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Providers for Zip Code 48043

Obamacare 2017 Marketplace Rates For Macomb County, Michigan

Friday, December 9th, 2016

Click for Mount Clemens, Michigan Forecast

Obamacare Providers, Plans and 2017 Rates for Macomb County

The health insurance rates listed below are for calendar year 2017.

2017 Rates and Providers

(click here for 2014)

(click here for 2015)

(click here for 2016)

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

Currently, there are 90 plans offered in Macomb County.

Below, you’ll find a summary of plans and rates for each of these providers. This chart is designed to give you a preview of your health insurance options. For detailed information on available subsidies to make your coverage affordable, you must complete an application at HealthCare.gov or contact the provider directly.

 

The table below shows premiums for the following scenarios:

  • Individual
  • Couple
  • Couple with 1 2 or 3 children
  • Individual with 1 2 or 3 children
  • A child alone

Each scenario is covered for age

  • Age 21, 30, 40, 50
  • Age 60 (Individual and Couple only)

 

Note: If you are over 65, you qualify for Medicare. Click here to see listings of 2017 Medicare Advantage plans for Macomb County

 

For each plan, there are links that go to the insurance provider's website in a new window. You can find links to:

  • a summary of plan benefits and costs,
  • a plan brochure, and
  • a "Provider Directory" -- where you can find out which doctors and hospitals in the Mount Clemens, MI area accept this insurance coverage as within the plan's "network".

‡Source: HealthCare.gov has released sample rates for all counties in those states served by HealthCare.gov. We have integrated that data into our tables and provide you that information for Macomb County here.

Health Alliance Plan (HAP)

Local: 1-313-872-8100 | Toll Free: 1-855-948-4427

Plan: (HMO) HAP Personal Alliance 6550 HMO (HSA)

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-948-4427 - Provider Directory for This Plan: (Health Alliance Plan (HAP))

Deductible: Individual: $6,550 : Family: $13,100
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$205.75
$233.53
$262.95
$367.47
$558.41
$411.50
$467.06
$525.90
$734.94
$1116.82
$542.15
$597.71
$656.55
$865.59
$672.80
$728.36
$787.20
$996.24
$803.45
$859.01
$917.85
$1126.89
$336.40
$364.18
$393.60
$498.12
$467.05
$494.83
$524.25
$628.77
$597.70
$625.48
$654.90
$759.42
$130.65

Plan: (HMO) HAP Personal Alliance 1000 HMO Henry Ford Choice

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-948-4427 - Provider Directory for This Plan: (Health Alliance Plan (HAP))

Deductible: Individual: $1,000 : Family: $2,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$284.68
$323.11
$363.82
$508.44
$772.62
$569.36
$646.22
$727.64
$1016.88
$1545.24
$750.13
$826.99
$908.41
$1197.65
$930.90
$1007.76
$1089.18
$1378.42
$1111.67
$1188.53
$1269.95
$1559.19
$465.45
$503.88
$544.59
$689.21
$646.22
$684.65
$725.36
$869.98
$826.99
$865.42
$906.13
$1050.75
$180.77

Plan: (HMO) HAP Personal Alliance 6550 HMO (HSA) Henry Ford Choice

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-948-4427 - Provider Directory for This Plan: (Health Alliance Plan (HAP))

Deductible: Individual: $6,550 : Family: $13,100
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$154.37
$175.21
$197.28
$275.70
$418.96
$308.74
$350.42
$394.56
$551.40
$837.92
$406.76
$448.44
$492.58
$649.42
$504.78
$546.46
$590.60
$747.44
$602.80
$644.48
$688.62
$845.46
$252.39
$273.23
$295.30
$373.72
$350.41
$371.25
$393.32
$471.74
$448.43
$469.27
$491.34
$569.76
$98.02

Molina Healthcare of Michigan, Inc.

Local: 1-888-560-4087 | Toll Free: 1-888-560-4087

TTY: 1-888-665-4629

Plan: (HMO) Molina Marketplace Gold Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-560-4087 - Provider Directory for This Plan: (Molina Healthcare of Michigan, Inc.)

Deductible: Individual: $1,025 : Family: $2,050
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$239.32
$271.62
$305.85
$427.42
$649.50
$478.64
$543.24
$611.70
$854.84
$1299.00
$630.61
$695.21
$763.67
$1006.81
$782.58
$847.18
$915.64
$1158.78
$934.55
$999.15
$1067.61
$1310.75
$391.29
$423.59
$457.82
$579.39
$543.26
$575.56
$609.79
$731.36
$695.23
$727.53
$761.76
$883.33
$151.97

Humana Medical Plan of Michigan, Inc.

Local: 1-877-720-4854 | Toll Free: 1-877-720-4854

TTY: 711

Plan: (HMO) Humana Bronze 6550/Detroit HMOx

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana Medical Plan of Michigan, Inc.)

Deductible: Individual: $6,550 : Family: $13,100
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$177.15
$201.07
$226.40
$316.39
$480.79
$354.30
$402.14
$452.80
$632.78
$961.58
$466.79
$514.63
$565.29
$745.27
$579.28
$627.12
$677.78
$857.76
$691.77
$739.61
$790.27
$970.25
$289.64
$313.56
$338.89
$428.88
$402.13
$426.05
$451.38
$541.37
$514.62
$538.54
$563.87
$653.86
$112.49

McLaren Health Plan Community

Local: 1-888-327-0671 | Toll Free: 1-888-327-0671

TTY: 1-800-356-3232

Plan: (HMO) McLaren Rewards Gold

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-327-0671 - Provider Directory for This Plan: (McLaren Health Plan Community)

Deductible: Individual: $1,400 : Family: $2,800
Out of Pocket Maximum per year: Individual: $4,800 : Family: $9,600

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$339.95
$385.85
$434.46
$607.15
$922.63
$679.90
$771.70
$868.92
$1214.30
$1845.26
$895.77
$987.57
$1084.79
$1430.17
$1111.64
$1203.44
$1300.66
$1646.04
$1327.51
$1419.31
$1516.53
$1861.91
$555.82
$601.72
$650.33
$823.02
$771.69
$817.59
$866.20
$1038.89
$987.56
$1033.46
$1082.07
$1254.76
$215.87
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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

Plan: (PPO) Blue Cross® Premier PPO Value

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-288-2738 - Provider Directory for This Plan: (Blue Cross Blue Shield of Michigan Mutual Insurance Company)

Deductible: Individual: $7,150 : Family: $14,300
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Catastrophic 21
30
40
50
60
$191.90
$217.81
$245.25
$342.73
$520.82
$383.80
$435.62
$490.50
$685.46
$1041.64
$505.66
$557.48
$612.36
$807.32
$627.52
$679.34
$734.22
$929.18
$749.38
$801.20
$856.08
$1051.04
$313.76
$339.67
$367.11
$464.59
$435.62
$461.53
$488.97
$586.45
$557.48
$583.39
$610.83
$708.31
$121.86

Plan: (PPO) Blue Cross® Premier PPO Bronze HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-288-2738 - Provider Directory for This Plan: (Blue Cross Blue Shield of Michigan Mutual Insurance Company)

Deductible: Individual: $6,550 : Family: $13,100
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$248.66
$282.23
$317.79
$444.11
$674.86
$497.32
$564.46
$635.58
$888.22
$1349.72
$655.22
$722.36
$793.48
$1046.12
$813.12
$880.26
$951.38
$1204.02
$971.02
$1038.16
$1109.28
$1361.92
$406.56
$440.13
$475.69
$602.01
$564.46
$598.03
$633.59
$759.91
$722.36
$755.93
$791.49
$917.81
$157.90

Plan: (PPO) Blue Cross® Premier PPO Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-288-2738 - Provider Directory for This Plan: (Blue Cross Blue Shield of Michigan Mutual Insurance Company)

