ADVERTISEMENT
|
Blue Cross Blue Shield of Illinois
Local: 1-800-538-8833 | Toll Free: 1-800-538-8833 | TTY: 1-800-526-0844
|
|
Gold
|
Annual Out of Pocket Expenses
|
Individual |
Family |
Annual Deductible |
$750 |
$2,250 |
Maximum Out of Pocket Per Year |
$8,150 |
$16,300 |
Deductible: Individual:
$750
| Family:
$2,250
Out of Pocket Maximum per year: Individual:
$8,150
| Family:
$16,300
Monthly Premiums:
|
21
30
40
50
60
|
$422.85
$479.93
$540.40
$755.20
$1,147.60 |
$845.70
$959.86
$1,080.80
$1,510.40
$2,295.20 |
$1,169.18
$1,283.34
$1,404.28
$1,833.88 |
$1,492.66
$1,606.82
$1,727.76
$2,157.36 |
$1,816.14
$1,930.30
$2,051.24
$2,480.84 |
$746.33
$803.41
$863.88
$1,078.68 |
$1,069.81
$1,126.89
$1,187.36
$1,402.16 |
$1,393.29
$1,450.37
$1,510.84
$1,725.64 |
$323.48 |
|
Silver
|
Annual Out of Pocket Expenses
|
Individual |
Family |
Annual Deductible |
$2,800 |
$8,400 |
Maximum Out of Pocket Per Year |
$8,150 |
$16,300 |
Deductible: Individual:
$2,800
| Family:
$8,400
Out of Pocket Maximum per year: Individual:
$8,150
| Family:
$16,300
Monthly Premiums:
|
21
30
40
50
60
|
$376.52
$427.35
$481.20
$672.47
$1,021.88 |
$753.04
$854.70
$962.40
$1,344.94
$2,043.76 |
$1,041.08
$1,142.74
$1,250.44
$1,632.98 |
$1,329.12
$1,430.78
$1,538.48
$1,921.02 |
$1,617.16
$1,718.82
$1,826.52
$2,209.06 |
$664.56
$715.39
$769.24
$960.51 |
$952.60
$1,003.43
$1,057.28
$1,248.55 |
$1,240.64
$1,291.47
$1,345.32
$1,536.59 |
$288.04 |
|
Bronze
|
Annual Out of Pocket Expenses
|
Individual |
Family |
Annual Deductible |
$7,400 |
$16,300 |
Maximum Out of Pocket Per Year |
$8,150 |
$16,300 |
Deductible: Individual:
$7,400
| Family:
$16,300
Out of Pocket Maximum per year: Individual:
$8,150
| Family:
$16,300
Monthly Premiums:
|
21
30
40
50
60
|
$303.64
$344.63
$388.05
$542.29
$824.07 |
$607.28
$689.26
$776.10
$1,084.58
$1,648.14 |
$839.56
$921.54
$1,008.38
$1,316.86 |
$1,071.84
$1,153.82
$1,240.66
$1,549.14 |
$1,304.12
$1,386.10
$1,472.94
$1,781.42 |
$535.92
$576.91
$620.33
$774.57 |
$768.20
$809.19
$852.61
$1,006.85 |
$1,000.48
$1,041.47
$1,084.89
$1,239.13 |
$232.28 |
|
Gold
|
Annual Out of Pocket Expenses
|
Individual |
Family |
Annual Deductible |
$750 |
$2,250 |
Maximum Out of Pocket Per Year |
$8,150 |
$16,300 |
Deductible: Individual:
$750
| Family:
$2,250
Out of Pocket Maximum per year: Individual:
$8,150
| Family:
$16,300
Monthly Premiums:
|
21
30
40
50
60
|
$573.62
$651.06
$733.08
$1,024.48
$1,556.80 |
$1,147.24
$1,302.12
$1,466.16
$2,048.96
$3,113.60 |
$1,586.06
$1,740.94
$1,904.98
$2,487.78 |
$2,024.88
$2,179.76
$2,343.80
$2,926.60 |
$2,463.70
$2,618.58
$2,782.62
$3,365.42 |
$1,012.44
$1,089.88
$1,171.90
$1,463.30 |
$1,451.26
$1,528.70
$1,610.72
$1,902.12 |
$1,890.08
