Douglas County, Kansas Obamacare 2024 Rates

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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 Douglas County, KS.

The health insurance rates listed below are for calendar year 2024.

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, 66 Plans and 2024 Rates for Douglas County, Kansas

Below, you’ll find a summary of the 66 plans for Douglas County, Kansas and rates for each of these providers. This chart is designed to give you a preview of your health insurance options.


Obamacare Rates and Providers for Other Years

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Blue Cross and Blue Shield of Kansas, Inc.

Local: 1-785-291-4186 | Toll Free: 1-800-392-7366 | TTY: 1-800-430-1270

Toc - Plan #1 Blue Cross and Blue Shield of Kansas, Inc.
Gold

(EPO) BlueCare EPO Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-392-7366

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$4,950 $9,900 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
$521.69
$592.12
$666.72
$931.73
$1,415.86
$920.78
$991.21
$1,065.81
$1,330.82
$1,319.87
$1,390.30
$1,464.90
$1,729.91
$1,718.96
$1,789.39
$1,863.99
$2,129.00
$399.09
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,043.38
$1,184.24
$1,333.44
$1,863.46
$2,831.72
$1,442.47
$1,583.33
$1,732.53
$2,262.55
$1,841.56
$1,982.42
$2,131.62
$2,661.64
$2,240.65
$2,381.51
$2,530.71
$3,060.73
$399.09
Toc - Plan #2 Blue Cross and Blue Shield of Kansas, Inc.
Silver

(EPO) BlueCare EPO Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-392-7366

Annual Out of Pocket Expenses:

Individual Family
$4,500 $9,000 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
$546.05
$619.77
$697.86
$975.25
$1,481.99
$963.78
$1,037.50
$1,115.59
$1,392.98
$1,381.51
$1,455.23
$1,533.32
$1,810.71
$1,799.24
$1,872.96
$1,951.05
$2,228.44
$417.73
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,092.10
$1,239.54
$1,395.72
$1,950.50
$2,963.98
$1,509.83
$1,657.27
$1,813.45
$2,368.23
$1,927.56
$2,075.00
$2,231.18
$2,785.96
$2,345.29
$2,492.73
$2,648.91
$3,203.69
$417.73
Toc - Plan #3 Blue Cross and Blue Shield of Kansas, Inc.
Silver

(EPO) BlueCare EPO Simple Silver HDHP

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-392-7366

Annual Out of Pocket Expenses:

Individual Family
$4,900 $9,800 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$541.98
$615.14
$692.65
$967.97
$1,470.93
$956.59
$1,029.75
$1,107.26
$1,382.58
$1,371.20
$1,444.36
$1,521.87
$1,797.19
$1,785.81
$1,858.97
$1,936.48
$2,211.80
$414.61
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,083.96
$1,230.28
$1,385.30
$1,935.94
$2,941.86
$1,498.57
$1,644.89
$1,799.91
$2,350.55
$1,913.18
$2,059.50
$2,214.52
$2,765.16
$2,327.79
$2,474.11
$2,629.13
$3,179.77
$414.61
Toc - Plan #4 Blue Cross and Blue Shield of Kansas, Inc.
Expanded Bronze

(EPO) BlueCare EPO Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-392-7366

Annual Out of Pocket Expenses:

Individual Family
$8,200 $16,400 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$412.80
$468.52
$527.55
$737.26
$1,120.33
$728.59
$784.31
$843.34
$1,053.05
$1,044.38
$1,100.10
$1,159.13
$1,368.84
$1,360.17
$1,415.89
$1,474.92
$1,684.63
$315.79
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$825.60
$937.04
$1,055.10
$1,474.52
$2,240.66
$1,141.39
$1,252.83
$1,370.89
$1,790.31
$1,457.18
$1,568.62
$1,686.68
$2,106.10
$1,772.97
$1,884.41
$2,002.47
$2,421.89
$315.79
Toc - Plan #5 Blue Cross and Blue Shield of Kansas, Inc.
Expanded Bronze

(EPO) BlueCare EPO Simple Bronze HDHP

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-392-7366

Annual Out of Pocket Expenses:

Individual Family
$7,100 $14,200 Annual Deductible
$7,100 $14,200 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
$422.03
$479.00
$539.35
$753.74
$1,145.38
$744.88
$801.85
$862.20
$1,076.59
$1,067.73
$1,124.70
$1,185.05
$1,399.44
$1,390.58
$1,447.55
$1,507.90
$1,722.29
$322.85
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$844.06
$958.00
$1,078.70
$1,507.48
$2,290.76
$1,166.91
$1,280.85
$1,401.55
$1,830.33
$1,489.76
$1,603.70
$1,724.40
$2,153.18
$1,812.61
$1,926.55
$2,047.25
$2,476.03
$322.85
Toc - Plan #6 Blue Cross and Blue Shield of Kansas, Inc.
Silver

(EPO) BlueCare EPO Silver Plus

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-392-7366

Annual Out of Pocket Expenses:

Individual Family
$5,500 $11,000 Annual Deductible
$7,350 $14,700 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
$529.15
$600.59
$676.25
$945.06
$1,436.11
$933.95
$1,005.39
$1,081.05
$1,349.86
$1,338.75
$1,410.19
$1,485.85
$1,754.66
$1,743.55
$1,814.99
$1,890.65
$2,159.46
$404.80
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,058.30
$1,201.18
$1,352.50
$1,890.12
$2,872.22
$1,463.10
$1,605.98
$1,757.30
$2,294.92
$1,867.90
$2,010.78
$2,162.10
$2,699.72
$2,272.70
$2,415.58
$2,566.90
$3,104.52
$404.80
Toc - Plan #7 Blue Cross and Blue Shield of Kansas, Inc.
Expanded Bronze

(EPO) BlueCare EPO Standardized Expanded Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-392-7366

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,400 $18,800 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
$412.80
$468.52
$527.55
$737.26
$1,120.33
$728.59
$784.31
$843.34
$1,053.05
$1,044.38
$1,100.10
$1,159.13
$1,368.84
$1,360.17
$1,415.89
$1,474.92
$1,684.63
$315.79
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$825.60
$937.04
$1,055.10
$1,474.52
$2,240.66
$1,141.39
$1,252.83
$1,370.89
$1,790.31
$1,457.18
$1,568.62
$1,686.68
$2,106.10
$1,772.97
$1,884.41
$2,002.47
$2,421.89
$315.79
Toc - Plan #8 Blue Cross and Blue Shield of Kansas, Inc.
Silver

