Door County, Wisconsin Obamacare 2024 Rates
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Obamacare is also known as the Affordable Care Act. This page gives you an overview of the rates for individual and family health insurance plans available from , the marketplace for Door 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, 83 Plans and 2024 Rates for Door County, Wisconsin
Below, you’ll find a summary of the 83 plans for Door 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 |
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Chorus Community Health PlansLocal: 1-844-201-4672 | Toll Free: 1-844-201-4672 | TTY: 1-844-531-4856 |
Toc - Plan #1 Chorus Community Health Plans | ||||||||||||||||||||
Silver
(EPO) Chorus Standard Silver |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-201-4672
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$407.20 $462.16 $520.39 $727.24 $1,105.11 |
$718.70 $773.66 $831.89 $1,038.74 |
$1,030.20 $1,085.16 $1,143.39 $1,350.24 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$814.40 $924.32 $1,040.78 $1,454.48 $2,210.22 |
$1,125.90 $1,235.82 $1,352.28 $1,765.98 |
$1,437.40 $1,547.32 $1,663.78 $2,077.48 |
Toc - Plan #2 Chorus Community Health Plans | ||||||||||||||||||||
Silver
(EPO) Chorus Silver |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-201-4672
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$376.66 $427.50 $481.36 $672.70 $1,022.23 |
$664.80 $715.64 $769.50 $960.84 |
$952.94 $1,003.78 $1,057.64 $1,248.98 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$753.32 $855.00 $962.72 $1,345.40 $2,044.46 |
$1,041.46 $1,143.14 $1,250.86 $1,633.54 |
$1,329.60 $1,431.28 $1,539.00 $1,921.68 |
Toc - Plan #3 Chorus Community Health Plans | ||||||||||||||||||||
Gold
(EPO) Chorus Gold |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-201-4672
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$441.40 $500.98 $564.10 $788.33 $1,197.94 |
$779.07 $838.65 $901.77 $1,126.00 |
$1,116.74 $1,176.32 $1,239.44 $1,463.67 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$882.80 $1,001.96 $1,128.20 $1,576.66 $2,395.88 |
$1,220.47 $1,339.63 $1,465.87 $1,914.33 |
$1,558.14 $1,677.30 $1,803.54 $2,252.00 |
Toc - Plan #4 Chorus Community Health Plans | ||||||||||||||||||||
Expanded Bronze
(EPO) Chorus Bronze HDHP |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-201-4672
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$340.83 $386.83 $435.57 $608.70 $924.98 |
$601.56 $647.56 $696.30 $869.43 |
$862.29 $908.29 $957.03 $1,130.16 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$681.66 $773.66 $871.14 $1,217.40 $1,849.96 |
$942.39 $1,034.39 $1,131.87 $1,478.13 |
$1,203.12 $1,295.12 $1,392.60 $1,738.86 |
Toc - Plan #5 Chorus Community Health Plans | ||||||||||||||||||||
Silver
(EPO) Chorus Silver Select |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-201-4672
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$393.76 $446.91 $503.22 $703.24 $1,068.64 |
$694.98 $748.13 $804.44 $1,004.46 |
$996.20 $1,049.35 $1,105.66 $1,305.68 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$787.52 $893.82 $1,006.44 $1,406.48 $2,137.28 |
$1,088.74 $1,195.04 $1,307.66 $1,707.70 |
$1,389.96 $1,496.26 $1,608.88 $2,008.92 |
Toc - Plan #6 Chorus Community Health Plans | ||||||||||||||||||||
Catastrophic
(EPO) Chorus Catastrophic |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-201-4672
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$261.83 $297.17 $334.61 $467.62 $710.59 |
$462.12 $497.46 $534.90 $667.91 |
$662.41 $697.75 $735.19 $868.20 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$523.66 $594.34 $669.22 $935.24 $1,421.18 |
$723.95 $794.63 $869.51 $1,135.53 |
$924.24 $994.92 $1,069.80 $1,335.82 |
Toc - Plan #7 Chorus Community Health Plans | ||||||||||||||||||||
Expanded Bronze
(EPO) Chorus Bronze Copay |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-201-4672
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$353.45 $401.16 $451.70 $631.24 $959.24 |
$623.83 $671.54 $722.08 $901.62 |
$894.21 $941.92 $992.46 $1,172.00 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$706.90 $802.32 $903.40 $1,262.48 $1,918.48 |
$977.28 $1,072.70 $1,173.78 $1,532.86 |
$1,247.66 $1,343.08 $1,444.16 $1,803.24 |
Toc - Plan #8 Chorus Community Health Plans | ||||||||||||||||||||
Silver
(EPO) Chorus Silver Copay |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-201-4672
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$443.03 $502.83 $566.18 $791.24 $1,202.36 |
