Obamacare 2020 Rates and Health Insurance Providers for Fort Bend County , Texas

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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 HealthCare.gov, the marketplace for Fort Bend County, Texas.

The health insurance rates listed below are for calendar year 2020.

Obamacare Providers, Plans and 2020 Rates for Fort Bend County, Texas

Below, you’ll find a summary of the 50 plans for Fort Bend County, Texas 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 take one of the following actions:

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

The table below shows premiums for the following profiles at various ages:

Individuals
Couples
Couples with 1, 2, or 3 children
Individuals with 1, 2, or 3 children
A child alone

Each plan links to the insurance provider's website. You can find the following:

Summary of plan benefits and costs
Plan brochure
Provider Directory where you can find out which doctors and hospitals in the Richmond, TX area accept this insurance coverage as within the plan's network.

Counties in Texas

2020 Obamacare Rates, Providers, and Plans for Fort Bend County

Oscar Insurance Company

Local: 1-855-672-2755 | Toll Free: 1-855-672-2755

Bronze

(EPO) Oscar Simple Bronze

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Oscar Insurance Company
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $8,150 $16,300

Maximum Out of Pocket Per Year $8,150 $16,300

Deductible: Individual: $8,150 | Family: $16,300
Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$231.58
$262.84
$295.95
$413.59
$628.49

$463.16
$525.68
$591.90
$827.18
$1,256.98

$640.31
$702.83
$769.05
$1,004.33

$817.46
$879.98
$946.20
$1,181.48

$994.61
$1,057.13
$1,123.35
$1,358.63

$408.73
$439.99
$473.10
$590.74

$585.88
$617.14
$650.25
$767.89

$763.03
$794.29
$827.40
$945.04

$177.15

Expanded Bronze

(EPO) Oscar Classic Bronze

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Oscar Insurance Company
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $5,500 $11,000

Maximum Out of Pocket Per Year $8,150 $16,300

Deductible: Individual: $5,500 | Family: $11,000
Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$239.07
$271.33
$305.51
$426.95
$648.80

$478.14
$542.66
$611.02
$853.90
$1,297.60

$661.02
$725.54
$793.90
$1,036.78

$843.90
$908.42
$976.78
$1,219.66

$1,026.78
$1,091.30
$1,159.66
$1,402.54

$421.95
$454.21
$488.39
$609.83

$604.83
$637.09
$671.27
$792.71

$787.71
$819.97
$854.15
$975.59

$182.88

Expanded Bronze

(EPO) Oscar Saver Bronze

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Oscar Insurance Company
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $6,000 $12,000

Maximum Out of Pocket Per Year $6,750 $13,500

Deductible: Individual: $6,000 | Family: $12,000
Out of Pocket Maximum per year: Individual: $6,750 | Family: $13,500

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$244.16
$277.11
$312.02
$436.05
$662.62

$488.32
$554.22
$624.04
$872.10
$1,325.24

$675.09
$740.99
$810.81
$1,058.87

$861.86
$927.76
$997.58
$1,245.64

$1,048.63
$1,114.53
$1,184.35
$1,432.41

$430.93
$463.88
$498.79
$622.82

$617.70
$650.65
$685.56
$809.59

$804.47
$837.42
$872.33
$996.36

$186.77

Expanded Bronze

(EPO) Oscar Classic Bronze Next

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Oscar Insurance Company
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $0 $0

Maximum Out of Pocket Per Year $8,150 $16,300

Deductible: Individual: $0 | Family: $0
Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$287.75
$326.59
$367.73
$513.91
$780.93

$575.50
$653.18
$735.46
$1,027.82
$1,561.86

$795.62
$873.30
$955.58
$1,247.94

$1,015.74
$1,093.42
$1,175.70
$1,468.06

$1,235.86
$1,313.54
$1,395.82
$1,688.18

$507.87
$546.71
$587.85
$734.03

$727.99
$766.83
$807.97
$954.15

$948.11
$986.95
$1,028.09
$1,174.27

$220.12

Silver

(EPO) Oscar Classic Silver

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Oscar Insurance Company
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $5,000 $10,000

Maximum Out of Pocket Per Year $8,150 $16,300

Deductible: Individual: $5,000 | Family: $10,000
Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$332.49
$377.37
$424.92
$593.82
$902.36

$664.98
$754.74
$849.84
$1,187.64
$1,804.72

$919.33
$1,009.09
$1,104.19
$1,441.99

$1,173.68
$1,263.44
$1,358.54
$1,696.34

$1,428.03
$1,517.79
$1,612.89
$1,950.69

$586.84
$631.72
$679.27
$848.17

$841.19
$886.07
$933.62
$1,102.52

$1,095.54
$1,140.42
$1,187.97
$1,356.87

$254.35

Silver

(EPO) Oscar Simple Silver

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Oscar Insurance Company
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $8,150 $16,300

Maximum Out of Pocket Per Year $8,150 $16,300

Deductible: Individual: $8,150 | Family: $16,300
Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$336.07
$381.43
$429.48
$600.20
$912.07

$672.14
$762.86
$858.96
$1,200.40
$1,824.14

$929.23
$1,019.95
$1,116.05
$1,457.49

$1,186.32
$1,277.04
$1,373.14
$1,714.58

$1,443.41
$1,534.13
$1,630.23
$1,971.67

$593.16
$638.52
$686.57
$857.29

$850.25
$895.61
$943.66
$1,114.38

$1,107.34
$1,152.70
$1,200.75
$1,371.47

$257.09

Silver

(EPO) Oscar Saver Silver

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Oscar Insurance Company
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $3,000 $6,000

Maximum Out of Pocket Per Year $6,650 $13,300

Deductible: Individual: $3,000 | Family: $6,000
Out of Pocket Maximum per year: Individual: $6,650 | Family: $13,300

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$325.33
$369.24
$415.76
$581.03
$882.92

$650.66
$738.48
$831.52
$1,162.06
$1,765.84

$899.53
$987.35
$1,080.39
$1,410.93

$1,148.40
$1,236.22
$1,329.26
$1,659.80

$1,397.27
$1,485.09
$1,578.13
$1,908.67

$574.20
$618.11
$664.63
$829.90

$823.07
$866.98
$913.50
$1,078.77

$1,071.94
$1,115.85
$1,162.37
$1,327.64

$248.87

Silver

(EPO) Oscar Classic Silver Next

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Oscar Insurance Company
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $7,000 $14,000

Maximum Out of Pocket Per Year $8,150 $16,300

Deductible: Individual: $7,000 | Family: $14,000
Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$333.56
$378.58
$426.27
$595.72
$905.25

