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Providers for Zip Code 54521

Obamacare 2017 Marketplace Rates For Vilas County, Wisconsin

Saturday, December 10th, 2016

Click for Eagle River, Wisconsin Forecast

Obamacare Providers, Plans and 2017 Rates for Vilas 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 Vilas County, Wisconsin.

Currently, there are 43 plans offered in Vilas 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 Vilas 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 Eagle River, 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 Vilas County here.

Security Health Plan of Wisconsin, Inc.

Local: 1-715-221-9258 x19258 | Toll Free: 1-844-293-9624

TTY: 1-877-727-2232

Plan: (HMO) Classic $1,500 - 20%

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-293-9624 - Provider Directory for This Plan: (Security Health Plan of Wisconsin, Inc.)

Deductible: Individual: $1,500 : Family: $3,000
Out of Pocket Maximum per year: Individual: $3,500 : Family: $7,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$471.48
$535.12
$602.54
$842.05
$1279.57
$942.96
$1070.24
$1205.08
$1684.10
$2559.14
$1242.34
$1369.62
$1504.46
$1983.48
$1541.72
$1669.00
$1803.84
$2282.86
$1841.10
$1968.38
$2103.22
$2582.24
$770.86
$834.50
$901.92
$1141.43
$1070.24
$1133.88
$1201.30
$1440.81
$1369.62
$1433.26
$1500.68
$1740.19
$299.38

Plan: (HMO) Classic $3,750 HDHP

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-293-9624 - Provider Directory for This Plan: (Security Health Plan of Wisconsin, Inc.)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$415.60
$471.70
$531.13
$742.25
$1127.92
$831.20
$943.40
$1062.26
$1484.50
$2255.84
$1095.10
$1207.30
$1326.16
$1748.40
$1359.00
$1471.20
$1590.06
$2012.30
$1622.90
$1735.10
$1853.96
$2276.20
$679.50
$735.60
$795.03
$1006.15
$943.40
$999.50
$1058.93
$1270.05
$1207.30
$1263.40
$1322.83
$1533.95
$263.90

Plan: (HMO) Classic $2,500 - 20%

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-293-9624 - Provider Directory for This Plan: (Security Health Plan of Wisconsin, Inc.)

Deductible: Individual: $2,500 : Family: $5,000
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$390.81
$443.56
$499.44
$697.97
$1060.63
$781.62
$887.12
$998.88
$1395.94
$2121.26
$1029.78
$1135.28
$1247.04
$1644.10
$1277.94
$1383.44
$1495.20
$1892.26
$1526.10
$1631.60
$1743.36
$2140.42
$638.97
$691.72
$747.60
$946.13
$887.13
$939.88
$995.76
$1194.29
$1135.29
$1188.04
$1243.92
$1442.45
$248.16

Plan: (HMO) Classic $2,000 - 30%

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-293-9624 - Provider Directory for This Plan: (Security Health Plan of Wisconsin, Inc.)

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$390.15
$442.81
$498.59
$696.78
$1058.83
$780.30
$885.62
$997.18
$1393.56
$2117.66
$1028.04
$1133.36
$1244.92
$1641.30
$1275.78
$1381.10
$1492.66
$1889.04
$1523.52
$1628.84
$1740.40
$2136.78
$637.89
$690.55
$746.33
$944.52
$885.63
$938.29
$994.07
$1192.26
$1133.37
$1186.03
$1241.81
$1440.00
$247.74

Plan: (HMO) Classic $6,000 HDHP

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-293-9624 - Provider Directory for This Plan: (Security Health Plan of Wisconsin, Inc.)

Deductible: Individual: $6,000 : Family: $12,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$330.63
$375.26
$422.54
$590.50
$897.31
$661.26
$750.52
$845.08
$1181.00
$1794.62
$871.21
$960.47
$1055.03
$1390.95
$1081.16
$1170.42
$1264.98
$1600.90
$1291.11
$1380.37
$1474.93
$1810.85
$540.58
$585.21
$632.49
$800.45
$750.53
$795.16
$842.44
$1010.40
$960.48
$1005.11
$1052.39
$1220.35
$209.95

Plan: (HMO) Classic $5,500 HDHP

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-293-9624 - Provider Directory for This Plan: (Security Health Plan of Wisconsin, Inc.)