$781.94 $841.74 $905.09 $1,130.15 |
$1,120.85 $1,180.65 $1,244.00 $1,469.06 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$886.06 $1,005.66 $1,132.36 $1,582.48 $2,404.72 |
$1,224.97 $1,344.57 $1,471.27 $1,921.39 |
$1,563.88 $1,683.48 $1,810.18 $2,260.30 |
Toc - Plan #9 Chorus Community Health Plans | ||||||||||||||||||||
Bronze
(EPO) Chorus Clear Bronze |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-201-4672
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$293.59 $333.22 $375.20 $524.34 $796.79 |
$518.18 $557.81 $599.79 $748.93 |
$742.77 $782.40 $824.38 $973.52 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$587.18 $666.44 $750.40 $1,048.68 $1,593.58 |
$811.77 $891.03 $974.99 $1,273.27 |
$1,036.36 $1,115.62 $1,199.58 $1,497.86 |
Toc - Plan #10 Chorus Community Health Plans | ||||||||||||||||||||
Silver
(EPO) Chorus Core Silver |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-201-4672
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$367.70 $417.33 $469.91 $656.70 $997.92 |
$648.98 $698.61 $751.19 $937.98 |
$930.26 $979.89 $1,032.47 $1,219.26 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$735.40 $834.66 $939.82 $1,313.40 $1,995.84 |
$1,016.68 $1,115.94 $1,221.10 $1,594.68 |
$1,297.96 $1,397.22 $1,502.38 $1,875.96 |
Toc - Plan #11 Chorus Community Health Plans | ||||||||||||||||||||
Gold
(EPO) Chorus Core Gold |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-201-4672
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$431.63 $489.89 $551.61 $770.88 $1,171.42 |
$761.82 $820.08 $881.80 $1,101.07 |
$1,092.01 $1,150.27 $1,211.99 $1,431.26 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$863.26 $979.78 $1,103.22 $1,541.76 $2,342.84 |
$1,193.45 $1,309.97 $1,433.41 $1,871.95 |
$1,523.64 $1,640.16 $1,763.60 $2,202.14 |
Toc - Plan #12 Chorus Community Health Plans | ||||||||||||||||||||
Expanded Bronze
(EPO) Chorus Core Bronze |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-201-4672
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$305.40 $346.62 $390.29 $545.43 $828.83 |
$539.03 $580.25 $623.92 $779.06 |
$772.66 $813.88 $857.55 $1,012.69 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$610.80 $693.24 $780.58 $1,090.86 $1,657.66 |
$844.43 $926.87 $1,014.21 $1,324.49 |
$1,078.06 $1,160.50 $1,247.84 $1,558.12 |
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Dean Health PlanLocal: 1-800-279-1302 | Toll Free: 1-800-279-1302 | TTY: 1-800-279-1302 |
Toc - Plan #13 Dean Health Plan | ||||||||||||||||||||
Gold
(HMO) Prevea360 Gold Copay Plus 1500X (Free Virtual Care) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$499.14 $566.53 $637.91 $891.47 $1,354.68 |
$880.99 $948.38 $1,019.76 $1,273.32 |
$1,262.84 $1,330.23 $1,401.61 $1,655.17 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$998.28 $1,133.06 $1,275.82 $1,782.94 $2,709.36 |
$1,380.13 $1,514.91 $1,657.67 $2,164.79 |
$1,761.98 $1,896.76 $2,039.52 $2,546.64 |
Toc - Plan #14 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Prevea360 Silver Copay Plus 4800X (Free Virtual Care) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$471.96 $535.67 $603.16 $842.91 $1,280.89 |
$833.01 $896.72 $964.21 $1,203.96 |
$1,194.06 $1,257.77 $1,325.26 $1,565.01 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$943.92 $1,071.34 $1,206.32 $1,685.82 $2,561.78 |
$1,304.97 $1,432.39 $1,567.37 $2,046.87 |
$1,666.02 $1,793.44 $1,928.42 $2,407.92 |
Toc - Plan #15 Dean Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) Prevea360 Bronze Copay Plus 9400X (Free Virtual Care) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$312.69 $354.90 $399.61 $558.46 $848.63 |
$551.89 $594.10 $638.81 $797.66 |
$791.09 $833.30 $878.01 $1,036.86 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$625.38 $709.80 $799.22 $1,116.92 $1,697.26 |
$864.58 $949.00 $1,038.42 $1,356.12 |
$1,103.78 $1,188.20 $1,277.62 $1,595.32 |
Toc - Plan #16 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Prevea360 Silver HSA-E HDHP 3550X |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$473.44 $537.36 $605.06 $845.57 $1,284.92 |
$835.62 $899.54 $967.24 $1,207.75 |
$1,197.80 $1,261.72 $1,329.42 $1,569.93 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$946.88 $1,074.72 $1,210.12 $1,691.14 $2,569.84 |
$1,309.06 $1,436.90 $1,572.30 $2,053.32 |
$1,671.24 $1,799.08 $1,934.48 $2,415.50 |
Toc - Plan #17 Dean Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) Prevea360 Bronze HSA-E HDHP 7450X |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$329.53 $374.01 $421.14 $588.54 $894.34 |
