Obamacare 2023 Rates for Lawrence County

Obamacare > Rates > Missouri > Lawrence 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 Lawrence County, MO.

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, 85 Plans and 2023 Rates for Lawrence County, Missouri

Below, you’ll find a summary of the 85 plans for Lawrence County, Missouri and rates for each of these providers.‡ This chart is designed to give you a preview of your health insurance options.

Anthem Blue Cross and Blue Shield

Local: 1-855-738-6677 | Toll Free: 1-855-738-6677

Toc - Plan #1 Anthem Blue Cross and Blue Shield

Silver

(EPO) Anthem Silver Pathway X 3100 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-738-6677

Annual Out of Pocket Expenses:

Individual Family

$3,100 $6,200 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

$451.64
$512.61
$577.20
$806.63
$1,225.75

$797.14
$858.11
$922.70
$1,152.13

$1,142.64
$1,203.61
$1,268.20
$1,497.63

$1,488.14
$1,549.11
$1,613.70
$1,843.13

$345.50

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$903.28
$1,025.22
$1,154.40
$1,613.26
$2,451.50

$1,248.78
$1,370.72
$1,499.90
$1,958.76

$1,594.28
$1,716.22
$1,845.40
$2,304.26

$1,939.78
$2,061.72
$2,190.90
$2,649.76

$345.50

Toc - Plan #2 Anthem Blue Cross and Blue Shield

Expanded Bronze

(EPO) Anthem Bronze Pathway X 6800 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-738-6677

Annual Out of Pocket Expenses:

Individual Family

$6,800 $13,600 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

$373.14
$423.51
$476.87
$666.43
$1,012.70

$658.59
$708.96
$762.32
$951.88

$944.04
$994.41
$1,047.77
$1,237.33

$1,229.49
$1,279.86
$1,333.22
$1,522.78

$285.45

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$746.28
$847.02
$953.74
$1,332.86
$2,025.40

$1,031.73
$1,132.47
$1,239.19
$1,618.31

$1,317.18
$1,417.92
$1,524.64
$1,903.76

$1,602.63
$1,703.37
$1,810.09
$2,189.21

$285.45

Toc - Plan #3 Anthem Blue Cross and Blue Shield

Expanded Bronze

(EPO) Anthem Bronze Pathway X 0% for HSA

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-738-6677

Annual Out of Pocket Expenses:

Individual Family

$7,450 $14,900 Annual Deductible

$7,450 $14,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$371.80
$421.99
$475.16
$664.03
$1,009.07

$656.23
$706.42
$759.59
$948.46

$940.66
$990.85
$1,044.02
$1,232.89

$1,225.09
$1,275.28
$1,328.45
$1,517.32

$284.43

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$743.60
$843.98
$950.32
$1,328.06
$2,018.14

$1,028.03
$1,128.41
$1,234.75
$1,612.49

$1,312.46
$1,412.84
$1,519.18
$1,896.92

$1,596.89
$1,697.27
$1,803.61
$2,181.35

$284.43

Toc - Plan #4 Anthem Blue Cross and Blue Shield

Expanded Bronze

(EPO) Anthem Bronze Pathway X 20% for HSA

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-738-6677

Annual Out of Pocket Expenses:

Individual Family

$5,900 $11,800 Annual Deductible

$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$376.20
$426.99
$480.78
$671.89
$1,021.01

$663.99
$714.78
$768.57
$959.68

$951.78
$1,002.57
$1,056.36
$1,247.47

$1,239.57
$1,290.36
$1,344.15
$1,535.26

$287.79

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$752.40
$853.98
$961.56
$1,343.78
$2,042.02

$1,040.19
$1,141.77
$1,249.35
$1,631.57

$1,327.98
$1,429.56
$1,537.14
$1,919.36

$1,615.77
$1,717.35
$1,824.93
$2,207.15

$287.79

Toc - Plan #5 Anthem Blue Cross and Blue Shield

Silver

(EPO) Anthem Silver Pathway X 3900 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-738-6677

Annual Out of Pocket Expenses:

Individual Family

$3,900 $7,800 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

$449.36
$510.02
$574.28
$802.56
$1,219.56

$793.12
$853.78
$918.04
$1,146.32

$1,136.88
$1,197.54
$1,261.80
$1,490.08

$1,480.64
$1,541.30
$1,605.56
$1,833.84

$343.76

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$898.72
$1,020.04
$1,148.56
$1,605.12
$2,439.12

$1,242.48
$1,363.80
$1,492.32
$1,948.88

$1,586.24
$1,707.56
$1,836.08
$2,292.64

$1,930.00
$2,051.32
$2,179.84
$2,636.40

$343.76

Toc - Plan #6 Anthem Blue Cross and Blue Shield

Silver

(EPO) Anthem Silver Pathway X 3000 for HSA

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-738-6677

Annual Out of Pocket Expenses:

Individual Family

$3,000 $6,000 Annual Deductible

$6,450 $12,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$450.78
$511.64
$576.10
$805.09
$1,223.42

$795.63
$856.49
$920.95
$1,149.94

$1,140.48
$1,201.34
$1,265.80
$1,494.79

$1,485.33
$1,546.19
$1,610.65
$1,839.64

$344.85

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$901.56
$1,023.28
$1,152.20
$1,610.18
$2,446.84

$1,246.41
$1,368.13
$1,497.05
$1,955.03

$1,591.26
$1,712.98
$1,841.90
$2,299.88

$1,936.11
$2,057.83
$2,186.75
$2,644.73

$344.85

Toc - Plan #7 Anthem Blue Cross and Blue Shield

Expanded Bronze

(EPO) Anthem Bronze Pathway X 6500 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-738-6677

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

$370.53
$420.55
$473.54
$661.77
$1,005.62

$653.99
$704.01
$757.00
$945.23

$937.45
$987.47
$1,040.46
$1,228.69

$1,220.91
$1,270.93
$1,323.92
$1,512.15

$283.46

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$741.06
$841.10
$947.08
$1,323.54
$2,011.24

$1,024.52
$1,124.56
$1,230.54
$1,607.00

$1,307.98
$1,408.02
$1,514.00
$1,890.46

$1,591.44
$1,691.48
$1,797.46
$2,173.92

$283.46

Toc - Plan #8 Anthem Blue Cross and Blue Shield

Silver

(EPO) Anthem Silver Pathway X 5400 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-738-6677

Annual Out of Pocket Expenses:

Individual Family

$5,400 $10,800 Annual Deductible

$8,300 $16,600 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

$441.74
$501.37
$564.54
$788.95
$1,198.88

$779.67
$839.30
$902.47
$1,126.88

$1,117.60
$1,177.23
$1,240.40
$1,464.81

$1,455.53
$1,515.16
$1,578.33
$1,802.74

$337.93

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$883.48
$1,002.74
$1,129.08
$1,577.90
$2,397.76

$1,221.41
$1,340.67
$1,467.01
$1,915.83

$1,559.34
$1,678.60
$1,804.94
$2,253.76

$1,897.27
$2,016.53
$2,142.87
$2,591.69

$337.93

Toc - Plan #9 Anthem Blue Cross and Blue Shield

Silver

(EPO) Anthem Silver Pathway X 6500 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-738-6677

Annual Out of Pocket Expenses:

Individual Family

$6,500 $13,000 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

$438.89
$498.14
$560.90
$783.86
$1,191.15

$774.64
$833.89
$896.65
$1,119.61

$1,110.39
$1,169.64
$1,232.40
$1,455.36

$1,446.14
$1,505.39
$1,568.15
$1,791.11

$335.75

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$877.78
$996.28
$1,121.80
$1,567.72
$2,382.30

$1,213.53
$1,332.03
$1,457.55
$1,903.47

$1,549.28
$1,667.78
$1,793.30
$2,239.22

$1,885.03
$2,003.53
$2,129.05
$2,574.97

$335.75

Toc - Plan #10 Anthem Blue Cross and Blue Shield

Catastrophic

(EPO) Anthem Catastrophic Pathway X 9100

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-738-6677

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

$271.06
$307.65
$346.41
$484.11
$735.66

$478.42
$515.01
$553.77
$691.47

$685.78
$722.37
$761.13
$898.83

$893.14
$929.73
$968.49
$1,106.19

$207.36

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$542.12
$615.30
$692.82
$968.22
$1,471.32

$749.48
$822.66
$900.18
$1,175.58

$956.84
$1,030.02
$1,107.54
$1,382.94

$1,164.20
$1,237.38
$1,314.90
$1,590.30

$207.36

Toc - Plan #11 Anthem Blue Cross and Blue Shield

Expanded Bronze

(EPO) Anthem Bronze Pathway X 4350 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-738-6677

Annual Out of Pocket Expenses:

Individual Family

$4,350 $8,700 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

$385.56
$437.61
$492.75
$688.61
$1,046.41

$680.51
$732.56
$787.70
$983.56

$975.46
$1,027.51
$1,082.65
$1,278.51

$1,270.41
$1,322.46
$1,377.60
$1,573.46

$294.95

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$771.12
$875.22
$985.50
$1,377.22
$2,092.82

