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Obamacare 2021 Rates and Health Insurance Providers for Dodge County , Wisconsin

Obamacare > Rates > Wisconsin > Dodge County

Obamacare Rates and Providers for Other Years

2014 | 2015 | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 |

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 Dodge County, Wisconsin.

The health insurance rates listed below are for calendar year 2021.

Obamacare Providers, Plans and 2021 Rates for Dodge County, Wisconsin

Below, you’ll find a summary of the 83 plans for Dodge County, Wisconsin and rates for each of these providers. This chart is designed to give you a preview of your health insurance options.

  • Quartz

    Local: 1-608-644-3430 | Toll Free: 1-800-362-3310 | TTY: 1-800-877-8973

  • Security Health Plan

    Local: 1-715-221-9258x19258 | Toll Free: 1-844-293-9624 | TTY: 1-877-727-2232

  • Dean Health Plan

    Local: 1-800-279-1302 | Toll Free: 1-800-279-1302 | TTY: 1-800-279-1302

  • Molina Healthcare

    Local: 1-888-560-2043 | Toll Free: 1-888-560-2043
  • Arise Health Plan

    Local: 1-920-490-6900 | Toll Free: 1-800-332-6249 | TTY: 1-888-332-0144

  • Group Health Cooperative-SCW

    Local: 1-608-828-4831 | Toll Free: 1-855-344-2729 | TTY: 1-608-828-4815

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

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

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

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

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

    2021 Obamacare Rates, Providers, and Plans for Dodge County

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    Quartz

    Local: 1-608-644-3430 | Toll Free: 1-800-362-3310 | TTY: 1-800-877-8973

    Toc - Plan #1

    Silver

    (HMO) Quartz One Silver I302 with Dental

    Annual Out of Pocket Expenses
    Individual Family
    $5,000 $10,000 Annual Deductible
    $7,900 $15,800 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $435,50
    $494,29
    $556,56
    $777,80
    $1 181,93
    $871,00
    $988,58
    $1 113,12
    $1 555,60
    $2 363,86
    $1 204,15
    $1 321,73
    $1 446,27
    $1 888,75
    $1 537,30
    $1 654,88
    $1 779,42
    $2 221,90
    $1 870,45
    $1 988,03
    $2 112,57
    $2 555,05
    $768,65
    $827,44
    $889,71
    $1 110,95
    $1 101,80
    $1 160,59
    $1 222,86
    $1 444,10
    $1 434,95
    $1 493,74
    $1 556,01
    $1 777,25
    $333,15
    Toc - Plan #2

    Silver

    (HMO) Quartz One Silver I303 with Dental

    Annual Out of Pocket Expenses
    Individual Family
    $8,500 $17,000 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $419,34
    $475,95
    $535,91
    $748,94
    $1 138,08
    $838,68
    $951,90
    $1 071,82
    $1 497,88
    $2 276,16
    $1 159,47
    $1 272,69
    $1 392,61
    $1 818,67
    $1 480,26
    $1 593,48
    $1 713,40
    $2 139,46
    $1 801,05
    $1 914,27
    $2 034,19
    $2 460,25
    $740,13
    $796,74
    $856,70
    $1 069,73
    $1 060,92
    $1 117,53
    $1 177,49
    $1 390,52
    $1 381,71
    $1 438,32
    $1 498,28
    $1 711,31
    $320,79
    Toc - Plan #3

    Gold

    (HMO) Quartz One Gold I402 Maintenance with Dental

    Annual Out of Pocket Expenses
    Individual Family
    $1,500 $3,000 Annual Deductible
    $7,900 $15,800 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $385,03
    $437,00
    $492,06
    $687,65
    $1 044,96
    $770,06
    $874,00
    $984,12
    $1 375,30
    $2 089,92
    $1 064,60
    $1 168,54
    $1 278,66
    $1 669,84
    $1 359,14
    $1 463,08
    $1 573,20
    $1 964,38
    $1 653,68
    $1 757,62
    $1 867,74
    $2 258,92
    $679,57
    $731,54
    $786,60
    $982,19
    $974,11
    $1 026,08
    $1 081,14
    $1 276,73
    $1 268,65
    $1 320,62
    $1 375,68
    $1 571,27
    $294,54
    Toc - Plan #4

    Gold

    (HMO) Quartz One Gold I401 with Dental

    Annual Out of Pocket Expenses
    Individual Family
    $2,000 $4,000 Annual Deductible
    $7,000 $14,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $389,47
    $442,04
    $497,73
    $695,58
    $1 057,00
    $778,94
    $884,08
    $995,46
    $1 391,16
    $2 114,00
    $1 076,88
    $1 182,02
    $1 293,40
    $1 689,10
    $1 374,82
    $1 479,96
    $1 591,34
    $1 987,04
    $1 672,76
    $1 777,90
    $1 889,28
    $2 284,98
    $687,41
    $739,98
    $795,67
    $993,52
    $985,35
    $1 037,92
    $1 093,61
    $1 291,46
    $1 283,29
    $1 335,86
    $1 391,55
    $1 589,40
    $297,94
    Toc - Plan #5

    Silver

    (HMO) Quartz One Silver I301 with Dental

    Annual Out of Pocket Expenses
    Individual Family
    $4,400 $8,800 Annual Deductible
    $8,150 $16,300 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $434,70
    $493,38
    $555,54
    $776,37
    $1 179,77
    $869,40
    $986,76
    $1 111,08
    $1 552,74
    $2 359,54
    $1 201,94
    $1 319,30
    $1 443,62
    $1 885,28
    $1 534,48
    $1 651,84
    $1 776,16
    $2 217,82
    $1 867,02
    $1 984,38
    $2 108,70
    $2 550,36
    $767,24
    $825,92
    $888,08
    $1 108,91
    $1 099,78
    $1 158,46
    $1 220,62
    $1 441,45
    $1 432,32
    $1 491,00
    $1 553,16
    $1 773,99
    $332,54
    Toc - Plan #6

    Expanded Bronze

    (HMO) Quartz One Bronze I202 with Dental

    Annual Out of Pocket Expenses
    Individual Family
    $8,200 $16,400 Annual Deductible
    $8,200 $16,400 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $300,39
    $340,94
    $383,90
    $536,49
    $815,26
    $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
    $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
    Toc - Plan #7

    Gold

    (HMO) Quartz One Gold I405 with Dental

    Annual Out of Pocket Expenses
    Individual Family
    $2,000 $4,000 Annual Deductible
    $6,500 $13,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $385,55
    $437,60
    $492,73
    $688,59
    $1 046,38
    $771,10
    $875,20
    $985,46
    $1 377,18
    $2 092,76
    $1 066,04
    $1 170,14
    $1 280,40
    $1 672,12
    $1 360,98
    $1 465,08
    $1 575,34
    $1 967,06
    $1 655,92
    $1 760,02
    $1 870,28
    $2 262,00
    $680,49
    $732,54
    $787,67
    $983,53
    $975,43
    $1 027,48
    $1 082,61
    $1 278,47
    $1 270,37
    $1 322,42
    $1 377,55
    $1 573,41
    $294,94
    Toc - Plan #8

    Expanded Bronze

    (HMO) Quartz One Bronze I201 with Dental

    Annual Out of Pocket Expenses
    Individual Family
    $8,000 $16,000 Annual Deductible
    $8,250 $16,500 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $301,47
    $342,16
    $385,27
    $538,41
    $818,17
    $602,94
    $684,32
    $770,54
    $1 076,82
    $1 636,34
    $833,56
    $914,94
    $1 001,16
    $1 307,44
    $1 064,18
    $1 145,56
    $1 231,78
    $1 538,06
    $1 294,80
    $1 376,18
    $1 462,40
    $1 768,68
    $532,09
    $572,78
    $615,89
    $769,03
    $762,71
    $803,40
    $846,51
    $999,65
    $993,33
    $1 034,02
    $1 077,13
    $1 230,27
    $230,62
    Toc - Plan #9

    Expanded Bronze

    (HMO) Quartz One Bronze I204 with Dental

    Annual Out of Pocket Expenses
    Individual Family
    $2,450 $4,900 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $313,85
    $356,22
    $401,10
    $560,53
    $851,78
    $627,70
    $712,44
    $802,20
    $1 121,06
    $1 703,56
    $867,79
    $952,53
    $1 042,29
    $1 361,15
    $1 107,88
    $1 192,62
    $1 282,38
    $1 601,24
    $1 347,97
    $1 432,71
    $1 522,47
    $1 841,33
    $553,94
    $596,31
    $641,19
    $800,62
    $794,03
    $836,40
    $881,28
    $1 040,71
    $1 034,12
    $1 076,49
    $1 121,37
    $1 280,80
    $240,09
    Toc - Plan #10

