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Providers for Zip Code 54755

Obamacare 2017 Marketplace Rates For Buffalo County, Wisconsin

Friday, December 9th, 2016

Click for Mondovi, Wisconsin Forecast

Obamacare Providers, Plans and 2017 Rates for Buffalo County

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

2017 Rates and Providers

(click here for 2014)

(click here for 2015)

(click here for 2016)

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

Currently, there are 30 plans offered in Buffalo County.

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

 

The table below shows premiums for the following scenarios:

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

Each scenario is covered for age

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

 

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

 

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

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

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

Gundersen Health Plan, Inc.

Local: 1-608-775-8092 | Toll Free: 1-855-685-6404

Plan: (POS) Platinum $1000 - 0%

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.)

Deductible: Individual: $1,000 : Family: $2,000
Out of Pocket Maximum per year: Individual: $1,000 : Family: $2,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Platinum 21
30
40
50
60
$530.87
$602.54
$678.45
$948.13
$1440.78
$1061.74
$1205.08
$1356.90
$1896.26
$2881.56
$1398.84
$1542.18
$1694.00
$2233.36
$1735.94
$1879.28
$2031.10
$2570.46
$2073.04
$2216.38
$2368.20
$2907.56
$867.97
$939.64
$1015.55
$1285.23
$1205.07
$1276.74
$1352.65
$1622.33
$1542.17
$1613.84
$1689.75
$1959.43
$337.10

Plan: (POS) Platinum $500 - 20%

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.)

Deductible: Individual: $500 : Family: $1,000
Out of Pocket Maximum per year: Individual: $1,000 : Family: $2,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Platinum 21
30
40
50
60
$535.75
$608.08
$684.69
$956.85
$1454.03
$1071.50
$1216.16
$1369.38
$1913.70
$2908.06
$1411.70
$1556.36
$1709.58
$2253.90
$1751.90
$1896.56
$2049.78
$2594.10
$2092.10
$2236.76
$2389.98
$2934.30
$875.95
$948.28
$1024.89
$1297.05
$1216.15
$1288.48
$1365.09
$1637.25
$1556.35
$1628.68
$1705.29
$1977.45
$340.20

Plan: (POS) Gold $1750 - 30%

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.)

Deductible: Individual: $1,750 : Family: $3,500
Out of Pocket Maximum per year: Individual: $3,250 : Family: $6,500

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$474.11
$538.11
$605.91
$846.76
$1286.73
$948.22
$1076.22
$1211.82
$1693.52
$2573.46
$1249.28
$1377.28
$1512.88
$1994.58
$1550.34
$1678.34
$1813.94
$2295.64
$1851.40
$1979.40
$2115.00
$2596.70
$775.17
$839.17
$906.97
$1147.82
$1076.23
$1140.23
$1208.03
$1448.88
$1377.29
$1441.29
$1509.09
$1749.94
$301.06

Plan: (POS) Gold $3500 - 0%

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$449.25
$509.90
$574.14
$802.36
$1219.26
$898.50
$1019.80
$1148.28
$1604.72
$2438.52
$1183.77
$1305.07
$1433.55
$1889.99
$1469.04
$1590.34
$1718.82
$2175.26
$1754.31
$1875.61
$2004.09
$2460.53
$734.52
$795.17
$859.41
$1087.63
$1019.79
$1080.44
$1144.68
$1372.90
$1305.06
$1365.71
$1429.95
$1658.17
$285.27

Health Tradition Health Plan

Local: 1-608-781-9692 | Toll Free: 1-888-459-3020

Plan: (HMO) Gold 1000/80

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-459-3020 - Provider Directory for This Plan: (Health Tradition Health Plan)

Deductible: Individual: $1,000 : Family: $2,000
Out of Pocket Maximum per year: Individual: $4,750 : Family: $9,500

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$441.41
$501.00
$564.13
$788.36
$1197.99
$882.82
$1002.00
$1128.26
$1576.72
$2395.98
$1163.12
$1282.30
$1408.56
$1857.02
$1443.42
$1562.60
$1688.86
$2137.32
$1723.72
$1842.90
$1969.16
$2417.62
$721.71
$781.30
$844.43
$1068.66
$1002.01
$1061.60
$1124.73
$1348.96
$1282.31
$1341.90
$1405.03
$1629.26
$280.30