(EPO) BlueCare EPO Standardized Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-392-7366

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 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
$532.28
$604.13
$680.25
$950.65
$1,444.60
$939.47
$1,011.32
$1,087.44
$1,357.84
$1,346.66
$1,418.51
$1,494.63
$1,765.03
$1,753.85
$1,825.70
$1,901.82
$2,172.22
$407.19
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,064.56
$1,208.26
$1,360.50
$1,901.30
$2,889.20
$1,471.75
$1,615.45
$1,767.69
$2,308.49
$1,878.94
$2,022.64
$2,174.88
$2,715.68
$2,286.13
$2,429.83
$2,582.07
$3,122.87
$407.19
Toc - Plan #9 Blue Cross and Blue Shield of Kansas, Inc.
Gold

(EPO) BlueCare EPO Standardized Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-392-7366

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 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
$506.30
$574.65
$647.06
$904.26
$1,374.11
$893.62
$961.97
$1,034.38
$1,291.58
$1,280.94
$1,349.29
$1,421.70
$1,678.90
$1,668.26
$1,736.61
$1,809.02
$2,066.22
$387.32
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,012.60
$1,149.30
$1,294.12
$1,808.52
$2,748.22
$1,399.92
$1,536.62
$1,681.44
$2,195.84
$1,787.24
$1,923.94
$2,068.76
$2,583.16
$2,174.56
$2,311.26
$2,456.08
$2,970.48
$387.32

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Ambetter from Sunflower Health Plan

Local: 1-844-518-9505 | Toll Free: 1-844-518-9505 | TTY: 1-844-546-9713

Toc - Plan #10 Ambetter from Sunflower Health Plan
Silver

(EPO) Complete Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-518-9505

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$8,500 $17,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$411.95
$467.55
$526.46
$735.72
$1,118.00
$727.08
$782.68
$841.59
$1,050.85
$1,042.21
$1,097.81
$1,156.72
$1,365.98
$1,357.34
$1,412.94
$1,471.85
$1,681.11
$315.13
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$823.90
$935.10
$1,052.92
$1,471.44
$2,236.00
$1,139.03
$1,250.23
$1,368.05
$1,786.57
$1,454.16
$1,565.36
$1,683.18
$2,101.70
$1,769.29
$1,880.49
$1,998.31
$2,416.83
$315.13
Toc - Plan #11 Ambetter from Sunflower Health Plan
Gold

(EPO) Complete Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-518-9505

Annual Out of Pocket Expenses:

Individual Family
$1,450 $2,900 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$438.34
$497.50
$560.18
$782.85
$1,189.62
$773.66
$832.82
$895.50
$1,118.17
$1,108.98
$1,168.14
$1,230.82
$1,453.49
$1,444.30
$1,503.46
$1,566.14
$1,788.81
$335.32
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$876.68
$995.00
$1,120.36
$1,565.70
$2,379.24
$1,212.00
$1,330.32
$1,455.68
$1,901.02
$1,547.32
$1,665.64
$1,791.00
$2,236.34
$1,882.64
$2,000.96
$2,126.32
$2,571.66
$335.32
Toc - Plan #12 Ambetter from Sunflower Health Plan
Expanded Bronze

(EPO) Choice Bronze HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-518-9505

Annual Out of Pocket Expenses:

Individual Family
$7,250 $14,500 Annual Deductible
$7,250 $14,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$338.28
$383.93
$432.30
$604.14
$918.06
$597.05
$642.70
$691.07
$862.91
$855.82
$901.47
$949.84
$1,121.68
$1,114.59
$1,160.24
$1,208.61
$1,380.45
$258.77
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$676.56
$767.86
$864.60
$1,208.28
$1,836.12
$935.33
$1,026.63
$1,123.37
$1,467.05
$1,194.10
$1,285.40
$1,382.14
$1,725.82
$1,452.87
$1,544.17
$1,640.91
$1,984.59
$258.77
Toc - Plan #13 Ambetter from Sunflower Health Plan
Gold

(EPO) Everyday Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-518-9505

Annual Out of Pocket Expenses:

Individual Family
$750 $1,500 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$420.03
$476.72
$536.78
$750.15
$1,139.93
$741.34
$798.03
$858.09
$1,071.46
$1,062.65
$1,119.34
$1,179.40
$1,392.77
$1,383.96
$1,440.65
$1,500.71
$1,714.08
$321.31
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$840.06
$953.44
$1,073.56
$1,500.30
$2,279.86
$1,161.37
$1,274.75
$1,394.87
$1,821.61
$1,482.68
$1,596.06
$1,716.18
$2,142.92
$1,803.99
$1,917.37
$2,037.49
$2,464.23
$321.31
Toc - Plan #14 Ambetter from Sunflower Health Plan
Expanded Bronze

(EPO) Everyday Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-518-9505

Annual Out of Pocket Expenses:

Individual Family
$8,450 $16,900 Annual Deductible
$9,250 $18,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$330.79
$375.44
$422.74
$590.78
$897.75
$583.84
$628.49
$675.79
$843.83
$836.89
$881.54
$928.84
$1,096.88
$1,089.94
$1,134.59
$1,181.89
$1,349.93
$253.05
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$661.58
$750.88
$845.48
$1,181.56
$1,795.50
$914.63
$1,003.93
$1,098.53
$1,434.61
$1,167.68
$1,256.98
$1,351.58
$1,687.66
$1,420.73
$1,510.03
$1,604.63
$1,940.71
$253.05
Toc - Plan #15 Ambetter from Sunflower Health Plan
Expanded Bronze

(EPO) Elite Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-518-9505

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,250 $18,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$376.25
$427.03
$480.83
$671.96
$1,021.11
$664.07
$714.85
$768.65
$959.78
$951.89
$1,002.67
$1,056.47
$1,247.60
$1,239.71
$1,290.49
$1,344.29
$1,535.42
$287.82
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$752.50
$854.06
$961.66
$1,343.92
$2,042.22
$1,040.32
$1,141.88
$1,249.48
$1,631.74
$1,328.14
$1,429.70
$1,537.30
$1,919.56
$1,615.96
$1,717.52
$1,825.12
$2,207.38
$287.82
Toc - Plan #16 Ambetter from Sunflower Health Plan
Silver