$1,967.52
$2,049.54
$2,340.94 |
$438.82 |
|
Silver
|
Annual Out of Pocket Expenses
|
Individual |
Family |
Annual Deductible |
$2,200 |
$6,600 |
Maximum Out of Pocket Per Year |
$8,150 |
$16,300 |
Deductible: Individual:
$2,200
| Family:
$6,600
Out of Pocket Maximum per year: Individual:
$8,150
| Family:
$16,300
Monthly Premiums:
|
21
30
40
50
60
|
$497.27
$564.40
$635.51
$888.12
$1,349.58 |
$994.54
$1,128.80
$1,271.02
$1,776.24
$2,699.16 |
$1,374.95
$1,509.21
$1,651.43
$2,156.65 |
$1,755.36
$1,889.62
$2,031.84
$2,537.06 |
$2,135.77
$2,270.03
$2,412.25
$2,917.47 |
$877.68
$944.81
$1,015.92
$1,268.53 |
$1,258.09
$1,325.22
$1,396.33
$1,648.94 |
$1,638.50
$1,705.63
$1,776.74
$2,029.35 |
$380.41 |
|
Bronze
|
Annual Out of Pocket Expenses
|
Individual |
Family |
Annual Deductible |
$3,500 |
$10,500 |
Maximum Out of Pocket Per Year |
$6,750 |
$13,500 |
Deductible: Individual:
$3,500
| Family:
$10,500
Out of Pocket Maximum per year: Individual:
$6,750
| Family:
$13,500
Monthly Premiums:
|
21
30
40
50
60
|
$428.53
$486.38
$547.66
$765.35
$1,163.02 |
$857.06
$972.76
$1,095.32
$1,530.70
$2,326.04 |
$1,184.88
$1,300.58
$1,423.14
$1,858.52 |
$1,512.70
$1,628.40
$1,750.96
$2,186.34 |
$1,840.52
$1,956.22
$2,078.78
$2,514.16 |
$756.35
$814.20
$875.48
$1,093.17 |
$1,084.17
$1,142.02
$1,203.30
$1,420.99 |
$1,411.99
$1,469.84
$1,531.12
$1,748.81 |
$327.82 |
|
Catastrophic
|
Annual Out of Pocket Expenses
|
Individual |
Family |
Annual Deductible |
$8,150 |
$16,300 |
Maximum Out of Pocket Per Year |
$8,150 |
$16,300 |
Deductible: Individual:
$8,150
| Family:
$16,300
Out of Pocket Maximum per year: Individual:
$8,150
| Family:
$16,300
Monthly Premiums:
|
21
30
40
50
60
|
$358.35
$406.73
$457.97
$640.01
$972.56 |
$716.70
$813.46
$915.94
$1,280.02
$1,945.12 |
$990.84
$1,087.60
$1,190.08
$1,554.16 |
$1,264.98
$1,361.74
$1,464.22
$1,828.30 |
$1,539.12
$1,635.88
$1,738.36
$2,102.44 |
$632.49
$680.87
$732.11
$914.15 |
$906.63
$955.01
$1,006.25
$1,188.29 |
$1,180.77
$1,229.15
$1,280.39
$1,462.43 |
$274.14 |
|
Bronze
|
Annual Out of Pocket Expenses
|
Individual |
Family |
Annual Deductible |
$6,000 |
$16,300 |
Maximum Out of Pocket Per Year |
$8,150 |
$16,300 |
Deductible: Individual:
$6,000
| Family:
$16,300
Out of Pocket Maximum per year: Individual:
$8,150
| Family:
$16,300
Monthly Premiums:
|
21
30
40
50
60
|
$387.10
$439.36
$494.72
$691.37
$1,050.60 |
$774.20
$878.72
$989.44
$1,382.74
$2,101.20 |
$1,070.33
$1,174.85
$1,285.57
$1,678.87 |
$1,366.46
$1,470.98
$1,581.70
$1,975.00 |
$1,662.59
$1,767.11
$1,877.83
$2,271.13 |
$683.23
$735.49
$790.85
$987.50 |
$979.36
$1,031.62
$1,086.98
$1,283.63 |
$1,275.49
$1,327.75
$1,383.11
$1,579.76 |
$296.13 |
ADVERTISEMENT
|