$581.62 $626.10 $673.23 $840.63 |
$833.71 $878.19 $925.32 $1,092.72 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$659.06 $748.02 $842.28 $1,177.08 $1,788.68 |
$911.15 $1,000.11 $1,094.37 $1,429.17 |
$1,163.24 $1,252.20 $1,346.46 $1,681.26 |
Toc - Plan #18 Dean Health Plan | ||||||||||||||||||||
Catastrophic
(HMO) Prevea360 Catastrophic Safety Net |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$226.02 $256.53 $288.85 $403.66 $613.41 |
$398.92 $429.43 $461.75 $576.56 |
$571.82 $602.33 $634.65 $749.46 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$452.04 $513.06 $577.70 $807.32 $1,226.82 |
$624.94 $685.96 $750.60 $980.22 |
$797.84 $858.86 $923.50 $1,153.12 |
Toc - Plan #19 Dean Health Plan | ||||||||||||||||||||
Gold
(HMO) Prevea360 Gold HSA HDHP 2000X |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$445.41 $505.54 $569.23 $795.50 $1,208.84 |
$786.15 $846.28 $909.97 $1,136.24 |
$1,126.89 $1,187.02 $1,250.71 $1,476.98 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$890.82 $1,011.08 $1,138.46 $1,591.00 $2,417.68 |
$1,231.56 $1,351.82 $1,479.20 $1,931.74 |
$1,572.30 $1,692.56 $1,819.94 $2,272.48 |
Toc - Plan #20 Dean Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) Prevea360 Bronze Copay PCP 8000X (Free Virtual Care) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$306.15 $347.48 $391.26 $546.78 $830.89 |
$540.35 $581.68 $625.46 $780.98 |
$774.55 $815.88 $859.66 $1,015.18 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$612.30 $694.96 $782.52 $1,093.56 $1,661.78 |
$846.50 $929.16 $1,016.72 $1,327.76 |
$1,080.70 $1,163.36 $1,250.92 $1,561.96 |
Toc - Plan #21 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Prevea360 Silver Copay PCP 4500X (Free Virtual Care) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$448.19 $508.70 $572.79 $800.47 $1,216.39 |
$791.06 $851.57 $915.66 $1,143.34 |
$1,133.93 $1,194.44 $1,258.53 $1,486.21 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$896.38 $1,017.40 $1,145.58 $1,600.94 $2,432.78 |
$1,239.25 $1,360.27 $1,488.45 $1,943.81 |
$1,582.12 $1,703.14 $1,831.32 $2,286.68 |
Toc - Plan #22 Dean Health Plan | ||||||||||||||||||||
Gold
(HMO) Prevea360 Gold Copay PCP 3000X (Free Virtual Care) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$450.12 $510.88 $575.25 $803.91 $1,221.62 |
$794.46 $855.22 $919.59 $1,148.25 |
$1,138.80 $1,199.56 $1,263.93 $1,492.59 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$900.24 $1,021.76 $1,150.50 $1,607.82 $2,443.24 |
$1,244.58 $1,366.10 $1,494.84 $1,952.16 |
$1,588.92 $1,710.44 $1,839.18 $2,296.50 |
Toc - Plan #23 Dean Health Plan | ||||||||||||||||||||
Gold
(HMO) Prevea360 Gold Standard 1500X (Free Virtual Care) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$463.04 $525.55 $591.77 $826.99 $1,256.70 |
$817.27 $879.78 $946.00 $1,181.22 |
$1,171.50 $1,234.01 $1,300.23 $1,535.45 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$926.08 $1,051.10 $1,183.54 $1,653.98 $2,513.40 |
$1,280.31 $1,405.33 $1,537.77 $2,008.21 |
$1,634.54 $1,759.56 $1,892.00 $2,362.44 |
Toc - Plan #24 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Prevea360 Silver Standard 5900X (Free Virtual Care) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$451.90 $512.91 $577.53 $807.10 $1,226.47 |
$797.61 $858.62 $923.24 $1,152.81 |
$1,143.32 $1,204.33 $1,268.95 $1,498.52 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$903.80 $1,025.82 $1,155.06 $1,614.20 $2,452.94 |
$1,249.51 $1,371.53 $1,500.77 $1,959.91 |
$1,595.22 $1,717.24 $1,846.48 $2,305.62 |
Toc - Plan #25 Dean Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) Prevea360 Bronze Standard 7500X (Free Virtual Care) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$317.24 $360.07 $405.44 $566.60 $861.00 |
$559.93 $602.76 $648.13 $809.29 |
$802.62 $845.45 $890.82 $1,051.98 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$634.48 $720.14 $810.88 $1,133.20 $1,722.00 |
$877.17 $962.83 $1,053.57 $1,375.89 |
$1,119.86 $1,205.52 $1,296.26 $1,618.58 |
Toc - Plan #26 Dean Health Plan | ||||||||||||||||||||
Bronze
(HMO) Prevea360 Bronze Standard 9100X (Free Virtual Care) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$281.50 $319.50 $359.75 $502.75 $763.98 |
$496.84 $534.84 $575.09 $718.09 |
$712.18 $750.18 $790.43 $933.43 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$563.00 $639.00 $719.50 $1,005.50 $1,527.96 |
$778.34 $854.34 $934.84 $1,220.84 |
$993.68 $1,069.68 $1,150.18 $1,436.18 |
ADVERTISEMENT