Deductible: Individual: $5,500 : Family: $11,000
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
$340.55
$386.52
$435.21
$608.21
$924.23
$681.10
$773.04
$870.42
$1216.42
$1848.46
$897.34
$989.28
$1086.66
$1432.66
$1113.58
$1205.52
$1302.90
$1648.90
$1329.82
$1421.76
$1519.14
$1865.14
$556.79
$602.76
$651.45
$824.45
$773.03
$819.00
$867.69
$1040.69
$989.27
$1035.24
$1083.93
$1256.93
$216.24

Plan: (HMO) Classic Protection

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-293-9624 - Provider Directory for This Plan: (Security Health Plan of Wisconsin, Inc.)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Catastrophic 21
30
40
50
60
$224.83
$255.18
$287.33
$401.54
$610.17
$449.66
$510.36
$574.66
$803.08
$1220.34
$592.42
$653.12
$717.42
$945.84
$735.18
$795.88
$860.18
$1088.60
$877.94
$938.64
$1002.94
$1231.36
$367.59
$397.94
$430.09
$544.30
$510.35
$540.70
$572.85
$687.06
$653.11
$683.46
$715.61
$829.82
$142.76

Plan: (HMO) Classic $4,500 - 30%

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-293-9624 - Provider Directory for This Plan: (Security Health Plan of Wisconsin, Inc.)

Deductible: Individual: $4,500 : Family: $9,000
Out of Pocket Maximum per year: Individual: $6,400 : Family: $12,800

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$387.17
$439.43
$494.79
$691.47
$1050.76
$774.34
$878.86
$989.58
$1382.94
$2101.52
$1020.19
$1124.71
$1235.43
$1628.79
$1266.04
$1370.56
$1481.28
$1874.64
$1511.89
$1616.41
$1727.13
$2120.49
$633.02
$685.28
$740.64
$937.32
$878.87
$931.13
$986.49
$1183.17
$1124.72
$1176.98
$1232.34
$1429.02
$245.85

Plan: (HMO) Classic $6,500 HDHP

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-293-9624 - Provider Directory for This Plan: (Security Health Plan of Wisconsin, Inc.)

Deductible: Individual: $6,500 : Family: $13,000
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$316.42
$359.12
$404.37
$565.10
$858.73
$632.84
$718.24
$808.74
$1130.20
$1717.46
$833.76
$919.16
$1009.66
$1331.12
$1034.68
$1120.08
$1210.58
$1532.04
$1235.60
$1321.00
$1411.50
$1732.96
$517.34
$560.04
$605.29
$766.02
$718.26
$760.96
$806.21
$966.94
$919.18
$961.88
$1007.13
$1167.86
$200.92

Plan: (HMO) Classic $7,150

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-293-9624 - Provider Directory for This Plan: (Security Health Plan of Wisconsin, Inc.)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$306.50
$347.86
$391.69
$547.39
$831.81
$613.00
$695.72
$783.38
$1094.78
$1663.62
$807.62
$890.34
$978.00
$1289.40
$1002.24
$1084.96
$1172.62
$1484.02
$1196.86
$1279.58
$1367.24
$1678.64
$501.12
$542.48
$586.31
$742.01
$695.74
$737.10
$780.93
$936.63
$890.36
$931.72
$975.55
$1131.25
$194.62

Plan: (HMO) Classic $5,500 - 30%

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-293-9624 - Provider Directory for This Plan: (Security Health Plan of Wisconsin, Inc.)

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
Silver 21
30
40
50
60
$372.95
$423.29
$476.62
$666.08
$1012.17
$745.90
$846.58
$953.24
$1332.16
$2024.34
$982.72
$1083.40
$1190.06
$1568.98
$1219.54
$1320.22
$1426.88
$1805.80
$1456.36
$1557.04
$1663.70
$2042.62
$609.77
$660.11
$713.44
$902.90
$846.59
$896.93
$950.26
$1139.72
$1083.41
$1133.75
$1187.08
$1376.54
$236.82

Plan: (EPO) Select $1,500 - 20%

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-293-9624 - Provider Directory for This Plan: (Security Health Plan of Wisconsin, Inc.)