Deductible: Individual: $1,800 : Family: $3,600
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$333.39
$378.40
$426.07
$595.43
$904.82
$666.78
$756.80
$852.14
$1190.86
$1809.64
$878.48
$968.50
$1063.84
$1402.56
$1090.18
$1180.20
$1275.54
$1614.26
$1301.88
$1391.90
$1487.24
$1825.96
$545.09
$590.10
$637.77
$807.13
$756.79
$801.80
$849.47
$1018.83
$968.49
$1013.50
$1061.17
$1230.53
$211.70

Plan: (PPO) Blue Cross® Premier PPO Gold

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-288-2738 - Provider Directory for This Plan: (Blue Cross Blue Shield of Michigan Mutual Insurance Company)

Deductible: Individual: $250 : Family: $500
Out of Pocket Maximum per year: Individual: $5,100 : Family: $10,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$411.84
$467.44
$526.33
$735.55
$1117.73
$823.68
$934.88
$1052.66
$1471.10
$2235.46
$1085.20
$1196.40
$1314.18
$1732.62
$1346.72
$1457.92
$1575.70
$1994.14
$1608.24
$1719.44
$1837.22
$2255.66
$673.36
$728.96
$787.85
$997.07
$934.88
$990.48
$1049.37
$1258.59
$1196.40
$1252.00
$1310.89
$1520.11
$261.52

Plan: (PPO) Blue Cross® Premier PPO Bronze Saver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-288-2738 - Provider Directory for This Plan: (Blue Cross Blue Shield of Michigan Mutual Insurance Company)

Deductible: Individual: $7,150 : Family: $14,300
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$231.95
$263.26
$296.43
$414.26
$629.51
$463.90
$526.52
$592.86
$828.52
$1259.02
$611.19
$673.81
$740.15
$975.81
$758.48
$821.10
$887.44
$1123.10
$905.77
$968.39
$1034.73
$1270.39
$379.24
$410.55
$443.72
$561.55
$526.53
$557.84
$591.01
$708.84
$673.82
$705.13
$738.30
$856.13
$147.29

Plan: (PPO) Blue Cross® Premier PPO Silver Saver HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-288-2738 - Provider Directory for This Plan: (Blue Cross Blue Shield of Michigan Mutual Insurance Company)

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: Individual: $4,500 : Family: $9,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$305.63
$346.89
$390.60
$545.86
$829.48
$611.26
$693.78
$781.20
$1091.72
$1658.96
$805.34
$887.86
$975.28
$1285.80
$999.42
$1081.94
$1169.36
$1479.88
$1193.50
$1276.02
$1363.44
$1673.96
$499.71
$540.97
$584.68
$739.94
$693.79
$735.05
$778.76
$934.02
$887.87
$929.13
$972.84
$1128.10
$194.08

Plan: (PPO) Blue Cross® PPO Silver Extra with Dental and Vision, a Multi-State Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-288-2738 - Provider Directory for This Plan: (Blue Cross Blue Shield of Michigan Mutual Insurance Company)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$363.84
$412.96
$464.99
$649.82
$987.46
$727.68
$825.92
$929.98
$1299.64
$1974.92
$958.72
$1056.96
$1161.02
$1530.68
$1189.76
$1288.00
$1392.06
$1761.72
$1420.80
$1519.04
$1623.10
$1992.76
$594.88
$644.00
$696.03
$880.86
$825.92
$875.04
$927.07
$1111.90
$1056.96
$1106.08
$1158.11
$1342.94
$231.04

Plan: (PPO) Blue Cross® PPO Gold Extra with Dental and Vision, a Multi-State Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-288-2738 - Provider Directory for This Plan: (Blue Cross Blue Shield of Michigan Mutual Insurance Company)

Deductible: Individual: $1,250 : Family: $2,500
Out of Pocket Maximum per year: Individual: $4,750 : Family: $9,500

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$454.38
$515.72
$580.70
$811.52
$1233.19
$908.76
$1031.44
$1161.40
$1623.04
$2466.38
$1197.29
$1319.97
$1449.93
$1911.57
$1485.82
$1608.50
$1738.46
$2200.10
$1774.35
$1897.03
$2026.99
$2488.63
$742.91
$804.25
$869.23
$1100.05
$1031.44
$1092.78
$1157.76
$1388.58
$1319.97
$1381.31
$1446.29
$1677.11
$288.53

Plan: (EPO) Blue Cross® Metro Detroit EPO Bronze HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-288-2738 - Provider Directory for This Plan: (Blue Cross Blue Shield of Michigan Mutual Insurance Company)

Deductible: Individual: $6,550 : Family: $13,100
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$226.32
$256.87
$289.24
$404.21
$614.23
$452.64
$513.74
$578.48
$808.42
$1228.46
$596.35
$657.45
$722.19
$952.13
$740.06
$801.16
$865.90
$1095.84
$883.77
$944.87
$1009.61
$1239.55
$370.03
$400.58
$432.95
$547.92
$513.74
$544.29
$576.66
$691.63
$657.45
$688.00
$720.37
$835.34
$143.71

Plan: (EPO) Blue Cross® Metro Detroit EPO Silver Well-Being

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-288-2738 - Provider Directory for This Plan: (Blue Cross Blue Shield of Michigan Mutual Insurance Company)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $6,000 : Family: $12,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$290.11
$329.27
$370.76
$518.14
$787.36
$580.22
$658.54
$741.52
$1036.28
$1574.72
$764.44
$842.76
$925.74
$1220.50
$948.66
$1026.98
$1109.96
$1404.72
$1132.88
$1211.20
$1294.18
$1588.94
$474.33
$513.49
$554.98
$702.36
$658.55
$697.71
$739.20
$886.58
$842.77
$881.93
$923.42
$1070.80
$184.22

Plan: (PPO) Blue Cross® Premier PPO Bronze Extra

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-288-2738 - Provider Directory for This Plan: (Blue Cross Blue Shield of Michigan Mutual Insurance Company)

Deductible: Individual: $6,650 : Family: $13,300
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$258.38
$293.26
$330.21
$461.47
$701.24
$516.76
$586.52
$660.42
$922.94
$1402.48
$680.83
$750.59
$824.49
$1087.01
$844.90
$914.66
$988.56
$1251.08
$1008.97
$1078.73
$1152.63
$1415.15
$422.45
$457.33
$494.28
$625.54
$586.52
$621.40
$658.35
$789.61
$750.59
$785.47
$822.42
$953.68
$164.07

Plan: (PPO) Blue Cross® Premier PPO Silver Extra

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-288-2738 - Provider Directory for This Plan: (Blue Cross Blue Shield of Michigan Mutual Insurance Company)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$346.53
$393.31
$442.87
$618.90
$940.48
$693.06
$786.62
$885.74
$1237.80
$1880.96
$913.11
$1006.67
$1105.79
$1457.85
$1133.16
$1226.72
$1325.84
$1677.90
$1353.21
$1446.77
$1545.89
$1897.95
$566.58
$613.36
$662.92
$838.95
$786.63
$833.41
$882.97
$1059.00
$1006.68
$1053.46
$1103.02
$1279.05
$220.05
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Priority Health

Local: 1-855-682-5217 | Toll Free: 1-855-682-5217

TTY: 1-888-551-6761

Plan: (HMO) MyPriority HMO RxPlus Silver 1900

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-682-5217 - Provider Directory for This Plan: (Priority Health)

Deductible: Individual: $1,900 : Family: $3,800
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$265.88
$301.77
$339.79
$474.86
$721.60
$531.76
$603.54
$679.58
$949.72
$1443.20
$700.59
$772.37
$848.41
$1118.55
$869.42
$941.20
$1017.24
$1287.38
$1038.25
$1110.03
$1186.07
$1456.21
$434.71
$470.60
$508.62
$643.69
$603.54
$639.43
$677.45
$812.52
$772.37
$808.26
$846.28
$981.35
$168.83

Plan: (HMO) MyPriority HMO RxPlus Silver 1800

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-682-5217 - Provider Directory for This Plan: (Priority Health)

