Waushara County, Wisconsin Obamacare 2024 Rates
ADVERTISEMENT
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 Waushara County, WI.
The health insurance rates listed below are for calendar year 2024.
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, 91 Plans and 2024 Rates for Waushara County, Wisconsin
Below, you’ll find a summary of the 91 plans for Waushara County, Wisconsin and rates for each of these providers.‡ This chart is designed to give you a preview of your health insurance options.
Obamacare Rates and Providers for Other Years
2014 | 2015 | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 | 2022 | 2023 | 2024 |
ADVERTISEMENT
HealthPartnersLocal: 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$497.10 $564.21 $635.29 $887.82 $1,349.13 |
$877.38 $944.49 $1,015.57 $1,268.10 |
$1,257.66 $1,324.77 $1,395.85 $1,648.38 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$994.20 $1,128.42 $1,270.58 $1,775.64 $2,698.26 |
$1,374.48 $1,508.70 $1,650.86 $2,155.92 |
$1,754.76 $1,888.98 $2,031.14 $2,536.20 |
Toc - Plan #2 HealthPartners | ||||||||||||||||||||
Gold
(PPO) Robin Oak $1,500 w/Copay P-S Gold |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$480.50 $545.37 $614.08 $858.17 $1,304.08 |
$848.08 $912.95 $981.66 $1,225.75 |
$1,215.66 $1,280.53 $1,349.24 $1,593.33 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$961.00 $1,090.74 $1,228.16 $1,716.34 $2,608.16 |
$1,328.58 $1,458.32 $1,595.74 $2,083.92 |
$1,696.16 $1,825.90 $1,963.32 $2,451.50 |
Toc - Plan #3 HealthPartners | ||||||||||||||||||||
Silver
(PPO) Robin Select $3,600 Plus Silver |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$386.77 $438.98 $494.29 $690.77 $1,049.69 |
$682.65 $734.86 $790.17 $986.65 |
$978.53 $1,030.74 $1,086.05 $1,282.53 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$773.54 $877.96 $988.58 $1,381.54 $2,099.38 |
$1,069.42 $1,173.84 $1,284.46 $1,677.42 |
$1,365.30 $1,469.72 $1,580.34 $1,973.30 |
Toc - Plan #4 HealthPartners | ||||||||||||||||||||
Silver
(PPO) Robin Select $5,900 w/Copay P-S Silver |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$386.40 $438.56 $493.82 $690.11 $1,048.69 |
$682.00 $734.16 $789.42 $985.71 |
$977.60 $1,029.76 $1,085.02 $1,281.31 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$772.80 $877.12 $987.64 $1,380.22 $2,097.38 |
$1,068.40 $1,172.72 $1,283.24 $1,675.82 |
$1,364.00 $1,468.32 $1,578.84 $1,971.42 |
Toc - Plan #5 HealthPartners | ||||||||||||||||||||
Expanded Bronze
(PPO) Robin Select $6,350 Plus Bronze |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$297.55 $337.72 $380.27 $531.42 $807.55 |
$525.18 $565.35 $607.90 $759.05 |
$752.81 $792.98 $835.53 $986.68 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$595.10 $675.44 $760.54 $1,062.84 $1,615.10 |
$822.73 $903.07 $988.17 $1,290.47 |
$1,050.36 $1,130.70 $1,215.80 $1,518.10 |
Toc - Plan #6 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$300.05 $340.56 $383.46 $535.89 $814.34 |
$529.59 $570.10 $613.00 $765.43 |
$759.13 $799.64 $842.54 $994.97 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$600.10 $681.12 $766.92 $1,071.78 $1,628.68 |
$829.64 $910.66 $996.46 $1,301.32 |
$1,059.18 $1,140.20 $1,226.00 $1,530.86 |
Toc - Plan #7 HealthPartners | ||||||||||||||||||||
Silver
(PPO) Robin Select $3,800 HSA Silver |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$376.56 $427.40 $481.24 $672.54 $1,021.98 |
$664.63 $715.47 $769.31 $960.61 |
$952.70 $1,003.54 $1,057.38 $1,248.68 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$753.12 $854.80 $962.48 $1,345.08 $2,043.96 |
$1,041.19 $1,142.87 $1,250.55 $1,633.15 |
$1,329.26 $1,430.94 $1,538.62 $1,921.22 |
Toc - Plan #8 HealthPartners | ||||||||||||||||||||
Expanded Bronze
(PPO) Robin Select $8,000 HSA Bronze |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$284.47 $322.87 $363.55 $508.06 $772.05 |
$502.09 $540.49 $581.17 $725.68 |
$719.71 $758.11 $798.79 $943.30 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$568.94 $645.74 $727.10 $1,016.12 $1,544.10 |
$786.56 $863.36 $944.72 $1,233.74 |
$1,004.18 $1,080.98 $1,162.34 $1,451.36 |
Toc - Plan #9 HealthPartners | ||||||||||||||||||||
Catastrophic
(PPO) Robin Select $9,450 Catastrophic |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$225.34 $255.76 $287.98 $402.46 $611.57 |
$397.73 $428.15 $460.37 $574.85 |
$570.12 $600.54 $632.76 $747.24 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$450.68 $511.52 $575.96 $804.92 $1,223.14 |
$623.07 $683.91 $748.35 $977.31 |
$795.46 $856.30 $920.74 $1,149.70 |
ADVERTISEMENT
QuartzLocal: 1-608-644-3430 | Toll Free: 1-800-362-3310 | TTY: 1-800-877-8973 |
Toc - Plan #10 Quartz | ||||||||||||||||||||
Gold
(HMO) QUARTZ ONE GOLD I402 MAINTENANCE VALUE TIER RX W/DENTAL |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$497.68 $564.87 $636.03 $888.85 $1,350.70 |
$878.40 $945.59 $1,016.75 $1,269.57 |
$1,259.12 $1,326.31 $1,397.47 $1,650.29 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$995.36 $1,129.74 $1,272.06 $1,777.70 $2,701.40 |
$1,376.08 $1,510.46 $1,652.78 $2,158.42 |
$1,756.80 $1,891.18 $2,033.50 $2,539.14 |
Toc - Plan #11 Quartz | ||||||||||||||||||||
Gold
(HMO) QUARTZ ONE GOLD I410 STANDARD W/DENTAL |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$501.56 $569.26 $640.99 $895.78 $1,361.22 |
$885.25 $952.95 $1,024.68 $1,279.47 |