$1,066.07
$1,170.17
$1,280.45
$1,672.17

$1,361.02
$1,465.12
$1,575.40
$1,967.12

$1,655.97
$1,760.07
$1,870.35
$2,262.07

$294.95

Toc - Plan #12 Anthem Blue Cross and Blue Shield

Bronze

(EPO) Anthem Bronze Pathway X 9100/0% Standard

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-738-6677

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

$350.00
$397.25
$447.30
$625.10
$949.90

$617.75
$665.00
$715.05
$892.85

$885.50
$932.75
$982.80
$1,160.60

$1,153.25
$1,200.50
$1,250.55
$1,428.35

$267.75

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$700.00
$794.50
$894.60
$1,250.20
$1,899.80

$967.75
$1,062.25
$1,162.35
$1,517.95

$1,235.50
$1,330.00
$1,430.10
$1,785.70

$1,503.25
$1,597.75
$1,697.85
$2,053.45

$267.75

Toc - Plan #13 Anthem Blue Cross and Blue Shield

Expanded Bronze

(EPO) Anthem Bronze Pathway X 7500/50% Standard

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-738-6677

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

$383.61
$435.40
$490.25
$685.13
$1,041.12

$677.07
$728.86
$783.71
$978.59

$970.53
$1,022.32
$1,077.17
$1,272.05

$1,263.99
$1,315.78
$1,370.63
$1,565.51

$293.46

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$767.22
$870.80
$980.50
$1,370.26
$2,082.24

$1,060.68
$1,164.26
$1,273.96
$1,663.72

$1,354.14
$1,457.72
$1,567.42
$1,957.18

$1,647.60
$1,751.18
$1,860.88
$2,250.64

$293.46

Toc - Plan #14 Anthem Blue Cross and Blue Shield

Silver

(EPO) Anthem Silver Pathway X 5800/40% Standard

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-738-6677

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

$437.83
$496.94
$559.55
$781.96
$1,188.27

$772.77
$831.88
$894.49
$1,116.90

$1,107.71
$1,166.82
$1,229.43
$1,451.84

$1,442.65
$1,501.76
$1,564.37
$1,786.78

$334.94

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$875.66
$993.88
$1,119.10
$1,563.92
$2,376.54

$1,210.60
$1,328.82
$1,454.04
$1,898.86

$1,545.54
$1,663.76
$1,788.98
$2,233.80

$1,880.48
$1,998.70
$2,123.92
$2,568.74

$334.94

Toc - Plan #15 Anthem Blue Cross and Blue Shield

Gold

(EPO) Anthem Gold Pathway X 2000/25% Standard

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-738-6677

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

$672.39
$763.16
$859.31
$1,200.89
$1,824.87

$1,186.77
$1,277.54
$1,373.69
$1,715.27

$1,701.15
$1,791.92
$1,888.07
$2,229.65

$2,215.53
$2,306.30
$2,402.45
$2,744.03

$514.38

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,344.78
$1,526.32
$1,718.62
$2,401.78
$3,649.74

$1,859.16
$2,040.70
$2,233.00
$2,916.16

$2,373.54
$2,555.08
$2,747.38
$3,430.54

$2,887.92
$3,069.46
$3,261.76
$3,944.92

$514.38

Aetna CVS Health

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

Toc - Plan #16 Aetna CVS Health

Expanded Bronze

(EPO) Bronze: Aetna network of doctors & hospitals + Low-cost MinuteClinic + $0 Telehealth 24/7

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family

$6,000 $12,000 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

$344.31
$390.80
$440.03
$614.95
$934.47

$607.71
$654.20
$703.43
$878.35

$871.11
$917.60
$966.83
$1,141.75

$1,134.51
$1,181.00
$1,230.23
$1,405.15

$263.40

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$688.62
$781.60
$880.06
$1,229.90
$1,868.94

$952.02
$1,045.00
$1,143.46
$1,493.30

$1,215.42
$1,308.40
$1,406.86
$1,756.70

$1,478.82
$1,571.80
$1,670.26
$2,020.10

$263.40

Toc - Plan #17 Aetna CVS Health

Expanded Bronze

(EPO) Bronze: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 Telehealth 24/7

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family

$8,700 $17,400 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$344.75
$391.29
$440.59
$615.72
$935.65

$608.48
$655.02
$704.32
$879.45

$872.21
$918.75
$968.05
$1,143.18

$1,135.94
$1,182.48
$1,231.78
$1,406.91

$263.73

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$689.50
$782.58
$881.18
$1,231.44
$1,871.30

$953.23
$1,046.31
$1,144.91
$1,495.17

$1,216.96
$1,310.04
$1,408.64
$1,758.90

$1,480.69
$1,573.77
$1,672.37
$2,022.63

$263.73

Toc - Plan #18 Aetna CVS Health

Gold

(EPO) Gold: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 Telehealth 24/7

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family

$1,500 $3,000 Annual Deductible

$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$531.34
$603.07
$679.05
$948.98
$1,442.06

$937.82
$1,009.55
$1,085.53
$1,355.46

$1,344.30
$1,416.03
$1,492.01
$1,761.94

$1,750.78
$1,822.51
$1,898.49
$2,168.42

$406.48

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,062.68
$1,206.14
$1,358.10
$1,897.96
$2,884.12

$1,469.16
$1,612.62
$1,764.58
$2,304.44

$1,875.64
$2,019.10
$2,171.06
$2,710.92

$2,282.12
$2,425.58
$2,577.54
$3,117.40

$406.48

Toc - Plan #19 Aetna CVS Health

Silver

(EPO) Silver 2: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 Telehealth 24/7

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family

$5,000 $10,000 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

$428.16
$485.96
$547.18
$764.69
$1,162.02

$755.70
$813.50
$874.72
$1,092.23

$1,083.24
$1,141.04
$1,202.26
$1,419.77

$1,410.78
$1,468.58
$1,529.80
$1,747.31

$327.54

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$856.32
$971.92
$1,094.36
$1,529.38
$2,324.04

$1,183.86
$1,299.46
$1,421.90
$1,856.92

$1,511.40
$1,627.00
$1,749.44
$2,184.46

$1,838.94
$1,954.54
$2,076.98
$2,512.00

$327.54

Toc - Plan #20 Aetna CVS Health

Silver

(EPO) Silver 1: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 Telehealth 24/7

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family

$4,425 $8,850 Annual Deductible

$8,850 $17,700 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$430.62
$488.76
$550.34
$769.09
$1,168.71

$760.05
$818.19
$879.77
$1,098.52

$1,089.48
$1,147.62
$1,209.20
$1,427.95

$1,418.91
$1,477.05
$1,538.63
$1,757.38

$329.43

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$861.24
$977.52
$1,100.68
$1,538.18
$2,337.42

$1,190.67
$1,306.95
$1,430.11
$1,867.61

$1,520.10
$1,636.38
$1,759.54
$2,197.04

$1,849.53
$1,965.81
$2,088.97
$2,526.47

$329.43

Toc - Plan #21 Aetna CVS Health

Expanded Bronze

(EPO) Bronze S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 Telehealth 24/7

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

$9,000 $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

$333.41
$378.42
$426.10
$595.47
$904.87

$588.47
$633.48
$681.16
$850.53

$843.53
$888.54
$936.22
$1,105.59

$1,098.59
$1,143.60
$1,191.28
$1,360.65

$255.06

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$666.82
$756.84
$852.20
$1,190.94
$1,809.74

$921.88
$1,011.90
$1,107.26
$1,446.00

$1,176.94
$1,266.96
$1,362.32
$1,701.06

$1,432.00
$1,522.02
$1,617.38
$1,956.12

$255.06

Toc - Plan #22 Aetna CVS Health

Gold

(EPO) Gold S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 Telehealth 24/7

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-336-3915

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

$484.85
$550.31
$619.64
$865.95
$1,315.89

$855.76
$921.22
$990.55
$1,236.86

$1,226.67
$1,292.13
$1,361.46
$1,607.77

$1,597.58
$1,663.04
$1,732.37
$1,978.68

$370.91

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$969.70
$1,100.62
$1,239.28
$1,731.90
$2,631.78

$1,340.61
$1,471.53
$1,610.19
$2,102.81

$1,711.52
$1,842.44
$1,981.10
$2,473.72

$2,082.43
$2,213.35
$2,352.01
$2,844.63

$370.91

Toc - Plan #23 Aetna CVS Health

Silver

(EPO) Silver 3: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 Telehealth 24/7

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family

$7,000 $14,000 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

$407.53
$462.54
$520.82
$727.84
$1,106.03

$719.29
$774.30
$832.58
$1,039.60

$1,031.05
$1,086.06
$1,144.34
$1,351.36

$1,342.81
$1,397.82
$1,456.10
$1,663.12

$311.76

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$815.06
$925.08
$1,041.64
$1,455.68
$2,212.06

$1,126.82
$1,236.84
$1,353.40
$1,767.44

$1,438.58
$1,548.60
$1,665.16
$2,079.20

$1,750.34
$1,860.36
$1,976.92
$2,390.96

$311.76

Toc - Plan #24 Aetna CVS Health

Silver

(EPO) Silver S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 Telehealth 24/7

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-336-3915

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

$399.56
$453.50
$510.63
$713.61
$1,084.40

$705.22
$759.16
$816.29
$1,019.27

$1,010.88
$1,064.82
$1,121.95
$1,324.93

$1,316.54
$1,370.48
$1,427.61
$1,630.59

$305.66

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$799.12
$907.00
$1,021.26
$1,427.22
$2,168.80

