Obamacare 2023 Rates for Prince William County

Obamacare > Rates > Virginia > Prince William County

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

The health insurance rates listed below are for calendar year 2023.

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

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

Obamacare Providers, 93 Plans and 2023 Rates for Prince William County, Virginia

Below, you’ll find a summary of the 93 plans for Prince William County, Virginia and rates for each of these providers.‡ This chart is designed to give you a preview of your health insurance options.

CareFirst BlueChoice

Local: 1-855-444-3119 | Toll Free: 1-855-444-3119 | TTY: 1-202-479-3546

Toc - Plan #1 CareFirst BlueChoice

Silver

(HMO) BlueChoice HMO HSA Silver 3000

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-444-3119

Annual Out of Pocket Expenses:

Individual Family

$3,000 $6,000 Annual Deductible

$6,500 $13,000 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

$362.56
$411.51
$463.35
$647.53
$983.99

$639.92
$688.87
$740.71
$924.89

$917.28
$966.23
$1,018.07
$1,202.25

$1,194.64
$1,243.59
$1,295.43
$1,479.61

$277.36

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$725.12
$823.02
$926.70
$1,295.06
$1,967.98

$1,002.48
$1,100.38
$1,204.06
$1,572.42

$1,279.84
$1,377.74
$1,481.42
$1,849.78

$1,557.20
$1,655.10
$1,758.78
$2,127.14

$277.36

Toc - Plan #2 CareFirst BlueChoice

Gold

(HMO) BlueChoice HMO Gold 1750

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-444-3119

Annual Out of Pocket Expenses:

Individual Family

$1,750 $3,500 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$354.55
$402.41
$453.11
$633.23
$962.25

$625.78
$673.64
$724.34
$904.46

$897.01
$944.87
$995.57
$1,175.69

$1,168.24
$1,216.10
$1,266.80
$1,446.92

$271.23

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$709.10
$804.82
$906.22
$1,266.46
$1,924.50

$980.33
$1,076.05
$1,177.45
$1,537.69

$1,251.56
$1,347.28
$1,448.68
$1,808.92

$1,522.79
$1,618.51
$1,719.91
$2,080.15

$271.23

Toc - Plan #3 CareFirst BlueChoice

Catastrophic

(HMO) BlueChoice HMO Young Adult 9100

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-444-3119

Annual Out of Pocket Expenses:

Individual Family

$9,100 $18,200 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$127.70
$144.94
$163.20
$228.07
$346.58

$225.39
$242.63
$260.89
$325.76

$323.08
$340.32
$358.58
$423.45

$420.77
$438.01
$456.27
$521.14

$97.69

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$255.40
$289.88
$326.40
$456.14
$693.16

$353.09
$387.57
$424.09
$553.83

$450.78
$485.26
$521.78
$651.52

$548.47
$582.95
$619.47
$749.21

$97.69

Toc - Plan #4 CareFirst BlueChoice

Silver

(HMO) BlueChoice HMO Standard Silver $5,800

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-444-3119

Annual Out of Pocket Expenses:

Individual Family

$5,800 $11,600 Annual Deductible

$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$343.31
$389.66
$438.75
$613.15
$931.74

$605.94
$652.29
$701.38
$875.78

$868.57
$914.92
$964.01
$1,138.41

$1,131.20
$1,177.55
$1,226.64
$1,401.04

$262.63

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$686.62
$779.32
$877.50
$1,226.30
$1,863.48

$949.25
$1,041.95
$1,140.13
$1,488.93

$1,211.88
$1,304.58
$1,402.76
$1,751.56

$1,474.51
$1,567.21
$1,665.39
$2,014.19

$262.63

Toc - Plan #5 CareFirst BlueChoice

Gold

(HMO) BlueChoice HMO Standard Gold $2,000

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-444-3119

Annual Out of Pocket Expenses:

Individual Family

$2,000 $4,000 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$326.90
$371.03
$417.78
$583.84
$887.21

$576.98
$621.11
$667.86
$833.92

$827.06
$871.19
$917.94
$1,084.00

$1,077.14
$1,121.27
$1,168.02
$1,334.08

$250.08

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$653.80
$742.06
$835.56
$1,167.68
$1,774.42

$903.88
$992.14
$1,085.64
$1,417.76

$1,153.96
$1,242.22
$1,335.72
$1,667.84

$1,404.04
$1,492.30
$1,585.80
$1,917.92

$250.08

Optima Health Plan

Local: 1-866-946-6034 | Toll Free: 1-866-946-6034 | TTY: 1-800-828-1140

Toc - Plan #6 Optima Health Plan

Expanded Bronze

(HMO) OptimaFit Bronze 6250 20% HSA Direct M

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-866-946-6034

Annual Out of Pocket Expenses:

Individual Family

$6,250 $12,500 Annual Deductible

$7,050 $14,100 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

$240.82
$273.33
$307.77
$430.11
$653.59

$425.05
$457.56
$492.00
$614.34

$609.28
$641.79
$676.23
$798.57

$793.51
$826.02
$860.46
$982.80

$184.23

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$481.64
$546.66
$615.54
$860.22
$1,307.18

$665.87
$730.89
$799.77
$1,044.45

$850.10
$915.12
$984.00
$1,228.68

$1,034.33
$1,099.35
$1,168.23
$1,412.91

$184.23

Toc - Plan #7 Optima Health Plan

Gold

(HMO) OptimaFit Gold 1300 20% Direct M

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-866-946-6034

Annual Out of Pocket Expenses:

Individual Family

$1,300 $2,600 Annual Deductible

$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$288.16
$327.06
$368.27
$514.66
$782.07

$508.60
$547.50
$588.71
$735.10

$729.04
$767.94
$809.15
$955.54

$949.48
$988.38
$1,029.59
$1,175.98

$220.44

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$576.32
$654.12
$736.54
$1,029.32
$1,564.14

$796.76
$874.56
$956.98
$1,249.76

$1,017.20
$1,095.00
$1,177.42
$1,470.20

$1,237.64
$1,315.44
$1,397.86
$1,690.64

$220.44

Toc - Plan #8 Optima Health Plan

Expanded Bronze

(HMO) OptimaFit Bronze 7200 40% Direct M

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-866-946-6034

Annual Out of Pocket Expenses:

Individual Family

$7,200 $14,400 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$220.09
$249.80
$281.28
$393.08
$597.33

$388.46
$418.17
$449.65
$561.45

$556.83
$586.54
$618.02
$729.82

$725.20
$754.91
$786.39
$898.19

$168.37

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$440.18
$499.60
$562.56
$786.16
$1,194.66

$608.55
$667.97
$730.93
$954.53

$776.92
$836.34
$899.30
$1,122.90

$945.29
$1,004.71
$1,067.67
$1,291.27

$168.37

Toc - Plan #9 Optima Health Plan

Silver

(HMO) OptimaFit Silver 3800 25% Direct M

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-866-946-6034

Annual Out of Pocket Expenses:

Individual Family

$3,800 $7,600 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$290.39
$329.59
$371.11
$518.63
$788.11

$512.54
$551.74
$593.26
$740.78

$734.69
$773.89
$815.41
$962.93

$956.84
$996.04
$1,037.56
$1,185.08

$222.15

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$580.78
$659.18
$742.22
$1,037.26
$1,576.22

$802.93
$881.33
$964.37
$1,259.41

$1,025.08
$1,103.48
$1,186.52
$1,481.56

$1,247.23
$1,325.63
$1,408.67
$1,703.71

$222.15

Toc - Plan #10 Optima Health Plan

Silver

(HMO) OptimaFit Silver 6600 30% Direct M

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-866-946-6034

Annual Out of Pocket Expenses:

Individual Family

$6,600 $13,200 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

$284.48
$322.88
$363.56
$508.08
$772.07

$502.10
$540.50
$581.18
$725.70

$719.72
$758.12
$798.80
$943.32

$937.34
$975.74
$1,016.42
$1,160.94

$217.62

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$568.96
$645.76
$727.12
$1,016.16
$1,544.14

$786.58
$863.38
$944.74
$1,233.78

$1,004.20
$1,081.00
$1,162.36
$1,451.40

$1,221.82
$1,298.62
$1,379.98
$1,669.02

$217.62

Toc - Plan #11 Optima Health Plan

Gold

(HMO) OptimaFit Gold 2200 20% Direct M

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-866-946-6034

Annual Out of Pocket Expenses:

Individual Family

$2,200 $4,400 Annual Deductible

$6,000 $12,000 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

$291.99
$331.41
$373.16
$521.49
$792.46

$515.36
$554.78
$596.53
$744.86

$738.73
$778.15
$819.90
$968.23

$962.10
$1,001.52
$1,043.27
$1,191.60

$223.37

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$583.98
$662.82
$746.32
$1,042.98
$1,584.92

$807.35
$886.19
$969.69
$1,266.35

$1,030.72
$1,109.56
$1,193.06
$1,489.72

$1,254.09
$1,332.93
$1,416.43
$1,713.09

$223.37

Toc - Plan #12 Optima Health Plan

Gold

(HMO) OptimaFit Gold 2000 25% Standard M

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-866-946-6034

Annual Out of Pocket Expenses:

Individual Family

$2,000 $4,000 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$291.88
$331.28
$373.02
$521.29
$792.16

$515.17
$554.57
$596.31
$744.58

$738.46
$777.86
$819.60
$967.87

$961.75
$1,001.15
$1,042.89
$1,191.16

$223.29

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$583.76
$662.56
$746.04
$1,042.58
$1,584.32

$807.05
$885.85
$969.33
$1,265.87

$1,030.34
$1,109.14
$1,192.62
$1,489.16

$1,253.63
$1,332.43
$1,415.91
$1,712.45

$223.29

Toc - Plan #13 Optima Health Plan

Silver

(HMO) OptimaFit Silver 5800 40% Standard M

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-866-946-6034

Annual Out of Pocket Expenses:

Individual Family

$5,800 $11,600 Annual Deductible

$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$285.21
$323.71
$364.50
$509.38
$774.06

$503.39
$541.89
$582.68
$727.56

$721.57
$760.07
$800.86
$945.74

$939.75
$978.25
$1,019.04
$1,163.92

$218.18

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$570.42
$647.42
$729.00
$1,018.76
$1,548.12