    Silver

    (HMO) Quartz One Silver I302

    Annual Out of Pocket Expenses
    Individual Family
    $5,000 $10,000 Annual Deductible
    $7,900 $15,800 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $418,48
    $474,97
    $534,81
    $747,40
    $1 135,74
    $836,96
    $949,94
    $1 069,62
    $1 494,80
    $2 271,48
    $1 157,09
    $1 270,07
    $1 389,75
    $1 814,93
    $1 477,22
    $1 590,20
    $1 709,88
    $2 135,06
    $1 797,35
    $1 910,33
    $2 030,01
    $2 455,19
    $738,61
    $795,10
    $854,94
    $1 067,53
    $1 058,74
    $1 115,23
    $1 175,07
    $1 387,66
    $1 378,87
    $1 435,36
    $1 495,20
    $1 707,79
    $320,13
    Toc - Plan #11

    Silver

    (HMO) Quartz One Silver I303

    Annual Out of Pocket Expenses
    Individual Family
    $8,500 $17,000 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $402,95
    $457,35
    $514,97
    $719,67
    $1 093,60
    $805,90
    $914,70
    $1 029,94
    $1 439,34
    $2 187,20
    $1 114,16
    $1 222,96
    $1 338,20
    $1 747,60
    $1 422,42
    $1 531,22
    $1 646,46
    $2 055,86
    $1 730,68
    $1 839,48
    $1 954,72
    $2 364,12
    $711,21
    $765,61
    $823,23
    $1 027,93
    $1 019,47
    $1 073,87
    $1 131,49
    $1 336,19
    $1 327,73
    $1 382,13
    $1 439,75
    $1 644,45
    $308,26
    Toc - Plan #12

    Gold

    (HMO) Quartz One Gold I402 Maintenance

    Annual Out of Pocket Expenses
    Individual Family
    $1,500 $3,000 Annual Deductible
    $7,900 $15,800 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $369,98
    $419,92
    $472,83
    $660,78
    $1 004,12
    $739,96
    $839,84
    $945,66
    $1 321,56
    $2 008,24
    $1 022,99
    $1 122,87
    $1 228,69
    $1 604,59
    $1 306,02
    $1 405,90
    $1 511,72
    $1 887,62
    $1 589,05
    $1 688,93
    $1 794,75
    $2 170,65
    $653,01
    $702,95
    $755,86
    $943,81
    $936,04
    $985,98
    $1 038,89
    $1 226,84
    $1 219,07
    $1 269,01
    $1 321,92
    $1 509,87
    $283,03
    Toc - Plan #13

    Gold

    (HMO) Quartz One Gold I401

    Annual Out of Pocket Expenses
    Individual Family
    $2,000 $4,000 Annual Deductible
    $7,000 $14,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $374,24
    $424,76
    $478,28
    $668,39
    $1 015,68
    $748,48
    $849,52
    $956,56
    $1 336,78
    $2 031,36
    $1 034,77
    $1 135,81
    $1 242,85
    $1 623,07
    $1 321,06
    $1 422,10
    $1 529,14
    $1 909,36
    $1 607,35
    $1 708,39
    $1 815,43
    $2 195,65
    $660,53
    $711,05
    $764,57
    $954,68
    $946,82
    $997,34
    $1 050,86
    $1 240,97
    $1 233,11
    $1 283,63
    $1 337,15
    $1 527,26
    $286,29
    Toc - Plan #14

    Silver

    (HMO) Quartz One Silver I301

    Annual Out of Pocket Expenses
    Individual Family
    $4,400 $8,800 Annual Deductible
    $8,150 $16,300 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $417,71
    $474,10
    $533,83
    $746,03
    $1 133,66
    $835,42
    $948,20
    $1 067,66
    $1 492,06
    $2 267,32
    $1 154,97
    $1 267,75
    $1 387,21
    $1 811,61
    $1 474,52
    $1 587,30
    $1 706,76
    $2 131,16
    $1 794,07
    $1 906,85
    $2 026,31
    $2 450,71
    $737,26
    $793,65
    $853,38
    $1 065,58
    $1 056,81
    $1 113,20
    $1 172,93
    $1 385,13
    $1 376,36
    $1 432,75
    $1 492,48
    $1 704,68
    $319,55
    Toc - Plan #15

    Expanded Bronze

    (HMO) Quartz One Bronze I202

    Annual Out of Pocket Expenses
    Individual Family
    $8,200 $16,400 Annual Deductible
    $8,200 $16,400 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $288,65
    $327,62
    $368,89
    $515,53
    $783,39
    $577,30
    $655,24
    $737,78
    $1 031,06
    $1 566,78
    $798,12
    $876,06
    $958,60
    $1 251,88
    $1 018,94
    $1 096,88
    $1 179,42
    $1 472,70
    $1 239,76
    $1 317,70
    $1 400,24
    $1 693,52
    $509,47
    $548,44
    $589,71
    $736,35
    $730,29
    $769,26
    $810,53
    $957,17
    $951,11
    $990,08
    $1 031,35
    $1 177,99
    $220,82
    Toc - Plan #16

    Gold

    (HMO) Quartz One Gold I405

    Annual Out of Pocket Expenses
    Individual Family
    $2,000 $4,000 Annual Deductible
    $6,500 $13,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $370,48
    $420,49
    $473,47
    $661,68
    $1 005,48
    $740,96
    $840,98
    $946,94
    $1 323,36
    $2 010,96
    $1 024,38
    $1 124,40
    $1 230,36
    $1 606,78
    $1 307,80
    $1 407,82
    $1 513,78
    $1 890,20
    $1 591,22
    $1 691,24
    $1 797,20
    $2 173,62
    $653,90
    $703,91
    $756,89
    $945,10
    $937,32
    $987,33
    $1 040,31
    $1 228,52
    $1 220,74
    $1 270,75
    $1 323,73
    $1 511,94
    $283,42
    Toc - Plan #17

    Expanded Bronze

    (HMO) Quartz One Bronze I201

    Annual Out of Pocket Expenses
    Individual Family
    $8,000 $16,000 Annual Deductible
    $8,250 $16,500 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $289,68
    $328,79
    $370,21
    $517,37
    $786,19
    $579,36
    $657,58
    $740,42
    $1 034,74
    $1 572,38
    $800,96
    $879,18
    $962,02
    $1 256,34
    $1 022,56
    $1 100,78
    $1 183,62
    $1 477,94
    $1 244,16
    $1 322,38
    $1 405,22
    $1 699,54
    $511,28
    $550,39
    $591,81
    $738,97
    $732,88
    $771,99
    $813,41
    $960,57
    $954,48
    $993,59
    $1 035,01
    $1 182,17
    $221,60
    Toc - Plan #18

    Expanded Bronze

    (HMO) Quartz One Bronze I204

    Annual Out of Pocket Expenses
    Individual Family
    $2,450 $4,900 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $301,59
    $342,29
    $385,42
    $538,62
    $818,49
    $603,18
    $684,58
    $770,84
    $1 077,24
    $1 636,98
    $833,89
    $915,29
    $1 001,55
    $1 307,95
    $1 064,60
    $1 146,00
    $1 232,26
    $1 538,66
    $1 295,31
    $1 376,71
    $1 462,97
    $1 769,37
    $532,30
    $573,00
    $616,13
    $769,33
    $763,01
    $803,71
    $846,84
    $1 000,04
    $993,72
    $1 034,42
    $1 077,55
    $1 230,75
    $230,71
    Toc - Plan #19

    Gold

    (HMO) Quartz One Gold I404 HSA

    Annual Out of Pocket Expenses
    Individual Family
    $2,000 $4,000 Annual Deductible
    $6,650 $13,300 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $390,06
    $442,71
    $498,49
    $696,63
    $1 058,60
    $780,12
    $885,42
    $996,98
    $1 393,26
    $2 117,20
    $1 078,51
    $1 183,81
    $1 295,37
    $1 691,65
    $1 376,90
    $1 482,20
    $1 593,76
    $1 990,04
    $1 675,29
    $1 780,59
    $1 892,15
    $2 288,43
    $688,45
    $741,10
    $796,88
    $995,02
    $986,84
    $1 039,49
    $1 095,27
    $1 293,41
    $1 285,23
    $1 337,88
    $1 393,66
    $1 591,80
    $298,39
    Toc - Plan #20

    Expanded Bronze

    (HMO) Quartz One Bronze I203 HSA

    Annual Out of Pocket Expenses
    Individual Family
    $6,850 $13,700 Annual Deductible
    $6,850 $13,700 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $296,71
    $336,76
    $379,19
    $529,91
    $805,25
    $593,42
    $673,52
    $758,38
    $1 059,82
    $1 610,50
    $820,40
    $900,50
    $985,36
    $1 286,80
    $1 047,38
    $1 127,48
    $1 212,34
    $1 513,78
    $1 274,36
    $1 354,46
    $1 439,32
    $1 740,76
    $523,69
    $563,74
    $606,17
    $756,89
    $750,67
    $790,72
    $833,15
    $983,87
    $977,65
    $1 017,70
    $1 060,13
    $1 210,85
    $226,98
    Toc - Plan #21

