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Obamacare 2023 Rates for Menominee County

Obamacare > Rates > Wisconsin > Menominee County

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

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

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

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

Obamacare Providers, 45 Plans and 2023 Rates for Menominee County, Wisconsin

Below, you’ll find a summary of the 45 plans for Menominee County, Wisconsin and rates for each of these providers.‡ This chart is designed to give you a preview of your health insurance options.

You may also be interested in:

Obamacare Rates and Providers for Other Years

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HealthPartners

Local: 1-952-883-5900 | Toll Free: 1-855-813-3887 | TTY: 1-952-883-6060
Toc - Plan #1 HealthPartners
Gold

(PPO) Robin Oak $1,000 w/Copay P-S Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-813-3887

Annual Out of Pocket Expenses:

Individual Family
$1,000 $2,000 Annual Deductible
$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$459.04
$521.01
$586.65
$819.85
$1,245.83 		$810.21
$872.18
$937.82
$1,171.02 		$1,161.38
$1,223.35
$1,288.99
$1,522.19 		$1,512.55
$1,574.52
$1,640.16
$1,873.36 		$351.17
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$918.08
$1,042.02
$1,173.30
$1,639.70
$2,491.66 		$1,269.25
$1,393.19
$1,524.47
$1,990.87 		$1,620.42
$1,744.36
$1,875.64
$2,342.04 		$1,971.59
$2,095.53
$2,226.81
$2,693.21 		$351.17
Toc - Plan #2 HealthPartners
Expanded Bronze

(PPO) Robin Oak $6,250 Plus Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-813-3887

Annual Out of Pocket Expenses:

Individual Family
$6,250 $12,500 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$322.53
$366.07
$412.19
$576.04
$875.35 		$569.27
$612.81
$658.93
$822.78 		$816.01
$859.55
$905.67
$1,069.52 		$1,062.75
$1,106.29
$1,152.41
$1,316.26 		$246.74
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$645.06
$732.14
$824.38
$1,152.08
$1,750.70 		$891.80
$978.88
$1,071.12
$1,398.82 		$1,138.54
$1,225.62
$1,317.86
$1,645.56 		$1,385.28
$1,472.36
$1,564.60
$1,892.30 		$246.74
Toc - Plan #3 HealthPartners
Catastrophic

(PPO) Robin Oak $9,100 Catastrophic

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-813-3887

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$243.13
$275.95
$310.72
$434.23
$659.85 		$429.12
$461.94
$496.71
$620.22 		$615.11
$647.93
$682.70
$806.21 		$801.10
$833.92
$868.69
$992.20 		$185.99
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$486.26
$551.90
$621.44
$868.46
$1,319.70 		$672.25
$737.89
$807.43
$1,054.45 		$858.24
$923.88
$993.42
$1,240.44 		$1,044.23
$1,109.87
$1,179.41
$1,426.43 		$185.99
Toc - Plan #4 HealthPartners
Silver

(PPO) Robin Oak $3,800 Plus Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-813-3887

Annual Out of Pocket Expenses:

Individual Family
$3,800 $7,600 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$411.40
$466.94
$525.77
$734.76
$1,116.54 		$726.12
$781.66
$840.49
$1,049.48 		$1,040.84
$1,096.38
$1,155.21
$1,364.20 		$1,355.56
$1,411.10
$1,469.93
$1,678.92 		$314.72
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$822.80
$933.88
$1,051.54
$1,469.52
$2,233.08 		$1,137.52
$1,248.60
$1,366.26
$1,784.24 		$1,452.24
$1,563.32
$1,680.98
$2,098.96 		$1,766.96
$1,878.04
$1,995.70
$2,413.68 		$314.72
Toc - Plan #5 HealthPartners
Expanded Bronze

(PPO) Robin Oak $7,500 HSA Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-813-3887

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:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$312.16
$354.30
$398.94
$557.52
$847.20 		$550.96
$593.10
$637.74
$796.32 		$789.76
$831.90
$876.54
$1,035.12 		$1,028.56
$1,070.70
$1,115.34
$1,273.92 		$238.80
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$624.32
$708.60
$797.88
$1,115.04
$1,694.40 		$863.12
$947.40
$1,036.68
$1,353.84 		$1,101.92
$1,186.20
$1,275.48
$1,592.64 		$1,340.72
$1,425.00
$1,514.28
$1,831.44 		$238.80
Toc - Plan #6 HealthPartners
Gold