Deductible: Individual: $1,500 : Family: $3,000
Out of Pocket Maximum per year: Individual: $3,500 : Family: $7,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$385.19
$437.18
$492.26
$687.93
$1045.37
$770.38
$874.36
$984.52
$1375.86
$2090.74
$1014.97
$1118.95
$1229.11
$1620.45
$1259.56
$1363.54
$1473.70
$1865.04
$1504.15
$1608.13
$1718.29
$2109.63
$629.78
$681.77
$736.85
$932.52
$874.37
$926.36
$981.44
$1177.11
$1118.96
$1170.95
$1226.03
$1421.70
$244.59

Plan: (EPO) Select $3,750 HDHP

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-293-9624 - Provider Directory for This Plan: (Security Health Plan of Wisconsin, Inc.)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$339.56
$385.39
$433.95
$606.44
$921.54
$679.12
$770.78
$867.90
$1212.88
$1843.08
$894.74
$986.40
$1083.52
$1428.50
$1110.36
$1202.02
$1299.14
$1644.12
$1325.98
$1417.64
$1514.76
$1859.74
$555.18
$601.01
$649.57
$822.06
$770.80
$816.63
$865.19
$1037.68
$986.42
$1032.25
$1080.81
$1253.30
$215.62

Plan: (EPO) Select $2,500 - 20%

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-293-9624 - Provider Directory for This Plan: (Security Health Plan of Wisconsin, Inc.)

Deductible: Individual: $2,500 : Family: $5,000
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$319.39
$362.50
$408.17
$570.42
$866.81
$638.78
$725.00
$816.34
$1140.84
$1733.62
$841.59
$927.81
$1019.15
$1343.65
$1044.40
$1130.62
$1221.96
$1546.46
$1247.21
$1333.43
$1424.77
$1749.27
$522.20
$565.31
$610.98
$773.23
$725.01
$768.12
$813.79
$976.04
$927.82
$970.93
$1016.60
$1178.85
$202.81

Plan: (EPO) Select $2,000 - 30%

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-293-9624 - Provider Directory for This Plan: (Security Health Plan of Wisconsin, Inc.)

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$318.73
$361.75
$407.33
$569.24
$865.01
$637.46
$723.50
$814.66
$1138.48
$1730.02
$839.85
$925.89
$1017.05
$1340.87
$1042.24
$1128.28
$1219.44
$1543.26
$1244.63
$1330.67
$1421.83
$1745.65
$521.12
$564.14
$609.72
$771.63
$723.51
$766.53
$812.11
$974.02
$925.90
$968.92
$1014.50
$1176.41
$202.39

Plan: (EPO) Select $6,000 HDHP

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-293-9624 - Provider Directory for This Plan: (Security Health Plan of Wisconsin, Inc.)

Deductible: Individual: $6,000 : Family: $12,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$270.13
$306.59
$345.21
$482.43
$733.11
$540.26
$613.18
$690.42
$964.86
$1466.22
$711.79
$784.71
$861.95
$1136.39
$883.32
$956.24
$1033.48
$1307.92
$1054.85
$1127.77
$1205.01
$1479.45
$441.66
$478.12
$516.74
$653.96
$613.19
$649.65
$688.27
$825.49
$784.72
$821.18
$859.80
$997.02
$171.53

Plan: (EPO) Select $5,500 HDHP

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-293-9624 - Provider Directory for This Plan: (Security Health Plan of Wisconsin, Inc.)