$788.60
$865.60
$947.18
$1,236.94

$1,006.78
$1,083.78
$1,165.36
$1,455.12

$1,224.96
$1,301.96
$1,383.54
$1,673.30

$218.18

Toc - Plan #14 Optima Health Plan

Bronze

(HMO) OptimaFit Bronze 9100 0% Standard M

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-866-946-6034

Annual Out of Pocket Expenses:

Individual Family

$9,100 $18,200 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$226.05
$256.57
$288.89
$403.72
$613.50

$398.98
$429.50
$461.82
$576.65

$571.91
$602.43
$634.75
$749.58

$744.84
$775.36
$807.68
$922.51

$172.93

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$452.10
$513.14
$577.78
$807.44
$1,227.00

$625.03
$686.07
$750.71
$980.37

$797.96
$859.00
$923.64
$1,153.30

$970.89
$1,031.93
$1,096.57
$1,326.23

$172.93

UnitedHealthcare

Local: 1-877-265-9199 | Toll Free: 1-877-265-9199 | TTY: 1-877-265-9199

Toc - Plan #15 UnitedHealthcare

Silver

(HMO) UHC Silver Value $2,950 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx, No Referrals)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-265-9199

Annual Out of Pocket Expenses:

Individual Family

$2,950 $5,900 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

$329.94
$374.49
$421.67
$589.28
$895.47

$582.35
$626.90
$674.08
$841.69

$834.76
$879.31
$926.49
$1,094.10

$1,087.17
$1,131.72
$1,178.90
$1,346.51

$252.41

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$659.88
$748.98
$843.34
$1,178.56
$1,790.94

$912.29
$1,001.39
$1,095.75
$1,430.97

$1,164.70
$1,253.80
$1,348.16
$1,683.38

$1,417.11
$1,506.21
$1,600.57
$1,935.79

$252.41

Toc - Plan #16 UnitedHealthcare

Expanded Bronze

(HMO) UHC Bronze Value $6,500 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx, No Referrals)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-265-9199

Annual Out of Pocket Expenses:

Individual Family

$6,500 $13,000 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$256.59
$291.23
$327.92
$458.26
$696.37

$452.88
$487.52
$524.21
$654.55

$649.17
$683.81
$720.50
$850.84

$845.46
$880.10
$916.79
$1,047.13

$196.29

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$513.18
$582.46
$655.84
$916.52
$1,392.74

$709.47
$778.75
$852.13
$1,112.81

$905.76
$975.04
$1,048.42
$1,309.10

$1,102.05
$1,171.33
$1,244.71
$1,505.39

$196.29

Toc - Plan #17 UnitedHealthcare

Silver

(HMO) UHC Silver Value $3,600 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-265-9199

Annual Out of Pocket Expenses:

Individual Family

$3,600 $7,200 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$318.27
$361.24
$406.75
$568.43
$863.78

$561.75
$604.72
$650.23
$811.91

$805.23
$848.20
$893.71
$1,055.39

$1,048.71
$1,091.68
$1,137.19
$1,298.87

$243.48

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$636.54
$722.48
$813.50
$1,136.86
$1,727.56

$880.02
$965.96
$1,056.98
$1,380.34

$1,123.50
$1,209.44
$1,300.46
$1,623.82

$1,366.98
$1,452.92
$1,543.94
$1,867.30

$243.48

Toc - Plan #18 UnitedHealthcare

Gold

(HMO) UHC Gold Value $1,800 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $2 T1 Preferred Rx)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-265-9199

Annual Out of Pocket Expenses:

Individual Family

$1,800 $3,600 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$310.33
$352.22
$396.60
$554.25
$842.24

$547.73
$589.62
$634.00
$791.65

$785.13
$827.02
$871.40
$1,029.05

$1,022.53
$1,064.42
$1,108.80
$1,266.45

$237.40

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$620.66
$704.44
$793.20
$1,108.50
$1,684.48

$858.06
$941.84
$1,030.60
$1,345.90

$1,095.46
$1,179.24
$1,268.00
$1,583.30

$1,332.86
$1,416.64
$1,505.40
$1,820.70

$237.40

Toc - Plan #19 UnitedHealthcare

Gold

(HMO) UHC Gold Advantage+ (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $2 T1 Preferred Rx, Dental + Vision)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-265-9199

Annual Out of Pocket Expenses:

Individual Family

$1,200 $2,400 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$339.94
$385.83
$434.44
$607.13
$922.60

$599.99
$645.88
$694.49
$867.18

$860.04
$905.93
$954.54
$1,127.23

$1,120.09
$1,165.98
$1,214.59
$1,387.28

$260.05

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$679.88
$771.66
$868.88
$1,214.26
$1,845.20

$939.93
$1,031.71
$1,128.93
$1,474.31

$1,199.98
$1,291.76
$1,388.98
$1,734.36

$1,460.03
$1,551.81
$1,649.03
$1,994.41

$260.05

Toc - Plan #20 UnitedHealthcare

Gold

(HMO) UHC Gold Standard

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-265-9199

Annual Out of Pocket Expenses:

Individual Family

$2,000 $4,000 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$314.95
$357.46
$402.50
$562.50
$854.77

$555.88
$598.39
$643.43
$803.43

$796.81
$839.32
$884.36
$1,044.36

$1,037.74
$1,080.25
$1,125.29
$1,285.29

$240.93

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$629.90
$714.92
$805.00
$1,125.00
$1,709.54

$870.83
$955.85
$1,045.93
$1,365.93

$1,111.76
$1,196.78
$1,286.86
$1,606.86

$1,352.69
$1,437.71
$1,527.79
$1,847.79

$240.93

Toc - Plan #21 UnitedHealthcare

Silver

(HMO) UHC Silver Standard

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-265-9199

Annual Out of Pocket Expenses:

Individual Family

$5,800 $11,600 Annual Deductible

$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$319.33
$362.44
$408.11
$570.33
$866.67

$563.62
$606.73
$652.40
$814.62

$807.91
$851.02
$896.69
$1,058.91

$1,052.20
$1,095.31
$1,140.98
$1,303.20

$244.29

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$638.66
$724.88
$816.22
$1,140.66
$1,733.34

$882.95
$969.17
$1,060.51
$1,384.95

$1,127.24
$1,213.46
$1,304.80
$1,629.24

$1,371.53
$1,457.75
$1,549.09
$1,873.53

$244.29

Toc - Plan #22 UnitedHealthcare

Expanded Bronze

(HMO) UHC Bronze Value HSA

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-265-9199

Annual Out of Pocket Expenses:

Individual Family

$6,700 $13,400 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$251.47
$285.42
$321.38
$449.13
$682.50

$443.85
$477.80
$513.76
$641.51

$636.23
$670.18
$706.14
$833.89

$828.61
$862.56
$898.52
$1,026.27

$192.38

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$502.94
$570.84
$642.76
$898.26
$1,365.00

$695.32
$763.22
$835.14
$1,090.64

$887.70
$955.60
$1,027.52
$1,283.02

$1,080.08
$1,147.98
$1,219.90
$1,475.40

$192.38

Toc - Plan #23 UnitedHealthcare

Expanded Bronze

(HMO) UHC Bronze Virtual First (Unlimited $0 App-based Care, $3 T1 Preferred Rx) (Disponible en espa�ol)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-265-9199

Annual Out of Pocket Expenses:

Individual Family

$7,250 $14,500 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

$239.69
$272.05
$306.33
$428.09
$650.53

$423.06
$455.42
$489.70
$611.46

$606.43
$638.79
$673.07
$794.83

$789.80
$822.16
$856.44
$978.20

$183.37

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$479.38
$544.10
$612.66
$856.18
$1,301.06

$662.75
$727.47
$796.03
$1,039.55

$846.12
$910.84
$979.40
$1,222.92

$1,029.49
$1,094.21
$1,162.77
$1,406.29

$183.37

Toc - Plan #24 UnitedHealthcare

Bronze

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

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-265-9199

Annual Out of Pocket Expenses:

Individual Family

$9,100 $18,200 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$242.36
$275.08
$309.74
$432.85
$657.76

$427.77
$460.49
$495.15
$618.26

$613.18
$645.90
$680.56
$803.67

$798.59
$831.31
$865.97
$989.08

$185.41

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$484.72
$550.16
$619.48
$865.70
$1,315.52

$670.13
$735.57
$804.89
$1,051.11

$855.54
$920.98
$990.30
$1,236.52

$1,040.95
$1,106.39
$1,175.71
$1,421.93

$185.41

Toc - Plan #25 UnitedHealthcare

Expanded Bronze

(HMO) UHC Bronze Standard $7,500 Deductible

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-265-9199

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$249.96
$283.71
$319.45
$446.44
$678.40

$441.18
$474.93
$510.67
$637.66

$632.40
$666.15
$701.89
$828.88

$823.62
$857.37
$893.11
$1,020.10

$191.22

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$499.92
$567.42
$638.90
$892.88
$1,356.80

$691.14
$758.64
$830.12
$1,084.10

$882.36
$949.86
$1,021.34
$1,275.32

$1,073.58
$1,141.08
$1,212.56
$1,466.54

$191.22

Toc - Plan #26 UnitedHealthcare

Bronze

(HMO) UHC Bronze Standard $9,100 Deductible

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-265-9199

Annual Out of Pocket Expenses:

Individual Family

$9,100 $18,200 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$236.09
$267.96
$301.72
$421.66
$640.75

$416.70
$448.57
$482.33
$602.27

$597.31
$629.18
$662.94
$782.88

$777.92
$809.79
$843.55
$963.49

$180.61

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$472.18
$535.92
$603.44
$843.32
$1,281.50

$652.79
$716.53
$784.05
$1,023.93

$833.40
$897.14
$964.66
$1,204.54

$1,014.01
$1,077.75
$1,145.27
$1,385.15

$180.61

Toc - Plan #27 UnitedHealthcare

Gold

(HMO) UHC Gold Value $2,100 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $1 T1 Preferred Rx, No Referrals)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-265-9199

Annual Out of Pocket Expenses:

Individual Family

$2,100 $4,200 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

$318.68
$361.70
$407.27
$569.16
$864.90

$562.47
$605.49
$651.06
$812.95

$806.26
$849.28
$894.85
$1,056.74

$1,050.05
$1,093.07
$1,138.64
$1,300.53

$243.79

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$637.36
$723.40
$814.54
$1,138.32
$1,729.80