(PPO) Robin Oak $2,000 w/Copay P-S Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-813-3887

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$443.24
$503.08
$566.46
$791.63
$1,202.95 		$782.32
$842.16
$905.54
$1,130.71 		$1,121.40
$1,181.24
$1,244.62
$1,469.79 		$1,460.48
$1,520.32
$1,583.70
$1,808.87 		$339.08
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$886.48
$1,006.16
$1,132.92
$1,583.26
$2,405.90 		$1,225.56
$1,345.24
$1,472.00
$1,922.34 		$1,564.64
$1,684.32
$1,811.08
$2,261.42 		$1,903.72
$2,023.40
$2,150.16
$2,600.50 		$339.08
Toc - Plan #7 HealthPartners
Silver

(PPO) Robin Oak $5,800 w/Copay P-S Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-813-3887

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$412.61
$468.31
$527.32
$736.92
$1,119.82 		$728.26
$783.96
$842.97
$1,052.57 		$1,043.91
$1,099.61
$1,158.62
$1,368.22 		$1,359.56
$1,415.26
$1,474.27
$1,683.87 		$315.65
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$825.22
$936.62
$1,054.64
$1,473.84
$2,239.64 		$1,140.87
$1,252.27
$1,370.29
$1,789.49 		$1,456.52
$1,567.92
$1,685.94
$2,105.14 		$1,772.17
$1,883.57
$2,001.59
$2,420.79 		$315.65
Toc - Plan #8 HealthPartners
Expanded Bronze

(PPO) Robin Oak $7,500 w/Copay P-S Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-813-3887

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$324.82
$368.67
$415.12
$580.13
$881.56 		$573.31
$617.16
$663.61
$828.62 		$821.80
$865.65
$912.10
$1,077.11 		$1,070.29
$1,114.14
$1,160.59
$1,325.60 		$248.49
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$649.64
$737.34
$830.24
$1,160.26
$1,763.12 		$898.13
$985.83
$1,078.73
$1,408.75 		$1,146.62
$1,234.32
$1,327.22
$1,657.24 		$1,395.11
$1,482.81
$1,575.71
$1,905.73 		$248.49
Toc - Plan #9 HealthPartners
Silver

(PPO) Robin Oak $3,500 HSA Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-813-3887

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 Annual Deductible
$7,300 $14,600 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$407.83
$462.89
$521.21
$728.38
$1,106.85 		$719.82
$774.88
$833.20
$1,040.37 		$1,031.81
$1,086.87
$1,145.19
$1,352.36 		$1,343.80
$1,398.86
$1,457.18
$1,664.35 		$311.99
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$815.66
$925.78
$1,042.42
$1,456.76
$2,213.70 		$1,127.65
$1,237.77
$1,354.41
$1,768.75 		$1,439.64
$1,549.76
$1,666.40
$2,080.74 		$1,751.63
$1,861.75
$1,978.39
$2,392.73 		$311.99
Toc - Plan #10 HealthPartners
Silver

(PPO) Robin Select $3,800 Plus Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-813-3887

Annual Out of Pocket Expenses:

Individual Family
$3,800 $7,600 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$366.17
$415.60
$467.97
$653.98
$993.79 		$646.29
$695.72
$748.09
$934.10 		$926.41
$975.84
$1,028.21
$1,214.22 		$1,206.53
$1,255.96
$1,308.33
$1,494.34 		$280.12
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$732.34
$831.20
$935.94
$1,307.96
$1,987.58 		$1,012.46
$1,111.32
$1,216.06
$1,588.08 		$1,292.58
$1,391.44
$1,496.18
$1,868.20 		$1,572.70
$1,671.56
$1,776.30
$2,148.32 		$280.12
Toc - Plan #11 HealthPartners
Silver

(PPO) Robin Select $5,800 w/Copay P-S Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-813-3887

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$367.22
$416.79
$469.31
$655.85
$996.64 		$648.14
$697.71
$750.23
$936.77 		$929.06
$978.63
$1,031.15
$1,217.69 		$1,209.98
$1,259.55
$1,312.07
$1,498.61 		$280.92
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$734.44
$833.58
$938.62
$1,311.70
$1,993.28 		$1,015.36
$1,114.50
$1,219.54
$1,592.62 		$1,296.28
$1,395.42
$1,500.46
$1,873.54 		$1,577.20
$1,676.34
$1,781.38
$2,154.46 		$280.92
Toc - Plan #12 HealthPartners
Expanded Bronze