$1,268.94 $1,336.64 $1,408.37 $1,663.16 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,003.12 $1,138.52 $1,281.98 $1,791.56 $2,722.44 |
$1,386.81 $1,522.21 $1,665.67 $2,175.25 |
$1,770.50 $1,905.90 $2,049.36 $2,558.94 |
Toc - Plan #12 Quartz | ||||||||||||||||||||
Silver
(HMO) QUARTZ ONE SILVER I308 VALUE TIER RX W/DENTAL |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$530.19 $601.76 $677.57 $946.90 $1,438.91 |
$935.78 $1,007.35 $1,083.16 $1,352.49 |
$1,341.37 $1,412.94 $1,488.75 $1,758.08 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,060.38 $1,203.52 $1,355.14 $1,893.80 $2,877.82 |
$1,465.97 $1,609.11 $1,760.73 $2,299.39 |
$1,871.56 $2,014.70 $2,166.32 $2,704.98 |
Toc - Plan #13 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I204 VALUE TIER RX W/DENTAL |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$394.48 $447.73 $504.14 $704.53 $1,070.60 |
$696.25 $749.50 $805.91 $1,006.30 |
$998.02 $1,051.27 $1,107.68 $1,308.07 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$788.96 $895.46 $1,008.28 $1,409.06 $2,141.20 |
$1,090.73 $1,197.23 $1,310.05 $1,710.83 |
$1,392.50 $1,499.00 $1,611.82 $2,012.60 |
Toc - Plan #14 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I205 VALUE TIER RX W/DENTAL |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$383.93 $435.75 $490.65 $685.69 $1,041.97 |
$677.63 $729.45 $784.35 $979.39 |
$971.33 $1,023.15 $1,078.05 $1,273.09 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$767.86 $871.50 $981.30 $1,371.38 $2,083.94 |
$1,061.56 $1,165.20 $1,275.00 $1,665.08 |
$1,355.26 $1,458.90 $1,568.70 $1,958.78 |
Toc - Plan #15 Quartz | ||||||||||||||||||||
Silver
(HMO) QUARTZ ONE SILVER I320 VALUE TIER RX W/DENTAL |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$542.80 $616.07 $693.69 $969.43 $1,473.15 |
$958.04 $1,031.31 $1,108.93 $1,384.67 |
$1,373.28 $1,446.55 $1,524.17 $1,799.91 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,085.60 $1,232.14 $1,387.38 $1,938.86 $2,946.30 |
$1,500.84 $1,647.38 $1,802.62 $2,354.10 |
$1,916.08 $2,062.62 $2,217.86 $2,769.34 |
Toc - Plan #16 Quartz | ||||||||||||||||||||
Gold
(HMO) QUARTZ ONE GOLD I420 VALUE TIER RX |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$456.02 $517.58 $582.79 $814.45 $1,237.63 |
$804.87 $866.43 $931.64 $1,163.30 |
$1,153.72 $1,215.28 $1,280.49 $1,512.15 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$912.04 $1,035.16 $1,165.58 $1,628.90 $2,475.26 |
$1,260.89 $1,384.01 $1,514.43 $1,977.75 |
$1,609.74 $1,732.86 $1,863.28 $2,326.60 |
Toc - Plan #17 Quartz | ||||||||||||||||||||
Gold
(HMO) QUARTZ ONE GOLD I402 MAINTENANCE VALUE TIER RX |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$473.96 $537.94 $605.71 $846.48 $1,286.31 |
$836.54 $900.52 $968.29 $1,209.06 |
$1,199.12 $1,263.10 $1,330.87 $1,571.64 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$947.92 $1,075.88 $1,211.42 $1,692.96 $2,572.62 |
$1,310.50 $1,438.46 $1,574.00 $2,055.54 |
$1,673.08 $1,801.04 $1,936.58 $2,418.12 |
Toc - Plan #18 Quartz | ||||||||||||||||||||
Gold
(HMO) QUARTZ ONE GOLD I410 STANDARD |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$477.65 $542.13 $610.43 $853.08 $1,296.33 |
$843.05 $907.53 $975.83 $1,218.48 |
$1,208.45 $1,272.93 $1,341.23 $1,583.88 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$955.30 $1,084.26 $1,220.86 $1,706.16 $2,592.66 |
$1,320.70 $1,449.66 $1,586.26 $2,071.56 |
$1,686.10 $1,815.06 $1,951.66 $2,436.96 |
Toc - Plan #19 Quartz | ||||||||||||||||||||
Silver
(HMO) QUARTZ ONE SILVER I308 VALUE TIER RX |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$504.91 $573.07 $645.27 $901.77 $1,370.32 |
$891.16 $959.32 $1,031.52 $1,288.02 |
$1,277.41 $1,345.57 $1,417.77 $1,674.27 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,009.82 $1,146.14 $1,290.54 $1,803.54 $2,740.64 |
$1,396.07 $1,532.39 $1,676.79 $2,189.79 |
$1,782.32 $1,918.64 $2,063.04 $2,576.04 |
Toc - Plan #20 Quartz | ||||||||||||||||||||
Silver
(HMO) QUARTZ ONE SILVER I309 STANDARD |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$491.45 $557.79 $628.06 $877.71 $1,333.77 |
$867.40 $933.74 $1,004.01 $1,253.66 |
$1,243.35 $1,309.69 $1,379.96 $1,629.61 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$982.90 $1,115.58 $1,256.12 $1,755.42 $2,667.54 |
$1,358.85 $1,491.53 $1,632.07 $2,131.37 |
$1,734.80 $1,867.48 $2,008.02 $2,507.32 |
Toc - Plan #21 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I204 VALUE TIER RX |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$375.67 $426.39 $480.11 $670.95 $1,019.57 |
$663.06 $713.78 $767.50 $958.34 |
$950.45 $1,001.17 $1,054.89 $1,245.73 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$751.34 $852.78 $960.22 $1,341.90 $2,039.14 |
$1,038.73 $1,140.17 $1,247.61 $1,629.29 |
$1,326.12 $1,427.56 $1,535.00 $1,916.68 |
Toc - Plan #22 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I205 VALUE TIER RX |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$365.63 $414.98 $467.26 $653.00 $992.30 |
$645.33 $694.68 $746.96 $932.70 |
$925.03 $974.38 $1,026.66 $1,212.40 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$731.26 $829.96 $934.52 $1,306.00 $1,984.60 |
$1,010.96 $1,109.66 $1,214.22 $1,585.70 |
$1,290.66 $1,389.36 $1,493.92 $1,865.40 |
Toc - Plan #23 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I206 STANDARD |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$348.96 $396.06 $445.96 $623.23 $947.06 |
$615.91 $663.01 $712.91 $890.18 |