Molina HealthcareLocal: 1-888-560-2043 | Toll Free: 1-888-560-2043 |
Toc - Plan #27 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 |
$453.15 $514.32 $579.12 $809.32 $1,229.85 |
$799.81 $860.98 $925.78 $1,155.98 |
$1,146.47 $1,207.64 $1,272.44 $1,502.64 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$906.30 $1,028.64 $1,158.24 $1,618.64 $2,459.70 |
$1,252.96 $1,375.30 $1,504.90 $1,965.30 |
$1,599.62 $1,721.96 $1,851.56 $2,311.96 |
Toc - Plan #28 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 |
$384.72 $436.66 $491.67 $687.11 $1,044.13 |
$679.03 $730.97 $785.98 $981.42 |
$973.34 $1,025.28 $1,080.29 $1,275.73 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$769.44 $873.32 $983.34 $1,374.22 $2,088.26 |
$1,063.75 $1,167.63 $1,277.65 $1,668.53 |
$1,358.06 $1,461.94 $1,571.96 $1,962.84 |
Toc - Plan #29 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 |
$467.76 $530.90 $597.79 $835.41 $1,269.49 |
$825.59 $888.73 $955.62 $1,193.24 |
$1,183.42 $1,246.56 $1,313.45 $1,551.07 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$935.52 $1,061.80 $1,195.58 $1,670.82 $2,538.98 |
$1,293.35 $1,419.63 $1,553.41 $2,028.65 |
$1,651.18 $1,777.46 $1,911.24 $2,386.48 |
Toc - Plan #30 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 |
$375.68 $426.39 $480.11 $670.96 $1,019.59 |
$663.07 $713.78 $767.50 $958.35 |
$950.46 $1,001.17 $1,054.89 $1,245.74 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$751.36 $852.78 $960.22 $1,341.92 $2,039.18 |
$1,038.75 $1,140.17 $1,247.61 $1,629.31 |
$1,326.14 $1,427.56 $1,535.00 $1,916.70 |
Toc - Plan #31 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 |
$378.76 $429.89 $484.05 $676.46 $1,027.95 |
$668.51 $719.64 $773.80 $966.21 |
$958.26 $1,009.39 $1,063.55 $1,255.96 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$757.52 $859.78 $968.10 $1,352.92 $2,055.90 |
$1,047.27 $1,149.53 $1,257.85 $1,642.67 |
$1,337.02 $1,439.28 $1,547.60 $1,932.42 |
Toc - Plan #32 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 |
$455.74 $517.27 $582.44 $813.96 $1,236.89 |
$804.38 $865.91 $931.08 $1,162.60 |
$1,153.02 $1,214.55 $1,279.72 $1,511.24 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$911.48 $1,034.54 $1,164.88 $1,627.92 $2,473.78 |
$1,260.12 $1,383.18 $1,513.52 $1,976.56 |
$1,608.76 $1,731.82 $1,862.16 $2,325.20 |
Toc - Plan #33 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 |
$387.07 $439.32 $494.67 $691.30 $1,050.50 |
$683.18 $735.43 $790.78 $987.41 |
$979.29 $1,031.54 $1,086.89 $1,283.52 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$774.14 $878.64 $989.34 $1,382.60 $2,101.00 |
$1,070.25 $1,174.75 $1,285.45 $1,678.71 |
$1,366.36 $1,470.86 $1,581.56 $1,974.82 |
ADVERTISEMENT
Anthem Blue Cross and Blue ShieldLocal: 1-855-748-1813 | Toll Free: 1-855-748-1813 |
Toc - Plan #34 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(HMO) Anthem Bronze Blue Priority/Lean 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 |
$313.94 $356.32 $401.22 $560.70 $852.03 |
$554.10 $596.48 $641.38 $800.86 |
$794.26 $836.64 $881.54 $1,041.02 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$627.88 $712.64 $802.44 $1,121.40 $1,704.06 |
$868.04 $952.80 $1,042.60 $1,361.56 |
$1,108.20 $1,192.96 $1,282.76 $1,601.72 |
Toc - Plan #35 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(HMO) Anthem Silver Blue Priority/Lean 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 |
$390.72 $443.47 $499.34 $697.83 $1,060.41 |
$689.62 $742.37 $798.24 $996.73 |
$988.52 $1,041.27 $1,097.14 $1,295.63 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$781.44 $886.94 $998.68 $1,395.66 $2,120.82 |
$1,080.34 $1,185.84 $1,297.58 $1,694.56 |
$1,379.24 $1,484.74 $1,596.48 $1,993.46 |
Toc - Plan #36 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Bronze
(HMO) Anthem Bronze Blue Priority/Lean 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 |
$299.27 $339.67 $382.47 $534.50 $812.22 |
$528.21 $568.61 $611.41 $763.44 |
$757.15 $797.55 $840.35 $992.38 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$598.54 $679.34 $764.94 $1,069.00 $1,624.44 |
$827.48 $908.28 $993.88 $1,297.94 |
$1,056.42 $1,137.22 $1,222.82 $1,526.88 |
Toc - Plan #37 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Gold
(HMO) Anthem Gold Blue Priority/Lean 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 |
$418.06 $474.50 $534.28 $746.66 $1,134.61 |
$737.88 $794.32 $854.10 $1,066.48 |
$1,057.70 $1,114.14 $1,173.92 $1,386.30 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$836.12 $949.00 $1,068.56 $1,493.32 $2,269.22 |