    Catastrophic

    (HMO) Quartz One Catastrophic I101

    Annual Out of Pocket Expenses
    Individual Family
    $8,550 $17,100 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $216,08
    $245,24
    $276,14
    $385,90
    $586,42
    $432,16
    $490,48
    $552,28
    $771,80
    $1 172,84
    $597,45
    $655,77
    $717,57
    $937,09
    $762,74
    $821,06
    $882,86
    $1 102,38
    $928,03
    $986,35
    $1 048,15
    $1 267,67
    $381,37
    $410,53
    $441,43
    $551,19
    $546,66
    $575,82
    $606,72
    $716,48
    $711,95
    $741,11
    $772,01
    $881,77
    $165,29
    Toc - Plan #22

    Silver

    (HMO) Quartz One Silver I304 HSA

    Annual Out of Pocket Expenses
    Individual Family
    $5,250 $10,500 Annual Deductible
    $5,250 $10,500 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $431,66
    $489,92
    $551,65
    $770,93
    $1 171,50
    $863,32
    $979,84
    $1 103,30
    $1 541,86
    $2 343,00
    $1 193,53
    $1 310,05
    $1 433,51
    $1 872,07
    $1 523,74
    $1 640,26
    $1 763,72
    $2 202,28
    $1 853,95
    $1 970,47
    $2 093,93
    $2 532,49
    $761,87
    $820,13
    $881,86
    $1 101,14
    $1 092,08
    $1 150,34
    $1 212,07
    $1 431,35
    $1 422,29
    $1 480,55
    $1 542,28
    $1 761,56
    $330,21
    Toc - Plan #23

    Gold

    (HMO) Quartz One Gold I403 HSA

    Annual Out of Pocket Expenses
    Individual Family
    $3,000 $6,000 Annual Deductible
    $3,000 $6,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $395,80
    $449,22
    $505,82
    $706,88
    $1 074,18
    $791,60
    $898,44
    $1 011,64
    $1 413,76
    $2 148,36
    $1 094,38
    $1 201,22
    $1 314,42
    $1 716,54
    $1 397,16
    $1 504,00
    $1 617,20
    $2 019,32
    $1 699,94
    $1 806,78
    $1 919,98
    $2 322,10
    $698,58
    $752,00
    $808,60
    $1 009,66
    $1 001,36
    $1 054,78
    $1 111,38
    $1 312,44
    $1 304,14
    $1 357,56
    $1 414,16
    $1 615,22
    $302,78
    ADVERTISEMENT

    Security Health Plan

    Local: 1-715-221-9258x19258 | Toll Free: 1-844-293-9624 | TTY: 1-877-727-2232

    Toc - Plan #24

    Catastrophic

    (EPO) Select Protection

    Annual Out of Pocket Expenses
    Individual Family
    $8,550 $17,100 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $233,25
    $264,72
    $298,08
    $416,56
    $633,01
    $466,50
    $529,44
    $596,16
    $833,12
    $1 266,02
    $644,93
    $707,87
    $774,59
    $1 011,55
    $823,36
    $886,30
    $953,02
    $1 189,98
    $1 001,79
    $1 064,73
    $1 131,45
    $1 368,41
    $411,68
    $443,15
    $476,51
    $594,99
    $590,11
    $621,58
    $654,94
    $773,42
    $768,54
    $800,01
    $833,37
    $951,85
    $178,43
    Toc - Plan #25

    Bronze

    (EPO) Select $8,550

    Annual Out of Pocket Expenses
    Individual Family
    $8,550 $17,100 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $341,00
    $387,02
    $435,79
    $609,01
    $925,45
    $682,00
    $774,04
    $871,58
    $1 218,02
    $1 850,90
    $942,86
    $1 034,90
    $1 132,44
    $1 478,88
    $1 203,72
    $1 295,76
    $1 393,30
    $1 739,74
    $1 464,58
    $1 556,62
    $1 654,16
    $2 000,60
    $601,86
    $647,88
    $696,65
    $869,87
    $862,72
    $908,74
    $957,51
    $1 130,73
    $1 123,58
    $1 169,60
    $1 218,37
    $1 391,59
    $260,86
    Toc - Plan #26

    Silver

    (EPO) Select $6,950 - 30%

    Annual Out of Pocket Expenses
    Individual Family
    $6,950 $13,900 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $517,29
    $587,11
    $661,09
    $923,87
    $1 403,90
    $1 034,58
    $1 174,22
    $1 322,18
    $1 847,74
    $2 807,80
    $1 430,30
    $1 569,94
    $1 717,90
    $2 243,46
    $1 826,02
    $1 965,66
    $2 113,62
    $2 639,18
    $2 221,74
    $2 361,38
    $2 509,34
    $3 034,90
    $913,01
    $982,83
    $1 056,81
    $1 319,59
    $1 308,73
    $1 378,55
    $1 452,53
    $1 715,31
    $1 704,45
    $1 774,27
    $1 848,25
    $2 111,03
    $395,72
    Toc - Plan #27

    Silver

    (EPO) Select $4,500 HDHP

    Annual Out of Pocket Expenses
    Individual Family
    $4,500 $9,000 Annual Deductible
    $7,000 $14,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $541,84
    $614,98
    $692,46
    $967,71
    $1 470,54
    $1 083,68
    $1 229,96
    $1 384,92
    $1 935,42
    $2 941,08
    $1 498,18
    $1 644,46
    $1 799,42
    $2 349,92
    $1 912,68
    $2 058,96
    $2 213,92
    $2 764,42
    $2 327,18
    $2 473,46
    $2 628,42
    $3 178,92
    $956,34
    $1 029,48
    $1 106,96
    $1 382,21
    $1 370,84
    $1 443,98
    $1 521,46
    $1 796,71
    $1 785,34
    $1 858,48
    $1 935,96
    $2 211,21
    $414,50
    Toc - Plan #28

    Bronze

    (EPO) Select $7,500

    Annual Out of Pocket Expenses
    Individual Family
    $7,500 $15,000 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $346,11
    $392,83
    $442,32
    $618,14
    $939,33
    $692,22
    $785,66
    $884,64
    $1 236,28
    $1 878,66
    $956,99
    $1 050,43
    $1 149,41
    $1 501,05
    $1 221,76
    $1 315,20
    $1 414,18
    $1 765,82
    $1 486,53
    $1 579,97
    $1 678,95
    $2 030,59
    $610,88
    $657,60
    $707,09
    $882,91
    $875,65
    $922,37
    $971,86
    $1 147,68
    $1 140,42
    $1 187,14
    $1 236,63
    $1 412,45
    $264,77
    Toc - Plan #29

    Silver

    (EPO) Select $4,800 - 30%

    Annual Out of Pocket Expenses
    Individual Family
    $4,800 $9,600 Annual Deductible
    $7,900 $15,800 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $526,50
    $597,56
    $672,85
    $940,31
    $1 428,89
    $1 053,00
    $1 195,12
    $1 345,70
    $1 880,62
    $2 857,78
    $1 455,76
    $1 597,88
    $1 748,46
    $2 283,38
    $1 858,52
    $2 000,64
    $2 151,22
    $2 686,14
    $2 261,28
    $2 403,40
    $2 553,98
    $3 088,90
    $929,26
    $1 000,32
    $1 075,61
    $1 343,07
    $1 332,02
    $1 403,08
    $1 478,37
    $1 745,83
    $1 734,78
    $1 805,84
    $1 881,13
    $2 148,59
    $402,76
    Toc - Plan #30

    Expanded Bronze

    (EPO) Select $6,200 HDHP

    Annual Out of Pocket Expenses
    Individual Family
    $6,200 $12,400 Annual Deductible
    $7,000 $14,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $377,49
    $428,44
    $482,41
    $674,17
    $1 024,47
    $754,98
    $856,88
    $964,82
    $1 348,34
    $2 048,94
    $1 043,75
    $1 145,65
    $1 253,59
    $1 637,11
    $1 332,52
    $1 434,42
    $1 542,36
    $1 925,88
    $1 621,29
    $1 723,19
    $1 831,13
    $2 214,65
    $666,26
    $717,21
    $771,18
    $962,94
    $955,03
    $1 005,98
    $1 059,95
    $1 251,71
    $1 243,80
    $1 294,75
    $1 348,72
    $1 540,48
    $288,77
    Toc - Plan #31

    Gold

    (EPO) Select $3,500 - 30%

    Annual Out of Pocket Expenses
    Individual Family
    $3,500 $7,000 Annual Deductible
    $6,500 $13,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $478,76
    $543,38
    $611,84
    $855,05
    $1 299,33
    $957,52
    $1 086,76
    $1 223,68
    $1 710,10
    $2 598,66
    $1 323,76
    $1 453,00
    $1 589,92
    $2 076,34
    $1 690,00
    $1 819,24
    $1 956,16
    $2 442,58
    $2 056,24
    $2 185,48
    $2 322,40
    $2 808,82
    $845,00
    $909,62
    $978,08
    $1 221,29
    $1 211,24
    $1 275,86
    $1 344,32
    $1 587,53
    $1 577,48
    $1 642,10
    $1 710,56
    $1 953,77
    $366,24
    ADVERTISEMENT