Plan: (HMO) Gold 2000/80 w/copay

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-459-3020 - Provider Directory for This Plan: (Health Tradition Health Plan)

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $3,750 : Family: $7,500

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$443.51
$503.38
$566.80
$792.10
$1203.67
$887.02
$1006.76
$1133.60
$1584.20
$2407.34
$1168.65
$1288.39
$1415.23
$1865.83
$1450.28
$1570.02
$1696.86
$2147.46
$1731.91
$1851.65
$1978.49
$2429.09
$725.14
$785.01
$848.43
$1073.73
$1006.77
$1066.64
$1130.06
$1355.36
$1288.40
$1348.27
$1411.69
$1636.99
$281.63

Plan: (HMO) Bronze 6000/80

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-459-3020 - Provider Directory for This Plan: (Health Tradition Health Plan)

Deductible: Individual: $6,000 : Family: $12,000
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$311.39
$353.43
$397.96
$556.14
$845.11
$622.78
$706.86
$795.92
$1112.28
$1690.22
$820.52
$904.60
$993.66
$1310.02
$1018.26
$1102.34
$1191.40
$1507.76
$1216.00
$1300.08
$1389.14
$1705.50
$509.13
$551.17
$595.70
$753.88
$706.87
$748.91
$793.44
$951.62
$904.61
$946.65
$991.18
$1149.36
$197.74

Plan: (HMO) Bronze HDHP 100

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-459-3020 - Provider Directory for This Plan: (Health Tradition Health Plan)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$276.84
$314.21
$353.80
$494.43
$751.33
$553.68
$628.42
$707.60
$988.86
$1502.66
$729.47
$804.21
$883.39
$1164.65
$905.26
$980.00
$1059.18
$1340.44
$1081.05
$1155.79
$1234.97
$1516.23
$452.63
$490.00
$529.59
$670.22
$628.42
$665.79
$705.38
$846.01
$804.21
$841.58
$881.17
$1021.80
$175.79

Plan: (HMO) Essential

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-459-3020 - Provider Directory for This Plan: (Health Tradition Health Plan)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Catastrophic 21
30
40
50
60
$240.61
$273.10
$307.50
$429.73
$653.02
$481.22
$546.20
$615.00
$859.46
$1306.04
$634.01
$698.99
$767.79
$1012.25
$786.80
$851.78
$920.58
$1165.04
$939.59
$1004.57
$1073.37
$1317.83
$393.40
$425.89
$460.29
$582.52
$546.19
$578.68
$613.08
$735.31
$698.98
$731.47
$765.87
$888.10
$152.79

Plan: (HMO) Silver 2500/80

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-459-3020 - Provider Directory for This Plan: (Health Tradition Health Plan)

Deductible: Individual: $2,500 : Family: $5,000
Out of Pocket Maximum per year: Individual: $5,000 : Family: $10,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$384.54
$436.45
$491.44
$686.79
$1043.63
$769.08
$872.90
$982.88
$1373.58
$2087.26
$1013.27
$1117.09
$1227.07
$1617.77
$1257.46
$1361.28
$1471.26
$1861.96
$1501.65
$1605.47
$1715.45
$2106.15
$628.73
$680.64
$735.63
$930.98
$872.92
$924.83
$979.82
$1175.17
$1117.11
$1169.02
$1224.01
$1419.36
$244.19

Plan: (HMO) Silver 4000/80 w/copay

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-459-3020 - Provider Directory for This Plan: (Health Tradition Health Plan)

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$380.49
$431.86
$486.27
$679.56
$1032.65
$760.98
$863.72
$972.54
$1359.12
$2065.30
$1002.60
$1105.34
$1214.16
$1600.74
$1244.22
$1346.96
$1455.78
$1842.36
$1485.84
$1588.58
$1697.40
$2083.98
$622.11
$673.48
$727.89
$921.18
$863.73
$915.10
$969.51
$1162.80
$1105.35
$1156.72
$1211.13
$1404.42
$241.62