$667.12
$757.16
$852.54
$1,191.44
$1,810.50

$922.28
$1,012.32
$1,107.70
$1,446.60

$1,177.44
$1,267.48
$1,362.86
$1,701.76

$1,432.60
$1,522.64
$1,618.02
$1,956.92

$588.72
$633.74
$681.43
$850.88

$843.88
$888.90
$936.59
$1,106.04

$1,099.04
$1,144.06
$1,191.75
$1,361.20

$255.16

Catastrophic

(EPO) Oscar Simple Secure

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Oscar Insurance Company
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $8,150 $16,300

Maximum Out of Pocket Per Year $8,150 $16,300

Deductible: Individual: $8,150 | Family: $16,300
Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$198.05
$224.77
$253.09
$353.70
$537.48

$396.10
$449.54
$506.18
$707.40
$1,074.96

$547.60
$601.04
$657.68
$858.90

$699.10
$752.54
$809.18
$1,010.40

$850.60
$904.04
$960.68
$1,161.90

$349.55
$376.27
$404.59
$505.20

$501.05
$527.77
$556.09
$656.70

$652.55
$679.27
$707.59
$808.20

$151.50

Gold

(EPO) Oscar Classic Gold

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Oscar Insurance Company
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $1,700 $3,400

Maximum Out of Pocket Per Year $8,150 $16,300

Deductible: Individual: $1,700 | Family: $3,400
Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$384.83
$436.77
$491.80
$687.29
$1,044.40

$769.66
$873.54
$983.60
$1,374.58
$2,088.80

$1,064.05
$1,167.93
$1,277.99
$1,668.97

$1,358.44
$1,462.32
$1,572.38
$1,963.36

$1,652.83
$1,756.71
$1,866.77
$2,257.75

$679.22
$731.16
$786.19
$981.68

$973.61
$1,025.55
$1,080.58
$1,276.07

$1,268.00
$1,319.94
$1,374.97
$1,570.46

$294.39

Community Health Choice, Inc.

Local: 1-713-295-6704 | Toll Free: 1-855-315-5386 | TTY: 1-800-735-2989

Gold

(HMO) Community Health Choice HMO Gold 001

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Community Health Choice, Inc.
Customer Service Phone: 1-855-315-5386

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $0 $0

Maximum Out of Pocket Per Year $8,150 $16,300

Deductible: Individual: $0 | Family: $0
Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$461.11
$523.36
$589.30
$823.54
$1,251.45

$922.22
$1,046.72
$1,178.60
$1,647.08
$2,502.90

$1,274.97
$1,399.47
$1,531.35
$1,999.83

$1,627.72
$1,752.22
$1,884.10
$2,352.58

$1,980.47
$2,104.97
$2,236.85
$2,705.33

$813.86
$876.11
$942.05
$1,176.29

$1,166.61
$1,228.86
$1,294.80
$1,529.04

$1,519.36
$1,581.61
$1,647.55
$1,881.79

$352.75

Expanded Bronze

(HMO) Community Health Choice HMO Bronze 003

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Community Health Choice, Inc.
Customer Service Phone: 1-855-315-5386

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $7,150 $14,300

Maximum Out of Pocket Per Year $8,150 $16,300

Deductible: Individual: $7,150 | Family: $14,300
Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$274.69
$311.77
$351.05
$490.60
$745.51

$549.38
$623.54
$702.10
$981.20
$1,491.02

$759.52
$833.68
$912.24
$1,191.34

$969.66
$1,043.82
$1,122.38
$1,401.48

$1,179.80
$1,253.96
$1,332.52
$1,611.62

$484.83
$521.91
$561.19
$700.74

$694.97
$732.05
$771.33
$910.88

$905.11
$942.19
$981.47
$1,121.02

$210.14

Silver

(HMO) Community Health Choice HMO Silver 004

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Community Health Choice, Inc.
Customer Service Phone: 1-855-315-5386

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $3,000 $6,000

Maximum Out of Pocket Per Year $7,900 $15,800

Deductible: Individual: $3,000 | Family: $6,000
Out of Pocket Maximum per year: Individual: $7,900 | Family: $15,800

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$382.11
$433.69
$488.34
$682.45
$1,037.05

$764.22
$867.38
$976.68
$1,364.90
$2,074.10

$1,056.53
$1,159.69
$1,268.99
$1,657.21

$1,348.84
$1,452.00
$1,561.30
$1,949.52

$1,641.15
$1,744.31
$1,853.61
$2,241.83

$674.42
$726.00
$780.65
$974.76

$966.73
$1,018.31
$1,072.96
$1,267.07

$1,259.04
$1,310.62
$1,365.27
$1,559.38

$292.31

Gold

(HMO) Community Health Choice HMO Gold 005

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Community Health Choice, Inc.
Customer Service Phone: 1-855-315-5386

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $750 $1,500

Maximum Out of Pocket Per Year $6,500 $13,000

Deductible: Individual: $750 | Family: $1,500
Out of Pocket Maximum per year: Individual: $6,500 | Family: $13,000

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$446.11
$506.33
$570.13
$796.75
$1,210.74

$892.22
$1,012.66
$1,140.26
$1,593.50
$2,421.48

$1,233.49
$1,353.93
$1,481.53
$1,934.77

$1,574.76
$1,695.20
$1,822.80
$2,276.04

$1,916.03
$2,036.47
$2,164.07
$2,617.31

$787.38
$847.60
$911.40
$1,138.02

$1,128.65
$1,188.87
$1,252.67
$1,479.29

$1,469.92
$1,530.14
$1,593.94
$1,820.56

$341.27

Expanded Bronze

(HMO) Community Health Choice HMO Bronze 008 High Deductible Health Plan- HSA Compatible

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Community Health Choice, Inc.
Customer Service Phone: 1-855-315-5386

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $6,750 $13,500

Maximum Out of Pocket Per Year $6,750 $13,500

Deductible: Individual: $6,750 | Family: $13,500
Out of Pocket Maximum per year: Individual: $6,750 | Family: $13,500

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$265.54
$301.39
$339.36
$474.25
$720.68

$531.08
$602.78
$678.72
$948.50
$1,441.36

$734.22
$805.92
$881.86
$1,151.64

$937.36
$1,009.06
$1,085.00
$1,354.78

$1,140.50
$1,212.20
$1,288.14
$1,557.92

$468.68
$504.53
$542.50
$677.39

$671.82
$707.67
$745.64
$880.53

$874.96
$910.81
$948.78
$1,083.67

$203.14

Silver

(HMO) Community Health Choice HMO Silver 009

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Community Health Choice, Inc.
Customer Service Phone: 1-855-315-5386

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $5,000 $10,000

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

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

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$363.24
$412.28
$464.22
$648.75
$985.83

