,440.54
$1,576.28
$2,058.52
$1,675.48
$1,803.64
$1,939.38
$2,421.62
$2,038.58
$2,166.74
$2,302.48
$2,784.72
$837.74
$901.82
$969.69
$1,210.81
$1,200.84
$1,264.92
$1,332.79
$1,573.91
$1,563.94
$1,628.02
$1,695.89
$1,937.01
$363.10

Silver

Plan: (POS) POS 3500a OSF Silver

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)
Customer Service Phone: 1-866-247-3296

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

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
0-14
Silver 21
30
40
50
60
$474.64
$538.72
$606.59
$847.71
$1,288.17
$949.28
$1,077.44
$1,213.18
$1,695.42
$2,576.34
$1,312.38
$1,440.54
$1,576.28
$2,058.52
$1,675.48
$1,803.64
$1,939.38
$2,421.62
$2,038.58
$2,166.74
$2,302.48
$2,784.72
$837.74
$901.82
$969.69
$1,210.81
$1,200.84
$1,264.92
$1,332.79
$1,573.91
$1,563.94
$1,628.02
$1,695.89
$1,937.01
$363.10

Bronze

Plan: (POS) POS 3750c Methodist Bronze

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)
Customer Service Phone: 1-866-247-3296

Deductible: Individual: $3,750 : Family: $7,500
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
0-14
Bronze 21
30
40
50
60
$338.70
$384.42
$432.86
$604.92
$919.23
$677.40
$768.84
$865.72
$1,209.84
$1,838.46
$936.51
$1,027.95
$1,124.83
$1,468.95
$1,195.62
$1,287.06
$1,383.94
$1,728.06
$1,454.73
$1,546.17
$1,643.05
$1,987.17
$597.81
$643.53
$691.97
$864.03
$856.92
$902.64
$951.08
$1,123.14
$1,116.03
$1,161.75
$1,210.19
$1,382.25
$259.11

Silver

Plan: (POS) POS 6300 OSF Silver

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)
Customer Service Phone: 1-866-247-3296

Deductible: Individual: $6,300 : Family: $12,600
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

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
0-14
Silver 21
30
40
50
60
$491.24
$557.56
$627.80
$877.35
$1,333.23
$982.48
$1,115.12
$1,255.60
$1,754.70
$2,666.46
$1,358.28
$1,490.92
$1,631.40
$2,130.50
$1,734.08
$1,866.72
$2,007.20
$2,506.30
$2,109.88
$2,242.52
$2,383.00
$2,882.10
$867.04
$933.36
$1,003.60
$1,253.15
$1,242.84
$1,309.16
$1,379.40
$1,628.95
$1,618.64
$1,684.96
$1,755.20
$2,004.75
$375.80

Silver

Plan: (POS) POS 7350 Methodist Silver

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)
Customer Service Phone: 1-866-247-3296

Deductible: Individual: $7,350 : Family: $14,700
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

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
0-14
Silver 21
30
40
50
60
$461.17
$523.43
$589.38
$823.65
$1,251.62
$922.34
$1,046.86
$1,178.76
$1,647.30
$2,503.24
$1,275.14
$1,399.66
$1,531.56
$2,000.10
$1,627.94
$1,752.46
$1,884.36
$2,352.90
$1,980.74
$2,105.26
$2,237.16
$2,705.70
$813.97
$876.23
$942.18
$1,176.45
$1,166.77
$1,229.03
$1,294.98
$1,529.25
$1,519.57
$1,581.83
$1,647.78
$1,882.05
$352.80

Silver

Plan: (POS) POS 7350 OSF Silver

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)
Customer Service Phone: 1-866-247-3296

Deductible: Individual: $7,350 : Family: $14,700
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

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
0-14
Silver 21
30
40
50
60
$461.17
$523.43
$589.38
$823.65
$1,251.62
$922.34
$1,046.86
$1,178.76
$1,647.30
$2,503.24
$1,275.14
$1,399.66
$1,531.56
$2,000.10
$1,627.94
$1,752.46
$1,884.36
$2,352.90
$1,980.74
$2,105.26
$2,237.16
$2,705.70
$813.97
$876.23
$942.18
$1,176.45
$1,166.77
$1,229.03
$1,294.98
$1,529.25
$1,519.57
$1,581.83
$1,647.78
$1,882.05
$352.80

Expanded Bronze

Plan: (POS) POS 6650a Methodist Bronze

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)
Customer Service Phone: 1-866-247-3296

Deductible: Individual: $6,650 : Family: $13,300
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

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
0-14
Expanded Bronze 21
30
40
50
60
$341.93
$388.09
$436.99
$610.69
$928.00
$683.86
$776.18
$873.98
$1,221.38
$1,856.00
$945.44
$1,037.76
$1,135.56
$1,482.96
$1,207.02
$1,299.34
$1,397.14
$1,744.54
$1,468.60
$1,560.92
$1,658.72
$2,006.12
$603.51
$649.67
$698.57
$872.27
$865.09
$911.25
$960.15
$1,133.85
$1,126.67
$1,172.83
$1,221.73
$1,395.43
$261.58

Expanded Bronze

Plan: (POS) POS 6650a OSF Bronze

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)
Customer Service Phone: 1-866-247-3296