$1,155.94 $1,268.82 $1,388.38 $1,813.14 |
$1,475.76 $1,588.64 $1,708.20 $2,132.96 |
Toc - Plan #38 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(HMO) Anthem Bronze Blue Priority/Lean 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 |
$320.14 $363.36 $409.14 $571.77 $868.86 |
$565.05 $608.27 $654.05 $816.68 |
$809.96 $853.18 $898.96 $1,061.59 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$640.28 $726.72 $818.28 $1,143.54 $1,737.72 |
$885.19 $971.63 $1,063.19 $1,388.45 |
$1,130.10 $1,216.54 $1,308.10 $1,633.36 |
Toc - Plan #39 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(HMO) Anthem Silver Blue Priority/Lean 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 |
$381.75 $433.29 $487.88 $681.81 $1,036.07 |
$673.79 $725.33 $779.92 $973.85 |
$965.83 $1,017.37 $1,071.96 $1,265.89 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$763.50 $866.58 $975.76 $1,363.62 $2,072.14 |
$1,055.54 $1,158.62 $1,267.80 $1,655.66 |
$1,347.58 $1,450.66 $1,559.84 $1,947.70 |
Toc - Plan #40 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(HMO) Anthem Bronze Blue Priority/Lean 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 |
$314.22 $356.64 $401.57 $561.20 $852.79 |
$554.60 $597.02 $641.95 $801.58 |
$794.98 $837.40 $882.33 $1,041.96 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$628.44 $713.28 $803.14 $1,122.40 $1,705.58 |
$868.82 $953.66 $1,043.52 $1,362.78 |
$1,109.20 $1,194.04 $1,283.90 $1,603.16 |
Toc - Plan #41 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(HMO) Anthem Bronze Blue Priority/Lean 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 |
$315.15 $357.70 $402.76 $562.86 $855.32 |
$556.24 $598.79 $643.85 $803.95 |
$797.33 $839.88 $884.94 $1,045.04 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$630.30 $715.40 $805.52 $1,125.72 $1,710.64 |
$871.39 $956.49 $1,046.61 $1,366.81 |
$1,112.48 $1,197.58 $1,287.70 $1,607.90 |
Toc - Plan #42 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(HMO) Anthem Silver Blue Priority/Lean 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 |
$390.92 $443.69 $499.60 $698.18 $1,060.96 |
$689.97 $742.74 $798.65 $997.23 |
$989.02 $1,041.79 $1,097.70 $1,296.28 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$781.84 $887.38 $999.20 $1,396.36 $2,121.92 |
$1,080.89 $1,186.43 $1,298.25 $1,695.41 |
$1,379.94 $1,485.48 $1,597.30 $1,994.46 |
Toc - Plan #43 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Gold
(HMO) Anthem Gold Blue Priority/Lean 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 |
$425.88 $483.37 $544.27 $760.62 $1,155.84 |
$751.68 $809.17 $870.07 $1,086.42 |
$1,077.48 $1,134.97 $1,195.87 $1,412.22 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$851.76 $966.74 $1,088.54 $1,521.24 $2,311.68 |
$1,177.56 $1,292.54 $1,414.34 $1,847.04 |
$1,503.36 $1,618.34 $1,740.14 $2,172.84 |
Toc - Plan #44 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(HMO) Anthem Silver Blue Priority/Lean 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 |
$381.44 $432.93 $487.48 $681.25 $1,035.23 |
$673.24 $724.73 $779.28 $973.05 |
$965.04 $1,016.53 $1,071.08 $1,264.85 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$762.88 $865.86 $974.96 $1,362.50 $2,070.46 |
$1,054.68 $1,157.66 $1,266.76 $1,654.30 |
$1,346.48 $1,449.46 $1,558.56 $1,946.10 |
Toc - Plan #45 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 |
$371.09 $421.19 $474.25 $662.77 $1,007.14 |
$654.97 $705.07 $758.13 $946.65 |
$938.85 $988.95 $1,042.01 $1,230.53 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$742.18 $842.38 $948.50 $1,325.54 $2,014.28 |
$1,026.06 $1,126.26 $1,232.38 $1,609.42 |
$1,309.94 $1,410.14 $1,516.26 $1,893.30 |
Toc - Plan #46 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 |
$439.24 $498.54 $561.35 $784.48 $1,192.10 |
$775.26 $834.56 $897.37 $1,120.50 |
$1,111.28 $1,170.58 $1,233.39 $1,456.52 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$878.48 $997.08 $1,122.70 $1,568.96 $2,384.20 |
$1,214.50 $1,333.10 $1,458.72 $1,904.98 |
$1,550.52 $1,669.12 $1,794.74 $2,241.00 |
Toc - Plan #47 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 |
$336.27 $381.67 $429.75 $600.58 $912.64 |
$593.52 $638.92 $687.00 $857.83 |
$850.77 $896.17 $944.25 $1,115.08 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$672.54 $763.34 $859.50 $1,201.16 $1,825.28 |
$929.79 $1,020.59 $1,116.75 $1,458.41 |
$1,187.04 $1,277.84 $1,374.00 $1,715.66 |
Toc - Plan #48 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 |
