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Providers for Zip Code 82401

Obamacare 2017 Marketplace Rates For Washakie County, Wyoming

Saturday, December 10th, 2016

Click for Worland, Wyoming Forecast

Obamacare Providers, Plans and 2017 Rates for Washakie 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 Washakie County, Wyoming.

Currently, there are 30 plans offered in Washakie 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 Washakie 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 Worland, WY 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 Washakie County here.

Blue Cross Blue Shield of Wyoming

Local: 1-307-634-1393 x2949 | Toll Free: 1-800-851-2227

TTY: 1-800-696-4710

Plan: (PPO) BlueSelect Catastrophic with Kid's Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-851-2227 - Provider Directory for This Plan: (Blue Cross Blue Shield of Wyoming)

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
$318.59
$361.60
$407.15
$568.99
$864.64
$637.18
$723.20
$814.30
$1137.98
$1729.28
$839.49
$925.51
$1016.61
$1340.29
$1041.80
$1127.82
$1218.92
$1542.60
$1244.11
$1330.13
$1421.23
$1744.91
$520.90
$563.91
$609.46
$771.30
$723.21
$766.22
$811.77
$973.61
$925.52
$968.53
$1014.08
$1175.92
$202.31

Plan: (PPO) BlueSelect Gold Classic with Kid's Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-851-2227 - Provider Directory for This Plan: (Blue Cross Blue Shield of Wyoming)

Deductible: Individual: $750 : Family: $1,500
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$490.29
$556.48
$626.59
$875.65
$1330.63
$980.58
$1112.96
$1253.18
$1751.30
$2661.26
$1291.91
$1424.29
$1564.51
$2062.63
$1603.24
$1735.62
$1875.84
$2373.96
$1914.57
$2046.95
$2187.17
$2685.29
$801.62
$867.81
$937.92
$1186.98
$1112.95
$1179.14
$1249.25
$1498.31
$1424.28
$1490.47
$1560.58
$1809.64
$311.33

Plan: (PPO) BlueSelect Gold Basic with Kid's Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-851-2227 - Provider Directory for This Plan: (Blue Cross Blue Shield of Wyoming)

Deductible: Individual: $1,000 : Family: $2,000
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
Gold 21
30
40
50
60
$488.18
$554.08
$623.89
$871.88
$1324.91
$976.36
$1108.16
$1247.78
$1743.76
$2649.82
$1286.35
$1418.15
$1557.77
$2053.75
$1596.34
$1728.14
$1867.76
$2363.74
$1906.33
$2038.13
$2177.75
$2673.73
$798.17
$864.07
$933.88
$1181.87
$1108.16
$1174.06
$1243.87
$1491.86
$1418.15
$1484.05
$1553.86
$1801.85
$309.99

Plan: (PPO) BlueSelect Silver Basic with Kid's Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-851-2227 - Provider Directory for This Plan: (Blue Cross Blue Shield of Wyoming)

Deductible: Individual: $2,500 : Family: $5,000
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
$432.86
$491.29
$553.19
$773.08
$1174.76
$865.72
$982.58
$1106.38
$1546.16
$2349.52
$1140.59
$1257.45
$1381.25
$1821.03
$1415.46
$1532.32
$1656.12
$2095.90
$1690.33
$1807.19
$1930.99
$2370.77
$707.73
$766.16
$828.06
$1047.95
$982.60
$1041.03
$1102.93
$1322.82
$1257.47
$1315.90
$1377.80
$1597.69
$274.87

Plan: (PPO) BlueSelect Bronze Basic with Kid's Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-851-2227 - Provider Directory for This Plan: (Blue Cross Blue Shield of Wyoming)

Deductible: Individual: $6,000 : Family: $12,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$377.08
$427.98
$481.90
$673.45
$1023.37
$754.16
$855.96
$963.80
$1346.90
$2046.74
$993.60
$1095.40
$1203.24
$1586.34
$1233.04
$1334.84
$1442.68
$1825.78
$1472.48
$1574.28
$1682.12
$2065.22
$616.52
$667.42
$721.34
$912.89
$855.96
$906.86
$960.78
$1152.33
$1095.40
$1146.30
$1200.22
$1391.77
$239.44

Plan: (PPO) BlueSelect Bronze Core with Kid's Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-851-2227 - Provider Directory for This Plan: (Blue Cross Blue Shield of Wyoming)