$1,104.78
$1,212.66
$1,326.92
$1,732.88

$1,410.44
$1,518.32
$1,632.58
$2,038.54

$1,716.10
$1,823.98
$1,938.24
$2,344.20

$305.66

Medica

Local: 1-888-592-8211 | Toll Free: 1-888-592-8211 | TTY: 1-800-676-3777

Toc - Plan #25 Medica

Expanded Bronze

(EPO) Balance by Medica Bronze HSA ($0 Virtual Care after Deductible with Designated Providers)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family

$5,400 $10,800 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$389.78
$442.39
$498.12
$696.13
$1,057.83

$687.95
$740.56
$796.29
$994.30

$986.12
$1,038.73
$1,094.46
$1,292.47

$1,284.29
$1,336.90
$1,392.63
$1,590.64

$298.17

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$779.56
$884.78
$996.24
$1,392.26
$2,115.66

$1,077.73
$1,182.95
$1,294.41
$1,690.43

$1,375.90
$1,481.12
$1,592.58
$1,988.60

$1,674.07
$1,779.29
$1,890.75
$2,286.77

$298.17

Toc - Plan #26 Medica

Catastrophic

(EPO) Balance by Medica Catastrophic ($0 Virtual Care with Designated Providers)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-592-8211

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

$229.89
$260.92
$293.79
$410.57
$623.91

$405.75
$436.78
$469.65
$586.43

$581.61
$612.64
$645.51
$762.29

$757.47
$788.50
$821.37
$938.15

$175.86

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$459.78
$521.84
$587.58
$821.14
$1,247.82

$635.64
$697.70
$763.44
$997.00

$811.50
$873.56
$939.30
$1,172.86

$987.36
$1,049.42
$1,115.16
$1,348.72

$175.86

Toc - Plan #27 Medica

Silver

(EPO) Balance by Medica Silver Share ($0 Virtual Care with Designated Providers)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family

$2,000 $4,000 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

$454.55
$515.90
$580.90
$811.80
$1,233.61

$802.27
$863.62
$928.62
$1,159.52

$1,149.99
$1,211.34
$1,276.34
$1,507.24

$1,497.71
$1,559.06
$1,624.06
$1,854.96

$347.72

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$909.10
$1,031.80
$1,161.80
$1,623.60
$2,467.22

$1,256.82
$1,379.52
$1,509.52
$1,971.32

$1,604.54
$1,727.24
$1,857.24
$2,319.04

$1,952.26
$2,074.96
$2,204.96
$2,666.76

$347.72

Toc - Plan #28 Medica

Expanded Bronze

(EPO) Balance by Medica Bronze Share Plus ($0 Virtual Care with Designated Providers)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-592-8211

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

$331.83
$376.62
$424.07
$592.63
$900.56

$585.67
$630.46
$677.91
$846.47

$839.51
$884.30
$931.75
$1,100.31

$1,093.35
$1,138.14
$1,185.59
$1,354.15

$253.84

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$663.66
$753.24
$848.14
$1,185.26
$1,801.12

$917.50
$1,007.08
$1,101.98
$1,439.10

$1,171.34
$1,260.92
$1,355.82
$1,692.94

$1,425.18
$1,514.76
$1,609.66
$1,946.78

$253.84

Toc - Plan #29 Medica

Expanded Bronze

(EPO) Balance by Medica Bronze Copay $0 PCP ($0 Virtual Care with Designated Providers)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-592-8211

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

$322.39
$365.91
$412.01
$575.78
$874.95

$569.01
$612.53
$658.63
$822.40

$815.63
$859.15
$905.25
$1,069.02

$1,062.25
$1,105.77
$1,151.87
$1,315.64

$246.62

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$644.78
$731.82
$824.02
$1,151.56
$1,749.90

$891.40
$978.44
$1,070.64
$1,398.18

$1,138.02
$1,225.06
$1,317.26
$1,644.80

$1,384.64
$1,471.68
$1,563.88
$1,891.42

$246.62

Toc - Plan #30 Medica

Gold

(EPO) Balance by Medica Gold Copay $0 PCP ($0 Virtual Care with Designated Providers)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family

$1,000 $2,000 Annual Deductible

$8,350 $16,700 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$481.04
$545.97
$614.76
$859.12
$1,305.51

$849.03
$913.96
$982.75
$1,227.11

$1,217.02
$1,281.95
$1,350.74
$1,595.10

$1,585.01
$1,649.94
$1,718.73
$1,963.09

$367.99

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$962.08
$1,091.94
$1,229.52
$1,718.24
$2,611.02

$1,330.07
$1,459.93
$1,597.51
$2,086.23

$1,698.06
$1,827.92
$1,965.50
$2,454.22

$2,066.05
$2,195.91
$2,333.49
$2,822.21

$367.99

Toc - Plan #31 Medica

Expanded Bronze

(EPO) Balance by Medica Bronze Premier ($0 Virtual Care with Designated Providers)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family

$1,500 $3,000 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

$323.55
$367.21
$413.48
$577.84
$878.08

$571.06
$614.72
$660.99
$825.35

$818.57
$862.23
$908.50
$1,072.86

$1,066.08
$1,109.74
$1,156.01
$1,320.37

$247.51

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$647.10
$734.42
$826.96
$1,155.68
$1,756.16

$894.61
$981.93
$1,074.47
$1,403.19

$1,142.12
$1,229.44
$1,321.98
$1,650.70

$1,389.63
$1,476.95
$1,569.49
$1,898.21

$247.51

Toc - Plan #32 Medica

Gold

(EPO) Balance by Medica Gold Standard ($0 Virtual Care with Designated Providers)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-592-8211

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

$457.52
$519.27
$584.69
$817.10
$1,241.67

$807.51
$869.26
$934.68
$1,167.09

$1,157.50
$1,219.25
$1,284.67
$1,517.08

$1,507.49
$1,569.24
$1,634.66
$1,867.07

$349.99

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$915.04
$1,038.54
$1,169.38
$1,634.20
$2,483.34

$1,265.03
$1,388.53
$1,519.37
$1,984.19

$1,615.02
$1,738.52
$1,869.36
$2,334.18

$1,965.01
$2,088.51
$2,219.35
$2,684.17

$349.99

Toc - Plan #33 Medica

Silver

(EPO) Balance by Medica Silver Standard ($0 Virtual Care with Designated Providers)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-592-8211

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

$435.28
$494.03
$556.27
$777.38
$1,181.31

$768.26
$827.01
$889.25
$1,110.36

$1,101.24
$1,159.99
$1,222.23
$1,443.34

$1,434.22
$1,492.97
$1,555.21
$1,776.32

$332.98

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$870.56
$988.06
$1,112.54
$1,554.76
$2,362.62

$1,203.54
$1,321.04
$1,445.52
$1,887.74

$1,536.52
$1,654.02
$1,778.50
$2,220.72

$1,869.50
$1,987.00
$2,111.48
$2,553.70

$332.98

Toc - Plan #34 Medica

Bronze

(EPO) Balance by Medica Bronze Standard ($0 Virtual Care with Designated Providers)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-888-592-8211

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

$309.95
$351.78
$396.10
$553.55
$841.17

$547.05
$588.88
$633.20
$790.65

$784.15
$825.98
$870.30
$1,027.75

$1,021.25
$1,063.08
$1,107.40
$1,264.85

$237.10

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$619.90
$703.56
$792.20
$1,107.10
$1,682.34

$857.00
$940.66
$1,029.30
$1,344.20

$1,094.10
$1,177.76
$1,266.40
$1,581.30

$1,331.20
$1,414.86
$1,503.50
$1,818.40

$237.10

UnitedHealthcare

Local: 1-877-632-4195 | Toll Free: 1-877-632-4195 | TTY: 1-877-940-4172

Toc - Plan #35 UnitedHealthcare

Gold

(EPO) 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: 1-877-632-4195

Annual Out of Pocket Expenses:

Individual Family

$2,200 $4,400 Annual Deductible

$8,400 $16,800 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

$460.02
$522.13
$587.91
$821.60
$1,248.50

$811.94
$874.05
$939.83
$1,173.52

$1,163.86
$1,225.97
$1,291.75
$1,525.44

$1,515.78
$1,577.89
$1,643.67
$1,877.36

$351.92

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$920.04
$1,044.26
$1,175.82
$1,643.20
$2,497.00

$1,271.96
$1,396.18
$1,527.74
$1,995.12

$1,623.88
$1,748.10
$1,879.66
$2,347.04

$1,975.80
$2,100.02
$2,231.58
$2,698.96

$351.92

Toc - Plan #36 UnitedHealthcare

Gold

(EPO) 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: 1-877-632-4195

Annual Out of Pocket Expenses:

Individual Family

$500 $1,000 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

$484.24
$549.62
$618.86
$864.86
$1,314.23

$854.69
$920.07
$989.31
$1,235.31

$1,225.14
$1,290.52
$1,359.76
$1,605.76

$1,595.59
$1,660.97
$1,730.21
$1,976.21

$370.45

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$968.48
$1,099.24
$1,237.72
$1,729.72
$2,628.46