Deductible: Individual: $1,800 : Family: $3,600
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$260.03
$295.13
$332.32
$464.41
$705.72
$520.06
$590.26
$664.64
$928.82
$1411.44
$685.18
$755.38
$829.76
$1093.94
$850.30
$920.50
$994.88
$1259.06
$1015.42
$1085.62
$1160.00
$1424.18
$425.15
$460.25
$497.44
$629.53
$590.27
$625.37
$662.56
$794.65
$755.39
$790.49
$827.68
$959.77
$165.12

Plan: (HMO) MyPriority HMO HSA Bronze 6550

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-682-5217 - Provider Directory for This Plan: (Priority Health)

Deductible: Individual: $6,550 : Family: $13,100
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$202.08
$229.36
$258.26
$360.91
$548.45
$404.16
$458.72
$516.52
$721.82
$1096.90
$532.48
$587.04
$644.84
$850.14
$660.80
$715.36
$773.16
$978.46
$789.12
$843.68
$901.48
$1106.78
$330.40
$357.68
$386.58
$489.23
$458.72
$486.00
$514.90
$617.55
$587.04
$614.32
$643.22
$745.87
$128.32

Plan: (HMO) MyPriority HMO RxPlus Bronze 4500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-682-5217 - Provider Directory for This Plan: (Priority Health)

Deductible: Individual: $4,500 : Family: $9,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$212.82
$241.55
$271.98
$380.10
$577.59
$425.64
$483.10
$543.96
$760.20
$1155.18
$560.78
$618.24
$679.10
$895.34
$695.92
$753.38
$814.24
$1030.48
$831.06
$888.52
$949.38
$1165.62
$347.96
$376.69
$407.12
$515.24
$483.10
$511.83
$542.26
$650.38
$618.24
$646.97
$677.40
$785.52
$135.14

Plan: (HMO) MyPriority HMO HSA Silver 1500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-682-5217 - Provider Directory for This Plan: (Priority Health)

Deductible: Individual: $1,500 : Family: $3,000
Out of Pocket Maximum per year: Individual: $5,250 : Family: $10,500

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$267.72
$303.86
$342.15
$478.15
$726.59
$535.44
$607.72
$684.30
$956.30
$1453.18
$705.44
$777.72
$854.30
$1126.30
$875.44
$947.72
$1024.30
$1296.30
$1045.44
$1117.72
$1194.30
$1466.30
$437.72
$473.86
$512.15
$648.15
$607.72
$643.86
$682.15
$818.15
$777.72
$813.86
$852.15
$988.15
$170.00

Plan: (HMO) MyPriority HMO Bronze 6700

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-682-5217 - Provider Directory for This Plan: (Priority Health)

Deductible: Individual: $6,700 : Family: $13,400
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$199.27
$226.17
$254.67
$355.90
$540.82
$398.54
$452.34
$509.34
$711.80
$1081.64
$525.08
$578.88
$635.88
$838.34
$651.62
$705.42
$762.42
$964.88
$778.16
$831.96
$888.96
$1091.42
$325.81
$352.71
$381.21
$482.44
$452.35
$479.25
$507.75
$608.98
$578.89
$605.79
$634.29
$735.52
$126.54

Plan: (HMO) MyPriority HMO Silver 1400

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-682-5217 - Provider Directory for This Plan: (Priority Health)

Deductible: Individual: $1,400 : Family: $2,800
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$266.40
$302.36
$340.46
$475.79
$723.01
$532.80
$604.72
$680.92
$951.58
$1446.02
$701.96
$773.88
$850.08
$1120.74
$871.12
$943.04
$1019.24
$1289.90
$1040.28
$1112.20
$1188.40
$1459.06
$435.56
$471.52
$509.62
$644.95
$604.72
$640.68
$678.78
$814.11
$773.88
$809.84
$847.94
$983.27
$169.16

Plan: (HMO) MyPriority HMO Federal Standard Silver 3500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-682-5217 - Provider Directory for This Plan: (Priority Health)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$270.41
$306.92
$345.58
$482.95
$733.89
$540.82
$613.84
$691.16
$965.90
$1467.78
$712.53
$785.55
$862.87
$1137.61
$884.24
$957.26
$1034.58
$1309.32
$1055.95
$1128.97
$1206.29
$1481.03
$442.12
$478.63
$517.29
$654.66
$613.83
$650.34
$689.00
$826.37
$785.54
$822.05
$860.71
$998.08
$171.71

Plan: (HMO) MyPriority HMO Holistic Bronze 5550

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-682-5217 - Provider Directory for This Plan: (Priority Health)

Deductible: Individual: $5,550 : Family: $11,100
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$209.46
$237.74
$267.69
$374.10
$568.47
$418.92
$475.48
$535.38
$748.20
$1136.94
$551.93
$608.49
$668.39
$881.21
$684.94
$741.50
$801.40
$1014.22
$817.95
$874.51
$934.41
$1147.23
$342.47
$370.75
$400.70
$507.11
$475.48
$503.76
$533.71
$640.12
$608.49
$636.77
$666.72
$773.13
$133.01

Plan: (POS) MyPriority POS HSA Bronze 6550

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-682-5217 - Provider Directory for This Plan: (Priority Health)

Deductible: Individual: $6,550 : Family: $13,100
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$203.52
$231.00
$260.10
$363.49
$552.35
$407.04
$462.00
$520.20
$726.98
$1104.70
$536.28
$591.24
$649.44
$856.22
$665.52
$720.48
$778.68
$985.46
$794.76
$849.72
$907.92
$1114.70
$332.76
$360.24
$389.34
$492.73
$462.00
$489.48
$518.58
$621.97
$591.24
$618.72
$647.82
$751.21
$129.24

Plan: (HMO) MyPriority HMO RxPlus Silver 2500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-682-5217 - Provider Directory for This Plan: (Priority Health)

Deductible: Individual: $2,500 : Family: $5,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$244.51
$277.52
$312.48
$436.69
$663.60
$489.02
$555.04
$624.96
$873.38
$1327.20
$644.28
$710.30
$780.22
$1028.64
$799.54
$865.56
$935.48
$1183.90
$954.80
$1020.82
$1090.74
$1339.16
$399.77
$432.78
$467.74
$591.95
$555.03
$588.04
$623.00
$747.21
$710.29
$743.30
$778.26
$902.47
$155.26

Plan: (HMO) MyPriority HMO Silver 2000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-682-5217 - Provider Directory for This Plan: (Priority Health)

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$251.53
$285.49
$321.46
$449.23
$682.65
$503.06
$570.98
$642.92
$898.46
$1365.30
$662.78
$730.70
$802.64
$1058.18
$822.50
$890.42
$962.36
$1217.90
$982.22
$1050.14
$1122.08
$1377.62
$411.25
$445.21
$481.18
$608.95
$570.97
$604.93
$640.90
$768.67
$730.69
$764.65
$800.62
$928.39
$159.72

Plan: (HMO) MyPriority HMO Holistic Silver 2500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-682-5217 - Provider Directory for This Plan: (Priority Health)

Deductible: Individual: $2,500 : Family: $5,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$248.28
$281.80
$317.30
$443.43
$673.83
$496.56
$563.60
$634.60
$886.86
$1347.66
$654.22
$721.26
$792.26
$1044.52
$811.88
$878.92
$949.92
$1202.18
$969.54
$1036.58
$1107.58
$1359.84
$405.94
$439.46
$474.96
$601.09
$563.60
$597.12
$632.62
$758.75
$721.26
$754.78
$790.28
$916.41
$157.66

Plan: (POS) MyPriority POS RxPlus Silver 1800

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-682-5217 - Provider Directory for This Plan: (Priority Health)