(EPO) Clear Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-518-9505

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
$400.49
$454.54
$511.81
$715.25
$1,086.89
$706.85
$760.90
$818.17
$1,021.61
$1,013.21
$1,067.26
$1,124.53
$1,327.97
$1,319.57
$1,373.62
$1,430.89
$1,634.33
$306.36
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$800.98
$909.08
$1,023.62
$1,430.50
$2,173.78
$1,107.34
$1,215.44
$1,329.98
$1,736.86
$1,413.70
$1,521.80
$1,636.34
$2,043.22
$1,720.06
$1,828.16
$1,942.70
$2,349.58
$306.36
Toc - Plan #17 Ambetter from Sunflower Health Plan
Silver

(EPO) Focused Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-518-9505

Annual Out of Pocket Expenses:

Individual Family
$6,300 $12,600 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
$405.82
$460.59
$518.62
$724.77
$1,101.36
$716.26
$771.03
$829.06
$1,035.21
$1,026.70
$1,081.47
$1,139.50
$1,345.65
$1,337.14
$1,391.91
$1,449.94
$1,656.09
$310.44
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$811.64
$921.18
$1,037.24
$1,449.54
$2,202.72
$1,122.08
$1,231.62
$1,347.68
$1,759.98
$1,432.52
$1,542.06
$1,658.12
$2,070.42
$1,742.96
$1,852.50
$1,968.56
$2,380.86
$310.44
Toc - Plan #18 Ambetter from Sunflower Health Plan
Gold

(EPO) Elite Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-518-9505

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$5,500 $11,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$478.73
$543.35
$611.81
$855.00
$1,299.26
$844.95
$909.57
$978.03
$1,221.22
$1,211.17
$1,275.79
$1,344.25
$1,587.44
$1,577.39
$1,642.01
$1,710.47
$1,953.66
$366.22
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$957.46
$1,086.70
$1,223.62
$1,710.00
$2,598.52
$1,323.68
$1,452.92
$1,589.84
$2,076.22
$1,689.90
$1,819.14
$1,956.06
$2,442.44
$2,056.12
$2,185.36
$2,322.28
$2,808.66
$366.22
Toc - Plan #19 Ambetter from Sunflower Health Plan
Expanded Bronze

(EPO) Standard Expanded Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-518-9505

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,400 $18,800 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
$325.38
$369.30
$415.82
$581.11
$883.06
$574.29
$618.21
$664.73
$830.02
$823.20
$867.12
$913.64
$1,078.93
$1,072.11
$1,116.03
$1,162.55
$1,327.84
$248.91
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$650.76
$738.60
$831.64
$1,162.22
$1,766.12
$899.67
$987.51
$1,080.55
$1,411.13
$1,148.58
$1,236.42
$1,329.46
$1,660.04
$1,397.49
$1,485.33
$1,578.37
$1,908.95
$248.91
Toc - Plan #20 Ambetter from Sunflower Health Plan
Silver

(EPO) Standard Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-518-9505

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 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
$398.02
$451.74
$508.65
$710.84
$1,080.19
$702.50
$756.22
$813.13
$1,015.32
$1,006.98
$1,060.70
$1,117.61
$1,319.80
$1,311.46
$1,365.18
$1,422.09
$1,624.28
$304.48
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$796.04
$903.48
$1,017.30
$1,421.68
$2,160.38
$1,100.52
$1,207.96
$1,321.78
$1,726.16
$1,405.00
$1,512.44
$1,626.26
$2,030.64
$1,709.48
$1,816.92
$1,930.74
$2,335.12
$304.48
Toc - Plan #21 Ambetter from Sunflower Health Plan
Gold

(EPO) Standard Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-518-9505

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 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
$421.34
$478.21
$538.46
$752.50
$1,143.49
$743.66
$800.53
$860.78
$1,074.82
$1,065.98
$1,122.85
$1,183.10
$1,397.14
$1,388.30
$1,445.17
$1,505.42
$1,719.46
$322.32
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$842.68
$956.42
$1,076.92
$1,505.00
$2,286.98
$1,165.00
$1,278.74
$1,399.24
$1,827.32
$1,487.32
$1,601.06
$1,721.56
$2,149.64
$1,809.64
$1,923.38
$2,043.88
$2,471.96
$322.32
Toc - Plan #22 Ambetter from Sunflower Health Plan
Gold

(EPO) Complete Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-518-9505

Annual Out of Pocket Expenses:

Individual Family
$1,450 $2,900 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$452.34
$513.39
$578.07
$807.86
$1,227.62
$798.37
$859.42
$924.10
$1,153.89
$1,144.40
$1,205.45
$1,270.13
$1,499.92
$1,490.43
$1,551.48
$1,616.16
$1,845.95
$346.03
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$904.68
$1,026.78
$1,156.14
$1,615.72
$2,455.24
$1,250.71
$1,372.81
$1,502.17
$1,961.75
$1,596.74
$1,718.84
$1,848.20
$2,307.78
$1,942.77
$2,064.87
$2,194.23
$2,653.81
$346.03
Toc - Plan #23 Ambetter from Sunflower Health Plan
Silver

(EPO) Complete Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-518-9505

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$8,500 $17,000 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
$425.11
$482.48
$543.27
$759.22
$1,153.71
$750.31
$807.68
$868.47
$1,084.42
$1,075.51
$1,132.88
$1,193.67
$1,409.62
$1,400.71
$1,458.08
$1,518.87
$1,734.82
$325.20
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$850.22
$964.96
$1,086.54
$1,518.44
$2,307.42
$1,175.42
$1,290.16
$1,411.74
$1,843.64
$1,500.62
$1,615.36
$1,736.94
$2,168.84
$1,825.82
$1,940.56
$2,062.14
$2,494.04
$325.20
Toc - Plan #24 Ambetter from Sunflower Health Plan
Expanded Bronze

(EPO) Choice Bronze HSA + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-518-9505

Annual Out of Pocket Expenses:

Individual Family
$7,250 $14,500 Annual Deductible
$7,250 $14,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$349.08
$396.20
$446.11
$623.44
$947.38
$616.12
$663.24
$713.15
$890.48
$883.16
$930.28
$980.19
$1,157.52
$1,150.20
$1,197.32
$1,247.23
$1,424.56
$267.04
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$698.16
$792.40
$892.22
$1,246.88
$1,894.76
$965.20
$1,059.44
$1,159.26
$1,513.92
$1,232.24
$1,326.48
$1,426.30
$1,780.96
$1,499.28
$1,593.52
$1,693.34
$2,048.00
$267.04
Toc - Plan #25 Ambetter from Sunflower Health Plan
Gold

(EPO) Everyday Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-518-9505

Annual Out of Pocket Expenses:

Individual Family
$750 $1,500 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$433.44
$491.95
$553.93
$774.11
$1,176.34
$765.02
$823.53
$885.51
$1,105.69
$1,096.60
$1,155.11
$1,217.09
$1,437.27
$1,428.18
$1,486.69
$1,548.67
$1,768.85
$331.58
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$866.88
$983.90
$1,107.86
$1,548.22
$2,352.68
$1,198.46
$1,315.48
$1,439.44
$1,879.80
$1,530.04
$1,647.06
$1,771.02
$2,211.38
$1,861.62
$1,978.64
$2,102.60
$2,542.96
$331.58
Toc - Plan #26 Ambetter from Sunflower Health Plan
Expanded Bronze

(EPO) Everyday Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-518-9505

Annual Out of Pocket Expenses:

Individual Family
$8,450 $16,900 Annual Deductible
$9,250 $18,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$341.36
$387.43
$436.25
$609.65
$926.43
$602.49
$648.56
$697.38
$870.78
$863.62
$909.69
$958.51
$1,131.91
$1,124.75
$1,170.82
$1,219.64
$1,393.04
$261.13
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$682.72
$774.86
$872.50
$1,219.30
$1,852.86
$943.85
$1,035.99
$1,133.63
$1,480.43
$1,204.98
$1,297.12
$1,394.76
$1,741.56
$1,466.11
$1,558.25
$1,655.89
$2,002.69
$261.13
Toc - Plan #27 Ambetter from Sunflower Health Plan
Expanded Bronze

(EPO) Elite Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-518-9505

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,250 $18,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$388.26
$440.67
$496.19
$693.42
$1,053.72
$685.27
$737.68
$793.20
$990.43
$982.28
$1,034.69
$1,090.21
$1,287.44
$1,279.29
$1,331.70
$1,387.22
$1,584.45
$297.01
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$776.52
$881.34
$992.38
$1,386.84
$2,107.44
$1,073.53
$1,178.35
$1,289.39
$1,683.85
$1,370.54
$1,475.36
$1,586.40
$1,980.86
$1,667.55
$1,772.37
$1,883.41
$2,277.87
$297.01
Toc - Plan #28 Ambetter from Sunflower Health Plan
Silver

(EPO) Focused Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-518-9505

Annual Out of Pocket Expenses:

Individual Family
$6,300 $12,600 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
$418.78
$475.31
$535.19
$747.93
$1,136.55
$739.14
$795.67
$855.55
$1,068.29
$1,059.50
$1,116.03
$1,175.91
$1,388.65
$1,379.86
$1,436.39
$1,496.27
$1,709.01
$320.36
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$837.56
$950.62
$1,070.38
$1,495.86
$2,273.10
$1,157.92
$1,270.98
$1,390.74
$1,816.22
$1,478.28
$1,591.34
$1,711.10
$2,136.58
$1,798.64
$1,911.70
$2,031.46
$2,456.94
$320.36
Toc - Plan #29 Ambetter from Sunflower Health Plan
Silver

(EPO) Clear Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-518-9505

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
$413.28
$469.06
$528.16
$738.10
$1,121.61
$729.43
$785.21
$844.31
$1,054.25
$1,045.58
$1,101.36
$1,160.46
$1,370.40
$1,361.73
$1,417.51
$1,476.61
$1,686.55
$316.15
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$826.56
$938.12
$1,056.32
$1,476.20
$2,243.22
$1,142.71
$1,254.27
$1,372.47
$1,792.35
$1,458.86
$1,570.42
$1,688.62
$2,108.50
$1,775.01
$1,886.57
$2,004.77
$2,424.65
$316.15
Toc - Plan #30 Ambetter from Sunflower Health Plan
Gold

(EPO) Elite Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-518-9505

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$5,500 $11,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$494.03
$560.71
$631.35
$882.31
$1,340.76
$871.95
$938.63
$1,009.27
$1,260.23
$1,249.87
$1,316.55
$1,387.19
$1,638.15
$1,627.79
$1,694.47
$1,765.11
$2,016.07
$377.92
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$988.06
$1,121.42
$1,262.70
$1,764.62
$2,681.52
$1,365.98
$1,499.34
$1,640.62
$2,142.54
$1,743.90
$1,877.26
$2,018.54
$2,520.46
$2,121.82
$2,255.18
$2,396.46
$2,898.38
$377.92
Toc - Plan #31 Ambetter from Sunflower Health Plan
Expanded Bronze

(EPO) Standard Expanded Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-518-9505

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,400 $18,800 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
$335.77
$381.09
$429.11
$599.68
$911.27
$592.63
$637.95
$685.97
$856.54
$849.49
$894.81
$942.83
$1,113.40
$1,106.35
$1,151.67
$1,199.69
$1,370.26
$256.86
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$671.54
$762.18
$858.22
$1,199.36
$1,822.54
$928.40
$1,019.04
$1,115.08
$1,456.22
$1,185.26
$1,275.90
$1,371.94
$1,713.08
$1,442.12
$1,532.76
$1,628.80
$1,969.94
$256.86
Toc - Plan #32 Ambetter from Sunflower Health Plan
Silver

(EPO) Standard Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-518-9505

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 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
$410.73
$466.17
$524.90
$733.55
$1,114.70
$724.93
$780.37
$839.10
$1,047.75
$1,039.13
$1,094.57
$1,153.30
$1,361.95
$1,353.33
$1,408.77
$1,467.50
$1,676.15
$314.20
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$821.46
$932.34
$1,049.80
$1,467.10
$2,229.40
$1,135.66
$1,246.54
$1,364.00
$1,781.30
$1,449.86
$1,560.74
$1,678.20
$2,095.50
$1,764.06
$1,874.94
$1,992.40
$2,409.70
$314.20
Toc - Plan #33 Ambetter from Sunflower Health Plan
Gold