$882.86 $929.96 $979.86 $1,157.13 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$697.92 $792.12 $891.92 $1,246.46 $1,894.12 |
$964.87 $1,059.07 $1,158.87 $1,513.41 |
$1,231.82 $1,326.02 $1,425.82 $1,780.36 |
Toc - Plan #24 Quartz | ||||||||||||||||||||
Silver
(HMO) QUARTZ ONE SILVER I320 VALUE TIER RX |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$516.93 $586.71 $660.63 $923.22 $1,402.92 |
$912.37 $982.15 $1,056.07 $1,318.66 |
$1,307.81 $1,377.59 $1,451.51 $1,714.10 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,033.86 $1,173.42 $1,321.26 $1,846.44 $2,805.84 |
$1,429.30 $1,568.86 $1,716.70 $2,241.88 |
$1,824.74 $1,964.30 $2,112.14 $2,637.32 |
Toc - Plan #25 Quartz | ||||||||||||||||||||
Gold
(HMO) QUARTZ ONE GOLD I401 VALUE TIER RX |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$449.12 $509.75 $573.97 $802.12 $1,218.91 |
$792.70 $853.33 $917.55 $1,145.70 |
$1,136.28 $1,196.91 $1,261.13 $1,489.28 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$898.24 $1,019.50 $1,147.94 $1,604.24 $2,437.82 |
$1,241.82 $1,363.08 $1,491.52 $1,947.82 |
$1,585.40 $1,706.66 $1,835.10 $2,291.40 |
Toc - Plan #26 Quartz | ||||||||||||||||||||
Silver
(HMO) QUARTZ ONE SILVER I303 VALUE TIER RX |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$480.34 $545.18 $613.86 $857.87 $1,303.62 |
$847.79 $912.63 $981.31 $1,225.32 |
$1,215.24 $1,280.08 $1,348.76 $1,592.77 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$960.68 $1,090.36 $1,227.72 $1,715.74 $2,607.24 |
$1,328.13 $1,457.81 $1,595.17 $2,083.19 |
$1,695.58 $1,825.26 $1,962.62 $2,450.64 |
Toc - Plan #27 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I201 VALUE TIER RX |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$328.83 $373.22 $420.24 $587.28 $892.43 |
$580.38 $624.77 $671.79 $838.83 |
$831.93 $876.32 $923.34 $1,090.38 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$657.66 $746.44 $840.48 $1,174.56 $1,784.86 |
$909.21 $997.99 $1,092.03 $1,426.11 |
$1,160.76 $1,249.54 $1,343.58 $1,677.66 |
Toc - Plan #28 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) QUARTZ ONE BRONZE I203 HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$357.40 $405.64 $456.74 $638.30 $969.96 |
$630.80 $679.04 $730.14 $911.70 |
$904.20 $952.44 $1,003.54 $1,185.10 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$714.80 $811.28 $913.48 $1,276.60 $1,939.92 |
$988.20 $1,084.68 $1,186.88 $1,550.00 |
$1,261.60 $1,358.08 $1,460.28 $1,823.40 |
Toc - Plan #29 Quartz | ||||||||||||||||||||
Catastrophic
(HMO) QUARTZ ONE CATASTROPHIC I101 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$259.49 $294.51 $331.62 $463.43 $704.23 |
$457.99 $493.01 $530.12 $661.93 |
$656.49 $691.51 $728.62 $860.43 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$518.98 $589.02 $663.24 $926.86 $1,408.46 |
$717.48 $787.52 $861.74 $1,125.36 |
$915.98 $986.02 $1,060.24 $1,323.86 |
Toc - Plan #30 Quartz | ||||||||||||||||||||
Silver
(HMO) QUARTZ ONE SILVER I304 HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$509.45 $578.22 $651.07 $909.87 $1,382.63 |
$899.18 $967.95 $1,040.80 $1,299.60 |
$1,288.91 $1,357.68 $1,430.53 $1,689.33 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,018.90 $1,156.44 $1,302.14 $1,819.74 $2,765.26 |
$1,408.63 $1,546.17 $1,691.87 $2,209.47 |
$1,798.36 $1,935.90 $2,081.60 $2,599.20 |
Toc - Plan #31 Quartz | ||||||||||||||||||||
Gold
(HMO) QUARTZ ONE GOLD I403 HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$467.39 $530.48 $597.32 $834.75 $1,268.49 |
$824.94 $888.03 $954.87 $1,192.30 |
$1,182.49 $1,245.58 $1,312.42 $1,549.85 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$934.78 $1,060.96 $1,194.64 $1,669.50 $2,536.98 |
$1,292.33 $1,418.51 $1,552.19 $2,027.05 |
$1,649.88 $1,776.06 $1,909.74 $2,384.60 |
ADVERTISEMENT
Molina HealthcareLocal: 1-888-560-2043 | Toll Free: 1-888-560-2043 |
Toc - Plan #32 Molina Healthcare | ||||||||||||||||||||
Gold
(HMO) Gold 1 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$470.22 $533.70 $600.94 $839.81 $1,276.17 |
$829.94 $893.42 $960.66 $1,199.53 |
$1,189.66 $1,253.14 $1,320.38 $1,559.25 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$940.44 $1,067.40 $1,201.88 $1,679.62 $2,552.34 |
$1,300.16 $1,427.12 $1,561.60 $2,039.34 |
$1,659.88 $1,786.84 $1,921.32 $2,399.06 |
Toc - Plan #33 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Silver 1 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$399.21 $453.10 $510.19 $712.99 $1,083.46 |
$704.61 $758.50 $815.59 $1,018.39 |
$1,010.01 $1,063.90 $1,120.99 $1,323.79 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$798.42 $906.20 $1,020.38 $1,425.98 $2,166.92 |
$1,103.82 $1,211.60 $1,325.78 $1,731.38 |
$1,409.22 $1,517.00 $1,631.18 $2,036.78 |
Toc - Plan #34 Molina Healthcare | ||||||||||||||||||||
Gold
(HMO) Gold 8 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$485.37 $550.90 $620.31 $866.88 $1,317.31 |
$856.68 $922.21 $991.62 $1,238.19 |
$1,227.99 $1,293.52 $1,362.93 $1,609.50 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$970.74 $1,101.80 $1,240.62 $1,733.76 $2,634.62 |
$1,342.05 $1,473.11 $1,611.93 $2,105.07 |
$1,713.36 $1,844.42 $1,983.24 $2,476.38 |
Toc - Plan #35 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Silver 8 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$389.83 $442.45 $498.20 $696.23 $1,057.99 |
$688.05 $740.67 $796.42 $994.45 |