$1,338.93
$1,469.69
$1,608.17
$2,100.17

$1,709.38
$1,840.14
$1,978.62
$2,470.62

$2,079.83
$2,210.59
$2,349.07
$2,841.07

$370.45

Toc - Plan #37 UnitedHealthcare

Silver

(EPO) 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: 1-877-632-4195

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

$427.18
$484.84
$545.93
$762.93
$1,159.35

$753.97
$811.63
$872.72
$1,089.72

$1,080.76
$1,138.42
$1,199.51
$1,416.51

$1,407.55
$1,465.21
$1,526.30
$1,743.30

$326.79

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$854.36
$969.68
$1,091.86
$1,525.86
$2,318.70

$1,181.15
$1,296.47
$1,418.65
$1,852.65

$1,507.94
$1,623.26
$1,745.44
$2,179.44

$1,834.73
$1,950.05
$2,072.23
$2,506.23

$326.79

Toc - Plan #38 UnitedHealthcare

Silver

(EPO) 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: 1-877-632-4195

Annual Out of Pocket Expenses:

Individual Family

$2,000 $4,000 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

$422.40
$479.43
$539.83
$754.41
$1,146.41

$745.54
$802.57
$862.97
$1,077.55

$1,068.68
$1,125.71
$1,186.11
$1,400.69

$1,391.82
$1,448.85
$1,509.25
$1,723.83

$323.14

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$844.80
$958.86
$1,079.66
$1,508.82
$2,292.82

$1,167.94
$1,282.00
$1,402.80
$1,831.96

$1,491.08
$1,605.14
$1,725.94
$2,155.10

$1,814.22
$1,928.28
$2,049.08
$2,478.24

$323.14

Toc - Plan #39 UnitedHealthcare

Silver

(EPO) 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: 1-877-632-4195

Annual Out of Pocket Expenses:

Individual Family

$2,000 $4,000 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

$440.31
$499.75
$562.72
$786.40
$1,195.01

$777.15
$836.59
$899.56
$1,123.24

$1,113.99
$1,173.43
$1,236.40
$1,460.08

$1,450.83
$1,510.27
$1,573.24
$1,796.92

$336.84

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$880.62
$999.50
$1,125.44
$1,572.80
$2,390.02

$1,217.46
$1,336.34
$1,462.28
$1,909.64

$1,554.30
$1,673.18
$1,799.12
$2,246.48

$1,891.14
$2,010.02
$2,135.96
$2,583.32

$336.84

Toc - Plan #40 UnitedHealthcare

Silver

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

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-632-4195

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

$433.00
$491.46
$553.38
$773.34
$1,175.17

$764.25
$822.71
$884.63
$1,104.59

$1,095.50
$1,153.96
$1,215.88
$1,435.84

$1,426.75
$1,485.21
$1,547.13
$1,767.09

$331.25

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$866.00
$982.92
$1,106.76
$1,546.68
$2,350.34

$1,197.25
$1,314.17
$1,438.01
$1,877.93

$1,528.50
$1,645.42
$1,769.26
$2,209.18

$1,859.75
$1,976.67
$2,100.51
$2,540.43

$331.25

Toc - Plan #41 UnitedHealthcare

Silver

(EPO) UHC Silver Value HSA $5,400 Deductible

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-632-4195

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

$430.55
$488.67
$550.24
$768.96
$1,168.51

$759.92
$818.04
$879.61
$1,098.33

$1,089.29
$1,147.41
$1,208.98
$1,427.70

$1,418.66
$1,476.78
$1,538.35
$1,757.07

$329.37

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$861.10
$977.34
$1,100.48
$1,537.92
$2,337.02

$1,190.47
$1,306.71
$1,429.85
$1,867.29

$1,519.84
$1,636.08
$1,759.22
$2,196.66

$1,849.21
$1,965.45
$2,088.59
$2,526.03

$329.37

Toc - Plan #42 UnitedHealthcare

Silver

(EPO) UHC Silver Standard

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-632-4195

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

$429.38
$487.34
$548.74
$766.86
$1,165.32

$757.85
$815.81
$877.21
$1,095.33

$1,086.32
$1,144.28
$1,205.68
$1,423.80

$1,414.79
$1,472.75
$1,534.15
$1,752.27

$328.47

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$858.76
$974.68
$1,097.48
$1,533.72
$2,330.64

$1,187.23
$1,303.15
$1,425.95
$1,862.19

$1,515.70
$1,631.62
$1,754.42
$2,190.66

$1,844.17
$1,960.09
$2,082.89
$2,519.13

$328.47

Toc - Plan #43 UnitedHealthcare

Gold

(EPO) UHC Gold Standard

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-632-4195

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

$471.16
$534.77
$602.14
$841.49
$1,278.73

$831.60
$895.21
$962.58
$1,201.93

$1,192.04
$1,255.65
$1,323.02
$1,562.37

$1,552.48
$1,616.09
$1,683.46
$1,922.81

$360.44

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$942.32
$1,069.54
$1,204.28
$1,682.98
$2,557.46

$1,302.76
$1,429.98
$1,564.72
$2,043.42

$1,663.20
$1,790.42
$1,925.16
$2,403.86

$2,023.64
$2,150.86
$2,285.60
$2,764.30

$360.44

Toc - Plan #44 UnitedHealthcare

Bronze

(EPO) UHC Bronze Essential ($3 T1 Preferred Rx)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-632-4195

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

$353.52
$401.24
$451.79
$631.38
$959.44

$623.96
$671.68
$722.23
$901.82

$894.40
$942.12
$992.67
$1,172.26

$1,164.84
$1,212.56
$1,263.11
$1,442.70

$270.44

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$707.04
$802.48
$903.58
$1,262.76
$1,918.88

$977.48
$1,072.92
$1,174.02
$1,533.20

$1,247.92
$1,343.36
$1,444.46
$1,803.64

$1,518.36
$1,613.80
$1,714.90
$2,074.08

$270.44

Toc - Plan #45 UnitedHealthcare

Expanded Bronze

(EPO) UHC Bronze Value $6,500 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-632-4195

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

$368.14
$417.84
$470.48
$657.49
$999.13

$649.77
$699.47
$752.11
$939.12

$931.40
$981.10
$1,033.74
$1,220.75

$1,213.03
$1,262.73
$1,315.37
$1,502.38

$281.63

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$736.28
$835.68
$940.96
$1,314.98
$1,998.26

$1,017.91
$1,117.31
$1,222.59
$1,596.61

$1,299.54
$1,398.94
$1,504.22
$1,878.24

$1,581.17
$1,680.57
$1,785.85
$2,159.87

$281.63

Toc - Plan #46 UnitedHealthcare

Expanded Bronze

(EPO) UHC Bronze Value HSA $6,700 Deductible

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-632-4195

Annual Out of Pocket Expenses:

Individual Family

$6,700 $13,400 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$366.45
$415.92
$468.32
$654.48
$994.54

$646.78
$696.25
$748.65
$934.81

$927.11
$976.58
$1,028.98
$1,215.14

$1,207.44
$1,256.91
$1,309.31
$1,495.47

$280.33

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$732.90
$831.84
$936.64
$1,308.96
$1,989.08

$1,013.23
$1,112.17
$1,216.97
$1,589.29

$1,293.56
$1,392.50
$1,497.30
$1,869.62

$1,573.89
$1,672.83
$1,777.63
$2,149.95

$280.33

Toc - Plan #47 UnitedHealthcare

Expanded Bronze

(EPO) UHC Bronze Standard $7,500 Deductible

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-632-4195

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

$370.58
$420.60
$473.60
$661.85
$1,005.74

$654.07
$704.09
$757.09
$945.34

$937.56
$987.58
$1,040.58
$1,228.83

$1,221.05
$1,271.07
$1,324.07
$1,512.32

$283.49

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$741.16
$841.20
$947.20
$1,323.70
$2,011.48

$1,024.65
$1,124.69
$1,230.69
$1,607.19

$1,308.14
$1,408.18
$1,514.18
$1,890.68

$1,591.63
$1,691.67
$1,797.67
$2,174.17

$283.49

Toc - Plan #48 UnitedHealthcare

Bronze

(EPO) UHC Bronze Standard $9,100 Deductible

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-632-4195

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

$344.17
$390.64
$439.86
$614.70
$934.09

$607.46
$653.93
$703.15
$877.99

$870.75
$917.22
$966.44
$1,141.28

$1,134.04
$1,180.51
$1,229.73
$1,404.57

$263.29

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$688.34
$781.28
$879.72
$1,229.40
$1,868.18

$951.63
$1,044.57
$1,143.01
$1,492.69

$1,214.92
$1,307.86
$1,406.30
$1,755.98

$1,478.21
$1,571.15
$1,669.59
$2,019.27

$263.29

Cox HealthPlans

Local: 1-417-269-4679 | Toll Free: 1-800-205-7665 | TTY: 1-800-735-2966

Toc - Plan #49 Cox HealthPlans

Expanded Bronze

(EPO) Bronze Connect 1

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-205-7665

Annual Out of Pocket Expenses:

Individual Family

$8,000 $16,000 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

$349.00
$396.00
$446.00
$623.00
$947.00

$616.00
$663.00
$713.00
$890.00

$883.00
$930.00
$980.00
$1,157.00

$1,150.00
$1,197.00
$1,247.00
$1,424.00

$267.00

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$698.00
$792.00
$892.00
$1,246.00
$1,894.00