(PPO) Robin Select $6,250 Plus Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-813-3887

Annual Out of Pocket Expenses:

Individual Family
$6,250 $12,500 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$287.04
$325.79
$366.84
$512.65
$779.03 		$506.63
$545.38
$586.43
$732.24 		$726.22
$764.97
$806.02
$951.83 		$945.81
$984.56
$1,025.61
$1,171.42 		$219.59
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$574.08
$651.58
$733.68
$1,025.30
$1,558.06 		$793.67
$871.17
$953.27
$1,244.89 		$1,013.26
$1,090.76
$1,172.86
$1,464.48 		$1,232.85
$1,310.35
$1,392.45
$1,684.07 		$219.59
Toc - Plan #13 HealthPartners
Expanded Bronze

(PPO) Robin Select $7,500 w/Copay P-S Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-813-3887

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$289.10
$328.13
$369.47
$516.33
$784.62 		$510.26
$549.29
$590.63
$737.49 		$731.42
$770.45
$811.79
$958.65 		$952.58
$991.61
$1,032.95
$1,179.81 		$221.16
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$578.20
$656.26
$738.94
$1,032.66
$1,569.24 		$799.36
$877.42
$960.10
$1,253.82 		$1,020.52
$1,098.58
$1,181.26
$1,474.98 		$1,241.68
$1,319.74
$1,402.42
$1,696.14 		$221.16
Toc - Plan #14 HealthPartners
Silver

(PPO) Robin Select $3,500 HSA Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-813-3887

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 Annual Deductible
$7,300 $14,600 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$362.95
$411.95
$463.85
$648.23
$985.05 		$640.61
$689.61
$741.51
$925.89 		$918.27
$967.27
$1,019.17
$1,203.55 		$1,195.93
$1,244.93
$1,296.83
$1,481.21 		$277.66
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$725.90
$823.90
$927.70
$1,296.46
$1,970.10 		$1,003.56
$1,101.56
$1,205.36
$1,574.12 		$1,281.22
$1,379.22
$1,483.02
$1,851.78 		$1,558.88
$1,656.88
$1,760.68
$2,129.44 		$277.66
Toc - Plan #15 HealthPartners
Expanded Bronze

(PPO) Robin Select $7,500 HSA Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-813-3887

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:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$277.84
$315.35
$355.08
$496.22
$754.06 		$490.39
$527.90
$567.63
$708.77 		$702.94
$740.45
$780.18
$921.32 		$915.49
$953.00
$992.73
$1,133.87 		$212.55
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$555.68
$630.70
$710.16
$992.44
$1,508.12 		$768.23
$843.25
$922.71
$1,204.99 		$980.78
$1,055.80
$1,135.26
$1,417.54 		$1,193.33
$1,268.35
$1,347.81
$1,630.09 		$212.55
Toc - Plan #16 HealthPartners
Catastrophic

(PPO) Robin Select $9,100 Catastrophic

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-813-3887

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$216.38
$245.59
$276.53
$386.45
$587.26 		$381.91
$411.12
$442.06
$551.98 		$547.44
$576.65
$607.59
$717.51 		$712.97
$742.18
$773.12
$883.04 		$165.53
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$432.76
$491.18
$553.06
$772.90
$1,174.52 		$598.29
$656.71
$718.59
$938.43 		$763.82
$822.24
$884.12
$1,103.96 		$929.35
$987.77
$1,049.65
$1,269.49 		$165.53

ADVERTISEMENT

Security Health Plan

Local: 1-715-221-9258x19258 | Toll Free: 1-844-293-9624 | TTY: 1-877-727-2232
Toc - Plan #17 Security Health Plan
Gold

(EPO) SimplyOne $3,500 - 30%

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-293-9624

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:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$393.87
$447.03
$503.35
$703.43
$1,068.92 		$695.17
$748.33
$804.65
$1,004.73 		$996.47
$1,049.63
$1,105.95
$1,306.03 		$1,297.77
$1,350.93
$1,407.25
$1,607.33 		$301.30
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$787.74
$894.06
$1,006.70
$1,406.86
$2,137.84 		$1,089.04
$1,195.36
$1,308.00
$1,708.16 		$1,390.34
$1,496.66
$1,609.30
$2,009.46 		$1,691.64
$1,797.96
$1,910.60
$2,310.76 		$301.30
Toc - Plan #18 Security Health Plan
Silver

