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Providers for Zip Code 53402

Obamacare 2017 Marketplace Rates For Racine County, Wisconsin

Friday, December 9th, 2016

Click for Racine, Wisconsin Forecast

Obamacare Providers, Plans and 2017 Rates for Racine County

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

2017 Rates and Providers

(click here for 2014)

(click here for 2015)

(click here for 2016)

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

Currently, there are 29 plans offered in Racine County.

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

 

The table below shows premiums for the following scenarios:

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

Each scenario is covered for age

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

 

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

 

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

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

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

Children's Community Health Plan

Local: 1-844-201-4672 | Toll Free: 1-844-201-4672

TTY: 1-844-531-4856

Plan: (EPO) Together Bronze

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-201-4672 - Provider Directory for This Plan: (Children's Community Health Plan)

Deductible: Individual: $6,250 : Family: $12,500
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$259.61
$294.64
$331.77
$463.64
$704.55
$519.22
$589.28
$663.54
$927.28
$1409.10
$684.06
$754.12
$828.38
$1092.12
$848.90
$918.96
$993.22
$1256.96
$1013.74
$1083.80
$1158.06
$1421.80
$424.45
$459.48
$496.61
$628.48
$589.29
$624.32
$661.45
$793.32
$754.13
$789.16
$826.29
$958.16
$164.84

Molina Healthcare of Wisconsin, Inc.

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

Plan: (HMO) Molina Marketplace Bronze

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-560-2043 - Provider Directory for This Plan: (Molina Healthcare of Wisconsin, Inc.)

Deductible: Individual: $6,650 : Family: $13,300
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$258.83
$293.78
$330.79
$462.28
$702.47
$517.66
$587.56
$661.58
$924.56
$1404.94
$682.02
$751.92
$825.94
$1088.92
$846.38
$916.28
$990.30
$1253.28
$1010.74
$1080.64
$1154.66
$1417.64
$423.19
$458.14
$495.15
$626.64
$587.55
$622.50
$659.51
$791.00
$751.91
$786.86
$823.87
$955.36
$164.36

Children's Community Health Plan

Local: 1-844-201-4672 | Toll Free: 1-844-201-4672

TTY: 1-844-531-4856

Plan: (EPO) Together Standard Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-201-4672 - Provider Directory for This Plan: (Children's Community Health Plan)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$315.06
$357.58
$402.63
$562.67
$855.03
$630.12
$715.16
$805.26
$1125.34
$1710.06
$830.17
$915.21
$1005.31
$1325.39
$1030.22
$1115.26
$1205.36
$1525.44
$1230.27
$1315.31
$1405.41
$1725.49
$515.11
$557.63
$602.68
$762.72
$715.16
$757.68
$802.73
$962.77
$915.21
$957.73
$1002.78
$1162.82
$200.05

Plan: (EPO) Together Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-201-4672 - Provider Directory for This Plan: (Children's Community Health Plan)

Deductible: Individual: $3,000 : Family: $6,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$303.71
$344.70
$388.13
$542.42
$824.25
$607.42
$689.40
$776.26
$1084.84
$1648.50
$800.27
$882.25
$969.11
$1277.69
$993.12
$1075.10
$1161.96
$1470.54
$1185.97
$1267.95
$1354.81
$1663.39
$496.56
$537.55
$580.98
$735.27
$689.41
$730.40
$773.83
$928.12
$882.26
$923.25
$966.68
$1120.97
$192.85

Plan: (EPO) Together Gold

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-201-4672 - Provider Directory for This Plan: (Children's Community Health Plan)

Deductible: Individual: $700 : Family: $1,400
Out of Pocket Maximum per year: Individual: $5,750 : Family: $11,500

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$391.30
$444.11
$500.06
$698.84
$1061.95
$782.60
$888.22
$1000.12
$1397.68
$2123.90
$1031.07
$1136.69
$1248.59
$1646.15
$1279.54
$1385.16
$1497.06
$1894.62
$1528.01
$1633.63
$1745.53
$2143.09
$639.77
$692.58
$748.53
$947.31
$888.24
$941.05
$997.00
$1195.78
$1136.71
$1189.52
$1245.47
$1444.25
$248.47

Molina Healthcare of Wisconsin, Inc.