$965.00
$1,059.00
$1,159.00
$1,513.00

$1,232.00
$1,326.00
$1,426.00
$1,780.00

$1,499.00
$1,593.00
$1,693.00
$2,047.00

$267.00

Toc - Plan #50 Cox HealthPlans

Silver

(EPO) Silver Connect 5

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-205-7665

Annual Out of Pocket Expenses:

Individual Family

$7,350 $14,700 Annual Deductible

$7,350 $14,700 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$421.00
$477.00
$537.00
$751.00
$1,141.00

$743.00
$799.00
$859.00
$1,073.00

$1,065.00
$1,121.00
$1,181.00
$1,395.00

$1,387.00
$1,443.00
$1,503.00
$1,717.00

$322.00

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$842.00
$954.00
$1,074.00
$1,502.00
$2,282.00

$1,164.00
$1,276.00
$1,396.00
$1,824.00

$1,486.00
$1,598.00
$1,718.00
$2,146.00

$1,808.00
$1,920.00
$2,040.00
$2,468.00

$322.00

Toc - Plan #51 Cox HealthPlans

Gold

(EPO) Gold Connect 7

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-205-7665

Annual Out of Pocket Expenses:

Individual Family

$1,000 $2,000 Annual Deductible

$7,150 $14,300 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

$499.00
$566.00
$637.00
$890.00
$1,353.00

$880.00
$947.00
$1,018.00
$1,271.00

$1,261.00
$1,328.00
$1,399.00
$1,652.00

$1,642.00
$1,709.00
$1,780.00
$2,033.00

$381.00

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$998.00
$1,132.00
$1,274.00
$1,780.00
$2,706.00

$1,379.00
$1,513.00
$1,655.00
$2,161.00

$1,760.00
$1,894.00
$2,036.00
$2,542.00

$2,141.00
$2,275.00
$2,417.00
$2,923.00

$381.00

Toc - Plan #52 Cox HealthPlans

Silver

(EPO) Silver Connect 9

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-205-7665

Annual Out of Pocket Expenses:

Individual Family

$6,000 $12,000 Annual Deductible

$7,800 $15,600 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

$417.00
$473.00
$533.00
$745.00
$1,132.00

$736.00
$792.00
$852.00
$1,064.00

$1,055.00
$1,111.00
$1,171.00
$1,383.00

$1,374.00
$1,430.00
$1,490.00
$1,702.00

$319.00

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$834.00
$946.00
$1,066.00
$1,490.00
$2,264.00

$1,153.00
$1,265.00
$1,385.00
$1,809.00

$1,472.00
$1,584.00
$1,704.00
$2,128.00

$1,791.00
$1,903.00
$2,023.00
$2,447.00

$319.00

Toc - Plan #53 Cox HealthPlans

Bronze

(EPO) Bronze Standard

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-205-7665

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

$333.00
$377.00
$424.00
$593.00
$902.00

$587.00
$631.00
$678.00
$847.00

$841.00
$885.00
$932.00
$1,101.00

$1,095.00
$1,139.00
$1,186.00
$1,355.00

$254.00

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$666.00
$754.00
$848.00
$1,186.00
$1,804.00

$920.00
$1,008.00
$1,102.00
$1,440.00

$1,174.00
$1,262.00
$1,356.00
$1,694.00

$1,428.00
$1,516.00
$1,610.00
$1,948.00

$254.00

Toc - Plan #54 Cox HealthPlans

Expanded Bronze

(EPO) Bronze Expanded Standard

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-205-7665

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

$363.00
$411.00
$463.00
$647.00
$984.00

$640.00
$688.00
$740.00
$924.00

$917.00
$965.00
$1,017.00
$1,201.00

$1,194.00
$1,242.00
$1,294.00
$1,478.00

$277.00

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$726.00
$822.00
$926.00
$1,294.00
$1,968.00

$1,003.00
$1,099.00
$1,203.00
$1,571.00

$1,280.00
$1,376.00
$1,480.00
$1,848.00

$1,557.00
$1,653.00
$1,757.00
$2,125.00

$277.00

Toc - Plan #55 Cox HealthPlans

Silver

(EPO) Silver Standard

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-205-7665

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

$423.00
$479.00
$540.00
$754.00
$1,147.00

$746.00
$802.00
$863.00
$1,077.00

$1,069.00
$1,125.00
$1,186.00
$1,400.00

$1,392.00
$1,448.00
$1,509.00
$1,723.00

$323.00

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$846.00
$958.00
$1,080.00
$1,508.00
$2,294.00

$1,169.00
$1,281.00
$1,403.00
$1,831.00

$1,492.00
$1,604.00
$1,726.00
$2,154.00

$1,815.00
$1,927.00
$2,049.00
$2,477.00

$323.00

Toc - Plan #56 Cox HealthPlans

Silver

(EPO) Silver Connect 6

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-205-7665

Annual Out of Pocket Expenses:

Individual Family

$3,000 $6,000 Annual Deductible

$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$444.00
$504.00
$567.00
$793.00
$1,204.00

$783.00
$843.00
$906.00
$1,132.00

$1,122.00
$1,182.00
$1,245.00
$1,471.00

$1,461.00
$1,521.00
$1,584.00
$1,810.00

$339.00

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$888.00
$1,008.00
$1,134.00
$1,586.00
$2,408.00

$1,227.00
$1,347.00
$1,473.00
$1,925.00

$1,566.00
$1,686.00
$1,812.00
$2,264.00

$1,905.00
$2,025.00
$2,151.00
$2,603.00

$339.00

Toc - Plan #57 Cox HealthPlans

Gold

(EPO) Gold Standard

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-205-7665

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

$476.00
$540.00
$608.00
$850.00
$1,291.00

$840.00
$904.00
$972.00
$1,214.00

$1,204.00
$1,268.00
$1,336.00
$1,578.00

$1,568.00
$1,632.00
$1,700.00
$1,942.00

$364.00

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$952.00
$1,080.00
$1,216.00
$1,700.00
$2,582.00

$1,316.00
$1,444.00
$1,580.00
$2,064.00

$1,680.00
$1,808.00
$1,944.00
$2,428.00

$2,044.00
$2,172.00
$2,308.00
$2,792.00

$364.00

Ambetter from Home State Health

Local: 1-855-650-3789 | Toll Free: 1-855-650-3789 | TTY: 1-855-650-3789

Toc - Plan #58 Ambetter from Home State Health

Bronze

(EPO) Clear Bronze

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-650-3789

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

$346.77
$393.58
$443.16
$619.32
$941.12

$612.04
$658.85
$708.43
$884.59

$877.31
$924.12
$973.70
$1,149.86

$1,142.58
$1,189.39
$1,238.97
$1,415.13

$265.27

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$693.54
$787.16
$886.32
$1,238.64
$1,882.24

$958.81
$1,052.43
$1,151.59
$1,503.91

$1,224.08
$1,317.70
$1,416.86
$1,769.18

$1,489.35
$1,582.97
$1,682.13
$2,034.45

$265.27

Toc - Plan #59 Ambetter from Home State Health

Silver

(EPO) Premier Silver

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-650-3789

Annual Out of Pocket Expenses:

Individual Family

$7,750 $15,500 Annual Deductible

$7,750 $15,500 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

$401.64
$455.85
$513.28
$717.30
$1,090.01

$708.88
$763.09
$820.52
$1,024.54

$1,016.12
$1,070.33
$1,127.76
$1,331.78

$1,323.36
$1,377.57
$1,435.00
$1,639.02

$307.24

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$803.28
$911.70
$1,026.56
$1,434.60
$2,180.02

$1,110.52
$1,218.94
$1,333.80
$1,741.84

$1,417.76
$1,526.18
$1,641.04
$2,049.08

$1,725.00
$1,833.42
$1,948.28
$2,356.32

$307.24

Toc - Plan #60 Ambetter from Home State Health

Silver

(EPO) Complete Silver

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-650-3789

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

$400.15
$454.16
$511.38
$714.65
$1,085.98

$706.26
$760.27
$817.49
$1,020.76

$1,012.37
$1,066.38
$1,123.60
$1,326.87

$1,318.48
$1,372.49
$1,429.71
$1,632.98

$306.11

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$800.30
$908.32
$1,022.76
$1,429.30
$2,171.96

$1,106.41
$1,214.43
$1,328.87
$1,735.41

$1,412.52
$1,520.54
$1,634.98
$2,041.52

$1,718.63
$1,826.65
$1,941.09
$2,347.63

$306.11

Toc - Plan #61 Ambetter from Home State Health

Gold

(EPO) Complete Gold

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-650-3789

Annual Out of Pocket Expenses:

Individual Family

$1,450 $2,900 Annual Deductible

$7,700 $15,400 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

$497.54
$564.70
$635.85
$888.60
$1,350.31

$878.15
$945.31
$1,016.46
$1,269.21

$1,258.76
$1,325.92
$1,397.07
$1,649.82

$1,639.37
$1,706.53
$1,777.68
$2,030.43

$380.61

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$995.08
$1,129.40
$1,271.70
$1,777.20
$2,700.62