Deductible: Individual: $1,800 : Family: $3,600
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$263.86
$299.48
$337.21
$471.25
$716.12
$527.72
$598.96
$674.42
$942.50
$1432.24
$695.27
$766.51
$841.97
$1110.05
$862.82
$934.06
$1009.52
$1277.60
$1030.37
$1101.61
$1177.07
$1445.15
$431.41
$467.03
$504.76
$638.80
$598.96
$634.58
$672.31
$806.35
$766.51
$802.13
$839.86
$973.90
$167.55

Plan: (POS) MyPriority POS RxPlus Bronze 4500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-682-5217 - Provider Directory for This Plan: (Priority Health)

Deductible: Individual: $4,500 : Family: $9,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$214.96
$243.98
$274.72
$383.92
$583.40
$429.92
$487.96
$549.44
$767.84
$1166.80
$566.42
$624.46
$685.94
$904.34
$702.92
$760.96
$822.44
$1040.84
$839.42
$897.46
$958.94
$1177.34
$351.46
$380.48
$411.22
$520.42
$487.96
$516.98
$547.72
$656.92
$624.46
$653.48
$684.22
$793.42
$136.50

Plan: (POS) MyPriority POS HSA Silver 1500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-682-5217 - Provider Directory for This Plan: (Priority Health)

Deductible: Individual: $1,500 : Family: $3,000
Out of Pocket Maximum per year: Individual: $5,250 : Family: $10,500

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$271.59
$308.25
$347.09
$485.06
$737.10
$543.18
$616.50
$694.18
$970.12
$1474.20
$715.64
$788.96
$866.64
$1142.58
$888.10
$961.42
$1039.10
$1315.04
$1060.56
$1133.88
$1211.56
$1487.50
$444.05
$480.71
$519.55
$657.52
$616.51
$653.17
$692.01
$829.98
$788.97
$825.63
$864.47
$1002.44
$172.46

Plan: (POS) MyPriority POS Bronze 6700

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-682-5217 - Provider Directory for This Plan: (Priority Health)

Deductible: Individual: $6,700 : Family: $13,400
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$200.52
$227.59
$256.26
$358.13
$544.21
$401.04
$455.18
$512.52
$716.26
$1088.42
$528.37
$582.51
$639.85
$843.59
$655.70
$709.84
$767.18
$970.92
$783.03
$837.17
$894.51
$1098.25
$327.85
$354.92
$383.59
$485.46
$455.18
$482.25
$510.92
$612.79
$582.51
$609.58
$638.25
$740.12
$127.33

Plan: (POS) MyPriority POS Silver 1400

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-682-5217 - Provider Directory for This Plan: (Priority Health)

Deductible: Individual: $1,400 : Family: $2,800
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$270.77
$307.32
$346.04
$483.60
$734.87
$541.54
$614.64
$692.08
$967.20
$1469.74
$713.48
$786.58
$864.02
$1139.14
$885.42
$958.52
$1035.96
$1311.08
$1057.36
$1130.46
$1207.90
$1483.02
$442.71
$479.26
$517.98
$655.54
$614.65
$651.20
$689.92
$827.48
$786.59
$823.14
$861.86
$999.42
$171.94

Plan: (POS) MyPriority POS Holistic Bronze 5550

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-682-5217 - Provider Directory for This Plan: (Priority Health)

Deductible: Individual: $5,550 : Family: $11,100
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$210.84
$239.30
$269.45
$376.56
$572.22
$421.68
$478.60
$538.90
$753.12
$1144.44
$555.56
$612.48
$672.78
$887.00
$689.44
$746.36
$806.66
$1020.88
$823.32
$880.24
$940.54
$1154.76
$344.72
$373.18
$403.33
$510.44
$478.60
$507.06
$537.21
$644.32
$612.48
$640.94
$671.09
$778.20
$133.88

Plan: (POS) MyPriority POS Holistic Silver 2500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-682-5217 - Provider Directory for This Plan: (Priority Health)

Deductible: Individual: $2,500 : Family: $5,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$250.67
$284.51
$320.36
$447.70
$680.32
$501.34
$569.02
$640.72
$895.40
$1360.64
$660.52
$728.20
$799.90
$1054.58
$819.70
$887.38
$959.08
$1213.76
$978.88
$1046.56
$1118.26
$1372.94
$409.85
$443.69
$479.54
$606.88
$569.03
$602.87
$638.72
$766.06
$728.21
$762.05
$797.90
$925.24
$159.18

Plan: (POS) MyPriority POS RxPlus Silver 2500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-682-5217 - Provider Directory for This Plan: (Priority Health)

Deductible: Individual: $2,500 : Family: $5,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$247.30
$280.69
$316.05
$441.68
$671.17
$494.60
$561.38
$632.10
$883.36
$1342.34
$651.64
$718.42
$789.14
$1040.40
$808.68
$875.46
$946.18
$1197.44
$965.72
$1032.50
$1103.22
$1354.48
$404.34
$437.73
$473.09
$598.72
$561.38
$594.77
$630.13
$755.76
$718.42
$751.81
$787.17
$912.80
$157.04

Plan: (POS) MyPriority POS Silver 2000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-682-5217 - Provider Directory for This Plan: (Priority Health)

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$254.83
$289.23
$325.67
$455.13
$691.61
$509.66
$578.46
$651.34
$910.26
$1383.22
$671.48
$740.28
$813.16
$1072.08
$833.30
$902.10
$974.98
$1233.90
$995.12
$1063.92
$1136.80
$1395.72
$416.65
$451.05
$487.49
$616.95
$578.47
$612.87
$649.31
$778.77
$740.29
$774.69
$811.13
$940.59
$161.82
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Health Alliance Plan (HAP)

Local: 1-313-872-8100 | Toll Free: 1-855-948-4427

Plan: (HMO) HAP Personal Alliance 2500 HMO

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-948-4427 - Provider Directory for This Plan: (Health Alliance Plan (HAP))

Deductible: Individual: $2,500 : Family: $5,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$325.79
$369.77
$416.36
$581.86
$884.19
$651.58
$739.54
$832.72
$1163.72
$1768.38
$858.46
$946.42
$1039.60
$1370.60
$1065.34
$1153.30
$1246.48
$1577.48
$1272.22
$1360.18
$1453.36
$1784.36
$532.67
$576.65
$623.24
$788.74
$739.55
$783.53
$830.12
$995.62
$946.43
$990.41
$1037.00
$1202.50
$206.88

Plan: (HMO) HAP Personal Alliance 5000 HMO

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-948-4427 - Provider Directory for This Plan: (Health Alliance Plan (HAP))

Deductible: Individual: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$240.78
$273.29
$307.72
$430.03
$653.48
$481.56
$546.58
$615.44
$860.06
$1306.96
$634.46
$699.48
$768.34
$1012.96
$787.36
$852.38
$921.24
$1165.86
$940.26
$1005.28
$1074.14
$1318.76
$393.68
$426.19
$460.62
$582.93
$546.58
$579.09
$613.52
$735.83
$699.48
$731.99
$766.42
$888.73
$152.90

Plan: (HMO) HAP Personal Alliance 5500 HMO (HSA)

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-948-4427 - Provider Directory for This Plan: (Health Alliance Plan (HAP))

Deductible: Individual: $5,500 : Family: $11,000
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$208.08
$236.17
$265.93
$371.63
$564.73
$416.16
$472.34
$531.86
$743.26
$1129.46
$548.29
$604.47
$663.99
$875.39
$680.42
$736.60
$796.12
$1007.52
$812.55
$868.73
$928.25
$1139.65
$340.21
$368.30
$398.06
$503.76
$472.34
$500.43
$530.19
$635.89
$604.47
$632.56
$662.32
$768.02
$132.13

Plan: (HMO) HAP Personal Alliance 7150 HMO

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-948-4427 - Provider Directory for This Plan: (Health Alliance Plan (HAP))