(EPO) Standard Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-518-9505

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 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
$434.80
$493.49
$555.66
$776.53
$1,180.02
$767.41
$826.10
$888.27
$1,109.14
$1,100.02
$1,158.71
$1,220.88
$1,441.75
$1,432.63
$1,491.32
$1,553.49
$1,774.36
$332.61
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$869.60
$986.98
$1,111.32
$1,553.06
$2,360.04
$1,202.21
$1,319.59
$1,443.93
$1,885.67
$1,534.82
$1,652.20
$1,776.54
$2,218.28
$1,867.43
$1,984.81
$2,109.15
$2,550.89
$332.61

ADVERTISEMENT

Oscar Insurance Company

Local: 1-855-672-2755 | Toll Free: 1-855-672-2755

Toc - Plan #34 Oscar Insurance Company
Expanded Bronze

(EPO) Bronze Classic

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$7,750 $15,500 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$309.60
$351.38
$395.65
$552.93
$840.23
$546.44
$588.22
$632.49
$789.77
$783.28
$825.06
$869.33
$1,026.61
$1,020.12
$1,061.90
$1,106.17
$1,263.45
$236.84
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$619.20
$702.76
$791.30
$1,105.86
$1,680.46
$856.04
$939.60
$1,028.14
$1,342.70
$1,092.88
$1,176.44
$1,264.98
$1,579.54
$1,329.72
$1,413.28
$1,501.82
$1,816.38
$236.84
Toc - Plan #35 Oscar Insurance Company
Expanded Bronze

(EPO) Bronze Elite + PCP Saver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,450 $18,900 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
$356.70
$404.85
$455.85
$637.05
$968.06
$629.57
$677.72
$728.72
$909.92
$902.44
$950.59
$1,001.59
$1,182.79
$1,175.31
$1,223.46
$1,274.46
$1,455.66
$272.87
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$713.40
$809.70
$911.70
$1,274.10
$1,936.12
$986.27
$1,082.57
$1,184.57
$1,546.97
$1,259.14
$1,355.44
$1,457.44
$1,819.84
$1,532.01
$1,628.31
$1,730.31
$2,092.71
$272.87
Toc - Plan #36 Oscar Insurance Company
Silver

(EPO) Silver Classic

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$5,400 $10,800 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
$379.48
$430.69
$484.96
$677.73
$1,029.87
$669.77
$720.98
$775.25
$968.02
$960.06
$1,011.27
$1,065.54
$1,258.31
$1,250.35
$1,301.56
$1,355.83
$1,548.60
$290.29
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$758.96
$861.38
$969.92
$1,355.46
$2,059.74
$1,049.25
$1,151.67
$1,260.21
$1,645.75
$1,339.54
$1,441.96
$1,550.50
$1,936.04
$1,629.83
$1,732.25
$1,840.79
$2,226.33
$290.29
Toc - Plan #37 Oscar Insurance Company
Catastrophic

(EPO) Secure

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$9,450 $18,900 Annual Deductible
$9,450 $18,900 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
$244.33
$277.30
$312.24
$436.35
$663.08
$431.23
$464.20
$499.14
$623.25
$618.13
$651.10
$686.04
$810.15
$805.03
$838.00
$872.94
$997.05
$186.90
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$488.66
$554.60
$624.48
$872.70
$1,326.16
$675.56
$741.50
$811.38
$1,059.60
$862.46
$928.40
$998.28
$1,246.50
$1,049.36
$1,115.30
$1,185.18
$1,433.40
$186.90
Toc - Plan #38 Oscar Insurance Company
Expanded Bronze

(EPO) Bronze Classic PCP Saver Plus

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$9,100 $18,200 Annual Deductible
$9,400 $18,800 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
$321.37
$364.74
$410.70
$573.95
$872.17
$567.21
$610.58
$656.54
$819.79
$813.05
$856.42
$902.38
$1,065.63
$1,058.89
$1,102.26
$1,148.22
$1,311.47
$245.84
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$642.74
$729.48
$821.40
$1,147.90
$1,744.34
$888.58
$975.32
$1,067.24
$1,393.74
$1,134.42
$1,221.16
$1,313.08
$1,639.58
$1,380.26
$1,467.00
$1,558.92
$1,885.42
$245.84
Toc - Plan #39 Oscar Insurance Company
Expanded Bronze

(EPO) Bronze Classic 4700

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$4,700 $9,400 Annual Deductible
$9,400 $18,800 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
$325.21
$369.10
$415.60
$580.80
$882.58
$573.99
$617.88
$664.38
$829.58
$822.77
$866.66
$913.16
$1,078.36
$1,071.55
$1,115.44
$1,161.94
$1,327.14
$248.78
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$650.42
$738.20
$831.20
$1,161.60
$1,765.16
$899.20
$986.98
$1,079.98
$1,410.38
$1,147.98
$1,235.76
$1,328.76
$1,659.16
$1,396.76
$1,484.54
$1,577.54
$1,907.94
$248.78
Toc - Plan #40 Oscar Insurance Company
Silver

(EPO) Silver Simple PCP Saver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$5,750 $11,500 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
$371.66
$421.82
$474.97
$663.76
$1,008.65
$655.97
$706.13
$759.28
$948.07
$940.28
$990.44
$1,043.59
$1,232.38
$1,224.59
$1,274.75
$1,327.90
$1,516.69
$284.31
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$743.32
$843.64
$949.94
$1,327.52
$2,017.30
$1,027.63
$1,127.95
$1,234.25
$1,611.83
$1,311.94
$1,412.26
$1,518.56
$1,896.14
$1,596.25
$1,696.57
$1,802.87
$2,180.45
$284.31
Toc - Plan #41 Oscar Insurance Company
Silver

(EPO) Silver Elite Saver Plus

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

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
$390.48
$443.18
$499.02
$697.38
$1,059.73
$689.19
$741.89
$797.73
$996.09
$987.90
$1,040.60
$1,096.44
$1,294.80
$1,286.61
$1,339.31
$1,395.15
$1,593.51
$298.71
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$780.96
$886.36
$998.04
$1,394.76
$2,119.46
$1,079.67
$1,185.07
$1,296.75
$1,693.47
$1,378.38
$1,483.78
$1,595.46
$1,992.18
$1,677.09
$1,782.49
$1,894.17
$2,290.89
$298.71
Toc - Plan #42 Oscar Insurance Company
Silver