$1,375.69
$1,510.01
$1,652.31
$2,157.81

$1,756.30
$1,890.62
$2,032.92
$2,538.42

$2,136.91
$2,271.23
$2,413.53
$2,919.03

$380.61

Toc - Plan #62 Ambetter from Home State Health

Expanded Bronze

(EPO) Everyday Bronze

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-650-3789

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

$375.49
$426.17
$479.86
$670.61
$1,019.05

$662.73
$713.41
$767.10
$957.85

$949.97
$1,000.65
$1,054.34
$1,245.09

$1,237.21
$1,287.89
$1,341.58
$1,532.33

$287.24

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$750.98
$852.34
$959.72
$1,341.22
$2,038.10

$1,038.22
$1,139.58
$1,246.96
$1,628.46

$1,325.46
$1,426.82
$1,534.20
$1,915.70

$1,612.70
$1,714.06
$1,821.44
$2,202.94

$287.24

Toc - Plan #63 Ambetter from Home State Health

Expanded Bronze

(EPO) Choice Bronze HSA

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-650-3789

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

$381.15
$432.60
$487.10
$680.72
$1,034.42

$672.72
$724.17
$778.67
$972.29

$964.29
$1,015.74
$1,070.24
$1,263.86

$1,255.86
$1,307.31
$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

$762.30
$865.20
$974.20
$1,361.44
$2,068.84

$1,053.87
$1,156.77
$1,265.77
$1,653.01

$1,345.44
$1,448.34
$1,557.34
$1,944.58

$1,637.01
$1,739.91
$1,848.91
$2,236.15

$291.57

Toc - Plan #64 Ambetter from Home State Health

Expanded Bronze

(EPO) Elite Bronze

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-650-3789

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

$420.55
$477.32
$537.45
$751.09
$1,141.35

$742.27
$799.04
$859.17
$1,072.81

$1,063.99
$1,120.76
$1,180.89
$1,394.53

$1,385.71
$1,442.48
$1,502.61
$1,716.25

$321.72

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$841.10
$954.64
$1,074.90
$1,502.18
$2,282.70

$1,162.82
$1,276.36
$1,396.62
$1,823.90

$1,484.54
$1,598.08
$1,718.34
$2,145.62

$1,806.26
$1,919.80
$2,040.06
$2,467.34

$321.72

Toc - Plan #65 Ambetter from Home State Health

Silver

(EPO) Clear Silver

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-650-3789

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

$387.22
$439.48
$494.85
$691.55
$1,050.88

$683.43
$735.69
$791.06
$987.76

$979.64
$1,031.90
$1,087.27
$1,283.97

$1,275.85
$1,328.11
$1,383.48
$1,580.18

$296.21

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$774.44
$878.96
$989.70
$1,383.10
$2,101.76

$1,070.65
$1,175.17
$1,285.91
$1,679.31

$1,366.86
$1,471.38
$1,582.12
$1,975.52

$1,663.07
$1,767.59
$1,878.33
$2,271.73

$296.21

Toc - Plan #66 Ambetter from Home State Health

Silver

(EPO) Focused Silver

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-650-3789

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

$394.49
$447.73
$504.14
$704.54
$1,070.61

$696.26
$749.50
$805.91
$1,006.31

$998.03
$1,051.27
$1,107.68
$1,308.08

$1,299.80
$1,353.04
$1,409.45
$1,609.85

$301.77

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$788.98
$895.46
$1,008.28
$1,409.08
$2,141.22

$1,090.75
$1,197.23
$1,310.05
$1,710.85

$1,392.52
$1,499.00
$1,611.82
$2,012.62

$1,694.29
$1,800.77
$1,913.59
$2,314.39

$301.77

Toc - Plan #67 Ambetter from Home State Health

Gold

(EPO) Everyday Gold

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-650-3789

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

$476.54
$540.86
$609.00
$851.08
$1,293.30

$841.08
$905.40
$973.54
$1,215.62

$1,205.62
$1,269.94
$1,338.08
$1,580.16

$1,570.16
$1,634.48
$1,702.62
$1,944.70

$364.54

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$953.08
$1,081.72
$1,218.00
$1,702.16
$2,586.60

$1,317.62
$1,446.26
$1,582.54
$2,066.70

$1,682.16
$1,810.80
$1,947.08
$2,431.24

$2,046.70
$2,175.34
$2,311.62
$2,795.78

$364.54

Toc - Plan #68 Ambetter from Home State Health

Gold

(EPO) Clear Gold

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-650-3789

Annual Out of Pocket Expenses:

Individual Family

$900 $1,800 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$469.47
$532.84
$599.97
$838.46
$1,274.12

$828.61
$891.98
$959.11
$1,197.60

$1,187.75
$1,251.12
$1,318.25
$1,556.74

$1,546.89
$1,610.26
$1,677.39
$1,915.88

$359.14

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$938.94
$1,065.68
$1,199.94
$1,676.92
$2,548.24

$1,298.08
$1,424.82
$1,559.08
$2,036.06

$1,657.22
$1,783.96
$1,918.22
$2,395.20

$2,016.36
$2,143.10
$2,277.36
$2,754.34

$359.14

Toc - Plan #69 Ambetter from Home State Health

Gold

(EPO) Elite Gold

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-650-3789

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$5,300 $10,600 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

$544.57
$618.08
$695.95
$972.59
$1,477.95

$961.16
$1,034.67
$1,112.54
$1,389.18

$1,377.75
$1,451.26
$1,529.13
$1,805.77

$1,794.34
$1,867.85
$1,945.72
$2,222.36

$416.59

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,089.14
$1,236.16
$1,391.90
$1,945.18
$2,955.90

$1,505.73
$1,652.75
$1,808.49
$2,361.77

$1,922.32
$2,069.34
$2,225.08
$2,778.36

$2,338.91
$2,485.93
$2,641.67
$3,194.95

$416.59

Toc - Plan #70 Ambetter from Home State Health

Bronze

(EPO) CMS Standard Bronze

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-650-3789

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

$330.59
$375.21
$422.48
$590.41
$897.19

$583.48
$628.10
$675.37
$843.30

$836.37
$880.99
$928.26
$1,096.19

$1,089.26
$1,133.88
$1,181.15
$1,349.08

$252.89

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$661.18
$750.42
$844.96
$1,180.82
$1,794.38

$914.07
$1,003.31
$1,097.85
$1,433.71

$1,166.96
$1,256.20
$1,350.74
$1,686.60

$1,419.85
$1,509.09
$1,603.63
$1,939.49

$252.89

Toc - Plan #71 Ambetter from Home State Health

Expanded Bronze

(EPO) CMS Standard Expanded Bronze

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-650-3789

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

$363.68
$412.77
$464.77
$649.52
$987.01

$641.89
$690.98
$742.98
$927.73

$920.10
$969.19
$1,021.19
$1,205.94

$1,198.31
$1,247.40
$1,299.40
$1,484.15

$278.21

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$727.36
$825.54
$929.54
$1,299.04
$1,974.02

$1,005.57
$1,103.75
$1,207.75
$1,577.25

$1,283.78
$1,381.96
$1,485.96
$1,855.46

$1,561.99
$1,660.17
$1,764.17
$2,133.67

$278.21

Toc - Plan #72 Ambetter from Home State Health

Silver

(EPO) CMS Standard Silver

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-650-3789

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

$386.49
$438.66
$493.93
$690.26
$1,048.92

$682.15
$734.32
$789.59
$985.92

$977.81
$1,029.98
$1,085.25
$1,281.58

$1,273.47
$1,325.64
$1,380.91
$1,577.24

$295.66

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$772.98
$877.32
$987.86
$1,380.52
$2,097.84

$1,068.64
$1,172.98
$1,283.52
$1,676.18

$1,364.30
$1,468.64
$1,579.18
$1,971.84

$1,659.96
$1,764.30
$1,874.84
$2,267.50

$295.66

Toc - Plan #73 Ambetter from Home State Health

Gold

(EPO) CMS Standard Gold

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-650-3789

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

$469.79
$533.20
$600.38
$839.03
$1,274.99

$829.17
$892.58
$959.76
$1,198.41

$1,188.55
$1,251.96
$1,319.14
$1,557.79

$1,547.93
$1,611.34
$1,678.52
$1,917.17

$359.38

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$939.58
$1,066.40
$1,200.76
$1,678.06
$2,549.98

$1,298.96
$1,425.78
$1,560.14
$2,037.44

$1,658.34
$1,785.16
$1,919.52
$2,396.82

$2,017.72
$2,144.54
$2,278.90
$2,756.20

$359.38

Toc - Plan #74 Ambetter from Home State Health

Expanded Bronze

(EPO) Clear Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-650-3789

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

$358.06
$406.39
$457.59
$639.48
$971.76

$631.97
$680.30
$731.50
$913.39

$905.88
$954.21
$1,005.41
$1,187.30

$1,179.79
$1,228.12
$1,279.32
$1,461.21

$273.91

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$716.12
$812.78
$915.18
$1,278.96
$1,943.52

$990.03
$1,086.69
$1,189.09
$1,552.87

$1,263.94
$1,360.60
$1,463.00
$1,826.78

$1,537.85
$1,634.51
$1,736.91
$2,100.69

$273.91

Toc - Plan #75 Ambetter from Home State Health

Expanded Bronze

(EPO) Everyday Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-650-3789

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

$387.71
$440.04
$495.49
$692.44
$1,052.23

$684.30
$736.63
$792.08
$989.03

$980.89
$1,033.22
$1,088.67
$1,285.62

$1,277.48
$1,329.81
$1,385.26
$1,582.21

$296.59

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$775.42
$880.08
$990.98
$1,384.88
$2,104.46