$986.27 $1,038.89 $1,094.64 $1,292.67 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$779.66 $884.90 $996.40 $1,392.46 $2,115.98 |
$1,077.88 $1,183.12 $1,294.62 $1,690.68 |
$1,376.10 $1,481.34 $1,592.84 $1,988.90 |
Toc - Plan #36 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Silver 12 with First 4 Primary Care Visits Free |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$393.02 $446.08 $502.29 $701.94 $1,066.67 |
$693.68 $746.74 $802.95 $1,002.60 |
$994.34 $1,047.40 $1,103.61 $1,303.26 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$786.04 $892.16 $1,004.58 $1,403.88 $2,133.34 |
$1,086.70 $1,192.82 $1,305.24 $1,704.54 |
$1,387.36 $1,493.48 $1,605.90 $2,005.20 |
Toc - Plan #37 Molina Healthcare | ||||||||||||||||||||
Gold
(HMO) Gold 1 with Adult Vision Services |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$472.91 $536.75 $604.38 $844.62 $1,283.48 |
$834.69 $898.53 $966.16 $1,206.40 |
$1,196.47 $1,260.31 $1,327.94 $1,568.18 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$945.82 $1,073.50 $1,208.76 $1,689.24 $2,566.96 |
$1,307.60 $1,435.28 $1,570.54 $2,051.02 |
$1,669.38 $1,797.06 $1,932.32 $2,412.80 |
Toc - Plan #38 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Silver 1 with Adult Vision Services |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$401.65 $455.87 $513.30 $717.34 $1,090.07 |
$708.91 $763.13 $820.56 $1,024.60 |
$1,016.17 $1,070.39 $1,127.82 $1,331.86 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$803.30 $911.74 $1,026.60 $1,434.68 $2,180.14 |
$1,110.56 $1,219.00 $1,333.86 $1,741.94 |
$1,417.82 $1,526.26 $1,641.12 $2,049.20 |
ADVERTISEMENT
Anthem Blue Cross and Blue ShieldLocal: 1-855-748-1813 | Toll Free: 1-855-748-1813 |
Toc - Plan #39 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(POS) 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$383.51 $435.28 $490.13 $684.95 $1,040.85 |
$676.90 $728.67 $783.52 $978.34 |
$970.29 $1,022.06 $1,076.91 $1,271.73 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$767.02 $870.56 $980.26 $1,369.90 $2,081.70 |
$1,060.41 $1,163.95 $1,273.65 $1,663.29 |
$1,353.80 $1,457.34 $1,567.04 $1,956.68 |
Toc - Plan #40 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(POS) 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$453.95 $515.23 $580.15 $810.75 $1,232.02 |
$801.22 $862.50 $927.42 $1,158.02 |
$1,148.49 $1,209.77 $1,274.69 $1,505.29 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$907.90 $1,030.46 $1,160.30 $1,621.50 $2,464.04 |
$1,255.17 $1,377.73 $1,507.57 $1,968.77 |
$1,602.44 $1,725.00 $1,854.84 $2,316.04 |
Toc - Plan #41 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Bronze
(POS) Anthem Bronze Blue Preferred/Broad 9450 ($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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$347.53 $394.45 $444.14 $620.69 $943.20 |
$613.39 $660.31 $710.00 $886.55 |
$879.25 $926.17 $975.86 $1,152.41 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$695.06 $788.90 $888.28 $1,241.38 $1,886.40 |
$960.92 $1,054.76 $1,154.14 $1,507.24 |
$1,226.78 $1,320.62 $1,420.00 $1,773.10 |
Toc - Plan #42 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(POS) 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$364.55 $413.76 $465.89 $651.09 $989.39 |
$643.43 $692.64 $744.77 $929.97 |
$922.31 $971.52 $1,023.65 $1,208.85 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$729.10 $827.52 $931.78 $1,302.18 $1,978.78 |
$1,007.98 $1,106.40 $1,210.66 $1,581.06 |
$1,286.86 $1,385.28 $1,489.54 $1,859.94 |
Toc - Plan #43 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(POS) Anthem Bronze Blue Preferred/Broad 5000 (3 Free PCP Visits + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$365.95 $415.35 $467.68 $653.59 $993.19 |
$645.90 $695.30 $747.63 $933.54 |
$925.85 $975.25 $1,027.58 $1,213.49 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$731.90 $830.70 $935.36 $1,307.18 $1,986.38 |
$1,011.85 $1,110.65 $1,215.31 $1,587.13 |
$1,291.80 $1,390.60 $1,495.26 $1,867.08 |
Toc - Plan #44 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(POS) Anthem Silver Blue Preferred/Broad 5300 (3 Free PCP Visits + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$443.29 $503.13 $566.52 $791.72 $1,203.09 |
$782.41 $842.25 $905.64 $1,130.84 |
$1,121.53 $1,181.37 $1,244.76 $1,469.96 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$886.58 $1,006.26 $1,133.04 $1,583.44 $2,406.18 |
$1,225.70 $1,345.38 $1,472.16 $1,922.56 |
$1,564.82 $1,684.50 $1,811.28 $2,261.68 |
Toc - Plan #45 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Gold
(POS) 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$485.43 $550.96 $620.38 $866.98 $1,317.46 |
$856.78 $922.31 $991.73 $1,238.33 |
$1,228.13 $1,293.66 $1,363.08 $1,609.68 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$970.86 $1,101.92 $1,240.76 $1,733.96 $2,634.92 |
$1,342.21 $1,473.27 $1,612.11 $2,105.31 |
$1,713.56 $1,844.62 $1,983.46 $2,476.66 |
Toc - Plan #46 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(POS) 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$364.88 $414.14 $466.32 $651.68 $990.28 |
$644.01 $693.27 $745.45 $930.81 |
$923.14 $972.40 $1,024.58 $1,209.94 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$729.76 $828.28 $932.64 $1,303.36 $1,980.56 |
$1,008.89 $1,107.41 $1,211.77 $1,582.49 |
$1,288.02 $1,386.54 $1,490.90 $1,861.62 |