Plan: (HMO) Silver HDHP 85

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-459-3020 - Provider Directory for This Plan: (Health Tradition Health Plan)

Deductible: Individual: $3,000 : Family: $6,000
Out of Pocket Maximum per year: Individual: $5,000 : Family: $10,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$360.82
$409.53
$461.13
$644.43
$979.27
$721.64
$819.06
$922.26
$1288.86
$1958.54
$950.77
$1048.19
$1151.39
$1517.99
$1179.90
$1277.32
$1380.52
$1747.12
$1409.03
$1506.45
$1609.65
$1976.25
$589.95
$638.66
$690.26
$873.56
$819.08
$867.79
$919.39
$1102.69
$1048.21
$1096.92
$1148.52
$1331.82
$229.13

Plan: (HMO) Silver 3000/70 w/copay

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-459-3020 - Provider Directory for This Plan: (Health Tradition Health Plan)

Deductible: Individual: $3,000 : Family: $6,000
Out of Pocket Maximum per year: Individual: $5,400 : Family: $10,800

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$384.49
$436.40
$491.38
$686.70
$1043.51
$768.98
$872.80
$982.76
$1373.40
$2087.02
$1013.14
$1116.96
$1226.92
$1617.56
$1257.30
$1361.12
$1471.08
$1861.72
$1501.46
$1605.28
$1715.24
$2105.88
$628.65
$680.56
$735.54
$930.86
$872.81
$924.72
$979.70
$1175.02
$1116.97
$1168.88
$1223.86
$1419.18
$244.16

Plan: (HMO) Silver HDHP 100

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-459-3020 - Provider Directory for This Plan: (Health Tradition Health Plan)

Deductible: Individual: $4,400 : Family: $8,800
Out of Pocket Maximum per year: Individual: $4,400 : Family: $8,800

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$342.87
$389.16
$438.19
$612.37
$930.55
$685.74
$778.32
$876.38
$1224.74
$1861.10
$903.47
$996.05
$1094.11
$1442.47
$1121.20
$1213.78
$1311.84
$1660.20
$1338.93
$1431.51
$1529.57
$1877.93
$560.60
$606.89
$655.92
$830.10
$778.33
$824.62
$873.65
$1047.83
$996.06
$1042.35
$1091.38
$1265.56
$217.73

Plan: (HMO) Silver 4000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-459-3020 - Provider Directory for This Plan: (Health Tradition Health Plan)

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: Individual: $5,000 : Family: $10,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$354.55
$402.41
$453.11
$633.22
$962.23
$709.10
$804.82
$906.22
$1266.44
$1924.46
$934.24
$1029.96
$1131.36
$1491.58
$1159.38
$1255.10
$1356.50
$1716.72
$1384.52
$1480.24
$1581.64
$1941.86
$579.69
$627.55
$678.25
$858.36
$804.83
$852.69
$903.39
$1083.50
$1029.97
$1077.83
$1128.53
$1308.64
$225.14

Plan: (HMO) Bronze HDHP 50

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-459-3020 - Provider Directory for This Plan: (Health Tradition Health Plan)

Deductible: Individual: $4,500 : Family: $9,000
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$280.42
$318.28
$358.38
$500.83
$761.05
$560.84
$636.56
$716.76
$1001.66
$1522.10
$738.91
$814.63
$894.83
$1179.73
$916.98
$992.70
$1072.90
$1357.80
$1095.05
$1170.77
$1250.97
$1535.87
$458.49
$496.35
$536.45
$678.90
$636.56
$674.42
$714.52
$856.97
$814.63
$852.49
$892.59
$1035.04
$178.07

Plan: (HMO) Bronze 7150/100 Rx

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-459-3020 - Provider Directory for This Plan: (Health Tradition Health Plan)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$296.14
$336.12
$378.46
$528.90
$803.71
$592.28
$672.24
$756.92
$1057.80
$1607.42
$780.33
$860.29
$944.97
$1245.85
$968.38
$1048.34
$1133.02
$1433.90
$1156.43
$1236.39
$1321.07
$1621.95
$484.19
$524.17
$566.51
$716.95
$672.24
$712.22
$754.56
$905.00
$860.29
$900.27
$942.61
$1093.05
$188.05