$881.15
$967.19
$1,058.33
$1,382.11

$1,124.94
$1,210.98
$1,302.12
$1,625.90

$1,368.73
$1,454.77
$1,545.91
$1,869.69

$243.79

Toc - Plan #28 UnitedHealthcare

Silver

(HMO) UHC Silver Virtual First (Unlimited $0 App-based Care, $3 T1 Preferred Rx) (Disponible en espa�ol)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-265-9199

Annual Out of Pocket Expenses:

Individual Family

$3,600 $7,200 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$312.57
$354.76
$399.46
$558.24
$848.30

$551.68
$593.87
$638.57
$797.35

$790.79
$832.98
$877.68
$1,036.46

$1,029.90
$1,072.09
$1,116.79
$1,275.57

$239.11

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$625.14
$709.52
$798.92
$1,116.48
$1,696.60

$864.25
$948.63
$1,038.03
$1,355.59

$1,103.36
$1,187.74
$1,277.14
$1,594.70

$1,342.47
$1,426.85
$1,516.25
$1,833.81

$239.11

CareFirst BlueCross BlueShield

Local: 1-855-444-3119 | Toll Free: 1-855-444-3119 | TTY: 1-202-479-3546

Toc - Plan #29 CareFirst BlueCross BlueShield

Gold

(PPO) BluePreferred PPO Gold 1750

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-444-3119

Annual Out of Pocket Expenses:

Individual Family

$1,750 $3,500 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$663.29
$752.83
$847.68
$1,184.64
$1,800.17

$1,170.71
$1,260.25
$1,355.10
$1,692.06

$1,678.13
$1,767.67
$1,862.52
$2,199.48

$2,185.55
$2,275.09
$2,369.94
$2,706.90

$507.42

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,326.58
$1,505.66
$1,695.36
$2,369.28
$3,600.34

$1,834.00
$2,013.08
$2,202.78
$2,876.70

$2,341.42
$2,520.50
$2,710.20
$3,384.12

$2,848.84
$3,027.92
$3,217.62
$3,891.54

$507.42

Toc - Plan #30 CareFirst BlueCross BlueShield

Silver

(PPO) BluePreferred PPO HSA Silver 3000

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-444-3119

Annual Out of Pocket Expenses:

Individual Family

$3,000 $6,000 Annual Deductible

$6,500 $13,000 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

$666.84
$756.86
$852.22
$1,190.98
$1,809.80

$1,176.97
$1,266.99
$1,362.35
$1,701.11

$1,687.10
$1,777.12
$1,872.48
$2,211.24

$2,197.23
$2,287.25
$2,382.61
$2,721.37

$510.13

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,333.68
$1,513.72
$1,704.44
$2,381.96
$3,619.60

$1,843.81
$2,023.85
$2,214.57
$2,892.09

$2,353.94
$2,533.98
$2,724.70
$3,402.22

$2,864.07
$3,044.11
$3,234.83
$3,912.35

$510.13

Toc - Plan #31 CareFirst BlueCross BlueShield

Silver

(PPO) BluePreferred PPO Standard Silver 5800

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-444-3119

Annual Out of Pocket Expenses:

Individual Family

$5,800 $11,600 Annual Deductible

$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$645.91
$733.11
$825.47
$1,153.60
$1,753.00

$1,140.03
$1,227.23
$1,319.59
$1,647.72

$1,634.15
$1,721.35
$1,813.71
$2,141.84

$2,128.27
$2,215.47
$2,307.83
$2,635.96

$494.12

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,291.82
$1,466.22
$1,650.94
$2,307.20
$3,506.00

$1,785.94
$1,960.34
$2,145.06
$2,801.32

$2,280.06
$2,454.46
$2,639.18
$3,295.44

$2,774.18
$2,948.58
$3,133.30
$3,789.56

$494.12

Toc - Plan #32 CareFirst BlueCross BlueShield

Gold

(PPO) BluePreferred PPO Standard Gold 2000

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-444-3119

Annual Out of Pocket Expenses:

Individual Family

$2,000 $4,000 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$646.57
$733.86
$826.32
$1,154.77
$1,754.79

$1,141.20
$1,228.49
$1,320.95
$1,649.40

$1,635.83
$1,723.12
$1,815.58
$2,144.03

$2,130.46
$2,217.75
$2,310.21
$2,638.66

$494.63

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,293.14
$1,467.72
$1,652.64
$2,309.54
$3,509.58

$1,787.77
$1,962.35
$2,147.27
$2,804.17

$2,282.40
$2,456.98
$2,641.90
$3,298.80

$2,777.03
$2,951.61
$3,136.53
$3,793.43

$494.63

Cigna Health and Life Insurance Company

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

Toc - Plan #33 Cigna Health and Life Insurance Company

Bronze

(EPO) Cigna Connect 7800

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family

$7,800 $15,600 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$224.84
$255.19
$287.34
$401.56
$610.21

$396.84
$427.19
$459.34
$573.56

$568.84
$599.19
$631.34
$745.56

$740.84
$771.19
$803.34
$917.56

$172.00

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$449.68
$510.38
$574.68
$803.12
$1,220.42

$621.68
$682.38
$746.68
$975.12

$793.68
$854.38
$918.68
$1,147.12

$965.68
$1,026.38
$1,090.68
$1,319.12

$172.00

Toc - Plan #34 Cigna Health and Life Insurance Company

Expanded Bronze

(EPO) Cigna Connect 6750

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family

$6,750 $13,500 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

$236.19
$268.08
$301.85
$421.84
$641.03

$416.88
$448.77
$482.54
$602.53

$597.57
$629.46
$663.23
$783.22

$778.26
$810.15
$843.92
$963.91

$180.69

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$472.38
$536.16
$603.70
$843.68
$1,282.06

$653.07
$716.85
$784.39
$1,024.37

$833.76
$897.54
$965.08
$1,205.06

$1,014.45
$1,078.23
$1,145.77
$1,385.75

$180.69

Toc - Plan #35 Cigna Health and Life Insurance Company

Silver

(EPO) Cigna Connect 5000 + Acupuncture

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

$303.93
$344.96
$388.42
$542.81
$824.86

$536.43
$577.46
$620.92
$775.31

$768.93
$809.96
$853.42
$1,007.81

$1,001.43
$1,042.46
$1,085.92
$1,240.31

$232.50

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$607.86
$689.92
$776.84
$1,085.62
$1,649.72

$840.36
$922.42
$1,009.34
$1,318.12

$1,072.86
$1,154.92
$1,241.84
$1,550.62

$1,305.36
$1,387.42
$1,474.34
$1,783.12

$232.50

Toc - Plan #36 Cigna Health and Life Insurance Company

Gold

(EPO) Cigna Connect 1600

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family

$1,600 $3,200 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

$291.02
$330.31
$371.92
$519.76
$789.83

$513.65
$552.94
$594.55
$742.39

$736.28
$775.57
$817.18
$965.02

$958.91
$998.20
$1,039.81
$1,187.65

$222.63

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$582.04
$660.62
$743.84
$1,039.52
$1,579.66

$804.67
$883.25
$966.47
$1,262.15

$1,027.30
$1,105.88
$1,189.10
$1,484.78

$1,249.93
$1,328.51
$1,411.73
$1,707.41

$222.63

Toc - Plan #37 Cigna Health and Life Insurance Company

Silver

(EPO) Cigna Connect 6500

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

$9,100 $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

$300.36
$340.90
$383.85
$536.43
$815.16

$530.13
$570.67
$613.62
$766.20

$759.90
$800.44
$843.39
$995.97

$989.67
$1,030.21
$1,073.16
$1,225.74

$229.77

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$600.72
$681.80
$767.70
$1,072.86
$1,630.32

$830.49
$911.57
$997.47
$1,302.63

$1,060.26
$1,141.34
$1,227.24
$1,532.40

$1,290.03
$1,371.11
$1,457.01
$1,762.17

$229.77

Toc - Plan #38 Cigna Health and Life Insurance Company

Expanded Bronze

(EPO) Cigna Connect 3400

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family

$3,400 $6,800 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

$235.18
$266.93
$300.56
$420.04
$638.28

$415.09
$446.84
$480.47
$599.95

$595.00
$626.75
$660.38
$779.86

$774.91
$806.66
$840.29
$959.77

$179.91

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$470.36
$533.86
$601.12
$840.08
$1,276.56

$650.27
$713.77
$781.03
$1,019.99

$830.18
$893.68
$960.94
$1,199.90

$1,010.09
$1,073.59
$1,140.85
$1,379.81

$179.91

Toc - Plan #39 Cigna Health and Life Insurance Company

Silver

(EPO) Cigna Connect 3800 Enhanced Diabetes Care

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family

$3,800 $7,600 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$301.26
$341.94
$385.02
$538.06
$817.63

$531.73
$572.41
$615.49
$768.53

$762.20
$802.88
$845.96
$999.00

$992.67
$1,033.35
$1,076.43
$1,229.47

$230.47

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$602.52
$683.88
$770.04
$1,076.12
$1,635.26

$832.99
$914.35
$1,000.51
$1,306.59

$1,063.46
$1,144.82
$1,230.98
$1,537.06

$1,293.93
$1,375.29
$1,461.45
$1,767.53

$230.47

Toc - Plan #40 Cigna Health and Life Insurance Company

Gold

(EPO) Cigna Connect 1950

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family

$1,950 $3,900 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

$287.31
$326.10
$367.19
$513.14
$779.77

$507.11
$545.90
$586.99
$732.94

$726.91
$765.70
$806.79
$952.74

$946.71
$985.50
$1,026.59
$1,172.54

$219.80

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$574.62
$652.20
$734.38
$1,026.28
$1,559.54

$794.42
$872.00
$954.18
$1,246.08

$1,014.22
$1,091.80
$1,173.98
$1,465.88

$1,234.02
$1,311.60
$1,393.78
$1,685.68

$219.80

Toc - Plan #41 Cigna Health and Life Insurance Company

Expanded Bronze

(EPO) Cigna Connect 6800 Enhanced Diabetes Care

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family

$6,800 $13,600 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$235.35
$267.12
$300.78
$420.34
$638.74

$415.39
$447.16
$480.82
$600.38

$595.43
$627.20
$660.86
$780.42

$775.47
$807.24
$840.90
$960.46

$180.04

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$470.70
$534.24
$601.56
$840.68
$1,277.48