$1,072.01
$1,176.67
$1,287.57
$1,681.47

$1,368.60
$1,473.26
$1,584.16
$1,978.06

$1,665.19
$1,769.85
$1,880.75
$2,274.65

$296.59

Toc - Plan #76 Ambetter from Home State Health

Gold

(EPO) Complete Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-650-3789

Annual Out of Pocket Expenses:

Individual Family

$1,450 $2,900 Annual Deductible

$7,700 $15,400 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

$513.74
$583.09
$656.55
$917.53
$1,394.27

$906.75
$976.10
$1,049.56
$1,310.54

$1,299.76
$1,369.11
$1,442.57
$1,703.55

$1,692.77
$1,762.12
$1,835.58
$2,096.56

$393.01

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,027.48
$1,166.18
$1,313.10
$1,835.06
$2,788.54

$1,420.49
$1,559.19
$1,706.11
$2,228.07

$1,813.50
$1,952.20
$2,099.12
$2,621.08

$2,206.51
$2,345.21
$2,492.13
$3,014.09

$393.01

Toc - Plan #77 Ambetter from Home State Health

Silver

(EPO) Complete Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-650-3789

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

$413.18
$468.94
$528.03
$737.92
$1,121.34

$729.25
$785.01
$844.10
$1,053.99

$1,045.32
$1,101.08
$1,160.17
$1,370.06

$1,361.39
$1,417.15
$1,476.24
$1,686.13

$316.07

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$826.36
$937.88
$1,056.06
$1,475.84
$2,242.68

$1,142.43
$1,253.95
$1,372.13
$1,791.91

$1,458.50
$1,570.02
$1,688.20
$2,107.98

$1,774.57
$1,886.09
$2,004.27
$2,424.05

$316.07

Toc - Plan #78 Ambetter from Home State Health

Silver

(EPO) Premier Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-650-3789

Annual Out of Pocket Expenses:

Individual Family

$7,750 $15,500 Annual Deductible

$7,750 $15,500 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

$414.71
$470.69
$529.99
$740.66
$1,125.50

$731.96
$787.94
$847.24
$1,057.91

$1,049.21
$1,105.19
$1,164.49
$1,375.16

$1,366.46
$1,422.44
$1,481.74
$1,692.41

$317.25

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$829.42
$941.38
$1,059.98
$1,481.32
$2,251.00

$1,146.67
$1,258.63
$1,377.23
$1,798.57

$1,463.92
$1,575.88
$1,694.48
$2,115.82

$1,781.17
$1,893.13
$2,011.73
$2,433.07

$317.25

Toc - Plan #79 Ambetter from Home State Health

Expanded Bronze

(EPO) Choice Bronze HSA + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-650-3789

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

$393.56
$446.68
$502.96
$702.88
$1,068.10

$694.63
$747.75
$804.03
$1,003.95

$995.70
$1,048.82
$1,105.10
$1,305.02

$1,296.77
$1,349.89
$1,406.17
$1,606.09

$301.07

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$787.12
$893.36
$1,005.92
$1,405.76
$2,136.20

$1,088.19
$1,194.43
$1,306.99
$1,706.83

$1,389.26
$1,495.50
$1,608.06
$2,007.90

$1,690.33
$1,796.57
$1,909.13
$2,308.97

$301.07

Toc - Plan #80 Ambetter from Home State Health

Expanded Bronze

(EPO) Elite Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-650-3789

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

$434.24
$492.86
$554.95
$775.54
$1,178.51

$766.43
$825.05
$887.14
$1,107.73

$1,098.62
$1,157.24
$1,219.33
$1,439.92

$1,430.81
$1,489.43
$1,551.52
$1,772.11

$332.19

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$868.48
$985.72
$1,109.90
$1,551.08
$2,357.02

$1,200.67
$1,317.91
$1,442.09
$1,883.27

$1,532.86
$1,650.10
$1,774.28
$2,215.46

$1,865.05
$1,982.29
$2,106.47
$2,547.65

$332.19

Toc - Plan #81 Ambetter from Home State Health

Silver

(EPO) Focused Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-650-3789

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

$407.33
$462.31
$520.55
$727.47
$1,105.47

$718.93
$773.91
$832.15
$1,039.07

$1,030.53
$1,085.51
$1,143.75
$1,350.67

$1,342.13
$1,397.11
$1,455.35
$1,662.27

$311.60

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$814.66
$924.62
$1,041.10
$1,454.94
$2,210.94

$1,126.26
$1,236.22
$1,352.70
$1,766.54

$1,437.86
$1,547.82
$1,664.30
$2,078.14

$1,749.46
$1,859.42
$1,975.90
$2,389.74

$311.60

Toc - Plan #82 Ambetter from Home State Health

Gold

(EPO) Everyday Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-650-3789

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

$492.05
$558.47
$628.83
$878.79
$1,335.41

$868.46
$934.88
$1,005.24
$1,255.20

$1,244.87
$1,311.29
$1,381.65
$1,631.61

$1,621.28
$1,687.70
$1,758.06
$2,008.02

$376.41

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$984.10
$1,116.94
$1,257.66
$1,757.58
$2,670.82

$1,360.51
$1,493.35
$1,634.07
$2,133.99

$1,736.92
$1,869.76
$2,010.48
$2,510.40

$2,113.33
$2,246.17
$2,386.89
$2,886.81

$376.41

Toc - Plan #83 Ambetter from Home State Health

Silver

(EPO) Clear Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-650-3789

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

$399.82
$453.79
$510.96
$714.07
$1,085.09

$705.68
$759.65
$816.82
$1,019.93

$1,011.54
$1,065.51
$1,122.68
$1,325.79

$1,317.40
$1,371.37
$1,428.54
$1,631.65

$305.86

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$799.64
$907.58
$1,021.92
$1,428.14
$2,170.18

$1,105.50
$1,213.44
$1,327.78
$1,734.00

$1,411.36
$1,519.30
$1,633.64
$2,039.86

$1,717.22
$1,825.16
$1,939.50
$2,345.72

$305.86

Toc - Plan #84 Ambetter from Home State Health

Gold

(EPO) Clear Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-650-3789

Annual Out of Pocket Expenses:

Individual Family

$900 $1,800 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$484.75
$550.18
$619.50
$865.75
$1,315.60

$855.58
$921.01
$990.33
$1,236.58

$1,226.41
$1,291.84
$1,361.16
$1,607.41

$1,597.24
$1,662.67
$1,731.99
$1,978.24

$370.83

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$969.50
$1,100.36
$1,239.00
$1,731.50
$2,631.20

$1,340.33
$1,471.19
$1,609.83
$2,102.33

$1,711.16
$1,842.02
$1,980.66
$2,473.16

$2,081.99
$2,212.85
$2,351.49
$2,843.99

$370.83

Toc - Plan #85 Ambetter from Home State Health

Gold

(EPO) Elite Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-650-3789

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$5,300 $10,600 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

$562.30
$638.20
$718.61
$1,004.26
$1,526.06

$992.45
$1,068.35
$1,148.76
$1,434.41

$1,422.60
$1,498.50
$1,578.91
$1,864.56

$1,852.75
$1,928.65
$2,009.06
$2,294.71

$430.15

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,124.60
$1,276.40
$1,437.22
$2,008.52
$3,052.12

$1,554.75
$1,706.55
$1,867.37
$2,438.67

$1,984.90
$2,136.70
$2,297.52
$2,868.82

$2,415.05
$2,566.85
$2,727.67
$3,298.97

$430.15

‡Source: HealthCare.gov has released sample rates for all counties in the 36 states served by HealthCare.gov. We have integrated that data into our tables and provide you that information for Lawrence County here.

Lawrence County is in “Rating Area 8” of Missouri.

Currently, there are 85 plans offered in Rating Area 8.