Plan: (HMO) Bronze 7150/100

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-459-3020 - Provider Directory for This Plan: (Health Tradition Health Plan)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$263.17
$298.69
$336.33
$470.01
$714.23
$526.34
$597.38
$672.66
$940.02
$1428.46
$693.45
$764.49
$839.77
$1107.13
$860.56
$931.60
$1006.88
$1274.24
$1027.67
$1098.71
$1173.99
$1441.35
$430.28
$465.80
$503.44
$637.12
$597.39
$632.91
$670.55
$804.23
$764.50
$800.02
$837.66
$971.34
$167.11

Gundersen Health Plan, Inc.

Local: 1-608-775-8092 | Toll Free: 1-855-685-6404

Plan: (POS) Silver $4000 - 10%

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.)

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: Individual: $6,000 : Family: $12,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$414.17
$470.08
$529.31
$739.71
$1124.06
$828.34
$940.16
$1058.62
$1479.42
$2248.12
$1091.34
$1203.16
$1321.62
$1742.42
$1354.34
$1466.16
$1584.62
$2005.42
$1617.34
$1729.16
$1847.62
$2268.42
$677.17
$733.08
$792.31
$1002.71
$940.17
$996.08
$1055.31
$1265.71
$1203.17
$1259.08
$1318.31
$1528.71
$263.00

Plan: (POS) Silver $2500 - 50%

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.)

Deductible: Individual: $2,500 : Family: $5,000
Out of Pocket Maximum per year: Individual: $6,000 : Family: $12,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$410.32
$465.71
$524.39
$732.83
$1113.61
$820.64
$931.42
$1048.78
$1465.66
$2227.22
$1081.19
$1191.97
$1309.33
$1726.21
$1341.74
$1452.52
$1569.88
$1986.76
$1602.29
$1713.07
$1830.43
$2247.31
$670.87
$726.26
$784.94
$993.38
$931.42
$986.81
$1045.49
$1253.93
$1191.97
$1247.36
$1306.04
$1514.48
$260.55

Plan: (POS) Silver $2500 - 20%

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.)

Deductible: Individual: $2,500 : Family: $5,000
Out of Pocket Maximum per year: Individual: $5,000 : Family: $10,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$432.56
$490.96
$552.81
$772.55
$1173.97
$865.12
$981.92
$1105.62
$1545.10
$2347.94
$1139.80
$1256.60
$1380.30
$1819.78
$1414.48
$1531.28
$1654.98
$2094.46
$1689.16
$1805.96
$1929.66
$2369.14
$707.24
$765.64
$827.49
$1047.23
$981.92
$1040.32
$1102.17
$1321.91
$1256.60
$1315.00
$1376.85
$1596.59
$274.68

Plan: (POS) Bronze $3750 - 50%

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.)

Deductible: Individual: $3,750 : Family: $7,500
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$342.16
$388.35
$437.28
$611.10
$928.62
$684.32
$776.70
$874.56
$1222.20
$1857.24
$901.59
$993.97
$1091.83
$1439.47
$1118.86
$1211.24
$1309.10
$1656.74
$1336.13
$1428.51
$1526.37
$1874.01
$559.43
$605.62
$654.55
$828.37
$776.70
$822.89
$871.82
$1045.64
$993.97
$1040.16
$1089.09
$1262.91
$217.27

Plan: (POS) Bronze $5000 - 10%

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.)

Deductible: Individual: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$357.07
$405.27
$456.34
$637.73
$969.09
$714.14
$810.54
$912.68
$1275.46
$1938.18
$940.88
$1037.28
$1139.42
$1502.20
$1167.62
$1264.02
$1366.16
$1728.94
$1394.36
$1490.76
$1592.90
$1955.68
$583.81
$632.01
$683.08
$864.47
$810.55
$858.75
$909.82
$1091.21
$1037.29
$1085.49
$1136.56
$1317.95
$226.74

Plan: (POS) Bronze $6500 - 10%

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.)