Deductible: Individual: $7,150 : Family: $14,300
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Catastrophic 21
30
40
50
60
$163.48
$185.55
$208.93
$291.98
$443.68
$326.96
$371.10
$417.86
$583.96
$887.36
$430.77
$474.91
$521.67
$687.77
$534.58
$578.72
$625.48
$791.58
$638.39
$682.53
$729.29
$895.39
$267.29
$289.36
$312.74
$395.79
$371.10
$393.17
$416.55
$499.60
$474.91
$496.98
$520.36
$603.41
$103.81

Plan: (HMO) HAP Personal Alliance 3250 HMO

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-948-4427 - Provider Directory for This Plan: (Health Alliance Plan (HAP))

Deductible: Individual: $3,250 : Family: $6,500
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$311.31
$353.34
$397.85
$556.00
$844.90
$622.62
$706.68
$795.70
$1112.00
$1689.80
$820.30
$904.36
$993.38
$1309.68
$1017.98
$1102.04
$1191.06
$1507.36
$1215.66
$1299.72
$1388.74
$1705.04
$508.99
$551.02
$595.53
$753.68
$706.67
$748.70
$793.21
$951.36
$904.35
$946.38
$990.89
$1149.04
$197.68

Plan: (HMO) HAP Personal Alliance 2500 HMO Henry Ford Choice

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-948-4427 - Provider Directory for This Plan: (Health Alliance Plan (HAP))

Deductible: Individual: $2,500 : Family: $5,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$244.51
$277.52
$312.48
$436.69
$663.60
$489.02
$555.04
$624.96
$873.38
$1327.20
$644.28
$710.30
$780.22
$1028.64
$799.54
$865.56
$935.48
$1183.90
$954.80
$1020.82
$1090.74
$1339.16
$399.77
$432.78
$467.74
$591.95
$555.03
$588.04
$623.00
$747.21
$710.29
$743.30
$778.26
$902.47
$155.26

Plan: (HMO) HAP Personal Alliance 5000 HMO Henry Ford Choice

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-948-4427 - Provider Directory for This Plan: (Health Alliance Plan (HAP))

Deductible: Individual: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$180.76
$205.16
$231.01
$322.84
$490.58
$361.52
$410.32
$462.02
$645.68
$981.16
$476.30
$525.10
$576.80
$760.46
$591.08
$639.88
$691.58
$875.24
$705.86
$754.66
$806.36
$990.02
$295.54
$319.94
$345.79
$437.62
$410.32
$434.72
$460.57
$552.40
$525.10
$549.50
$575.35
$667.18
$114.78

Plan: (HMO) HAP Personal Alliance 5500 HMO (HSA) Henry Ford Choice

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-948-4427 - Provider Directory for This Plan: (Health Alliance Plan (HAP))

Deductible: Individual: $5,500 : Family: $11,000
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$156.24
$177.33
$199.67
$279.04
$424.04
$312.48
$354.66
$399.34
$558.08
$848.08
$411.69
$453.87
$498.55
$657.29
$510.90
$553.08
$597.76
$756.50
$610.11
$652.29
$696.97
$855.71
$255.45
$276.54
$298.88
$378.25
$354.66
$375.75
$398.09
$477.46
$453.87
$474.96
$497.30
$576.67
$99.21

Plan: (HMO) HAP Personal Alliance 7150 HMO Henry Ford Choice

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-948-4427 - Provider Directory for This Plan: (Health Alliance Plan (HAP))

Deductible: Individual: $7,150 : Family: $14,300
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Catastrophic 21
30
40
50
60
$122.61
$139.16
$156.70
$218.98
$332.76
$245.22
$278.32
$313.40
$437.96
$665.52
$323.08
$356.18
$391.26
$515.82
$400.94
$434.04
$469.12
$593.68
$478.80
$511.90
$546.98
$671.54
$200.47
$217.02
$234.56
$296.84
$278.33
$294.88
$312.42
$374.70
$356.19
$372.74
$390.28
$452.56
$77.86

Plan: (HMO) HAP Personal Alliance 3250 HMO Henry Ford Choice

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-948-4427 - Provider Directory for This Plan: (Health Alliance Plan (HAP))

Deductible: Individual: $3,250 : Family: $6,500
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$233.77
$265.33
$298.76
$417.51
$634.45
$467.54
$530.66
$597.52
$835.02
$1268.90
$615.98
$679.10
$745.96
$983.46
$764.42
$827.54
$894.40
$1131.90
$912.86
$975.98
$1042.84
$1280.34
$382.21
$413.77
$447.20
$565.95
$530.65
$562.21
$595.64
$714.39
$679.09
$710.65
$744.08
$862.83
$148.44
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Molina Healthcare of Michigan, Inc.

Local: 1-888-560-4087 | Toll Free: 1-888-560-4087

TTY: 1-888-665-4629

Plan: (HMO) Molina Marketplace Silver Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-560-4087 - Provider Directory for This Plan: (Molina Healthcare of Michigan, Inc.)

Deductible: Individual: $2,400 : Family: $4,800
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$185.12
$210.11
$236.58
$330.63
$502.42
$370.24
$420.22
$473.16
$661.26
$1004.84
$487.79
$537.77
$590.71
$778.81
$605.34
$655.32
$708.26
$896.36
$722.89
$772.87
$825.81
$1013.91
$302.67
$327.66
$354.13
$448.18
$420.22
$445.21
$471.68
$565.73
$537.77
$562.76
$589.23
$683.28
$117.55

Plan: (HMO) Molina Marketplace Bronze Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-560-4087 - Provider Directory for This Plan: (Molina Healthcare of Michigan, Inc.)

Deductible: Individual: $6,650 : Family: $13,300
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$150.35
$170.65
$192.15
$268.52
$408.05
$300.70
$341.30
$384.30
$537.04
$816.10
$396.17
$436.77
$479.77
$632.51
$491.64
$532.24
$575.24
$727.98
$587.11
$627.71
$670.71
$823.45
$245.82
$266.12
$287.62
$363.99
$341.29
$361.59
$383.09
$459.46
$436.76
$457.06
$478.56
$554.93
$95.47

Plan: (HMO) Molina Marketplace Options Silver Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-560-4087 - Provider Directory for This Plan: (Molina Healthcare of Michigan, Inc.)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$186.95
$212.18
$238.92
$333.89
$507.37
$373.90
$424.36
$477.84
$667.78
$1014.74
$492.61
$543.07
$596.55
$786.49
$611.32
$661.78
$715.26
$905.20
$730.03
$780.49
$833.97
$1023.91
$305.66
$330.89
$357.63
$452.60
$424.37
$449.60
$476.34
$571.31
$543.08
$568.31
$595.05
$690.02
$118.71

Plan: (HMO) Molina Marketplace Options Bronze Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-560-4087 - Provider Directory for This Plan: (Molina Healthcare of Michigan, Inc.)

Deductible: Individual: $6,650 : Family: $13,300
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$153.19
$173.87
$195.78
$273.60
$415.76
$306.38
$347.74
$391.56
$547.20
$831.52
$403.66
$445.02
$488.84
$644.48
$500.94
$542.30
$586.12
$741.76
$598.22
$639.58
$683.40
$839.04
$250.47
$271.15
$293.06
$370.88
$347.75
$368.43
$390.34
$468.16
$445.03
$465.71
$487.62
$565.44
$97.28
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Humana Medical Plan of Michigan, Inc.

Local: 1-877-720-4854 | Toll Free: 1-877-720-4854

TTY: 711

Plan: (HMO) Humana Basic 7150/Detroit HMOx

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana Medical Plan of Michigan, Inc.)

Deductible: Individual: $7,150 : Family: $14,300
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Catastrophic 21
30
40
50
60
$136.31
$154.71
$174.20
$243.45
$369.95
$272.62
$309.42
$348.40
$486.90
$739.90
$359.18
$395.98
$434.96
$573.46
$445.74
$482.54
$521.52
$660.02
$532.30
$569.10
$608.08
$746.58
$222.87
$241.27
$260.76
$330.01
$309.43
$327.83
$347.32
$416.57
$395.99
$414.39
$433.88
$503.13
$86.56

Plan: (HMO) Humana Silver 3550/Detroit HMOx

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana Medical Plan of Michigan, Inc.)

