North Dakota Obamacare

2017 Obamacare Rates for Traill County

North Dakota 2017 Obamacare Rates for Traill County

 
Mayville, ND

Providers for Zip Code 58257

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Obamacare Providers, Plans and 2017 Rates for Traill County

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

2017 Rates and Providers

(click here for 2014)

(click here for 2015)

(click here for 2016)

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

Currently, there are 24 plans offered in Traill County.

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

 

The table below shows premiums for the following scenarios:

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

Each scenario is covered for age

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

 

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

 

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

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

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

Blue Cross Blue Shield of North Dakota

Local: 1-701-277-2227 | Toll Free: 1-800-342-4718

Plan: (PPO) BlueCare 70 Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-342-4718 - Provider Directory for This Plan: (Blue Cross Blue Shield of North Dakota)

Deductible: Individual: $3,000 : Family: $6,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $265.79
$301.67
$339.67
$474.69
$721.34		 $531.58
$603.34
$679.34
$949.38
$1442.68		 $700.35
$772.11
$848.11
$1118.15		 $869.12
$940.88
$1016.88
$1286.92		 $1037.89
$1109.65
$1185.65
$1455.69		 $434.56
$470.44
$508.44
$643.46		 $603.33
$639.21
$677.21
$812.23		 $772.10
$807.98
$845.98
$981.00		 $168.77

Plan: (PPO) BlueCare 70 Gold

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-342-4718 - Provider Directory for This Plan: (Blue Cross Blue Shield of North Dakota)

Deductible: Individual: $500 : Family: $1,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $325.33
$369.25
$415.77
$581.03
$882.95		 $650.66
$738.50
$831.54
$1162.06
$1765.90		 $857.24
$945.08
$1038.12
$1368.64		 $1063.82
$1151.66
$1244.70
$1575.22		 $1270.40
$1358.24
$1451.28
$1781.80		 $531.91
$575.83
$622.35
$787.61		 $738.49
$782.41
$828.93
$994.19		 $945.07
$988.99
$1035.51
$1200.77		 $206.58

Plan: (PPO) BlueDirect 80 Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-342-4718 - Provider Directory for This Plan: (Blue Cross Blue Shield of North Dakota)

Deductible: Individual: $2,600 : Family: $5,200
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $283.94
$322.27
$362.88
$507.12
$770.62		 $567.88
$644.54
$725.76
$1014.24
$1541.24		 $748.19
$824.85
$906.07
$1194.55		 $928.50
$1005.16
$1086.38
$1374.86		 $1108.81
$1185.47
$1266.69
$1555.17		 $464.25
$502.58
$543.19
$687.43		 $644.56
$682.89
$723.50
$867.74		 $824.87
$863.20
$903.81
$1048.05		 $180.31

Plan: (PPO) BlueBirect 100 Bronze

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-342-4718 - Provider Directory for This Plan: (Blue Cross Blue Shield of North Dakota)

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $223.26
$253.40
$285.32
$398.74
$605.92		 $446.52
$506.80
$570.64
$797.48
$1211.84		 $588.29
$648.57
$712.41
$939.25		 $730.06
$790.34
$854.18
$1081.02		 $871.83
$932.11
$995.95
$1222.79		 $365.03
$395.17
$427.09
$540.51		 $506.80
$536.94
$568.86
$682.28		 $648.57
$678.71
$710.63
$824.05		 $141.77

Plan: (PPO) BlueEssential 100

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-342-4718 - Provider Directory for This Plan: (Blue Cross Blue Shield of North Dakota)

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Catastrophic 21
30
40
50
60		 $128.66
$146.03
$164.43
$229.79
$349.19		 $257.32
$292.06
$328.86
$459.58
$698.38		 $339.02
$373.76
$410.56
$541.28		 $420.72
$455.46
$492.26
$622.98		 $502.42
$537.16
$573.96
$704.68		 $210.36
$227.73
$246.13
$311.49		 $292.06
$309.43
$327.83
$393.19		 $373.76
$391.13
$409.53
$474.89		 $81.70

Plan: (PPO) BlueDirect 90 Gold

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-342-4718 - Provider Directory for This Plan: (Blue Cross Blue Shield of North Dakota)

