Dyer County, Tennessee Obamacare 2024 Rates

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

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

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

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

Obamacare Providers, 63 Plans and 2024 Rates for Dyer County, Tennessee

Below, you’ll find a summary of the 63 plans for Dyer County, Tennessee and rates for each of these providers. This chart is designed to give you a preview of your health insurance options.


Obamacare Rates and Providers for Other Years

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BlueCross BlueShield of Tennessee

Local: 1-423-535-5600 | Toll Free: 1-800-565-9140

Toc - Plan #1 BlueCross BlueShield of Tennessee
Expanded Bronze

(EPO) BlueCross B07S HSA + $0 Virtual Care for Medical & Mental Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-565-9140

Annual Out of Pocket Expenses:

Individual Family
$5,950 $11,900 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
$386.71
$438.92
$494.22
$690.66
$1,049.53
$682.54
$734.75
$790.05
$986.49
$978.37
$1,030.58
$1,085.88
$1,282.32
$1,274.20
$1,326.41
$1,381.71
$1,578.15
$295.83
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$773.42
$877.84
$988.44
$1,381.32
$2,099.06
$1,069.25
$1,173.67
$1,284.27
$1,677.15
$1,365.08
$1,469.50
$1,580.10
$1,972.98
$1,660.91
$1,765.33
$1,875.93
$2,268.81
$295.83
Toc - Plan #2 BlueCross BlueShield of Tennessee
Bronze

(EPO) BlueCross B08S $0 Virtual Care for Medical & Mental Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-565-9140

Annual Out of Pocket Expenses:

Individual Family
$8,700 $17,400 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
$359.53
$408.07
$459.48
$642.12
$975.76
$634.57
$683.11
$734.52
$917.16
$909.61
$958.15
$1,009.56
$1,192.20
$1,184.65
$1,233.19
$1,284.60
$1,467.24
$275.04
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$719.06
$816.14
$918.96
$1,284.24
$1,951.52
$994.10
$1,091.18
$1,194.00
$1,559.28
$1,269.14
$1,366.22
$1,469.04
$1,834.32
$1,544.18
$1,641.26
$1,744.08
$2,109.36
$275.04
Toc - Plan #3 BlueCross BlueShield of Tennessee
Expanded Bronze

(EPO) BlueCross B10S $0 Virtual Care for Medical & Mental Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-565-9140

Annual Out of Pocket Expenses:

Individual Family
$7,100 $14,200 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
$380.62
$432.00
$486.43
$679.79
$1,033.00
$671.79
$723.17
$777.60
$970.96
$962.96
$1,014.34
$1,068.77
$1,262.13
$1,254.13
$1,305.51
$1,359.94
$1,553.30
$291.17
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$761.24
$864.00
$972.86
$1,359.58
$2,066.00
$1,052.41
$1,155.17
$1,264.03
$1,650.75
$1,343.58
$1,446.34
$1,555.20
$1,941.92
$1,634.75
$1,737.51
$1,846.37
$2,233.09
$291.17
Toc - Plan #4 BlueCross BlueShield of Tennessee
Bronze

(EPO) BlueCross B15S $0 Virtual Care for Medical & Mental Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-565-9140

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$347.49
$394.40
$444.09
$620.62
$943.09
$613.32
$660.23
$709.92
$886.45
$879.15
$926.06
$975.75
$1,152.28
$1,144.98
$1,191.89
$1,241.58
$1,418.11
$265.83
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$694.98
$788.80
$888.18
$1,241.24
$1,886.18
$960.81
$1,054.63
$1,154.01
$1,507.07
$1,226.64
$1,320.46
$1,419.84
$1,772.90
$1,492.47
$1,586.29
$1,685.67
$2,038.73
$265.83
Toc - Plan #5 BlueCross BlueShield of Tennessee
Silver

(EPO) BlueCross S04S $0 Virtual Care for Medical & Mental Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-565-9140

Annual Out of Pocket Expenses:

Individual Family
$3,300 $6,600 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
$491.28
$557.60
$627.86
$877.43
$1,333.33
$867.11
$933.43
$1,003.69
$1,253.26
$1,242.94
$1,309.26
$1,379.52
$1,629.09
$1,618.77
$1,685.09
$1,755.35
$2,004.92
$375.83
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$982.56
$1,115.20
$1,255.72
$1,754.86
$2,666.66
$1,358.39
$1,491.03
$1,631.55
$2,130.69
$1,734.22
$1,866.86
$2,007.38
$2,506.52
$2,110.05
$2,242.69
$2,383.21
$2,882.35
$375.83
Toc - Plan #6 BlueCross BlueShield of Tennessee
Silver

(EPO) BlueCross S24S $35 PCP Copay + $0 Virtual Care for Medical & Mental Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-565-9140

Annual Out of Pocket Expenses:

Individual Family
$5,450 $10,900 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
$450.90
$511.77
$576.25
$805.31
$1,223.74
$795.84
$856.71
$921.19
$1,150.25
$1,140.78
$1,201.65
$1,266.13
$1,495.19
$1,485.72
$1,546.59
$1,611.07
$1,840.13
$344.94
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$901.80
$1,023.54
$1,152.50
$1,610.62
$2,447.48
$1,246.74
$1,368.48
$1,497.44
$1,955.56
$1,591.68
$1,713.42
$1,842.38
$2,300.50
$1,936.62
$2,058.36
$2,187.32
$2,645.44
$344.94
Toc - Plan #7 BlueCross BlueShield of Tennessee
Silver

(EPO) BlueCross S25S $55 PCP Copay + $0 Virtual Care for Medical & Mental Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-565-9140