Deductible: Individual: $5,500 : Family: $11,000
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
$278.40
$315.97
$355.78
$497.20
$755.54
$556.80
$631.94
$711.56
$994.40
$1511.08
$733.58
$808.72
$888.34
$1171.18
$910.36
$985.50
$1065.12
$1347.96
$1087.14
$1162.28
$1241.90
$1524.74
$455.18
$492.75
$532.56
$673.98
$631.96
$669.53
$709.34
$850.76
$808.74
$846.31
$886.12
$1027.54
$176.78

Plan: (EPO) Select Protection

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-293-9624 - Provider Directory for This Plan: (Security Health Plan of Wisconsin, Inc.)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Catastrophic 21
30
40
50
60
$183.51
$208.27
$234.51
$327.72
$498.01
$367.02
$416.54
$469.02
$655.44
$996.02
$483.54
$533.06
$585.54
$771.96
$600.06
$649.58
$702.06
$888.48
$716.58
$766.10
$818.58
$1005.00
$300.03
$324.79
$351.03
$444.24
$416.55
$441.31
$467.55
$560.76
$533.07
$557.83
$584.07
$677.28
$116.52

Plan: (EPO) Select $4,500 - 30%

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-293-9624 - Provider Directory for This Plan: (Security Health Plan of Wisconsin, Inc.)

Deductible: Individual: $4,500 : Family: $9,000
Out of Pocket Maximum per year: Individual: $6,400 : Family: $12,800

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$316.42
$359.12
$404.37
$565.10
$858.73
$632.84
$718.24
$808.74
$1130.20
$1717.46
$833.76
$919.16
$1009.66
$1331.12
$1034.68
$1120.08
$1210.58
$1532.04
$1235.60
$1321.00
$1411.50
$1732.96
$517.34
$560.04
$605.29
$766.02
$718.26
$760.96
$806.21
$966.94
$919.18
$961.88
$1007.13
$1167.86
$200.92

Plan: (EPO) Select $6,500 HDHP

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-293-9624 - Provider Directory for This Plan: (Security Health Plan of Wisconsin, Inc.)

Deductible: Individual: $6,500 : Family: $13,000
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$258.56
$293.45
$330.42
$461.77
$701.70
$517.12
$586.90
$660.84
$923.54
$1403.40
$681.30
$751.08
$825.02
$1087.72
$845.48
$915.26
$989.20
$1251.90
$1009.66
$1079.44
$1153.38
$1416.08
$422.74
$457.63
$494.60
$625.95
$586.92
$621.81
$658.78
$790.13
$751.10
$785.99
$822.96
$954.31
$164.18

Plan: (EPO) Select $7,150

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-293-9624 - Provider Directory for This Plan: (Security Health Plan of Wisconsin, Inc.)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$250.62
$284.45
$320.28
$447.60
$680.16
$501.24
$568.90
$640.56
$895.20
$1360.32
$660.38
$728.04
$799.70
$1054.34
$819.52
$887.18
$958.84
$1213.48
$978.66
$1046.32
$1117.98
$1372.62
$409.76
$443.59
$479.42
$606.74
$568.90
$602.73
$638.56
$765.88
$728.04
$761.87
$797.70
$925.02
$159.14

Plan: (EPO) Select $5,500 - 30%

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-293-9624 - Provider Directory for This Plan: (Security Health Plan of Wisconsin, Inc.)

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
Silver 21
30
40
50
60
$304.85
$345.99
$389.58
$544.44
$827.32
$609.70
$691.98
$779.16
$1088.88
$1654.64
$803.27
$885.55
$972.73
$1282.45
$996.84
$1079.12
$1166.30
$1476.02
$1190.41
$1272.69
$1359.87
$1669.59
$498.42
$539.56
$583.15
$738.01
$691.99
$733.13
$776.72
$931.58
$885.56
$926.70
$970.29
$1125.15
$193.57

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
$343.06
$389.37
$438.43
$612.71
$931.07
$686.12
$778.74
$876.86
$1225.42
$1862.14
$903.96
$996.58
$1094.70
$1443.26
$1121.80
$1214.42
$1312.54
$1661.10
$1339.64
$1432.26
$1530.38
$1878.94
$560.90
$607.21
$656.27
$830.55
$778.74
$825.05
$874.11
$1048.39
$996.58
$1042.89
$1091.95
$1266.23
$217.84

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
$268.93
$305.23
$343.69
$480.30
$729.87
$537.86
$610.46
$687.38
$960.60
$1459.74
$708.63
$781.23
$858.15
$1131.37
$879.40
$952.00
$1028.92
$1302.14
$1050.17
$1122.77
$1199.69
$1472.91
$439.70
$476.00
$514.46
$651.07
$610.47
$646.77
$685.23
$821.84
$781.24
$817.54
$856.00
$992.61
$170.77