$650.74
$714.28
$781.60
$1,020.72

$830.78
$894.32
$961.64
$1,200.76

$1,010.82
$1,074.36
$1,141.68
$1,380.80

$180.04

Toc - Plan #42 Cigna Health and Life Insurance Company

Expanded Bronze

(EPO) Cigna Connect HSA 7050

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family

$7,050 $14,100 Annual Deductible

$7,050 $14,100 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

$236.40
$268.31
$302.11
$422.20
$641.58

$417.24
$449.15
$482.95
$603.04

$598.08
$629.99
$663.79
$783.88

$778.92
$810.83
$844.63
$964.72

$180.84

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$472.80
$536.62
$604.22
$844.40
$1,283.16

$653.64
$717.46
$785.06
$1,025.24

$834.48
$898.30
$965.90
$1,206.08

$1,015.32
$1,079.14
$1,146.74
$1,386.92

$180.84

Toc - Plan #43 Cigna Health and Life Insurance Company

Gold

(EPO) Cigna Connect 1900 Enhanced Diabetes Care

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family

$1,900 $3,800 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

$288.96
$327.98
$369.30
$516.09
$784.25

$510.02
$549.04
$590.36
$737.15

$731.08
$770.10
$811.42
$958.21

$952.14
$991.16
$1,032.48
$1,179.27

$221.06

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$577.92
$655.96
$738.60
$1,032.18
$1,568.50

$798.98
$877.02
$959.66
$1,253.24

$1,020.04
$1,098.08
$1,180.72
$1,474.30

$1,241.10
$1,319.14
$1,401.78
$1,695.36

$221.06

Toc - Plan #44 Cigna Health and Life Insurance Company

Silver

(EPO) Cigna Connect 3250

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family

$3,250 $6,500 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

$294.76
$334.55
$376.70
$526.44
$799.98

$520.25
$560.04
$602.19
$751.93

$745.74
$785.53
$827.68
$977.42

$971.23
$1,011.02
$1,053.17
$1,202.91

$225.49

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$589.52
$669.10
$753.40
$1,052.88
$1,599.96

$815.01
$894.59
$978.89
$1,278.37

$1,040.50
$1,120.08
$1,204.38
$1,503.86

$1,265.99
$1,345.57
$1,429.87
$1,729.35

$225.49

Toc - Plan #45 Cigna Health and Life Insurance Company

Silver

(EPO) Cigna Connect 4200 Enhanced Asthma COPD Care

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family

$4,200 $8,400 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$302.38
$343.20
$386.44
$540.05
$820.65

$533.70
$574.52
$617.76
$771.37

$765.02
$805.84
$849.08
$1,002.69

$996.34
$1,037.16
$1,080.40
$1,234.01

$231.32

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$604.76
$686.40
$772.88
$1,080.10
$1,641.30

$836.08
$917.72
$1,004.20
$1,311.42

$1,067.40
$1,149.04
$1,235.52
$1,542.74

$1,298.72
$1,380.36
$1,466.84
$1,774.06

$231.32

Toc - Plan #46 Cigna Health and Life Insurance Company

Gold

(EPO) Cigna Connect 2300

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family

$2,300 $4,600 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

$287.82
$326.67
$367.83
$514.05
$781.14

$508.00
$546.85
$588.01
$734.23

$728.18
$767.03
$808.19
$954.41

$948.36
$987.21
$1,028.37
$1,174.59

$220.18

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$575.64
$653.34
$735.66
$1,028.10
$1,562.28

$795.82
$873.52
$955.84
$1,248.28

$1,016.00
$1,093.70
$1,176.02
$1,468.46

$1,236.18
$1,313.88
$1,396.20
$1,688.64

$220.18

Toc - Plan #47 Cigna Health and Life Insurance Company

Gold

(EPO) Cigna Simple Choice 2000

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family

$2,000 $4,000 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$286.88
$325.60
$366.63
$512.36
$778.58

$506.34
$545.06
$586.09
$731.82

$725.80
$764.52
$805.55
$951.28

$945.26
$983.98
$1,025.01
$1,170.74

$219.46

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$573.76
$651.20
$733.26
$1,024.72
$1,557.16

$793.22
$870.66
$952.72
$1,244.18

$1,012.68
$1,090.12
$1,172.18
$1,463.64

$1,232.14
$1,309.58
$1,391.64
$1,683.10

$219.46

Toc - Plan #48 Cigna Health and Life Insurance Company

Silver

(EPO) Cigna Simple Choice 5800

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family

$5,800 $11,600 Annual Deductible

$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$300.39
$340.94
$383.90
$536.49
$815.26

$530.19
$570.74
$613.70
$766.29

$759.99
$800.54
$843.50
$996.09

$989.79
$1,030.34
$1,073.30
$1,225.89

$229.80

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$600.78
$681.88
$767.80
$1,072.98
$1,630.52

$830.58
$911.68
$997.60
$1,302.78

$1,060.38
$1,141.48
$1,227.40
$1,532.58

$1,290.18
$1,371.28
$1,457.20
$1,762.38

$229.80

Toc - Plan #49 Cigna Health and Life Insurance Company

Bronze

(EPO) Cigna Simple Choice 9100

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family

$9,100 $18,200 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$224.33
$254.62
$286.70
$400.66
$608.83

$395.94
$426.23
$458.31
$572.27

$567.55
$597.84
$629.92
$743.88

$739.16
$769.45
$801.53
$915.49

$171.61

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$448.66
$509.24
$573.40
$801.32
$1,217.66

$620.27
$680.85
$745.01
$972.93

$791.88
$852.46
$916.62
$1,144.54

$963.49
$1,024.07
$1,088.23
$1,316.15

$171.61

Toc - Plan #50 Cigna Health and Life Insurance Company

Expanded Bronze

(EPO) Cigna Simple Choice 7500

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

$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$233.19
$264.68
$298.02
$416.48
$632.89

$411.58
$443.07
$476.41
$594.87

$589.97
$621.46
$654.80
$773.26

$768.36
$799.85
$833.19
$951.65

$178.39

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$466.38
$529.36
$596.04
$832.96
$1,265.78

$644.77
$707.75
$774.43
$1,011.35

$823.16
$886.14
$952.82
$1,189.74

$1,001.55
$1,064.53
$1,131.21
$1,368.13

$178.39

Toc - Plan #51 Cigna Health and Life Insurance Company

Expanded Bronze

(EPO) Cigna Connect 0

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$9,100 $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

$252.77
$286.90
$323.04
$451.45
$686.03

$446.14
$480.27
$516.41
$644.82

$639.51
$673.64
$709.78
$838.19

$832.88
$867.01
$903.15
$1,031.56

$193.37

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$505.54
$573.80
$646.08
$902.90
$1,372.06

$698.91
$767.17
$839.45
$1,096.27

$892.28
$960.54
$1,032.82
$1,289.64

$1,085.65
$1,153.91
$1,226.19
$1,483.01

$193.37

Toc - Plan #52 Cigna Health and Life Insurance Company

Expanded Bronze

(EPO) Cigna Connect 7600 Enhanced Asthma COPD Care

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family

$7,600 $15,200 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$234.95
$266.66
$300.26
$419.61
$637.64

$414.68
$446.39
$479.99
$599.34

$594.41
$626.12
$659.72
$779.07

$774.14
$805.85
$839.45
$958.80

$179.73

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$469.90
$533.32
$600.52
$839.22
$1,275.28

$649.63
$713.05
$780.25
$1,018.95

$829.36
$892.78
$959.98
$1,198.68

$1,009.09
$1,072.51
$1,139.71
$1,378.41

$179.73

Toc - Plan #53 Cigna Health and Life Insurance Company

Gold

(EPO) Cigna Connect 2100 Enhanced Asthma COPD Care

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family

$2,100 $4,200 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$286.98
$325.72
$366.76
$512.54
$778.85

$506.52
$545.26
$586.30
$732.08

$726.06
$764.80
$805.84
$951.62

$945.60
$984.34
$1,025.38
$1,171.16

$219.54

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$573.96
$651.44
$733.52
$1,025.08
$1,557.70

$793.50
$870.98
$953.06
$1,244.62

$1,013.04
$1,090.52
$1,172.60
$1,464.16

$1,232.58
$1,310.06
$1,392.14
$1,683.70

$219.54

Innovation Health Plan, Inc.

Local: 1-866-833-2957 | Toll Free: 1-866-833-2957

Toc - Plan #54 Innovation Health Plan, Inc.

Expanded Bronze

(HMO) Innovation Health - Aetna Bronze (Low Premium + Telehealth + Low-Cost MinuteClinic Visits at CVS)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-866-833-2957

Annual Out of Pocket Expenses:

Individual Family

$6,000 $12,000 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$219.43
$249.05
$280.43
$391.90
$595.53

$387.29
$416.91
$448.29
$559.76

$555.15
$584.77
$616.15
$727.62

$723.01
$752.63
$784.01
$895.48

$167.86

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$438.86
$498.10
$560.86
$783.80
$1,191.06

$606.72
$665.96
$728.72
$951.66

$774.58
$833.82
$896.58
$1,119.52

$942.44
$1,001.68
$1,064.44
$1,287.38

$167.86

Toc - Plan #55 Innovation Health Plan, Inc.

Expanded Bronze

(HMO) Innovation Health - Aetna Bronze (Low Premium + Telehealth + $0 MinuteClinic Visits at CVS)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-866-833-2957

Annual Out of Pocket Expenses:

Individual Family

$8,800 $17,600 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$203.98
$231.51
$260.68
$364.30
$553.59

$360.02
$387.55
$416.72
$520.34

$516.06
$543.59
$572.76
$676.38

$672.10
$699.63
$728.80
$832.42

$156.04

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$407.96
$463.02
$521.36
$728.60
$1,107.18

$564.00
$619.06
$677.40
$884.64

$720.04
$775.10
$833.44
$1,040.68

$876.08
$931.14
$989.48
$1,196.72

$156.04

Toc - Plan #56 Innovation Health Plan, Inc.