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $2,900 : Family: $5,800

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $332.50
$377.39
$424.94
$593.85
$902.41		 $665.00
$754.78
$849.88
$1187.70
$1804.82		 $876.14
$965.92
$1061.02
$1398.84		 $1087.28
$1177.06
$1272.16
$1609.98		 $1298.42
$1388.20
$1483.30
$1821.12		 $543.64
$588.53
$636.08
$804.99		 $754.78
$799.67
$847.22
$1016.13		 $965.92
$1010.81
$1058.36
$1227.27		 $211.14

Plan: (PPO) Simply Blue 60

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-342-4718 - Provider Directory for This Plan: (Blue Cross Blue Shield of North Dakota)

Deductible: Individual: $6,800 : Family: $13,600
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $211.41
$239.94
$270.17
$377.57
$573.76		 $422.82
$479.88
$540.34
$755.14
$1147.52		 $557.06
$614.12
$674.58
$889.38		 $691.30
$748.36
$808.82
$1023.62		 $825.54
$882.60
$943.06
$1157.86		 $345.65
$374.18
$404.41
$511.81		 $479.89
$508.42
$538.65
$646.05		 $614.13
$642.66
$672.89
$780.29		 $134.24

Medica Health Plans

Local: 1-888-592-8211 | Toll Free: 1-888-592-8211

TTY: 1-800-855-2800

Plan: (POS) Medica Applause Gold Copay

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-592-8211 - Provider Directory for This Plan: (Medica Health Plans)

Deductible: Individual: $300 : Family: $900
Out of Pocket Maximum per year: Individual: $5,000 : Family: $10,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $366.10
$415.51
$467.86
$653.83
$993.56		 $732.20
$831.02
$935.72
$1307.66
$1987.12		 $964.67
$1063.49
$1168.19
$1540.13		 $1197.14
$1295.96
$1400.66
$1772.60		 $1429.61
$1528.43
$1633.13
$2005.07		 $598.57
$647.98
$700.33
$886.30		 $831.04
$880.45
$932.80
$1118.77		 $1063.51
$1112.92
$1165.27
$1351.24		 $232.47

Plan: (POS) Medica Applause Silver Copay

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-592-8211 - Provider Directory for This Plan: (Medica Health Plans)

Deductible: Individual: $2,600 : Family: $7,800
Out of Pocket Maximum per year: Individual: $5,750 : Family: $11,500

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $307.34
$348.82
$392.77
$548.89
$834.10		 $614.68
$697.64
$785.54
$1097.78
$1668.20		 $809.83
$892.79
$980.69
$1292.93		 $1004.98
$1087.94
$1175.84
$1488.08		 $1200.13
$1283.09
$1370.99
$1683.23		 $502.49
$543.97
$587.92
$744.04		 $697.64
$739.12
$783.07
$939.19		 $892.79
$934.27
$978.22
$1134.34		 $195.15

Plan: (POS) Medica Applause Bronze Copay

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-592-8211 - Provider Directory for This Plan: (Medica Health Plans)

Deductible: Individual: $6,850 : Family: $13,700
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $264.22
$299.87
$337.65
$471.87
$717.05		 $528.44
$599.74
$675.30
$943.74
$1434.10		 $696.21
$767.51
$843.07
$1111.51		 $863.98
$935.28
$1010.84
$1279.28		 $1031.75
$1103.05
$1178.61
$1447.05		 $431.99
$467.64
$505.42
$639.64		 $599.76
$635.41
$673.19
$807.41		 $767.53
$803.18
$840.96
$975.18		 $167.77

Plan: (POS) Medica Applause Silver H S A

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-592-8211 - Provider Directory for This Plan: (Medica Health Plans)

Deductible: Individual: $1,300 : Family: $3,900
Out of Pocket Maximum per year: Individual: $5,500 : Family: $11,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $301.12
$341.76
$384.81
$537.78
$817.20		 $602.24
$683.52
$769.62
$1075.56
$1634.40		 $793.44
$874.72
$960.82
$1266.76		 $984.64
$1065.92
$1152.02
$1457.96		 $1175.84
$1257.12
$1343.22
$1649.16		 $492.32
$532.96
$576.01
$728.98		 $683.52
$724.16
$767.21
$920.18		 $874.72
$915.36
$958.41
$1111.38		 $191.20