Deductible: Individual: $6,500 : Family: $13,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$338.11
$383.75
$432.10
$603.86
$917.63
$676.22
$767.50
$864.20
$1207.72
$1835.26
$890.92
$982.20
$1078.90
$1422.42
$1105.62
$1196.90
$1293.60
$1637.12
$1320.32
$1411.60
$1508.30
$1851.82
$552.81
$598.45
$646.80
$818.56
$767.51
$813.15
$861.50
$1033.26
$982.21
$1027.85
$1076.20
$1247.96
$214.70

Plan: (POS) Catastrophic $7150 - 0%

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Catastrophic 21
30
40
50
60
$316.61
$359.35
$404.63
$565.47
$859.28
$633.22
$718.70
$809.26
$1130.94
$1718.56
$834.27
$919.75
$1010.31
$1331.99
$1035.32
$1120.80
$1211.36
$1533.04
$1236.37
$1321.85
$1412.41
$1734.09
$517.66
$560.40
$605.68
$766.52
$718.71
$761.45
$806.73
$967.57
$919.76
$962.50
$1007.78
$1168.62
$201.05

Plan: (POS) Silver HSA $4400 - 0%

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.)

Deductible: Individual: $4,400 : Family: $8,800
Out of Pocket Maximum per year: Individual: $4,400 : Family: $8,800

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$378.54
$429.64
$483.77
$676.07
$1027.36
$757.08
$859.28
$967.54
$1352.14
$2054.72
$997.45
$1099.65
$1207.91
$1592.51
$1237.82
$1340.02
$1448.28
$1832.88
$1478.19
$1580.39
$1688.65
$2073.25
$618.91
$670.01
$724.14
$916.44
$859.28
$910.38
$964.51
$1156.81
$1099.65
$1150.75
$1204.88
$1397.18
$240.37

Plan: (POS) Silver HSA $2000 - 50%

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.)

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $4,000 : Family: $8,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$393.88
$447.05
$503.38
$703.47
$1068.99
$787.76
$894.10
$1006.76
$1406.94
$2137.98
$1037.87
$1144.21
$1256.87
$1657.05
$1287.98
$1394.32
$1506.98
$1907.16
$1538.09
$1644.43
$1757.09
$2157.27
$643.99
$697.16
$753.49
$953.58
$894.10
$947.27
$1003.60
$1203.69
$1144.21
$1197.38
$1253.71
$1453.80
$250.11

Plan: (POS) Bronze HSA $4400 - 50%

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.)

Deductible: Individual: $4,400 : Family: $8,800
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$342.85
$389.13
$438.16
$612.33
$930.49
$685.70
$778.26
$876.32
$1224.66
$1860.98
$903.41
$995.97
$1094.03
$1442.37
$1121.12
$1213.68
$1311.74
$1660.08
$1338.83
$1431.39
$1529.45
$1877.79
$560.56
$606.84
$655.87
$830.04
$778.27
$824.55
$873.58
$1047.75
$995.98
$1042.26
$1091.29
$1265.46
$217.71

Plan: (POS) Bronze HSA $6550 - 0%

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$323.22
$366.85
$413.08
$577.27
$877.22
$646.44
$733.70
$826.16
$1154.54
$1754.44
$851.68
$938.94
$1031.40
$1359.78
$1056.92
$1144.18
$1236.64
$1565.02
$1262.16
$1349.42
$1441.88
$1770.26
$528.46
$572.09
$618.32
$782.51
$733.70
$777.33
$823.56
$987.75
$938.94
$982.57
$1028.80
$1192.99
$205.24

Plan: (POS) Bronze HSA $5750 - 20%

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.)

Deductible: Individual: $5,750 : Family: $11,500
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$325.38
$369.31
$415.84
$581.13
$883.08
$650.76
$738.62
$831.68
$1162.26
$1766.16
$857.38
$945.24
$1038.30
$1368.88
$1064.00
$1151.86
$1244.92
$1575.50
$1270.62
$1358.48
$1451.54
$1782.12
$532.00
$575.93
$622.46
$787.75
$738.62
$782.55
$829.08
$994.37
$945.24
$989.17
$1035.70
$1200.99
$206.62