(EPO) SimplyOne $4,100 HDHP

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-293-9624

Annual Out of Pocket Expenses:

Individual Family
$4,100 $8,200 Annual Deductible
$7,050 $14,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$478.36
$542.93
$611.33
$854.33
$1,298.24 		$844.30
$908.87
$977.27
$1,220.27 		$1,210.24
$1,274.81
$1,343.21
$1,586.21 		$1,576.18
$1,640.75
$1,709.15
$1,952.15 		$365.94
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$956.72
$1,085.86
$1,222.66
$1,708.66
$2,596.48 		$1,322.66
$1,451.80
$1,588.60
$2,074.60 		$1,688.60
$1,817.74
$1,954.54
$2,440.54 		$2,054.54
$2,183.68
$2,320.48
$2,806.48 		$365.94
Toc - Plan #19 Security Health Plan
Expanded Bronze

(EPO) SimplyOne $6,200 HDHP

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-293-9624

Annual Out of Pocket Expenses:

Individual Family
$6,200 $12,400 Annual Deductible
$7,050 $14,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$326.07
$370.08
$416.71
$582.35
$884.94 		$575.51
$619.52
$666.15
$831.79 		$824.95
$868.96
$915.59
$1,081.23 		$1,074.39
$1,118.40
$1,165.03
$1,330.67 		$249.44
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$652.14
$740.16
$833.42
$1,164.70
$1,769.88 		$901.58
$989.60
$1,082.86
$1,414.14 		$1,151.02
$1,239.04
$1,332.30
$1,663.58 		$1,400.46
$1,488.48
$1,581.74
$1,913.02 		$249.44
Toc - Plan #20 Security Health Plan
Bronze

(EPO) SimplyOne $9,100

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-293-9624

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$280.88
$318.79
$358.95
$501.63
$762.28 		$495.74
$533.65
$573.81
$716.49 		$710.60
$748.51
$788.67
$931.35 		$925.46
$963.37
$1,003.53
$1,146.21 		$214.86
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$561.76
$637.58
$717.90
$1,003.26
$1,524.56 		$776.62
$852.44
$932.76
$1,218.12 		$991.48
$1,067.30
$1,147.62
$1,432.98 		$1,206.34
$1,282.16
$1,362.48
$1,647.84 		$214.86
Toc - Plan #21 Security Health Plan
Catastrophic

(EPO) SimplyOne Protection

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-293-9624

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$192.15
$218.08
$245.56
$343.17
$521.47 		$339.14
$365.07
$392.55
$490.16 		$486.13
$512.06
$539.54
$637.15 		$633.12
$659.05
$686.53
$784.14 		$146.99
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$384.30
$436.16
$491.12
$686.34
$1,042.94 		$531.29
$583.15
$638.11
$833.33 		$678.28
$730.14
$785.10
$980.32 		$825.27
$877.13
$932.09
$1,127.31 		$146.99
Toc - Plan #22 Security Health Plan
Gold

(EPO) SimplyOne $2,000 - 25%

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-293-9624

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$418.18
$474.63
$534.42
$746.85
$1,134.92 		$738.08
$794.53
$854.32
$1,066.75 		$1,057.98
$1,114.43
$1,174.22
$1,386.65 		$1,377.88
$1,434.33
$1,494.12
$1,706.55 		$319.90
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$836.36
$949.26
$1,068.84
$1,493.70
$2,269.84 		$1,156.26
$1,269.16
$1,388.74
$1,813.60 		$1,476.16
$1,589.06
$1,708.64
$2,133.50 		$1,796.06
$1,908.96
$2,028.54
$2,453.40 		$319.90
Toc - Plan #23 Security Health Plan
Silver

(EPO) SimplyOne $5,800 - 40%

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-293-9624

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$414.58
$470.54
$529.82
$740.42
$1,125.14 		$731.73
$787.69
$846.97
$1,057.57 		$1,048.88
$1,104.84
$1,164.12
$1,374.72 		$1,366.03
$1,421.99
$1,481.27
$1,691.87 		$317.15
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$829.16
$941.08
$1,059.64
$1,480.84
$2,250.28 		$1,146.31
$1,258.23
$1,376.79
$1,797.99 		$1,463.46
$1,575.38
$1,693.94
$2,115.14 		$1,780.61
$1,892.53
$2,011.09
$2,432.29 		$317.15
Toc - Plan #24 Security Health Plan
Expanded Bronze