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$452.90
$514.04
$578.81
$808.88
$1,229.17
$799.37
$860.51
$925.28
$1,155.35
$1,145.84
$1,206.98
$1,271.75
$1,501.82
$1,492.31
$1,553.45
$1,618.22
$1,848.29
$346.47
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$905.80
$1,028.08
$1,157.62
$1,617.76
$2,458.34
$1,252.27
$1,374.55
$1,504.09
$1,964.23
$1,598.74
$1,721.02
$1,850.56
$2,310.70
$1,945.21
$2,067.49
$2,197.03
$2,657.17
$346.47
Toc - Plan #8 BlueCross BlueShield of Tennessee
Gold

(EPO) BlueCross G06S $35 PCP Copay + $0 Virtual Care for Medical & Mental Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-565-9140

Annual Out of Pocket Expenses:

Individual Family
$3,000 $6,000 Annual Deductible
$6,600 $13,200 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
$640.62
$727.10
$818.71
$1,144.15
$1,738.64
$1,130.69
$1,217.17
$1,308.78
$1,634.22
$1,620.76
$1,707.24
$1,798.85
$2,124.29
$2,110.83
$2,197.31
$2,288.92
$2,614.36
$490.07
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,281.24
$1,454.20
$1,637.42
$2,288.30
$3,477.28
$1,771.31
$1,944.27
$2,127.49
$2,778.37
$2,261.38
$2,434.34
$2,617.56
$3,268.44
$2,751.45
$2,924.41
$3,107.63
$3,758.51
$490.07
Toc - Plan #9 BlueCross BlueShield of Tennessee
Gold

(EPO) BlueCross G08S $30 PCP Copay + $0 Virtual Care for Medical & Mental Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-565-9140

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$651.24
$739.16
$832.28
$1,163.11
$1,767.47
$1,149.44
$1,237.36
$1,330.48
$1,661.31
$1,647.64
$1,735.56
$1,828.68
$2,159.51
$2,145.84
$2,233.76
$2,326.88
$2,657.71
$498.20
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,302.48
$1,478.32
$1,664.56
$2,326.22
$3,534.94
$1,800.68
$1,976.52
$2,162.76
$2,824.42
$2,298.88
$2,474.72
$2,660.96
$3,322.62
$2,797.08
$2,972.92
$3,159.16
$3,820.82
$498.20
Toc - Plan #10 BlueCross BlueShield of Tennessee
Expanded Bronze

(EPO) BlueCross B16S $50 PCP Copay + $0 Virtual Care for Medical & Mental Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-565-9140

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$378.45
$429.54
$483.66
$675.91
$1,027.11
$667.96
$719.05
$773.17
$965.42
$957.47
$1,008.56
$1,062.68
$1,254.93
$1,246.98
$1,298.07
$1,352.19
$1,544.44
$289.51
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$756.90
$859.08
$967.32
$1,351.82
$2,054.22
$1,046.41
$1,148.59
$1,256.83
$1,641.33
$1,335.92
$1,438.10
$1,546.34
$1,930.84
$1,625.43
$1,727.61
$1,835.85
$2,220.35
$289.51
Toc - Plan #11 BlueCross BlueShield of Tennessee
Silver

(EPO) BlueCross S26S $40 PCP Copay + $0 Virtual Care for Medical & Mental Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-565-9140

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$450.97
$511.85
$576.34
$805.43
$1,223.93
$795.96
$856.84
$921.33
$1,150.42
$1,140.95
$1,201.83
$1,266.32
$1,495.41
$1,485.94
$1,546.82
$1,611.31
$1,840.40
$344.99
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$901.94
$1,023.70
$1,152.68
$1,610.86
$2,447.86
$1,246.93
$1,368.69
$1,497.67
$1,955.85
$1,591.92
$1,713.68
$1,842.66
$2,300.84
$1,936.91
$2,058.67
$2,187.65
$2,645.83
$344.99
Toc - Plan #12 BlueCross BlueShield of Tennessee
Silver

(EPO) BlueCross S27S $60 PCP Copay + $0 Virtual Care for Medical & Mental Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-565-9140

Annual Out of Pocket Expenses:

Individual Family
$5,700 $11,400 Annual Deductible
$6,700 $13,400 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
$450.81
$511.67
$576.14
$805.15
$1,223.50
$795.68
$856.54
$921.01
$1,150.02
$1,140.55
$1,201.41
$1,265.88
$1,494.89
$1,485.42
$1,546.28
$1,610.75
$1,839.76
$344.87
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$901.62
$1,023.34
$1,152.28
$1,610.30
$2,447.00
$1,246.49
$1,368.21
$1,497.15
$1,955.17
$1,591.36
$1,713.08
$1,842.02
$2,300.04
$1,936.23
$2,057.95
$2,186.89
$2,644.91
$344.87

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UnitedHealthcare

Local: 1-877-250-8188 | Toll Free: 1-877-250-8188 | TTY: 1-877-250-8188

Toc - Plan #13 UnitedHealthcare
Silver

(EPO) UHC Silver Value (Virtual Urgent Care + PCP Visits, No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-250-8188

Annual Out of Pocket Expenses:

Individual Family
$3,250 $6,500 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$473.21
$537.09
$604.76
$845.15
$1,284.29
$835.22
$899.10
$966.77
$1,207.16
$1,197.23
$1,261.11
$1,328.78
$1,569.17
$1,559.24
$1,623.12
$1,690.79
$1,931.18
$362.01
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$946.42
$1,074.18
$1,209.52
$1,690.30
$2,568.58
$1,308.43
$1,436.19
$1,571.53
$2,052.31
$1,670.44
$1,798.20
$1,933.54
$2,414.32
$2,032.45
$2,160.21
$2,295.55
$2,776.33
$362.01
Toc - Plan #14 UnitedHealthcare
Expanded Bronze

(EPO) UHC Bronze Value (Virtual Urgent Care + PCP Visits, No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-250-8188