    Dean Health Plan

    Local: 1-800-279-1302 | Toll Free: 1-800-279-1302 | TTY: 1-800-279-1302

    Toc - Plan #32

    Catastrophic

    (HMO) Dean Catastrophic Safety Net

    Annual Out of Pocket Expenses
    Individual Family
    $8,550 $17,100 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $225,28
    $255,69
    $287,91
    $402,35
    $611,41
    $450,56
    $511,38
    $575,82
    $804,70
    $1 222,82
    $622,90
    $683,72
    $748,16
    $977,04
    $795,24
    $856,06
    $920,50
    $1 149,38
    $967,58
    $1 028,40
    $1 092,84
    $1 321,72
    $397,62
    $428,03
    $460,25
    $574,69
    $569,96
    $600,37
    $632,59
    $747,03
    $742,30
    $772,71
    $804,93
    $919,37
    $172,34
    Toc - Plan #33

    Silver

    (HMO) Dean Silver Copay Plus 4800X

    Annual Out of Pocket Expenses
    Individual Family
    $4,800 $9,600 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $424,60
    $481,92
    $542,64
    $758,34
    $1 152,37
    $849,20
    $963,84
    $1 085,28
    $1 516,68
    $2 304,74
    $1 174,02
    $1 288,66
    $1 410,10
    $1 841,50
    $1 498,84
    $1 613,48
    $1 734,92
    $2 166,32
    $1 823,66
    $1 938,30
    $2 059,74
    $2 491,14
    $749,42
    $806,74
    $867,46
    $1 083,16
    $1 074,24
    $1 131,56
    $1 192,28
    $1 407,98
    $1 399,06
    $1 456,38
    $1 517,10
    $1 732,80
    $324,82
    Toc - Plan #34

    Silver

    (HMO) Dean Silver Classic 5000X

    Annual Out of Pocket Expenses
    Individual Family
    $5,000 $10,000 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $415,93
    $472,08
    $531,55
    $742,84
    $1 128,82
    $831,86
    $944,16
    $1 063,10
    $1 485,68
    $2 257,64
    $1 150,04
    $1 262,34
    $1 381,28
    $1 803,86
    $1 468,22
    $1 580,52
    $1 699,46
    $2 122,04
    $1 786,40
    $1 898,70
    $2 017,64
    $2 440,22
    $734,11
    $790,26
    $849,73
    $1 061,02
    $1 052,29
    $1 108,44
    $1 167,91
    $1 379,20
    $1 370,47
    $1 426,62
    $1 486,09
    $1 697,38
    $318,18
    Toc - Plan #35

    Silver

    (HMO) Dean Silver Value Copay 5000X

    Annual Out of Pocket Expenses
    Individual Family
    $5,000 $10,000 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $423,55
    $480,73
    $541,30
    $756,47
    $1 149,52
    $847,10
    $961,46
    $1 082,60
    $1 512,94
    $2 299,04
    $1 171,12
    $1 285,48
    $1 406,62
    $1 836,96
    $1 495,14
    $1 609,50
    $1 730,64
    $2 160,98
    $1 819,16
    $1 933,52
    $2 054,66
    $2 485,00
    $747,57
    $804,75
    $865,32
    $1 080,49
    $1 071,59
    $1 128,77
    $1 189,34
    $1 404,51
    $1 395,61
    $1 452,79
    $1 513,36
    $1 728,53
    $324,02
    Toc - Plan #36

    Gold

    (HMO) Dean Gold Value Copay 3700X

    Annual Out of Pocket Expenses
    Individual Family
    $3,700 $7,400 Annual Deductible
    $3,700 $7,400 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $405,26
    $459,97
    $517,93
    $723,80
    $1 099,88
    $810,52
    $919,94
    $1 035,86
    $1 447,60
    $2 199,76
    $1 120,55
    $1 229,97
    $1 345,89
    $1 757,63
    $1 430,58
    $1 540,00
    $1 655,92
    $2 067,66
    $1 740,61
    $1 850,03
    $1 965,95
    $2 377,69
    $715,29
    $770,00
    $827,96
    $1 033,83
    $1 025,32
    $1 080,03
    $1 137,99
    $1 343,86
    $1 335,35
    $1 390,06
    $1 448,02
    $1 653,89
    $310,03
    Toc - Plan #37

    Bronze

    (HMO) Dean Bronze Value Copay 8500X

    Annual Out of Pocket Expenses
    Individual Family
    $8,500 $17,000 Annual Deductible
    $8,500 $17,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $272,05
    $308,78
    $347,69
    $485,89
    $738,36
    $544,10
    $617,56
    $695,38
    $971,78
    $1 476,72
    $752,22
    $825,68
    $903,50
    $1 179,90
    $960,34
    $1 033,80
    $1 111,62
    $1 388,02
    $1 168,46
    $1 241,92
    $1 319,74
    $1 596,14
    $480,17
    $516,90
    $555,81
    $694,01
    $688,29
    $725,02
    $763,93
    $902,13
    $896,41
    $933,14
    $972,05
    $1 110,25
    $208,12
    Toc - Plan #38

    Silver

    (HMO) Dean Silver HSA-E 4500X

    Annual Out of Pocket Expenses
    Individual Family
    $4,500 $9,000 Annual Deductible
    $6,900 $13,800 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $406,38
    $461,24
    $519,36
    $725,80
    $1 102,92
    $812,76
    $922,48
    $1 038,72
    $1 451,60
    $2 205,84
    $1 123,64
    $1 233,36
    $1 349,60
    $1 762,48
    $1 434,52
    $1 544,24
    $1 660,48
    $2 073,36
    $1 745,40
    $1 855,12
    $1 971,36
    $2 384,24
    $717,26
    $772,12
    $830,24
    $1 036,68
    $1 028,14
    $1 083,00
    $1 141,12
    $1 347,56
    $1 339,02
    $1 393,88
    $1 452,00
    $1 658,44
    $310,88
    Toc - Plan #39

    Gold

    (HMO) Dean Gold Copay Plus 1500X

    Annual Out of Pocket Expenses
    Individual Family
    $1,500 $3,000 Annual Deductible
    $5,100 $10,200 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $418,28
    $474,74
    $534,56
    $747,04
    $1 135,20
    $836,56
    $949,48
    $1 069,12
    $1 494,08
    $2 270,40
    $1 156,54
    $1 269,46
    $1 389,10
    $1 814,06
    $1 476,52
    $1 589,44
    $1 709,08
    $2 134,04
    $1 796,50
    $1 909,42
    $2 029,06
    $2 454,02
    $738,26
    $794,72
    $854,54
    $1 067,02
    $1 058,24
    $1 114,70
    $1 174,52
    $1 387,00
    $1 378,22
    $1 434,68
    $1 494,50
    $1 706,98
    $319,98
    Toc - Plan #40

    Expanded Bronze

    (HMO) Dean Bronze HSA-E 6850X

    Annual Out of Pocket Expenses
    Individual Family
    $6,850 $13,700 Annual Deductible
    $6,850 $13,700 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $288,97
    $327,98
    $369,31
    $516,10
    $784,27
    $577,94
    $655,96
    $738,62
    $1 032,20
    $1 568,54
    $799,00
    $877,02
    $959,68
    $1 253,26
    $1 020,06
    $1 098,08
    $1 180,74
    $1 474,32
    $1 241,12
    $1 319,14
    $1 401,80
    $1 695,38
    $510,03
    $549,04
    $590,37
    $737,16
    $731,09
    $770,10
    $811,43
    $958,22
    $952,15
    $991,16
    $1 032,49
    $1 179,28
    $221,06
    Toc - Plan #41

    Expanded Bronze

    (HMO) Dean Bronze Copay Plus 8500X

    Annual Out of Pocket Expenses
    Individual Family
    $8,500 $17,000 Annual Deductible
    $8,500 $17,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $279,36
    $317,07
    $357,02
    $498,93
    $758,17
    $558,72
    $634,14
    $714,04
    $997,86
    $1 516,34
    $772,43
    $847,85
    $927,75
    $1 211,57
    $986,14
    $1 061,56
    $1 141,46
    $1 425,28
    $1 199,85
    $1 275,27
    $1 355,17
    $1 638,99
    $493,07
    $530,78
    $570,73
    $712,64
    $706,78
    $744,49
    $784,44
    $926,35
    $920,49
    $958,20
    $998,15
    $1 140,06
    $213,71
    Toc - Plan #42