Deductible: Individual: $3,550 : Family: $7,100
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$226.65
$257.25
$289.66
$404.80
$615.13
$453.30
$514.50
$579.32
$809.60
$1230.26
$597.22
$658.42
$723.24
$953.52
$741.14
$802.34
$867.16
$1097.44
$885.06
$946.26
$1011.08
$1241.36
$370.57
$401.17
$433.58
$548.72
$514.49
$545.09
$577.50
$692.64
$658.41
$689.01
$721.42
$836.56
$143.92

Meridian Health Plan of Michigan, Inc.

Local: 1-855-537-9746 | Toll Free: 1-855-537-9746

Plan: (HMO) Meridian Catastrophic

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-537-9746 - Provider Directory for This Plan: (Meridian Health Plan of Michigan, Inc.)

Deductible: Individual: $7,150 : Family: $14,300
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Catastrophic 21
30
40
50
60
$147.33
$167.20
$188.27
$263.11
$399.82
$294.66
$334.40
$376.54
$526.22
$799.64
$388.21
$427.95
$470.09
$619.77
$481.76
$521.50
$563.64
$713.32
$575.31
$615.05
$657.19
$806.87
$240.88
$260.75
$281.82
$356.66
$334.43
$354.30
$375.37
$450.21
$427.98
$447.85
$468.92
$543.76
$93.55

Plan: (HMO) Meridian Healthy Bronze

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-537-9746 - Provider Directory for This Plan: (Meridian Health Plan of Michigan, Inc.)

Deductible: Individual: $7,150 : Family: $14,300
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$158.12
$179.45
$202.06
$282.38
$429.11
$316.24
$358.90
$404.12
$564.76
$858.22
$416.64
$459.30
$504.52
$665.16
$517.04
$559.70
$604.92
$765.56
$617.44
$660.10
$705.32
$865.96
$258.52
$279.85
$302.46
$382.78
$358.92
$380.25
$402.86
$483.18
$459.32
$480.65
$503.26
$583.58
$100.40

Plan: (HMO) Meridian Healthy Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-537-9746 - Provider Directory for This Plan: (Meridian Health Plan of Michigan, Inc.)

Deductible: Individual: $5,400 : Family: $10,800
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$182.61
$207.25
$233.36
$326.12
$495.58
$365.22
$414.50
$466.72
$652.24
$991.16
$481.17
$530.45
$582.67
$768.19
$597.12
$646.40
$698.62
$884.14
$713.07
$762.35
$814.57
$1000.09
$298.56
$323.20
$349.31
$442.07
$414.51
$439.15
$465.26
$558.02
$530.46
$555.10
$581.21
$673.97
$115.95

Plan: (HMO) Meridian Healthy Gold

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-537-9746 - Provider Directory for This Plan: (Meridian Health Plan of Michigan, Inc.)

Deductible: Individual: $2,200 : Family: $4,400
Out of Pocket Maximum per year: Individual: $3,500 : Family: $7,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$245.19
$278.27
$313.33
$437.88
$665.41
$490.38
$556.54
$626.66
$875.76
$1330.82
$646.07
$712.23
$782.35
$1031.45
$801.76
$867.92
$938.04
$1187.14
$957.45
$1023.61
$1093.73
$1342.83
$400.88
$433.96
$469.02
$593.57
$556.57
$589.65
$624.71
$749.26
$712.26
$745.34
$780.40
$904.95
$155.69

Plan: (HMO) Meridian Smart Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-537-9746 - Provider Directory for This Plan: (Meridian Health Plan of Michigan, Inc.)

Deductible: Individual: $0 : Family: $0
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$247.87
$281.32
$316.76
$442.67
$672.68
$495.74
$562.64
$633.52
$885.34
$1345.36
$653.13
$720.03
$790.91
$1042.73
$810.52
$877.42
$948.30
$1200.12
$967.91
$1034.81
$1105.69
$1357.51
$405.26
$438.71
$474.15
$600.06
$562.65
$596.10
$631.54
$757.45
$720.04
$753.49
$788.93
$914.84
$157.39

Plan: (HMO) Meridian Standard Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-537-9746 - Provider Directory for This Plan: (Meridian Health Plan of Michigan, Inc.)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$225.30
$255.71
$287.92
$402.37
$611.44
$450.60
$511.42
$575.84
$804.74
$1222.88
$593.66
$654.48
$718.90
$947.80
$736.72
$797.54
$861.96
$1090.86
$879.78
$940.60
$1005.02
$1233.92
$368.36
$398.77
$430.98
$545.43
$511.42
$541.83
$574.04
$688.49
$654.48
$684.89
$717.10
$831.55
$143.06
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Total Health Care USA, Inc.

Local: 1-313-871-2000 x350 | Toll Free: 1-800-826-2862

TTY: 1-800-649-3777

Plan: (HMO) Total HMO Standard

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-826-2862 - Provider Directory for This Plan: (Total Health Care USA, Inc.)

Deductible: Individual: $750 : Family: $1,500
Out of Pocket Maximum per year: Individual: $5,000 : Family: $10,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$243.58
$276.45
$311.28
$435.01
$661.04
$487.16
$552.90
$622.56
$870.02
$1322.08
$641.82
$707.56
$777.22
$1024.68
$796.48
$862.22
$931.88
$1179.34
$951.14
$1016.88
$1086.54
$1334.00
$398.24
$431.11
$465.94
$589.67
$552.90
$585.77
$620.60
$744.33
$707.56
$740.43
$775.26
$898.99
$154.66

Plan: (HMO) Totally You

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-826-2862 - Provider Directory for This Plan: (Total Health Care USA, Inc.)

Deductible: Individual: $3,000 : Family: $6,000
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$209.80
$238.11
$268.11
$374.68
$569.37
$419.60
$476.22
$536.22
$749.36
$1138.74
$552.82
$609.44
$669.44
$882.58
$686.04
$742.66
$802.66
$1015.80
$819.26
$875.88
$935.88
$1149.02
$343.02
$371.33
$401.33
$507.90
$476.24
$504.55
$534.55
$641.12
$609.46
$637.77
$667.77
$774.34
$133.22

Plan: (HMO) Totally You - Complete

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-826-2862 - Provider Directory for This Plan: (Total Health Care USA, Inc.)

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: Individual: $6,000 : Family: $12,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$191.13
$216.92
$244.25
$341.34
$518.70
$382.26
$433.84
$488.50
$682.68
$1037.40
$503.62
$555.20
$609.86
$804.04
$624.98
$676.56
$731.22
$925.40
$746.34
$797.92
$852.58
$1046.76
$312.49
$338.28
$365.61
$462.70
$433.85
$459.64
$486.97
$584.06
$555.21
$581.00
$608.33
$705.42
$121.36

Plan: (HMO) Totally You - Standardized

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-826-2862 - Provider Directory for This Plan: (Total Health Care USA, Inc.)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$210.22
$238.59
$268.65
$375.43
$570.51
$420.44
$477.18
$537.30
$750.86
$1141.02
$553.92
$610.66
$670.78
$884.34
$687.40
$744.14
$804.26
$1017.82
$820.88
$877.62
$937.74
$1151.30
$343.70
$372.07
$402.13
$508.91
$477.18
$505.55
$535.61
$642.39
$610.66
$639.03
$669.09
$775.87
$133.48

Plan: (HMO) Total Saver Plus

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-826-2862 - Provider Directory for This Plan: (Total Health Care USA, Inc.)

Deductible: Individual: $5,500 : Family: $11,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$162.39
$184.30
$207.52
$290.01
$440.69
$324.78
$368.60
$415.04
$580.02
$881.38
$427.89
$471.71
$518.15
$683.13
$531.00
$574.82
$621.26
$786.24
$634.11
$677.93
$724.37
$889.35
$265.50
$287.41
$310.63
$393.12
$368.61
$390.52
$413.74
$496.23
$471.72
$493.63
$516.85
$599.34
$103.11

Plan: (HMO) Total Saver Complete

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-826-2862 - Provider Directory for This Plan: (Total Health Care USA, Inc.)