Quartz Health Benefit Plans Corporation
Local: 1-608-644-3430 | Toll Free: 1-800-362-3310 | TTY: 1-800-877-8973
|
|
Gold
|
Annual Out of Pocket Expenses
|
Individual |
Family |
Annual Deductible |
$2,000 |
$4,000 |
Maximum Out of Pocket Per Year |
$7,900 |
$15,800 |
Deductible: Individual:
$2,000
| Family:
$4,000
Out of Pocket Maximum per year: Individual:
$7,900
| Family:
$15,800
Monthly Premiums:
|
21
30
40
50
60
|
$448.23
$508.74
$572.84
$800.54
$1,216.49 |
$896.46
$1,017.48
$1,145.68
$1,601.08
$2,432.98 |
$1,239.35
$1,360.37
$1,488.57
$1,943.97 |
$1,582.24
$1,703.26
$1,831.46
$2,286.86 |
$1,925.13
$2,046.15
$2,174.35
$2,629.75 |
$791.12
$851.63
$915.73
$1,143.43 |
$1,134.01
$1,194.52
$1,258.62
$1,486.32 |
$1,476.90
$1,537.41
$1,601.51
$1,829.21 |
$342.89 |
|
Gold
|
Annual Out of Pocket Expenses
|
Individual |
Family |
Annual Deductible |
$1,500 |
$3,000 |
Maximum Out of Pocket Per Year |
$7,900 |
$15,800 |
Deductible: Individual:
$1,500
| Family:
$3,000
Out of Pocket Maximum per year: Individual:
$7,900
| Family:
$15,800
Monthly Premiums:
|
21
30
40
50
60
|
$454.05
$515.34
$580.27
$810.93
$1,232.29 |
$908.10
$1,030.68
$1,160.54
$1,621.86
$2,464.58 |
$1,255.45
$1,378.03
$1,507.89
$1,969.21 |
$1,602.80
$1,725.38
$1,855.24
$2,316.56 |
$1,950.15
$2,072.73
$2,202.59
$2,663.91 |
$801.40
$862.69
$927.62
$1,158.28 |
$1,148.75
$1,210.04
$1,274.97
$1,505.63 |
$1,496.10
$1,557.39
$1,622.32
$1,852.98 |
$347.35 |
|
Gold
|
Annual Out of Pocket Expenses
|
Individual |
Family |
Annual Deductible |
$3,000 |
$6,000 |
Maximum Out of Pocket Per Year |
$3,000 |
$6,000 |
Deductible: Individual:
$3,000
| Family:
$6,000
Out of Pocket Maximum per year: Individual:
$3,000
| Family:
$6,000
Monthly Premiums:
|
21
30
40
50
60
|
$477.13
$541.54
$609.76
$852.14
$1,294.91 |
$954.26
$1,083.08
$1,219.52
$1,704.28
$2,589.82 |
$1,319.26
$1,448.08
$1,584.52
$2,069.28 |
$1,684.26
$1,813.08
$1,949.52
$2,434.28 |
$2,049.26
$2,178.08
$2,314.52
$2,799.28 |
$842.13
$906.54
$974.76
$1,217.14 |
$1,207.13
$1,271.54
$1,339.76
$1,582.14 |
$1,572.13
$1,636.54
$1,704.76
$1,947.14 |
$365.00 |
|
Gold
|
Annual Out of Pocket Expenses
|
Individual |
Family |
Annual Deductible |
$2,000 |
$4,000 |
Maximum Out of Pocket Per Year |
$6,650 |
$13,300 |
Deductible: Individual:
$2,000
| Family:
$4,000
Out of Pocket Maximum per year: Individual:
$6,650
| Family:
$13,300
Monthly Premiums:
|
21
30
40
50
60
|
$472.95
$536.79
$604.43
$844.68
$1,283.58 |
$945.90
$1,073.58
$1,208.86
$1,689.36
$2,567.16 |
$1,307.70
$1,435.38
$1,570.66
$2,051.16 |
$1,669.50
$1,797.18
$1,932.46
$2,412.96 |
$2,031.30
$2,158.98
$2,294.26
$2,774.76 |
$834.75
$898.59
$966.23
$1,206.48 |
$1,196.55
$1,260.39
$1,328.03
$1,568.28 |
$1,558.35