$352.75 $400.37 $450.81 $630.01 $957.36 |
$622.60 $670.22 $720.66 $899.86 |
$892.45 $940.07 $990.51 $1,169.71 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$705.50 $800.74 $901.62 $1,260.02 $1,914.72 |
$975.35 $1,070.59 $1,171.47 $1,529.87 |
$1,245.20 $1,340.44 $1,441.32 $1,799.72 |
Toc - Plan #49 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 |
$354.10 $401.90 $452.54 $632.42 $961.03 |
$624.99 $672.79 $723.43 $903.31 |
$895.88 $943.68 $994.32 $1,174.20 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$708.20 $803.80 $905.08 $1,264.84 $1,922.06 |
$979.09 $1,074.69 $1,175.97 $1,535.73 |
$1,249.98 $1,345.58 $1,446.86 $1,806.62 |
Toc - Plan #50 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 |
$428.93 $486.84 $548.17 $766.07 $1,164.12 |
$757.06 $814.97 $876.30 $1,094.20 |
$1,085.19 $1,143.10 $1,204.43 $1,422.33 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$857.86 $973.68 $1,096.34 $1,532.14 $2,328.24 |
$1,185.99 $1,301.81 $1,424.47 $1,860.27 |
$1,514.12 $1,629.94 $1,752.60 $2,188.40 |
Toc - Plan #51 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 |
$469.70 $533.11 $600.28 $838.88 $1,274.77 |
$829.02 $892.43 $959.60 $1,198.20 |
$1,188.34 $1,251.75 $1,318.92 $1,557.52 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$939.40 $1,066.22 $1,200.56 $1,677.76 $2,549.54 |
$1,298.72 $1,425.54 $1,559.88 $2,037.08 |
$1,658.04 $1,784.86 $1,919.20 $2,396.40 |
Toc - Plan #52 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 |
$353.06 $400.72 $451.21 $630.57 $958.20 |
$623.15 $670.81 $721.30 $900.66 |
$893.24 $940.90 $991.39 $1,170.75 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$706.12 $801.44 $902.42 $1,261.14 $1,916.40 |
$976.21 $1,071.53 $1,172.51 $1,531.23 |
$1,246.30 $1,341.62 $1,442.60 $1,801.32 |
Toc - Plan #53 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 |
$428.58 $486.44 $547.73 $765.44 $1,163.17 |
$756.44 $814.30 $875.59 $1,093.30 |
$1,084.30 $1,142.16 $1,203.45 $1,421.16 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$857.16 $972.88 $1,095.46 $1,530.88 $2,326.34 |
$1,185.02 $1,300.74 $1,423.32 $1,858.74 |
$1,512.88 $1,628.60 $1,751.18 $2,186.60 |
Toc - Plan #54 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 |
$478.53 $543.13 $611.56 $854.65 $1,298.73 |
$844.61 $909.21 $977.64 $1,220.73 |
$1,210.69 $1,275.29 $1,343.72 $1,586.81 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$957.06 $1,086.26 $1,223.12 $1,709.30 $2,597.46 |
$1,323.14 $1,452.34 $1,589.20 $2,075.38 |
$1,689.22 $1,818.42 $1,955.28 $2,441.46 |
Toc - Plan #55 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 |
$439.00 $498.27 $561.04 $784.05 $1,191.45 |
$774.84 $834.11 $896.88 $1,119.89 |
$1,110.68 $1,169.95 $1,232.72 $1,455.73 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$878.00 $996.54 $1,122.08 $1,568.10 $2,382.90 |
$1,213.84 $1,332.38 $1,457.92 $1,903.94 |
$1,549.68 $1,668.22 $1,793.76 $2,239.78 |
ADVERTISEMENT
Common Ground Healthcare CooperativeLocal: 1-877-514-2442 | Toll Free: 1-877-514-2442 | TTY: 1-844-472-2442 |
Toc - Plan #56 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 |
$316.55 $359.28 $404.54 $565.35 $859.10 |
$558.71 $601.44 $646.70 $807.51 |
$800.87 $843.60 $888.86 $1,049.67 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$633.10 $718.56 $809.08 $1,130.70 $1,718.20 |
$875.26 $960.72 $1,051.24 $1,372.86 |
$1,117.42 $1,202.88 $1,293.40 $1,615.02 |
Toc - Plan #57 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 |
$494.46 $561.20 $631.91 $883.09 $1,341.94 |
$872.71 $939.45 $1,010.16 $1,261.34 |
$1,250.96 $1,317.70 $1,388.41 $1,639.59 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$988.92 $1,122.40 $1,263.82 $1,766.18 $2,683.88 |
$1,367.17 $1,500.65 $1,642.07 $2,144.43 |
$1,745.42 $1,878.90 $2,020.32 $2,522.68 |
Toc - Plan #58 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 |
$430.67 $488.80 $550.39 $769.16 $1,168.82 |
$760.13 $818.26 $879.85 $1,098.62 |
$1,089.59 $1,147.72 $1,209.31 $1,428.08 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$861.34 $977.60 $1,100.78 $1,538.32 $2,337.64 |
$1,190.80 $1,307.06 $1,430.24 $1,867.78 |
$1,520.26 $1,636.52 $1,759.70 $2,197.24 |
Toc - Plan #59 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 |
$466.64 $529.63 $596.36 $833.40 $1,266.44 |
$823.61 $886.60 $953.33 $1,190.37 |
$1,180.58 $1,243.57 $1,310.30 $1,547.34 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$933.28 $1,059.26 $1,192.72 $1,666.80 $2,532.88 |
$1,290.25 $1,416.23 $1,549.69 $2,023.77 |
$1,647.22 $1,773.20 $1,906.66 $2,380.74 |