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
$230.00
$261.04
$293.93
$410.77
$624.21
$460.00
$522.08
$587.86
$821.54
$1248.42
$606.05
$668.13
$733.91
$967.59
$752.10
$814.18
$879.96
$1113.64
$898.15
$960.23
$1026.01
$1259.69
$376.05
$407.09
$439.98
$556.82
$522.10
$553.14
$586.03
$702.87
$668.15
$699.19
$732.08
$848.92
$146.05

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
$271.44
$308.08
$346.90
$484.79
$736.68
$542.88
$616.16
$693.80
$969.58
$1473.36
$715.24
$788.52
$866.16
$1141.94
$887.60
$960.88
$1038.52
$1314.30
$1059.96
$1133.24
$1210.88
$1486.66
$443.80
$480.44
$519.26
$657.15
$616.16
$652.80
$691.62
$829.51
$788.52
$825.16
$863.98
$1001.87
$172.36

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
$236.65
$268.59
$302.43
$422.65
$642.26
$473.30
$537.18
$604.86
$845.30
$1284.52
$623.57
$687.45
$755.13
$995.57
$773.84
$837.72
$905.40
$1145.84
$924.11
$987.99
$1055.67
$1296.11
$386.92
$418.86
$452.70
$572.92
$537.19
$569.13
$602.97
$723.19
$687.46
$719.40
$753.24
$873.46
$150.27

Aspirus Arise Health Plan of Wisconsin, Inc.

Local: 1-715-972-8140 | Toll Free: 1-800-332-6290

TTY: 1-888-332-0144

Plan: (HMO) HMO Bronze 7150

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-332-6290 - Provider Directory for This Plan: (Aspirus Arise Health Plan of Wisconsin, Inc.)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$269.68
$306.09
$344.65
$481.65
$731.91
$539.36
$612.18
$689.30
$963.30
$1463.82
$710.61
$783.43
$860.55
$1134.55
$881.86
$954.68
$1031.80
$1305.80
$1053.11
$1125.93
$1203.05
$1477.05
$440.93
$477.34
$515.90
$652.90
$612.18
$648.59
$687.15
$824.15
$783.43
$819.84
$858.40
$995.40
$171.25

Plan: (HMO) HMO Silver 7000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-332-6290 - Provider Directory for This Plan: (Aspirus Arise Health Plan of Wisconsin, Inc.)

Deductible: Individual: $7,000 : Family: $14,000
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
$331.95
$376.76
$424.23
$592.86
$900.91
$663.90
$753.52
$848.46
$1185.72
$1801.82
$874.69
$964.31
$1059.25
$1396.51
$1085.48
$1175.10
$1270.04
$1607.30
$1296.27
$1385.89
$1480.83
$1818.09
$542.74
$587.55
$635.02
$803.65
$753.53
$798.34
$845.81
$1014.44
$964.32
$1009.13
$1056.60
$1225.23
$210.79

Plan: (HMO) HMO Silver 4500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-332-6290 - Provider Directory for This Plan: (Aspirus Arise Health Plan of Wisconsin, Inc.)

Deductible: Individual: $4,500 : Family: $9,000
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
$344.78
$391.33
$440.63
$615.78
$935.73
$689.56
$782.66
$881.26
$1231.56
$1871.46
$908.50
$1001.60
$1100.20
$1450.50
$1127.44
$1220.54
$1319.14
$1669.44
$1346.38
$1439.48
$1538.08
$1888.38
$563.72
$610.27
$659.57
$834.72
$782.66
$829.21
$878.51
$1053.66
$1001.60
$1048.15
$1097.45
$1272.60
$218.94

Plan: (HMO) HMO HDHP Bronze 5500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-332-6290 - Provider Directory for This Plan: (Aspirus Arise Health Plan of Wisconsin, Inc.)