Deductible: Individual: $6,650 : Family: $13,300
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

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
0-14
Expanded Bronze 21
30
40
50
60
$341.93
$388.09
$436.99
$610.69
$928.00
$683.86
$776.18
$873.98
$1,221.38
$1,856.00
$945.44
$1,037.76
$1,135.56
$1,482.96
$1,207.02
$1,299.34
$1,397.14
$1,744.54
$1,468.60
$1,560.92
$1,658.72
$2,006.12
$603.51
$649.67
$698.57
$872.27
$865.09
$911.25
$960.15
$1,133.85
$1,126.67
$1,172.83
$1,221.73
$1,395.43
$261.58

Blue Cross Blue Shield of Illinois

Local: 1-800-538-8833 | Toll Free: 1-800-538-8833

TTY: 1-800-526-0844

Gold

Plan: (PPO) Blue Choice Preferred Gold PPO? 204

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Blue Cross Blue Shield of Illinois)
Customer Service Phone: 1-800-538-8833

Deductible: Individual: $750 : Family: $2,250
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

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
0-14
Gold 21
30
40
50
60
$511.64
$580.71
$653.88
$913.79
$1,388.60
$1,023.28
$1,161.42
$1,307.76
$1,827.58
$2,777.20
$1,414.69
$1,552.83
$1,699.17
$2,218.99
$1,806.10
$1,944.24
$2,090.58
$2,610.40
$2,197.51
$2,335.65
$2,481.99
$3,001.81
$903.05
$972.12
$1,045.29
$1,305.20
$1,294.46
$1,363.53
$1,436.70
$1,696.61
$1,685.87
$1,754.94
$1,828.11
$2,088.02
$391.41

Silver

Plan: (PPO) Blue Choice Preferred Silver PPO? 203

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Blue Cross Blue Shield of Illinois)
Customer Service Phone: 1-800-538-8833

Deductible: Individual: $1,450 : Family: $4,350
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

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
0-14
Silver 21
30
40
50
60
$488.09
$553.98
$623.77
$871.72
$1,324.67
$976.18
$1,107.96
$1,247.54
$1,743.44
$2,649.34
$1,349.57
$1,481.35
$1,620.93
$2,116.83
$1,722.96
$1,854.74
$1,994.32
$2,490.22
$2,096.35
$2,228.13
$2,367.71
$2,863.61
$861.48
$927.37
$997.16
$1,245.11
$1,234.87
$1,300.76
$1,370.55
$1,618.50
$1,608.26
$1,674.15
$1,743.94
$1,991.89
$373.39

Bronze

Plan: (PPO) Blue Choice Preferred Bronze PPO? 202

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Blue Cross Blue Shield of Illinois)
Customer Service Phone: 1-800-538-8833

Deductible: Individual: $2,850 : Family: $8,550
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
0-14
Bronze 21
30
40
50
60
$398.40
$452.19
$509.16
$711.55
$1,081.26
$796.80
$904.38
$1,018.32
$1,423.10
$2,162.52
$1,101.58
$1,209.16
$1,323.10
$1,727.88
$1,406.36
$1,513.94
$1,627.88
$2,032.66
$1,711.14
$1,818.72
$1,932.66
$2,337.44
$703.18
$756.97
$813.94
$1,016.33
$1,007.96
$1,061.75
$1,118.72
$1,321.11
$1,312.74
$1,366.53
$1,423.50
$1,625.89
$304.78

Catastrophic

Plan: (PPO) Blue Choice Preferred Security PPO? 200

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Blue Cross Blue Shield of Illinois)
Customer Service Phone: 1-800-538-8833

Deductible: Individual: $7,350 : Family: $14,700
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

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
0-14
Catastrophic 21
30
40
50
60
$337.73
$383.33
$431.62
$603.19
$916.61
$675.46
$766.66
$863.24
$1,206.38
$1,833.22
$933.83
$1,025.03
$1,121.61
$1,464.75
$1,192.20
$1,283.40
$1,379.98
$1,723.12
$1,450.57
$1,541.77
$1,638.35
$1,981.49
$596.10
$641.70
$689.99
$861.56
$854.47
$900.07
$948.36
$1,119.93
$1,112.84
$1,158.44
$1,206.73
$1,378.30
$258.37

Bronze

Plan: (PPO) Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits

Summary of Benefits and Coverage - Plan Brochure
Provider Directory for This Plan: (Blue Cross Blue Shield of Illinois)
Customer Service Phone: 1-800-538-8833

Deductible: Individual: $5,500 : Family: $14,700
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

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
0-14
Bronze 21
30
40
50
60
$362.29
$411.20
$463.01
$647.05
$983.26
$724.58
$822.40
$926.02
$1,294.10
$1,966.52
$1,001.73
$1,099.55
$1,203.17
$1,571.25
$1,278.88
$1,376.70
$1,480.32
$1,848.40
$1,556.03
$1,653.85
$1,757.47
$2,125.55
$639.44
$688.35
$740.16
$924.20
$916.59
$965.50
$1,017.31
$1,201.35
$1,193.74
$1,242.65
$1,294.46
$1,478.50
$277.15

‡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 Knox County here.

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