Obamacare 2023 Rates for Genesee County

Obamacare > Rates > Michigan > Genesee County

Obamacare is also known as the Affordable Care Act. This page gives you an overview of the rates for individual and family health insurance plans available from , the marketplace for Genesee County, MI.

The health insurance rates listed below are for calendar year 2023.

For information on subsidies to make your coverage affordable, you must take one of the following actions:

Contact a licensed health insurance agent
Complete an application at Healthcare.gov
Contact the provider directly

Obamacare Providers, 111 Plans and 2023 Rates for Genesee County, Michigan

Below, you’ll find a summary of the 111 plans for Genesee County, Michigan and rates for each of these providers.‡ This chart is designed to give you a preview of your health insurance options.

Blue Cross Blue Shield of Michigan Mutual Insurance Company

Local: 1-888-288-2738 | Toll Free: 1-888-288-2738 | TTY: 1-800-481-8704

Toc - Plan #1 Blue Cross Blue Shield of Michigan Mutual Insurance Company

Catastrophic

(PPO) Blue Cross� Premier PPO Value

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-288-2738

Annual Out of Pocket Expenses:

Individual Family

$9,100 $18,200 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$211.42
$239.96
$270.19
$377.60
$573.79

$373.16
$401.70
$431.93
$539.34

$534.90
$563.44
$593.67
$701.08

$696.64
$725.18
$755.41
$862.82

$161.74

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$422.84
$479.92
$540.38
$755.20
$1,147.58

$584.58
$641.66
$702.12
$916.94

$746.32
$803.40
$863.86
$1,078.68

$908.06
$965.14
$1,025.60
$1,240.42

$161.74

Toc - Plan #2 Blue Cross Blue Shield of Michigan Mutual Insurance Company

Expanded Bronze

(PPO) Blue Cross� Premier PPO Bronze HSA

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-288-2738

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 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

$281.58
$319.59
$359.86
$502.90
$764.21

$496.99
$535.00
$575.27
$718.31

$712.40
$750.41
$790.68
$933.72

$927.81
$965.82
$1,006.09
$1,149.13

$215.41

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$563.16
$639.18
$719.72
$1,005.80
$1,528.42

$778.57
$854.59
$935.13
$1,221.21

$993.98
$1,070.00
$1,150.54
$1,436.62

$1,209.39
$1,285.41
$1,365.95
$1,652.03

$215.41

Toc - Plan #3 Blue Cross Blue Shield of Michigan Mutual Insurance Company

Silver

(PPO) Blue Cross� Premier PPO Silver

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-288-2738

Annual Out of Pocket Expenses:

Individual Family

$2,875 $5,750 Annual Deductible

$8,800 $17,600 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

$381.08
$432.53
$487.02
$680.61
$1,034.25

$672.61
$724.06
$778.55
$972.14

$964.14
$1,015.59
$1,070.08
$1,263.67

$1,255.67
$1,307.12
$1,361.61
$1,555.20

$291.53

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$762.16
$865.06
$974.04
$1,361.22
$2,068.50

$1,053.69
$1,156.59
$1,265.57
$1,652.75

$1,345.22
$1,448.12
$1,557.10
$1,944.28

$1,636.75
$1,739.65
$1,848.63
$2,235.81

$291.53

Toc - Plan #4 Blue Cross Blue Shield of Michigan Mutual Insurance Company

Gold

(PPO) Blue Cross� Premier PPO Gold

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-288-2738

Annual Out of Pocket Expenses:

Individual Family

$1,050 $2,100 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

$467.59
$530.71
$597.58
$835.12
$1,269.04

$825.30
$888.42
$955.29
$1,192.83

$1,183.01
$1,246.13
$1,313.00
$1,550.54

$1,540.72
$1,603.84
$1,670.71
$1,908.25

$357.71

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$935.18
$1,061.42
$1,195.16
$1,670.24
$2,538.08

$1,292.89
$1,419.13
$1,552.87
$2,027.95

$1,650.60
$1,776.84
$1,910.58
$2,385.66

$2,008.31
$2,134.55
$2,268.29
$2,743.37

$357.71

Toc - Plan #5 Blue Cross Blue Shield of Michigan Mutual Insurance Company

Bronze

(PPO) Blue Cross� Premier PPO Bronze Secure

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-288-2738

Annual Out of Pocket Expenses:

Individual Family

$9,100 $18,200 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$259.64
$294.69
$331.82
$463.72
$704.66

$458.26
$493.31
$530.44
$662.34

$656.88
$691.93
$729.06
$860.96

$855.50
$890.55
$927.68
$1,059.58

$198.62

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$519.28
$589.38
$663.64
$927.44
$1,409.32

$717.90
$788.00
$862.26
$1,126.06

$916.52
$986.62
$1,060.88
$1,324.68

$1,115.14
$1,185.24
$1,259.50
$1,523.30

$198.62

Toc - Plan #6 Blue Cross Blue Shield of Michigan Mutual Insurance Company

Silver

(PPO) Blue Cross� Premier PPO Silver Saver HSA

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-288-2738

Annual Out of Pocket Expenses:

Individual Family

$3,400 $6,800 Annual Deductible

$7,050 $14,100 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

$381.14
$432.59
$487.10
$680.72
$1,034.41

$672.71
$724.16
$778.67
$972.29

$964.28
$1,015.73
$1,070.24
$1,263.86

$1,255.85
$1,307.30
$1,361.81
$1,555.43

$291.57

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$762.28
$865.18
$974.20
$1,361.44
$2,068.82

$1,053.85
$1,156.75
$1,265.77
$1,653.01

$1,345.42
$1,448.32
$1,557.34
$1,944.58

$1,636.99
$1,739.89
$1,848.91
$2,236.15

$291.57

Toc - Plan #7 Blue Cross Blue Shield of Michigan Mutual Insurance Company

Expanded Bronze

(PPO) Blue Cross� Premier PPO Bronze Extra

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-288-2738

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$294.97
$334.79
$376.97
$526.82
$800.55

$520.62
$560.44
$602.62
$752.47

$746.27
$786.09
$828.27
$978.12

$971.92
$1,011.74
$1,053.92
$1,203.77

$225.65

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$589.94
$669.58
$753.94
$1,053.64
$1,601.10

$815.59
$895.23
$979.59
$1,279.29

$1,041.24
$1,120.88
$1,205.24
$1,504.94

$1,266.89
$1,346.53
$1,430.89
$1,730.59

$225.65

Toc - Plan #8 Blue Cross Blue Shield of Michigan Mutual Insurance Company

Silver

(PPO) Blue Cross� Premier PPO Silver Extra

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-288-2738

Annual Out of Pocket Expenses:

Individual Family

$5,800 $11,600 Annual Deductible

$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$405.14
$459.83
$517.77
$723.58
$1,099.55

$715.07
$769.76
$827.70
$1,033.51

$1,025.00
$1,079.69
$1,137.63
$1,343.44

$1,334.93
$1,389.62
$1,447.56
$1,653.37

$309.93

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$810.28
$919.66
$1,035.54
$1,447.16
$2,199.10

$1,120.21
$1,229.59
$1,345.47
$1,757.09

$1,430.14
$1,539.52
$1,655.40
$2,067.02

$1,740.07
$1,849.45
$1,965.33
$2,376.95

$309.93

Toc - Plan #9 Blue Cross Blue Shield of Michigan Mutual Insurance Company

Gold

(PPO) Blue Cross� Premier PPO Gold Extra

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-288-2738

Annual Out of Pocket Expenses:

Individual Family

$2,000 $4,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$509.06
$577.78
$650.58
$909.18
$1,381.59

$898.49
$967.21
$1,040.01
$1,298.61

$1,287.92
$1,356.64
$1,429.44
$1,688.04

$1,677.35
$1,746.07
$1,818.87
$2,077.47

$389.43

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,018.12
$1,155.56
$1,301.16
$1,818.36
$2,763.18

$1,407.55
$1,544.99
$1,690.59
$2,207.79

$1,796.98
$1,934.42
$2,080.02
$2,597.22

$2,186.41
$2,323.85
$2,469.45
$2,986.65

$389.43

Priority Health

Local: 1-855-682-5217 | Toll Free: 1-855-682-5217 | TTY: 1-888-551-6761

Toc - Plan #10 Priority Health

Expanded Bronze

(HMO) MyPriority HSA Bronze 7100

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-682-5217

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

$269.08
$305.41
$343.88
$480.58
$730.28

$474.93
$511.26
$549.73
$686.43

$680.78
$717.11
$755.58
$892.28

$886.63
$922.96
$961.43
$1,098.13

$205.85

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$538.16
$610.82
$687.76
$961.16
$1,460.56

$744.01
$816.67
$893.61
$1,167.01

$949.86
$1,022.52
$1,099.46
$1,372.86

$1,155.71
$1,228.37
$1,305.31
$1,578.71

$205.85

Toc - Plan #11 Priority Health

Expanded Bronze

(HMO) MyPriority Bronze 9100

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-682-5217

Annual Out of Pocket Expenses:

Individual Family

$9,100 $18,200 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$245.89
$279.09
$314.25
$439.16
$667.35

$434.00
$467.20
$502.36
$627.27

$622.11
$655.31
$690.47
$815.38

$810.22
$843.42
$878.58
$1,003.49

$188.11

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$491.78
$558.18
$628.50
$878.32
$1,334.70

$679.89
$746.29
$816.61
$1,066.43

$868.00
$934.40
$1,004.72
$1,254.54

$1,056.11
$1,122.51
$1,192.83
$1,442.65

$188.11

Toc - Plan #12 Priority Health

Expanded Bronze

(HMO) MyPriority Telehealth PCP Bronze 9100 - Virtual First

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-682-5217

Annual Out of Pocket Expenses:

Individual Family

$9,100 $18,200 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$232.37
$263.74
$296.97
$415.01
$630.65

$410.13
$441.50
$474.73
$592.77

$587.89
$619.26
$652.49
$770.53

$765.65
$797.02
$830.25
$948.29

$177.76

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$464.74
$527.48
$593.94
$830.02
$1,261.30

$642.50
$705.24
$771.70
$1,007.78

$820.26
$883.00
$949.46
$1,185.54

$998.02
$1,060.76
$1,127.22
$1,363.30

$177.76

Toc - Plan #13 Priority Health

Expanded Bronze

(HMO) MyPriority Travel Bronze 9100

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-682-5217

Annual Out of Pocket Expenses:

Individual Family

$9,100 $18,200 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$282.77
$320.94
$361.38
$505.03
$767.44

$499.09
$537.26
$577.70
$721.35

$715.41
$753.58
$794.02
$937.67

$931.73
$969.90
$1,010.34
$1,153.99

$216.32

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$565.54
$641.88
$722.76
$1,010.06
$1,534.88

$781.86
$858.20
$939.08
$1,226.38

$998.18
$1,074.52
$1,155.40
$1,442.70

$1,214.50
$1,290.84
$1,371.72
$1,659.02

$216.32

Toc - Plan #14 Priority Health

Silver

(HMO) MyPriority Silver 3600

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-682-5217

Annual Out of Pocket Expenses:

Individual Family

$3,600 $7,200 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$335.69
$381.01
$429.01
$599.54
$911.06

$592.49
$637.81
$685.81
$856.34

$849.29
$894.61
$942.61
$1,113.14

$1,106.09
$1,151.41
$1,199.41
$1,369.94

$256.80

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$671.38
$762.02
$858.02
$1,199.08
$1,822.12

$928.18
$1,018.82
$1,114.82
$1,455.88

$1,184.98
$1,275.62
$1,371.62
$1,712.68

$1,441.78
$1,532.42
$1,628.42
$1,969.48

$256.80

Toc - Plan #15 Priority Health

Silver

(HMO) MyPriority Silver 5500

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-682-5217

Annual Out of Pocket Expenses:

Individual Family

$5,500 $11,000 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

$324.53
$368.34
$414.75
$579.61
$880.77

$572.80
$616.61
$663.02
$827.88

$821.07
$864.88
$911.29
$1,076.15

$1,069.34
$1,113.15
$1,159.56
$1,324.42

$248.27

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$649.06
$736.68
$829.50
$1,159.22
$1,761.54

$897.33
$984.95
$1,077.77
$1,407.49

$1,145.60
$1,233.22
$1,326.04
$1,655.76

$1,393.87
$1,481.49
$1,574.31
$1,904.03

$248.27

Toc - Plan #16 Priority Health

Silver

(HMO) MyPriority Telehealth PCP Silver 5500 - Virtual First

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-682-5217

Annual Out of Pocket Expenses:

Individual Family

$5,500 $11,000 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

$306.68
$348.08
$391.94
$547.73
$832.33

$541.29
$582.69
$626.55
$782.34

$775.90
$817.30
$861.16
$1,016.95

$1,010.51
$1,051.91
$1,095.77
$1,251.56

$234.61

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$613.36
$696.16
$783.88
$1,095.46
$1,664.66

$847.97
$930.77
$1,018.49
$1,330.07

$1,082.58
$1,165.38
$1,253.10
$1,564.68

$1,317.19
$1,399.99
$1,487.71
$1,799.29

$234.61

Toc - Plan #17 Priority Health

Silver

(HMO) MyPriority Travel Silver 5500

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-682-5217

Annual Out of Pocket Expenses:

Individual Family

$5,500 $11,000 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

$389.43
$442.00
$497.69
$695.52
$1,056.91

$687.34
$739.91
$795.60
$993.43

$985.25
$1,037.82
$1,093.51
$1,291.34

$1,283.16
$1,335.73
$1,391.42
$1,589.25

$297.91

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$778.86
$884.00
$995.38
$1,391.04
$2,113.82

$1,076.77
$1,181.91
$1,293.29
$1,688.95

$1,374.68
$1,479.82
$1,591.20
$1,986.86

$1,672.59
$1,777.73
$1,889.11
$2,284.77

$297.91

Toc - Plan #18 Priority Health

Expanded Bronze

(HMO) MyPriority Standard Bronze 7500

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-682-5217

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$248.05
$281.54
$317.01
$443.02
$673.21

$437.81
$471.30
$506.77
$632.78

$627.57
$661.06
$696.53
$822.54

$817.33
$850.82
$886.29
$1,012.30

$189.76

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$496.10
$563.08
$634.02
$886.04
$1,346.42

$685.86
$752.84
$823.78
$1,075.80

$875.62
$942.60
$1,013.54
$1,265.56

$1,065.38
$1,132.36
$1,203.30
$1,455.32

$189.76

Toc - Plan #19 Priority Health

Silver

(HMO) MyPriority Standard Silver 5800

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-682-5217

Annual Out of Pocket Expenses:

Individual Family

$5,800 $11,600 Annual Deductible

$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$346.21
$392.95
$442.46
$618.33
$939.61

$611.06
$657.80
$707.31
$883.18

$875.91
$922.65
$972.16
$1,148.03

$1,140.76
$1,187.50
$1,237.01
$1,412.88

$264.85

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$692.42
$785.90
$884.92
$1,236.66
$1,879.22

$957.27
$1,050.75
$1,149.77
$1,501.51

$1,222.12
$1,315.60
$1,414.62
$1,766.36

$1,486.97
$1,580.45
$1,679.47
$2,031.21

$264.85

Toc - Plan #20 Priority Health

Gold

(HMO) MyPriority Standard Gold 2000

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-682-5217

Annual Out of Pocket Expenses:

Individual Family

$2,000 $4,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$455.96
$517.51
$582.72
$814.34
$1,237.48

$804.77
$866.32
$931.53
$1,163.15

$1,153.58
$1,215.13
$1,280.34
$1,511.96

$1,502.39
$1,563.94
$1,629.15
$1,860.77

$348.81

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$911.92
$1,035.02
$1,165.44
$1,628.68
$2,474.96

$1,260.73
$1,383.83
$1,514.25
$1,977.49

$1,609.54
$1,732.64
$1,863.06
$2,326.30

$1,958.35
$2,081.45
$2,211.87
$2,675.11

$348.81

Molina Healthcare

Local: 1-888-560-4087 | Toll Free: 1-888-560-4087 | TTY: 1-888-665-4629

Toc - Plan #21 Molina Healthcare

Gold

(HMO) Confident Care Gold 1

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-560-4087

Annual Out of Pocket Expenses:

Individual Family

$1,900 $3,800 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

$286.21
$324.85
$365.78
$511.18
$776.78

$505.16
$543.80
$584.73
$730.13

$724.11
$762.75
$803.68
$949.08

$943.06
$981.70
$1,022.63
$1,168.03

$218.95

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$572.42
$649.70
$731.56
$1,022.36
$1,553.56

$791.37
$868.65
$950.51
$1,241.31

$1,010.32
$1,087.60
$1,169.46
$1,460.26

$1,229.27
$1,306.55
$1,388.41
$1,679.21

$218.95

Toc - Plan #22 Molina Healthcare

Silver

(HMO) Constant Care Silver 1

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-560-4087

Annual Out of Pocket Expenses:

Individual Family

$2,500 $5,000 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

$283.05
$321.26
$361.74
$505.53
$768.20

$499.59
$537.80
$578.28
$722.07

$716.13
$754.34
$794.82
$938.61

$932.67
$970.88
$1,011.36
$1,155.15

$216.54

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$566.10
$642.52
$723.48
$1,011.06
$1,536.40

$782.64
$859.06
$940.02
$1,227.60

$999.18
$1,075.60
$1,156.56
$1,444.14

$1,215.72
$1,292.14
$1,373.10
$1,660.68

$216.54

Toc - Plan #23 Molina Healthcare

Gold

(HMO) Confident Care Gold 8

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-560-4087

Annual Out of Pocket Expenses:

Individual Family

$2,000 $4,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$286.18
$324.82
$365.74
$511.12
$776.70

$505.11
$543.75
$584.67
$730.05

$724.04
$762.68
$803.60
$948.98

$942.97
$981.61
$1,022.53
$1,167.91

$218.93

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$572.36
$649.64
$731.48
$1,022.24
$1,553.40

$791.29
$868.57
$950.41
$1,241.17

$1,010.22
$1,087.50
$1,169.34
$1,460.10

$1,229.15
$1,306.43
$1,388.27
$1,679.03

$218.93

Toc - Plan #24 Molina Healthcare

Silver

(HMO) Constant Care Silver 8

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-560-4087

Annual Out of Pocket Expenses:

Individual Family

$5,800 $11,600 Annual Deductible

$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$280.90
$318.83
$359.00
$501.69
$762.37

$495.79
$533.72
$573.89
$716.58

$710.68
$748.61
$788.78
$931.47

$925.57
$963.50
$1,003.67
$1,146.36

$214.89

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$561.80
$637.66
$718.00
$1,003.38
$1,524.74

$776.69
$852.55
$932.89
$1,218.27

$991.58
$1,067.44
$1,147.78
$1,433.16

$1,206.47
$1,282.33
$1,362.67
$1,648.05

$214.89

Toc - Plan #25 Molina Healthcare

Gold

(HMO) Confident Care Gold 1 + Vision

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-560-4087

Annual Out of Pocket Expenses:

Individual Family

$1,900 $3,800 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

$290.98
$330.26
$371.87
$519.68
$789.71

$513.58
$552.86
$594.47
$742.28

$736.18
$775.46
$817.07
$964.88

$958.78
$998.06
$1,039.67
$1,187.48

$222.60

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$581.96
$660.52
$743.74
$1,039.36
$1,579.42

$804.56
$883.12
$966.34
$1,261.96

$1,027.16
$1,105.72
$1,188.94
$1,484.56

$1,249.76
$1,328.32
$1,411.54
$1,707.16

$222.60

Toc - Plan #26 Molina Healthcare

Silver

(HMO) Constant Care Silver 1 + Vision

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-560-4087

Annual Out of Pocket Expenses:

Individual Family

$2,500 $5,000 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

$289.19
$328.23
$369.59
$516.50
$784.87

$510.42
$549.46
$590.82
$737.73

$731.65
$770.69
$812.05
$958.96

$952.88
$991.92
$1,033.28
$1,180.19

$221.23

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$578.38
$656.46
$739.18
$1,033.00
$1,569.74

$799.61
$877.69
$960.41
$1,254.23

$1,020.84
$1,098.92
$1,181.64
$1,475.46

$1,242.07
$1,320.15
$1,402.87
$1,696.69

$221.23

Ambetter from Meridian

Local: 1-833-993-2426 | Toll Free: 1-833-993-2426 | TTY: 1-833-993-2426

Toc - Plan #27 Ambetter from Meridian

Bronze

(HMO) Clear Bronze

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-833-993-2426

Annual Out of Pocket Expenses:

Individual Family

$8,600 $17,200 Annual Deductible

$8,600 $17,200 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

$214.25
$243.17
$273.80
$382.64
$581.46

$378.15
$407.07
$437.70
$546.54

$542.05
$570.97
$601.60
$710.44

$705.95
$734.87
$765.50
$874.34

$163.90

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$428.50
$486.34
$547.60
$765.28
$1,162.92

$592.40
$650.24
$711.50
$929.18

$756.30
$814.14
$875.40
$1,093.08

$920.20
$978.04
$1,039.30
$1,256.98

$163.90

Toc - Plan #28 Ambetter from Meridian

Expanded Bronze

(HMO) Choice Bronze HSA

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-833-993-2426

Annual Out of Pocket Expenses:

Individual Family

$6,900 $13,800 Annual Deductible

$6,900 $13,800 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

$233.44
$264.94
$298.32
$416.90
$633.52

$412.01
$443.51
$476.89
$595.47

$590.58
$622.08
$655.46
$774.04

$769.15
$800.65
$834.03
$952.61

$178.57

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$466.88
$529.88
$596.64
$833.80
$1,267.04

$645.45
$708.45
$775.21
$1,012.37

$824.02
$887.02
$953.78
$1,190.94

$1,002.59
$1,065.59
$1,132.35
$1,369.51

$178.57

Toc - Plan #29 Ambetter from Meridian

Silver

(HMO) Complete Silver

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-833-993-2426

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

$282.54
$320.67
$361.08
$504.60
$766.79

$498.68
$536.81
$577.22
$720.74

$714.82
$752.95
$793.36
$936.88

$930.96
$969.09
$1,009.50
$1,153.02

$216.14

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$565.08
$641.34
$722.16
$1,009.20
$1,533.58

$781.22
$857.48
$938.30
$1,225.34

$997.36
$1,073.62
$1,154.44
$1,441.48

$1,213.50
$1,289.76
$1,370.58
$1,657.62

$216.14

Toc - Plan #30 Ambetter from Meridian

Gold

(HMO) Complete Gold

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-833-993-2426

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

$316.30
$358.99
$404.22
$564.90
$858.42

$558.27
$600.96
$646.19
$806.87

$800.24
$842.93
$888.16
$1,048.84

$1,042.21
$1,084.90
$1,130.13
$1,290.81

$241.97

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$632.60
$717.98
$808.44
$1,129.80
$1,716.84

$874.57
$959.95
$1,050.41
$1,371.77

$1,116.54
$1,201.92
$1,292.38
$1,613.74

$1,358.51
$1,443.89
$1,534.35
$1,855.71

$241.97

Toc - Plan #31 Ambetter from Meridian

Expanded Bronze

(HMO) Everyday Bronze

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-833-993-2426

Annual Out of Pocket Expenses:

Individual Family

$8,300 $16,600 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

$233.64
$265.17
$298.57
$417.26
$634.06

$412.36
$443.89
$477.29
$595.98

$591.08
$622.61
$656.01
$774.70

$769.80
$801.33
$834.73
$953.42

$178.72

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$467.28
$530.34
$597.14
$834.52
$1,268.12