Toc - Plan #60 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 |
$424.90 $482.25 $543.01 $758.86 $1,153.16 |
$749.94 $807.29 $868.05 $1,083.90 |
$1,074.98 $1,132.33 $1,193.09 $1,408.94 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$849.80 $964.50 $1,086.02 $1,517.72 $2,306.32 |
$1,174.84 $1,289.54 $1,411.06 $1,842.76 |
$1,499.88 $1,614.58 $1,736.10 $2,167.80 |
Toc - Plan #61 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 |
$360.12 $408.73 $460.22 $643.16 $977.34 |
$635.61 $684.22 $735.71 $918.65 |
$911.10 $959.71 $1,011.20 $1,194.14 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$720.24 $817.46 $920.44 $1,286.32 $1,954.68 |
$995.73 $1,092.95 $1,195.93 $1,561.81 |
$1,271.22 $1,368.44 $1,471.42 $1,837.30 |
Toc - Plan #62 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 |
$203.62 $231.10 $260.22 $363.65 $552.61 |
$359.38 $386.86 $415.98 $519.41 |
$515.14 $542.62 $571.74 $675.17 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$407.24 $462.20 $520.44 $727.30 $1,105.22 |
$563.00 $617.96 $676.20 $883.06 |
$718.76 $773.72 $831.96 $1,038.82 |
Toc - Plan #63 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 |
$302.50 $343.33 $386.59 $540.26 $820.97 |
$533.91 $574.74 $618.00 $771.67 |
$765.32 $806.15 $849.41 $1,003.08 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$605.00 $686.66 $773.18 $1,080.52 $1,641.94 |
$836.41 $918.07 $1,004.59 $1,311.93 |
$1,067.82 $1,149.48 $1,236.00 $1,543.34 |
Toc - Plan #64 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 |
$315.29 $357.84 $402.93 $563.09 $855.67 |
$556.48 $599.03 $644.12 $804.28 |
$797.67 $840.22 $885.31 $1,045.47 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$630.58 $715.68 $805.86 $1,126.18 $1,711.34 |
$871.77 $956.87 $1,047.05 $1,367.37 |
$1,112.96 $1,198.06 $1,288.24 $1,608.56 |
Toc - Plan #65 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 |
$492.21 $558.65 $629.03 $879.07 $1,335.83 |
$868.74 $935.18 $1,005.56 $1,255.60 |
$1,245.27 $1,311.71 $1,382.09 $1,632.13 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$984.42 $1,117.30 $1,258.06 $1,758.14 $2,671.66 |
$1,360.95 $1,493.83 $1,634.59 $2,134.67 |
$1,737.48 $1,870.36 $2,011.12 $2,511.20 |
Toc - Plan #66 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 |
$447.18 $507.54 $571.49 $798.65 $1,213.63 |
$789.27 $849.63 $913.58 $1,140.74 |
$1,131.36 $1,191.72 $1,255.67 $1,482.83 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$894.36 $1,015.08 $1,142.98 $1,597.30 $2,427.26 |
$1,236.45 $1,357.17 $1,485.07 $1,939.39 |
$1,578.54 $1,699.26 $1,827.16 $2,281.48 |
Toc - Plan #67 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 |
$310.56 $352.47 $396.88 $554.63 $842.82 |
$548.13 $590.04 $634.45 $792.20 |
$785.70 $827.61 $872.02 $1,029.77 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$621.12 $704.94 $793.76 $1,109.26 $1,685.64 |
$858.69 $942.51 $1,031.33 $1,346.83 |
$1,096.26 $1,180.08 $1,268.90 $1,584.40 |
Toc - Plan #68 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 |
$306.26 $347.60 $391.39 $546.97 $831.17 |
$540.54 $581.88 $625.67 $781.25 |
$774.82 $816.16 $859.95 $1,015.53 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$612.52 $695.20 $782.78 $1,093.94 $1,662.34 |
$846.80 $929.48 $1,017.06 $1,328.22 |
$1,081.08 $1,163.76 $1,251.34 $1,562.50 |
Toc - Plan #69 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 |
$377.36 $428.29 $482.25 $673.94 $1,024.12 |
$666.03 $716.96 $770.92 $962.61 |
$954.70 $1,005.63 $1,059.59 $1,251.28 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$754.72 $856.58 $964.50 $1,347.88 $2,048.24 |
$1,043.39 $1,145.25 $1,253.17 $1,636.55 |
$1,332.06 $1,433.92 $1,541.84 $1,925.22 |
Toc - Plan #70 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 |
$442.91 $502.70 $566.03 $791.03 $1,202.04 |
$781.73 $841.52 $904.85 $1,129.85 |
$1,120.55 $1,180.34 $1,243.67 $1,468.67 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$885.82 $1,005.40 $1,132.06 $1,582.06 $2,404.08 |
$1,224.64 $1,344.22 $1,470.88 $1,920.88 |
$1,563.46 $1,683.04 $1,809.70 $2,259.70 |
Toc - Plan #71 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 |
$360.00 $408.59 $460.07 $642.94 $977.02 |
$635.39 $683.98 $735.46 $918.33 |
$910.78 $959.37 $1,010.85 $1,193.72 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$720.00 $817.18 $920.14 $1,285.88 $1,954.04 |
$995.39 $1,092.57 $1,195.53 $1,561.27 |
$1,270.78 $1,367.96 $1,470.92 $1,836.66 |
Toc - Plan #72 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 |
$469.63 $533.01 $600.17 $838.73 $1,274.54 |