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$366.11
$415.54
$467.89
$653.87
$993.62
$646.19
$695.62
$747.97
$933.95
$926.27
$975.70
$1,028.05
$1,214.03
$1,206.35
$1,255.78
$1,308.13
$1,494.11
$280.08
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$732.22
$831.08
$935.78
$1,307.74
$1,987.24
$1,012.30
$1,111.16
$1,215.86
$1,587.82
$1,292.38
$1,391.24
$1,495.94
$1,867.90
$1,572.46
$1,671.32
$1,776.02
$2,147.98
$280.08
Toc - Plan #15 UnitedHealthcare
Gold

(EPO) UHC Gold Standard (No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-250-8188

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$676.23
$767.52
$864.22
$1,207.75
$1,835.29
$1,193.55
$1,284.84
$1,381.54
$1,725.07
$1,710.87
$1,802.16
$1,898.86
$2,242.39
$2,228.19
$2,319.48
$2,416.18
$2,759.71
$517.32
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,352.46
$1,535.04
$1,728.44
$2,415.50
$3,670.58
$1,869.78
$2,052.36
$2,245.76
$2,932.82
$2,387.10
$2,569.68
$2,763.08
$3,450.14
$2,904.42
$3,087.00
$3,280.40
$3,967.46
$517.32
Toc - Plan #16 UnitedHealthcare
Silver

(EPO) UHC Silver Copay Focus (No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-250-8188

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$481.69
$546.71
$615.59
$860.29
$1,307.29
$850.18
$915.20
$984.08
$1,228.78
$1,218.67
$1,283.69
$1,352.57
$1,597.27
$1,587.16
$1,652.18
$1,721.06
$1,965.76
$368.49
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$963.38
$1,093.42
$1,231.18
$1,720.58
$2,614.58
$1,331.87
$1,461.91
$1,599.67
$2,089.07
$1,700.36
$1,830.40
$1,968.16
$2,457.56
$2,068.85
$2,198.89
$2,336.65
$2,826.05
$368.49
Toc - Plan #17 UnitedHealthcare
Silver

(EPO) UHC Silver Standard (No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-250-8188

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$480.25
$545.08
$613.76
$857.72
$1,303.38
$847.64
$912.47
$981.15
$1,225.11
$1,215.03
$1,279.86
$1,348.54
$1,592.50
$1,582.42
$1,647.25
$1,715.93
$1,959.89
$367.39
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$960.50
$1,090.16
$1,227.52
$1,715.44
$2,606.76
$1,327.89
$1,457.55
$1,594.91
$2,082.83
$1,695.28
$1,824.94
$1,962.30
$2,450.22
$2,062.67
$2,192.33
$2,329.69
$2,817.61
$367.39
Toc - Plan #18 UnitedHealthcare
Expanded Bronze

(EPO) UHC Bronze Value HSA (No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-250-8188

Annual Out of Pocket Expenses:

Individual Family
$6,700 $13,400 Annual Deductible
$8,050 $16,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$373.00
$423.36
$476.69
$666.18
$1,012.32
$658.35
$708.71
$762.04
$951.53
$943.70
$994.06
$1,047.39
$1,236.88
$1,229.05
$1,279.41
$1,332.74
$1,522.23
$285.35
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$746.00
$846.72
$953.38
$1,332.36
$2,024.64
$1,031.35
$1,132.07
$1,238.73
$1,617.71
$1,316.70
$1,417.42
$1,524.08
$1,903.06
$1,602.05
$1,702.77
$1,809.43
$2,188.41
$285.35
Toc - Plan #19 UnitedHealthcare
Expanded Bronze

(EPO) UHC Bronze Standard (No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-250-8188

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$374.65
$425.22
$478.80
$669.12
$1,016.78
$661.26
$711.83
$765.41
$955.73
$947.87
$998.44
$1,052.02
$1,242.34
$1,234.48
$1,285.05
$1,338.63
$1,528.95
$286.61
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$749.30
$850.44
$957.60
$1,338.24
$2,033.56
$1,035.91
$1,137.05
$1,244.21
$1,624.85
$1,322.52
$1,423.66
$1,530.82
$1,911.46
$1,609.13
$1,710.27
$1,817.43
$2,198.07
$286.61
Toc - Plan #20 UnitedHealthcare
Bronze

(EPO) UHC Bronze Essential (Virtual Urgent Care, No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-250-8188

Annual Out of Pocket Expenses:

Individual Family
$6,350 $12,700 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$355.52
$403.52
$454.36
$634.96
$964.88
$627.50
$675.50
$726.34
$906.94
$899.48
$947.48
$998.32
$1,178.92
$1,171.46
$1,219.46
$1,270.30
$1,450.90
$271.98
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$711.04
$807.04
$908.72
$1,269.92
$1,929.76
$983.02
$1,079.02
$1,180.70
$1,541.90
$1,255.00
$1,351.00
$1,452.68
$1,813.88
$1,526.98
$1,622.98
$1,724.66
$2,085.86
$271.98
Toc - Plan #21 UnitedHealthcare
Expanded Bronze

(EPO) UHC Bronze Copay Focus (Virtual Urgent Care, No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-250-8188

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$377.72
$428.71
$482.73
$674.60
$1,025.12
$666.68
$717.67
$771.69
$963.56
$955.64
$1,006.63
$1,060.65
$1,252.52
$1,244.60
$1,295.59
$1,349.61
$1,541.48
$288.96
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$755.44
$857.42
$965.46
$1,349.20
$2,050.24
$1,044.40
$1,146.38
$1,254.42
$1,638.16
$1,333.36
$1,435.34
$1,543.38
$1,927.12
$1,622.32
$1,724.30
$1,832.34
$2,216.08
$288.96
Toc - Plan #22 UnitedHealthcare
Silver

(EPO) UHC Silver Advantage (No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-250-8188

Annual Out of Pocket Expenses:

Individual Family
$2,500 $5,000 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$476.57
$540.90
$609.05
$851.14
$1,293.39
$841.14
$905.47
$973.62
$1,215.71
$1,205.71
$1,270.04
$1,338.19
$1,580.28
$1,570.28
$1,634.61
$1,702.76
$1,944.85
$364.57
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$953.14
$1,081.80
$1,218.10
$1,702.28
$2,586.78
$1,317.71
$1,446.37
$1,582.67
$2,066.85
$1,682.28
$1,810.94
$1,947.24
$2,431.42
$2,046.85
$2,175.51
$2,311.81
$2,795.99
$364.57
Toc - Plan #23 UnitedHealthcare
Gold

(EPO) UHC Gold Copay Focus (No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-250-8188

Annual Out of Pocket Expenses:

Individual Family
$0 $0 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
$682.54
$774.68
$872.29
$1,219.02
$1,852.41
$1,204.69
$1,296.83
$1,394.44
$1,741.17
$1,726.84
$1,818.98
$1,916.59
$2,263.32
$2,248.99
$2,341.13
$2,438.74
$2,785.47
$522.15
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,365.08
$1,549.36
$1,744.58
$2,438.04
$3,704.82
$1,887.23
$2,071.51
$2,266.73
$2,960.19
$2,409.38
$2,593.66
$2,788.88
$3,482.34
$2,931.53
$3,115.81
$3,311.03
$4,004.49
$522.15
Toc - Plan #24 UnitedHealthcare
Silver

(EPO) UHC Silver Advantage+ (Dental + Vision, No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-250-8188

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$489.80
$555.92
$625.96
$874.77
$1,329.30
$864.50
$930.62
$1,000.66
$1,249.47
$1,239.20
$1,305.32
$1,375.36
$1,624.17
$1,613.90
$1,680.02
$1,750.06
$1,998.87
$374.70
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$979.60
$1,111.84
$1,251.92
$1,749.54
$2,658.60
$1,354.30
$1,486.54
$1,626.62
$2,124.24
$1,729.00
$1,861.24
$2,001.32
$2,498.94
$2,103.70
$2,235.94
$2,376.02
$2,873.64
$374.70
Toc - Plan #25 UnitedHealthcare
Gold

(EPO) UHC Gold Advantage+ (Dental + Vision, No Referrals)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-250-8188

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$681.41
$773.40
$870.84
$1,217.00
$1,849.34
$1,202.69
$1,294.68
$1,392.12
$1,738.28
$1,723.97
$1,815.96
$1,913.40
$2,259.56
$2,245.25
$2,337.24
$2,434.68
$2,780.84
$521.28
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,362.82
$1,546.80
$1,741.68
$2,434.00
$3,698.68
$1,884.10
$2,068.08
$2,262.96
$2,955.28
$2,405.38
$2,589.36
$2,784.24
$3,476.56
$2,926.66
$3,110.64
$3,305.52
$3,997.84
$521.28

ADVERTISEMENT

Ambetter of Tennessee

Local: 1-833-709-4735 | Toll Free: 1-833-709-4735

Toc - Plan #26 Ambetter of Tennessee
Silver

(EPO) Complete Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

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
$432.53
$490.91
$552.76
$772.48
$1,173.86
$763.41
$821.79
$883.64
$1,103.36
$1,094.29
$1,152.67
$1,214.52
$1,434.24
$1,425.17
$1,483.55
$1,545.40
$1,765.12
$330.88
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$865.06
$981.82
$1,105.52
$1,544.96
$2,347.72
$1,195.94
$1,312.70
$1,436.40
$1,875.84
$1,526.82
$1,643.58
$1,767.28
$2,206.72
$1,857.70
$1,974.46
$2,098.16
$2,537.60
$330.88
Toc - Plan #27 Ambetter of Tennessee
Gold

(EPO) Complete Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$440.24
$499.67
$562.62
$786.26
$1,194.80
$777.02
$836.45
$899.40
$1,123.04
$1,113.80
$1,173.23
$1,236.18
$1,459.82
$1,450.58
$1,510.01
$1,572.96
$1,796.60
$336.78
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$880.48
$999.34
$1,125.24
$1,572.52
$2,389.60
$1,217.26
$1,336.12
$1,462.02
$1,909.30
$1,554.04
$1,672.90
$1,798.80
$2,246.08
$1,890.82
$2,009.68
$2,135.58
$2,582.86
$336.78
Toc - Plan #28 Ambetter of Tennessee
Expanded Bronze

(EPO) Choice Bronze HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$334.34
$379.47
$427.28
$597.12
$907.38
$590.11
$635.24
$683.05
$852.89
$845.88
$891.01
$938.82
$1,108.66
$1,101.65
$1,146.78
$1,194.59
$1,364.43
$255.77
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$668.68
$758.94
$854.56
$1,194.24
$1,814.76
$924.45
$1,014.71
$1,110.33
$1,450.01
$1,180.22
$1,270.48
$1,366.10
$1,705.78
$1,435.99
$1,526.25
$1,621.87
$1,961.55
$255.77
Toc - Plan #29 Ambetter of Tennessee
Silver

(EPO) Everyday Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 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
$428.36
$486.18
$547.43
$765.04
$1,162.55
$756.05
$813.87
$875.12
$1,092.73
$1,083.74
$1,141.56
$1,202.81
$1,420.42
$1,411.43
$1,469.25
$1,530.50
$1,748.11
$327.69
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$856.72
$972.36
$1,094.86
$1,530.08
$2,325.10
$1,184.41
$1,300.05
$1,422.55
$1,857.77
$1,512.10
$1,627.74
$1,750.24
$2,185.46
$1,839.79
$1,955.43
$2,077.93
$2,513.15
$327.69
Toc - Plan #30 Ambetter of Tennessee
Expanded Bronze