Top

2023 Obamacare Plans for Lawrence County, MO

Plan Browser: 85 Plans

Anthem Blue Cross and Blue Shield

Local: 1-855-738-6677 | Toll Free: 1-855-738-6677

1. Silver Anthem Silver Pathway X 3100 ($0 Virtual PCP + $0 Select Drugs + Incentives)

2. Expanded Bronze Anthem Bronze Pathway X 6800 ($0 Virtual PCP + $0 Select Drugs + Incentives)

3. Expanded Bronze Anthem Bronze Pathway X 0% for HSA

4. Expanded Bronze Anthem Bronze Pathway X 20% for HSA

5. Silver Anthem Silver Pathway X 3900 ($0 Virtual PCP + $0 Select Drugs + Incentives)

6. Silver Anthem Silver Pathway X 3000 for HSA

7. Expanded Bronze Anthem Bronze Pathway X 6500 ($0 Virtual PCP + $0 Select Drugs + Incentives)

8. Silver Anthem Silver Pathway X 5400 ($0 Virtual PCP + $0 Select Drugs + Incentives)

9. Silver Anthem Silver Pathway X 6500 ($0 Virtual PCP + $0 Select Drugs + Incentives)

10. Catastrophic Anthem Catastrophic Pathway X 9100

11. Expanded Bronze Anthem Bronze Pathway X 4350 ($0 Virtual PCP + $0 Select Drugs + Incentives)

12. Bronze Anthem Bronze Pathway X 9100/0% Standard

13. Expanded Bronze Anthem Bronze Pathway X 7500/50% Standard

14. Silver Anthem Silver Pathway X 5800/40% Standard

15. Gold Anthem Gold Pathway X 2000/25% Standard

Aetna CVS Health

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

16. Expanded Bronze Bronze: Aetna network of doctors & hospitals + Low-cost MinuteClinic + $0 Telehealth 24/7

17. Expanded Bronze Bronze: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 Telehealth 24/7

18. Gold Gold: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 Telehealth 24/7

19. Silver Silver 2: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 Telehealth 24/7

20. Silver Silver 1: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 Telehealth 24/7

21. Expanded Bronze Bronze S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 Telehealth 24/7

22. Gold Gold S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 Telehealth 24/7

23. Silver Silver 3: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 Telehealth 24/7

24. Silver Silver S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 Telehealth 24/7

Medica

Local: 1-888-592-8211 | Toll Free: 1-888-592-8211 | TTY: 1-800-676-3777

25. Expanded Bronze Balance by Medica Bronze HSA ($0 Virtual Care after Deductible with Designated Providers)

26. Catastrophic Balance by Medica Catastrophic ($0 Virtual Care with Designated Providers)

27. Silver Balance by Medica Silver Share ($0 Virtual Care with Designated Providers)

28. Expanded Bronze Balance by Medica Bronze Share Plus ($0 Virtual Care with Designated Providers)

29. Expanded Bronze Balance by Medica Bronze Copay $0 PCP ($0 Virtual Care with Designated Providers)

30. Gold Balance by Medica Gold Copay $0 PCP ($0 Virtual Care with Designated Providers)

31. Expanded Bronze Balance by Medica Bronze Premier ($0 Virtual Care with Designated Providers)

32. Gold Balance by Medica Gold Standard ($0 Virtual Care with Designated Providers)

33. Silver Balance by Medica Silver Standard ($0 Virtual Care with Designated Providers)

34. Bronze Balance by Medica Bronze Standard ($0 Virtual Care with Designated Providers)

UnitedHealthcare

Local: 1-877-632-4195 | Toll Free: 1-877-632-4195 | TTY: 1-877-940-4172

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

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

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

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

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

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

41. Silver UHC Silver Value HSA $5,400 Deductible

42. Silver UHC Silver Standard

43. Gold UHC Gold Standard

44. Bronze UHC Bronze Essential ($3 T1 Preferred Rx)

45. Expanded Bronze UHC Bronze Value $6,500 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx)

46. Expanded Bronze UHC Bronze Value HSA $6,700 Deductible

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

48. Bronze UHC Bronze Standard $9,100 Deductible

Cox HealthPlans

Local: 1-417-269-4679 | Toll Free: 1-800-205-7665 | TTY: 1-800-735-2966

49. Expanded Bronze Bronze Connect 1

50. Silver Silver Connect 5

51. Gold Gold Connect 7

52. Silver Silver Connect 9

53. Bronze Bronze Standard

54. Expanded Bronze Bronze Expanded Standard

55. Silver Silver Standard

56. Silver Silver Connect 6

57. Gold Gold Standard

Ambetter from Home State Health

Local: 1-855-650-3789 | Toll Free: 1-855-650-3789 | TTY: 1-855-650-3789

58. Bronze Clear Bronze

59. Silver Premier Silver

60. Silver Complete Silver

61. Gold Complete Gold

62. Expanded Bronze Everyday Bronze

63. Expanded Bronze Choice Bronze HSA

64. Expanded Bronze Elite Bronze

65. Silver Clear Silver

66. Silver Focused Silver

67. Gold Everyday Gold

68. Gold Clear Gold

69. Gold Elite Gold

70. Bronze CMS Standard Bronze

71. Expanded Bronze CMS Standard Expanded Bronze

72. Silver CMS Standard Silver

73. Gold CMS Standard Gold

74. Expanded Bronze Clear Bronze + Vision + Adult Dental

75. Expanded Bronze Everyday Bronze + Vision + Adult Dental

76. Gold Complete Gold + Vision + Adult Dental

77. Silver Complete Silver + Vision + Adult Dental

78. Silver Premier Silver + Vision + Adult Dental

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

80. Expanded Bronze Elite Bronze + Vision + Adult Dental

81. Silver Focused Silver + Vision + Adult Dental

82. Gold Everyday Gold + Vision + Adult Dental

83. Silver Clear Silver + Vision + Adult Dental

84. Gold Clear Gold + Vision + Adult Dental

85. Gold Elite Gold + Vision + Adult Dental

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

Obamacare Providers, 85 Plans and 2023 Rates for Lawrence County, Missouri

You may also be interested in:

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

How do I sign up in Missouri?

Using a Broker to Help You Sign Up

Obamacare Rates and Providers for Other Years

How To Sign Up for Obamacare in Missouri for 2023

Where's the Missouri Health Care Exchange?

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

Missouri Has Expanded Medicaid

The Medicaid Coverage Gap

Get Help Finding a Health Insurance Plan in Missouri

Get Help From Missouri's Health Insurance Exchange

Get Help From a Licensed Insurance Broker

More Information

Anthem Blue Cross and Blue Shield

(EPO) Anthem Silver Pathway X 3100 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Annual Out of Pocket Expenses:

Individual Family $3,100 $6,200 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

(EPO) Anthem Bronze Pathway X 6800 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Annual Out of Pocket Expenses:

Individual Family $6,800 $13,600 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

(EPO) Anthem Bronze Pathway X 0% for HSA

Annual Out of Pocket Expenses:

Individual Family $7,450 $14,900 Annual Deductible $7,450 $14,900 Maximum Out of Pocket Per Year

Monthly Premiums:

(EPO) Anthem Bronze Pathway X 20% for HSA

Annual Out of Pocket Expenses:

Individual Family $5,900 $11,800 Annual Deductible $7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

(EPO) Anthem Silver Pathway X 3900 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Annual Out of Pocket Expenses:

Individual Family $3,900 $7,800 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

(EPO) Anthem Silver Pathway X 3000 for HSA

Annual Out of Pocket Expenses:

Individual Family $3,000 $6,000 Annual Deductible $6,450 $12,900 Maximum Out of Pocket Per Year

Monthly Premiums:

(EPO) Anthem Bronze Pathway X 6500 ($0 Virtual PCP + $0 Select Drugs + Incentives)

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:

(EPO) Anthem Silver Pathway X 5400 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Annual Out of Pocket Expenses:

Individual Family $5,400 $10,800 Annual Deductible $8,300 $16,600 Maximum Out of Pocket Per Year

Monthly Premiums:

(EPO) Anthem Silver Pathway X 6500 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Annual Out of Pocket Expenses:

Individual Family $6,500 $13,000 Annual Deductible $8,500 $17,000 Maximum Out of Pocket Per Year

Monthly Premiums:

(EPO) Anthem Catastrophic Pathway X 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:

(EPO) Anthem Bronze Pathway X 4350 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Annual Out of Pocket Expenses:

Individual Family $4,350 $8,700 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

(EPO) Anthem Bronze Pathway X 9100/0% Standard

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:

(EPO) Anthem Bronze Pathway X 7500/50% Standard

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:

(EPO) Anthem Silver Pathway X 5800/40% Standard

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:

(EPO) Anthem Gold Pathway X 2000/25% Standard

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:

Aetna CVS Health

(EPO) Bronze: Aetna network of doctors & hospitals + Low-cost MinuteClinic + $0 Telehealth 24/7

Annual Out of Pocket Expenses:

Individual Family

$3,100 $6,200 Annual Deductible

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

Individual Family

$6,800 $13,600 Annual Deductible

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

Individual Family

$7,450 $14,900 Annual Deductible

$7,450 $14,900 Maximum Out of Pocket Per Year

Individual Family

$5,900 $11,800 Annual Deductible

$7,000 $14,000 Maximum Out of Pocket Per Year

Individual Family

$3,900 $7,800 Annual Deductible

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

Individual Family

$3,000 $6,000 Annual Deductible

$6,450 $12,900 Maximum Out of Pocket Per Year

Individual Family

$6,500 $13,000 Annual Deductible

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

Individual Family

$5,400 $10,800 Annual Deductible

$8,300 $16,600 Maximum Out of Pocket Per Year

Individual Family

$6,500 $13,000 Annual Deductible

$8,500 $17,000 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

$4,350 $8,700 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

$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

$6,000 $12,000 Annual Deductible

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

Individual Family

$8,700 $17,400 Annual Deductible

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

Individual Family

$1,500 $3,000 Annual Deductible

$7,000 $14,000 Maximum Out of Pocket Per Year

Individual Family

$5,000 $10,000 Annual Deductible

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

Individual Family

$4,425 $8,850 Annual Deductible

$8,850 $17,700 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

$2,000 $4,000 Annual Deductible

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

Individual Family

$7,000 $14,000 Annual Deductible

$8,800 $17,600 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

$5,400 $10,800 Annual Deductible

$7,500 $15,000 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

$2,000 $4,000 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

$7,500 $15,000 Annual Deductible

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

Individual Family

$1,000 $2,000 Annual Deductible

$8,350 $16,700 Maximum Out of Pocket Per Year

Individual Family

$1,500 $3,000 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