(EPO) SimplyOne $7,500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-293-9624

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$287.06
$325.80
$366.85
$512.67
$779.06 		$506.65
$545.39
$586.44
$732.26 		$726.24
$764.98
$806.03
$951.85 		$945.83
$984.57
$1,025.62
$1,171.44 		$219.59
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$574.12
$651.60
$733.70
$1,025.34
$1,558.12 		$793.71
$871.19
$953.29
$1,244.93 		$1,013.30
$1,090.78
$1,172.88
$1,464.52 		$1,232.89
$1,310.37
$1,392.47
$1,684.11 		$219.59
Toc - Plan #25 Security Health Plan
Gold

(HMO) Premier $2,000 - 25%

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-293-9624

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$519.71
$589.85
$664.17
$928.18
$1,410.45 		$917.28
$987.42
$1,061.74
$1,325.75 		$1,314.85
$1,384.99
$1,459.31
$1,723.32 		$1,712.42
$1,782.56
$1,856.88
$2,120.89 		$397.57
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,039.42
$1,179.70
$1,328.34
$1,856.36
$2,820.90 		$1,436.99
$1,577.27
$1,725.91
$2,253.93 		$1,834.56
$1,974.84
$2,123.48
$2,651.50 		$2,232.13
$2,372.41
$2,521.05
$3,049.07 		$397.57
Toc - Plan #26 Security Health Plan
Gold

(HMO) Premier $3,500 - 30%

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-293-9624

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:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$489.49
$555.55
$625.55
$874.20
$1,328.44 		$863.94
$930.00
$1,000.00
$1,248.65 		$1,238.39
$1,304.45
$1,374.45
$1,623.10 		$1,612.84
$1,678.90
$1,748.90
$1,997.55 		$374.45
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$978.98
$1,111.10
$1,251.10
$1,748.40
$2,656.88 		$1,353.43
$1,485.55
$1,625.55
$2,122.85 		$1,727.88
$1,860.00
$2,000.00
$2,497.30 		$2,102.33
$2,234.45
$2,374.45
$2,871.75 		$374.45
Toc - Plan #27 Security Health Plan
Silver

(HMO) Premier $5,800 - 40%

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-293-9624

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$515.23
$584.77
$658.45
$920.18
$1,398.30 		$909.37
$978.91
$1,052.59
$1,314.32 		$1,303.51
$1,373.05
$1,446.73
$1,708.46 		$1,697.65
$1,767.19
$1,840.87
$2,102.60 		$394.14
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,030.46
$1,169.54
$1,316.90
$1,840.36
$2,796.60 		$1,424.60
$1,563.68
$1,711.04
$2,234.50 		$1,818.74
$1,957.82
$2,105.18
$2,628.64 		$2,212.88
$2,351.96
$2,499.32
$3,022.78 		$394.14
Toc - Plan #28 Security Health Plan
Silver

(HMO) Premier $4,100 HDHP

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-293-9624

Annual Out of Pocket Expenses:

Individual Family
$4,100 $8,200 Annual Deductible
$7,050 $14,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$594.49
$674.74
$759.75
$1,061.75
$1,613.43 		$1,049.27
$1,129.52
$1,214.53
$1,516.53 		$1,504.05
$1,584.30
$1,669.31
$1,971.31 		$1,958.83
$2,039.08
$2,124.09
$2,426.09 		$454.78
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1,188.98
$1,349.48
$1,519.50
$2,123.50
$3,226.86 		$1,643.76
$1,804.26
$1,974.28
$2,578.28 		$2,098.54
$2,259.04
$2,429.06
$3,033.06 		$2,553.32
$2,713.82
$2,883.84
$3,487.84 		$454.78
Toc - Plan #29 Security Health Plan
Expanded Bronze

(HMO) Premier $6,200 HDHP

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-293-9624

Annual Out of Pocket Expenses:

Individual Family
$6,200 $12,400 Annual Deductible
$7,050 $14,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$405.24
$459.93
$517.88
$723.73
$1,099.78 		$715.24
$769.93
$827.88
$1,033.73 		$1,025.24
$1,079.93
$1,137.88
$1,343.73 		$1,335.24
$1,389.93
$1,447.88
$1,653.73 		$310.00
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$810.48
$919.86
$1,035.76
$1,447.46
$2,199.56 		$1,120.48
$1,229.86
$1,345.76
$1,757.46 		$1,430.48
$1,539.86
$1,655.76
$2,067.46 		$1,740.48
$1,849.86
$1,965.76
$2,377.46 		$310.00
Toc - Plan #30 Security Health Plan
Expanded Bronze

(HMO) Premier $7,500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-293-9624

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$356.75
$404.90
$455.91
$637.14
$968.19 		$629.66
$677.81
$728.82
$910.05 		$902.57
$950.72
$1,001.73
$1,182.96 		$1,175.48
$1,223.63
$1,274.64
$1,455.87 		$272.91
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$713.50
$809.80
$911.82
$1,274.28
$1,936.38 		$986.41
$1,082.71
$1,184.73
$1,547.19 		$1,259.32
$1,355.62
$1,457.64
$1,820.10 		$1,532.23
$1,628.53
$1,730.55
$2,093.01 		$272.91
Toc - Plan #31 Security Health Plan
Bronze

(HMO) Premier $9,100

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-293-9624

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$349.07
$396.18
$446.10
$623.42
$947.35 		$616.10
$663.21
$713.13
$890.45 		$883.13
$930.24
$980.16
$1,157.48 		$1,150.16
$1,197.27
$1,247.19
$1,424.51 		$267.03
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$698.14
$792.36
$892.20
$1,246.84
$1,894.70 		$965.17
$1,059.39
$1,159.23
$1,513.87 		$1,232.20
$1,326.42
$1,426.26
$1,780.90 		$1,499.23
$1,593.45
$1,693.29
$2,047.93 		$267.03
Toc - Plan #32 Security Health Plan
Catastrophic

(HMO) Premier Protection

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-293-9624

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$238.80
$271.03
$305.17
$426.48
$648.08 		$421.48
$453.71
$487.85
$609.16 		$604.16
$636.39
$670.53
$791.84 		$786.84
$819.07
$853.21
$974.52 		$182.68
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$477.60
$542.06
$610.34
$852.96
$1,296.16 		$660.28
$724.74
$793.02
$1,035.64 		$842.96
$907.42
$975.70
$1,218.32 		$1,025.64
$1,090.10
$1,158.38
$1,401.00 		$182.68

ADVERTISEMENT

Anthem Blue Cross and Blue Shield

Local: 1-855-748-1813 | Toll Free: 1-855-748-1813

Toc - Plan #33 Anthem Blue Cross and Blue Shield
Expanded Bronze

(HMO) Anthem Bronze Blue Preferred/Broad 0 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1813

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$347.79
$394.74
$444.48
$621.15
$943.90 		$613.85
$660.80
$710.54
$887.21 		$879.91
$926.86
$976.60
$1,153.27 		$1,145.97
$1,192.92
$1,242.66
$1,419.33 		$266.06
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$695.58
$789.48
$888.96
$1,242.30
$1,887.80 		$961.64
$1,055.54
$1,155.02
$1,508.36 		$1,227.70
$1,321.60
$1,421.08
$1,774.42 		$1,493.76
$1,587.66
$1,687.14
$2,040.48 		$266.06
Toc - Plan #34 Anthem Blue Cross and Blue Shield
Expanded Bronze

(HMO) Anthem Bronze Blue Preferred/Broad 5000 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1813

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$337.22
$382.74
$430.97
$602.27
$915.22 		$595.19
$640.71
$688.94
$860.24 		$853.16
$898.68
$946.91
$1,118.21 		$1,111.13
$1,156.65
$1,204.88
$1,376.18 		$257.97
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$674.44
$765.48
$861.94
$1,204.54
$1,830.44 		$932.41
$1,023.45
$1,119.91
$1,462.51 		$1,190.38
$1,281.42
$1,377.88
$1,720.48 		$1,448.35
$1,539.39
$1,635.85
$1,978.45 		$257.97
Toc - Plan #35 Anthem Blue Cross and Blue Shield
Expanded Bronze