$726.48
$824.56
$928.44
$1,297.50
$1,971.66

$1,004.36
$1,102.44
$1,206.32
$1,575.38

$1,282.24
$1,380.32
$1,484.20
$1,853.26

$1,560.12
$1,658.20
$1,762.08
$2,131.14

$641.12
$690.16
$742.10
$926.63

$919.00
$968.04
$1,019.98
$1,204.51

$1,196.88
$1,245.92
$1,297.86
$1,482.39

$277.88

Celtic Insurance Company

Local: 1-877-687-1196 | Toll Free: 1-877-687-1196 | TTY: 1-800-735-2989

Silver

(EPO) Ambetter Balanced Care 11 (2020)

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Celtic Insurance Company
Customer Service Phone: 1-877-687-1196

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $6,000 $12,000

Maximum Out of Pocket Per Year $8,100 $16,200

Deductible: Individual: $6,000 | Family: $12,000
Out of Pocket Maximum per year: Individual: $8,100 | Family: $16,200

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$304.78
$345.91
$389.49
$544.31
$827.13

$609.56
$691.82
$778.98
$1,088.62
$1,654.26

$842.71
$924.97
$1,012.13
$1,321.77

$1,075.86
$1,158.12
$1,245.28
$1,554.92

$1,309.01
$1,391.27
$1,478.43
$1,788.07

$537.93
$579.06
$622.64
$777.46

$771.08
$812.21
$855.79
$1,010.61

$1,004.23
$1,045.36
$1,088.94
$1,243.76

$233.15

Silver

(EPO) Ambetter Balanced Care 1 (2020)

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Celtic Insurance Company
Customer Service Phone: 1-877-687-1196

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $5,650 $11,300

Maximum Out of Pocket Per Year $6,950 $13,900

Deductible: Individual: $5,650 | Family: $11,300
Out of Pocket Maximum per year: Individual: $6,950 | Family: $13,900

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$326.24
$370.28
$416.93
$582.65
$885.40

$652.48
$740.56
$833.86
$1,165.30
$1,770.80

$902.05
$990.13
$1,083.43
$1,414.87

$1,151.62
$1,239.70
$1,333.00
$1,664.44

$1,401.19
$1,489.27
$1,582.57
$1,914.01

$575.81
$619.85
$666.50
$832.22

$825.38
$869.42
$916.07
$1,081.79

$1,074.95
$1,118.99
$1,165.64
$1,331.36

$249.57

Silver

(EPO) Ambetter Balanced Care 3 (2020)

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Celtic Insurance Company
Customer Service Phone: 1-877-687-1196

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $3,350 $6,700

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

Deductible: Individual: $3,350 | Family: $6,700
Out of Pocket Maximum per year: Individual: $7,450 | Family: $14,900

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$328.36
$372.68
$419.63
$586.43
$891.14

$656.72
$745.36
$839.26
$1,172.86
$1,782.28

$907.91
$996.55
$1,090.45
$1,424.05

$1,159.10
$1,247.74
$1,341.64
$1,675.24

$1,410.29
$1,498.93
$1,592.83
$1,926.43

$579.55
$623.87
$670.82
$837.62

$830.74
$875.06
$922.01
$1,088.81

$1,081.93
$1,126.25
$1,173.20
$1,340.00

$251.19

Bronze

(EPO) Ambetter Essential Care 1 (2020)

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Celtic Insurance Company
Customer Service Phone: 1-877-687-1196

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $8,150 $16,300

Maximum Out of Pocket Per Year $8,150 $16,300

Deductible: Individual: $8,150 | Family: $16,300
Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$253.00
$287.14
$323.32
$451.84
$686.62

$506.00
$574.28
$646.64
$903.68
$1,373.24

$699.54
$767.82
$840.18
$1,097.22

$893.08
$961.36
$1,033.72
$1,290.76

$1,086.62
$1,154.90
$1,227.26
$1,484.30

$446.54
$480.68
$516.86
$645.38

$640.08
$674.22
$710.40
$838.92

$833.62
$867.76
$903.94
$1,032.46

$193.54

Silver

(EPO) Ambetter Balanced Care 14 (2020)

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Celtic Insurance Company
Customer Service Phone: 1-877-687-1196

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $0 $0

Maximum Out of Pocket Per Year $8,150 $16,300

Deductible: Individual: $0 | Family: $0
Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$334.61
$379.78
$427.62
$597.60
$908.11

$669.22
$759.56
$855.24
$1,195.20
$1,816.22

$925.19
$1,015.53
$1,111.21
$1,451.17

$1,181.16
$1,271.50
$1,367.18
$1,707.14

$1,437.13
$1,527.47
$1,623.15
$1,963.11

$590.58
$635.75
$683.59
$853.57

$846.55
$891.72
$939.56
$1,109.54

$1,102.52
$1,147.69
$1,195.53
$1,365.51

$255.97

Silver

(EPO) Ambetter Balanced Care 15 (2020)

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Celtic Insurance Company
Customer Service Phone: 1-877-687-1196

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $2,950 $5,900

Maximum Out of Pocket Per Year $8,150 $16,300

Deductible: Individual: $2,950 | Family: $5,900
Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$329.08
$373.49
$420.55
$587.71
$893.08

$658.16
$746.98
$841.10
$1,175.42
$1,786.16

$909.90
$998.72
$1,092.84
$1,427.16

$1,161.64
$1,250.46
$1,344.58
$1,678.90

$1,413.38
$1,502.20
$1,596.32
$1,930.64

$580.82
$625.23
$672.29
$839.45

$832.56
$876.97
$924.03
$1,091.19

$1,084.30
$1,128.71
$1,175.77
$1,342.93

$251.74

Expanded Bronze

(EPO) Ambetter Essential Care 4 HSA (2020)

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Celtic Insurance Company
Customer Service Phone: 1-877-687-1196

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $5,400 $10,800

Maximum Out of Pocket Per Year $6,750 $13,500

Deductible: Individual: $5,400 | Family: $10,800
Out of Pocket Maximum per year: Individual: $6,750 | Family: $13,500

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$276.68
$314.02
$353.58
$494.13
$750.88

$553.36
$628.04
$707.16
$988.26
$1,501.76

$765.01
$839.69
$918.81
$1,199.91

$976.66
$1,051.34
$1,130.46
$1,411.56

$1,188.31
$1,262.99
$1,342.11
$1,623.21

$488.33
$525.67
$565.23
$705.78

$699.98
$737.32
$776.88
$917.43

$911.63
$948.97
$988.53
$1,129.08

$211.65

Expanded Bronze

(EPO) Ambetter Essential Care 10 (2020)

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Celtic Insurance Company
Customer Service Phone: 1-877-687-1196

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $7,200 $14,400

Maximum Out of Pocket Per Year $8,150 $16,300

Deductible: Individual: $7,200 | Family: $14,400
Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$273.44
$310.35
$349.45
$488.35
$742.10