Toc - Plan #47 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(POS) Anthem Silver Blue Preferred/Broad 5900/40% Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$442.93 $502.73 $566.06 $791.07 $1,202.11 |
$781.77 $841.57 $904.90 $1,129.91 |
$1,120.61 $1,180.41 $1,243.74 $1,468.75 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$885.86 $1,005.46 $1,132.12 $1,582.14 $2,404.22 |
$1,224.70 $1,344.30 $1,470.96 $1,920.98 |
$1,563.54 $1,683.14 $1,809.80 $2,259.82 |
Toc - Plan #48 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Gold
(POS) Anthem Gold Blue Preferred/Broad 1500/25% Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$494.55 $561.31 $632.03 $883.27 $1,342.21 |
$872.88 $939.64 $1,010.36 $1,261.60 |
$1,251.21 $1,317.97 $1,388.69 $1,639.93 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$989.10 $1,122.62 $1,264.06 $1,766.54 $2,684.42 |
$1,367.43 $1,500.95 $1,642.39 $2,144.87 |
$1,745.76 $1,879.28 $2,020.72 $2,523.20 |
Toc - Plan #49 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(POS) Anthem Silver Blue Preferred/Broad 4000 (3 Free PCP Visits + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$453.70 $514.95 $579.83 $810.31 $1,231.34 |
$800.78 $862.03 $926.91 $1,157.39 |
$1,147.86 $1,209.11 $1,273.99 $1,504.47 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$907.40 $1,029.90 $1,159.66 $1,620.62 $2,462.68 |
$1,254.48 $1,376.98 $1,506.74 $1,967.70 |
$1,601.56 $1,724.06 $1,853.82 $2,314.78 |
ADVERTISEMENT
Aspirus Health PlanLocal: 1-866-631-4611 | Toll Free: 1-866-631-4611 | TTY: 1-866-631-8597 |
Toc - Plan #50 Aspirus Health Plan | ||||||||||||||||||||
Silver
(HMO) HMO Silver 7500 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-866-631-4611
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$407.43 $462.43 $520.69 $727.67 $1,105.76 |
$719.11 $774.11 $832.37 $1,039.35 |
$1,030.79 $1,085.79 $1,144.05 $1,351.03 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$814.86 $924.86 $1,041.38 $1,455.34 $2,211.52 |
$1,126.54 $1,236.54 $1,353.06 $1,767.02 |
$1,438.22 $1,548.22 $1,664.74 $2,078.70 |
Toc - Plan #51 Aspirus Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) HMO HDHP Bronze 6250 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-866-631-4611
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$326.09 $370.11 $416.74 $582.39 $885.00 |
$575.55 $619.57 $666.20 $831.85 |
$825.01 $869.03 $915.66 $1,081.31 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$652.18 $740.22 $833.48 $1,164.78 $1,770.00 |
$901.64 $989.68 $1,082.94 $1,414.24 |
$1,151.10 $1,239.14 $1,332.40 $1,663.70 |
Toc - Plan #52 Aspirus Health Plan | ||||||||||||||||||||
Bronze
(HMO) HMO Bronze 9450 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-866-631-4611
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$299.87 $340.36 $383.24 $535.57 $813.86 |
$529.27 $569.76 $612.64 $764.97 |
$758.67 $799.16 $842.04 $994.37 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$599.74 $680.72 $766.48 $1,071.14 $1,627.72 |
$829.14 $910.12 $995.88 $1,300.54 |
$1,058.54 $1,139.52 $1,225.28 $1,529.94 |
Toc - Plan #53 Aspirus Health Plan | ||||||||||||||||||||
Gold
(HMO) HMO Gold 2400 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-866-631-4611
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$424.24 $481.51 $542.17 $757.69 $1,151.38 |
$748.78 $806.05 $866.71 $1,082.23 |
$1,073.32 $1,130.59 $1,191.25 $1,406.77 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$848.48 $963.02 $1,084.34 $1,515.38 $2,302.76 |
$1,173.02 $1,287.56 $1,408.88 $1,839.92 |
$1,497.56 $1,612.10 $1,733.42 $2,164.46 |
Toc - Plan #54 Aspirus Health Plan | ||||||||||||||||||||
Catastrophic
(HMO) HMO Catastrophic 9450 with 3 free PCP Visits |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-866-631-4611
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$217.08 $246.39 $277.43 $387.71 $589.16 |
$383.15 $412.46 $443.50 $553.78 |
$549.22 $578.53 $609.57 $719.85 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$434.16 $492.78 $554.86 $775.42 $1,178.32 |
$600.23 $658.85 $720.93 $941.49 |
$766.30 $824.92 $887.00 $1,107.56 |
Toc - Plan #55 Aspirus Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) HMO HDHP Bronze 7200 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-866-631-4611
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$324.81 $368.65 $415.10 $580.10 $881.52 |
$573.29 $617.13 $663.58 $828.58 |
$821.77 $865.61 $912.06 $1,077.06 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$649.62 $737.30 $830.20 $1,160.20 $1,763.04 |
$898.10 $985.78 $1,078.68 $1,408.68 |
$1,146.58 $1,234.26 $1,327.16 $1,657.16 |
Toc - Plan #56 Aspirus Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) HMO Bronze 7500 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-866-631-4611
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$319.57 $362.71 $408.41 $570.75 $867.31 |
$564.04 $607.18 $652.88 $815.22 |
$808.51 $851.65 $897.35 $1,059.69 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$639.14 $725.42 $816.82 $1,141.50 $1,734.62 |
$883.61 $969.89 $1,061.29 $1,385.97 |
$1,128.08 $1,214.36 $1,305.76 $1,630.44 |
Toc - Plan #57 Aspirus Health Plan | ||||||||||||||||||||
Silver
(HMO) HMO Silver 5900 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-866-631-4611
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$406.37 $461.23 $519.34 $725.78 $1,102.89 |
$717.24 $772.10 $830.21 $1,036.65 |