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

Plan: (HMO) Molina Marketplace Gold

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-560-2043 - Provider Directory for This Plan: (Molina Healthcare of Wisconsin, Inc.)

Deductible: Individual: $1,025 : Family: $2,050
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$386.08
$438.20
$493.40
$689.53
$1047.81
$772.16
$876.40
$986.80
$1379.06
$2095.62
$1017.32
$1121.56
$1231.96
$1624.22
$1262.48
$1366.72
$1477.12
$1869.38
$1507.64
$1611.88
$1722.28
$2114.54
$631.24
$683.36
$738.56
$934.69
$876.40
$928.52
$983.72
$1179.85
$1121.56
$1173.68
$1228.88
$1425.01
$245.16

Plan: (HMO) Molina Marketplace Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-560-2043 - Provider Directory for This Plan: (Molina Healthcare of Wisconsin, Inc.)

Deductible: Individual: $2,400 : Family: $4,800
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$302.65
$343.50
$386.78
$540.53
$821.38
$605.30
$687.00
$773.56
$1081.06
$1642.76
$797.48
$879.18
$965.74
$1273.24
$989.66
$1071.36
$1157.92
$1465.42
$1181.84
$1263.54
$1350.10
$1657.60
$494.83
$535.68
$578.96
$732.71
$687.01
$727.86
$771.14
$924.89
$879.19
$920.04
$963.32
$1117.07
$192.18

Plan: (HMO) Molina Marketplace Options Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-560-2043 - Provider Directory for This Plan: (Molina Healthcare of Wisconsin, Inc.)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$305.47
$346.71
$390.39
$545.57
$829.05
$610.94
$693.42
$780.78
$1091.14
$1658.10
$804.91
$887.39
$974.75
$1285.11
$998.88
$1081.36
$1168.72
$1479.08
$1192.85
$1275.33
$1362.69
$1673.05
$499.44
$540.68
$584.36
$739.54
$693.41
$734.65
$778.33
$933.51
$887.38
$928.62
$972.30
$1127.48
$193.97

Plan: (HMO) Molina Marketplace Options Bronze

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-560-2043 - Provider Directory for This Plan: (Molina Healthcare of Wisconsin, Inc.)

Deductible: Individual: $6,650 : Family: $13,300
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$266.32
$302.27
$340.35
$475.64
$722.79
$532.64
$604.54
$680.70
$951.28
$1445.58
$701.75
$773.65
$849.81
$1120.39
$870.86
$942.76
$1018.92
$1289.50
$1039.97
$1111.87
$1188.03
$1458.61
$435.43
$471.38
$509.46
$644.75
$604.54
$640.49
$678.57
$813.86
$773.65
$809.60
$847.68
$982.97
$169.11
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Network Health Plan

Local: 1-920-720-1400 x1400 | Toll Free: 1-855-275-1400

TTY: 1-800-947-3529

Plan: (HMO) Prestige Silver 0

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-275-1400 - Provider Directory for This Plan: (Network Health Plan)

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$334.96
$380.18
$428.08
$598.24
$909.09
$669.92
$760.36
$856.16
$1196.48
$1818.18
$882.62
$973.06
$1068.86
$1409.18
$1095.32
$1185.76
$1281.56
$1621.88
$1308.02
$1398.46
$1494.26
$1834.58
$547.66
$592.88
$640.78
$810.94
$760.36
$805.58
$853.48
$1023.64
$973.06
$1018.28
$1066.18
$1236.34
$212.70

Plan: (HMO) Prestige Bronze 20 HDHP

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-275-1400 - Provider Directory for This Plan: (Network Health Plan)

Deductible: Individual: $5,500 : Family: $11,000
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$297.44
$337.60
$380.13
$531.23
$807.26
$594.88
$675.20
$760.26
$1062.46
$1614.52
$783.76
$864.08
$949.14
$1251.34
$972.64
$1052.96
$1138.02
$1440.22
$1161.52
$1241.84
$1326.90
$1629.10
$486.32
$526.48
$569.01
$720.11
$675.20
$715.36
$757.89
$908.99
$864.08
$904.24
$946.77
$1097.87
$188.88
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Common Ground Healthcare Cooperative