Gold

(HMO) Innovation Health - Aetna Gold (Telehealth and $0 MinuteClinic Visits at CVS)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-866-833-2957

Annual Out of Pocket Expenses:

Individual Family

$1,500 $3,000 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$307.42
$348.92
$392.88
$549.05
$834.34

$542.60
$584.10
$628.06
$784.23

$777.78
$819.28
$863.24
$1,019.41

$1,012.96
$1,054.46
$1,098.42
$1,254.59

$235.18

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$614.84
$697.84
$785.76
$1,098.10
$1,668.68

$850.02
$933.02
$1,020.94
$1,333.28

$1,085.20
$1,168.20
$1,256.12
$1,568.46

$1,320.38
$1,403.38
$1,491.30
$1,803.64

$235.18

Toc - Plan #57 Innovation Health Plan, Inc.

Silver

(HMO) Innovation Health - Aetna Silver 2 (Telehealth and $0 MinuteClinic Visits at CVS)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-866-833-2957

Annual Out of Pocket Expenses:

Individual Family

$4,400 $8,800 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$280.05
$317.86
$357.91
$500.17
$760.06

$494.29
$532.10
$572.15
$714.41

$708.53
$746.34
$786.39
$928.65

$922.77
$960.58
$1,000.63
$1,142.89

$214.24

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$560.10
$635.72
$715.82
$1,000.34
$1,520.12

$774.34
$849.96
$930.06
$1,214.58

$988.58
$1,064.20
$1,144.30
$1,428.82

$1,202.82
$1,278.44
$1,358.54
$1,643.06

$214.24

Toc - Plan #58 Innovation Health Plan, Inc.

Silver

(HMO) Innovation Health - Aetna Silver 3 (Telehealth and $0 MinuteClinic Visits at CVS)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-866-833-2957

Annual Out of Pocket Expenses:

Individual Family

$6,400 $12,800 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$278.11
$315.66
$355.43
$496.71
$754.80

$490.87
$528.42
$568.19
$709.47

$703.63
$741.18
$780.95
$922.23

$916.39
$953.94
$993.71
$1,134.99

$212.76

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$556.22
$631.32
$710.86
$993.42
$1,509.60

$768.98
$844.08
$923.62
$1,206.18

$981.74
$1,056.84
$1,136.38
$1,418.94

$1,194.50
$1,269.60
$1,349.14
$1,631.70

$212.76

Toc - Plan #59 Innovation Health Plan, Inc.

Silver

(HMO) Innovation Health - Aetna Silver 4 ($0 Deductible + $0 MinuteClinic & Telehealth at CVS)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-866-833-2957

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$8,950 $17,900 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

$338.47
$384.16
$432.56
$604.51
$918.61

$597.40
$643.09
$691.49
$863.44

$856.33
$902.02
$950.42
$1,122.37

$1,115.26
$1,160.95
$1,209.35
$1,381.30

$258.93

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$676.94
$768.32
$865.12
$1,209.02
$1,837.22

$935.87
$1,027.25
$1,124.05
$1,467.95

$1,194.80
$1,286.18
$1,382.98
$1,726.88

$1,453.73
$1,545.11
$1,641.91
$1,985.81

$258.93

Toc - Plan #60 Innovation Health Plan, Inc.

Expanded Bronze

(HMO) Innovation Health - Aetna Bronze S (Low Premium + Telehealth + $0 MinuteClinic Visits at CVS)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-866-833-2957

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$216.32
$245.52
$276.45
$386.34
$587.08

$381.80
$411.00
$441.93
$551.82

$547.28
$576.48
$607.41
$717.30

$712.76
$741.96
$772.89
$882.78

$165.48

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$432.64
$491.04
$552.90
$772.68
$1,174.16

$598.12
$656.52
$718.38
$938.16

$763.60
$822.00
$883.86
$1,103.64

$929.08
$987.48
$1,049.34
$1,269.12

$165.48

Toc - Plan #61 Innovation Health Plan, Inc.

Gold

(HMO) Innovation Health - Aetna Gold S (Telehealth and $0 MinuteClinic Visits at CVS)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-866-833-2957

Annual Out of Pocket Expenses:

Individual Family

$2,000 $4,000 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$272.42
$309.20
$348.15
$486.54
$739.35

$480.82
$517.60
$556.55
$694.94

$689.22
$726.00
$764.95
$903.34

$897.62
$934.40
$973.35
$1,111.74

$208.40

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$544.84
$618.40
$696.30
$973.08
$1,478.70

$753.24
$826.80
$904.70
$1,181.48

$961.64
$1,035.20
$1,113.10
$1,389.88

$1,170.04
$1,243.60
$1,321.50
$1,598.28

$208.40

Toc - Plan #62 Innovation Health Plan, Inc.

Silver

(HMO) Innovation Health - Aetna Silver S (Telehealth and $0 MinuteClinic Visits at CVS)

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-866-833-2957

Annual Out of Pocket Expenses:

Individual Family

$5,800 $11,600 Annual Deductible

$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$268.51
$304.76
$343.16
$479.56
$728.75

$473.92
$510.17
$548.57
$684.97

$679.33
$715.58
$753.98
$890.38

$884.74
$920.99
$959.39
$1,095.79

$205.41

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$537.02
$609.52
$686.32
$959.12
$1,457.50

$742.43
$814.93
$891.73
$1,164.53

$947.84
$1,020.34
$1,097.14
$1,369.94

$1,153.25
$1,225.75
$1,302.55
$1,575.35

$205.41

HealthKeepers, Inc.

Local: 1-855-748-1810 | Toll Free: 1-855-748-1810

Toc - Plan #63 HealthKeepers, Inc.

Catastrophic

(HMO) Anthem HealthKeepers Catastrophic X 9100

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-748-1810

Annual Out of Pocket Expenses:

Individual Family

$9,100 $18,200 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$194.18
$220.39
$248.16
$346.81
$527.00

$342.73
$368.94
$396.71
$495.36

$491.28
$517.49
$545.26
$643.91

$639.83
$666.04
$693.81
$792.46

$148.55

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$388.36
$440.78
$496.32
$693.62
$1,054.00

$536.91
$589.33
$644.87
$842.17

$685.46
$737.88
$793.42
$990.72

$834.01
$886.43
$941.97
$1,139.27

$148.55

Toc - Plan #64 HealthKeepers, Inc.

Expanded Bronze

(HMO) Anthem HealthKeepers Bronze X 5500

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-748-1810

Annual Out of Pocket Expenses:

Individual Family

$5,500 $11,000 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

$257.76
$292.56
$329.42
$460.36
$699.56

$454.95
$489.75
$526.61
$657.55

$652.14
$686.94
$723.80
$854.74

$849.33
$884.13
$920.99
$1,051.93

$197.19

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$515.52
$585.12
$658.84
$920.72
$1,399.12

$712.71
$782.31
$856.03
$1,117.91

$909.90
$979.50
$1,053.22
$1,315.10

$1,107.09
$1,176.69
$1,250.41
$1,512.29

$197.19

Toc - Plan #65 HealthKeepers, Inc.

Expanded Bronze

(HMO) Anthem HealthKeepers Bronze X 5900 for HSA

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-748-1810

Annual Out of Pocket Expenses:

Individual Family

$5,900 $11,800 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$260.77
$295.97
$333.26
$465.74
$707.73

$460.26
$495.46
$532.75
$665.23

$659.75
$694.95
$732.24
$864.72

$859.24
$894.44
$931.73
$1,064.21

$199.49

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$521.54
$591.94
$666.52
$931.48
$1,415.46

$721.03
$791.43
$866.01
$1,130.97

$920.52
$990.92
$1,065.50
$1,330.46

$1,120.01
$1,190.41
$1,264.99
$1,529.95

$199.49

Toc - Plan #66 HealthKeepers, Inc.

Bronze

(HMO) Anthem HealthKeepers Bronze X 8200

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-748-1810

Annual Out of Pocket Expenses:

Individual Family

$8,200 $16,400 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$246.58
$279.87
$315.13
$440.39
$669.22

$435.21
$468.50
$503.76
$629.02

$623.84
$657.13
$692.39
$817.65

$812.47
$845.76
$881.02
$1,006.28

$188.63

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$493.16
$559.74
$630.26
$880.78
$1,338.44

$681.79
$748.37
$818.89
$1,069.41

$870.42
$937.00
$1,007.52
$1,258.04

$1,059.05
$1,125.63
$1,196.15
$1,446.67

$188.63

Toc - Plan #67 HealthKeepers, Inc.

Gold

(HMO) Anthem HealthKeepers Gold X 1800

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-748-1810

Annual Out of Pocket Expenses:

Individual Family

$1,800 $5,400 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

$326.80
$370.92
$417.65
$583.66
$886.94

$576.80
$620.92
$667.65
$833.66

$826.80
$870.92
$917.65
$1,083.66

$1,076.80
$1,120.92
$1,167.65
$1,333.66

$250.00

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$653.60
$741.84
$835.30
$1,167.32
$1,773.88

$903.60
$991.84
$1,085.30
$1,417.32

$1,153.60
$1,241.84
$1,335.30
$1,667.32

$1,403.60
$1,491.84
$1,585.30
$1,917.32

$250.00

Toc - Plan #68 HealthKeepers, Inc.

Silver

(HMO) Anthem HealthKeepers Silver X 2400

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-748-1810

Annual Out of Pocket Expenses:

Individual Family

$2,400 $4,800 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

$331.11
$375.81
$423.16
$591.36
$898.63

$584.41
$629.11
$676.46
$844.66

$837.71
$882.41
$929.76
$1,097.96

$1,091.01
$1,135.71
$1,183.06
$1,351.26

$253.30

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$662.22
$751.62
$846.32
$1,182.72
$1,797.26

$915.52
$1,004.92
$1,099.62
$1,436.02

$1,168.82
$1,258.22
$1,352.92
$1,689.32

$1,422.12
$1,511.52
$1,606.22
$1,942.62

$253.30

Toc - Plan #69 HealthKeepers, Inc.

Silver

(HMO) Anthem HealthKeepers Silver X 5000

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-748-1810

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

$320.11
$363.32
$409.10
$571.72
$868.78

$564.99
$608.20
$653.98
$816.60

$809.87
$853.08
$898.86
$1,061.48

$1,054.75
$1,097.96
$1,143.74
$1,306.36

$244.88

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$640.22
$726.64
$818.20
$1,143.44
$1,737.56

$885.10
$971.52
$1,063.08
$1,388.32

$1,129.98
$1,216.40
$1,307.96
$1,633.20

$1,374.86
$1,461.28
$1,552.84
$1,878.08

$244.88

Toc - Plan #70 HealthKeepers, Inc.