    Gold

    (HMO) Dean Gold Copay Elite 1500X

    Annual Out of Pocket Expenses
    Individual Family
    $1,500 $3,000 Annual Deductible
    $5,100 $10,200 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $397,64
    $451,32
    $508,18
    $710,18
    $1 079,18
    $795,28
    $902,64
    $1 016,36
    $1 420,36
    $2 158,36
    $1 099,47
    $1 206,83
    $1 320,55
    $1 724,55
    $1 403,66
    $1 511,02
    $1 624,74
    $2 028,74
    $1 707,85
    $1 815,21
    $1 928,93
    $2 332,93
    $701,83
    $755,51
    $812,37
    $1 014,37
    $1 006,02
    $1 059,70
    $1 116,56
    $1 318,56
    $1 310,21
    $1 363,89
    $1 420,75
    $1 622,75
    $304,19
    Toc - Plan #43

    Silver

    (HMO) Dean Silver Copay Elite 4800X

    Annual Out of Pocket Expenses
    Individual Family
    $4,800 $9,600 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $403,82
    $458,33
    $516,08
    $721,22
    $1 095,96
    $807,64
    $916,66
    $1 032,16
    $1 442,44
    $2 191,92
    $1 116,56
    $1 225,58
    $1 341,08
    $1 751,36
    $1 425,48
    $1 534,50
    $1 650,00
    $2 060,28
    $1 734,40
    $1 843,42
    $1 958,92
    $2 369,20
    $712,74
    $767,25
    $825,00
    $1 030,14
    $1 021,66
    $1 076,17
    $1 133,92
    $1 339,06
    $1 330,58
    $1 385,09
    $1 442,84
    $1 647,98
    $308,92
    ADVERTISEMENT

    Molina Healthcare

    Local: 1-888-560-2043 | Toll Free: 1-888-560-2043

    Toc - Plan #44

    Gold

    (HMO) Confident Care Gold 1

    Annual Out of Pocket Expenses
    Individual Family
    $2,925 $5,850 Annual Deductible
    $6,500 $13,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $395,71
    $449,13
    $505,72
    $706,74
    $1 073,96
    $791,42
    $898,26
    $1 011,44
    $1 413,48
    $2 147,92
    $1 094,14
    $1 200,98
    $1 314,16
    $1 716,20
    $1 396,86
    $1 503,70
    $1 616,88
    $2 018,92
    $1 699,58
    $1 806,42
    $1 919,60
    $2 321,64
    $698,43
    $751,85
    $808,44
    $1 009,46
    $1 001,15
    $1 054,57
    $1 111,16
    $1 312,18
    $1 303,87
    $1 357,29
    $1 413,88
    $1 614,90
    $302,72
    Toc - Plan #45

    Silver

    (HMO) Constant Care Silver 1

    Annual Out of Pocket Expenses
    Individual Family
    $0 $0 Annual Deductible
    $8,500 $17,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $348,80
    $395,88
    $445,76
    $622,95
    $946,63
    $697,60
    $791,76
    $891,52
    $1 245,90
    $1 893,26
    $964,43
    $1 058,59
    $1 158,35
    $1 512,73
    $1 231,26
    $1 325,42
    $1 425,18
    $1 779,56
    $1 498,09
    $1 592,25
    $1 692,01
    $2 046,39
    $615,63
    $662,71
    $712,59
    $889,78
    $882,46
    $929,54
    $979,42
    $1 156,61
    $1 149,29
    $1 196,37
    $1 246,25
    $1 423,44
    $266,83
    Toc - Plan #46

    Bronze

    (HMO) Core Care Bronze 1

    Annual Out of Pocket Expenses
    Individual Family
    $6,100 $12,200 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $276,46
    $313,78
    $353,31
    $493,75
    $750,30
    $552,92
    $627,56
    $706,62
    $987,50
    $1 500,60
    $764,41
    $839,05
    $918,11
    $1 198,99
    $975,90
    $1 050,54
    $1 129,60
    $1 410,48
    $1 187,39
    $1 262,03
    $1 341,09
    $1 621,97
    $487,95
    $525,27
    $564,80
    $705,24
    $699,44
    $736,76
    $776,29
    $916,73
    $910,93
    $948,25
    $987,78
    $1 128,22
    $211,49
    Toc - Plan #47

    Silver

    (HMO) Constant Care Silver 4

    Annual Out of Pocket Expenses
    Individual Family
    $7,450 $14,900 Annual Deductible
    $7,450 $14,900 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $345,11
    $391,70
    $441,05
    $616,37
    $936,63
    $690,22
    $783,40
    $882,10
    $1 232,74
    $1 873,26
    $954,23
    $1 047,41
    $1 146,11
    $1 496,75
    $1 218,24
    $1 311,42
    $1 410,12
    $1 760,76
    $1 482,25
    $1 575,43
    $1 674,13
    $2 024,77
    $609,12
    $655,71
    $705,06
    $880,38
    $873,13
    $919,72
    $969,07
    $1 144,39
    $1 137,14
    $1 183,73
    $1 233,08
    $1 408,40
    $264,01
    Toc - Plan #48

    Expanded Bronze

    (HMO) Core Care Bronze 4

    Annual Out of Pocket Expenses
    Individual Family
    $0 $0 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $289,59
    $328,68
    $370,09
    $517,20
    $785,94
    $579,18
    $657,36
    $740,18
    $1 034,40
    $1 571,88
    $800,71
    $878,89
    $961,71
    $1 255,93
    $1 022,24
    $1 100,42
    $1 183,24
    $1 477,46
    $1 243,77
    $1 321,95
    $1 404,77
    $1 698,99
    $511,12
    $550,21
    $591,62
    $738,73
    $732,65
    $771,74
    $813,15
    $960,26
    $954,18
    $993,27
    $1 034,68
    $1 181,79
    $221,53
    Toc - Plan #49

    Expanded Bronze

    (HMO) Core Care Bronze 5

    Annual Out of Pocket Expenses
    Individual Family
    $0 $0 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $281,56
    $319,57
    $359,83
    $502,87
    $764,16
    $563,12
    $639,14
    $719,66
    $1 005,74
    $1 528,32
    $778,51
    $854,53
    $935,05
    $1 221,13
    $993,90
    $1 069,92
    $1 150,44
    $1 436,52
    $1 209,29
    $1 285,31
    $1 365,83
    $1 651,91
    $496,95
    $534,96
    $575,22
    $718,26
    $712,34
    $750,35
    $790,61
    $933,65
    $927,73
    $965,74
    $1 006,00
    $1 149,04
    $215,39
    Toc - Plan #50

    Gold

    (HMO) Confident Care Gold 1 + Vision

    Annual Out of Pocket Expenses
    Individual Family
    $2,925 $5,850 Annual Deductible
    $6,500 $13,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $398,84
    $452,68
    $509,72
    $712,33
    $1 082,45
    $797,68
    $905,36
    $1 019,44
    $1 424,66
    $2 164,90
    $1 102,79
    $1 210,47
    $1 324,55
    $1 729,77
    $1 407,90
    $1 515,58
    $1 629,66
    $2 034,88
    $1 713,01
    $1 820,69
    $1 934,77
    $2 339,99
    $703,95
    $757,79
    $814,83
    $1 017,44
    $1 009,06
    $1 062,90
    $1 119,94
    $1 322,55
    $1 314,17
    $1 368,01
    $1 425,05
    $1 627,66
    $305,11
    Toc - Plan #51

    Silver

    (HMO) Constant Care Silver 1 + Vision

    Annual Out of Pocket Expenses
    Individual Family
    $0 $0 Annual Deductible
    $8,500 $17,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $351,93
    $399,44
    $449,76
    $628,54
    $955,13
    $703,86
    $798,88
    $899,52
    $1 257,08
    $1 910,26
    $973,08
    $1 068,10
    $1 168,74
    $1 526,30
    $1 242,30
    $1 337,32
    $1 437,96
    $1 795,52
    $1 511,52
    $1 606,54
    $1 707,18
    $2 064,74
    $621,15
    $668,66
    $718,98
    $897,76
    $890,37
    $937,88
    $988,20
    $1 166,98
    $1 159,59
    $1 207,10
    $1 257,42
    $1 436,20
    $269,22
    Toc - Plan #52

    Bronze

    (HMO) Core Care Bronze 1 + Vision

    Annual Out of Pocket Expenses
    Individual Family
    $6,100 $12,200 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $279,59
    $317,33
    $357,31
    $499,34
    $758,80
    $559,18
    $634,66
    $714,62
    $998,68
    $1 517,60
    $773,06
    $848,54
    $928,50
    $1 212,56
    $986,94
    $1 062,42
    $1 142,38
    $1 426,44
    $1 200,82
    $1 276,30
    $1 356,26
    $1 640,32
    $493,47
    $531,21
    $571,19
    $713,22
    $707,35
    $745,09
    $785,07
    $927,10
    $921,23
    $958,97
    $998,95
    $1 140,98
    $213,88
    Toc - Plan #53