(HMO) Anthem Bronze Blue Preferred/Broad 6550 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1813

Annual Out of Pocket Expenses:

Individual Family
$6,550 $13,100 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$331.18
$375.89
$423.25
$591.49
$898.82 		$584.53
$629.24
$676.60
$844.84 		$837.88
$882.59
$929.95
$1,098.19 		$1,091.23
$1,135.94
$1,183.30
$1,351.54 		$253.35
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$662.36
$751.78
$846.50
$1,182.98
$1,797.64 		$915.71
$1,005.13
$1,099.85
$1,436.33 		$1,169.06
$1,258.48
$1,353.20
$1,689.68 		$1,422.41
$1,511.83
$1,606.55
$1,943.03 		$253.35
Toc - Plan #36 Anthem Blue Cross and Blue Shield
Bronze

(HMO) Anthem Bronze Blue Preferred/Broad 9100 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1813

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$313.91
$356.29
$401.18
$560.64
$851.95 		$554.05
$596.43
$641.32
$800.78 		$794.19
$836.57
$881.46
$1,040.92 		$1,034.33
$1,076.71
$1,121.60
$1,281.06 		$240.14
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$627.82
$712.58
$802.36
$1,121.28
$1,703.90 		$867.96
$952.72
$1,042.50
$1,361.42 		$1,108.10
$1,192.86
$1,282.64
$1,601.56 		$1,348.24
$1,433.00
$1,522.78
$1,841.70 		$240.14
Toc - Plan #37 Anthem Blue Cross and Blue Shield
Expanded Bronze

(HMO) Anthem Bronze Blue Preferred/Broad 0% for HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1813

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:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$330.49
$375.11
$422.37
$590.26
$896.95 		$583.31
$627.93
$675.19
$843.08 		$836.13
$880.75
$928.01
$1,095.90 		$1,088.95
$1,133.57
$1,180.83
$1,348.72 		$252.82
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$660.98
$750.22
$844.74
$1,180.52
$1,793.90 		$913.80
$1,003.04
$1,097.56
$1,433.34 		$1,166.62
$1,255.86
$1,350.38
$1,686.16 		$1,419.44
$1,508.68
$1,603.20
$1,938.98 		$252.82
Toc - Plan #38 Anthem Blue Cross and Blue Shield
Gold

(HMO) Anthem Gold Blue Preferred/Broad 1000 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1813

Annual Out of Pocket Expenses:

Individual Family
$1,000 $2,000 Annual Deductible
$6,900 $13,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$428.71
$486.59
$547.89
$765.68
$1,163.52 		$756.67
$814.55
$875.85
$1,093.64 		$1,084.63
$1,142.51
$1,203.81
$1,421.60 		$1,412.59
$1,470.47
$1,531.77
$1,749.56 		$327.96
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$857.42
$973.18
$1,095.78
$1,531.36
$2,327.04 		$1,185.38
$1,301.14
$1,423.74
$1,859.32 		$1,513.34
$1,629.10
$1,751.70
$2,187.28 		$1,841.30
$1,957.06
$2,079.66
$2,515.24 		$327.96
Toc - Plan #39 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Blue Preferred/Broad 4000 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1813

Annual Out of Pocket Expenses:

Individual Family
$4,000 $8,000 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$413.91
$469.79
$528.98
$739.24
$1,123.35 		$730.55
$786.43
$845.62
$1,055.88 		$1,047.19
$1,103.07
$1,162.26
$1,372.52 		$1,363.83
$1,419.71
$1,478.90
$1,689.16 		$316.64
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$827.82
$939.58
$1,057.96
$1,478.48
$2,246.70 		$1,144.46
$1,256.22
$1,374.60
$1,795.12 		$1,461.10
$1,572.86
$1,691.24
$2,111.76 		$1,777.74
$1,889.50
$2,007.88
$2,428.40 		$316.64
Toc - Plan #40 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Blue Preferred/Broad 4100 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1813

Annual Out of Pocket Expenses:

Individual Family
$4,100 $8,200 Annual Deductible
$7,250 $14,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$418.89
$475.44
$535.34
$748.14
$1,136.87 		$739.34
$795.89
$855.79
$1,068.59 		$1,059.79
$1,116.34
$1,176.24
$1,389.04 		$1,380.24
$1,436.79
$1,496.69
$1,709.49 		$320.45
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$837.78
$950.88
$1,070.68
$1,496.28
$2,273.74 		$1,158.23
$1,271.33
$1,391.13
$1,816.73 		$1,478.68
$1,591.78
$1,711.58
$2,137.18 		$1,799.13
$1,912.23
$2,032.03
$2,457.63 		$320.45
Toc - Plan #41 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Blue Preferred/Broad 5300 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1813