$1,028.11 $1,082.97 $1,141.08 $1,347.52 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$812.74 $922.46 $1,038.68 $1,451.56 $2,205.78 |
$1,123.61 $1,233.33 $1,349.55 $1,762.43 |
$1,434.48 $1,544.20 $1,660.42 $2,073.30 |
Toc - Plan #58 Aspirus Health Plan | ||||||||||||||||||||
Silver
(HMO) HMO HDHP Silver 5400 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-866-631-4611
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$413.30 $469.10 $528.20 $738.16 $1,121.70 |
$729.48 $785.28 $844.38 $1,054.34 |
$1,045.66 $1,101.46 $1,160.56 $1,370.52 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$826.60 $938.20 $1,056.40 $1,476.32 $2,243.40 |
$1,142.78 $1,254.38 $1,372.58 $1,792.50 |
$1,458.96 $1,570.56 $1,688.76 $2,108.68 |
Toc - Plan #59 Aspirus Health Plan | ||||||||||||||||||||
Gold
(HMO) HMO Gold 1500 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-866-631-4611
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$423.77 $480.98 $541.58 $756.85 $1,150.11 |
$747.95 $805.16 $865.76 $1,081.03 |
$1,072.13 $1,129.34 $1,189.94 $1,405.21 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$847.54 $961.96 $1,083.16 $1,513.70 $2,300.22 |
$1,171.72 $1,286.14 $1,407.34 $1,837.88 |
$1,495.90 $1,610.32 $1,731.52 $2,162.06 |
Toc - Plan #60 Aspirus Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) HMO Bronze $0 Medical Deductible |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-866-631-4611
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$320.85 $364.16 $410.04 $573.04 $870.78 |
$566.30 $609.61 $655.49 $818.49 |
$811.75 $855.06 $900.94 $1,063.94 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$641.70 $728.32 $820.08 $1,146.08 $1,741.56 |
$887.15 $973.77 $1,065.53 $1,391.53 |
$1,132.60 $1,219.22 $1,310.98 $1,636.98 |
Toc - Plan #61 Aspirus Health Plan | ||||||||||||||||||||
Silver
(POS) POS Silver 5900 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-866-631-4611
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$465.31 $528.13 $594.67 $831.05 $1,262.86 |
$821.28 $884.10 $950.64 $1,187.02 |
$1,177.25 $1,240.07 $1,306.61 $1,542.99 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$930.62 $1,056.26 $1,189.34 $1,662.10 $2,525.72 |
$1,286.59 $1,412.23 $1,545.31 $2,018.07 |
$1,642.56 $1,768.20 $1,901.28 $2,374.04 |
Toc - Plan #62 Aspirus Health Plan | ||||||||||||||||||||
Expanded Bronze
(POS) POS HDHP Bronze 6250 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-866-631-4611
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$358.90 $407.35 $458.67 $640.99 $974.05 |
$633.46 $681.91 $733.23 $915.55 |
$908.02 $956.47 $1,007.79 $1,190.11 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$717.80 $814.70 $917.34 $1,281.98 $1,948.10 |
$992.36 $1,089.26 $1,191.90 $1,556.54 |
$1,266.92 $1,363.82 $1,466.46 $1,831.10 |
Toc - Plan #63 Aspirus Health Plan | ||||||||||||||||||||
Expanded Bronze
(POS) POS Bronze 7500 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-866-631-4611
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$365.54 $414.89 $467.16 $652.85 $992.07 |
$645.18 $694.53 $746.80 $932.49 |
$924.82 $974.17 $1,026.44 $1,212.13 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$731.08 $829.78 $934.32 $1,305.70 $1,984.14 |
$1,010.72 $1,109.42 $1,213.96 $1,585.34 |
$1,290.36 $1,389.06 $1,493.60 $1,864.98 |
ADVERTISEMENT
Common Ground Healthcare CooperativeLocal: 1-877-514-2442 | Toll Free: 1-877-514-2442 | TTY: 1-844-472-2442 |
Toc - Plan #64 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Copay Bronze $0 Ded / $2250 Rx Ded - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$301.75 $342.48 $385.63 $538.91 $818.93 |
$532.58 $573.31 $616.46 $769.74 |
$763.41 $804.14 $847.29 $1,000.57 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$603.50 $684.96 $771.26 $1,077.82 $1,637.86 |
$834.33 $915.79 $1,002.09 $1,308.65 |
$1,065.16 $1,146.62 $1,232.92 $1,539.48 |
Toc - Plan #65 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Copay Gold $0 Ded - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$471.34 $534.96 $602.36 $841.79 $1,279.18 |
$831.90 $895.52 $962.92 $1,202.35 |
$1,192.46 $1,256.08 $1,323.48 $1,562.91 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$942.68 $1,069.92 $1,204.72 $1,683.58 $2,558.36 |
$1,303.24 $1,430.48 $1,565.28 $2,044.14 |
$1,663.80 $1,791.04 $1,925.84 $2,404.70 |
Toc - Plan #66 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Gold $3000 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$410.53 $465.94 $524.65 $733.19 $1,114.16 |
$724.58 $779.99 $838.70 $1,047.24 |
$1,038.63 $1,094.04 $1,152.75 $1,361.29 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$821.06 $931.88 $1,049.30 $1,466.38 $2,228.32 |
$1,135.11 $1,245.93 $1,363.35 $1,780.43 |
$1,449.16 $1,559.98 $1,677.40 $2,094.48 |
Toc - Plan #67 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Gold $1800 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$444.82 $504.86 $568.47 $794.43 $1,207.21 |
$785.10 $845.14 $908.75 $1,134.71 |
$1,125.38 $1,185.42 $1,249.03 $1,474.99 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$889.64 $1,009.72 $1,136.94 $1,588.86 $2,414.42 |
$1,229.92 $1,350.00 $1,477.22 $1,929.14 |
$1,570.20 $1,690.28 $1,817.50 $2,269.42 |
Toc - Plan #68 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Silver $4000 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$405.03 $459.70 $517.62 $723.37 $1,099.23 |
$714.87 $769.54 $827.46 $1,033.21 |