(EPO) Silver Simple Diabetes

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 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
$380.62
$431.99
$486.42
$679.77
$1,032.98
$671.79
$723.16
$777.59
$970.94
$962.96
$1,014.33
$1,068.76
$1,262.11
$1,254.13
$1,305.50
$1,359.93
$1,553.28
$291.17
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$761.24
$863.98
$972.84
$1,359.54
$2,065.96
$1,052.41
$1,155.15
$1,264.01
$1,650.71
$1,343.58
$1,446.32
$1,555.18
$1,941.88
$1,634.75
$1,737.49
$1,846.35
$2,233.05
$291.17
Toc - Plan #43 Oscar Insurance Company
Expanded Bronze

(EPO) Bronze Classic Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,400 $18,800 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
$317.08
$359.88
$405.22
$566.29
$860.53
$559.64
$602.44
$647.78
$808.85
$802.20
$845.00
$890.34
$1,051.41
$1,044.76
$1,087.56
$1,132.90
$1,293.97
$242.56
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$634.16
$719.76
$810.44
$1,132.58
$1,721.06
$876.72
$962.32
$1,053.00
$1,375.14
$1,119.28
$1,204.88
$1,295.56
$1,617.70
$1,361.84
$1,447.44
$1,538.12
$1,860.26
$242.56
Toc - Plan #44 Oscar Insurance Company
Silver

(EPO) Silver Classic Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$368.83
$418.61
$471.35
$658.71
$1,000.98
$650.98
$700.76
$753.50
$940.86
$933.13
$982.91
$1,035.65
$1,223.01
$1,215.28
$1,265.06
$1,317.80
$1,505.16
$282.15
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$737.66
$837.22
$942.70
$1,317.42
$2,001.96
$1,019.81
$1,119.37
$1,224.85
$1,599.57
$1,301.96
$1,401.52
$1,507.00
$1,881.72
$1,584.11
$1,683.67
$1,789.15
$2,163.87
$282.15
Toc - Plan #45 Oscar Insurance Company
Gold

(EPO) Gold Classic Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 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
$419.23
$475.82
$535.77
$748.73
$1,137.77
$739.93
$796.52
$856.47
$1,069.43
$1,060.63
$1,117.22
$1,177.17
$1,390.13
$1,381.33
$1,437.92
$1,497.87
$1,710.83
$320.70
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$838.46
$951.64
$1,071.54
$1,497.46
$2,275.54
$1,159.16
$1,272.34
$1,392.24
$1,818.16
$1,479.86
$1,593.04
$1,712.94
$2,138.86
$1,800.56
$1,913.74
$2,033.64
$2,459.56
$320.70

ADVERTISEMENT

Aetna CVS Health

Local: 1-877-336-3915 | Toll Free: 1-877-336-3915

Toc - Plan #46 Aetna CVS Health
Expanded Bronze

(EPO) Bronze 2 HSA: Aetna network of doctors & hospitals + MinuteClinic + Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$6,200 $12,400 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$286.83
$325.55
$366.57
$512.28
$778.46
$506.26
$544.98
$586.00
$731.71
$725.69
$764.41
$805.43
$951.14
$945.12
$983.84
$1,024.86
$1,170.57
$219.43
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$573.66
$651.10
$733.14
$1,024.56
$1,556.92
$793.09
$870.53
$952.57
$1,243.99
$1,012.52
$1,089.96
$1,172.00
$1,463.42
$1,231.95
$1,309.39
$1,391.43
$1,682.85
$219.43
Toc - Plan #47 Aetna CVS Health
Expanded Bronze

(EPO) Bronze 4: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,400 $18,800 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
$321.44
$364.83
$410.80
$574.09
$872.38
$567.34
$610.73
$656.70
$819.99
$813.24
$856.63
$902.60
$1,065.89
$1,059.14
$1,102.53
$1,148.50
$1,311.79
$245.90
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$642.88
$729.66
$821.60
$1,148.18
$1,744.76
$888.78
$975.56
$1,067.50
$1,394.08
$1,134.68
$1,221.46
$1,313.40
$1,639.98
$1,380.58
$1,467.36
$1,559.30
$1,885.88
$245.90
Toc - Plan #48 Aetna CVS Health
Expanded Bronze

(EPO) Bronze S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,400 $18,800 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
$292.12
$331.55
$373.32
$521.72
$792.80
$515.59
$555.02
$596.79
$745.19
$739.06
$778.49
$820.26
$968.66
$962.53
$1,001.96
$1,043.73
$1,192.13
$223.47
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$584.24
$663.10
$746.64
$1,043.44
$1,585.60
$807.71
$886.57
$970.11
$1,266.91
$1,031.18
$1,110.04
$1,193.58
$1,490.38
$1,254.65
$1,333.51
$1,417.05
$1,713.85
$223.47
Toc - Plan #49 Aetna CVS Health
Gold

(EPO) Gold 3: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$795 $1,590 Annual Deductible
$9,195 $18,390 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
$416.83
$473.10
$532.71
$744.46
$1,131.27
$735.71
$791.98
$851.59
$1,063.34
$1,054.59
$1,110.86
$1,170.47
$1,382.22
$1,373.47
$1,429.74
$1,489.35
$1,701.10
$318.88
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$833.66
$946.20
$1,065.42
$1,488.92
$2,262.54
$1,152.54
$1,265.08
$1,384.30
$1,807.80
$1,471.42
$1,583.96
$1,703.18
$2,126.68
$1,790.30
$1,902.84
$2,022.06
$2,445.56
$318.88
Toc - Plan #50 Aetna CVS Health
Gold

(EPO) Gold S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 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
$419.13
$475.71
$535.64
$748.55
$1,137.50
$739.76
$796.34
$856.27
$1,069.18
$1,060.39
$1,116.97
$1,176.90
$1,389.81
$1,381.02
$1,437.60
$1,497.53
$1,710.44
$320.63
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$838.26
$951.42
$1,071.28
$1,497.10
$2,275.00
$1,158.89
$1,272.05
$1,391.91
$1,817.73
$1,479.52
$1,592.68
$1,712.54
$2,138.36
$1,800.15
$1,913.31
$2,033.17
$2,458.99
$320.63
Toc - Plan #51 Aetna CVS Health
Silver