$646.00
$709.06
$775.86
$1,013.24

$824.72
$887.78
$954.58
$1,191.96

$1,003.44
$1,066.50
$1,133.30
$1,370.68

$178.72

Toc - Plan #32 Ambetter from Meridian

Expanded Bronze

(HMO) Elite Bronze

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-833-993-2426

Annual Out of Pocket Expenses:

Individual Family

$0 $0 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

$265.90
$301.79
$339.81
$474.88
$721.63

$469.31
$505.20
$543.22
$678.29

$672.72
$708.61
$746.63
$881.70

$876.13
$912.02
$950.04
$1,085.11

$203.41

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$531.80
$603.58
$679.62
$949.76
$1,443.26

$735.21
$806.99
$883.03
$1,153.17

$938.62
$1,010.40
$1,086.44
$1,356.58

$1,142.03
$1,213.81
$1,289.85
$1,559.99

$203.41

Toc - Plan #33 Ambetter from Meridian

Silver

(HMO) Clear Silver

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-833-993-2426

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

$272.29
$309.03
$347.97
$486.29
$738.96

$480.58
$517.32
$556.26
$694.58

$688.87
$725.61
$764.55
$902.87

$897.16
$933.90
$972.84
$1,111.16

$208.29

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$544.58
$618.06
$695.94
$972.58
$1,477.92

$752.87
$826.35
$904.23
$1,180.87

$961.16
$1,034.64
$1,112.52
$1,389.16

$1,169.45
$1,242.93
$1,320.81
$1,597.45

$208.29

Toc - Plan #34 Ambetter from Meridian

Silver

(HMO) Focused Silver

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-833-993-2426

Annual Out of Pocket Expenses:

Individual Family

$6,100 $12,200 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

$276.89
$314.26
$353.85
$494.51
$751.46

$488.70
$526.07
$565.66
$706.32

$700.51
$737.88
$777.47
$918.13

$912.32
$949.69
$989.28
$1,129.94

$211.81

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$553.78
$628.52
$707.70
$989.02
$1,502.92

$765.59
$840.33
$919.51
$1,200.83

$977.40
$1,052.14
$1,131.32
$1,412.64

$1,189.21
$1,263.95
$1,343.13
$1,624.45

$211.81

Toc - Plan #35 Ambetter from Meridian

Gold

(HMO) Everyday Gold

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-833-993-2426

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

$302.09
$342.86
$386.06
$539.52
$819.85

$533.18
$573.95
$617.15
$770.61

$764.27
$805.04
$848.24
$1,001.70

$995.36
$1,036.13
$1,079.33
$1,232.79

$231.09

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$604.18
$685.72
$772.12
$1,079.04
$1,639.70

$835.27
$916.81
$1,003.21
$1,310.13

$1,066.36
$1,147.90
$1,234.30
$1,541.22

$1,297.45
$1,378.99
$1,465.39
$1,772.31

$231.09

Toc - Plan #36 Ambetter from Meridian

Gold

(HMO) Elite Gold

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-833-993-2426

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$5,000 $10,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$350.41
$397.70
$447.81
$625.81
$950.98

$618.46
$665.75
$715.86
$893.86

$886.51
$933.80
$983.91
$1,161.91

$1,154.56
$1,201.85
$1,251.96
$1,429.96

$268.05

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$700.82
$795.40
$895.62
$1,251.62
$1,901.96

$968.87
$1,063.45
$1,163.67
$1,519.67

$1,236.92
$1,331.50
$1,431.72
$1,787.72

$1,504.97
$1,599.55
$1,699.77
$2,055.77

$268.05

Toc - Plan #37 Ambetter from Meridian

Bronze

(HMO) CMS Standard Bronze

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-833-993-2426

Annual Out of Pocket Expenses:

Individual Family

$9,100 $18,200 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$202.95
$230.34
$259.36
$362.46
$550.79

$358.20
$385.59
$414.61
$517.71

$513.45
$540.84
$569.86
$672.96

$668.70
$696.09
$725.11
$828.21

$155.25

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$405.90
$460.68
$518.72
$724.92
$1,101.58

$561.15
$615.93
$673.97
$880.17

$716.40
$771.18
$829.22
$1,035.42

$871.65
$926.43
$984.47
$1,190.67

$155.25

Toc - Plan #38 Ambetter from Meridian

Expanded Bronze

(HMO) CMS Standard Expanded Bronze

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-833-993-2426

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$228.04
$258.82
$291.42
$407.26
$618.88

$402.48
$433.26
$465.86
$581.70

$576.92
$607.70
$640.30
$756.14

$751.36
$782.14
$814.74
$930.58

$174.44

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$456.08
$517.64
$582.84
$814.52
$1,237.76

$630.52
$692.08
$757.28
$988.96

$804.96
$866.52
$931.72
$1,163.40

$979.40
$1,040.96
$1,106.16
$1,337.84

$174.44

Toc - Plan #39 Ambetter from Meridian

Silver

(HMO) CMS Standard Silver

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-833-993-2426

Annual Out of Pocket Expenses:

Individual Family

$5,800 $11,600 Annual Deductible

$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$274.91
$312.02
$351.33
$490.98
$746.09

$485.21
$522.32
$561.63
$701.28

$695.51
$732.62
$771.93
$911.58

$905.81
$942.92
$982.23
$1,121.88

$210.30

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$549.82
$624.04
$702.66
$981.96
$1,492.18

$760.12
$834.34
$912.96
$1,192.26

$970.42
$1,044.64
$1,123.26
$1,402.56

$1,180.72
$1,254.94
$1,333.56
$1,612.86

$210.30

Toc - Plan #40 Ambetter from Meridian

Gold

(HMO) CMS Standard Gold

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-833-993-2426

Annual Out of Pocket Expenses:

Individual Family

$2,000 $4,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$298.19
$338.44
$381.08
$532.56
$809.27

$526.30
$566.55
$609.19
$760.67

$754.41
$794.66
$837.30
$988.78

$982.52
$1,022.77
$1,065.41
$1,216.89

$228.11

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$596.38
$676.88
$762.16
$1,065.12
$1,618.54

$824.49
$904.99
$990.27
$1,293.23

$1,052.60
$1,133.10
$1,218.38
$1,521.34

$1,280.71
$1,361.21
$1,446.49
$1,749.45

$228.11

Toc - Plan #41 Ambetter from Meridian

Bronze

(HMO) Clear Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-833-993-2426

Annual Out of Pocket Expenses:

Individual Family

$8,600 $17,200 Annual Deductible

$8,600 $17,200 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

$226.91
$257.54
$289.98
$405.25
$615.82

$400.49
$431.12
$463.56
$578.83

$574.07
$604.70
$637.14
$752.41

$747.65
$778.28
$810.72
$925.99

$173.58

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$453.82
$515.08
$579.96
$810.50
$1,231.64

$627.40
$688.66
$753.54
$984.08

$800.98
$862.24
$927.12
$1,157.66

$974.56
$1,035.82
$1,100.70
$1,331.24

$173.58

Toc - Plan #42 Ambetter from Meridian

Expanded Bronze

(HMO) Choice Bronze HSA + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-833-993-2426

Annual Out of Pocket Expenses:

Individual Family

$6,900 $13,800 Annual Deductible

$6,900 $13,800 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

$247.23
$280.60
$315.95
$441.54
$670.96

$436.35
$469.72
$505.07
$630.66

$625.47
$658.84
$694.19
$819.78

$814.59
$847.96
$883.31
$1,008.90

$189.12

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$494.46
$561.20
$631.90
$883.08
$1,341.92

$683.58
$750.32
$821.02
$1,072.20

$872.70
$939.44
$1,010.14
$1,261.32

$1,061.82
$1,128.56
$1,199.26
$1,450.44

$189.12

Toc - Plan #43 Ambetter from Meridian

Silver

(HMO) Complete Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-833-993-2426

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

$299.24
$339.62
$382.41
$534.42
$812.10

$528.15
$568.53
$611.32
$763.33

$757.06
$797.44
$840.23
$992.24

$985.97
$1,026.35
$1,069.14
$1,221.15

$228.91

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$598.48
$679.24
$764.82
$1,068.84
$1,624.20

$827.39
$908.15
$993.73
$1,297.75

$1,056.30
$1,137.06
$1,222.64
$1,526.66

$1,285.21
$1,365.97
$1,451.55
$1,755.57

$228.91

Toc - Plan #44 Ambetter from Meridian

Gold

(HMO) Complete Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-833-993-2426

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

$334.99
$380.21
$428.11
$598.28
$909.15

$591.25
$636.47
$684.37
$854.54

$847.51
$892.73
$940.63
$1,110.80

$1,103.77
$1,148.99
$1,196.89
$1,367.06

$256.26

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$669.98
$760.42
$856.22
$1,196.56
$1,818.30

$926.24
$1,016.68
$1,112.48
$1,452.82

$1,182.50
$1,272.94
$1,368.74
$1,709.08

$1,438.76
$1,529.20
$1,625.00
$1,965.34

$256.26

Toc - Plan #45 Ambetter from Meridian

Expanded Bronze

(HMO) Everyday Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-833-993-2426

Annual Out of Pocket Expenses:

Individual Family

$8,300 $16,600 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

$247.44
$280.83
$316.22
$441.91
$671.53

$436.72
$470.11
$505.50
$631.19

$626.00
$659.39
$694.78
$820.47

$815.28
$848.67
$884.06
$1,009.75

$189.28

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$494.88
$561.66
$632.44
$883.82
$1,343.06

$684.16
$750.94
$821.72
$1,073.10

$873.44
$940.22
$1,011.00
$1,262.38

$1,062.72
$1,129.50
$1,200.28
$1,451.66

$189.28

Toc - Plan #46 Ambetter from Meridian

Expanded Bronze

(HMO) Elite Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-833-993-2426

Annual Out of Pocket Expenses:

Individual Family

$0 $0 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

$281.61
$319.62
$359.89
$502.94
$764.27

$497.04
$535.05
$575.32
$718.37

$712.47
$750.48
$790.75
$933.80

$927.90
$965.91
$1,006.18
$1,149.23

$215.43

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$563.22
$639.24
$719.78
$1,005.88
$1,528.54

$778.65
$854.67
$935.21
$1,221.31

$994.08
$1,070.10
$1,150.64
$1,436.74

$1,209.51
$1,285.53
$1,366.07
$1,652.17

$215.43

Toc - Plan #47 Ambetter from Meridian

Silver

(HMO) Focused Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-833-993-2426

Annual Out of Pocket Expenses:

Individual Family

$6,100 $12,200 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

$293.25
$332.83
$374.76
$523.73
$795.86

$517.58
$557.16
$599.09
$748.06

$741.91
$781.49
$823.42
$972.39

$966.24
$1,005.82
$1,047.75
$1,196.72

$224.33

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$586.50
$665.66
$749.52
$1,047.46
$1,591.72

$810.83
$889.99
$973.85
$1,271.79

$1,035.16
$1,114.32
$1,198.18
$1,496.12

$1,259.49
$1,338.65
$1,422.51
$1,720.45

$224.33

Toc - Plan #48 Ambetter from Meridian

Gold

(HMO) Everyday Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-833-993-2426

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

$319.94
$363.12
$408.88
$571.40
$868.30

$564.69
$607.87
$653.63
$816.15

$809.44
$852.62
$898.38
$1,060.90

$1,054.19
$1,097.37
$1,143.13
$1,305.65

$244.75

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$639.88
$726.24
$817.76
$1,142.80
$1,736.60

$884.63
$970.99
$1,062.51
$1,387.55

$1,129.38
$1,215.74
$1,307.26
$1,632.30

$1,374.13
$1,460.49
$1,552.01
$1,877.05

$244.75

Toc - Plan #49 Ambetter from Meridian

Silver

(HMO) Clear Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-833-993-2426

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

$288.38
$327.29
$368.53
$515.02
$782.62

$508.98
$547.89
$589.13
$735.62

$729.58
$768.49
$809.73
$956.22

$950.18
$989.09
$1,030.33
$1,176.82

$220.60

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$576.76
$654.58
$737.06
$1,030.04
$1,565.24