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
$280.31
$318.15
$358.24
$500.63
$760.76
$560.62
$636.30
$716.48
$1001.26
$1521.52
$738.62
$814.30
$894.48
$1179.26
$916.62
$992.30
$1072.48
$1357.26
$1094.62
$1170.30
$1250.48
$1535.26
$458.31
$496.15
$536.24
$678.63
$636.31
$674.15
$714.24
$856.63
$814.31
$852.15
$892.24
$1034.63
$178.00

Plan: (HMO) HMO HDHP Silver 2700

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-332-6290 - Provider Directory for This Plan: (Aspirus Arise Health Plan of Wisconsin, Inc.)

Deductible: Individual: $2,700 : Family: $5,400
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
$339.62
$385.47
$434.03
$606.56
$921.73
$679.24
$770.94
$868.06
$1213.12
$1843.46
$894.90
$986.60
$1083.72
$1428.78
$1110.56
$1202.26
$1299.38
$1644.44
$1326.22
$1417.92
$1515.04
$1860.10
$555.28
$601.13
$649.69
$822.22
$770.94
$816.79
$865.35
$1037.88
$986.60
$1032.45
$1081.01
$1253.54
$215.66

Plan: (HMO) HMO Bronze 6250

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-332-6290 - Provider Directory for This Plan: (Aspirus Arise Health Plan of Wisconsin, Inc.)

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
$275.08
$312.22
$351.55
$491.29
$746.57
$550.16
$624.44
$703.10
$982.58
$1493.14
$724.84
$799.12
$877.78
$1157.26
$899.52
$973.80
$1052.46
$1331.94
$1074.20
$1148.48
$1227.14
$1506.62
$449.76
$486.90
$526.23
$665.97
$624.44
$661.58
$700.91
$840.65
$799.12
$836.26
$875.59
$1015.33
$174.68

Plan: (HMO) HMO Gold 2000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-332-6290 - Provider Directory for This Plan: (Aspirus Arise Health Plan of Wisconsin, Inc.)

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $3,850 : Family: $7,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$517.24
$587.07
$661.03
$923.79
$1403.79
$1034.48
$1174.14
$1322.06
$1847.58
$2807.58
$1362.93
$1502.59
$1650.51
$2176.03
$1691.38
$1831.04
$1978.96
$2504.48
$2019.83
$2159.49
$2307.41
$2832.93
$845.69
$915.52
$989.48
$1252.24
$1174.14
$1243.97
$1317.93
$1580.69
$1502.59
$1572.42
$1646.38
$1909.14
$328.45

Plan: (HMO) HMO Catastrophic 7150

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-332-6290 - Provider Directory for This Plan: (Aspirus Arise Health Plan of Wisconsin, Inc.)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Catastrophic 21
30
40
50
60
$236.57
$268.51
$302.34
$422.51
$642.05
$473.14
$537.02
$604.68
$845.02
$1284.10
$623.36
$687.24
$754.90
$995.24
$773.58
$837.46
$905.12
$1145.46
$923.80
$987.68
$1055.34
$1295.68
$386.79
$418.73
$452.56
$572.73
$537.01
$568.95
$602.78
$722.95
$687.23
$719.17
$753.00
$873.17
$150.22

Plan: (HMO) HMO HDHP Bronze 6550

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-332-6290 - Provider Directory for This Plan: (Aspirus Arise Health Plan of Wisconsin, Inc.)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$274.27
$311.30
$350.52
$489.85
$744.37
$548.54
$622.60
$701.04
$979.70
$1488.74
$722.70
$796.76
$875.20
$1153.86
$896.86
$970.92
$1049.36
$1328.02
$1071.02
$1145.08
$1223.52
$1502.18
$448.43
$485.46
$524.68
$664.01
$622.59
$659.62
$698.84
$838.17
$796.75
$833.78
$873.00
$1012.33
$174.16

Plan: (HMO) HMO HDHP Silver 4000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-332-6290 - Provider Directory for This Plan: (Aspirus Arise Health Plan of Wisconsin, Inc.)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$343.04
$389.35
$438.41
$612.67
$931.01
$686.08
$778.70
$876.82
$1225.34
$1862.02
$903.91
$996.53
$1094.65
$1443.17
$1121.74
$1214.36
$1312.48
$1661.00
$1339.57
$1432.19
$1530.31
$1878.83
$560.87
$607.18
$656.24
$830.50
$778.70
$825.01
$874.07
$1048.33
$996.53
$1042.84
$1091.90
$1266.16
$217.83