(EPO) Everyday Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$329.38
$373.84
$420.94
$588.26
$893.92
$581.35
$625.81
$672.91
$840.23
$833.32
$877.78
$924.88
$1,092.20
$1,085.29
$1,129.75
$1,176.85
$1,344.17
$251.97
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$658.76
$747.68
$841.88
$1,176.52
$1,787.84
$910.73
$999.65
$1,093.85
$1,428.49
$1,162.70
$1,251.62
$1,345.82
$1,680.46
$1,414.67
$1,503.59
$1,597.79
$1,932.43
$251.97
Toc - Plan #31 Ambetter of Tennessee
Expanded Bronze

(EPO) Elite Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$376.16
$426.93
$480.72
$671.81
$1,020.88
$663.92
$714.69
$768.48
$959.57
$951.68
$1,002.45
$1,056.24
$1,247.33
$1,239.44
$1,290.21
$1,344.00
$1,535.09
$287.76
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$752.32
$853.86
$961.44
$1,343.62
$2,041.76
$1,040.08
$1,141.62
$1,249.20
$1,631.38
$1,327.84
$1,429.38
$1,536.96
$1,919.14
$1,615.60
$1,717.14
$1,824.72
$2,206.90
$287.76
Toc - Plan #32 Ambetter of Tennessee
Silver

(EPO) Clear Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

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
$417.15
$473.45
$533.10
$745.01
$1,132.11
$736.26
$792.56
$852.21
$1,064.12
$1,055.37
$1,111.67
$1,171.32
$1,383.23
$1,374.48
$1,430.78
$1,490.43
$1,702.34
$319.11
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$834.30
$946.90
$1,066.20
$1,490.02
$2,264.22
$1,153.41
$1,266.01
$1,385.31
$1,809.13
$1,472.52
$1,585.12
$1,704.42
$2,128.24
$1,791.63
$1,904.23
$2,023.53
$2,447.35
$319.11
Toc - Plan #33 Ambetter of Tennessee
Silver

(EPO) Focused Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

Annual Out of Pocket Expenses:

Individual Family
$6,300 $12,600 Annual Deductible
$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$425.24
$482.63
$543.44
$759.45
$1,154.06
$750.54
$807.93
$868.74
$1,084.75
$1,075.84
$1,133.23
$1,194.04
$1,410.05
$1,401.14
$1,458.53
$1,519.34
$1,735.35
$325.30
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$850.48
$965.26
$1,086.88
$1,518.90
$2,308.12
$1,175.78
$1,290.56
$1,412.18
$1,844.20
$1,501.08
$1,615.86
$1,737.48
$2,169.50
$1,826.38
$1,941.16
$2,062.78
$2,494.80
$325.30
Toc - Plan #34 Ambetter of Tennessee
Gold

(EPO) Everyday Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

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
$421.23
$478.09
$538.32
$752.30
$1,143.20
$743.47
$800.33
$860.56
$1,074.54
$1,065.71
$1,122.57
$1,182.80
$1,396.78
$1,387.95
$1,444.81
$1,505.04
$1,719.02
$322.24
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$842.46
$956.18
$1,076.64
$1,504.60
$2,286.40
$1,164.70
$1,278.42
$1,398.88
$1,826.84
$1,486.94
$1,600.66
$1,721.12
$2,149.08
$1,809.18
$1,922.90
$2,043.36
$2,471.32
$322.24
Toc - Plan #35 Ambetter of Tennessee
Gold

(EPO) Elite Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$482.23
$547.32
$616.28
$861.24
$1,308.74
$851.13
$916.22
$985.18
$1,230.14
$1,220.03
$1,285.12
$1,354.08
$1,599.04
$1,588.93
$1,654.02
$1,722.98
$1,967.94
$368.90
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$964.46
$1,094.64
$1,232.56
$1,722.48
$2,617.48
$1,333.36
$1,463.54
$1,601.46
$2,091.38
$1,702.26
$1,832.44
$1,970.36
$2,460.28
$2,071.16
$2,201.34
$2,339.26
$2,829.18
$368.90
Toc - Plan #36 Ambetter of Tennessee
Expanded Bronze

(EPO) Standard Expanded Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$323.42
$367.07
$413.32
$577.61
$877.74
$570.83
$614.48
$660.73
$825.02
$818.24
$861.89
$908.14
$1,072.43
$1,065.65
$1,109.30
$1,155.55
$1,319.84
$247.41
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$646.84
$734.14
$826.64
$1,155.22
$1,755.48
$894.25
$981.55
$1,074.05
$1,402.63
$1,141.66
$1,228.96
$1,321.46
$1,650.04
$1,389.07
$1,476.37
$1,568.87
$1,897.45
$247.41
Toc - Plan #37 Ambetter of Tennessee
Silver

(EPO) Standard Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$416.94
$473.21
$532.83
$744.63
$1,131.54
$735.89
$792.16
$851.78
$1,063.58
$1,054.84
$1,111.11
$1,170.73
$1,382.53
$1,373.79
$1,430.06
$1,489.68
$1,701.48
$318.95
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$833.88
$946.42
$1,065.66
$1,489.26
$2,263.08
$1,152.83
$1,265.37
$1,384.61
$1,808.21
$1,471.78
$1,584.32
$1,703.56
$2,127.16
$1,790.73
$1,903.27
$2,022.51
$2,446.11
$318.95
Toc - Plan #38 Ambetter of Tennessee
Gold

(EPO) Standard Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$421.90
$478.84
$539.17
$753.49
$1,145.01
$744.65
$801.59
$861.92
$1,076.24
$1,067.40
$1,124.34
$1,184.67
$1,398.99
$1,390.15
$1,447.09
$1,507.42
$1,721.74
$322.75
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$843.80
$957.68
$1,078.34
$1,506.98
$2,290.02
$1,166.55
$1,280.43
$1,401.09
$1,829.73
$1,489.30
$1,603.18
$1,723.84
$2,152.48
$1,812.05
$1,925.93
$2,046.59
$2,475.23
$322.75
Toc - Plan #39 Ambetter of Tennessee
Silver