Deductible: Individual: $4,500 : Family: $8,000
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
$341.57
$387.68
$436.53
$610.04
$927.01
$683.14
$775.36
$873.06
$1220.08
$1854.02
$900.04
$992.26
$1089.96
$1436.98
$1116.94
$1209.16
$1306.86
$1653.88
$1333.84
$1426.06
$1523.76
$1870.78
$558.47
$604.58
$653.43
$826.94
$775.37
$821.48
$870.33
$1043.84
$992.27
$1038.38
$1087.23
$1260.74
$216.90

Plan: (PPO) BlueSelect Gold Core with Kid's Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-851-2227 - Provider Directory for This Plan: (Blue Cross Blue Shield of Wyoming)

Deductible: Individual: $1,550 : Family: $3,100
Out of Pocket Maximum per year: Individual: $6,450 : Family: $12,900

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
$488.87
$554.86
$624.77
$873.11
$1326.77
$977.74
$1109.72
$1249.54
$1746.22
$2653.54
$1288.17
$1420.15
$1559.97
$2056.65
$1598.60
$1730.58
$1870.40
$2367.08
$1909.03
$2041.01
$2180.83
$2677.51
$799.30
$865.29
$935.20
$1183.54
$1109.73
$1175.72
$1245.63
$1493.97
$1420.16
$1486.15
$1556.06
$1804.40
$310.43

Plan: (PPO) BlueSelect Gold HealthPlus with Kid's Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-851-2227 - Provider Directory for This Plan: (Blue Cross Blue Shield of Wyoming)

Deductible: Individual: $1,000 : Family: $2,000
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
Gold 21
30
40
50
60
$499.00
$566.37
$637.73
$891.22
$1354.29
$998.00
$1132.74
$1275.46
$1782.44
$2708.58
$1314.87
$1449.61
$1592.33
$2099.31
$1631.74
$1766.48
$1909.20
$2416.18
$1948.61
$2083.35
$2226.07
$2733.05
$815.87
$883.24
$954.60
$1208.09
$1132.74
$1200.11
$1271.47
$1524.96
$1449.61
$1516.98
$1588.34
$1841.83
$316.87

Plan: (PPO) BlueSelect Silver Classic with Kid's Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-851-2227 - Provider Directory for This Plan: (Blue Cross Blue Shield of Wyoming)

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

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
$430.42
$488.53
$550.08
$768.73
$1168.16
$860.84
$977.06
$1100.16
$1537.46
$2336.32
$1134.16
$1250.38
$1373.48
$1810.78
$1407.48
$1523.70
$1646.80
$2084.10
$1680.80
$1797.02
$1920.12
$2357.42
$703.74
$761.85
$823.40
$1042.05
$977.06
$1035.17
$1096.72
$1315.37
$1250.38
$1308.49
$1370.04
$1588.69
$273.32

Plan: (PPO) BlueSelect Silver Core with Kid's Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-851-2227 - Provider Directory for This Plan: (Blue Cross Blue Shield of Wyoming)

Deductible: Individual: $2,000 : Family: $4,000
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
Silver 21
30
40
50
60
$410.84
$466.30
$525.05
$733.75
$1115.00
$821.68
$932.60
$1050.10
$1467.50
$2230.00
$1082.56
$1193.48
$1310.98
$1728.38
$1343.44
$1454.36
$1571.86
$1989.26
$1604.32
$1715.24
$1832.74
$2250.14
$671.72
$727.18
$785.93
$994.63
$932.60
$988.06
$1046.81
$1255.51
$1193.48
$1248.94
$1307.69
$1516.39
$260.88

Plan: (PPO) BlueSelect Catastrophic

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-851-2227 - Provider Directory for This Plan: (Blue Cross Blue Shield of Wyoming)

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
$313.86
$356.23
$401.12
$560.56
$851.82
$627.72
$712.46
$802.24
$1121.12
$1703.64
$827.03
$911.77
$1001.55
$1320.43
$1026.34
$1111.08
$1200.86
$1519.74
$1225.65
$1310.39
$1400.17
$1719.05
$513.17
$555.54
$600.43
$759.87
$712.48
$754.85
$799.74
$959.18
$911.79
$954.16
$999.05
$1158.49
$199.31