Plan: (HMO) HMO STANDARD Bronze 6650

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-332-6290 - Provider Directory for This Plan: (Aspirus Arise Health Plan 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
$279.33
$317.04
$356.98
$498.88
$758.10
$558.66
$634.08
$713.96
$997.76
$1516.20
$736.03
$811.45
$891.33
$1175.13
$913.40
$988.82
$1068.70
$1352.50
$1090.77
$1166.19
$1246.07
$1529.87
$456.70
$494.41
$534.35
$676.25
$634.07
$671.78
$711.72
$853.62
$811.44
$849.15
$889.09
$1030.99
$177.37

Plan: (HMO) HMO STANDARD Silver 3500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-332-6290 - Provider Directory for This Plan: (Aspirus Arise Health Plan 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
$340.95
$386.98
$435.73
$608.94
$925.34
$681.90
$773.96
$871.46
$1217.88
$1850.68
$898.40
$990.46
$1087.96
$1434.38
$1114.90
$1206.96
$1304.46
$1650.88
$1331.40
$1423.46
$1520.96
$1867.38
$557.45
$603.48
$652.23
$825.44
$773.95
$819.98
$868.73
$1041.94
$990.45
$1036.48
$1085.23
$1258.44
$216.50

Plan: (POS) POS Silver 7000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-332-6290 - Provider Directory for This Plan: (Aspirus Arise Health Plan of Wisconsin, Inc.)

Deductible: Individual: $7,000 : Family: $14,000
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
$365.17
$414.47
$466.69
$652.19
$991.07
$730.34
$828.94
$933.38
$1304.38
$1982.14
$962.22
$1060.82
$1165.26
$1536.26
$1194.10
$1292.70
$1397.14
$1768.14
$1425.98
$1524.58
$1629.02
$2000.02
$597.05
$646.35
$698.57
$884.07
$828.93
$878.23
$930.45
$1115.95
$1060.81
$1110.11
$1162.33
$1347.83
$231.88

Plan: (POS) POS Silver 4500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-332-6290 - Provider Directory for This Plan: (Aspirus Arise Health Plan of Wisconsin, Inc.)

Deductible: Individual: $4,500 : Family: $9,000
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
$379.28
$430.48
$484.72
$677.39
$1029.37
$758.56
$860.96
$969.44
$1354.78
$2058.74
$999.40
$1101.80
$1210.28
$1595.62
$1240.24
$1342.64
$1451.12
$1836.46
$1481.08
$1583.48
$1691.96
$2077.30
$620.12
$671.32
$725.56
$918.23
$860.96
$912.16
$966.40
$1159.07
$1101.80
$1153.00
$1207.24
$1399.91
$240.84

Plan: (POS) POS HDHP Bronze 5500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-332-6290 - Provider Directory for This Plan: (Aspirus Arise Health Plan of Wisconsin, Inc.)

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
$308.37
$350.00
$394.10
$550.75
$836.92
$616.74
$700.00
$788.20
$1101.50
$1673.84
$812.55
$895.81
$984.01
$1297.31
$1008.36
$1091.62
$1179.82
$1493.12
$1204.17
$1287.43
$1375.63
$1688.93
$504.18
$545.81
$589.91
$746.56
$699.99
$741.62
$785.72
$942.37
$895.80
$937.43
$981.53
$1138.18
$195.81

Plan: (POS) POS HDHP Silver 2700

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-332-6290 - Provider Directory for This Plan: (Aspirus Arise Health Plan of Wisconsin, Inc.)

Deductible: Individual: $2,700 : Family: $5,400
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
$375.86
$426.60
$480.35
$671.29
$1020.08
$751.72
$853.20
$960.70
$1342.58
$2040.16
$990.39
$1091.87
$1199.37
$1581.25
$1229.06
$1330.54
$1438.04
$1819.92
$1467.73
$1569.21
$1676.71
$2058.59
$614.53
$665.27
$719.02
$909.96
$853.20
$903.94
$957.69
$1148.63
$1091.87
$1142.61
$1196.36
$1387.30
$238.67