Local: 1-877-514-2442 | Toll Free: 1-877-514-2442

TTY: 1-855-643-5001

Plan: (PPO) Envision Aurora Bellin PPO - Bronze 7150/100

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$291.90
$331.30
$373.04
$521.32
$792.20
$583.80
$662.60
$746.08
$1042.64
$1584.40
$769.15
$847.95
$931.43
$1227.99
$954.50
$1033.30
$1116.78
$1413.34
$1139.85
$1218.65
$1302.13
$1598.69
$477.25
$516.65
$558.39
$706.67
$662.60
$702.00
$743.74
$892.02
$847.95
$887.35
$929.09
$1077.37
$185.35
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Network Health Plan

Local: 1-920-720-1400 x1400 | Toll Free: 1-855-275-1400

TTY: 1-800-947-3529

Plan: (HMO) Prestige Silver 20 HDHP

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-275-1400 - Provider Directory for This Plan: (Network Health Plan)

Deductible: Individual: $2,600 : Family: $5,200
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$337.35
$382.90
$431.14
$602.51
$915.57
$674.70
$765.80
$862.28
$1205.02
$1831.14
$888.92
$980.02
$1076.50
$1419.24
$1103.14
$1194.24
$1290.72
$1633.46
$1317.36
$1408.46
$1504.94
$1847.68
$551.57
$597.12
$645.36
$816.73
$765.79
$811.34
$859.58
$1030.95
$980.01
$1025.56
$1073.80
$1245.17
$214.22

Plan: (HMO) Prestige Bronze Essential

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-275-1400 - Provider Directory for This Plan: (Network Health Plan)

Deductible: Individual: $5,500 : Family: $11,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$295.35
$335.23
$377.46
$527.50
$801.58
$590.70
$670.46
$754.92
$1055.00
$1603.16
$778.25
$858.01
$942.47
$1242.55
$965.80
$1045.56
$1130.02
$1430.10
$1153.35
$1233.11
$1317.57
$1617.65
$482.90
$522.78
$565.01
$715.05
$670.45
$710.33
$752.56
$902.60
$858.00
$897.88
$940.11
$1090.15
$187.55

Plan: (HMO) Prestige Bronze Standard

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-275-1400 - Provider Directory for This Plan: (Network Health Plan)

Deductible: Individual: $6,650 : Family: $13,300
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$301.92
$342.68
$385.86
$539.23
$819.41
$603.84
$685.36
$771.72
$1078.46
$1638.82
$795.56
$877.08
$963.44
$1270.18
$987.28
$1068.80
$1155.16
$1461.90
$1179.00
$1260.52
$1346.88
$1653.62
$493.64
$534.40
$577.58
$730.95
$685.36
$726.12
$769.30
$922.67
$877.08
$917.84
$961.02
$1114.39
$191.72

Plan: (HMO) Prestige Silver Standard

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-275-1400 - Provider Directory for This Plan: (Network Health Plan)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$351.28
$398.70
$448.93
$627.38
$953.37
$702.56
$797.40
$897.86
$1254.76
$1906.74
$925.62
$1020.46
$1120.92
$1477.82
$1148.68
$1243.52
$1343.98
$1700.88
$1371.74
$1466.58
$1567.04
$1923.94
$574.34
$621.76
$671.99
$850.44
$797.40
$844.82
$895.05
$1073.50
$1020.46
$1067.88
$1118.11
$1296.56
$223.06

Plan: (HMO) Prestige Silver Essential

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-275-1400 - Provider Directory for This Plan: (Network Health Plan)