$546.88
$620.70
$698.90
$976.70
$1,484.20

$756.06
$829.88
$908.08
$1,185.88

$965.24
$1,039.06
$1,117.26
$1,395.06

$1,174.42
$1,248.24
$1,326.44
$1,604.24

$482.62
$519.53
$558.63
$697.53

$691.80
$728.71
$767.81
$906.71

$900.98
$937.89
$976.99
$1,115.89

$209.18

Gold

(EPO) Ambetter Secure Care 5 (2020)

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Celtic Insurance Company
Customer Service Phone: 1-877-687-1196

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $1,250 $2,500

Maximum Out of Pocket Per Year $5,900 $11,800

Deductible: Individual: $1,250 | Family: $2,500
Out of Pocket Maximum per year: Individual: $5,900 | Family: $11,800

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$399.74
$453.69
$510.85
$713.91
$1,084.86

$799.48
$907.38
$1,021.70
$1,427.82
$2,169.72

$1,105.27
$1,213.17
$1,327.49
$1,733.61

$1,411.06
$1,518.96
$1,633.28
$2,039.40

$1,716.85
$1,824.75
$1,939.07
$2,345.19

$705.53
$759.48
$816.64
$1,019.70

$1,011.32
$1,065.27
$1,122.43
$1,325.49

$1,317.11
$1,371.06
$1,428.22
$1,631.28

$305.79

Silver

(EPO) Ambetter Balanced Care 3 (2020) + Adult Vision

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Celtic Insurance Company
Customer Service Phone: 1-877-687-1196

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $3,350 $6,700

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

Deductible: Individual: $3,350 | Family: $6,700
Out of Pocket Maximum per year: Individual: $7,450 | Family: $14,900

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$332.13
$376.96
$424.45
$593.17
$901.38

$664.26
$753.92
$848.90
$1,186.34
$1,802.76

$918.33
$1,007.99
$1,102.97
$1,440.41

$1,172.40
$1,262.06
$1,357.04
$1,694.48

$1,426.47
$1,516.13
$1,611.11
$1,948.55

$586.20
$631.03
$678.52
$847.24

$840.27
$885.10
$932.59
$1,101.31

$1,094.34
$1,139.17
$1,186.66
$1,355.38

$254.07

Silver

(EPO) Ambetter Balanced Care 1 (2020) + Adult Vision

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Celtic Insurance Company
Customer Service Phone: 1-877-687-1196

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $5,650 $11,300

Maximum Out of Pocket Per Year $6,950 $13,900

Deductible: Individual: $5,650 | Family: $11,300
Out of Pocket Maximum per year: Individual: $6,950 | Family: $13,900

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$329.99
$374.53
$421.72
$589.35
$895.57

$659.98
$749.06
$843.44
$1,178.70
$1,791.14

$912.42
$1,001.50
$1,095.88
$1,431.14

$1,164.86
$1,253.94
$1,348.32
$1,683.58

$1,417.30
$1,506.38
$1,600.76
$1,936.02

$582.43
$626.97
$674.16
$841.79

$834.87
$879.41
$926.60
$1,094.23

$1,087.31
$1,131.85
$1,179.04
$1,346.67

$252.44

Gold

(EPO) Ambetter Secure Care 5 (2020) + Adult Vision

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Celtic Insurance Company
Customer Service Phone: 1-877-687-1196

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $1,250 $2,500

Maximum Out of Pocket Per Year $5,900 $11,800

Deductible: Individual: $1,250 | Family: $2,500
Out of Pocket Maximum per year: Individual: $5,900 | Family: $11,800

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$404.33
$458.90
$516.72
$722.11
$1,097.32

$808.66
$917.80
$1,033.44
$1,444.22
$2,194.64

$1,117.96
$1,227.10
$1,342.74
$1,753.52

$1,427.26
$1,536.40
$1,652.04
$2,062.82

$1,736.56
$1,845.70
$1,961.34
$2,372.12

$713.63
$768.20
$826.02
$1,031.41

$1,022.93
$1,077.50
$1,135.32
$1,340.71

$1,332.23
$1,386.80
$1,444.62
$1,650.01

$309.30

Bronze

(EPO) Ambetter Essential Care 1 (2020) + Adult Vision

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Celtic Insurance Company
Customer Service Phone: 1-877-687-1196

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $8,150 $16,300

Maximum Out of Pocket Per Year $8,150 $16,300

Deductible: Individual: $8,150 | Family: $16,300
Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$255.91
$290.44
$327.04
$457.03
$694.51

$511.82
$580.88
$654.08
$914.06
$1,389.02

$707.58
$776.64
$849.84
$1,109.82

$903.34
$972.40
$1,045.60
$1,305.58

$1,099.10
$1,168.16
$1,241.36
$1,501.34

$451.67
$486.20
$522.80
$652.79

$647.43
$681.96
$718.56
$848.55

$843.19
$877.72
$914.32
$1,044.31

$195.76

Expanded Bronze

(EPO) Ambetter Essential Care 10 (2020) + Adult Vision

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Celtic Insurance Company
Customer Service Phone: 1-877-687-1196

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $7,200 $14,400

Maximum Out of Pocket Per Year $8,150 $16,300

Deductible: Individual: $7,200 | Family: $14,400
Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$276.58
$313.91
$353.46
$493.96
$750.62

$553.16
$627.82
$706.92
$987.92
$1,501.24

$764.74
$839.40
$918.50
$1,199.50

$976.32
$1,050.98
$1,130.08
$1,411.08

$1,187.90
$1,262.56
$1,341.66
$1,622.66

$488.16
$525.49
$565.04
$705.54

$699.74
$737.07
$776.62
$917.12

$911.32
$948.65
$988.20
$1,128.70

$211.58

Silver

(EPO) Ambetter Balanced Care 11 (2020) + Adult Vision

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Celtic Insurance Company
Customer Service Phone: 1-877-687-1196

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $6,000 $12,000

Maximum Out of Pocket Per Year $8,100 $16,200

Deductible: Individual: $6,000 | Family: $12,000
Out of Pocket Maximum per year: Individual: $8,100 | Family: $16,200

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$308.28
$349.88
$393.96
$550.56
$836.63

$616.56
$699.76
$787.92
$1,101.12
$1,673.26

$852.38
$935.58
$1,023.74
$1,336.94

$1,088.20
$1,171.40
$1,259.56
$1,572.76

$1,324.02
$1,407.22
$1,495.38
$1,808.58

$544.10
$585.70
$629.78
$786.38

$779.92
$821.52
$865.60
$1,022.20

$1,015.74
$1,057.34
$1,101.42
$1,258.02

$235.82

Silver

(EPO) Ambetter Balanced Care 14 (2020) + Adult Vision

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Celtic Insurance Company
Customer Service Phone: 1-877-687-1196

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $0 $0

Maximum Out of Pocket Per Year $8,150 $16,300

Deductible: Individual: $0 | Family: $0
Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$338.46
$384.14
$432.54
$604.47
$918.55