(EPO) Complete Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

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
$447.77
$508.21
$572.24
$799.70
$1,215.22
$790.31
$850.75
$914.78
$1,142.24
$1,132.85
$1,193.29
$1,257.32
$1,484.78
$1,475.39
$1,535.83
$1,599.86
$1,827.32
$342.54
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$895.54
$1,016.42
$1,144.48
$1,599.40
$2,430.44
$1,238.08
$1,358.96
$1,487.02
$1,941.94
$1,580.62
$1,701.50
$1,829.56
$2,284.48
$1,923.16
$2,044.04
$2,172.10
$2,627.02
$342.54
Toc - Plan #40 Ambetter of Tennessee
Gold

(EPO) Complete Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$455.76
$517.27
$582.44
$813.96
$1,236.90
$804.41
$865.92
$931.09
$1,162.61
$1,153.06
$1,214.57
$1,279.74
$1,511.26
$1,501.71
$1,563.22
$1,628.39
$1,859.91
$348.65
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$911.52
$1,034.54
$1,164.88
$1,627.92
$2,473.80
$1,260.17
$1,383.19
$1,513.53
$1,976.57
$1,608.82
$1,731.84
$1,862.18
$2,325.22
$1,957.47
$2,080.49
$2,210.83
$2,673.87
$348.65
Toc - Plan #41 Ambetter of Tennessee
Expanded Bronze

(EPO) Choice Bronze HSA + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$346.13
$392.84
$442.34
$618.16
$939.36
$610.91
$657.62
$707.12
$882.94
$875.69
$922.40
$971.90
$1,147.72
$1,140.47
$1,187.18
$1,236.68
$1,412.50
$264.78
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$692.26
$785.68
$884.68
$1,236.32
$1,878.72
$957.04
$1,050.46
$1,149.46
$1,501.10
$1,221.82
$1,315.24
$1,414.24
$1,765.88
$1,486.60
$1,580.02
$1,679.02
$2,030.66
$264.78
Toc - Plan #42 Ambetter of Tennessee
Silver

(EPO) Everyday Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 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
$443.46
$503.31
$566.72
$791.99
$1,203.51
$782.70
$842.55
$905.96
$1,131.23
$1,121.94
$1,181.79
$1,245.20
$1,470.47
$1,461.18
$1,521.03
$1,584.44
$1,809.71
$339.24
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$886.92
$1,006.62
$1,133.44
$1,583.98
$2,407.02
$1,226.16
$1,345.86
$1,472.68
$1,923.22
$1,565.40
$1,685.10
$1,811.92
$2,262.46
$1,904.64
$2,024.34
$2,151.16
$2,601.70
$339.24
Toc - Plan #43 Ambetter of Tennessee
Expanded Bronze

(EPO) Everyday Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$340.99
$387.01
$435.77
$608.99
$925.42
$601.84
$647.86
$696.62
$869.84
$862.69
$908.71
$957.47
$1,130.69
$1,123.54
$1,169.56
$1,218.32
$1,391.54
$260.85
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$681.98
$774.02
$871.54
$1,217.98
$1,850.84
$942.83
$1,034.87
$1,132.39
$1,478.83
$1,203.68
$1,295.72
$1,393.24
$1,739.68
$1,464.53
$1,556.57
$1,654.09
$2,000.53
$260.85
Toc - Plan #44 Ambetter of Tennessee
Expanded Bronze

(EPO) Elite Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$389.42
$441.98
$497.66
$695.48
$1,056.85
$687.32
$739.88
$795.56
$993.38
$985.22
$1,037.78
$1,093.46
$1,291.28
$1,283.12
$1,335.68
$1,391.36
$1,589.18
$297.90
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$778.84
$883.96
$995.32
$1,390.96
$2,113.70
$1,076.74
$1,181.86
$1,293.22
$1,688.86
$1,374.64
$1,479.76
$1,591.12
$1,986.76
$1,672.54
$1,777.66
$1,889.02
$2,284.66
$297.90
Toc - Plan #45 Ambetter of Tennessee
Silver

(EPO) Focused Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

Annual Out of Pocket Expenses:

Individual Family
$6,300 $12,600 Annual Deductible
$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$440.22
$499.64
$562.59
$786.21
$1,194.72
$776.98
$836.40
$899.35
$1,122.97
$1,113.74
$1,173.16
$1,236.11
$1,459.73
$1,450.50
$1,509.92
$1,572.87
$1,796.49
$336.76
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$880.44
$999.28
$1,125.18
$1,572.42
$2,389.44
$1,217.20
$1,336.04
$1,461.94
$1,909.18
$1,553.96
$1,672.80
$1,798.70
$2,245.94
$1,890.72
$2,009.56
$2,135.46
$2,582.70
$336.76
Toc - Plan #46 Ambetter of Tennessee
Gold

(EPO) Everyday Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

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
$436.07
$494.93
$557.29
$778.81
$1,183.48
$769.66
$828.52
$890.88
$1,112.40
$1,103.25
$1,162.11
$1,224.47
$1,445.99
$1,436.84
$1,495.70
$1,558.06
$1,779.58
$333.59
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$872.14
$989.86
$1,114.58
$1,557.62
$2,366.96
$1,205.73
$1,323.45
$1,448.17
$1,891.21
$1,539.32
$1,657.04
$1,781.76
$2,224.80
$1,872.91
$1,990.63
$2,115.35
$2,558.39
$333.59
Toc - Plan #47 Ambetter of Tennessee
Silver

(EPO) Clear Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

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
$431.84
$490.13
$551.88
$771.26
$1,172.00
$762.19
$820.48
$882.23
$1,101.61
$1,092.54
$1,150.83
$1,212.58
$1,431.96
$1,422.89
$1,481.18
$1,542.93
$1,762.31
$330.35
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$863.68
$980.26
$1,103.76
$1,542.52
$2,344.00
$1,194.03
$1,310.61
$1,434.11
$1,872.87
$1,524.38
$1,640.96
$1,764.46
$2,203.22
$1,854.73
$1,971.31
$2,094.81
$2,533.57
$330.35
Toc - Plan #48 Ambetter of Tennessee
Gold