$828.89 $892.27 $959.43 $1,197.99 |
$1,188.15 $1,251.53 $1,318.69 $1,557.25 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$939.26 $1,066.02 $1,200.34 $1,677.46 $2,549.08 |
$1,298.52 $1,425.28 $1,559.60 $2,036.72 |
$1,657.78 $1,784.54 $1,918.86 $2,395.98 |
Toc - Plan #73 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 |
$433.63 $492.16 $554.16 $774.44 $1,176.84 |
$765.35 $823.88 $885.88 $1,106.16 |
$1,097.07 $1,155.60 $1,217.60 $1,437.88 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$867.26 $984.32 $1,108.32 $1,548.88 $2,353.68 |
$1,198.98 $1,316.04 $1,440.04 $1,880.60 |
$1,530.70 $1,647.76 $1,771.76 $2,212.32 |
Toc - Plan #74 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 |
$427.86 $485.61 $546.79 $764.14 $1,161.18 |
$755.16 $812.91 $874.09 $1,091.44 |
$1,082.46 $1,140.21 $1,201.39 $1,418.74 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$855.72 $971.22 $1,093.58 $1,528.28 $2,322.36 |
$1,183.02 $1,298.52 $1,420.88 $1,855.58 |
$1,510.32 $1,625.82 $1,748.18 $2,182.88 |
Toc - Plan #75 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 |
$362.92 $411.90 $463.79 $648.15 $984.93 |
$640.54 $689.52 $741.41 $925.77 |
$918.16 $967.14 $1,019.03 $1,203.39 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$725.84 $823.80 $927.58 $1,296.30 $1,969.86 |
$1,003.46 $1,101.42 $1,205.20 $1,573.92 |
$1,281.08 $1,379.04 $1,482.82 $1,851.54 |
Toc - Plan #76 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 |
$363.05 $412.05 $463.96 $648.38 $985.28 |
$640.77 $689.77 $741.68 $926.10 |
$918.49 $967.49 $1,019.40 $1,203.82 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$726.10 $824.10 $927.92 $1,296.76 $1,970.56 |
$1,003.82 $1,101.82 $1,205.64 $1,574.48 |
$1,281.54 $1,379.54 $1,483.36 $1,852.20 |
Toc - Plan #77 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 |
$305.39 $346.61 $390.27 $545.41 $828.80 |
$539.01 $580.23 $623.89 $779.03 |
$772.63 $813.85 $857.51 $1,012.65 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$610.78 $693.22 $780.54 $1,090.82 $1,657.60 |
$844.40 $926.84 $1,014.16 $1,324.44 |
$1,078.02 $1,160.46 $1,247.78 $1,558.06 |
Toc - Plan #78 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 |
$313.45 $355.75 $400.58 $559.80 $850.67 |
$553.23 $595.53 $640.36 $799.58 |
$793.01 $835.31 $880.14 $1,039.36 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$626.90 $711.50 $801.16 $1,119.60 $1,701.34 |
$866.68 $951.28 $1,040.94 $1,359.38 |
$1,106.46 $1,191.06 $1,280.72 $1,599.16 |
Toc - Plan #79 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 |
$318.18 $361.13 $406.63 $568.26 $863.52 |
$561.58 $604.53 $650.03 $811.66 |
$804.98 $847.93 $893.43 $1,055.06 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$636.36 $722.26 $813.26 $1,136.52 $1,727.04 |
$879.76 $965.66 $1,056.66 $1,379.92 |
$1,123.16 $1,209.06 $1,300.06 $1,623.32 |
Toc - Plan #80 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 |
$450.15 $510.91 $575.28 $803.95 $1,221.68 |
$794.51 $855.27 $919.64 $1,148.31 |
$1,138.87 $1,199.63 $1,264.00 $1,492.67 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$900.30 $1,021.82 $1,150.56 $1,607.90 $2,443.36 |
$1,244.66 $1,366.18 $1,494.92 $1,952.26 |
$1,589.02 $1,710.54 $1,839.28 $2,296.62 |
Toc - Plan #81 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 |
$495.19 $562.03 $632.84 $884.40 $1,343.93 |
$874.01 $940.85 $1,011.66 $1,263.22 |
$1,252.83 $1,319.67 $1,390.48 $1,642.04 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$990.38 $1,124.06 $1,265.68 $1,768.80 $2,687.86 |
$1,369.20 $1,502.88 $1,644.50 $2,147.62 |
$1,748.02 $1,881.70 $2,023.32 $2,526.44 |
Toc - Plan #82 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 |
$319.45 $362.56 $408.24 $570.52 $866.96 |
$563.82 $606.93 $652.61 $814.89 |
$808.19 $851.30 $896.98 $1,059.26 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$638.90 $725.12 $816.48 $1,141.04 $1,733.92 |
$883.27 $969.49 $1,060.85 $1,385.41 |
$1,127.64 $1,213.86 $1,305.22 $1,629.78 |
Toc - Plan #83 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 |
$497.45 $564.60 $635.73 $888.44 $1,350.07 |
$878.00 $945.15 $1,016.28 $1,268.99 |
$1,258.55 $1,325.70 $1,396.83 $1,649.54 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$994.90 $1,129.20 $1,271.46 $1,776.88 $2,700.14 |
$1,375.45 $1,509.75 $1,652.01 $2,157.43 |
$1,756.00 $1,890.30 $2,032.56 $2,537.98 |
‡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 Door County here.
Door County is in “Rating Area 16” of Wisconsin.
Currently, there are 83 plans offered in Rating Area 16.