Plan: (PPO) BlueSelect Silver HealthPlus with Kid's Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-851-2227 - Provider Directory for This Plan: (Blue Cross Blue Shield of Wyoming)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$420.42
$477.18
$537.30
$750.87
$1141.02
$840.84
$954.36
$1074.60
$1501.74
$2282.04
$1107.81
$1221.33
$1341.57
$1768.71
$1374.78
$1488.30
$1608.54
$2035.68
$1641.75
$1755.27
$1875.51
$2302.65
$687.39
$744.15
$804.27
$1017.84
$954.36
$1011.12
$1071.24
$1284.81
$1221.33
$1278.09
$1338.21
$1551.78
$266.97

Plan: (PPO) BlueSelect Silver ValueTwo with Kid's Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-851-2227 - Provider Directory for This Plan: (Blue Cross Blue Shield of Wyoming)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$398.36
$452.14
$509.10
$711.47
$1081.14
$796.72
$904.28
$1018.20
$1422.94
$2162.28
$1049.68
$1157.24
$1271.16
$1675.90
$1302.64
$1410.20
$1524.12
$1928.86
$1555.60
$1663.16
$1777.08
$2181.82
$651.32
$705.10
$762.06
$964.43
$904.28
$958.06
$1015.02
$1217.39
$1157.24
$1211.02
$1267.98
$1470.35
$252.96

Plan: (PPO) BlueSelect Bronze Value with Kid's Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-851-2227 - Provider Directory for This Plan: (Blue Cross Blue Shield of Wyoming)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$352.26
$399.81
$450.18
$629.13
$956.02
$704.52
$799.62
$900.36
$1258.26
$1912.04
$928.21
$1023.31
$1124.05
$1481.95
$1151.90
$1247.00
$1347.74
$1705.64
$1375.59
$1470.69
$1571.43
$1929.33
$575.95
$623.50
$673.87
$852.82
$799.64
$847.19
$897.56
$1076.51
$1023.33
$1070.88
$1121.25
$1300.20
$223.69

Plan: (PPO) BlueSelect Bronze Classic with Kid's Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-851-2227 - Provider Directory for This Plan: (Blue Cross Blue Shield of Wyoming)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$360.01
$408.61
$460.09
$642.98
$977.06
$720.02
$817.22
$920.18
$1285.96
$1954.12
$948.63
$1045.83
$1148.79
$1514.57
$1177.24
$1274.44
$1377.40
$1743.18
$1405.85
$1503.05
$1606.01
$1971.79
$588.62
$637.22
$688.70
$871.59
$817.23
$865.83
$917.31
$1100.20
$1045.84
$1094.44
$1145.92
$1328.81
$228.61

Plan: (PPO) BlueSelect Silver ValueOne with Kid's Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-851-2227 - Provider Directory for This Plan: (Blue Cross Blue Shield of Wyoming)

Deductible: Individual: $3,250 : Family: $6,500
Out of Pocket Maximum per year: Individual: $5,600 : Family: $11,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$416.11
$472.29
$531.79
$743.17
$1129.32
$832.22
$944.58
$1063.58
$1486.34
$2258.64
$1096.45
$1208.81
$1327.81
$1750.57
$1360.68
$1473.04
$1592.04
$2014.80
$1624.91
$1737.27
$1856.27
$2279.03
$680.34
$736.52
$796.02
$1007.40
$944.57
$1000.75
$1060.25
$1271.63
$1208.80
$1264.98
$1324.48
$1535.86
$264.23

Plan: (PPO) BlueSelect Gold Classic

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-851-2227 - Provider Directory for This Plan: (Blue Cross Blue Shield of Wyoming)

Deductible: Individual: $750 : Family: $1,500
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$483.04
$548.25
$617.32
$862.71
$1310.96
$966.08
$1096.50
$1234.64
$1725.42
$2621.92
$1272.81
$1403.23
$1541.37
$2032.15
$1579.54
$1709.96
$1848.10
$2338.88
$1886.27
$2016.69
$2154.83
$2645.61
$789.77
$854.98
$924.05
$1169.44
$1096.50
$1161.71
$1230.78
$1476.17
$1403.23
$1468.44
$1537.51
$1782.90
$306.73

Plan: (PPO) BlueSelect Silver Classic

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-851-2227 - Provider Directory for This Plan: (Blue Cross Blue Shield of Wyoming)

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

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
$424.05
$481.29
$541.93
$757.35
$1150.86
$848.10
$962.58
$1083.86
$1514.70
$2301.72
$1117.37
$1231.85
$1353.13
$1783.97
$1386.64
$1501.12
$1622.40
$2053.24
$1655.91
$1770.39
$1891.67
$2322.51
$693.32
$750.56
$811.20
$1026.62
$962.59
$1019.83
$1080.47
$1295.89
$1231.86
$1289.10
$1349.74
$1565.16
$269.27