$676.92
$768.28
$865.08
$1,208.94
$1,837.10

$935.83
$1,027.19
$1,123.99
$1,467.85

$1,194.74
$1,286.10
$1,382.90
$1,726.76

$1,453.65
$1,545.01
$1,641.81
$1,985.67

$597.37
$643.05
$691.45
$863.38

$856.28
$901.96
$950.36
$1,122.29

$1,115.19
$1,160.87
$1,209.27
$1,381.20

$258.91

Silver

(EPO) Ambetter Balanced Care 15 (2020) + Adult Vision

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Celtic Insurance Company
Customer Service Phone: 1-877-687-1196

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $2,950 $5,900

Maximum Out of Pocket Per Year $8,150 $16,300

Deductible: Individual: $2,950 | Family: $5,900
Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$332.86
$377.78
$425.38
$594.46
$903.34

$665.72
$755.56
$850.76
$1,188.92
$1,806.68

$920.35
$1,010.19
$1,105.39
$1,443.55

$1,174.98
$1,264.82
$1,360.02
$1,698.18

$1,429.61
$1,519.45
$1,614.65
$1,952.81

$587.49
$632.41
$680.01
$849.09

$842.12
$887.04
$934.64
$1,103.72

$1,096.75
$1,141.67
$1,189.27
$1,358.35

$254.63

Silver

(EPO) Ambetter Balanced Care 3 (2020) + Vision + Adult Dental

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Celtic Insurance Company
Customer Service Phone: 1-877-687-1196

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $3,350 $6,700

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

Deductible: Individual: $3,350 | Family: $6,700
Out of Pocket Maximum per year: Individual: $7,450 | Family: $14,900

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$344.03
$390.46
$439.66
$614.42
$933.68

$688.06
$780.92
$879.32
$1,228.84
$1,867.36

$951.24
$1,044.10
$1,142.50
$1,492.02

$1,214.42
$1,307.28
$1,405.68
$1,755.20

$1,477.60
$1,570.46
$1,668.86
$2,018.38

$607.21
$653.64
$702.84
$877.60

$870.39
$916.82
$966.02
$1,140.78

$1,133.57
$1,180.00
$1,229.20
$1,403.96

$263.18

Silver

(EPO) Ambetter Balanced Care 1 (2020) + Vision + Adult Dental

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Celtic Insurance Company
Customer Service Phone: 1-877-687-1196

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $5,650 $11,300

Maximum Out of Pocket Per Year $6,950 $13,900

Deductible: Individual: $5,650 | Family: $11,300
Out of Pocket Maximum per year: Individual: $6,950 | Family: $13,900

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$341.82
$387.95
$436.83
$610.46
$927.66

$683.64
$775.90
$873.66
$1,220.92
$1,855.32

$945.12
$1,037.38
$1,135.14
$1,482.40

$1,206.60
$1,298.86
$1,396.62
$1,743.88

$1,468.08
$1,560.34
$1,658.10
$2,005.36

$603.30
$649.43
$698.31
$871.94

$864.78
$910.91
$959.79
$1,133.42

$1,126.26
$1,172.39
$1,221.27
$1,394.90

$261.48

Gold

(EPO) Ambetter Secure Care 5 (2020) + Vision + Adult Dental

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Celtic Insurance Company
Customer Service Phone: 1-877-687-1196

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $1,250 $2,500

Maximum Out of Pocket Per Year $5,900 $11,800

Deductible: Individual: $1,250 | Family: $2,500
Out of Pocket Maximum per year: Individual: $5,900 | Family: $11,800

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$418.82
$475.34
$535.23
$747.99
$1,136.64

$837.64
$950.68
$1,070.46
$1,495.98
$2,273.28

$1,158.03
$1,271.07
$1,390.85
$1,816.37

$1,478.42
$1,591.46
$1,711.24
$2,136.76

$1,798.81
$1,911.85
$2,031.63
$2,457.15

$739.21
$795.73
$855.62
$1,068.38

$1,059.60
$1,116.12
$1,176.01
$1,388.77

$1,379.99
$1,436.51
$1,496.40
$1,709.16

$320.39

Bronze

(EPO) Ambetter Essential Care 1 (2020) + Vision + Adult Dental

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Celtic Insurance Company
Customer Service Phone: 1-877-687-1196

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $8,150 $16,300

Maximum Out of Pocket Per Year $8,150 $16,300

Deductible: Individual: $8,150 | Family: $16,300
Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$265.08
$300.85
$338.75
$473.41
$719.39

$530.16
$601.70
$677.50
$946.82
$1,438.78

$732.94
$804.48
$880.28
$1,149.60

$935.72
$1,007.26
$1,083.06
$1,352.38

$1,138.50
$1,210.04
$1,285.84
$1,555.16

$467.86
$503.63
$541.53
$676.19

$670.64
$706.41
$744.31
$878.97

$873.42
$909.19
$947.09
$1,081.75

$202.78

Expanded Bronze

(EPO) Ambetter Essential Care 10 (2020) + Vision + Adult Dental

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Celtic Insurance Company
Customer Service Phone: 1-877-687-1196

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $7,200 $14,400

Maximum Out of Pocket Per Year $8,150 $16,300

Deductible: Individual: $7,200 | Family: $14,400
Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$286.49
$325.16
$366.13
$511.66
$777.52

$572.98
$650.32
$732.26
$1,023.32
$1,555.04

$792.14
$869.48
$951.42
$1,242.48

$1,011.30
$1,088.64
$1,170.58
$1,461.64

$1,230.46
$1,307.80
$1,389.74
$1,680.80

$505.65
$544.32
$585.29
$730.82

$724.81
$763.48
$804.45
$949.98

$943.97
$982.64
$1,023.61
$1,169.14

$219.16

Silver

(EPO) Ambetter Balanced Care 11 (2020) + Vision + Adult Dental

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Celtic Insurance Company
Customer Service Phone: 1-877-687-1196

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $6,000 $12,000

Maximum Out of Pocket Per Year $8,100 $16,200

Deductible: Individual: $6,000 | Family: $12,000
Out of Pocket Maximum per year: Individual: $8,100 | Family: $16,200

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$319.32
$362.42
$408.08
$570.29
$866.61

$638.64
$724.84
$816.16
$1,140.58
$1,733.22

$882.91
$969.11
$1,060.43
$1,384.85

$1,127.18
$1,213.38
$1,304.70
$1,629.12

$1,371.45
$1,457.65
$1,548.97
$1,873.39

$563.59
$606.69
$652.35
$814.56

$807.86
$850.96
$896.62
$1,058.83

$1,052.13
$1,095.23
$1,140.89
$1,303.10

$244.27

Silver

(EPO) Ambetter Balanced Care 14 (2020) + Vision + Adult Dental

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Celtic Insurance Company
Customer Service Phone: 1-877-687-1196