$1,622.19
$1,689.83
$1,930.08 |
$361.80 |
|
Silver
|
Annual Out of Pocket Expenses
|
Individual |
Family |
Annual Deductible |
$4,300 |
$8,600 |
Maximum Out of Pocket Per Year |
$8,150 |
$16,300 |
Deductible: Individual:
$4,300
| Family:
$8,600
Out of Pocket Maximum per year: Individual:
$8,150
| Family:
$16,300
Monthly Premiums:
|
21
30
40
50
60
|
$461.11
$523.35
$589.29
$823.53
$1,251.43 |
$922.22
$1,046.70
$1,178.58
$1,647.06
$2,502.86 |
$1,274.96
$1,399.44
$1,531.32
$1,999.80 |
$1,627.70
$1,752.18
$1,884.06
$2,352.54 |
$1,980.44
$2,104.92
$2,236.80
$2,705.28 |
$813.85
$876.09
$942.03
$1,176.27 |
$1,166.59
$1,228.83
$1,294.77
$1,529.01 |
$1,519.33
$1,581.57
$1,647.51
$1,881.75 |
$352.74 |
|
Silver
|
Annual Out of Pocket Expenses
|
Individual |
Family |
Annual Deductible |
$5,000 |
$10,000 |
Maximum Out of Pocket Per Year |
$7,900 |
$15,800 |
Deductible: Individual:
$5,000
| Family:
$10,000
Out of Pocket Maximum per year: Individual:
$7,900
| Family:
$15,800
Monthly Premiums:
|
21
30
40
50
60
|
$459.60
$521.64
$587.36
$820.84
$1,247.34 |
$919.20
$1,043.28
$1,174.72
$1,641.68
$2,494.68 |
$1,270.79
$1,394.87
$1,526.31
$1,993.27 |
$1,622.38
$1,746.46
$1,877.90
$2,344.86 |
$1,973.97
$2,098.05
$2,229.49
$2,696.45 |
$811.19
$873.23
$938.95
$1,172.43 |
$1,162.78
$1,224.82
$1,290.54
$1,524.02 |
$1,514.37
$1,576.41
$1,642.13
$1,875.61 |
$351.59 |
|
Silver
|
Annual Out of Pocket Expenses
|
Individual |
Family |
Annual Deductible |
$7,900 |
$15,800 |
Maximum Out of Pocket Per Year |
$7,900 |
$15,800 |
Deductible: Individual:
$7,900
| Family:
$15,800
Out of Pocket Maximum per year: Individual:
$7,900
| Family:
$15,800
Monthly Premiums:
|
21
30
40
50
60
|
$448.99
$509.59
$573.80
$801.88
$1,218.53 |
$897.98
$1,019.18
$1,147.60
$1,603.76
$2,437.06 |
$1,241.45
$1,362.65
$1,491.07
$1,947.23 |
$1,584.92
$1,706.12
$1,834.54
$2,290.70 |
$1,928.39
$2,049.59
$2,178.01
$2,634.17 |
$792.46
$853.06
$917.27
$1,145.35 |
$1,135.93
$1,196.53
$1,260.74
$1,488.82 |
$1,479.40
$1,540.00
$1,604.21
$1,832.29 |
$343.47 |
|
Silver
|
Annual Out of Pocket Expenses
|
Individual |
Family |
Annual Deductible |
$5,250 |
$10,500 |
Maximum Out of Pocket Per Year |
$5,250 |
$10,500 |
Deductible: Individual:
$5,250
| Family:
$10,500
Out of Pocket Maximum per year: Individual:
$5,250
| Family:
$10,500
Monthly Premiums:
|
21
30
40
50
60
|
$479.73
$544.49
$613.09
$856.79
$1,301.98 |
$959.46
$1,088.98
$1,226.18
$1,713.58
$2,603.96 |
$1,326.45
$1,455.97
$1,593.17
$2,080.57 |
$1,693.44
$1,822.96
$1,960.16
$2,447.56 |
$2,060.43
$2,189.95
$2,327.15
$2,814.55 |
$846.72
$911.48
$980.08
$1,223.78 |
$1,213.71
$1,278.47
$1,347.07
$1,590.77 |
$1,580.70
$1,645.46
$1,714.06
$1,957.76 |
$366.99 |
|
Expanded Bronze