(EPO) Elite Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$499.22
$566.60
$637.99
$891.59
$1,354.86
$881.12
$948.50
$1,019.89
$1,273.49
$1,263.02
$1,330.40
$1,401.79
$1,655.39
$1,644.92
$1,712.30
$1,783.69
$2,037.29
$381.90
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$998.44
$1,133.20
$1,275.98
$1,783.18
$2,709.72
$1,380.34
$1,515.10
$1,657.88
$2,165.08
$1,762.24
$1,897.00
$2,039.78
$2,546.98
$2,144.14
$2,278.90
$2,421.68
$2,928.88
$381.90
Toc - Plan #49 Ambetter of Tennessee
Expanded Bronze

(EPO) Standard Expanded Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$334.82
$380.01
$427.88
$597.96
$908.67
$590.95
$636.14
$684.01
$854.09
$847.08
$892.27
$940.14
$1,110.22
$1,103.21
$1,148.40
$1,196.27
$1,366.35
$256.13
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$669.64
$760.02
$855.76
$1,195.92
$1,817.34
$925.77
$1,016.15
$1,111.89
$1,452.05
$1,181.90
$1,272.28
$1,368.02
$1,708.18
$1,438.03
$1,528.41
$1,624.15
$1,964.31
$256.13
Toc - Plan #50 Ambetter of Tennessee
Silver

(EPO) Standard Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$431.63
$489.89
$551.61
$770.87
$1,171.41
$761.82
$820.08
$881.80
$1,101.06
$1,092.01
$1,150.27
$1,211.99
$1,431.25
$1,422.20
$1,480.46
$1,542.18
$1,761.44
$330.19
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$863.26
$979.78
$1,103.22
$1,541.74
$2,342.82
$1,193.45
$1,309.97
$1,433.41
$1,871.93
$1,523.64
$1,640.16
$1,763.60
$2,202.12
$1,853.83
$1,970.35
$2,093.79
$2,532.31
$330.19
Toc - Plan #51 Ambetter of Tennessee
Gold

(EPO) Standard Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-709-4735

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$436.77
$495.72
$558.17
$780.04
$1,185.35
$770.89
$829.84
$892.29
$1,114.16
$1,105.01
$1,163.96
$1,226.41
$1,448.28
$1,439.13
$1,498.08
$1,560.53
$1,782.40
$334.12
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$873.54
$991.44
$1,116.34
$1,560.08
$2,370.70
$1,207.66
$1,325.56
$1,450.46
$1,894.20
$1,541.78
$1,659.68
$1,784.58
$2,228.32
$1,875.90
$1,993.80
$2,118.70
$2,562.44
$334.12

ADVERTISEMENT

Cigna Healthcare

Local: 1-877-900-1237 | Toll Free: 1-877-900-1237 | TTY: 1-800-676-3777

Toc - Plan #52 Cigna Healthcare
Silver

(EPO) Connect Silver 4000 Indiv Med Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family
$4,000 $8,000 Annual Deductible
$9,050 $18,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$411.44
$466.98
$525.82
$734.83
$1,116.64
$726.19
$781.73
$840.57
$1,049.58
$1,040.94
$1,096.48
$1,155.32
$1,364.33
$1,355.69
$1,411.23
$1,470.07
$1,679.08
$314.75
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$822.88
$933.96
$1,051.64
$1,469.66
$2,233.28
$1,137.63
$1,248.71
$1,366.39
$1,784.41
$1,452.38
$1,563.46
$1,681.14
$2,099.16
$1,767.13
$1,878.21
$1,995.89
$2,413.91
$314.75
Toc - Plan #53 Cigna Healthcare
Gold

(EPO) Connect Gold 500 Indiv Med Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$555.05
$629.99
$709.36
$991.32
$1,506.41
$979.67
$1,054.61
$1,133.98
$1,415.94
$1,404.29
$1,479.23
$1,558.60
$1,840.56
$1,828.91
$1,903.85
$1,983.22
$2,265.18
$424.62
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,110.10
$1,259.98
$1,418.72
$1,982.64
$3,012.82
$1,534.72
$1,684.60
$1,843.34
$2,407.26
$1,959.34
$2,109.22
$2,267.96
$2,831.88
$2,383.96
$2,533.84
$2,692.58
$3,256.50
$424.62
Toc - Plan #54 Cigna Healthcare
Bronze

(EPO) Connect Bronze 6500 Indiv Med Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$351.87
$399.37
$449.69
$628.43
$954.96
$621.05
$668.55
$718.87
$897.61
$890.23
$937.73
$988.05
$1,166.79
$1,159.41
$1,206.91
$1,257.23
$1,435.97
$269.18
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$703.74
$798.74
$899.38
$1,256.86
$1,909.92
$972.92
$1,067.92
$1,168.56
$1,526.04
$1,242.10
$1,337.10
$1,437.74
$1,795.22
$1,511.28
$1,606.28
$1,706.92
$2,064.40
$269.18
Toc - Plan #55 Cigna Healthcare
Expanded Bronze

(EPO) Connect Bronze 5500 Indiv Med Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family
$5,500 $11,000 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$364.65
$413.87
$466.02
$651.26
$989.65
$643.60
$692.82
$744.97
$930.21
$922.55
$971.77
$1,023.92
$1,209.16
$1,201.50
$1,250.72
$1,302.87
$1,488.11
$278.95
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$729.30
$827.74
$932.04
$1,302.52
$1,979.30
$1,008.25
$1,106.69
$1,210.99
$1,581.47
$1,287.20
$1,385.64
$1,489.94
$1,860.42
$1,566.15
$1,664.59
$1,768.89
$2,139.37
$278.95
Toc - Plan #56 Cigna Healthcare
Silver