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $0 $0

Maximum Out of Pocket Per Year $8,150 $16,300

Deductible: Individual: $0 | Family: $0
Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$350.58
$397.90
$448.03
$626.13
$951.46

$701.16
$795.80
$896.06
$1,252.26
$1,902.92

$969.35
$1,063.99
$1,164.25
$1,520.45

$1,237.54
$1,332.18
$1,432.44
$1,788.64

$1,505.73
$1,600.37
$1,700.63
$2,056.83

$618.77
$666.09
$716.22
$894.32

$886.96
$934.28
$984.41
$1,162.51

$1,155.15
$1,202.47
$1,252.60
$1,430.70

$268.19

Silver

(EPO) Ambetter Balanced Care 15 (2020) + Vision + Adult Dental

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Celtic Insurance Company
Customer Service Phone: 1-877-687-1196

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $2,950 $5,900

Maximum Out of Pocket Per Year $8,150 $16,300

Deductible: Individual: $2,950 | Family: $5,900
Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$344.78
$391.32
$440.62
$615.76
$935.71

$689.56
$782.64
$881.24
$1,231.52
$1,871.42

$953.31
$1,046.39
$1,144.99
$1,495.27

$1,217.06
$1,310.14
$1,408.74
$1,759.02

$1,480.81
$1,573.89
$1,672.49
$2,022.77

$608.53
$655.07
$704.37
$879.51

$872.28
$918.82
$968.12
$1,143.26

$1,136.03
$1,182.57
$1,231.87
$1,407.01

$263.75

Blue Cross Blue Shield of Texas

Local: 1-888-697-0683 | Toll Free: 1-888-697-0683 | TTY: 1-800-735-2989

Gold

(HMO) Blue Advantage Gold HMO? 206 - Three $30 PCP Visits

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Blue Cross Blue Shield of Texas
Customer Service Phone: 1-888-697-0683

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $750 $2,250

Maximum Out of Pocket Per Year $8,150 $16,300

Deductible: Individual: $750 | Family: $2,250
Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$379.58
$430.83
$485.11
$677.94
$1,030.19

$759.16
$861.66
$970.22
$1,355.88
$2,060.38

$1,049.54
$1,152.04
$1,260.60
$1,646.26

$1,339.92
$1,442.42
$1,550.98
$1,936.64

$1,630.30
$1,732.80
$1,841.36
$2,227.02

$669.96
$721.21
$775.49
$968.32

$960.34
$1,011.59
$1,065.87
$1,258.70

$1,250.72
$1,301.97
$1,356.25
$1,549.08

$290.38

Catastrophic

(HMO) Blue Advantage Security HMO? 200

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Blue Cross Blue Shield of Texas
Customer Service Phone: 1-888-697-0683

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $8,150 $16,300

Maximum Out of Pocket Per Year $8,150 $16,300

Deductible: Individual: $8,150 | Family: $16,300
Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$259.13
$294.12
$331.17
$462.81
$703.29

$518.26
$588.24
$662.34
$925.62
$1,406.58

$716.50
$786.48
$860.58
$1,123.86

$914.74
$984.72
$1,058.82
$1,322.10

$1,112.98
$1,182.96
$1,257.06
$1,520.34

$457.37
$492.36
$529.41
$661.05

$655.61
$690.60
$727.65
$859.29

$853.85
$888.84
$925.89
$1,057.53

$198.24

Silver

(HMO) Blue Advantage Silver HMO? 205 - Two $25 PCP Visits

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Blue Cross Blue Shield of Texas
Customer Service Phone: 1-888-697-0683

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $1,900 $5,700

Maximum Out of Pocket Per Year $8,150 $16,300

Deductible: Individual: $1,900 | Family: $5,700
Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$376.14
$426.92
$480.71
$671.79
$1,020.85

$752.28
$853.84
$961.42
$1,343.58
$2,041.70

$1,040.03
$1,141.59
$1,249.17
$1,631.33

$1,327.78
$1,429.34
$1,536.92
$1,919.08

$1,615.53
$1,717.09
$1,824.67
$2,206.83

$663.89
$714.67
$768.46
$959.54

$951.64
$1,002.42
$1,056.21
$1,247.29

$1,239.39
$1,290.17
$1,343.96
$1,535.04

$287.75

Bronze

(HMO) Blue Advantage Bronze HMO? 204 - Two $40 PCP Visits

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Blue Cross Blue Shield of Texas
Customer Service Phone: 1-888-697-0683

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $6,000 $16,300

Maximum Out of Pocket Per Year $8,150 $16,300

Deductible: Individual: $6,000 | Family: $16,300
Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$274.74
$311.83
$351.11
$490.68
$745.63

$549.48
$623.66
$702.22
$981.36
$1,491.26

$759.65
$833.83
$912.39
$1,191.53

$969.82
$1,044.00
$1,122.56
$1,401.70

$1,179.99
$1,254.17
$1,332.73
$1,611.87

$484.91
$522.00
$561.28
$700.85

$695.08
$732.17
$771.45
$911.02

$905.25
$942.34
$981.62
$1,121.19

$210.17

Bronze

(HMO) Blue Advantage Bronze HMO? 301

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Blue Cross Blue Shield of Texas
Customer Service Phone: 1-888-697-0683

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $8,150 $16,300

Maximum Out of Pocket Per Year $8,150 $16,300

Deductible: Individual: $8,150 | Family: $16,300
Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$281.27
$319.24
$359.47
$502.35
$763.38

$562.54
$638.48
$718.94
$1,004.70
$1,526.76

$777.71
$853.65
$934.11
$1,219.87

$992.88
$1,068.82
$1,149.28
$1,435.04

$1,208.05
$1,283.99
$1,364.45
$1,650.21

$496.44
$534.41
$574.64
$717.52

$711.61
$749.58
$789.81
$932.69

$926.78
$964.75
$1,004.98
$1,147.86

$215.17

Gold

(HMO) Blue Advantage Plus Gold? 203

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Blue Cross Blue Shield of Texas
Customer Service Phone: 1-888-697-0683

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $750 $2,250

Maximum Out of Pocket Per Year $8,150 $16,300

Deductible: Individual: $750 | Family: $2,250
Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$442.41
$502.14
$565.41
$790.15
$1,200.71

$884.82
$1,004.28
$1,130.82
$1,580.30
$2,401.42

$1,223.27
$1,342.73
$1,469.27
$1,918.75

$1,561.72
$1,681.18
$1,807.72
$2,257.20

$1,900.17
$2,019.63
$2,146.17
$2,595.65

$780.86
$840.59
$903.86
$1,128.60

$1,119.31
$1,179.04
$1,242.31
$1,467.05

$1,457.76
$1,517.49
$1,580.76
$1,805.50

$338.45

Silver

(HMO) Blue Advantage Plus Silver? 202

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Blue Cross Blue Shield of Texas
Customer Service Phone: 1-888-697-0683