Deductible: Individual: $7,150 : Family: $14,300
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$158.40
$179.77
$202.42
$282.89
$429.87
$316.80
$359.54
$404.84
$565.78
$859.74
$417.38
$460.12
$505.42
$666.36
$517.96
$560.70
$606.00
$766.94
$618.54
$661.28
$706.58
$867.52
$258.98
$280.35
$303.00
$383.47
$359.56
$380.93
$403.58
$484.05
$460.14
$481.51
$504.16
$584.63
$100.58

McLaren Health Plan Community

Local: 1-888-327-0671 | Toll Free: 1-888-327-0671

TTY: 1-800-356-3232

Plan: (HMO) McLaren Rewards Platinum

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-327-0671 - Provider Directory for This Plan: (McLaren Health Plan Community)

Deductible: Individual: $500 : Family: $1,000
Out of Pocket Maximum per year: Individual: $1,250 : Family: $2,500

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Platinum 21
30
40
50
60
$387.52
$439.84
$495.25
$692.11
$1051.73
$775.04
$879.68
$990.50
$1384.22
$2103.46
$1021.12
$1125.76
$1236.58
$1630.30
$1267.20
$1371.84
$1482.66
$1876.38
$1513.28
$1617.92
$1728.74
$2122.46
$633.60
$685.92
$741.33
$938.19
$879.68
$932.00
$987.41
$1184.27
$1125.76
$1178.08
$1233.49
$1430.35
$246.08

Plan: (HMO) McLaren Young Adult/Catastrophic

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-327-0671 - Provider Directory for This Plan: (McLaren Health Plan Community)

Deductible: Individual: $7,150 : Family: $14,300
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Catastrophic 21
30
40
50
60
$187.40
$212.69
$239.49
$334.69
$508.59
$374.80
$425.38
$478.98
$669.38
$1017.18
$493.80
$544.38
$597.98
$788.38
$612.80
$663.38
$716.98
$907.38
$731.80
$782.38
$835.98
$1026.38
$306.40
$331.69
$358.49
$453.69
$425.40
$450.69
$477.49
$572.69
$544.40
$569.69
$596.49
$691.69
$119.00

Plan: (HMO) Silver Standard Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-327-0671 - Provider Directory for This Plan: (McLaren Health Plan Community)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$241.21
$273.77
$308.26
$430.80
$654.64
$482.42
$547.54
$616.52
$861.60
$1309.28
$635.59
$700.71
$769.69
$1014.77
$788.76
$853.88
$922.86
$1167.94
$941.93
$1007.05
$1076.03
$1321.11
$394.38
$426.94
$461.43
$583.97
$547.55
$580.11
$614.60
$737.14
$700.72
$733.28
$767.77
$890.31
$153.17

Plan: (HMO) Gold Standard Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-327-0671 - Provider Directory for This Plan: (McLaren Health Plan Community)

Deductible: Individual: $1,250 : Family: $2,500
Out of Pocket Maximum per year: Individual: $4,750 : Family: $9,500

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$311.50
$353.56
$398.10
$556.34
$845.42
$623.00
$707.12
$796.20
$1112.68
$1690.84
$820.80
$904.92
$994.00
$1310.48
$1018.60
$1102.72
$1191.80
$1508.28
$1216.40
$1300.52
$1389.60
$1706.08
$509.30
$551.36
$595.90
$754.14
$707.10
$749.16
$793.70
$951.94
$904.90
$946.96
$991.50
$1149.74
$197.80

Plan: (HMO) McLaren Bronze

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-327-0671 - Provider Directory for This Plan: (McLaren Health Plan Community)

Deductible: Individual: $6,000 : Family: $12,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$184.77
$209.71
$236.14
$330.00
$501.46
$369.54
$419.42
$472.28
$660.00
$1002.92
$486.87
$536.75
$589.61
$777.33
$604.20
$654.08
$706.94
$894.66
$721.53
$771.41
$824.27
$1011.99
$302.10
$327.04
$353.47
$447.33
$419.43
$444.37
$470.80
$564.66
$536.76
$561.70
$588.13
$681.99
$117.33

Blue Care Network of Michigan

Local: 1-800-662-6667 | Toll Free: 1-800-662-6667

TTY: 1-800-257-9980

Plan: (HMO) Blue Cross® Select HMO Value

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-662-6667 - Provider Directory for This Plan: (Blue Care Network of Michigan)

Deductible: Individual: $7,150 : Family: $14,300
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Catastrophic 21
30
40
50
60
$157.44
$178.69
$201.21
$281.19
$427.29
$314.88
$357.38
$402.42
$562.38
$854.58
$414.85
$457.35
$502.39
$662.35
$514.82
$557.32
$602.36
$762.32
$614.79
$657.29
$702.33
$862.29
$257.41
$278.66
$301.18
$381.16
$357.38
$378.63
$401.15
$481.13
$457.35
$478.60
$501.12
$581.10
$99.97

Plan: (HMO) Blue Cross® Select HMO Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-662-6667 - Provider Directory for This Plan: (Blue Care Network of Michigan)

Deductible: Individual: $1,650 : Family: $3,300
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$247.02
$280.37
$315.69
$441.18
$670.41
$494.04
$560.74
$631.38
$882.36
$1340.82
$650.90
$717.60
$788.24
$1039.22
$807.76
$874.46
$945.10
$1196.08
$964.62
$1031.32
$1101.96
$1352.94
$403.88
$437.23
$472.55
$598.04
$560.74
$594.09
$629.41
$754.90
$717.60
$750.95
$786.27
$911.76
$156.86

Plan: (HMO) Blue Cross® Preferred HMO Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-662-6667 - Provider Directory for This Plan: (Blue Care Network of Michigan)

Deductible: Individual: $1,650 : Family: $3,300
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$268.31
$304.53
$342.90
$479.20
$728.19
$536.62
$609.06
$685.80
$958.40
$1456.38
$707.00
$779.44
$856.18
$1128.78
$877.38
$949.82
$1026.56
$1299.16
$1047.76
$1120.20
$1196.94
$1469.54
$438.69
$474.91
$513.28
$649.58
$609.07
$645.29
$683.66
$819.96
$779.45
$815.67
$854.04
$990.34
$170.38

Plan: (HMO) Blue Cross® Select HMO Gold

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-662-6667 - Provider Directory for This Plan: (Blue Care Network of Michigan)

Deductible: Individual: $250 : Family: $500
Out of Pocket Maximum per year: Individual: $5,100 : Family: $10,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$325.39
$369.32
$415.85
$581.15
$883.11
$650.78
$738.64
$831.70
$1162.30
$1766.22
$857.40
$945.26
$1038.32
$1368.92
$1064.02
$1151.88
$1244.94
$1575.54
$1270.64
$1358.50
$1451.56
$1782.16
$532.01
$575.94
$622.47
$787.77
$738.63
$782.56
$829.09
$994.39
$945.25
$989.18
$1035.71
$1201.01
$206.62

Plan: (HMO) Blue Cross® Metro Detroit HMO Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-662-6667 - Provider Directory for This Plan: (Blue Care Network of Michigan)

Deductible: Individual: $1,650 : Family: $3,300
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$223.95
$254.18
$286.21
$399.97
$607.80
$447.90
$508.36
$572.42
$799.94
$1215.60
$590.11
$650.57
$714.63
$942.15
$732.32
$792.78
$856.84
$1084.36
$874.53
$934.99
$999.05
$1226.57
$366.16
$396.39
$428.42
$542.18
$508.37
$538.60
$570.63
$684.39
$650.58
$680.81
$712.84
$826.60
$142.21