Expanded Bronze

(HMO) Anthem HealthKeepers Bronze X 5800

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-748-1810

Annual Out of Pocket Expenses:

Individual Family

$5,800 $11,600 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$265.23
$301.04
$338.96
$473.70
$719.83

$468.13
$503.94
$541.86
$676.60

$671.03
$706.84
$744.76
$879.50

$873.93
$909.74
$947.66
$1,082.40

$202.90

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$530.46
$602.08
$677.92
$947.40
$1,439.66

$733.36
$804.98
$880.82
$1,150.30

$936.26
$1,007.88
$1,083.72
$1,353.20

$1,139.16
$1,210.78
$1,286.62
$1,556.10

$202.90

Toc - Plan #71 HealthKeepers, Inc.

Silver

(HMO) Anthem HealthKeepers Silver X 4200

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-748-1810

Annual Out of Pocket Expenses:

Individual Family

$4,200 $8,400 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$321.81
$365.25
$411.27
$574.75
$873.39

$567.99
$611.43
$657.45
$820.93

$814.17
$857.61
$903.63
$1,067.11

$1,060.35
$1,103.79
$1,149.81
$1,313.29

$246.18

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$643.62
$730.50
$822.54
$1,149.50
$1,746.78

$889.80
$976.68
$1,068.72
$1,395.68

$1,135.98
$1,222.86
$1,314.90
$1,641.86

$1,382.16
$1,469.04
$1,561.08
$1,888.04

$246.18

Toc - Plan #72 HealthKeepers, Inc.

Gold

(HMO) Anthem HealthKeepers Gold X 1500

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-748-1810

Annual Out of Pocket Expenses:

Individual Family

$1,500 $4,500 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

$325.82
$369.81
$416.40
$581.91
$884.28

$575.07
$619.06
$665.65
$831.16

$824.32
$868.31
$914.90
$1,080.41

$1,073.57
$1,117.56
$1,164.15
$1,329.66

$249.25

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$651.64
$739.62
$832.80
$1,163.82
$1,768.56

$900.89
$988.87
$1,082.05
$1,413.07

$1,150.14
$1,238.12
$1,331.30
$1,662.32

$1,399.39
$1,487.37
$1,580.55
$1,911.57

$249.25

Toc - Plan #73 HealthKeepers, Inc.

Expanded Bronze

(HMO) Anthem HealthKeepers Bronze X 7500 Standard

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-748-1810

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$270.69
$307.23
$345.94
$483.45
$734.65

$477.77
$514.31
$553.02
$690.53

$684.85
$721.39
$760.10
$897.61

$891.93
$928.47
$967.18
$1,104.69

$207.08

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$541.38
$614.46
$691.88
$966.90
$1,469.30

$748.46
$821.54
$898.96
$1,173.98

$955.54
$1,028.62
$1,106.04
$1,381.06

$1,162.62
$1,235.70
$1,313.12
$1,588.14

$207.08

Toc - Plan #74 HealthKeepers, Inc.

Bronze

(HMO) Anthem HealthKeepers Bronze X 9100 Standard

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-748-1810

Annual Out of Pocket Expenses:

Individual Family

$9,100 $18,200 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$248.28
$281.80
$317.30
$443.43
$673.83

$438.21
$471.73
$507.23
$633.36

$628.14
$661.66
$697.16
$823.29

$818.07
$851.59
$887.09
$1,013.22

$189.93

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$496.56
$563.60
$634.60
$886.86
$1,347.66

$686.49
$753.53
$824.53
$1,076.79

$876.42
$943.46
$1,014.46
$1,266.72

$1,066.35
$1,133.39
$1,204.39
$1,456.65

$189.93

Toc - Plan #75 HealthKeepers, Inc.

Silver

(HMO) Anthem HealthKeepers Silver X 5800 Standard

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-748-1810

Annual Out of Pocket Expenses:

Individual Family

$5,800 $11,600 Annual Deductible

$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$322.53
$366.07
$412.19
$576.04
$875.35

$569.27
$612.81
$658.93
$822.78

$816.01
$859.55
$905.67
$1,069.52

$1,062.75
$1,106.29
$1,152.41
$1,316.26

$246.74

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$645.06
$732.14
$824.38
$1,152.08
$1,750.70

$891.80
$978.88
$1,071.12
$1,398.82

$1,138.54
$1,225.62
$1,317.86
$1,645.56

$1,385.28
$1,472.36
$1,564.60
$1,892.30

$246.74

Toc - Plan #76 HealthKeepers, Inc.

Gold

(HMO) Anthem HealthKeepers Gold X 2000 Standard

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-748-1810

Annual Out of Pocket Expenses:

Individual Family

$2,000 $4,000 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$335.74
$381.06
$429.08
$599.63
$911.20

$592.58
$637.90
$685.92
$856.47

$849.42
$894.74
$942.76
$1,113.31

$1,106.26
$1,151.58
$1,199.60
$1,370.15

$256.84

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$671.48
$762.12
$858.16
$1,199.26
$1,822.40

$928.32
$1,018.96
$1,115.00
$1,456.10

$1,185.16
$1,275.80
$1,371.84
$1,712.94

$1,442.00
$1,532.64
$1,628.68
$1,969.78

$256.84

Kaiser Permanente

Local: 1-800-807-1140 | Toll Free: 1-800-807-1140 | TTY: 1-703-359-7616

Toc - Plan #77 Kaiser Permanente

Gold

(HMO) KP VA Gold 0/20/Vision

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-807-1140

Annual Out of Pocket Expenses:

Individual Family

$0 $0 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

$328.49
$372.84
$419.81
$586.68
$891.52

$579.78
$624.13
$671.10
$837.97

$831.07
$875.42
$922.39
$1,089.26

$1,082.36
$1,126.71
$1,173.68
$1,340.55

$251.29

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$656.98
$745.68
$839.62
$1,173.36
$1,783.04

$908.27
$996.97
$1,090.91
$1,424.65

$1,159.56
$1,248.26
$1,342.20
$1,675.94

$1,410.85
$1,499.55
$1,593.49
$1,927.23

$251.29

Toc - Plan #78 Kaiser Permanente

Silver

(HMO) KP VA Silver 2500/35/Vision

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-807-1140

Annual Out of Pocket Expenses:

Individual Family

$2,500 $5,000 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$330.24
$374.82
$422.05
$589.81
$896.27

$582.87
$627.45
$674.68
$842.44

$835.50
$880.08
$927.31
$1,095.07

$1,088.13
$1,132.71
$1,179.94
$1,347.70

$252.63

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$660.48
$749.64
$844.10
$1,179.62
$1,792.54

$913.11
$1,002.27
$1,096.73
$1,432.25

$1,165.74
$1,254.90
$1,349.36
$1,684.88

$1,418.37
$1,507.53
$1,601.99
$1,937.51

$252.63

Toc - Plan #79 Kaiser Permanente

Expanded Bronze

(HMO) KP VA Bronze 6000/55/Vision

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-807-1140

Annual Out of Pocket Expenses:

Individual Family

$6,000 $12,000 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

$238.82
$271.06
$305.21
$426.53
$648.16

$421.52
$453.76
$487.91
$609.23

$604.22
$636.46
$670.61
$791.93

$786.92
$819.16
$853.31
$974.63

$182.70

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$477.64
$542.12
$610.42
$853.06
$1,296.32

$660.34
$724.82
$793.12
$1,035.76

$843.04
$907.52
$975.82
$1,218.46

$1,025.74
$1,090.22
$1,158.52
$1,401.16

$182.70

Toc - Plan #80 Kaiser Permanente

Catastrophic

(HMO) KP VA Catastrophic 9100/0/Vision

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-807-1140

Annual Out of Pocket Expenses:

Individual Family

$9,100 $18,200 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$150.51
$170.83
$192.35
$268.81
$408.48

$265.65
$285.97
$307.49
$383.95

$380.79
$401.11
$422.63
$499.09

$495.93
$516.25
$537.77
$614.23

$115.14

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$301.02
$341.66
$384.70
$537.62
$816.96

$416.16
$456.80
$499.84
$652.76

$531.30
$571.94
$614.98
$767.90

$646.44
$687.08
$730.12
$883.04

$115.14

Toc - Plan #81 Kaiser Permanente

Platinum

(HMO) KP VA Platinum 0/15/Vision

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-807-1140

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$3,900 $7,800 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

$368.51
$418.26
$470.96
$658.16
$1,000.14

$650.42
$700.17
$752.87
$940.07

$932.33
$982.08
$1,034.78
$1,221.98

$1,214.24
$1,263.99
$1,316.69
$1,503.89

$281.91

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$737.02
$836.52
$941.92
$1,316.32
$2,000.28

$1,018.93
$1,118.43
$1,223.83
$1,598.23

$1,300.84
$1,400.34
$1,505.74
$1,880.14

$1,582.75
$1,682.25
$1,787.65
$2,162.05

$281.91

Toc - Plan #82 Kaiser Permanente

Silver

(HMO) KP VA Silver 5000/40/Vision

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-807-1140

Annual Out of Pocket Expenses:

Individual Family

$5,000 $10,000 Annual Deductible

$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$319.49
$362.62
$408.31
$570.61
$867.10

$563.90
$607.03
$652.72
$815.02

$808.31
$851.44
$897.13
$1,059.43

$1,052.72
$1,095.85
$1,141.54
$1,303.84

$244.41

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$638.98
$725.24
$816.62
$1,141.22
$1,734.20

$883.39
$969.65
$1,061.03
$1,385.63

$1,127.80
$1,214.06
$1,305.44
$1,630.04

$1,372.21
$1,458.47
$1,549.85
$1,874.45

$244.41

Toc - Plan #83 Kaiser Permanente

Gold

(HMO) KP VA Gold 1250/20/Vision

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-807-1140

Annual Out of Pocket Expenses:

Individual Family

$1,250 $2,500 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

$301.93
$342.69
$385.87
$539.25
$819.44

$532.91
$573.67
$616.85
$770.23

$763.89
$804.65
$847.83
$1,001.21

$994.87
$1,035.63
$1,078.81
$1,232.19

$230.98

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$603.86
$685.38
$771.74
$1,078.50
$1,638.88