$797.36
$875.18
$957.66
$1,250.64

$1,017.96
$1,095.78
$1,178.26
$1,471.24

$1,238.56
$1,316.38
$1,398.86
$1,691.84

$220.60

Toc - Plan #50 Ambetter from Meridian

Gold

(HMO) Elite Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-833-993-2426

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$5,000 $10,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$371.11
$421.20
$474.27
$662.79
$1,007.17

$655.00
$705.09
$758.16
$946.68

$938.89
$988.98
$1,042.05
$1,230.57

$1,222.78
$1,272.87
$1,325.94
$1,514.46

$283.89

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$742.22
$842.40
$948.54
$1,325.58
$2,014.34

$1,026.11
$1,126.29
$1,232.43
$1,609.47

$1,310.00
$1,410.18
$1,516.32
$1,893.36

$1,593.89
$1,694.07
$1,800.21
$2,177.25

$283.89

Toc - Plan #51 Ambetter from Meridian

Expanded Bronze

(HMO) Ambetter Virtual Access Bronze - Virtual PCP selection required

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-833-993-2426

Annual Out of Pocket Expenses:

Individual Family

$7,000 $14,000 Annual Deductible

$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$225.95
$256.44
$288.75
$403.53
$613.20

$398.79
$429.28
$461.59
$576.37

$571.63
$602.12
$634.43
$749.21

$744.47
$774.96
$807.27
$922.05

$172.84

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$451.90
$512.88
$577.50
$807.06
$1,226.40

$624.74
$685.72
$750.34
$979.90

$797.58
$858.56
$923.18
$1,152.74

$970.42
$1,031.40
$1,096.02
$1,325.58

$172.84

Toc - Plan #52 Ambetter from Meridian

Silver

(HMO) Ambetter Virtual Access Silver - Virtual PCP selection required

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-833-993-2426

Annual Out of Pocket Expenses:

Individual Family

$5,700 $11,400 Annual Deductible

$7,400 $14,800 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

$271.02
$307.59
$346.34
$484.01
$735.51

$478.34
$514.91
$553.66
$691.33

$685.66
$722.23
$760.98
$898.65

$892.98
$929.55
$968.30
$1,105.97

$207.32

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$542.04
$615.18
$692.68
$968.02
$1,471.02

$749.36
$822.50
$900.00
$1,175.34

$956.68
$1,029.82
$1,107.32
$1,382.66

$1,164.00
$1,237.14
$1,314.64
$1,589.98

$207.32

Toc - Plan #53 Ambetter from Meridian

Gold

(HMO) Ambetter Virtual Access Gold - Virtual PCP selection required

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-833-993-2426

Annual Out of Pocket Expenses:

Individual Family

$950 $1,900 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

$307.66
$349.18
$393.18
$549.46
$834.96

$543.01
$584.53
$628.53
$784.81

$778.36
$819.88
$863.88
$1,020.16

$1,013.71
$1,055.23
$1,099.23
$1,255.51

$235.35

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$615.32
$698.36
$786.36
$1,098.92
$1,669.92

$850.67
$933.71
$1,021.71
$1,334.27

$1,086.02
$1,169.06
$1,257.06
$1,569.62

$1,321.37
$1,404.41
$1,492.41
$1,804.97

$235.35

US Health and Life

Local: 1-833-600-1311 | Toll Free:

Toc - Plan #54 US Health and Life

Expanded Bronze

(EPO) Ascension Personalized Care Balanced Bronze 1

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family

$8,000 $16,000 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

$186.69
$211.89
$238.59
$333.43
$506.68

$329.51
$354.71
$381.41
$476.25

$472.33
$497.53
$524.23
$619.07

$615.15
$640.35
$667.05
$761.89

$142.82

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$373.38
$423.78
$477.18
$666.86
$1,013.36

$516.20
$566.60
$620.00
$809.68

$659.02
$709.42
$762.82
$952.50

$801.84
$852.24
$905.64
$1,095.32

$142.82

Toc - Plan #55 US Health and Life

Expanded Bronze

(EPO) Ascension Personalized Care Balanced Bronze 2

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family

$9,100 $18,200 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$184.50
$209.41
$235.79
$329.52
$500.74

$325.64
$350.55
$376.93
$470.66

$466.78
$491.69
$518.07
$611.80

$607.92
$632.83
$659.21
$752.94

$141.14

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$369.00
$418.82
$471.58
$659.04
$1,001.48

$510.14
$559.96
$612.72
$800.18

$651.28
$701.10
$753.86
$941.32

$792.42
$842.24
$895.00
$1,082.46

$141.14

Toc - Plan #56 US Health and Life

Expanded Bronze

(EPO) Ascension Personalized Care No Deductible Bronze

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone:

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

$212.76
$241.48
$271.90
$379.98
$577.42

$375.52
$404.24
$434.66
$542.74

$538.28
$567.00
$597.42
$705.50

$701.04
$729.76
$760.18
$868.26

$162.76

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$425.52
$482.96
$543.80
$759.96
$1,154.84

$588.28
$645.72
$706.56
$922.72

$751.04
$808.48
$869.32
$1,085.48

$913.80
$971.24
$1,032.08
$1,248.24

$162.76

Toc - Plan #57 US Health and Life

Silver

(EPO) Ascension Personalized Care Balanced Silver

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family

$5,400 $10,800 Annual Deductible

$5,400 $10,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$268.64
$304.91
$343.32
$479.79
$729.09

$474.15
$510.42
$548.83
$685.30

$679.66
$715.93
$754.34
$890.81

$885.17
$921.44
$959.85
$1,096.32

$205.51

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$537.28
$609.82
$686.64
$959.58
$1,458.18

$742.79
$815.33
$892.15
$1,165.09

$948.30
$1,020.84
$1,097.66
$1,370.60

$1,153.81
$1,226.35
$1,303.17
$1,576.11

$205.51

Toc - Plan #58 US Health and Life

Silver

(EPO) Ascension Personalized Care No Deductible Silver

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone:

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

$269.51
$305.89
$344.43
$481.34
$731.44

$475.68
$512.06
$550.60
$687.51

$681.85
$718.23
$756.77
$893.68

$888.02
$924.40
$962.94
$1,099.85

$206.17

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$539.02
$611.78
$688.86
$962.68
$1,462.88

$745.19
$817.95
$895.03
$1,168.85

$951.36
$1,024.12
$1,101.20
$1,375.02

$1,157.53
$1,230.29
$1,307.37
$1,581.19

$206.17

Toc - Plan #59 US Health and Life

Silver

(EPO) Ascension Personalized Care Low Premium Silver

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family

$4,000 $8,000 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

$247.91
$281.38
$316.83
$442.77
$672.82

$437.56
$471.03
$506.48
$632.42

$627.21
$660.68
$696.13
$822.07

$816.86
$850.33
$885.78
$1,011.72

$189.65

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$495.82
$562.76
$633.66
$885.54
$1,345.64

$685.47
$752.41
$823.31
$1,075.19

$875.12
$942.06
$1,012.96
$1,264.84

$1,064.77
$1,131.71
$1,202.61
$1,454.49

$189.65

Toc - Plan #60 US Health and Life

Expanded Bronze

(EPO) Ascension Personalized Care Standard Expanded Bronze

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$188.81
$214.30
$241.30
$337.22
$512.43

$333.25
$358.74
$385.74
$481.66

$477.69
$503.18
$530.18
$626.10

$622.13
$647.62
$674.62
$770.54

$144.44

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$377.62
$428.60
$482.60
$674.44
$1,024.86

$522.06
$573.04
$627.04
$818.88

$666.50
$717.48
$771.48
$963.32

$810.94
$861.92
$915.92
$1,107.76

$144.44

Toc - Plan #61 US Health and Life

Silver

(EPO) Ascension Personalized Care Standard Silver

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family

$5,800 $11,600 Annual Deductible

$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$249.61
$283.31
$319.01
$445.81
$677.45

$440.57
$474.27
$509.97
$636.77

$631.53
$665.23
$700.93
$827.73

$822.49
$856.19
$891.89
$1,018.69

$190.96

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$499.22
$566.62
$638.02
$891.62
$1,354.90

$690.18
$757.58
$828.98
$1,082.58

$881.14
$948.54
$1,019.94
$1,273.54

$1,072.10
$1,139.50
$1,210.90
$1,464.50

$190.96

Toc - Plan #62 US Health and Life

Gold

(EPO) Ascension Personalized Care Standard Gold

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family

$2,000 $4,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$305.14
$346.34
$389.97
$544.99
$828.16

$538.58
$579.78
$623.41
$778.43

$772.02
$813.22
$856.85
$1,011.87

$1,005.46
$1,046.66
$1,090.29
$1,245.31

$233.44

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$610.28
$692.68
$779.94
$1,089.98
$1,656.32

$843.72
$926.12
$1,013.38
$1,323.42

$1,077.16
$1,159.56
$1,246.82
$1,556.86

$1,310.60
$1,393.00
$1,480.26
$1,790.30

$233.44

UnitedHealthcare

Local: 1-888-200-0324 | Toll Free: 1-888-200-0324 | TTY: 1-888-200-0324

Toc - Plan #63 UnitedHealthcare

Expanded Bronze

(HMO) UHC Bronze Value $8,900 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0324

Annual Out of Pocket Expenses:

Individual Family

$8,900 $17,800 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

$223.76
$253.97
$285.97
$399.64
$607.29

$394.94
$425.15
$457.15
$570.82

$566.12
$596.33
$628.33
$742.00

$737.30
$767.51
$799.51
$913.18

$171.18

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$447.52
$507.94
$571.94
$799.28
$1,214.58

$618.70
$679.12
$743.12
$970.46

$789.88
$850.30
$914.30
$1,141.64

$961.06
$1,021.48
$1,085.48
$1,312.82

$171.18

Toc - Plan #64 UnitedHealthcare

Expanded Bronze

(HMO) UHC Bronze Value HSA

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0324

Annual Out of Pocket Expenses:

Individual Family

$7,250 $14,500 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

$227.98
$258.76
$291.36
$407.17
$618.74

$402.38
$433.16
$465.76
$581.57

$576.78
$607.56
$640.16
$755.97

$751.18
$781.96
$814.56
$930.37

$174.40

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$455.96
$517.52
$582.72
$814.34
$1,237.48

$630.36
$691.92
$757.12
$988.74

$804.76
$866.32
$931.52
$1,163.14

$979.16
$1,040.72
$1,105.92
$1,337.54

$174.40

Toc - Plan #65 UnitedHealthcare

Expanded Bronze

(HMO) UHC Bronze Essential HSA

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0324

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 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

$224.09
$254.34
$286.39
$400.22
$608.18

$395.52
$425.77
$457.82
$571.65

$566.95
$597.20
$629.25
$743.08

$738.38
$768.63
$800.68
$914.51

$171.43

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$448.18
$508.68
$572.78
$800.44
$1,216.36

$619.61
$680.11
$744.21
$971.87

$791.04
$851.54
$915.64
$1,143.30

$962.47
$1,022.97
$1,087.07
$1,314.73

$171.43

Toc - Plan #66 UnitedHealthcare

Gold

(HMO) UHC Gold Advantage (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $1 T1 Preferred Rx)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0324

Annual Out of Pocket Expenses:

Individual Family

$1,200 $2,400 Annual Deductible

$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$320.45
$363.71
$409.53
$572.32
$869.69

$565.59
$608.85
$654.67
$817.46

$810.73
$853.99
$899.81
$1,062.60

$1,055.87
$1,099.13
$1,144.95
$1,307.74

$245.14

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$640.90
$727.42
$819.06
$1,144.64
$1,739.38