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $1,100 $3,300

Maximum Out of Pocket Per Year $8,150 $16,300

Deductible: Individual: $1,100 | Family: $3,300
Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$446.39
$506.66
$570.49
$797.26
$1,211.51

$892.78
$1,013.32
$1,140.98
$1,594.52
$2,423.02

$1,234.27
$1,354.81
$1,482.47
$1,936.01

$1,575.76
$1,696.30
$1,823.96
$2,277.50

$1,917.25
$2,037.79
$2,165.45
$2,618.99

$787.88
$848.15
$911.98
$1,138.75

$1,129.37
$1,189.64
$1,253.47
$1,480.24

$1,470.86
$1,531.13
$1,594.96
$1,821.73

$341.49

Expanded Bronze

(HMO) Blue Advantage Plus Bronze? 303

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Blue Cross Blue Shield of Texas
Customer Service Phone: 1-888-697-0683

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $3,900 $11,700

Maximum Out of Pocket Per Year $8,150 $16,300

Deductible: Individual: $3,900 | Family: $11,700
Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$329.11
$373.54
$420.60
$587.79
$893.20

$658.22
$747.08
$841.20
$1,175.58
$1,786.40

$909.99
$998.85
$1,092.97
$1,427.35

$1,161.76
$1,250.62
$1,344.74
$1,679.12

$1,413.53
$1,502.39
$1,596.51
$1,930.89

$580.88
$625.31
$672.37
$839.56

$832.65
$877.08
$924.14
$1,091.33

$1,084.42
$1,128.85
$1,175.91
$1,343.10

$251.77

Bronze

(HMO) Blue Advantage Plus Bronze? 305

Summary of Benefits and Coverage
Plan Brochure
Provider Directory for Blue Cross Blue Shield of Texas
Customer Service Phone: 1-888-697-0683

Annual Out of Pocket Expenses

Individual Family

Annual Deductible $5,000 $15,000

Maximum Out of Pocket Per Year $8,150 $16,300

Deductible: Individual: $5,000 | Family: $15,000
Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Monthly Premiums:

Age

Individual

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$306.03
$347.35
$391.11
$546.58
$830.57

$612.06
$694.70
$782.22
$1,093.16
$1,661.14

$846.18
$928.82
$1,016.34
$1,327.28

$1,080.30
$1,162.94
$1,250.46
$1,561.40

$1,314.42
$1,397.06
$1,484.58
$1,795.52

$540.15
$581.47
$625.23
$780.70

$774.27
$815.59
$859.35
$1,014.82

$1,008.39
$1,049.71
$1,093.47
$1,248.94

$234.12

‡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 Fort Bend County here.

Fort Bend County is in “Rating Area 10” of Texas.

Currently, there are 50 plans offered in Rating Area 10.

Obamacare Providers, Plans and 2020 Rates for Fort Bend County, Texas

2020 Obamacare Rates, Providers, and Plans for Fort Bend County

Oscar Insurance Company

Bronze

(EPO) Oscar Simple Bronze

Annual Out of Pocket Expenses

Individual Family Annual Deductible $8,150 $16,300 Maximum Out of Pocket Per Year $8,150 $16,300 Deductible: Individual: $8,150 | Family: $16,300 Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Monthly Premiums:

Expanded Bronze

(EPO) Oscar Classic Bronze

Annual Out of Pocket Expenses

Individual Family Annual Deductible $5,500 $11,000 Maximum Out of Pocket Per Year $8,150 $16,300 Deductible: Individual: $5,500 | Family: $11,000 Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Monthly Premiums:

Expanded Bronze

(EPO) Oscar Saver Bronze

Annual Out of Pocket Expenses

Individual Family Annual Deductible $6,000 $12,000 Maximum Out of Pocket Per Year $6,750 $13,500 Deductible: Individual: $6,000 | Family: $12,000 Out of Pocket Maximum per year: Individual: $6,750 | Family: $13,500

Monthly Premiums:

Expanded Bronze

(EPO) Oscar Classic Bronze Next

Annual Out of Pocket Expenses

Individual Family Annual Deductible $0 $0 Maximum Out of Pocket Per Year $8,150 $16,300 Deductible: Individual: $0 | Family: $0 Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Monthly Premiums:

Silver

(EPO) Oscar Classic Silver

Annual Out of Pocket Expenses

Individual Family Annual Deductible $5,000 $10,000 Maximum Out of Pocket Per Year $8,150 $16,300 Deductible: Individual: $5,000 | Family: $10,000 Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Monthly Premiums:

Silver

(EPO) Oscar Simple Silver

Annual Out of Pocket Expenses

Individual Family Annual Deductible $8,150 $16,300 Maximum Out of Pocket Per Year $8,150 $16,300 Deductible: Individual: $8,150 | Family: $16,300 Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Monthly Premiums:

Silver

(EPO) Oscar Saver Silver

Annual Out of Pocket Expenses

Individual Family Annual Deductible $3,000 $6,000 Maximum Out of Pocket Per Year $6,650 $13,300 Deductible: Individual: $3,000 | Family: $6,000 Out of Pocket Maximum per year: Individual: $6,650 | Family: $13,300

Monthly Premiums:

Silver

(EPO) Oscar Classic Silver Next

Annual Out of Pocket Expenses

Individual Family Annual Deductible $7,000 $14,000 Maximum Out of Pocket Per Year $8,150 $16,300 Deductible: Individual: $7,000 | Family: $14,000 Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Monthly Premiums:

Catastrophic

(EPO) Oscar Simple Secure

Annual Out of Pocket Expenses

Individual Family Annual Deductible $8,150 $16,300 Maximum Out of Pocket Per Year $8,150 $16,300 Deductible: Individual: $8,150 | Family: $16,300 Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Monthly Premiums:

Gold

(EPO) Oscar Classic Gold

Annual Out of Pocket Expenses

Individual Family Annual Deductible $1,700 $3,400 Maximum Out of Pocket Per Year $8,150 $16,300 Deductible: Individual: $1,700 | Family: $3,400 Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Monthly Premiums:

Community Health Choice, Inc.