$1,024.71 $1,079.38 $1,137.30 $1,343.05 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$810.06 $919.40 $1,035.24 $1,446.74 $2,198.46 |
$1,119.90 $1,229.24 $1,345.08 $1,756.58 |
$1,429.74 $1,539.08 $1,654.92 $2,066.42 |
Toc - Plan #69 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Silver $5000 Ded / $5000 Rx Ded - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$343.28 $389.61 $438.70 $613.08 $931.64 |
$605.88 $652.21 $701.30 $875.68 |
$868.48 $914.81 $963.90 $1,138.28 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$686.56 $779.22 $877.40 $1,226.16 $1,863.28 |
$949.16 $1,041.82 $1,140.00 $1,488.76 |
$1,211.76 $1,304.42 $1,402.60 $1,751.36 |
Toc - Plan #70 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Catastrophic
(EPO) CGHC Catastrophic $9450 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$194.10 $220.29 $248.05 $346.65 $526.76 |
$342.58 $368.77 $396.53 $495.13 |
$491.06 $517.25 $545.01 $643.61 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$388.20 $440.58 $496.10 $693.30 $1,053.52 |
$536.68 $589.06 $644.58 $841.78 |
$685.16 $737.54 $793.06 $990.26 |
Toc - Plan #71 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Bronze $9450 ($35 PCP Copay) - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$288.36 $327.28 $368.51 $514.99 $782.58 |
$508.95 $547.87 $589.10 $735.58 |
$729.54 $768.46 $809.69 $956.17 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$576.72 $654.56 $737.02 $1,029.98 $1,565.16 |
$797.31 $875.15 $957.61 $1,250.57 |
$1,017.90 $1,095.74 $1,178.20 $1,471.16 |
Toc - Plan #72 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC HSA Bronze $7500 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$300.54 $341.11 $384.08 $536.75 $815.65 |
$530.45 $571.02 $613.99 $766.66 |
$760.36 $800.93 $843.90 $996.57 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$601.08 $682.22 $768.16 $1,073.50 $1,631.30 |
$830.99 $912.13 $998.07 $1,303.41 |
$1,060.90 $1,142.04 $1,227.98 $1,533.32 |
Toc - Plan #73 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC HSA Gold $3200 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$469.19 $532.52 $599.61 $837.96 $1,273.36 |
$828.11 $891.44 $958.53 $1,196.88 |
$1,187.03 $1,250.36 $1,317.45 $1,555.80 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$938.38 $1,065.04 $1,199.22 $1,675.92 $2,546.72 |
$1,297.30 $1,423.96 $1,558.14 $2,034.84 |
$1,656.22 $1,782.88 $1,917.06 $2,393.76 |
Toc - Plan #74 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC HSA Silver $3200 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$426.27 $483.81 $544.76 $761.30 $1,156.88 |
$752.36 $809.90 $870.85 $1,087.39 |
$1,078.45 $1,135.99 $1,196.94 $1,413.48 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$852.54 $967.62 $1,089.52 $1,522.60 $2,313.76 |
$1,178.63 $1,293.71 $1,415.61 $1,848.69 |
$1,504.72 $1,619.80 $1,741.70 $2,174.78 |
Toc - Plan #75 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Bronze
(EPO) CGHC Bronze $6000 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$296.03 $335.98 $378.32 $528.70 $803.40 |
$522.49 $562.44 $604.78 $755.16 |
$748.95 $788.90 $831.24 $981.62 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$592.06 $671.96 $756.64 $1,057.40 $1,606.80 |
$818.52 $898.42 $983.10 $1,283.86 |
$1,044.98 $1,124.88 $1,209.56 $1,510.32 |
Toc - Plan #76 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Bronze Standard $7500 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$291.94 $331.34 $373.09 $521.39 $792.30 |
$515.27 $554.67 $596.42 $744.72 |
$738.60 $778.00 $819.75 $968.05 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$583.88 $662.68 $746.18 $1,042.78 $1,584.60 |
$807.21 $886.01 $969.51 $1,266.11 |
$1,030.54 $1,109.34 $1,192.84 $1,489.44 |
Toc - Plan #77 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Silver Standard $5900 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$359.71 $408.26 $459.70 $642.42 $976.23 |
$634.88 $683.43 $734.87 $917.59 |
$910.05 $958.60 $1,010.04 $1,192.76 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$719.42 $816.52 $919.40 $1,284.84 $1,952.46 |
$994.59 $1,091.69 $1,194.57 $1,560.01 |
$1,269.76 $1,366.86 $1,469.74 $1,835.18 |
Toc - Plan #78 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Gold Standard $1500 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$422.20 $479.19 $539.56 $754.03 $1,145.83 |
$745.18 $802.17 $862.54 $1,077.01 |
$1,068.16 $1,125.15 $1,185.52 $1,399.99 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$844.40 $958.38 $1,079.12 $1,508.06 $2,291.66 |
$1,167.38 $1,281.36 $1,402.10 $1,831.04 |
$1,490.36 $1,604.34 $1,725.08 $2,154.02 |
Toc - Plan #79 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Silver $5650 Ded / $6000 Rx Ded - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$343.17 $389.48 $438.55 $612.88 $931.32 |
$605.68 $651.99 $701.06 $875.39 |
$868.19 $914.50 $963.57 $1,137.90 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$686.34 $778.96 $877.10 $1,225.76 $1,862.64 |
$948.85 $1,041.47 $1,139.61 $1,488.27 |
$1,211.36 $1,303.98 $1,402.12 $1,750.78 |
Toc - Plan #80 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Gold $1800 - Envision Network (Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$447.66 $508.09 $572.10 $799.51 $1,214.93 |
$790.12 $850.55 $914.56 $1,141.97 |
$1,132.58 $1,193.01 $1,257.02 $1,484.43 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$895.32 $1,016.18 $1,144.20 $1,599.02 $2,429.86 |