    Silver

    (HMO) Constant Care Silver 2

    Annual Out of Pocket Expenses
    Individual Family
    $5,200 $10,400 Annual Deductible
    $8,150 $16,300 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $348,42
    $395,46
    $445,28
    $622,28
    $945,61
    $696,84
    $790,92
    $890,56
    $1 244,56
    $1 891,22
    $963,38
    $1 057,46
    $1 157,10
    $1 511,10
    $1 229,92
    $1 324,00
    $1 423,64
    $1 777,64
    $1 496,46
    $1 590,54
    $1 690,18
    $2 044,18
    $614,96
    $662,00
    $711,82
    $888,82
    $881,50
    $928,54
    $978,36
    $1 155,36
    $1 148,04
    $1 195,08
    $1 244,90
    $1 421,90
    $266,54
    Toc - Plan #54

    Bronze

    (HMO) Core Care Bronze 2

    Annual Out of Pocket Expenses
    Individual Family
    $8,000 $16,000 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $274,01
    $311,01
    $350,19
    $489,39
    $743,67
    $548,02
    $622,02
    $700,38
    $978,78
    $1 487,34
    $757,64
    $831,64
    $910,00
    $1 188,40
    $967,26
    $1 041,26
    $1 119,62
    $1 398,02
    $1 176,88
    $1 250,88
    $1 329,24
    $1 607,64
    $483,63
    $520,63
    $559,81
    $699,01
    $693,25
    $730,25
    $769,43
    $908,63
    $902,87
    $939,87
    $979,05
    $1 118,25
    $209,62
    ADVERTISEMENT

    Arise Health Plan

    Local: 1-920-490-6900 | Toll Free: 1-800-332-6249 | TTY: 1-888-332-0144

    Toc - Plan #55

    Bronze

    (HMO) WPS HMO Bronze $8,550 | Select Network

    Annual Out of Pocket Expenses
    Individual Family
    $8,550 $17,100 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $299,32
    $339,73
    $382,53
    $534,59
    $812,35
    $598,64
    $679,46
    $765,06
    $1 069,18
    $1 624,70
    $827,62
    $908,44
    $994,04
    $1 298,16
    $1 056,60
    $1 137,42
    $1 223,02
    $1 527,14
    $1 285,58
    $1 366,40
    $1 452,00
    $1 756,12
    $528,30
    $568,71
    $611,51
    $763,57
    $757,28
    $797,69
    $840,49
    $992,55
    $986,26
    $1 026,67
    $1 069,47
    $1 221,53
    $228,98
    Toc - Plan #56

    Expanded Bronze

    (HMO) WPS HMO Bronze $6,500 with 3 Free PCP Visits | Select Network

    Annual Out of Pocket Expenses
    Individual Family
    $6,500 $13,000 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $310,79
    $352,75
    $397,19
    $555,07
    $843,48
    $621,58
    $705,50
    $794,38
    $1 110,14
    $1 686,96
    $859,33
    $943,25
    $1 032,13
    $1 347,89
    $1 097,08
    $1 181,00
    $1 269,88
    $1 585,64
    $1 334,83
    $1 418,75
    $1 507,63
    $1 823,39
    $548,54
    $590,50
    $634,94
    $792,82
    $786,29
    $828,25
    $872,69
    $1 030,57
    $1 024,04
    $1 066,00
    $1 110,44
    $1 268,32
    $237,75
    Toc - Plan #57

    Expanded Bronze

    (HMO) WPS HMO Bronze $7,200 | Select Network

    Annual Out of Pocket Expenses
    Individual Family
    $7,200 $14,400 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $304,51
    $345,62
    $389,16
    $543,85
    $826,44
    $609,02
    $691,24
    $778,32
    $1 087,70
    $1 652,88
    $841,97
    $924,19
    $1 011,27
    $1 320,65
    $1 074,92
    $1 157,14
    $1 244,22
    $1 553,60
    $1 307,87
    $1 390,09
    $1 477,17
    $1 786,55
    $537,46
    $578,57
    $622,11
    $776,80
    $770,41
    $811,52
    $855,06
    $1 009,75
    $1 003,36
    $1 044,47
    $1 088,01
    $1 242,70
    $232,95
    Toc - Plan #58

    Silver

    (HMO) WPS HMO Silver $7,500 | Select Network

    Annual Out of Pocket Expenses
    Individual Family
    $7,500 $15,000 Annual Deductible
    $7,500 $15,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $402,38
    $456,70
    $514,24
    $718,65
    $1 092,06
    $804,76
    $913,40
    $1 028,48
    $1 437,30
    $2 184,12
    $1 112,58
    $1 221,22
    $1 336,30
    $1 745,12
    $1 420,40
    $1 529,04
    $1 644,12
    $2 052,94
    $1 728,22
    $1 836,86
    $1 951,94
    $2 360,76
    $710,20
    $764,52
    $822,06
    $1 026,47
    $1 018,02
    $1 072,34
    $1 129,88
    $1 334,29
    $1 325,84
    $1 380,16
    $1 437,70
    $1 642,11
    $307,82
    Toc - Plan #59

    Silver

    (HMO) WPS HMO Silver $4,500 | Select Network

    Annual Out of Pocket Expenses
    Individual Family
    $4,500 $9,000 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $403,34
    $457,79
    $515,47
    $720,37
    $1 094,66
    $806,68
    $915,58
    $1 030,94
    $1 440,74
    $2 189,32
    $1 115,24
    $1 224,14
    $1 339,50
    $1 749,30
    $1 423,80
    $1 532,70
    $1 648,06
    $2 057,86
    $1 732,36
    $1 841,26
    $1 956,62
    $2 366,42
    $711,90
    $766,35
    $824,03
    $1 028,93
    $1 020,46
    $1 074,91
    $1 132,59
    $1 337,49
    $1 329,02
    $1 383,47
    $1 441,15
    $1 646,05
    $308,56
    Toc - Plan #60

    Silver

    (HMO) WPS HMO Silver $5,000 with 3 Free PCP Visits | Select Network

    Annual Out of Pocket Expenses
    Individual Family
    $5,000 $10,000 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $419,56
    $476,20
    $536,20
    $749,33
    $1 138,69
    $839,12
    $952,40
    $1 072,40
    $1 498,66
    $2 277,38
    $1 160,08
    $1 273,36
    $1 393,36
    $1 819,62
    $1 481,04
    $1 594,32
    $1 714,32
    $2 140,58
    $1 802,00
    $1 915,28
    $2 035,28
    $2 461,54
    $740,52
    $797,16
    $857,16
    $1 070,29
    $1 061,48
    $1 118,12
    $1 178,12
    $1 391,25
    $1 382,44
    $1 439,08
    $1 499,08
    $1 712,21
    $320,96
    Toc - Plan #61

    Gold

    (HMO) WPS HMO Gold $2,500 | Select Network

    Annual Out of Pocket Expenses
    Individual Family
    $2,500 $5,000 Annual Deductible
    $5,000 $10,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $555,76
    $630,79
    $710,26
    $992,59
    $1 508,33
    $1 111,52
    $1 261,58
    $1 420,52
    $1 985,18
    $3 016,66
    $1 536,68
    $1 686,74
    $1 845,68
    $2 410,34
    $1 961,84
    $2 111,90
    $2 270,84
    $2 835,50
    $2 387,00
    $2 537,06
    $2 696,00
    $3 260,66
    $980,92
    $1 055,95
    $1 135,42
    $1 417,75
    $1 406,08
    $1 481,11
    $1 560,58
    $1 842,91
    $1 831,24
    $1 906,27
    $1 985,74
    $2 268,07
    $425,16
    Toc - Plan #62

    Catastrophic

    (HMO) WPS HMO Catastrophic $8,550 with 3 Free PCP Visits | Select Network

    Annual Out of Pocket Expenses
    Individual Family
    $8,550 $17,100 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $260,22
    $295,35
    $332,56
    $464,75
    $706,24
    $520,44
    $590,70
    $665,12
    $929,50
    $1 412,48
    $719,51
    $789,77
    $864,19
    $1 128,57
    $918,58
    $988,84
    $1 063,26
    $1 327,64
    $1 117,65
    $1 187,91
    $1 262,33
    $1 526,71
    $459,29
    $494,42
    $531,63
    $663,82
    $658,36
    $693,49
    $730,70
    $862,89
    $857,43
    $892,56
    $929,77
    $1 061,96
    $199,07
    Toc - Plan #63

    Expanded Bronze

    (HMO) WPS HMO HDHP Bronze $7,000 | Select Network

    Annual Out of Pocket Expenses
    Individual Family
    $7,000 $14,000 Annual Deductible
    $7,000 $14,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $311,17
    $353,18
    $397,68
    $555,75
    $844,52
    $622,34
    $706,36
    $795,36
    $1 111,50
    $1 689,04
    $860,39
    $944,41
    $1 033,41
    $1 349,55
    $1 098,44
    $1 182,46
    $1 271,46
    $1 587,60
    $1 336,49
    $1 420,51
    $1 509,51
    $1 825,65
    $549,22
    $591,23
    $635,73
    $793,80
    $787,27
    $829,28
    $873,78
    $1 031,85
    $1 025,32
    $1 067,33
    $1 111,83
    $1 269,90
    $238,05
    Toc - Plan #64