Plan: (PPO) BlueSelect Gold Core

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-851-2227 - Provider Directory for This Plan: (Blue Cross Blue Shield of Wyoming)

Deductible: Individual: $1,550 : Family: $3,100
Out of Pocket Maximum per year: Individual: $6,450 : Family: $12,900

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
$481.66
$546.69
$615.57
$860.25
$1307.23
$963.32
$1093.38
$1231.14
$1720.50
$2614.46
$1269.18
$1399.24
$1537.00
$2026.36
$1575.04
$1705.10
$1842.86
$2332.22
$1880.90
$2010.96
$2148.72
$2638.08
$787.52
$852.55
$921.43
$1166.11
$1093.38
$1158.41
$1227.29
$1471.97
$1399.24
$1464.27
$1533.15
$1777.83
$305.86

Plan: (PPO) BlueSelect Silver Core

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-851-2227 - Provider Directory for This Plan: (Blue Cross Blue Shield of Wyoming)

Deductible: Individual: $2,000 : Family: $4,000
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
Silver 21
30
40
50
60
$404.74
$459.38
$517.25
$722.86
$1098.45
$809.48
$918.76
$1034.50
$1445.72
$2196.90
$1066.49
$1175.77
$1291.51
$1702.73
$1323.50
$1432.78
$1548.52
$1959.74
$1580.51
$1689.79
$1805.53
$2216.75
$661.75
$716.39
$774.26
$979.87
$918.76
$973.40
$1031.27
$1236.88
$1175.77
$1230.41
$1288.28
$1493.89
$257.01

Plan: (PPO) BlueSelect Bronze Classic

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-851-2227 - Provider Directory for This Plan: (Blue Cross Blue Shield of Wyoming)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$354.69
$402.57
$453.29
$633.47
$962.62
$709.38
$805.14
$906.58
$1266.94
$1925.24
$934.61
$1030.37
$1131.81
$1492.17
$1159.84
$1255.60
$1357.04
$1717.40
$1385.07
$1480.83
$1582.27
$1942.63
$579.92
$627.80
$678.52
$858.70
$805.15
$853.03
$903.75
$1083.93
$1030.38
$1078.26
$1128.98
$1309.16
$225.23

Plan: (PPO) BlueSelect Bronze Core

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-851-2227 - Provider Directory for This Plan: (Blue Cross Blue Shield of Wyoming)

Deductible: Individual: $4,500 : Family: $8,000
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
$336.52
$381.95
$430.08
$601.03
$913.32
$673.04
$763.90
$860.16
$1202.06
$1826.64
$886.73
$977.59
$1073.85
$1415.75
$1100.42
$1191.28
$1287.54
$1629.44
$1314.11
$1404.97
$1501.23
$1843.13
$550.21
$595.64
$643.77
$814.72
$763.90
$809.33
$857.46
$1028.41
$977.59
$1023.02
$1071.15
$1242.10
$213.69

Plan: (PPO) BlueSelect Gold HealthPlus

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-851-2227 - Provider Directory for This Plan: (Blue Cross Blue Shield of Wyoming)

Deductible: Individual: $1,000 : Family: $2,000
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
Gold 21
30
40
50
60
$491.62
$557.99
$628.29
$878.03
$1334.24
$983.24
$1115.98
$1256.58
$1756.06
$2668.48
$1295.42
$1428.16
$1568.76
$2068.24
$1607.60
$1740.34
$1880.94
$2380.42
$1919.78
$2052.52
$2193.12
$2692.60
$803.80
$870.17
$940.47
$1190.21
$1115.98
$1182.35
$1252.65
$1502.39
$1428.16
$1494.53
$1564.83
$1814.57
$312.18

Plan: (PPO) BlueSelect Silver HealthPlus

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-851-2227 - Provider Directory for This Plan: (Blue Cross Blue Shield of Wyoming)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$414.23
$470.15
$529.39
$739.81
$1124.22
$828.46
$940.30
$1058.78
$1479.62
$2248.44
$1091.50
$1203.34
$1321.82
$1742.66
$1354.54
$1466.38
$1584.86
$2005.70
$1617.58
$1729.42
$1847.90
$2268.74
$677.27
$733.19
$792.43
$1002.85
$940.31
$996.23
$1055.47
$1265.89
$1203.35
$1259.27
$1318.51
$1528.93
$263.04