$886.04
$972.56
$1,064.20
$1,389.78

$1,131.18
$1,217.70
$1,309.34
$1,634.92

$1,376.32
$1,462.84
$1,554.48
$1,880.06

$245.14

Toc - Plan #67 UnitedHealthcare

Gold

(HMO) UHC Gold Advantage+ (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $1 T1 Preferred Rx, Dental + Vision)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0324

Annual Out of Pocket Expenses:

Individual Family

$1,200 $2,400 Annual Deductible

$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$338.62
$384.33
$432.76
$604.77
$919.01

$597.66
$643.37
$691.80
$863.81

$856.70
$902.41
$950.84
$1,122.85

$1,115.74
$1,161.45
$1,209.88
$1,381.89

$259.04

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$677.24
$768.66
$865.52
$1,209.54
$1,838.02

$936.28
$1,027.70
$1,124.56
$1,468.58

$1,195.32
$1,286.74
$1,383.60
$1,727.62

$1,454.36
$1,545.78
$1,642.64
$1,986.66

$259.04

Toc - Plan #68 UnitedHealthcare

Gold

(HMO) UHC Gold Standard

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0324

Annual Out of Pocket Expenses:

Individual Family

$2,000 $4,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$317.42
$360.27
$405.66
$566.91
$861.48

$560.25
$603.10
$648.49
$809.74

$803.08
$845.93
$891.32
$1,052.57

$1,045.91
$1,088.76
$1,134.15
$1,295.40

$242.83

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$634.84
$720.54
$811.32
$1,133.82
$1,722.96

$877.67
$963.37
$1,054.15
$1,376.65

$1,120.50
$1,206.20
$1,296.98
$1,619.48

$1,363.33
$1,449.03
$1,539.81
$1,862.31

$242.83

Toc - Plan #69 UnitedHealthcare

Silver

(HMO) UHC Silver Virtual First (Unlimited $0 App-based Care, $3 T1 Preferred Rx) (Disponible en espa�ol)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0324

Annual Out of Pocket Expenses:

Individual Family

$4,000 $8,000 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

$268.25
$304.46
$342.82
$479.09
$728.03

$473.46
$509.67
$548.03
$684.30

$678.67
$714.88
$753.24
$889.51

$883.88
$920.09
$958.45
$1,094.72

$205.21

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$536.50
$608.92
$685.64
$958.18
$1,456.06

$741.71
$814.13
$890.85
$1,163.39

$946.92
$1,019.34
$1,096.06
$1,368.60

$1,152.13
$1,224.55
$1,301.27
$1,573.81

$205.21

Toc - Plan #70 UnitedHealthcare

Silver

(HMO) UHC Silver Standard

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0324

Annual Out of Pocket Expenses:

Individual Family

$5,800 $11,600 Annual Deductible

$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$281.55
$319.56
$359.83
$502.85
$764.14

$496.94
$534.95
$575.22
$718.24

$712.33
$750.34
$790.61
$933.63

$927.72
$965.73
$1,006.00
$1,149.02

$215.39

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$563.10
$639.12
$719.66
$1,005.70
$1,528.28

$778.49
$854.51
$935.05
$1,221.09

$993.88
$1,069.90
$1,150.44
$1,436.48

$1,209.27
$1,285.29
$1,365.83
$1,651.87

$215.39

Toc - Plan #71 UnitedHealthcare

Expanded Bronze

(HMO) UHC Bronze Virtual First (Unlimited $0 App-based Care, $3 T1 Preferred Rx) (Disponible en espa�ol)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0324

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$212.44
$241.12
$271.50
$379.42
$576.56

$374.96
$403.64
$434.02
$541.94

$537.48
$566.16
$596.54
$704.46

$700.00
$728.68
$759.06
$866.98

$162.52

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$424.88
$482.24
$543.00
$758.84
$1,153.12

$587.40
$644.76
$705.52
$921.36

$749.92
$807.28
$868.04
$1,083.88

$912.44
$969.80
$1,030.56
$1,246.40

$162.52

Toc - Plan #72 UnitedHealthcare

Expanded Bronze

(HMO) UHC Bronze Standard $7,500 Deductible

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0324

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$222.96
$253.06
$284.94
$398.20
$605.11

$393.52
$423.62
$455.50
$568.76

$564.08
$594.18
$626.06
$739.32

$734.64
$764.74
$796.62
$909.88

$170.56

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$445.92
$506.12
$569.88
$796.40
$1,210.22

$616.48
$676.68
$740.44
$966.96

$787.04
$847.24
$911.00
$1,137.52

$957.60
$1,017.80
$1,081.56
$1,308.08

$170.56

Toc - Plan #73 UnitedHealthcare

Bronze

(HMO) UHC Bronze Standard $9,100 Deductible

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0324

Annual Out of Pocket Expenses:

Individual Family

$9,100 $18,200 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$212.14
$240.78
$271.11
$378.88
$575.74

$374.43
$403.07
$433.40
$541.17

$536.72
$565.36
$595.69
$703.46

$699.01
$727.65
$757.98
$865.75

$162.29

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$424.28
$481.56
$542.22
$757.76
$1,151.48

$586.57
$643.85
$704.51
$920.05

$748.86
$806.14
$866.80
$1,082.34

$911.15
$968.43
$1,029.09
$1,244.63

$162.29

Toc - Plan #74 UnitedHealthcare

Gold

(HMO) UHC Gold Value (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $1 T1 Preferred Rx)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0324

Annual Out of Pocket Expenses:

Individual Family

$2,150 $4,300 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

$309.81
$351.63
$395.94
$553.32
$840.82

$546.81
$588.63
$632.94
$790.32

$783.81
$825.63
$869.94
$1,027.32

$1,020.81
$1,062.63
$1,106.94
$1,264.32

$237.00

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$619.62
$703.26
$791.88
$1,106.64
$1,681.64

$856.62
$940.26
$1,028.88
$1,343.64

$1,093.62
$1,177.26
$1,265.88
$1,580.64

$1,330.62
$1,414.26
$1,502.88
$1,817.64

$237.00

Toc - Plan #75 UnitedHealthcare

Silver

(HMO) UHC Silver Value $3,350 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0324

Annual Out of Pocket Expenses:

Individual Family

$3,350 $6,700 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

$281.26
$319.23
$359.45
$502.33
$763.34

$496.43
$534.40
$574.62
$717.50

$711.60
$749.57
$789.79
$932.67

$926.77
$964.74
$1,004.96
$1,147.84

$215.17

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$562.52
$638.46
$718.90
$1,004.66
$1,526.68

$777.69
$853.63
$934.07
$1,219.83

$992.86
$1,068.80
$1,149.24
$1,435.00

$1,208.03
$1,283.97
$1,364.41
$1,650.17

$215.17

Toc - Plan #76 UnitedHealthcare

Silver

(HMO) UHC Silver Value $4,000 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0324

Annual Out of Pocket Expenses:

Individual Family

$4,000 $8,000 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

$280.71
$318.61
$358.75
$501.36
$761.86

$495.46
$533.36
$573.50
$716.11

$710.21
$748.11
$788.25
$930.86

$924.96
$962.86
$1,003.00
$1,145.61

$214.75

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$561.42
$637.22
$717.50
$1,002.72
$1,523.72

$776.17
$851.97
$932.25
$1,217.47

$990.92
$1,066.72
$1,147.00
$1,432.22

$1,205.67
$1,281.47
$1,361.75
$1,646.97

$214.75

Toc - Plan #77 UnitedHealthcare

Silver

(HMO) UHC Silver Advantage (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0324

Annual Out of Pocket Expenses:

Individual Family

$3,000 $6,000 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

$275.68
$312.90
$352.32
$492.36
$748.19

$486.57
$523.79
$563.21
$703.25

$697.46
$734.68
$774.10
$914.14

$908.35
$945.57
$984.99
$1,125.03

$210.89

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$551.36
$625.80
$704.64
$984.72
$1,496.38

$762.25
$836.69
$915.53
$1,195.61

$973.14
$1,047.58
$1,126.42
$1,406.50

$1,184.03
$1,258.47
$1,337.31
$1,617.39

$210.89

Toc - Plan #78 UnitedHealthcare

Silver

(HMO) UHC Silver Advantage+ (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx, Dental + Vision)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0324

Annual Out of Pocket Expenses:

Individual Family

$3,000 $6,000 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

$293.84
$333.51
$375.53
$524.80
$797.49

$518.63
$558.30
$600.32
$749.59

$743.42
$783.09
$825.11
$974.38

$968.21
$1,007.88
$1,049.90
$1,199.17

$224.79

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$587.68
$667.02
$751.06
$1,049.60
$1,594.98

$812.47
$891.81
$975.85
$1,274.39

$1,037.26
$1,116.60
$1,200.64
$1,499.18

$1,262.05
$1,341.39
$1,425.43
$1,723.97

$224.79

Toc - Plan #79 UnitedHealthcare

Bronze

(HMO) UHC Bronze Essential $9,100 Deductible ($3 T1 Preferred Rx)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-200-0324

Annual Out of Pocket Expenses:

Individual Family

$9,100 $18,200 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$219.29
$248.90
$280.26
$391.66
$595.17

$387.05
$416.66
$448.02
$559.42

$554.81
$584.42
$615.78
$727.18

$722.57
$752.18
$783.54
$894.94

$167.76

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$438.58
$497.80
$560.52
$783.32
$1,190.34

$606.34
$665.56
$728.28
$951.08

$774.10
$833.32
$896.04
$1,118.84

$941.86
$1,001.08
$1,063.80
$1,286.60

$167.76

McLaren Health Plan Community

Local: 1-888-327-0671 | Toll Free: 1-888-327-0671 | TTY: 1-800-356-3232

Toc - Plan #80 McLaren Health Plan Community

Catastrophic

(HMO) McLaren Young Adult/Catastrophic

Benefits & Coverage Provider Directory

Customer Service Phone: 1-888-327-0671

Annual Out of Pocket Expenses:

Individual Family

$9,100 $18,200 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$206.89
$234.82
$264.41
$369.51
$561.50

$365.16
$393.09
$422.68
$527.78

$523.43
$551.36
$580.95
$686.05

$681.70
$709.63
$739.22
$844.32

$158.27

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$413.78
$469.64
$528.82
$739.02
$1,123.00

$572.05
$627.91
$687.09
$897.29

$730.32
$786.18
$845.36
$1,055.56

$888.59
$944.45
$1,003.63
$1,213.83

$158.27

Toc - Plan #81 McLaren Health Plan Community

Silver

(HMO) McLaren Silver Exchange

Benefits & Coverage Provider Directory

Customer Service Phone: 1-888-327-0671

Annual Out of Pocket Expenses:

Individual Family

$3,800 $7,600 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

$366.09
$415.51
$467.86
$653.83
$993.56

$646.15
$695.57
$747.92
$933.89

$926.21
$975.63
$1,027.98
$1,213.95

$1,206.27
$1,255.69
$1,308.04
$1,494.01

$280.06

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$732.18
$831.02
$935.72
$1,307.66
$1,987.12

$1,012.24
$1,111.08
$1,215.78
$1,587.72

$1,292.30
$1,391.14
$1,495.84
$1,867.78

$1,572.36
$1,671.20
$1,775.90
$2,147.84

$280.06

Toc - Plan #82 McLaren Health Plan Community

Gold

(HMO) McLaren Gold 1400

Benefits & Coverage Provider Directory

Customer Service Phone: 1-888-327-0671

Annual Out of Pocket Expenses:

Individual Family

$1,400 $2,800 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

$355.34
$403.32
$454.13
$634.65
$964.41

$627.18
$675.16
$725.97
$906.49

$899.02
$947.00
$997.81
$1,178.33

$1,170.86
$1,218.84
$1,269.65
$1,450.17

$271.84

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$710.68
$806.64
$908.26
$1,269.30
$1,928.82