Plan: (HMO) Blue Cross® Select HMO Silver Saver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-662-6667 - Provider Directory for This Plan: (Blue Care Network of Michigan)

Deductible: Individual: $4,500 : Family: $9,000
Out of Pocket Maximum per year: Individual: $5,500 : Family: $11,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$225.14
$255.53
$287.73
$402.10
$611.03
$450.28
$511.06
$575.46
$804.20
$1222.06
$593.24
$654.02
$718.42
$947.16
$736.20
$796.98
$861.38
$1090.12
$879.16
$939.94
$1004.34
$1233.08
$368.10
$398.49
$430.69
$545.06
$511.06
$541.45
$573.65
$688.02
$654.02
$684.41
$716.61
$830.98
$142.96

Plan: (HMO) Blue Cross® Metro Detroit HMO Silver Saver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-662-6667 - Provider Directory for This Plan: (Blue Care Network of Michigan)

Deductible: Individual: $4,500 : Family: $9,000
Out of Pocket Maximum per year: Individual: $5,500 : Family: $11,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$204.11
$231.66
$260.85
$364.54
$553.95
$408.22
$463.32
$521.70
$729.08
$1107.90
$537.83
$592.93
$651.31
$858.69
$667.44
$722.54
$780.92
$988.30
$797.05
$852.15
$910.53
$1117.91
$333.72
$361.27
$390.46
$494.15
$463.33
$490.88
$520.07
$623.76
$592.94
$620.49
$649.68
$753.37
$129.61

Plan: (HMO) Blue Cross® Select HMO Bronze HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-662-6667 - Provider Directory for This Plan: (Blue Care Network of Michigan)

Deductible: Individual: $5,950 : Family: $11,900
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$190.40
$216.10
$243.33
$340.05
$516.75
$380.80
$432.20
$486.66
$680.10
$1033.50
$501.70
$553.10
$607.56
$801.00
$622.60
$674.00
$728.46
$921.90
$743.50
$794.90
$849.36
$1042.80
$311.30
$337.00
$364.23
$460.95
$432.20
$457.90
$485.13
$581.85
$553.10
$578.80
$606.03
$702.75
$120.90

Plan: (HMO) Blue Cross® Preferred HMO Bronze HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-662-6667 - Provider Directory for This Plan: (Blue Care Network of Michigan)

Deductible: Individual: $5,950 : Family: $11,900
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$206.80
$234.72
$264.29
$369.34
$561.26
$413.60
$469.44
$528.58
$738.68
$1122.52
$544.92
$600.76
$659.90
$870.00
$676.24
$732.08
$791.22
$1001.32
$807.56
$863.40
$922.54
$1132.64
$338.12
$366.04
$395.61
$500.66
$469.44
$497.36
$526.93
$631.98
$600.76
$628.68
$658.25
$763.30
$131.32

Plan: (HMO) Blue Cross® Metro Detroit HMO Bronze HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-662-6667 - Provider Directory for This Plan: (Blue Care Network of Michigan)

Deductible: Individual: $5,950 : Family: $11,900
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$172.61
$195.91
$220.60
$308.28
$468.46
$345.22
$391.82
$441.20
$616.56
$936.92
$454.83
$501.43
$550.81
$726.17
$564.44
$611.04
$660.42
$835.78
$674.05
$720.65
$770.03
$945.39
$282.22
$305.52
$330.21
$417.89
$391.83
$415.13
$439.82
$527.50
$501.44
$524.74
$549.43
$637.11
$109.61

Plan: (HMO) Blue Cross® Select HMO Bronze Saver HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-662-6667 - Provider Directory for This Plan: (Blue Care Network of Michigan)

Deductible: Individual: $6,550 : Family: $13,100
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$179.25
$203.45
$229.08
$320.14
$486.48
$358.50
$406.90
$458.16
$640.28
$972.96
$472.32
$520.72
$571.98
$754.10
$586.14
$634.54
$685.80
$867.92
$699.96
$748.36
$799.62
$981.74
$293.07
$317.27
$342.90
$433.96
$406.89
$431.09
$456.72
$547.78
$520.71
$544.91
$570.54
$661.60
$113.82

Plan: (HMO) Blue Cross® Metro Detroit HMO Bronze Saver HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-662-6667 - Provider Directory for This Plan: (Blue Care Network of Michigan)

Deductible: Individual: $6,550 : Family: $13,100
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$162.52
$184.46
$207.70
$290.26
$441.08
$325.04
$368.92
$415.40
$580.52
$882.16
$428.24
$472.12
$518.60
$683.72
$531.44
$575.32
$621.80
$786.92
$634.64
$678.52
$725.00
$890.12
$265.72
$287.66
$310.90
$393.46
$368.92
$390.86
$414.10
$496.66
$472.12
$494.06
$517.30
$599.86
$103.20

Plan: (HMO) Blue Cross® Select HMO Silver Extra

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-662-6667 - Provider Directory for This Plan: (Blue Care Network of Michigan)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$257.79
$292.59
$329.46
$460.41
$699.64
$515.58
$585.18
$658.92
$920.82
$1399.28
$679.28
$748.88
$822.62
$1084.52
$842.98
$912.58
$986.32
$1248.22
$1006.68
$1076.28
$1150.02
$1411.92
$421.49
$456.29
$493.16
$624.11
$585.19
$619.99
$656.86
$787.81
$748.89
$783.69
$820.56
$951.51
$163.70

Plan: (HMO) Blue Cross® Preferred HMO Silver Extra

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-662-6667 - Provider Directory for This Plan: (Blue Care Network of Michigan)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$280.00
$317.80
$357.84
$500.08
$759.92
$560.00
$635.60
$715.68
$1000.16
$1519.84
$737.80
$813.40
$893.48
$1177.96
$915.60
$991.20
$1071.28
$1355.76
$1093.40
$1169.00
$1249.08
$1533.56
$457.80
$495.60
$535.64
$677.88
$635.60
$673.40
$713.44
$855.68
$813.40
$851.20
$891.24
$1033.48
$177.80

Plan: (HMO) Blue Cross® Metro Detroit HMO Silver Extra

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-662-6667 - Provider Directory for This Plan: (Blue Care Network of Michigan)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$233.70
$265.25
$298.67
$417.39
$634.26
$467.40
$530.50
$597.34
$834.78
$1268.52
$615.80
$678.90
$745.74
$983.18
$764.20
$827.30
$894.14
$1131.58
$912.60
$975.70
$1042.54
$1279.98
$382.10
$413.65
$447.07
$565.79
$530.50
$562.05
$595.47
$714.19
$678.90
$710.45
$743.87
$862.59
$148.40

Plan: (HMO) Blue Cross® Select HMO Bronze Extra

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-662-6667 - Provider Directory for This Plan: (Blue Care Network of Michigan)

Deductible: Individual: $6,650 : Family: $13,300
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$214.65
$243.63
$274.32
$383.36
$582.56
$429.30
$487.26
$548.64
$766.72
$1165.12
$565.60
$623.56
$684.94
$903.02
$701.90
$759.86
$821.24
$1039.32
$838.20
$896.16
$957.54
$1175.62
$350.95
$379.93
$410.62
$519.66
$487.25
$516.23
$546.92
$655.96
$623.55
$652.53
$683.22
$792.26
$136.30

Plan: (HMO) Blue Cross® Metro Detroit HMO Bronze Extra

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-662-6667 - Provider Directory for This Plan: (Blue Care Network of Michigan)

Deductible: Individual: $6,650 : Family: $13,300
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$194.60
$220.87
$248.70
$347.56
$528.14
$389.20
$441.74
$497.40
$695.12
$1056.28
$512.77
$565.31
$620.97
$818.69
$636.34
$688.88
$744.54
$942.26
$759.91
$812.45
$868.11
$1065.83
$318.17
$344.44
$372.27
$471.13
$441.74
$468.01
$495.84
$594.70
$565.31
$591.58
$619.41
$718.27
$123.57