Gold

(HMO) Community Health Choice HMO Gold 001

Annual Out of Pocket Expenses

Individual Family Annual Deductible $0 $0 Maximum Out of Pocket Per Year $8,150 $16,300 Deductible: Individual: $0 | Family: $0 Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Monthly Premiums:

Expanded Bronze

(HMO) Community Health Choice HMO Bronze 003

Annual Out of Pocket Expenses

Individual Family Annual Deductible $7,150 $14,300 Maximum Out of Pocket Per Year $8,150 $16,300 Deductible: Individual: $7,150 | Family: $14,300 Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Monthly Premiums:

Silver

(HMO) Community Health Choice HMO Silver 004

Annual Out of Pocket Expenses

Individual Family Annual Deductible $3,000 $6,000 Maximum Out of Pocket Per Year $7,900 $15,800 Deductible: Individual: $3,000 | Family: $6,000 Out of Pocket Maximum per year: Individual: $7,900 | Family: $15,800

Monthly Premiums:

Gold

(HMO) Community Health Choice HMO Gold 005

Annual Out of Pocket Expenses

Individual Family Annual Deductible $750 $1,500 Maximum Out of Pocket Per Year $6,500 $13,000 Deductible: Individual: $750 | Family: $1,500 Out of Pocket Maximum per year: Individual: $6,500 | Family: $13,000

Monthly Premiums:

Expanded Bronze

(HMO) Community Health Choice HMO Bronze 008 High Deductible Health Plan- HSA Compatible

Annual Out of Pocket Expenses

Individual Family Annual Deductible $6,750 $13,500 Maximum Out of Pocket Per Year $6,750 $13,500 Deductible: Individual: $6,750 | Family: $13,500 Out of Pocket Maximum per year: Individual: $6,750 | Family: $13,500

Monthly Premiums:

Silver

Individual Family

Annual Deductible $8,150 $16,300

Maximum Out of Pocket Per Year $8,150 $16,300

Deductible: Individual: $8,150 | Family: $16,300
Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Individual Family

Annual Deductible $5,500 $11,000

Maximum Out of Pocket Per Year $8,150 $16,300

Deductible: Individual: $5,500 | Family: $11,000
Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Individual Family

Annual Deductible $6,000 $12,000

Maximum Out of Pocket Per Year $6,750 $13,500

Deductible: Individual: $6,000 | Family: $12,000
Out of Pocket Maximum per year: Individual: $6,750 | Family: $13,500

Individual Family

Annual Deductible $0 $0

Maximum Out of Pocket Per Year $8,150 $16,300

Deductible: Individual: $0 | Family: $0
Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Individual Family

Annual Deductible $5,000 $10,000

Maximum Out of Pocket Per Year $8,150 $16,300

Deductible: Individual: $5,000 | Family: $10,000
Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Individual Family

Annual Deductible $8,150 $16,300

Maximum Out of Pocket Per Year $8,150 $16,300

Deductible: Individual: $8,150 | Family: $16,300
Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Individual Family

Annual Deductible $3,000 $6,000

Maximum Out of Pocket Per Year $6,650 $13,300

Deductible: Individual: $3,000 | Family: $6,000
Out of Pocket Maximum per year: Individual: $6,650 | Family: $13,300

Individual Family

Annual Deductible $7,000 $14,000

Maximum Out of Pocket Per Year $8,150 $16,300

Deductible: Individual: $7,000 | Family: $14,000
Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Individual Family

Annual Deductible $8,150 $16,300

Maximum Out of Pocket Per Year $8,150 $16,300

Deductible: Individual: $8,150 | Family: $16,300
Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Individual Family

Annual Deductible $1,700 $3,400

Maximum Out of Pocket Per Year $8,150 $16,300

Deductible: Individual: $1,700 | Family: $3,400
Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Individual Family

Annual Deductible $0 $0

Maximum Out of Pocket Per Year $8,150 $16,300

Deductible: Individual: $0 | Family: $0
Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Individual Family

Annual Deductible $7,150 $14,300

Maximum Out of Pocket Per Year $8,150 $16,300

Deductible: Individual: $7,150 | Family: $14,300
Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Individual Family

Annual Deductible $3,000 $6,000

Maximum Out of Pocket Per Year $7,900 $15,800

Deductible: Individual: $3,000 | Family: $6,000
Out of Pocket Maximum per year: Individual: $7,900 | Family: $15,800

Individual Family

Annual Deductible $750 $1,500

Maximum Out of Pocket Per Year $6,500 $13,000

Deductible: Individual: $750 | Family: $1,500
Out of Pocket Maximum per year: Individual: $6,500 | Family: $13,000

Individual Family

Annual Deductible $6,750 $13,500

Maximum Out of Pocket Per Year $6,750 $13,500

Deductible: Individual: $6,750 | Family: $13,500
Out of Pocket Maximum per year: Individual: $6,750 | Family: $13,500

Individual Family

Annual Deductible $5,000 $10,000

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

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

Individual Family

Annual Deductible $6,000 $12,000

Maximum Out of Pocket Per Year $8,100 $16,200

Deductible: Individual: $6,000 | Family: $12,000
Out of Pocket Maximum per year: Individual: $8,100 | Family: $16,200

Individual Family

Annual Deductible $5,650 $11,300

Maximum Out of Pocket Per Year $6,950 $13,900

Deductible: Individual: $5,650 | Family: $11,300
Out of Pocket Maximum per year: Individual: $6,950 | Family: $13,900

Individual Family

Annual Deductible $3,350 $6,700

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

Deductible: Individual: $3,350 | Family: $6,700
Out of Pocket Maximum per year: Individual: $7,450 | Family: $14,900

Individual Family

Annual Deductible $8,150 $16,300

Maximum Out of Pocket Per Year $8,150 $16,300

Deductible: Individual: $8,150 | Family: $16,300
Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Individual Family

Annual Deductible $0 $0

Maximum Out of Pocket Per Year $8,150 $16,300

Deductible: Individual: $0 | Family: $0
Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Individual Family

Annual Deductible $2,950 $5,900

Maximum Out of Pocket Per Year $8,150 $16,300

Deductible: Individual: $2,950 | Family: $5,900
Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Individual Family

Annual Deductible $5,400 $10,800

Maximum Out of Pocket Per Year $6,750 $13,500

Deductible: Individual: $5,400 | Family: $10,800
Out of Pocket Maximum per year: Individual: $6,750 | Family: $13,500

Individual Family

Annual Deductible $7,200 $14,400

Maximum Out of Pocket Per Year $8,150 $16,300

Deductible: Individual: $7,200 | Family: $14,400
Out of Pocket Maximum per year: Individual: $8,150 | Family: $16,300

Individual Family

Annual Deductible $1,250 $2,500

Maximum Out of Pocket Per Year $5,900 $11,800

Deductible: Individual: $1,250 | Family: $2,500
Out of Pocket Maximum per year: Individual: $5,900 | Family: $11,800

Individual Family

Annual Deductible $3,350 $6,700

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

Deductible: Individual: $3,350 | Family: $6,700
Out of Pocket Maximum per year: Individual: $7,450 | Family: $14,900

Individual Family

Annual Deductible $5,650 $11,300

Maximum Out of Pocket Per Year $6,950 $13,900

Deductible: Individual: $5,650 | Family: $11,300
Out of Pocket Maximum per year: Individual: $6,950 | Family: $13,900