$982.52
$1,078.48
$1,180.10
$1,541.14

$1,254.36
$1,350.32
$1,451.94
$1,812.98

$1,526.20
$1,622.16
$1,723.78
$2,084.82

$271.84

Toc - Plan #83 McLaren Health Plan Community

Bronze

(HMO) McLaren Bronze 6500

Benefits & Coverage Provider Directory

Customer Service Phone: 1-888-327-0671

Annual Out of Pocket Expenses:

Individual Family

$6,500 $13,000 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$228.80
$259.69
$292.41
$408.64
$620.97

$403.83
$434.72
$467.44
$583.67

$578.86
$609.75
$642.47
$758.70

$753.89
$784.78
$817.50
$933.73

$175.03

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$457.60
$519.38
$584.82
$817.28
$1,241.94

$632.63
$694.41
$759.85
$992.31

$807.66
$869.44
$934.88
$1,167.34

$982.69
$1,044.47
$1,109.91
$1,342.37

$175.03

Toc - Plan #84 McLaren Health Plan Community

Expanded Bronze

(HMO) McLaren Bronze Saver

Benefits & Coverage Provider Directory

Customer Service Phone: 1-888-327-0671

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

$252.01
$286.03
$322.06
$450.08
$683.95

$444.79
$478.81
$514.84
$642.86

$637.57
$671.59
$707.62
$835.64

$830.35
$864.37
$900.40
$1,028.42

$192.78

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$504.02
$572.06
$644.12
$900.16
$1,367.90

$696.80
$764.84
$836.90
$1,092.94

$889.58
$957.62
$1,029.68
$1,285.72

$1,082.36
$1,150.40
$1,222.46
$1,478.50

$192.78

Toc - Plan #85 McLaren Health Plan Community

Silver

(HMO) McLaren Silver VCP

Benefits & Coverage Provider Directory

Customer Service Phone: 1-888-327-0671

Annual Out of Pocket Expenses:

Individual Family

$3,800 $7,600 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

$340.41
$386.37
$435.04
$607.97
$923.87

$600.82
$646.78
$695.45
$868.38

$861.23
$907.19
$955.86
$1,128.79

$1,121.64
$1,167.60
$1,216.27
$1,389.20

$260.41

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$680.82
$772.74
$870.08
$1,215.94
$1,847.74

$941.23
$1,033.15
$1,130.49
$1,476.35

$1,201.64
$1,293.56
$1,390.90
$1,736.76

$1,462.05
$1,553.97
$1,651.31
$1,997.17

$260.41

Toc - Plan #86 McLaren Health Plan Community

Bronze

(HMO) McLaren Bronze 6500 VCP

Benefits & Coverage Provider Directory

Customer Service Phone: 1-888-327-0671

Annual Out of Pocket Expenses:

Individual Family

$6,500 $13,000 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$217.63
$247.01
$278.13
$388.69
$590.66

$384.12
$413.50
$444.62
$555.18

$550.61
$579.99
$611.11
$721.67

$717.10
$746.48
$777.60
$888.16

$166.49

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$435.26
$494.02
$556.26
$777.38
$1,181.32

$601.75
$660.51
$722.75
$943.87

$768.24
$827.00
$889.24
$1,110.36

$934.73
$993.49
$1,055.73
$1,276.85

$166.49

Toc - Plan #87 McLaren Health Plan Community

Gold

(HMO) McLaren Gold 1400 VCP

Benefits & Coverage Provider Directory

Customer Service Phone: 1-888-327-0671

Annual Out of Pocket Expenses:

Individual Family

$1,400 $2,800 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

$337.85
$383.46
$431.77
$603.39
$916.92

$596.30
$641.91
$690.22
$861.84

$854.75
$900.36
$948.67
$1,120.29

$1,113.20
$1,158.81
$1,207.12
$1,378.74

$258.45

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$675.70
$766.92
$863.54
$1,206.78
$1,833.84

$934.15
$1,025.37
$1,121.99
$1,465.23

$1,192.60
$1,283.82
$1,380.44
$1,723.68

$1,451.05
$1,542.27
$1,638.89
$1,982.13

$258.45

Toc - Plan #88 McLaren Health Plan Community

Silver

(HMO) McLaren Silver Exchange Rewards

Benefits & Coverage Provider Directory

Customer Service Phone: 1-888-327-0671

Annual Out of Pocket Expenses:

Individual Family

$2,000 $4,000 Annual Deductible

$8,250 $16,500 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

$356.52
$404.65
$455.63
$636.74
$967.59

$629.26
$677.39
$728.37
$909.48

$902.00
$950.13
$1,001.11
$1,182.22

$1,174.74
$1,222.87
$1,273.85
$1,454.96

$272.74

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$713.04
$809.30
$911.26
$1,273.48
$1,935.18

$985.78
$1,082.04
$1,184.00
$1,546.22

$1,258.52
$1,354.78
$1,456.74
$1,818.96

$1,531.26
$1,627.52
$1,729.48
$2,091.70

$272.74

Toc - Plan #89 McLaren Health Plan Community

Gold

(HMO) McLaren Gold Standard

Benefits & Coverage Provider Directory

Customer Service Phone: 1-888-327-0671

Annual Out of Pocket Expenses:

Individual Family

$2,000 $4,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$353.56
$401.29
$451.85
$631.46
$959.56

$624.03
$671.76
$722.32
$901.93

$894.50
$942.23
$992.79
$1,172.40

$1,164.97
$1,212.70
$1,263.26
$1,442.87

$270.47

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$707.12
$802.58
$903.70
$1,262.92
$1,919.12

$977.59
$1,073.05
$1,174.17
$1,533.39

$1,248.06
$1,343.52
$1,444.64
$1,803.86

$1,518.53
$1,613.99
$1,715.11
$2,074.33

$270.47

Toc - Plan #90 McLaren Health Plan Community

Silver

(HMO) McLaren Silver Standard

Benefits & Coverage Provider Directory

Customer Service Phone: 1-888-327-0671

Annual Out of Pocket Expenses:

Individual Family

$5,800 $11,600 Annual Deductible

$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$364.76
$414.00
$466.16
$651.46
$989.96

$643.80
$693.04
$745.20
$930.50

$922.84
$972.08
$1,024.24
$1,209.54

$1,201.88
$1,251.12
$1,303.28
$1,488.58

$279.04

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$729.52
$828.00
$932.32
$1,302.92
$1,979.92

$1,008.56
$1,107.04
$1,211.36
$1,581.96

$1,287.60
$1,386.08
$1,490.40
$1,861.00

$1,566.64
$1,665.12
$1,769.44
$2,140.04

$279.04

Toc - Plan #91 McLaren Health Plan Community

Bronze

(HMO) McLaren Bronze Standard

Benefits & Coverage Provider Directory

Customer Service Phone: 1-888-327-0671

Annual Out of Pocket Expenses:

Individual Family

$9,100 $18,200 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$229.30
$260.26
$293.05
$409.54
$622.33

$404.72
$435.68
$468.47
$584.96

$580.14
$611.10
$643.89
$760.38

$755.56
$786.52
$819.31
$935.80

$175.42

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$458.60
$520.52
$586.10
$819.08
$1,244.66

$634.02
$695.94
$761.52
$994.50

$809.44
$871.36
$936.94
$1,169.92

$984.86
$1,046.78
$1,112.36
$1,345.34

$175.42

Toc - Plan #92 McLaren Health Plan Community

Expanded Bronze

(HMO) McLaren Expanded Bronze Standard

Benefits & Coverage Provider Directory

Customer Service Phone: 1-888-327-0671

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$244.57
$277.59
$312.56
$436.80
$663.76

$431.67
$464.69
$499.66
$623.90

$618.77
$651.79
$686.76
$811.00

$805.87
$838.89
$873.86
$998.10

$187.10

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$489.14
$555.18
$625.12
$873.60
$1,327.52

$676.24
$742.28
$812.22
$1,060.70

$863.34
$929.38
$999.32
$1,247.80

$1,050.44
$1,116.48
$1,186.42
$1,434.90

$187.10

Blue Care Network of Michigan

Local: 1-888-227-2345 | Toll Free: 1-888-227-2345 | TTY: 1-800-257-9980

Toc - Plan #93 Blue Care Network of Michigan

Catastrophic

(HMO) Blue Cross� Select HMO Value

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-227-2345

Annual Out of Pocket Expenses:

Individual Family

$9,100 $18,200 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$204.68
$232.31
$261.58
$365.56
$555.50

$361.26
$388.89
$418.16
$522.14

$517.84
$545.47
$574.74
$678.72

$674.42
$702.05
$731.32
$835.30

$156.58

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$409.36
$464.62
$523.16
$731.12
$1,111.00

$565.94
$621.20
$679.74
$887.70

$722.52
$777.78
$836.32
$1,044.28

$879.10
$934.36
$992.90
$1,200.86

$156.58

Toc - Plan #94 Blue Care Network of Michigan

Silver

(HMO) Blue Cross� Select HMO Silver

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-227-2345

Annual Out of Pocket Expenses:

Individual Family

$4,650 $9,300 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

$354.87
$402.78
$453.52
$633.80
$963.12

$626.35
$674.26
$725.00
$905.28

$897.83
$945.74
$996.48
$1,176.76

$1,169.31
$1,217.22
$1,267.96
$1,448.24

$271.48

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$709.74
$805.56
$907.04
$1,267.60
$1,926.24

$981.22
$1,077.04
$1,178.52
$1,539.08

$1,252.70
$1,348.52
$1,450.00
$1,810.56

$1,524.18
$1,620.00
$1,721.48
$2,082.04

$271.48

Toc - Plan #95 Blue Care Network of Michigan

Silver

(HMO) Blue Cross� Preferred HMO Silver

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-227-2345

Annual Out of Pocket Expenses:

Individual Family

$4,650 $9,300 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

$389.92
$442.56
$498.32
$696.40
$1,058.24

$688.21
$740.85
$796.61
$994.69

$986.50
$1,039.14
$1,094.90
$1,292.98

$1,284.79
$1,337.43
$1,393.19
$1,591.27

$298.29

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$779.84
$885.12
$996.64
$1,392.80
$2,116.48

$1,078.13
$1,183.41
$1,294.93
$1,691.09

$1,376.42
$1,481.70
$1,593.22
$1,989.38

$1,674.71
$1,779.99
$1,891.51
$2,287.67

$298.29

Toc - Plan #96 Blue Care Network of Michigan

Gold

(HMO) Blue Cross� Preferred HMO Gold

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-227-2345

Annual Out of Pocket Expenses:

Individual Family

$1,600 $3,200 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$438.69
$497.91
$560.65
$783.50
$1,190.60

$774.29
$833.51
$896.25
$1,119.10

$1,109.89
$1,169.11
$1,231.85
$1,454.70

$1,445.49
$1,504.71
$1,567.45
$1,790.30

$335.60

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$877.38
$995.82
$1,121.30
$1,567.00
$2,381.20

$1,212.98
$1,331.42
$1,456.90
$1,902.60

$1,548.58
$1,667.02
$1,792.50
$2,238.20

$1,884.18
$2,002.62
$2,128.10
$2,573.80

$335.60

Toc - Plan #97 Blue Care Network of Michigan

Silver

(HMO) Blue Cross� Select HMO Silver Saver

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-227-2345

Annual Out of Pocket Expenses:

Individual Family

$5,500 $11,000 Annual Deductible

$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$318.03
$360.96
$406.44
$568.00
$863.13

$561.32
$604.25
$649.73
$811.29

$804.61
$847.54
$893.02
$1,054.58

$1,047.90
$1,090.83
$1,136.31
$1,297.87

$243.29

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$636.06
$721.92
$812.88
$1,136.00
$1,726.26

$879.35
$965.21
$1,056.17
$1,379.29

$1,122.64
$1,208.50
$1,299.46
$1,622.58

$1,365.93
$1,451.79
$1,542.75
$1,865.87

$243.29

Toc - Plan #98 Blue Care Network of Michigan

Silver

(HMO) Blue Cross� Preferred HMO Silver Saver

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-227-2345

Annual Out of Pocket Expenses:

Individual Family

$5,500 $11,000 Annual Deductible

$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$349.43
$396.60
$446.57
$624.08
$948.35

$616.74
$663.91
$713.88
$891.39

$884.05
$931.22
$981.19
$1,158.70

$1,151.36
$1,198.53
$1,248.50
$1,426.01

$267.31

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$698.86
$793.20
$893.14
$1,248.16
$1,896.70

$966.17
$1,060.51
$1,160.45
$1,515.47

$1,233.48
$1,327.82
$1,427.76
$1,782.78

$1,500.79
$1,595.13
$1,695.07
$2,050.09

$267.31

Toc - Plan #99 Blue Care Network of Michigan

Expanded Bronze

(HMO) Blue Cross� Select HMO Bronze

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-227-2345

Annual Out of Pocket Expenses:

Individual Family

$9,100 $18,200 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$249.51
$283.19
$318.87
$445.62
$677.17

$440.39
$474.07
$509.75
$636.50

$631.27
$664.95
$700.63
$827.38

$822.15
$855.83
$891.51
$1,018.26

$190.88

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$499.02
$566.38
$637.74
$891.24
$1,354.34

$689.90
$757.26
$828.62
$1,082.12

$880.78
$948.14
$1,019.50
$1,273.00

$1,071.66
$1,139.02
$1,210.38
$1,463.88

$190.88

Toc - Plan #100 Blue Care Network of Michigan

Expanded Bronze

(HMO) Blue Cross� Select HMO Bronze Saver HSA

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-227-2345

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 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

$253.53
$287.76
$324.01
$452.80
$688.08

$447.48
$481.71
$517.96
$646.75

$641.43
$675.66
$711.91
$840.70

$835.38
$869.61
$905.86
$1,034.65

$193.95

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$507.06
$575.52
$648.02
$905.60
$1,376.16

$701.01
$769.47
$841.97
$1,099.55

$894.96
$963.42
$1,035.92
$1,293.50

$1,088.91
$1,157.37
$1,229.87
$1,487.45

$193.95

Toc - Plan #101 Blue Care Network of Michigan

Expanded Bronze

(HMO) Blue Cross� Preferred HMO Bronze Saver HSA

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-227-2345

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 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

$278.56
$316.17
$356.00
$497.51
$756.01

$491.66
$529.27
$569.10
$710.61

$704.76
$742.37
$782.20
$923.71

$917.86
$955.47
$995.30
$1,136.81

$213.10

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$557.12
$632.34
$712.00
$995.02
$1,512.02

$770.22
$845.44
$925.10
$1,208.12

$983.32
$1,058.54
$1,138.20
$1,421.22

$1,196.42
$1,271.64
$1,351.30
$1,634.32

$213.10

Toc - Plan #102 Blue Care Network of Michigan

Expanded Bronze

(HMO) Blue Cross� Preferred HMO Bronze

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-227-2345

Annual Out of Pocket Expenses:

Individual Family

$9,100 $18,200 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$274.15
$311.16
$350.36
$489.63
$744.04

$483.87
$520.88
$560.08
$699.35

$693.59
$730.60
$769.80
$909.07

$903.31
$940.32
$979.52
$1,118.79

$209.72

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$548.30
$622.32
$700.72
$979.26
$1,488.08

$758.02
$832.04
$910.44
$1,188.98

$967.74
$1,041.76
$1,120.16
$1,398.70

$1,177.46
$1,251.48
$1,329.88
$1,608.42

$209.72

Toc - Plan #103 Blue Care Network of Michigan

Silver

(HMO) Blue Cross� Select HMO Silver Extra

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-227-2345

Annual Out of Pocket Expenses:

Individual Family

$5,800 $11,600 Annual Deductible

$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$372.70
$423.01
$476.31
$665.64
$1,011.51

$657.82
$708.13
$761.43
$950.76

$942.94
$993.25
$1,046.55
$1,235.88

$1,228.06
$1,278.37
$1,331.67
$1,521.00

$285.12

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$745.40
$846.02
$952.62
$1,331.28
$2,023.02

$1,030.52
$1,131.14
$1,237.74
$1,616.40

$1,315.64
$1,416.26
$1,522.86
$1,901.52

$1,600.76
$1,701.38
$1,807.98
$2,186.64

$285.12

Toc - Plan #104 Blue Care Network of Michigan

Silver

(HMO) Blue Cross� Preferred HMO Silver Extra

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-227-2345

Annual Out of Pocket Expenses:

Individual Family

$5,800 $11,600 Annual Deductible

$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$409.51
$464.79
$523.35
$731.38
$1,111.41

$722.79
$778.07
$836.63
$1,044.66

$1,036.07
$1,091.35
$1,149.91
$1,357.94

$1,349.35
$1,404.63
$1,463.19
$1,671.22

$313.28

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$819.02
$929.58
$1,046.70
$1,462.76
$2,222.82

$1,132.30
$1,242.86
$1,359.98
$1,776.04

$1,445.58
$1,556.14
$1,673.26
$2,089.32

$1,758.86
$1,869.42
$1,986.54
$2,402.60

$313.28

Toc - Plan #105 Blue Care Network of Michigan

Gold

(HMO) Blue Cross� Preferred HMO Gold Extra

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-227-2345

Annual Out of Pocket Expenses:

Individual Family

$2,000 $4,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$441.65
$501.27
$564.43
$788.79
$1,198.64

$779.51
$839.13
$902.29
$1,126.65

$1,117.37
$1,176.99
$1,240.15
$1,464.51

$1,455.23
$1,514.85
$1,578.01
$1,802.37

$337.86

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$883.30
$1,002.54
$1,128.86
$1,577.58
$2,397.28

$1,221.16
$1,340.40
$1,466.72
$1,915.44

$1,559.02
$1,678.26
$1,804.58
$2,253.30

$1,896.88
$2,016.12
$2,142.44
$2,591.16

$337.86

Toc - Plan #106 Blue Care Network of Michigan

Expanded Bronze

(HMO) Blue Cross� Select HMO Bronze Extra

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-227-2345

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$240.12
$272.54
$306.87
$428.85
$651.69

$423.81
$456.23
$490.56
$612.54

$607.50
$639.92
$674.25
$796.23

$791.19
$823.61
$857.94
$979.92

$183.69

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$480.24
$545.08
$613.74
$857.70
$1,303.38

$663.93
$728.77
$797.43
$1,041.39

$847.62
$912.46
$981.12
$1,225.08

$1,031.31
$1,096.15
$1,164.81
$1,408.77

$183.69

Toc - Plan #107 Blue Care Network of Michigan

Expanded Bronze

(HMO) Blue Cross� Preferred HMO Bronze Extra

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-227-2345

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$263.82
$299.44
$337.16
$471.18
$716.01

$465.64
$501.26
$538.98
$673.00

$667.46
$703.08
$740.80
$874.82

$869.28
$904.90
$942.62
$1,076.64

$201.82

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$527.64
$598.88
$674.32
$942.36
$1,432.02

$729.46
$800.70
$876.14
$1,144.18

$931.28
$1,002.52
$1,077.96
$1,346.00

$1,133.10
$1,204.34
$1,279.78
$1,547.82

$201.82

Toc - Plan #108 Blue Care Network of Michigan

Bronze

(HMO) Blue Cross� Select HMO Bronze Secure

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-227-2345

Annual Out of Pocket Expenses:

Individual Family

$9,100 $18,200 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$213.66
$242.50
$273.06
$381.60
$579.87

$377.11
$405.95
$436.51
$545.05

$540.56
$569.40
$599.96
$708.50

$704.01
$732.85
$763.41
$871.95

$163.45

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$427.32
$485.00
$546.12
$763.20
$1,159.74

$590.77
$648.45
$709.57
$926.65

$754.22
$811.90
$873.02
$1,090.10

$917.67
$975.35
$1,036.47
$1,253.55

$163.45

Toc - Plan #109 Blue Care Network of Michigan

Bronze

(HMO) Blue Cross� Preferred HMO Bronze Secure

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-227-2345

Annual Out of Pocket Expenses:

Individual Family

$9,100 $18,200 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$234.75
$266.44
$300.01
$419.26
$637.11

$414.33
$446.02
$479.59
$598.84

$593.91
$625.60
$659.17
$778.42

$773.49
$805.18
$838.75
$958.00

$179.58

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$469.50
$532.88
$600.02
$838.52
$1,274.22

$649.08
$712.46
$779.60
$1,018.10

$828.66
$892.04
$959.18
$1,197.68

$1,008.24
$1,071.62
$1,138.76
$1,377.26

$179.58

Toc - Plan #110 Blue Care Network of Michigan

Expanded Bronze

(HMO) Blue Cross� Preferred HMO Virtual Primary Care Bronze

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-227-2345

Annual Out of Pocket Expenses:

Individual Family

$9,000 $18,000 Annual Deductible

$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$252.85
$286.98
$323.14
$451.59
$686.23

$446.28
$480.41
$516.57
$645.02

$639.71
$673.84
$710.00
$838.45

$833.14
$867.27
$903.43
$1,031.88

$193.43

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$505.70
$573.96
$646.28
$903.18
$1,372.46

$699.13
$767.39
$839.71
$1,096.61

$892.56
$960.82
$1,033.14
$1,290.04

$1,085.99
$1,154.25
$1,226.57
$1,483.47

$193.43

Toc - Plan #111 Blue Care Network of Michigan

Silver

(HMO) Blue Cross� Preferred HMO Virtual Primary Care Silver

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-227-2345

Annual Out of Pocket Expenses:

Individual Family

$6,050 $12,100 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

$354.86
$402.77
$453.51
$633.78
$963.09

$626.33
$674.24
$724.98
$905.25

$897.80
$945.71
$996.45
$1,176.72

$1,169.27
$1,217.18
$1,267.92
$1,448.19

$271.47

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$709.72
$805.54
$907.02
$1,267.56
$1,926.18

$981.19
$1,077.01
$1,178.49
$1,539.03

$1,252.66
$1,348.48
$1,449.96
$1,810.50

$1,524.13
$1,619.95
$1,721.43
$2,081.97

$271.47

‡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 Genesee County here.

Genesee County is in “Rating Area 5” of Michigan.

Currently, there are 111 plans offered in Rating Area 5.