    Expanded Bronze

    (HMO) WPS HMO HDHP Bronze $6,830 | Select Network

    Annual Out of Pocket Expenses
    Individual Family
    $6,830 $13,660 Annual Deductible
    $6,830 $13,660 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $317,52
    $360,39
    $405,79
    $567,09
    $861,75
    $635,04
    $720,78
    $811,58
    $1 134,18
    $1 723,50
    $877,94
    $963,68
    $1 054,48
    $1 377,08
    $1 120,84
    $1 206,58
    $1 297,38
    $1 619,98
    $1 363,74
    $1 449,48
    $1 540,28
    $1 862,88
    $560,42
    $603,29
    $648,69
    $809,99
    $803,32
    $846,19
    $891,59
    $1 052,89
    $1 046,22
    $1 089,09
    $1 134,49
    $1 295,79
    $242,90
    Toc - Plan #65

    Expanded Bronze

    (HMO) WPS HMO HDHP Bronze $6,000 | Select Network

    Annual Out of Pocket Expenses
    Individual Family
    $6,000 $12,000 Annual Deductible
    $7,000 $14,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $311,82
    $353,92
    $398,51
    $556,91
    $846,28
    $623,64
    $707,84
    $797,02
    $1 113,82
    $1 692,56
    $862,18
    $946,38
    $1 035,56
    $1 352,36
    $1 100,72
    $1 184,92
    $1 274,10
    $1 590,90
    $1 339,26
    $1 423,46
    $1 512,64
    $1 829,44
    $550,36
    $592,46
    $637,05
    $795,45
    $788,90
    $831,00
    $875,59
    $1 033,99
    $1 027,44
    $1 069,54
    $1 114,13
    $1 272,53
    $238,54
    Toc - Plan #66

    Silver

    (HMO) WPS HMO HDHP Silver $2,800 | Select Network

    Annual Out of Pocket Expenses
    Individual Family
    $2,800 $5,600 Annual Deductible
    $7,000 $14,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $413,53
    $469,36
    $528,49
    $738,56
    $1 122,32
    $827,06
    $938,72
    $1 056,98
    $1 477,12
    $2 244,64
    $1 143,41
    $1 255,07
    $1 373,33
    $1 793,47
    $1 459,76
    $1 571,42
    $1 689,68
    $2 109,82
    $1 776,11
    $1 887,77
    $2 006,03
    $2 426,17
    $729,88
    $785,71
    $844,84
    $1 054,91
    $1 046,23
    $1 102,06
    $1 161,19
    $1 371,26
    $1 362,58
    $1 418,41
    $1 477,54
    $1 687,61
    $316,35
    Toc - Plan #67

    Silver

    (HMO) WPS HMO HDHP Silver $4,500 | Select Network

    Annual Out of Pocket Expenses
    Individual Family
    $4,500 $9,000 Annual Deductible
    $4,500 $9,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $412,57
    $468,27
    $527,26
    $736,85
    $1 119,71
    $825,14
    $936,54
    $1 054,52
    $1 473,70
    $2 239,42
    $1 140,76
    $1 252,16
    $1 370,14
    $1 789,32
    $1 456,38
    $1 567,78
    $1 685,76
    $2 104,94
    $1 772,00
    $1 883,40
    $2 001,38
    $2 420,56
    $728,19
    $783,89
    $842,88
    $1 052,47
    $1 043,81
    $1 099,51
    $1 158,50
    $1 368,09
    $1 359,43
    $1 415,13
    $1 474,12
    $1 683,71
    $315,62
    Toc - Plan #68

    Silver

    (HMO) WPS HMO HDHP Silver $5,500 | Select Network

    Annual Out of Pocket Expenses
    Individual Family
    $5,500 $11,000 Annual Deductible
    $5,500 $11,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $391,74
    $444,62
    $500,64
    $699,65
    $1 063,18
    $783,48
    $889,24
    $1 001,28
    $1 399,30
    $2 126,36
    $1 083,16
    $1 188,92
    $1 300,96
    $1 698,98
    $1 382,84
    $1 488,60
    $1 600,64
    $1 998,66
    $1 682,52
    $1 788,28
    $1 900,32
    $2 298,34
    $691,42
    $744,30
    $800,32
    $999,33
    $991,10
    $1 043,98
    $1 100,00
    $1 299,01
    $1 290,78
    $1 343,66
    $1 399,68
    $1 598,69
    $299,68
    Toc - Plan #69

    Bronze

    (POS) WPS POS Bronze $8,550 | Select Network

    Annual Out of Pocket Expenses
    Individual Family
    $8,550 $17,100 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $320,15
    $363,37
    $409,15
    $571,79
    $868,89
    $640,30
    $726,74
    $818,30
    $1 143,58
    $1 737,78
    $885,21
    $971,65
    $1 063,21
    $1 388,49
    $1 130,12
    $1 216,56
    $1 308,12
    $1 633,40
    $1 375,03
    $1 461,47
    $1 553,03
    $1 878,31
    $565,06
    $608,28
    $654,06
    $816,70
    $809,97
    $853,19
    $898,97
    $1 061,61
    $1 054,88
    $1 098,10
    $1 143,88
    $1 306,52
    $244,91
    Toc - Plan #70

    Expanded Bronze

    (POS) WPS POS HDHP Bronze $6,000 | Select Network

    Annual Out of Pocket Expenses
    Individual Family
    $6,000 $12,000 Annual Deductible
    $7,000 $14,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $333,48
    $378,50
    $426,19
    $595,60
    $905,06
    $666,96
    $757,00
    $852,38
    $1 191,20
    $1 810,12
    $922,07
    $1 012,11
    $1 107,49
    $1 446,31
    $1 177,18
    $1 267,22
    $1 362,60
    $1 701,42
    $1 432,29
    $1 522,33
    $1 617,71
    $1 956,53
    $588,59
    $633,61
    $681,30
    $850,71
    $843,70
    $888,72
    $936,41
    $1 105,82
    $1 098,81
    $1 143,83
    $1 191,52
    $1 360,93
    $255,11
    ADVERTISEMENT

    Group Health Cooperative-SCW

    Local: 1-608-828-4831 | Toll Free: 1-855-344-2729 | TTY: 1-608-828-4815

    Toc - Plan #71

    Platinum

    (HMO) Platinum 500 Ded/1500 MOOP

    Annual Out of Pocket Expenses
    Individual Family
    $500 $1,000 Annual Deductible
    $1,500 $3,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $431,21
    $489,42
    $551,08
    $770,13
    $1 170,29
    $862,42
    $978,84
    $1 102,16
    $1 540,26
    $2 340,58
    $1 192,30
    $1 308,72
    $1 432,04
    $1 870,14
    $1 522,18
    $1 638,60
    $1 761,92
    $2 200,02
    $1 852,06
    $1 968,48
    $2 091,80
    $2 529,90
    $761,09
    $819,30
    $880,96
    $1 100,01
    $1 090,97
    $1 149,18
    $1 210,84
    $1 429,89
    $1 420,85
    $1 479,06
    $1 540,72
    $1 759,77
    $329,88
    Toc - Plan #72

    Gold

    (HMO) Gold 2500 Ded/2500 MOOP HSA

    Annual Out of Pocket Expenses
    Individual Family
    $2,500 $5,000 Annual Deductible
    $2,500 $5,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $352,53
    $400,13
    $450,54
    $629,62
    $956,77
    $705,06
    $800,26
    $901,08
    $1 259,24
    $1 913,54
    $974,75
    $1 069,95
    $1 170,77
    $1 528,93
    $1 244,44
    $1 339,64
    $1 440,46
    $1 798,62
    $1 514,13
    $1 609,33
    $1 710,15
    $2 068,31
    $622,22
    $669,82
    $720,23
    $899,31
    $891,91
    $939,51
    $989,92
    $1 169,00
    $1 161,60
    $1 209,20
    $1 259,61
    $1 438,69
    $269,69
    Toc - Plan #73

    Expanded Bronze

    (HMO) Bronze 4000 Ded/8500 MOOP

    Annual Out of Pocket Expenses
    Individual Family
    $4,000 $8,000 Annual Deductible
    $8,500 $17,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $274,92
    $312,03
    $351,34
    $491,00
    $746,12
    $549,84
    $624,06
    $702,68
    $982,00
    $1 492,24
    $760,15
    $834,37
    $912,99
    $1 192,31
    $970,46
    $1 044,68
    $1 123,30
    $1 402,62
    $1 180,77
    $1 254,99
    $1 333,61
    $1 612,93
    $485,23
    $522,34
    $561,65
    $701,31
    $695,54
    $732,65
    $771,96
    $911,62
    $905,85
    $942,96
    $982,27
    $1 121,93
    $210,31
    Toc - Plan #74