(EPO) Connect Silver 3000 Indiv Med Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family
$3,000 $6,000 Annual Deductible
$9,300 $18,600 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
$414.53
$470.49
$529.77
$740.36
$1,125.04
$731.65
$787.61
$846.89
$1,057.48
$1,048.77
$1,104.73
$1,164.01
$1,374.60
$1,365.89
$1,421.85
$1,481.13
$1,691.72
$317.12
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$829.06
$940.98
$1,059.54
$1,480.72
$2,250.08
$1,146.18
$1,258.10
$1,376.66
$1,797.84
$1,463.30
$1,575.22
$1,693.78
$2,114.96
$1,780.42
$1,892.34
$2,010.90
$2,432.08
$317.12
Toc - Plan #57 Cigna Healthcare
Silver

(EPO) Connect Silver 5000 Indiv Med Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 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
$413.50
$469.32
$528.45
$738.51
$1,122.24
$729.83
$785.65
$844.78
$1,054.84
$1,046.16
$1,101.98
$1,161.11
$1,371.17
$1,362.49
$1,418.31
$1,477.44
$1,687.50
$316.33
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$827.00
$938.64
$1,056.90
$1,477.02
$2,244.48
$1,143.33
$1,254.97
$1,373.23
$1,793.35
$1,459.66
$1,571.30
$1,689.56
$2,109.68
$1,775.99
$1,887.63
$2,005.89
$2,426.01
$316.33
Toc - Plan #58 Cigna Healthcare
Expanded Bronze

(EPO) Connect Bronze 3500 Indiv Med Deductible Enhanced Diabetes Care

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$368.38
$418.11
$470.79
$657.93
$999.79
$650.19
$699.92
$752.60
$939.74
$932.00
$981.73
$1,034.41
$1,221.55
$1,213.81
$1,263.54
$1,316.22
$1,503.36
$281.81
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$736.76
$836.22
$941.58
$1,315.86
$1,999.58
$1,018.57
$1,118.03
$1,223.39
$1,597.67
$1,300.38
$1,399.84
$1,505.20
$1,879.48
$1,582.19
$1,681.65
$1,787.01
$2,161.29
$281.81
Toc - Plan #59 Cigna Healthcare
Expanded Bronze

(EPO) Connect Bronze 8500 Indiv Med Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family
$8,500 $17,000 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$362.73
$411.70
$463.57
$647.83
$984.44
$640.22
$689.19
$741.06
$925.32
$917.71
$966.68
$1,018.55
$1,202.81
$1,195.20
$1,244.17
$1,296.04
$1,480.30
$277.49
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$725.46
$823.40
$927.14
$1,295.66
$1,968.88
$1,002.95
$1,100.89
$1,204.63
$1,573.15
$1,280.44
$1,378.38
$1,482.12
$1,850.64
$1,557.93
$1,655.87
$1,759.61
$2,128.13
$277.49
Toc - Plan #60 Cigna Healthcare
Silver

(EPO) Connect Silver 0 Indiv Med Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$415.02
$471.05
$530.40
$741.23
$1,126.38
$732.51
$788.54
$847.89
$1,058.72
$1,050.00
$1,106.03
$1,165.38
$1,376.21
$1,367.49
$1,423.52
$1,482.87
$1,693.70
$317.49
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$830.04
$942.10
$1,060.80
$1,482.46
$2,252.76
$1,147.53
$1,259.59
$1,378.29
$1,799.95
$1,465.02
$1,577.08
$1,695.78
$2,117.44
$1,782.51
$1,894.57
$2,013.27
$2,434.93
$317.49
Toc - Plan #61 Cigna Healthcare
Expanded Bronze

(EPO) Connect Bronze CMS Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$363.81
$412.92
$464.95
$649.76
$987.38
$642.12
$691.23
$743.26
$928.07
$920.43
$969.54
$1,021.57
$1,206.38
$1,198.74
$1,247.85
$1,299.88
$1,484.69
$278.31
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$727.62
$825.84
$929.90
$1,299.52
$1,974.76
$1,005.93
$1,104.15
$1,208.21
$1,577.83
$1,284.24
$1,382.46
$1,486.52
$1,856.14
$1,562.55
$1,660.77
$1,764.83
$2,134.45
$278.31
Toc - Plan #62 Cigna Healthcare
Silver

(EPO) Connect Silver CMS Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$412.96
$468.71
$527.76
$737.55
$1,120.77
$728.87
$784.62
$843.67
$1,053.46
$1,044.78
$1,100.53
$1,159.58
$1,369.37
$1,360.69
$1,416.44
$1,475.49
$1,685.28
$315.91
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$825.92
$937.42
$1,055.52
$1,475.10
$2,241.54
$1,141.83
$1,253.33
$1,371.43
$1,791.01
$1,457.74
$1,569.24
$1,687.34
$2,106.92
$1,773.65
$1,885.15
$2,003.25
$2,422.83
$315.91
Toc - Plan #63 Cigna Healthcare
Gold

(EPO) Connect Gold CMS Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$542.32
$615.54
$693.09
$968.59
$1,471.87
$957.20
$1,030.42
$1,107.97
$1,383.47
$1,372.08
$1,445.30
$1,522.85
$1,798.35
$1,786.96
$1,860.18
$1,937.73
$2,213.23
$414.88
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,084.64
$1,231.08
$1,386.18
$1,937.18
$2,943.74
$1,499.52
$1,645.96
$1,801.06
$2,352.06
$1,914.40
$2,060.84
$2,215.94
$2,766.94
$2,329.28
$2,475.72
$2,630.82
$3,181.82
$414.88

‡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 Dyer County here.

Dyer County is in “Rating Area 5” of Tennessee.

Currently, there are 63 plans offered in Rating Area 5.

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2024 Obamacare Plans for Dyer County, TN

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