Plan: (POS) Medica Applause Bronze H S A

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-592-8211 - Provider Directory for This Plan: (Medica Health Plans)

Deductible: Individual: $6,400 : Family: $12,800
Out of Pocket Maximum per year: Individual: $6,400 : Family: $12,800

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $251.91
$285.91
$321.93
$449.90
$683.67		 $503.82
$571.82
$643.86
$899.80
$1367.34		 $663.78
$731.78
$803.82
$1059.76		 $823.74
$891.74
$963.78
$1219.72		 $983.70
$1051.70
$1123.74
$1379.68		 $411.87
$445.87
$481.89
$609.86		 $571.83
$605.83
$641.85
$769.82		 $731.79
$765.79
$801.81
$929.78		 $159.96

Plan: (POS) Medica Applause Catastrophic

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-592-8211 - Provider Directory for This Plan: (Medica Health Plans)

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Catastrophic 21
30
40
50
60		 $187.08
$212.33
$239.08
$334.11
$507.71		 $374.16
$424.66
$478.16
$668.22
$1015.42		 $492.95
$543.45
$596.95
$787.01		 $611.74
$662.24
$715.74
$905.80		 $730.53
$781.03
$834.53
$1024.59		 $305.87
$331.12
$357.87
$452.90		 $424.66
$449.91
$476.66
$571.69		 $543.45
$568.70
$595.45
$690.48		 $118.79

Plan: (POS) Medica Applause Gold Copay Plus

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-592-8211 - Provider Directory for This Plan: (Medica Health Plans)

Deductible: Individual: $1,000 : Family: $3,000
Out of Pocket Maximum per year: Individual: $4,000 : Family: $8,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $402.93
$457.31
$514.93
$719.61
$1093.51		 $805.86
$914.62
$1029.86
$1439.22
$2187.02		 $1061.71
$1170.47
$1285.71
$1695.07		 $1317.56
$1426.32
$1541.56
$1950.92		 $1573.41
$1682.17
$1797.41
$2206.77		 $658.78
$713.16
$770.78
$975.46		 $914.63
$969.01
$1026.63
$1231.31		 $1170.48
$1224.86
$1282.48
$1487.16		 $255.85

Sanford Health Plan

Local: 1-605-333-1089 | Toll Free: 1-888-535-4831

TTY: 1-877-652-1844

Plan: (HMO) Sanford Simplicity $1,250

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-535-4831 - Provider Directory for This Plan: (Sanford Health Plan)

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $354.13
$401.94
$452.58
$632.48
$961.11		 $708.26
$803.88
$905.16
$1264.96
$1922.22		 $933.13
$1028.75
$1130.03
$1489.83		 $1158.00
$1253.62
$1354.90
$1714.70		 $1382.87
$1478.49
$1579.77
$1939.57		 $579.00
$626.81
$677.45
$857.35		 $803.87
$851.68
$902.32
$1082.22		 $1028.74
$1076.55
$1127.19
$1307.09		 $224.87

Plan: (HMO) Sanford Simplicity $5,000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-535-4831 - Provider Directory for This Plan: (Sanford Health Plan)

Deductible: Individual: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $245.81
$278.99
$314.15
$439.02
$667.13		 $491.62
$557.98
$628.30
$878.04
$1334.26		 $647.71
$714.07
$784.39
$1034.13		 $803.80
$870.16
$940.48
$1190.22		 $959.89
$1026.25
$1096.57
$1346.31		 $401.90
$435.08
$470.24
$595.11		 $557.99
$591.17
$626.33
$751.20		 $714.08
$747.26
$782.42
$907.29		 $156.09

Plan: (HMO) Sanford Simplicity $7,150

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-535-4831 - Provider Directory for This Plan: (Sanford Health Plan)

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Catastrophic 21
30
40
50
60		 $220.17
$249.89
$281.38
$393.22
$597.54		 $440.34
$499.78
$562.76
$786.44
$1195.08		 $580.15
$639.59
$702.57
$926.25		 $719.96
$779.40
$842.38
$1066.06		 $859.77
$919.21
$982.19
$1205.87		 $359.98
$389.70
$421.19
$533.03		 $499.79
$529.51
$561.00
$672.84		 $639.60
$669.32
$700.81
$812.65		 $139.81