Annual Out of Pocket Expenses:

Individual Family
$5,300 $10,600 Annual Deductible
$8,250 $16,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$411.47
$467.02
$525.86
$734.89
$1,116.73 		$726.24
$781.79
$840.63
$1,049.66 		$1,041.01
$1,096.56
$1,155.40
$1,364.43 		$1,355.78
$1,411.33
$1,470.17
$1,679.20 		$314.77
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$822.94
$934.04
$1,051.72
$1,469.78
$2,233.46 		$1,137.71
$1,248.81
$1,366.49
$1,784.55 		$1,452.48
$1,563.58
$1,681.26
$2,099.32 		$1,767.25
$1,878.35
$1,996.03
$2,414.09 		$314.77
Toc - Plan #42 Anthem Blue Cross and Blue Shield
Bronze

(HMO) Anthem Bronze Blue Preferred/Broad 9100/0% Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1813

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$314.35
$356.79
$401.74
$561.43
$853.15 		$554.83
$597.27
$642.22
$801.91 		$795.31
$837.75
$882.70
$1,042.39 		$1,035.79
$1,078.23
$1,123.18
$1,282.87 		$240.48
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$628.70
$713.58
$803.48
$1,122.86
$1,706.30 		$869.18
$954.06
$1,043.96
$1,363.34 		$1,109.66
$1,194.54
$1,284.44
$1,603.82 		$1,350.14
$1,435.02
$1,524.92
$1,844.30 		$240.48
Toc - Plan #43 Anthem Blue Cross and Blue Shield
Expanded Bronze

(HMO) Anthem Bronze Blue Preferred/Broad 7500/50% Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1813

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$341.68
$387.81
$436.67
$610.24
$927.32 		$603.07
$649.20
$698.06
$871.63 		$864.46
$910.59
$959.45
$1,133.02 		$1,125.85
$1,171.98
$1,220.84
$1,394.41 		$261.39
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$683.36
$775.62
$873.34
$1,220.48
$1,854.64 		$944.75
$1,037.01
$1,134.73
$1,481.87 		$1,206.14
$1,298.40
$1,396.12
$1,743.26 		$1,467.53
$1,559.79
$1,657.51
$2,004.65 		$261.39
Toc - Plan #44 Anthem Blue Cross and Blue Shield
Silver

(HMO) Anthem Silver Blue Preferred/Broad 5800/40% Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1813

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$407.97
$463.05
$521.39
$728.63
$1,107.23 		$720.07
$775.15
$833.49
$1,040.73 		$1,032.17
$1,087.25
$1,145.59
$1,352.83 		$1,344.27
$1,399.35
$1,457.69
$1,664.93 		$312.10
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$815.94
$926.10
$1,042.78
$1,457.26
$2,214.46 		$1,128.04
$1,238.20
$1,354.88
$1,769.36 		$1,440.14
$1,550.30
$1,666.98
$2,081.46 		$1,752.24
$1,862.40
$1,979.08
$2,393.56 		$312.10
Toc - Plan #45 Anthem Blue Cross and Blue Shield
Gold

(HMO) Anthem Gold Blue Preferred/Broad 2000/25% Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1813

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$429.01
$486.93
$548.27
$766.21
$1,164.33 		$757.20
$815.12
$876.46
$1,094.40 		$1,085.39
$1,143.31
$1,204.65
$1,422.59 		$1,413.58
$1,471.50
$1,532.84
$1,750.78 		$328.19
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$858.02
$973.86
$1,096.54
$1,532.42
$2,328.66 		$1,186.21
$1,302.05
$1,424.73
$1,860.61 		$1,514.40
$1,630.24
$1,752.92
$2,188.80 		$1,842.59
$1,958.43
$2,081.11
$2,516.99 		$328.19

‡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 Menominee County here.

Menominee County is in “Rating Area 16” of Wisconsin.

Currently, there are 45 plans offered in Rating Area 16.

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2023 Obamacare Plans for Menominee County, WI

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