|
Annual Out of Pocket Expenses
|
Individual |
Family |
Annual Deductible |
$8,000 |
$16,000 |
Maximum Out of Pocket Per Year |
$8,150 |
$16,300 |
Deductible: Individual:
$8,000
| Family:
$16,000
Out of Pocket Maximum per year: Individual:
$8,150
| Family:
$16,300
Monthly Premiums:
|
21
30
40
50
60
|
$335.18
$380.43
$428.36
$598.63
$909.67 |
$670.36
$760.86
$856.72
$1,197.26
$1,819.34 |
$926.77
$1,017.27
$1,113.13
$1,453.67 |
$1,183.18
$1,273.68
$1,369.54
$1,710.08 |
$1,439.59
$1,530.09
$1,625.95
$1,966.49 |
$591.59
$636.84
$684.77
$855.04 |
$848.00
$893.25
$941.18
$1,111.45 |
$1,104.41
$1,149.66
$1,197.59
$1,367.86 |
$256.41 |
|
Expanded Bronze
|
Annual Out of Pocket Expenses
|
Individual |
Family |
Annual Deductible |
$7,900 |
$15,800 |
Maximum Out of Pocket Per Year |
$7,900 |
$15,800 |
Deductible: Individual:
$7,900
| Family:
$15,800
Out of Pocket Maximum per year: Individual:
$7,900
| Family:
$15,800
Monthly Premiums:
|
21
30
40
50
60
|
$343.06
$389.36
$438.42
$612.69
$931.04 |
$686.12
$778.72
$876.84
$1,225.38
$1,862.08 |
$948.56
$1,041.16
$1,139.28
$1,487.82 |
$1,211.00
$1,303.60
$1,401.72
$1,750.26 |
$1,473.44
$1,566.04
$1,664.16
$2,012.70 |
$605.50
$651.80
$700.86
$875.13 |
$867.94
$914.24
$963.30
$1,137.57 |
$1,130.38
$1,176.68
$1,225.74
$1,400.01 |
$262.44 |
|
Expanded Bronze
|
Annual Out of Pocket Expenses
|
Individual |
Family |
Annual Deductible |
$6,750 |
$13,500 |
Maximum Out of Pocket Per Year |
$6,750 |
$13,500 |
Deductible: Individual:
$6,750
| Family:
$13,500
Out of Pocket Maximum per year: Individual:
$6,750
| Family:
$13,500
Monthly Premiums:
|
21
30
40
50
60
|
$347.92
$394.88
$444.63
$621.37
$944.24 |
$695.84
$789.76
$889.26
$1,242.74
$1,888.48 |
$961.99
$1,055.91
$1,155.41
$1,508.89 |
$1,228.14
$1,322.06
$1,421.56
$1,775.04 |
$1,494.29
$1,588.21
$1,687.71
$2,041.19 |
$614.07
$661.03
$710.78
$887.52 |
$880.22
$927.18
$976.93
$1,153.67 |
$1,146.37
$1,193.33
$1,243.08
$1,419.82 |
$266.15 |
|
Catastrophic
|
Annual Out of Pocket Expenses
|
Individual |
Family |
Annual Deductible |
$8,150 |
$16,300 |
Maximum Out of Pocket Per Year |
$8,150 |
$16,300 |
Deductible: Individual:
$8,150
| Family:
$16,300
Out of Pocket Maximum per year: Individual:
$8,150
| Family:
$16,300
Monthly Premiums:
|
21
30
40
50
60
|
$255.34
$289.81
$326.32
$456.03
$692.99 |
$510.68
$579.62
$652.64
$912.06
$1,385.98 |
$706.01
$774.95
$847.97
$1,107.39 |
$901.34
$970.28
$1,043.30
$1,302.72 |
$1,096.67
$1,165.61
$1,238.63
$1,498.05 |
$450.67
$485.14
$521.65
$651.36 |
$646.00
$680.47
$716.98
$846.69 |
$841.33
$875.80
$912.31
$1,042.02 |
$195.33 |
Winnebago County is in “Rating Area 5” of Illinois.
Currently, there are 20 plans offered in Rating Area 5.