Plan: (HMO) Sanford Simplicity $6,000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-535-4831 - Provider Directory for This Plan: (Sanford Health Plan)

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $230.95
$262.13
$295.15
$412.48
$626.80		 $461.90
$524.26
$590.30
$824.96
$1253.60		 $608.55
$670.91
$736.95
$971.61		 $755.20
$817.56
$883.60
$1118.26		 $901.85
$964.21
$1030.25
$1264.91		 $377.60
$408.78
$441.80
$559.13		 $524.25
$555.43
$588.45
$705.78		 $670.90
$702.08
$735.10
$852.43		 $146.65

Plan: (HMO) Sanford Simplicity $3,500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-535-4831 - Provider Directory for This Plan: (Sanford Health Plan)

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $290.77
$330.02
$371.60
$519.32
$789.15		 $581.54
$660.04
$743.20
$1038.64
$1578.30		 $766.18
$844.68
$927.84
$1223.28		 $950.82
$1029.32
$1112.48
$1407.92		 $1135.46
$1213.96
$1297.12
$1592.56		 $475.41
$514.66
$556.24
$703.96		 $660.05
$699.30
$740.88
$888.60		 $844.69
$883.94
$925.52
$1073.24		 $184.64

Plan: (HMO) Sanford TRUE $6,000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-535-4831 - Provider Directory for This Plan: (Sanford Health Plan)

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $200.62
$227.70
$256.39
$358.31
$544.48		 $401.24
$455.40
$512.78
$716.62
$1088.96		 $528.63
$582.79
$640.17
$844.01		 $656.02
$710.18
$767.56
$971.40		 $783.41
$837.57
$894.95
$1098.79		 $328.01
$355.09
$383.78
$485.70		 $455.40
$482.48
$511.17
$613.09		 $582.79
$609.87
$638.56
$740.48		 $127.39

Plan: (HMO) Sanford TRUE $3,500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-535-4831 - Provider Directory for This Plan: (Sanford Health Plan)

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $253.24
$287.43
$323.64
$452.29
$687.29		 $506.48
$574.86
$647.28
$904.58
$1374.58		 $667.29
$735.67
$808.09
$1065.39		 $828.10
$896.48
$968.90
$1226.20		 $988.91
$1057.29
$1129.71
$1387.01		 $414.05
$448.24
$484.45
$613.10		 $574.86
$609.05
$645.26
$773.91		 $735.67
$769.86
$806.07
$934.72		 $160.81

Plan: (HMO) Sanford TRUE $5,000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-535-4831 - Provider Directory for This Plan: (Sanford Health Plan)

Deductible: Individual: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $212.21
$240.86
$271.20
$379.01
$575.94		 $424.42
$481.72
$542.40
$758.02
$1151.88		 $559.17
$616.47
$677.15
$892.77		 $693.92
$751.22
$811.90
$1027.52		 $828.67
$885.97
$946.65
$1162.27		 $346.96
$375.61
$405.95
$513.76		 $481.71
$510.36
$540.70
$648.51		 $616.46
$645.11
$675.45
$783.26		 $134.75

Plan: (HMO) Sanford TRUE $4,000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-535-4831 - Provider Directory for This Plan: (Sanford Health Plan)

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $258.88
$293.83
$330.85
$462.36
$702.60		 $517.76
$587.66
$661.70
$924.72
$1405.20		 $682.15
$752.05
$826.09
$1089.11		 $846.54
$916.44
$990.48
$1253.50		 $1010.93
$1080.83
$1154.87
$1417.89		 $423.27
$458.22
$495.24
$626.75		 $587.66
$622.61
$659.63
$791.14		 $752.05
$787.00
$824.02
$955.53		 $164.39

Plan: (HMO) Sanford Simplicity $4,000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-535-4831 - Provider Directory for This Plan: (Sanford Health Plan)

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $297.49
$337.65
$380.19
$531.32
$807.39		 $594.98
$675.30
$760.38
$1062.64
$1614.78		 $783.89
$864.21
$949.29
$1251.55		 $972.80
$1053.12
$1138.20
$1440.46		 $1161.71
$1242.03
$1327.11
$1629.37		 $486.40
$526.56
$569.10
$720.23		 $675.31
$715.47
$758.01
$909.14		 $864.22
$904.38
$946.92
$1098.05		 $188.91