    Expanded Bronze

    (HMO) Bronze 7000 Ded/7000 MOOP HSA

    Annual Out of Pocket Expenses
    Individual Family
    $7,000 $14,000 Annual Deductible
    $7,000 $14,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $275,07
    $312,20
    $351,53
    $491,26
    $746,52
    $550,14
    $624,40
    $703,06
    $982,52
    $1 493,04
    $760,57
    $834,83
    $913,49
    $1 192,95
    $971,00
    $1 045,26
    $1 123,92
    $1 403,38
    $1 181,43
    $1 255,69
    $1 334,35
    $1 613,81
    $485,50
    $522,63
    $561,96
    $701,69
    $695,93
    $733,06
    $772,39
    $912,12
    $906,36
    $943,49
    $982,82
    $1 122,55
    $210,43
    Toc - Plan #75

    Gold

    (HMO) Gold 2500 Ded/6500 MOOP

    Annual Out of Pocket Expenses
    Individual Family
    $2,500 $5,000 Annual Deductible
    $6,500 $13,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $348,87
    $395,96
    $445,85
    $623,07
    $946,81
    $697,74
    $791,92
    $891,70
    $1 246,14
    $1 893,62
    $964,62
    $1 058,80
    $1 158,58
    $1 513,02
    $1 231,50
    $1 325,68
    $1 425,46
    $1 779,90
    $1 498,38
    $1 592,56
    $1 692,34
    $2 046,78
    $615,75
    $662,84
    $712,73
    $889,95
    $882,63
    $929,72
    $979,61
    $1 156,83
    $1 149,51
    $1 196,60
    $1 246,49
    $1 423,71
    $266,88
    Toc - Plan #76

    Gold

    (HMO) Gold Simple Choice 1600 Ded/5400 MOOP

    Annual Out of Pocket Expenses
    Individual Family
    $1,600 $3,200 Annual Deductible
    $5,400 $10,800 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $359,04
    $407,51
    $458,86
    $641,25
    $974,43
    $718,08
    $815,02
    $917,72
    $1 282,50
    $1 948,86
    $992,75
    $1 089,69
    $1 192,39
    $1 557,17
    $1 267,42
    $1 364,36
    $1 467,06
    $1 831,84
    $1 542,09
    $1 639,03
    $1 741,73
    $2 106,51
    $633,71
    $682,18
    $733,53
    $915,92
    $908,38
    $956,85
    $1 008,20
    $1 190,59
    $1 183,05
    $1 231,52
    $1 282,87
    $1 465,26
    $274,67
    Toc - Plan #77

    Silver

    (HMO) Silver Simple Choice 4550X Ded/7900 MOOP

    Annual Out of Pocket Expenses
    Individual Family
    $4,000 $8,000 Annual Deductible
    $7,900 $15,800 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $393,13
    $446,20
    $502,42
    $702,12
    $1 066,94
    $786,26
    $892,40
    $1 004,84
    $1 404,24
    $2 133,88
    $1 087,00
    $1 193,14
    $1 305,58
    $1 704,98
    $1 387,74
    $1 493,88
    $1 606,32
    $2 005,72
    $1 688,48
    $1 794,62
    $1 907,06
    $2 306,46
    $693,87
    $746,94
    $803,16
    $1 002,86
    $994,61
    $1 047,68
    $1 103,90
    $1 303,60
    $1 295,35
    $1 348,42
    $1 404,64
    $1 604,34
    $300,74
    Toc - Plan #78

    Expanded Bronze

    (HMO) Bronze Simple Choice 6850 Ded/8200 MOOP

    Annual Out of Pocket Expenses
    Individual Family
    $6,850 $13,700 Annual Deductible
    $8,200 $16,400 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $284,09
    $322,44
    $363,07
    $507,38
    $771,01
    $568,18
    $644,88
    $726,14
    $1 014,76
    $1 542,02
    $785,51
    $862,21
    $943,47
    $1 232,09
    $1 002,84
    $1 079,54
    $1 160,80
    $1 449,42
    $1 220,17
    $1 296,87
    $1 378,13
    $1 666,75
    $501,42
    $539,77
    $580,40
    $724,71
    $718,75
    $757,10
    $797,73
    $942,04
    $936,08
    $974,43
    $1 015,06
    $1 159,37
    $217,33
    Toc - Plan #79

    Platinum

    (HMO) Platinum No Ded/2000 MOOP

    Annual Out of Pocket Expenses
    Individual Family
    $0 $0 Annual Deductible
    $2,000 $4,000 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $435,73
    $494,55
    $556,86
    $778,20
    $1 182,55
    $871,46
    $989,10
    $1 113,72
    $1 556,40
    $2 365,10
    $1 204,79
    $1 322,43
    $1 447,05
    $1 889,73
    $1 538,12
    $1 655,76
    $1 780,38
    $2 223,06
    $1 871,45
    $1 989,09
    $2 113,71
    $2 556,39
    $769,06
    $827,88
    $890,19
    $1 111,53
    $1 102,39
    $1 161,21
    $1 223,52
    $1 444,86
    $1 435,72
    $1 494,54
    $1 556,85
    $1 778,19
    $333,33
    Toc - Plan #80

    Bronze

    (HMO) Bronze 8550 Ded/8550 MOOP

    Annual Out of Pocket Expenses
    Individual Family
    $8,550 $17,100 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $270,02
    $306,47
    $345,08
    $482,24
    $732,81
    $540,04
    $612,94
    $690,16
    $964,48
    $1 465,62
    $746,60
    $819,50
    $896,72
    $1 171,04
    $953,16
    $1 026,06
    $1 103,28
    $1 377,60
    $1 159,72
    $1 232,62
    $1 309,84
    $1 584,16
    $476,58
    $513,03
    $551,64
    $688,80
    $683,14
    $719,59
    $758,20
    $895,36
    $889,70
    $926,15
    $964,76
    $1 101,92
    $206,56
    Toc - Plan #81

    Silver

    (HMO) Silver 4900 Ded/7900 MOOP

    Annual Out of Pocket Expenses
    Individual Family
    $4,900 $9,800 Annual Deductible
    $7,900 $15,800 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $440,99
    $500,52
    $563,58
    $787,61
    $1 196,84
    $881,98
    $1 001,04
    $1 127,16
    $1 575,22
    $2 393,68
    $1 219,34
    $1 338,40
    $1 464,52
    $1 912,58
    $1 556,70
    $1 675,76
    $1 801,88
    $2 249,94
    $1 894,06
    $2 013,12
    $2 139,24
    $2 587,30
    $778,35
    $837,88
    $900,94
    $1 124,97
    $1 115,71
    $1 175,24
    $1 238,30
    $1 462,33
    $1 453,07
    $1 512,60
    $1 575,66
    $1 799,69
    $337,36
    Toc - Plan #82

    Gold

    (HMO) Gold 1500 Ded/8550 MOOP

    Annual Out of Pocket Expenses
    Individual Family
    $1,500 $3,000 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $336,70
    $382,16
    $430,31
    $601,35
    $913,80
    $673,40
    $764,32
    $860,62
    $1 202,70
    $1 827,60
    $930,98
    $1 021,90
    $1 118,20
    $1 460,28
    $1 188,56
    $1 279,48
    $1 375,78
    $1 717,86
    $1 446,14
    $1 537,06
    $1 633,36
    $1 975,44
    $594,28
    $639,74
    $687,89
    $858,93
    $851,86
    $897,32
    $945,47
    $1 116,51
    $1 109,44
    $1 154,90
    $1 203,05
    $1 374,09
    $257,58
    Toc - Plan #83

    Silver

    (HMO) Silver 8100X Ded/8150 MOOP

    Annual Out of Pocket Expenses
    Individual Family
    $7,400 $14,800 Annual Deductible
    $8,550 $17,100 Maximum Out of Pocket Per Year
    Monthly Premiums:
    Age Individual
    Couple
    Couple
    1 Child
    Couple
    2 Chidren
    Couple
    3+ Children
    Individual
    1 Child
    Individual
    2 Children
    Individual
    3+ Children
    Child
    0-14
    21
    30
    40
    50
    60
    $408,54
    $463,69
    $522,11
    $729,65
    $1 108,76
    $817,08
    $927,38
    $1 044,22
    $1 459,30
    $2 217,52
    $1 129,61
    $1 239,91
    $1 356,75
    $1 771,83
    $1 442,14
    $1 552,44
    $1 669,28
    $2 084,36
    $1 754,67
    $1 864,97
    $1 981,81
    $2 396,89
    $721,07
    $776,22
    $834,64
    $1 042,18
    $1 033,60
    $1 088,75
    $1 147,17
    $1 354,71
    $1 346,13
    $1 401,28
    $1 459,70
    $1 667,24
    $312,53

    ‡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 Dodge County here.

    Dodge County is in “Rating Area 11” of Wisconsin.

    Currently, there are 83 plans offered in Rating Area 11.

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