$834.84
$916.36
$1,002.72
$1,309.48

$1,065.82
$1,147.34
$1,233.70
$1,540.46

$1,296.80
$1,378.32
$1,464.68
$1,771.44

$230.98

Toc - Plan #84 Kaiser Permanente

Gold

(HMO) KP VA Gold 1700/25/Vision

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-807-1140

Annual Out of Pocket Expenses:

Individual Family

$1,700 $3,400 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

$287.77
$326.62
$367.77
$513.96
$781.01

$507.91
$546.76
$587.91
$734.10

$728.05
$766.90
$808.05
$954.24

$948.19
$987.04
$1,028.19
$1,174.38

$220.14

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$575.54
$653.24
$735.54
$1,027.92
$1,562.02

$795.68
$873.38
$955.68
$1,248.06

$1,015.82
$1,093.52
$1,175.82
$1,468.20

$1,235.96
$1,313.66
$1,395.96
$1,688.34

$220.14

Toc - Plan #85 Kaiser Permanente

Silver

(HMO) KP VA Silver 6000/40/Vision

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-807-1140

Annual Out of Pocket Expenses:

Individual Family

$6,000 $12,000 Annual Deductible

$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$303.06
$343.97
$387.31
$541.27
$822.50

$534.90
$575.81
$619.15
$773.11

$766.74
$807.65
$850.99
$1,004.95

$998.58
$1,039.49
$1,082.83
$1,236.79

$231.84

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$606.12
$687.94
$774.62
$1,082.54
$1,645.00

$837.96
$919.78
$1,006.46
$1,314.38

$1,069.80
$1,151.62
$1,238.30
$1,546.22

$1,301.64
$1,383.46
$1,470.14
$1,778.06

$231.84

Toc - Plan #86 Kaiser Permanente

Bronze

(HMO) KP VA Bronze 7500/40%

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-807-1140

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$221.04
$250.88
$282.49
$394.78
$599.90

$390.14
$419.98
$451.59
$563.88

$559.24
$589.08
$620.69
$732.98

$728.34
$758.18
$789.79
$902.08

$169.10

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$442.08
$501.76
$564.98
$789.56
$1,199.80

$611.18
$670.86
$734.08
$958.66

$780.28
$839.96
$903.18
$1,127.76

$949.38
$1,009.06
$1,072.28
$1,296.86

$169.10

Toc - Plan #87 Kaiser Permanente

Expanded Bronze

(HMO) KP VA Bronze 6900/0%/HSA/Vision

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-807-1140

Annual Out of Pocket Expenses:

Individual Family

$6,900 $13,800 Annual Deductible

$6,900 $13,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$228.10
$258.89
$291.51
$407.39
$619.06

$402.60
$433.39
$466.01
$581.89

$577.10
$607.89
$640.51
$756.39

$751.60
$782.39
$815.01
$930.89

$174.50

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$456.20
$517.78
$583.02
$814.78
$1,238.12

$630.70
$692.28
$757.52
$989.28

$805.20
$866.78
$932.02
$1,163.78

$979.70
$1,041.28
$1,106.52
$1,338.28

$174.50

Toc - Plan #88 Kaiser Permanente

Gold

(HMO) KP VA Gold Virtual Forward 2000

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-807-1140

Annual Out of Pocket Expenses:

Individual Family

$2,000 $4,000 Annual Deductible

$5,000 $10,000 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

$293.38
$332.99
$374.94
$523.98
$796.23

$517.82
$557.43
$599.38
$748.42

$742.26
$781.87
$823.82
$972.86

$966.70
$1,006.31
$1,048.26
$1,197.30

$224.44

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$586.76
$665.98
$749.88
$1,047.96
$1,592.46

$811.20
$890.42
$974.32
$1,272.40

$1,035.64
$1,114.86
$1,198.76
$1,496.84

$1,260.08
$1,339.30
$1,423.20
$1,721.28

$224.44

Toc - Plan #89 Kaiser Permanente

Silver

(HMO) KP VA Silver Virtual Forward 4000

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-807-1140

Annual Out of Pocket Expenses:

Individual Family

$4,000 $8,000 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

$286.83
$325.55
$366.57
$512.28
$778.46

$506.25
$544.97
$585.99
$731.70

$725.67
$764.39
$805.41
$951.12

$945.09
$983.81
$1,024.83
$1,170.54

$219.42

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$573.66
$651.10
$733.14
$1,024.56
$1,556.92

$793.08
$870.52
$952.56
$1,243.98

$1,012.50
$1,089.94
$1,171.98
$1,463.40

$1,231.92
$1,309.36
$1,391.40
$1,682.82

$219.42

Toc - Plan #90 Kaiser Permanente

Platinum

(HMO) KP VA Standard Platinum 0/10/Vision

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-807-1140

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$3,000 $6,000 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

$378.56
$429.67
$483.80
$676.11
$1,027.41

$668.16
$719.27
$773.40
$965.71

$957.76
$1,008.87
$1,063.00
$1,255.31

$1,247.36
$1,298.47
$1,352.60
$1,544.91

$289.60

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$757.12
$859.34
$967.60
$1,352.22
$2,054.82

$1,046.72
$1,148.94
$1,257.20
$1,641.82

$1,336.32
$1,438.54
$1,546.80
$1,931.42

$1,625.92
$1,728.14
$1,836.40
$2,221.02

$289.60

Toc - Plan #91 Kaiser Permanente

Gold

(HMO) KP VA Standard Gold 2000/30/Vision

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-807-1140

Annual Out of Pocket Expenses:

Individual Family

$2,000 $4,000 Annual Deductible

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

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$292.69
$332.20
$374.06
$522.74
$794.36

$516.60
$556.11
$597.97
$746.65

$740.51
$780.02
$821.88
$970.56

$964.42
$1,003.93
$1,045.79
$1,194.47

$223.91

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$585.38
$664.40
$748.12
$1,045.48
$1,588.72

$809.29
$888.31
$972.03
$1,269.39

$1,033.20
$1,112.22
$1,195.94
$1,493.30

$1,257.11
$1,336.13
$1,419.85
$1,717.21

$223.91

Toc - Plan #92 Kaiser Permanente

Silver

(HMO) KP VA Standard Silver 5800/40/Vision

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-807-1140

Annual Out of Pocket Expenses:

Individual Family

$5,800 $11,600 Annual Deductible

$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$305.06
$346.24
$389.87
$544.84
$827.93

$538.43
$579.61
$623.24
$778.21

$771.80
$812.98
$856.61
$1,011.58

$1,005.17
$1,046.35
$1,089.98
$1,244.95

$233.37

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$610.12
$692.48
$779.74
$1,089.68
$1,655.86

$843.49
$925.85
$1,013.11
$1,323.05

$1,076.86
$1,159.22
$1,246.48
$1,556.42

$1,310.23
$1,392.59
$1,479.85
$1,789.79

$233.37

Toc - Plan #93 Kaiser Permanente

Expanded Bronze

(HMO) KP VA Standard Expanded Bronze 7500/50/Vision

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-807-1140

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$249.76
$283.48
$319.19
$446.07
$677.85

$440.83
$474.55
$510.26
$637.14

$631.90
$665.62
$701.33
$828.21

$822.97
$856.69
$892.40
$1,019.28

$191.07

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$499.52
$566.96
$638.38
$892.14
$1,355.70

$690.59
$758.03
$829.45
$1,083.21

$881.66
$949.10
$1,020.52
$1,274.28

$1,072.73
$1,140.17
$1,211.59
$1,465.35

$191.07

‡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 Prince William County here.

Prince William County is in “Rating Area 10” of Virginia.

Currently, there are 93 plans offered in Rating Area 10.

Top

2023 Obamacare Plans for Prince William County, VA

Plan Browser: 93 Plans

CareFirst BlueChoice

Local: 1-855-444-3119 | Toll Free: 1-855-444-3119 | TTY: 1-202-479-3546

1. Silver BlueChoice HMO HSA Silver 3000

2. Gold BlueChoice HMO Gold 1750

3. Catastrophic BlueChoice HMO Young Adult 9100

4. Silver BlueChoice HMO Standard Silver $5,800

5. Gold BlueChoice HMO Standard Gold $2,000

Optima Health Plan

Local: 1-866-946-6034 | Toll Free: 1-866-946-6034 | TTY: 1-800-828-1140

6. Expanded Bronze OptimaFit Bronze 6250 20% HSA Direct M

7. Gold OptimaFit Gold 1300 20% Direct M

8. Expanded Bronze OptimaFit Bronze 7200 40% Direct M

9. Silver OptimaFit Silver 3800 25% Direct M

10. Silver OptimaFit Silver 6600 30% Direct M

11. Gold OptimaFit Gold 2200 20% Direct M

12. Gold OptimaFit Gold 2000 25% Standard M

13. Silver OptimaFit Silver 5800 40% Standard M

14. Bronze OptimaFit Bronze 9100 0% Standard M

UnitedHealthcare

Local: 1-877-265-9199 | Toll Free: 1-877-265-9199 | TTY: 1-877-265-9199

15. Silver UHC Silver Value $2,950 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx, No Referrals)

16. Expanded Bronze UHC Bronze Value $6,500 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx, No Referrals)

17. Silver UHC Silver Value $3,600 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx)

18. Gold UHC Gold Value $1,800 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $2 T1 Preferred Rx)

19. Gold UHC Gold Advantage+ (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $2 T1 Preferred Rx, Dental + Vision)

20. Gold UHC Gold Standard

21. Silver UHC Silver Standard

22. Expanded Bronze UHC Bronze Value HSA

23. Expanded Bronze UHC Bronze Virtual First (Unlimited $0 App-based Care, $3 T1 Preferred Rx) (Disponible en espa�ol)

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

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

26. Bronze UHC Bronze Standard $9,100 Deductible

27. Gold UHC Gold Value $2,100 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $1 T1 Preferred Rx, No Referrals)

28. Silver UHC Silver Virtual First (Unlimited $0 App-based Care, $3 T1 Preferred Rx) (Disponible en espa�ol)

CareFirst BlueCross BlueShield

Local: 1-855-444-3119 | Toll Free: 1-855-444-3119 | TTY: 1-202-479-3546

29. Gold BluePreferred PPO Gold 1750

30. Silver BluePreferred PPO HSA Silver 3000

31. Silver BluePreferred PPO Standard Silver 5800

32. Gold BluePreferred PPO Standard Gold 2000

Cigna Health and Life Insurance Company

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

33. Bronze Cigna Connect 7800

34. Expanded Bronze Cigna Connect 6750

35. Silver Cigna Connect 5000 + Acupuncture

36. Gold Cigna Connect 1600

37. Silver Cigna Connect 6500

38. Expanded Bronze Cigna Connect 3400

39. Silver Cigna Connect 3800 Enhanced Diabetes Care

40. Gold Cigna Connect 1950

41. Expanded Bronze Cigna Connect 6800 Enhanced Diabetes Care

42. Expanded Bronze Cigna Connect HSA 7050

43. Gold Cigna Connect 1900 Enhanced Diabetes Care

44. Silver Cigna Connect 3250

45. Silver Cigna Connect 4200 Enhanced Asthma COPD Care

46. Gold Cigna Connect 2300

47. Gold Cigna Simple Choice 2000

48. Silver Cigna Simple Choice 5800

49. Bronze Cigna Simple Choice 9100

50. Expanded Bronze Cigna Simple Choice 7500

51. Expanded Bronze Cigna Connect 0

52. Expanded Bronze Cigna Connect 7600 Enhanced Asthma COPD Care

53. Gold Cigna Connect 2100 Enhanced Asthma COPD Care

Innovation Health Plan, Inc.