Plan: (PPO) BlueSelect Silver ValueTwo

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-851-2227 - Provider Directory for This Plan: (Blue Cross Blue Shield of Wyoming)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$392.44
$445.42
$501.54
$700.90
$1065.08
$784.88
$890.84
$1003.08
$1401.80
$2130.16
$1034.08
$1140.04
$1252.28
$1651.00
$1283.28
$1389.24
$1501.48
$1900.20
$1532.48
$1638.44
$1750.68
$2149.40
$641.64
$694.62
$750.74
$950.10
$890.84
$943.82
$999.94
$1199.30
$1140.04
$1193.02
$1249.14
$1448.50
$249.20

Plan: (PPO) BlueSelect Bronze Value

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-851-2227 - Provider Directory for This Plan: (Blue Cross Blue Shield of Wyoming)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$347.03
$393.88
$443.50
$619.79
$941.83
$694.06
$787.76
$887.00
$1239.58
$1883.66
$914.43
$1008.13
$1107.37
$1459.95
$1134.80
$1228.50
$1327.74
$1680.32
$1355.17
$1448.87
$1548.11
$1900.69
$567.40
$614.25
$663.87
$840.16
$787.77
$834.62
$884.24
$1060.53
$1008.14
$1054.99
$1104.61
$1280.90
$220.37

Plan: (PPO) BlueSelect Gold Basic

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-851-2227 - Provider Directory for This Plan: (Blue Cross Blue Shield of Wyoming)

Deductible: Individual: $1,000 : Family: $2,000
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
Gold 21
30
40
50
60
$480.93
$545.86
$614.63
$858.94
$1305.24
$961.86
$1091.72
$1229.26
$1717.88
$2610.48
$1267.25
$1397.11
$1534.65
$2023.27
$1572.64
$1702.50
$1840.04
$2328.66
$1878.03
$2007.89
$2145.43
$2634.05
$786.32
$851.25
$920.02
$1164.33
$1091.71
$1156.64
$1225.41
$1469.72
$1397.10
$1462.03
$1530.80
$1775.11
$305.39

Plan: (PPO) BlueSelect Silver Basic

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-851-2227 - Provider Directory for This Plan: (Blue Cross Blue Shield of Wyoming)

Deductible: Individual: $2,500 : Family: $5,000
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
$426.43
$484.00
$544.98
$761.61
$1157.33
$852.86
$968.00
$1089.96
$1523.22
$2314.66
$1123.65
$1238.79
$1360.75
$1794.01
$1394.44
$1509.58
$1631.54
$2064.80
$1665.23
$1780.37
$1902.33
$2335.59
$697.22
$754.79
$815.77
$1032.40
$968.01
$1025.58
$1086.56
$1303.19
$1238.80
$1296.37
$1357.35
$1573.98
$270.79

Plan: (PPO) BlueSelect Bronze Basic

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-851-2227 - Provider Directory for This Plan: (Blue Cross Blue Shield of Wyoming)

Deductible: Individual: $6,000 : Family: $12,000
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$371.48
$421.63
$474.75
$663.46
$1008.19
$742.96
$843.26
$949.50
$1326.92
$2016.38
$978.85
$1079.15
$1185.39
$1562.81
$1214.74
$1315.04
$1421.28
$1798.70
$1450.63
$1550.93
$1657.17
$2034.59
$607.37
$657.52
$710.64
$899.35
$843.26
$893.41
$946.53
$1135.24
$1079.15
$1129.30
$1182.42
$1371.13
$235.89

Plan: (PPO) BlueSelect Silver ValueOne

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-851-2227 - Provider Directory for This Plan: (Blue Cross Blue Shield of Wyoming)

Deductible: Individual: $3,250 : Family: $6,500
Out of Pocket Maximum per year: Individual: $5,600 : Family: $11,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$409.97
$465.31
$523.93
$732.19
$1112.64
$819.94
$930.62
$1047.86
$1464.38
$2225.28
$1080.27
$1190.95
$1308.19
$1724.71
$1340.60
$1451.28
$1568.52
$1985.04
$1600.93
$1711.61
$1828.85
$2245.37
$670.30
$725.64
$784.26
$992.52
$930.63
$985.97
$1044.59
$1252.85
$1190.96
$1246.30
$1304.92
$1513.18
$260.33