$1,237.78 $1,358.64 $1,486.66 $1,941.48 |
$1,580.24 $1,701.10 $1,829.12 $2,283.94 |
Toc - Plan #81 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Gold $3000 - Envision Network (Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$413.35 $469.14 $528.25 $738.22 $1,121.80 |
$729.55 $785.34 $844.45 $1,054.42 |
$1,045.75 $1,101.54 $1,160.65 $1,370.62 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$826.70 $938.28 $1,056.50 $1,476.44 $2,243.60 |
$1,142.90 $1,254.48 $1,372.70 $1,792.64 |
$1,459.10 $1,570.68 $1,688.90 $2,108.84 |
Toc - Plan #82 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Silver $4000 - Envision Network (Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$407.85 $462.90 $521.22 $728.40 $1,106.88 |
$719.85 $774.90 $833.22 $1,040.40 |
$1,031.85 $1,086.90 $1,145.22 $1,352.40 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$815.70 $925.80 $1,042.44 $1,456.80 $2,213.76 |
$1,127.70 $1,237.80 $1,354.44 $1,768.80 |
$1,439.70 $1,549.80 $1,666.44 $2,080.80 |
Toc - Plan #83 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Silver $5650 Ded / $6000 Rx Ded - Envision Network (Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$345.94 $392.63 $442.10 $617.84 $938.86 |
$610.58 $657.27 $706.74 $882.48 |
$875.22 $921.91 $971.38 $1,147.12 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$691.88 $785.26 $884.20 $1,235.68 $1,877.72 |
$956.52 $1,049.90 $1,148.84 $1,500.32 |
$1,221.16 $1,314.54 $1,413.48 $1,764.96 |
Toc - Plan #84 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Silver $5000 Ded / $5000 Rx Ded - Envision Network (Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$346.07 $392.78 $442.26 $618.06 $939.20 |
$610.80 $657.51 $706.99 $882.79 |
$875.53 $922.24 $971.72 $1,147.52 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$692.14 $785.56 $884.52 $1,236.12 $1,878.40 |
$956.87 $1,050.29 $1,149.25 $1,500.85 |
$1,221.60 $1,315.02 $1,413.98 $1,765.58 |
Toc - Plan #85 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Bronze $9450 ($35 PCP Copay) - Envision Network (Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$291.11 $330.40 $372.02 $519.90 $790.04 |
$513.80 $553.09 $594.71 $742.59 |
$736.49 $775.78 $817.40 $965.28 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$582.22 $660.80 $744.04 $1,039.80 $1,580.08 |
$804.91 $883.49 $966.73 $1,262.49 |
$1,027.60 $1,106.18 $1,189.42 $1,485.18 |
Toc - Plan #86 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Bronze
(EPO) CGHC Bronze $6000 - Envision Network (Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$298.79 $339.12 $381.84 $533.62 $810.89 |
$527.36 $567.69 $610.41 $762.19 |
$755.93 $796.26 $838.98 $990.76 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$597.58 $678.24 $763.68 $1,067.24 $1,621.78 |
$826.15 $906.81 $992.25 $1,295.81 |
$1,054.72 $1,135.38 $1,220.82 $1,524.38 |
Toc - Plan #87 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC HSA Bronze $7500 - Envision Network (Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$303.30 $344.24 $387.61 $541.68 $823.14 |
$535.32 $576.26 $619.63 $773.70 |
$767.34 $808.28 $851.65 $1,005.72 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$606.60 $688.48 $775.22 $1,083.36 $1,646.28 |
$838.62 $920.50 $1,007.24 $1,315.38 |
$1,070.64 $1,152.52 $1,239.26 $1,547.40 |
Toc - Plan #88 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC HSA Silver $3200 - Envision Network (Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$429.10 $487.02 $548.37 $766.35 $1,164.55 |
$757.35 $815.27 $876.62 $1,094.60 |
$1,085.60 $1,143.52 $1,204.87 $1,422.85 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$858.20 $974.04 $1,096.74 $1,532.70 $2,329.10 |
$1,186.45 $1,302.29 $1,424.99 $1,860.95 |
$1,514.70 $1,630.54 $1,753.24 $2,189.20 |
Toc - Plan #89 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC HSA Gold $3200 - Envision Network (Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$472.04 $535.75 $603.25 $843.04 $1,281.08 |
$833.14 $896.85 $964.35 $1,204.14 |
$1,194.24 $1,257.95 $1,325.45 $1,565.24 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$944.08 $1,071.50 $1,206.50 $1,686.08 $2,562.16 |
$1,305.18 $1,432.60 $1,567.60 $2,047.18 |
$1,666.28 $1,793.70 $1,928.70 $2,408.28 |
Toc - Plan #90 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Copay Bronze $0 Ded / $2250 Rx Ded - Envision Network (Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$304.51 $345.61 $389.15 $543.84 $826.41 |
$537.45 $578.55 $622.09 $776.78 |
$770.39 $811.49 $855.03 $1,009.72 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$609.02 $691.22 $778.30 $1,087.68 $1,652.82 |
$841.96 $924.16 $1,011.24 $1,320.62 |
$1,074.90 $1,157.10 $1,244.18 $1,553.56 |
Toc - Plan #91 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Copay Gold $0 Ded - Envision Network (Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$474.19 $538.20 $606.00 $846.89 $1,286.93 |
$836.94 $900.95 $968.75 $1,209.64 |
$1,199.69 $1,263.70 $1,331.50 $1,572.39 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$948.38 $1,076.40 $1,212.00 $1,693.78 $2,573.86 |
$1,311.13 $1,439.15 $1,574.75 $2,056.53 |
$1,673.88 $1,801.90 $1,937.50 $2,419.28 |
‡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 Waushara County here.
Waushara County is in “Rating Area 15” of Wisconsin.
Currently, there are 91 plans offered in Rating Area 15.