Local: 1-866-833-2957 | Toll Free: 1-866-833-2957

54. Expanded Bronze Innovation Health - Aetna Bronze (Low Premium + Telehealth + Low-Cost MinuteClinic Visits at CVS)

55. Expanded Bronze Innovation Health - Aetna Bronze (Low Premium + Telehealth + $0 MinuteClinic Visits at CVS)

56. Gold Innovation Health - Aetna Gold (Telehealth and $0 MinuteClinic Visits at CVS)

57. Silver Innovation Health - Aetna Silver 2 (Telehealth and $0 MinuteClinic Visits at CVS)

58. Silver Innovation Health - Aetna Silver 3 (Telehealth and $0 MinuteClinic Visits at CVS)

59. Silver Innovation Health - Aetna Silver 4 ($0 Deductible + $0 MinuteClinic & Telehealth at CVS)

60. Expanded Bronze Innovation Health - Aetna Bronze S (Low Premium + Telehealth + $0 MinuteClinic Visits at CVS)

61. Gold Innovation Health - Aetna Gold S (Telehealth and $0 MinuteClinic Visits at CVS)

62. Silver Innovation Health - Aetna Silver S (Telehealth and $0 MinuteClinic Visits at CVS)

HealthKeepers, Inc.

Local: 1-855-748-1810 | Toll Free: 1-855-748-1810

63. Catastrophic Anthem HealthKeepers Catastrophic X 9100

64. Expanded Bronze Anthem HealthKeepers Bronze X 5500

65. Expanded Bronze Anthem HealthKeepers Bronze X 5900 for HSA

66. Bronze Anthem HealthKeepers Bronze X 8200

67. Gold Anthem HealthKeepers Gold X 1800

68. Silver Anthem HealthKeepers Silver X 2400

69. Silver Anthem HealthKeepers Silver X 5000

70. Expanded Bronze Anthem HealthKeepers Bronze X 5800

71. Silver Anthem HealthKeepers Silver X 4200

72. Gold Anthem HealthKeepers Gold X 1500

73. Expanded Bronze Anthem HealthKeepers Bronze X 7500 Standard

74. Bronze Anthem HealthKeepers Bronze X 9100 Standard

75. Silver Anthem HealthKeepers Silver X 5800 Standard

76. Gold Anthem HealthKeepers Gold X 2000 Standard

Kaiser Permanente

Local: 1-800-807-1140 | Toll Free: 1-800-807-1140 | TTY: 1-703-359-7616

77. Gold KP VA Gold 0/20/Vision

78. Silver KP VA Silver 2500/35/Vision

79. Expanded Bronze KP VA Bronze 6000/55/Vision

80. Catastrophic KP VA Catastrophic 9100/0/Vision

81. Platinum KP VA Platinum 0/15/Vision

82. Silver KP VA Silver 5000/40/Vision

83. Gold KP VA Gold 1250/20/Vision

84. Gold KP VA Gold 1700/25/Vision

85. Silver KP VA Silver 6000/40/Vision

86. Bronze KP VA Bronze 7500/40%

87. Expanded Bronze KP VA Bronze 6900/0%/HSA/Vision

88. Gold KP VA Gold Virtual Forward 2000

89. Silver KP VA Silver Virtual Forward 4000

90. Platinum KP VA Standard Platinum 0/10/Vision

91. Gold KP VA Standard Gold 2000/30/Vision

92. Silver KP VA Standard Silver 5800/40/Vision

93. Expanded Bronze KP VA Standard Expanded Bronze 7500/50/Vision

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

Obamacare Providers, 93 Plans and 2023 Rates for Prince William County, Virginia

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Obamacare Rates and Providers for Other Years

How To Sign Up for Obamacare in Virginia for 2023

Where's the Virginia Health Care Exchange?

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

Virginia Has Expanded Medicaid

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More Information

CareFirst BlueChoice

(HMO) BlueChoice HMO HSA Silver 3000

Annual Out of Pocket Expenses:

Individual Family $3,000 $6,000 Annual Deductible $6,500 $13,000 Maximum Out of Pocket Per Year

Monthly Premiums:

(HMO) BlueChoice HMO Gold 1750

Annual Out of Pocket Expenses:

Individual Family $1,750 $3,500 Annual Deductible $6,650 $13,300 Maximum Out of Pocket Per Year

Monthly Premiums:

(HMO) BlueChoice HMO Young Adult 9100

Annual Out of Pocket Expenses:

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

Monthly Premiums:

(HMO) BlueChoice HMO Standard Silver $5,800

Annual Out of Pocket Expenses:

Individual Family $5,800 $11,600 Annual Deductible $8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

(HMO) BlueChoice HMO Standard Gold $2,000

Annual Out of Pocket Expenses:

Individual Family $2,000 $4,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

Optima Health Plan

(HMO) OptimaFit Bronze 6250 20% HSA Direct M

Annual Out of Pocket Expenses:

Individual Family $6,250 $12,500 Annual Deductible $7,050 $14,100 Maximum Out of Pocket Per Year

Monthly Premiums:

(HMO) OptimaFit Gold 1300 20% Direct M

Annual Out of Pocket Expenses:

Individual Family $1,300 $2,600 Annual Deductible $8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

(HMO) OptimaFit Bronze 7200 40% Direct M

Annual Out of Pocket Expenses:

Individual Family $7,200 $14,400 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

(HMO) OptimaFit Silver 3800 25% Direct M

Annual Out of Pocket Expenses:

Individual Family $3,800 $7,600 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

(HMO) OptimaFit Silver 6600 30% Direct M

Annual Out of Pocket Expenses:

Individual Family $6,600 $13,200 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

(HMO) OptimaFit Gold 2200 20% Direct M

Annual Out of Pocket Expenses:

Individual Family $2,200 $4,400 Annual Deductible $6,000 $12,000 Maximum Out of Pocket Per Year

Monthly Premiums:

(HMO) OptimaFit Gold 2000 25% Standard M

Annual Out of Pocket Expenses:

Individual Family $2,000 $4,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

(HMO) OptimaFit Silver 5800 40% Standard M

Annual Out of Pocket Expenses:

Individual Family $5,800 $11,600 Annual Deductible $8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

(HMO) OptimaFit Bronze 9100 0% Standard M

Annual Out of Pocket Expenses:

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

Monthly Premiums:

UnitedHealthcare

(HMO) UHC Silver Value $2,950 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx, No Referrals)

Annual Out of Pocket Expenses:

Individual Family $2,950 $5,900 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

(HMO) UHC Bronze Value $6,500 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx, No Referrals)

Annual Out of Pocket Expenses:

Individual Family $6,500 $13,000 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

(HMO) UHC Silver Value $3,600 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx)

Individual Family

$3,000 $6,000 Annual Deductible

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

Individual Family

$1,750 $3,500 Annual Deductible

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

Individual Family

$9,100 $18,200 Annual Deductible

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

Individual Family

$5,800 $11,600 Annual Deductible

$8,900 $17,800 Maximum Out of Pocket Per Year

Individual Family

$2,000 $4,000 Annual Deductible

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

Individual Family

$6,250 $12,500 Annual Deductible

$7,050 $14,100 Maximum Out of Pocket Per Year

Individual Family

$1,300 $2,600 Annual Deductible

$8,900 $17,800 Maximum Out of Pocket Per Year

Individual Family

$7,200 $14,400 Annual Deductible

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

Individual Family

$3,800 $7,600 Annual Deductible

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

Individual Family

$6,600 $13,200 Annual Deductible

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

Individual Family

$2,200 $4,400 Annual Deductible

$6,000 $12,000 Maximum Out of Pocket Per Year

Individual Family

$2,000 $4,000 Annual Deductible

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

Individual Family

$5,800 $11,600 Annual Deductible

$8,900 $17,800 Maximum Out of Pocket Per Year

Individual Family

$9,100 $18,200 Annual Deductible

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

Individual Family

$2,950 $5,900 Annual Deductible

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

Individual Family

$6,500 $13,000 Annual Deductible

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

Individual Family

$3,600 $7,200 Annual Deductible

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

Individual Family

$1,800 $3,600 Annual Deductible

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

Individual Family

$1,200 $2,400 Annual Deductible

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

Individual Family

$2,000 $4,000 Annual Deductible

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

Individual Family

$5,800 $11,600 Annual Deductible

$8,900 $17,800 Maximum Out of Pocket Per Year

Individual Family

$6,700 $13,400 Annual Deductible

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

Individual Family

$7,250 $14,500 Annual Deductible

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

Individual Family

$9,100 $18,200 Annual Deductible

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

Individual Family

$7,500 $15,000 Annual Deductible

$9,000 $18,000 Maximum Out of Pocket Per Year

Individual Family

$9,100 $18,200 Annual Deductible

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

Individual Family

$2,100 $4,200 Annual Deductible

$8,900 $17,800 Maximum Out of Pocket Per Year

Individual Family

$3,600 $7,200 Annual Deductible

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

Individual Family

$1,750 $3,500 Annual Deductible

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

Individual Family

$3,000 $6,000 Annual Deductible

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