Deductible: Individual: $2,500 : Family: $5,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$379.13
$430.31
$484.53
$677.12
$1028.95
$758.26
$860.62
$969.06
$1354.24
$2057.90
$999.01
$1101.37
$1209.81
$1594.99
$1239.76
$1342.12
$1450.56
$1835.74
$1480.51
$1582.87
$1691.31
$2076.49
$619.88
$671.06
$725.28
$917.87
$860.63
$911.81
$966.03
$1158.62
$1101.38
$1152.56
$1206.78
$1399.37
$240.75

Plan: (HMO) Prestige Gold Standard

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-275-1400 - Provider Directory for This Plan: (Network Health Plan)

Deductible: Individual: $1,250 : Family: $2,500
Out of Pocket Maximum per year: Individual: $4,750 : Family: $9,500

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$412.40
$468.07
$527.04
$736.53
$1119.23
$824.80
$936.14
$1054.08
$1473.06
$2238.46
$1086.67
$1198.01
$1315.95
$1734.93
$1348.54
$1459.88
$1577.82
$1996.80
$1610.41
$1721.75
$1839.69
$2258.67
$674.27
$729.94
$788.91
$998.40
$936.14
$991.81
$1050.78
$1260.27
$1198.01
$1253.68
$1312.65
$1522.14
$261.87

Plan: (HMO) Prestige Gold Essential

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-275-1400 - Provider Directory for This Plan: (Network Health Plan)

Deductible: Individual: $500 : Family: $1,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$422.92
$480.02
$540.50
$755.34
$1147.81
$845.84
$960.04
$1081.00
$1510.68
$2295.62
$1114.40
$1228.60
$1349.56
$1779.24
$1382.96
$1497.16
$1618.12
$2047.80
$1651.52
$1765.72
$1886.68
$2316.36
$691.48
$748.58
$809.06
$1023.90
$960.04
$1017.14
$1077.62
$1292.46
$1228.60
$1285.70
$1346.18
$1561.02
$268.56
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Common Ground Healthcare Cooperative

Local: 1-877-514-2442 | Toll Free: 1-877-514-2442

TTY: 1-855-643-5001

Plan: (PPO) Envision Aurora Bellin PPO - Gold 1000/90

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)

Deductible: Individual: $1,000 : Family: $2,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$445.80
$505.97
$569.71
$796.17
$1209.86
$891.60
$1011.94
$1139.42
$1592.34
$2419.72
$1174.67
$1295.01
$1422.49
$1875.41
$1457.74
$1578.08
$1705.56
$2158.48
$1740.81
$1861.15
$1988.63
$2441.55
$728.87
$789.04
$852.78
$1079.24
$1011.94
$1072.11
$1135.85
$1362.31
$1295.01
$1355.18
$1418.92
$1645.38
$283.07

Plan: (PPO) Envision Aurora Bellin PPO - Silver 3800/80

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)

Deductible: Individual: $3,800 : Family: $7,600
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$355.77
$403.79
$454.67
$635.39
$965.54
$711.54
$807.58
$909.34
$1270.78
$1931.08
$937.45
$1033.49
$1135.25
$1496.69
$1163.36
$1259.40
$1361.16
$1722.60
$1389.27
$1485.31
$1587.07
$1948.51
$581.68
$629.70
$680.58
$861.30
$807.59
$855.61
$906.49
$1087.21
$1033.50
$1081.52
$1132.40
$1313.12
$225.91

Plan: (PPO) Envision Aurora Bellin PPO - Silver 2500/80/Copy35

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)

Deductible: Individual: $2,500 : Family: $5,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$369.20
$419.03
$471.83
$659.38
$1001.99
$738.40
$838.06
$943.66
$1318.76
$2003.98
$972.84
$1072.50
$1178.10
$1553.20
$1207.28
$1306.94
$1412.54
$1787.64
$1441.72
$1541.38
$1646.98
$2022.08
$603.64
$653.47
$706.27
$893.82
$838.08
$887.91
$940.71
$1128.26
$1072.52
$1122.35
$1175.15
$1362.70
$234.44

Plan: (PPO) Envision Aurora Bellin PPO - Silver 2400/80

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)