(EPO) Silver 5: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$8,395 $16,790 Annual Deductible
$8,885 $17,770 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$382.15
$433.74
$488.38
$682.51
$1,037.14
$674.49
$726.08
$780.72
$974.85
$966.83
$1,018.42
$1,073.06
$1,267.19
$1,259.17
$1,310.76
$1,365.40
$1,559.53
$292.34
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$764.30
$867.48
$976.76
$1,365.02
$2,074.28
$1,056.64
$1,159.82
$1,269.10
$1,657.36
$1,348.98
$1,452.16
$1,561.44
$1,949.70
$1,641.32
$1,744.50
$1,853.78
$2,242.04
$292.34
Toc - Plan #52 Aetna CVS Health
Silver

(EPO) Silver 6: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$7,795 $15,590 Annual Deductible
$8,445 $16,890 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
$390.19
$442.87
$498.66
$696.88
$1,058.97
$688.69
$741.37
$797.16
$995.38
$987.19
$1,039.87
$1,095.66
$1,293.88
$1,285.69
$1,338.37
$1,394.16
$1,592.38
$298.50
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$780.38
$885.74
$997.32
$1,393.76
$2,117.94
$1,078.88
$1,184.24
$1,295.82
$1,692.26
$1,377.38
$1,482.74
$1,594.32
$1,990.76
$1,675.88
$1,781.24
$1,892.82
$2,289.26
$298.50
Toc - Plan #53 Aetna CVS Health
Silver

(EPO) Silver 7: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$7,795 $15,590 Annual Deductible
$8,845 $17,690 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
$390.19
$442.87
$498.66
$696.88
$1,058.97
$688.69
$741.37
$797.16
$995.38
$987.19
$1,039.87
$1,095.66
$1,293.88
$1,285.69
$1,338.37
$1,394.16
$1,592.38
$298.50
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$780.38
$885.74
$997.32
$1,393.76
$2,117.94
$1,078.88
$1,184.24
$1,295.82
$1,692.26
$1,377.38
$1,482.74
$1,594.32
$1,990.76
$1,675.88
$1,781.24
$1,892.82
$2,289.26
$298.50
Toc - Plan #54 Aetna CVS Health
Silver

(EPO) Silver S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 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
$382.34
$433.96
$488.63
$682.86
$1,037.67
$674.83
$726.45
$781.12
$975.35
$967.32
$1,018.94
$1,073.61
$1,267.84
$1,259.81
$1,311.43
$1,366.10
$1,560.33
$292.49
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$764.68
$867.92
$977.26
$1,365.72
$2,075.34
$1,057.17
$1,160.41
$1,269.75
$1,658.21
$1,349.66
$1,452.90
$1,562.24
$1,950.70
$1,642.15
$1,745.39
$1,854.73
$2,243.19
$292.49

ADVERTISEMENT

UnitedHealthcare

Local: 1-866-761-7748 | Toll Free: 1-866-761-7748 | TTY: 1-866-761-7748

Toc - Plan #55 UnitedHealthcare
Gold

(EPO) UHC Gold Standard (No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-761-7748

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 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
$445.19
$505.30
$568.96
$795.12
$1,208.26
$785.76
$845.87
$909.53
$1,135.69
$1,126.33
$1,186.44
$1,250.10
$1,476.26
$1,466.90
$1,527.01
$1,590.67
$1,816.83
$340.57
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$890.38
$1,010.60
$1,137.92
$1,590.24
$2,416.52
$1,230.95
$1,351.17
$1,478.49
$1,930.81
$1,571.52
$1,691.74
$1,819.06
$2,271.38
$1,912.09
$2,032.31
$2,159.63
$2,611.95
$340.57
Toc - Plan #56 UnitedHealthcare
Silver

(EPO) UHC Silver Value ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-761-7748

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 Annual Deductible
$9,450 $18,900 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
$414.94
$470.95
$530.29
$741.08
$1,126.14
$732.37
$788.38
$847.72
$1,058.51
$1,049.80
$1,105.81
$1,165.15
$1,375.94
$1,367.23
$1,423.24
$1,482.58
$1,693.37
$317.43
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$829.88
$941.90
$1,060.58
$1,482.16
$2,252.28
$1,147.31
$1,259.33
$1,378.01
$1,799.59
$1,464.74
$1,576.76
$1,695.44
$2,117.02
$1,782.17
$1,894.19
$2,012.87
$2,434.45
$317.43
Toc - Plan #57 UnitedHealthcare
Silver

(EPO) UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care + $0 PCP Visits, $5 Tier 2 Rx, No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-761-7748

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,450 $18,900 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
$420.78
$477.58
$537.76
$751.51
$1,141.99
$742.68
$799.48
$859.66
$1,073.41
$1,064.58
$1,121.38
$1,181.56
$1,395.31
$1,386.48
$1,443.28
$1,503.46
$1,717.21
$321.90
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$841.56
$955.16
$1,075.52
$1,503.02
$2,283.98
$1,163.46
$1,277.06
$1,397.42
$1,824.92
$1,485.36
$1,598.96
$1,719.32
$2,146.82
$1,807.26
$1,920.86
$2,041.22
$2,468.72
$321.90
Toc - Plan #58 UnitedHealthcare
Silver

(EPO) UHC Silver Standard (No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-761-7748

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 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
$418.36
$474.84
$534.67
$747.20
$1,135.44
$738.41
$794.89
$854.72
$1,067.25
$1,058.46
$1,114.94
$1,174.77
$1,387.30
$1,378.51
$1,434.99
$1,494.82
$1,707.35
$320.05
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$836.72
$949.68
$1,069.34
$1,494.40
$2,270.88
$1,156.77
$1,269.73
$1,389.39
$1,814.45
$1,476.82
$1,589.78
$1,709.44
$2,134.50
$1,796.87
$1,909.83
$2,029.49
$2,454.55
$320.05
Toc - Plan #59 UnitedHealthcare
Expanded Bronze

(EPO) UHC Bronze Value ($0 Virtual Urgent Care + $0 PCP Visits, $3 Tier 2 Rx, No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-761-7748

Annual Out of Pocket Expenses:

Individual Family
$7,100 $14,200 Annual Deductible
$9,450 $18,900 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
$300.81
$341.42
$384.44
$537.25
$816.41
$530.93
$571.54
$614.56
$767.37
$761.05
$801.66
$844.68
$997.49
$991.17
$1,031.78
$1,074.80
$1,227.61
$230.12
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$601.62
$682.84
$768.88
$1,074.50
$1,632.82
$831.74
$912.96
$999.00
$1,304.62
$1,061.86
$1,143.08
$1,229.12
$1,534.74
$1,291.98
$1,373.20
$1,459.24
$1,764.86
$230.12
Toc - Plan #60 UnitedHealthcare
Expanded Bronze

(EPO) UHC Bronze Standard (No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-761-7748

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,400 $18,800 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
$303.01
$343.91
$387.24
$541.17
$822.36
$534.81
$575.71
$619.04
$772.97
$766.61
$807.51
$850.84
$1,004.77
$998.41
$1,039.31
$1,082.64
$1,236.57
$231.80
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$606.02
$687.82
$774.48
$1,082.34
$1,644.72
$837.82
$919.62
$1,006.28
$1,314.14
$1,069.62
$1,151.42
$1,238.08
$1,545.94
$1,301.42
$1,383.22
$1,469.88
$1,777.74
$231.80
Toc - Plan #61 UnitedHealthcare
Expanded Bronze

(EPO) UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-761-7748

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,450 $18,900 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
$316.09
$358.76
$403.96
$564.54
$857.87
$557.90
$600.57
$645.77
$806.35
$799.71
$842.38
$887.58
$1,048.16
$1,041.52
$1,084.19
$1,129.39
$1,289.97
$241.81
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$632.18
$717.52
$807.92
$1,129.08
$1,715.74
$873.99
$959.33
$1,049.73
$1,370.89
$1,115.80
$1,201.14
$1,291.54
$1,612.70
$1,357.61
$1,442.95
$1,533.35
$1,854.51
$241.81
Toc - Plan #62 UnitedHealthcare
Silver

(EPO) UHC Silver Advantage ($0 Virtual Urgent Care + $0 PCP Visits, $3 Tier 2 Rx, $0 Insulin, No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-761-7748

Annual Out of Pocket Expenses:

Individual Family
$2,500 $5,000 Annual Deductible
$9,450 $18,900 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
$416.21
$472.40
$531.92
$743.35
$1,129.60
$734.61
$790.80
$850.32
$1,061.75
$1,053.01
$1,109.20
$1,168.72
$1,380.15
$1,371.41
$1,427.60
$1,487.12
$1,698.55
$318.40
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$832.42
$944.80
$1,063.84
$1,486.70
$2,259.20
$1,150.82
$1,263.20
$1,382.24
$1,805.10
$1,469.22
$1,581.60
$1,700.64
$2,123.50
$1,787.62
$1,900.00
$2,019.04
$2,441.90
$318.40
Toc - Plan #63 UnitedHealthcare
Gold

(EPO) UHC Gold Advantage ($0 Virtual Urgent Care + $0 PCP Visits, $1 Tier 2 Rx, No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-761-7748

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 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
$441.29
$500.87
$563.97
$788.15
$1,197.66
$778.88
$838.46
$901.56
$1,125.74
$1,116.47
$1,176.05
$1,239.15
$1,463.33
$1,454.06
$1,513.64
$1,576.74
$1,800.92
$337.59
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$882.58
$1,001.74
$1,127.94
$1,576.30
$2,395.32
$1,220.17
$1,339.33
$1,465.53
$1,913.89
$1,557.76
$1,676.92
$1,803.12
$2,251.48
$1,895.35
$2,014.51
$2,140.71
$2,589.07
$337.59
Toc - Plan #64 UnitedHealthcare
Gold

(EPO) UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care + $0 PCP Visits, $3 Tier 2 Rx, No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-761-7748

Annual Out of Pocket Expenses:

Individual Family
$0 $0 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
$444.98
$505.06
$568.69
$794.74
$1,207.68
$785.39
$845.47
$909.10
$1,135.15
$1,125.80
$1,185.88
$1,249.51
$1,475.56
$1,466.21
$1,526.29
$1,589.92
$1,815.97
$340.41
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$889.96
$1,010.12
$1,137.38
$1,589.48
$2,415.36
$1,230.37
$1,350.53
$1,477.79
$1,929.89
$1,570.78
$1,690.94
$1,818.20
$2,270.30
$1,911.19
$2,031.35
$2,158.61
$2,610.71
$340.41
Toc - Plan #65 UnitedHealthcare
Gold

(EPO) UHC Gold Advantage+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-761-7748

Annual Out of Pocket Expenses:

Individual Family
$500 $1,000 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
$448.88
$509.48
$573.67
$801.70
$1,218.27
$792.27
$852.87
$917.06
$1,145.09
$1,135.66
$1,196.26
$1,260.45
$1,488.48
$1,479.05
$1,539.65
$1,603.84
$1,831.87
$343.39
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$897.76
$1,018.96
$1,147.34
$1,603.40
$2,436.54
$1,241.15
$1,362.35
$1,490.73
$1,946.79
$1,584.54
$1,705.74
$1,834.12
$2,290.18
$1,927.93
$2,049.13
$2,177.51
$2,633.57
$343.39
Toc - Plan #66 UnitedHealthcare
Silver

(EPO) UHC Silver Advantage+ ($0 Virtual Urgent Care + $0 PCP Visits, $3 Tier 2 Rx, Dental + Vision, No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-866-761-7748

Annual Out of Pocket Expenses:

Individual Family
$2,500 $5,000 Annual Deductible
$9,450 $18,900 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
$429.54
$487.53
$548.95
$767.16
$1,165.77
$758.14
$816.13
$877.55
$1,095.76
$1,086.74
$1,144.73
$1,206.15
$1,424.36
$1,415.34
$1,473.33
$1,534.75
$1,752.96
$328.60
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$859.08
$975.06
$1,097.90
$1,534.32
$2,331.54
$1,187.68
$1,303.66
$1,426.50
$1,862.92
$1,516.28
$1,632.26
$1,755.10
$2,191.52
$1,844.88
$1,960.86
$2,083.70
$2,520.12
$328.60

‡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 Douglas County here.

Douglas County is in “Rating Area 2” of Kansas.

Currently, there are 66 plans offered in Rating Area 2.

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2024 Obamacare Plans for Douglas County, KS

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