Top

2023 Obamacare Plans for Genesee County, MI

Plan Browser: 111 Plans

Blue Cross Blue Shield of Michigan Mutual Insurance Company

Local: 1-888-288-2738 | Toll Free: 1-888-288-2738 | TTY: 1-800-481-8704

1. Catastrophic Blue Cross� Premier PPO Value

2. Expanded Bronze Blue Cross� Premier PPO Bronze HSA

3. Silver Blue Cross� Premier PPO Silver

4. Gold Blue Cross� Premier PPO Gold

5. Bronze Blue Cross� Premier PPO Bronze Secure

6. Silver Blue Cross� Premier PPO Silver Saver HSA

7. Expanded Bronze Blue Cross� Premier PPO Bronze Extra

8. Silver Blue Cross� Premier PPO Silver Extra

9. Gold Blue Cross� Premier PPO Gold Extra

Priority Health

Local: 1-855-682-5217 | Toll Free: 1-855-682-5217 | TTY: 1-888-551-6761

10. Expanded Bronze MyPriority HSA Bronze 7100

11. Expanded Bronze MyPriority Bronze 9100

12. Expanded Bronze MyPriority Telehealth PCP Bronze 9100 - Virtual First

13. Expanded Bronze MyPriority Travel Bronze 9100

14. Silver MyPriority Silver 3600

15. Silver MyPriority Silver 5500

16. Silver MyPriority Telehealth PCP Silver 5500 - Virtual First

17. Silver MyPriority Travel Silver 5500

18. Expanded Bronze MyPriority Standard Bronze 7500

19. Silver MyPriority Standard Silver 5800

20. Gold MyPriority Standard Gold 2000

Molina Healthcare

Local: 1-888-560-4087 | Toll Free: 1-888-560-4087 | TTY: 1-888-665-4629

21. Gold Confident Care Gold 1

22. Silver Constant Care Silver 1

23. Gold Confident Care Gold 8

24. Silver Constant Care Silver 8

25. Gold Confident Care Gold 1 + Vision

26. Silver Constant Care Silver 1 + Vision

Ambetter from Meridian

Local: 1-833-993-2426 | Toll Free: 1-833-993-2426 | TTY: 1-833-993-2426

27. Bronze Clear Bronze

28. Expanded Bronze Choice Bronze HSA

29. Silver Complete Silver

30. Gold Complete Gold

31. Expanded Bronze Everyday Bronze

32. Expanded Bronze Elite Bronze

33. Silver Clear Silver

34. Silver Focused Silver

35. Gold Everyday Gold

36. Gold Elite Gold

37. Bronze CMS Standard Bronze

38. Expanded Bronze CMS Standard Expanded Bronze

39. Silver CMS Standard Silver

40. Gold CMS Standard Gold

41. Bronze Clear Bronze + Vision + Adult Dental

42. Expanded Bronze Choice Bronze HSA + Vision + Adult Dental

43. Silver Complete Silver + Vision + Adult Dental

44. Gold Complete Gold + Vision + Adult Dental

45. Expanded Bronze Everyday Bronze + Vision + Adult Dental

46. Expanded Bronze Elite Bronze + Vision + Adult Dental

47. Silver Focused Silver + Vision + Adult Dental

48. Gold Everyday Gold + Vision + Adult Dental

49. Silver Clear Silver + Vision + Adult Dental

50. Gold Elite Gold + Vision + Adult Dental

51. Expanded Bronze Ambetter Virtual Access Bronze - Virtual PCP selection required

52. Silver Ambetter Virtual Access Silver - Virtual PCP selection required

53. Gold Ambetter Virtual Access Gold - Virtual PCP selection required

US Health and Life

Local: 1-833-600-1311 | Toll Free:

54. Expanded Bronze Ascension Personalized Care Balanced Bronze 1

55. Expanded Bronze Ascension Personalized Care Balanced Bronze 2

56. Expanded Bronze Ascension Personalized Care No Deductible Bronze

57. Silver Ascension Personalized Care Balanced Silver

58. Silver Ascension Personalized Care No Deductible Silver

59. Silver Ascension Personalized Care Low Premium Silver

60. Expanded Bronze Ascension Personalized Care Standard Expanded Bronze

61. Silver Ascension Personalized Care Standard Silver

62. Gold Ascension Personalized Care Standard Gold

UnitedHealthcare

Local: 1-888-200-0324 | Toll Free: 1-888-200-0324 | TTY: 1-888-200-0324

63. Expanded Bronze UHC Bronze Value $8,900 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx)

64. Expanded Bronze UHC Bronze Value HSA

65. Expanded Bronze UHC Bronze Essential HSA

66. Gold UHC Gold Advantage (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $1 T1 Preferred Rx)

67. Gold UHC Gold Advantage+ (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $1 T1 Preferred Rx, Dental + Vision)

68. Gold UHC Gold Standard

69. Silver UHC Silver Virtual First (Unlimited $0 App-based Care, $3 T1 Preferred Rx) (Disponible en espa�ol)

70. Silver UHC Silver Standard

71. Expanded Bronze UHC Bronze Virtual First (Unlimited $0 App-based Care, $3 T1 Preferred Rx) (Disponible en espa�ol)

72. Expanded Bronze UHC Bronze Standard $7,500 Deductible

73. Bronze UHC Bronze Standard $9,100 Deductible

74. Gold UHC Gold Value (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $1 T1 Preferred Rx)

75. Silver UHC Silver Value $3,350 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx)

76. Silver UHC Silver Value $4,000 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx)

77. Silver UHC Silver Advantage (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx)

78. Silver UHC Silver Advantage+ (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx, Dental + Vision)

79. Bronze UHC Bronze Essential $9,100 Deductible ($3 T1 Preferred Rx)

McLaren Health Plan Community

Local: 1-888-327-0671 | Toll Free: 1-888-327-0671 | TTY: 1-800-356-3232

80. Catastrophic McLaren Young Adult/Catastrophic

81. Silver McLaren Silver Exchange

82. Gold McLaren Gold 1400

83. Bronze McLaren Bronze 6500

84. Expanded Bronze McLaren Bronze Saver

85. Silver McLaren Silver VCP

86. Bronze McLaren Bronze 6500 VCP

87. Gold McLaren Gold 1400 VCP

88. Silver McLaren Silver Exchange Rewards

89. Gold McLaren Gold Standard

90. Silver McLaren Silver Standard

91. Bronze McLaren Bronze Standard

92. Expanded Bronze McLaren Expanded Bronze Standard

Blue Care Network of Michigan

Local: 1-888-227-2345 | Toll Free: 1-888-227-2345 | TTY: 1-800-257-9980

93. Catastrophic Blue Cross� Select HMO Value

94. Silver Blue Cross� Select HMO Silver

95. Silver Blue Cross� Preferred HMO Silver

96. Gold Blue Cross� Preferred HMO Gold

97. Silver Blue Cross� Select HMO Silver Saver

98. Silver Blue Cross� Preferred HMO Silver Saver

99. Expanded Bronze Blue Cross� Select HMO Bronze

100. Expanded Bronze Blue Cross� Select HMO Bronze Saver HSA

101. Expanded Bronze Blue Cross� Preferred HMO Bronze Saver HSA

102. Expanded Bronze Blue Cross� Preferred HMO Bronze

103. Silver Blue Cross� Select HMO Silver Extra

104. Silver Blue Cross� Preferred HMO Silver Extra

105. Gold Blue Cross� Preferred HMO Gold Extra

106. Expanded Bronze Blue Cross� Select HMO Bronze Extra

107. Expanded Bronze Blue Cross� Preferred HMO Bronze Extra

108. Bronze Blue Cross� Select HMO Bronze Secure

109. Bronze Blue Cross� Preferred HMO Bronze Secure

110. Expanded Bronze Blue Cross� Preferred HMO Virtual Primary Care Bronze

111. Silver Blue Cross� Preferred HMO Virtual Primary Care Silver

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For information on subsidies to make your coverage affordable, you must take one of the following actions:

Obamacare Providers, 111 Plans and 2023 Rates for Genesee County, Michigan

You may also be interested in:

Do I Qualify For a Tax Credit to Pay My Premiums?

How do I sign up in Michigan?

Using a Broker to Help You Sign Up

Obamacare Rates and Providers for Other Years

How To Sign Up for Obamacare in Michigan for 2023

Where's the Michigan Health Care Exchange?

Michigan Medicaid Expansion: Do I Qualify for Medicaid Under the ACA?

Michigan Has Expanded Medicaid

Get Help Finding a Health Insurance Plan in Michigan

Get Help From Michigan's Health Insurance Exchange

Get Help From a Licensed Insurance Broker

More Information

Blue Cross Blue Shield of Michigan Mutual Insurance Company

(PPO) Blue Cross� Premier PPO Value

Annual Out of Pocket Expenses:

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

Monthly Premiums:

(PPO) Blue Cross� Premier PPO Bronze HSA

Annual Out of Pocket Expenses:

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

Monthly Premiums:

(PPO) Blue Cross� Premier PPO Silver

Annual Out of Pocket Expenses:

Individual Family $2,875 $5,750 Annual Deductible $8,800 $17,600 Maximum Out of Pocket Per Year

Monthly Premiums:

(PPO) Blue Cross� Premier PPO Gold

Annual Out of Pocket Expenses:

Individual Family $1,050 $2,100 Annual Deductible $8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

(PPO) Blue Cross� Premier PPO Bronze Secure

Annual Out of Pocket Expenses:

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

Monthly Premiums:

(PPO) Blue Cross� Premier PPO Silver Saver HSA

Annual Out of Pocket Expenses:

Individual Family $3,400 $6,800 Annual Deductible $7,050 $14,100 Maximum Out of Pocket Per Year

Monthly Premiums:

(PPO) Blue Cross� Premier PPO Bronze Extra

Annual Out of Pocket Expenses:

Individual Family $7,500 $15,000 Annual Deductible $9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

(PPO) Blue Cross� Premier PPO Silver Extra

Annual Out of Pocket Expenses:

Individual Family $5,800 $11,600 Annual Deductible $8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

(PPO) Blue Cross� Premier PPO Gold Extra

Annual Out of Pocket Expenses:

Individual Family $2,000 $4,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

Priority Health

(HMO) MyPriority HSA Bronze 7100

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:

(HMO) MyPriority Bronze 9100

Annual Out of Pocket Expenses:

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

Monthly Premiums:

(HMO) MyPriority Telehealth PCP Bronze 9100 - Virtual First

Annual Out of Pocket Expenses:

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

Monthly Premiums:

(HMO) MyPriority Travel Bronze 9100

Annual Out of Pocket Expenses:

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

Monthly Premiums:

(HMO) MyPriority Silver 3600

Annual Out of Pocket Expenses:

Individual Family $3,600 $7,200 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

(HMO) MyPriority Silver 5500

Annual Out of Pocket Expenses:

Individual Family $5,500 $11,000 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

(HMO) MyPriority Telehealth PCP Silver 5500 - Virtual First

Annual Out of Pocket Expenses:

Individual Family $5,500 $11,000 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year

Individual Family

$9,100 $18,200 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Individual Family

$7,500 $15,000 Annual Deductible

$7,500 $15,000 Maximum Out of Pocket Per Year

Individual Family

$2,875 $5,750 Annual Deductible

$8,800 $17,600 Maximum Out of Pocket Per Year

Individual Family

$1,050 $2,100 Annual Deductible

$8,000 $16,000 Maximum Out of Pocket Per Year

Individual Family

$9,100 $18,200 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Individual Family

$3,400 $6,800 Annual Deductible

$7,050 $14,100 Maximum Out of Pocket Per Year

Individual Family

$7,500 $15,000 Annual Deductible

$9,000 $18,000 Maximum Out of Pocket Per Year

Individual Family

$5,800 $11,600 Annual Deductible

$8,900 $17,800 Maximum Out of Pocket Per Year

Individual Family

$2,000 $4,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Individual Family

$7,100 $14,200 Annual Deductible

$7,100 $14,200 Maximum Out of Pocket Per Year

Individual Family

$9,100 $18,200 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Individual Family

$9,100 $18,200 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Individual Family

$9,100 $18,200 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Individual Family

$3,600 $7,200 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Individual Family

$5,500 $11,000 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Individual Family

$5,500 $11,000 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Individual Family

$5,500 $11,000 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Individual Family

$7,500 $15,000 Annual Deductible

$9,000 $18,000 Maximum Out of Pocket Per Year

Individual Family

$5,800 $11,600 Annual Deductible

$8,900 $17,800 Maximum Out of Pocket Per Year

Individual Family

$2,000 $4,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Individual Family

$1,900 $3,800 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Individual Family

$2,500 $5,000 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Individual Family

$2,000 $4,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Individual Family

$5,800 $11,600 Annual Deductible

$8,900 $17,800 Maximum Out of Pocket Per Year

Individual Family

$1,900 $3,800 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Individual Family

$2,500 $5,000 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Individual Family

$8,600 $17,200 Annual Deductible

$8,600 $17,200 Maximum Out of Pocket Per Year

Individual Family

$6,900 $13,800 Annual Deductible

$6,900 $13,800 Maximum Out of Pocket Per Year

Individual Family

$6,000 $12,000 Annual Deductible

$8,500 $17,000 Maximum Out of Pocket Per Year

Individual Family

$1,450 $2,900 Annual Deductible

$7,500 $15,000 Maximum Out of Pocket Per Year

Individual Family

$8,300 $16,600 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Individual Family

$0 $0 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year