Deductible: Individual: $2,400 : Family: $4,800
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$368.64
$418.40
$471.11
$658.38
$1000.47
$737.28
$836.80
$942.22
$1316.76
$2000.94
$971.36
$1070.88
$1176.30
$1550.84
$1205.44
$1304.96
$1410.38
$1784.92
$1439.52
$1539.04
$1644.46
$2019.00
$602.72
$652.48
$705.19
$892.46
$836.80
$886.56
$939.27
$1126.54
$1070.88
$1120.64
$1173.35
$1360.62
$234.08

Plan: (PPO) Envision Aurora Bellin PPO - Silver 2000/70

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $7,000 : Family: $14,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$358.00
$406.32
$457.52
$639.38
$971.59
$716.00
$812.64
$915.04
$1278.76
$1943.18
$943.33
$1039.97
$1142.37
$1506.09
$1170.66
$1267.30
$1369.70
$1733.42
$1397.99
$1494.63
$1597.03
$1960.75
$585.33
$633.65
$684.85
$866.71
$812.66
$860.98
$912.18
$1094.04
$1039.99
$1088.31
$1139.51
$1321.37
$227.33

Plan: (PPO) Envision Aurora Bellin PPO - Catastrophic 7150/100

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Catastrophic 21
30
40
50
60
$238.75
$270.97
$305.11
$426.39
$647.94
$477.50
$541.94
$610.22
$852.78
$1295.88
$629.10
$693.54
$761.82
$1004.38
$780.70
$845.14
$913.42
$1155.98
$932.30
$996.74
$1065.02
$1307.58
$390.35
$422.57
$456.71
$577.99
$541.95
$574.17
$608.31
$729.59
$693.55
$725.77
$759.91
$881.19
$151.60

Plan: (PPO) Envision Aurora Bellin PPO - HSA Silver 3000/80

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)

Deductible: Individual: $3,000 : Family: $6,000
Out of Pocket Maximum per year: Individual: $5,600 : Family: $11,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$367.98
$417.64
$470.26
$657.19
$998.67
$735.96
$835.28
$940.52
$1314.38
$1997.34
$969.62
$1068.94
$1174.18
$1548.04
$1203.28
$1302.60
$1407.84
$1781.70
$1436.94
$1536.26
$1641.50
$2015.36
$601.64
$651.30
$703.92
$890.85
$835.30
$884.96
$937.58
$1124.51
$1068.96
$1118.62
$1171.24
$1358.17
$233.66

Plan: (PPO) Envision Aurora Bellin PPO - HSA Bronze 6500/100

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$296.00
$335.95
$378.28
$528.64
$803.32
$592.00
$671.90
$756.56
$1057.28
$1606.64
$779.95
$859.85
$944.51
$1245.23
$967.90
$1047.80
$1132.46
$1433.18
$1155.85
$1235.75
$1320.41
$1621.13
$483.95
$523.90
$566.23
$716.59
$671.90
$711.85
$754.18
$904.54
$859.85
$899.80
$942.13
$1092.49
$187.95

Plan: (PPO) Envision Aurora Bellin PPO - Silver 3500/80

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$364.63
$413.84
$465.98
$651.21
$989.58
$729.26
$827.68
$931.96
$1302.42
$1979.16
$960.79
$1059.21
$1163.49
$1533.95
$1192.32
$1290.74
$1395.02
$1765.48
$1423.85
$1522.27
$1626.55
$1997.01
$596.16
$645.37
$697.51
$882.74
$827.69
$876.90
$929.04
$1114.27
$1059.22
$1108.43
$1160.57
$1345.80
$231.53

Plan: (PPO) Envision Aurora Bellin PPO - Silver 5200/80

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)

Deductible: Individual: $5,200 : Family: $10,400
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$293.67
$333.30
$375.29
$524.47
$796.99
$587.34
$666.60
$750.58
$1048.94
$1593.98
$773.81
$853.07
$937.05
$1235.41
$960.28
$1039.54
$1123.52
$1421.88
$1146.75
$1226.01
$1309.99
$1608.35
$480.14
$519.77
$561.76
$710.94
$666.61
$706.24
$748.23
$897.41
$853.08
$892.71
$934.70
$1083.88
$186.47