Florence County, Wisconsin Obamacare 2024 Rates

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 Florence 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, 61 Plans and 2024 Rates for Florence County, Wisconsin

Below, you’ll find a summary of the 61 plans for Florence 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 |

HealthPartners

Local: 1-952-883-5900 | Toll Free: 1-855-813-3887 | TTY: 1-952-883-6060

Toc - Plan #1 HealthPartners

Gold

(PPO) Robin Oak $1,000 w/Copay P-S Gold

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-813-3887

Annual Out of Pocket Expenses:

Individual Family

$1,000 $2,000 Annual Deductible

$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$497.10
$564.21
$635.29
$887.82
$1,349.13

$877.38
$944.49
$1,015.57
$1,268.10

$1,257.66
$1,324.77
$1,395.85
$1,648.38

$1,637.94
$1,705.05
$1,776.13
$2,028.66

$380.28

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$994.20
$1,128.42
$1,270.58
$1,775.64
$2,698.26

$1,374.48
$1,508.70
$1,650.86
$2,155.92

$1,754.76
$1,888.98
$2,031.14
$2,536.20

$2,135.04
$2,269.26
$2,411.42
$2,916.48

$380.28

Toc - Plan #2 HealthPartners

Gold

(PPO) Robin Oak $1,500 w/Copay P-S Gold

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-813-3887

Annual Out of Pocket Expenses:

Individual Family

$1,500 $3,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$480.50
$545.37
$614.08
$858.17
$1,304.08

$848.08
$912.95
$981.66
$1,225.75

$1,215.66
$1,280.53
$1,349.24
$1,593.33

$1,583.24
$1,648.11
$1,716.82
$1,960.91

$367.58

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$961.00
$1,090.74
$1,228.16
$1,716.34
$2,608.16

$1,328.58
$1,458.32
$1,595.74
$2,083.92

$1,696.16
$1,825.90
$1,963.32
$2,451.50

$2,063.74
$2,193.48
$2,330.90
$2,819.08

$367.58

Toc - Plan #3 HealthPartners

Silver

(PPO) Robin Select $3,600 Plus Silver

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-813-3887

Annual Out of Pocket Expenses:

Individual Family

$3,600 $7,200 Annual Deductible

$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$386.77
$438.98
$494.29
$690.77
$1,049.69

$682.65
$734.86
$790.17
$986.65

$978.53
$1,030.74
$1,086.05
$1,282.53

$1,274.41
$1,326.62
$1,381.93
$1,578.41

$295.88

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$773.54
$877.96
$988.58
$1,381.54
$2,099.38

$1,069.42
$1,173.84
$1,284.46
$1,677.42

$1,365.30
$1,469.72
$1,580.34
$1,973.30

$1,661.18
$1,765.60
$1,876.22
$2,269.18

$295.88

Toc - Plan #4 HealthPartners

Silver

(PPO) Robin Select $5,900 w/Copay P-S Silver

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-813-3887

Annual Out of Pocket Expenses:

Individual Family

$5,900 $11,800 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$386.40
$438.56
$493.82
$690.11
$1,048.69

$682.00
$734.16
$789.42
$985.71

$977.60
$1,029.76
$1,085.02
$1,281.31

$1,273.20
$1,325.36
$1,380.62
$1,576.91

$295.60

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$772.80
$877.12
$987.64
$1,380.22
$2,097.38

$1,068.40
$1,172.72
$1,283.24
$1,675.82

$1,364.00
$1,468.32
$1,578.84
$1,971.42

$1,659.60
$1,763.92
$1,874.44
$2,267.02

$295.60

Toc - Plan #5 HealthPartners

Expanded Bronze

(PPO) Robin Select $6,350 Plus Bronze

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-813-3887

Annual Out of Pocket Expenses:

Individual Family

$6,350 $12,700 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$297.55
$337.72
$380.27
$531.42
$807.55

$525.18
$565.35
$607.90
$759.05

$752.81
$792.98
$835.53
$986.68

$980.44
$1,020.61
$1,063.16
$1,214.31

$227.63

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$595.10
$675.44
$760.54
$1,062.84
$1,615.10

$822.73
$903.07
$988.17
$1,290.47

$1,050.36
$1,130.70
$1,215.80
$1,518.10

$1,277.99
$1,358.33
$1,443.43
$1,745.73

$227.63

Toc - Plan #6 HealthPartners

Expanded Bronze

(PPO) Robin Select $7,500 w/Copay P-S Bronze

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-813-3887

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$300.05
$340.56
$383.46
$535.89
$814.34

$529.59
$570.10
$613.00
$765.43

$759.13
$799.64
$842.54
$994.97

$988.67
$1,029.18
$1,072.08
$1,224.51

$229.54

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$600.10
$681.12
$766.92
$1,071.78
$1,628.68

$829.64
$910.66
$996.46
$1,301.32

$1,059.18
$1,140.20
$1,226.00
$1,530.86

$1,288.72
$1,369.74
$1,455.54
$1,760.40

$229.54

Toc - Plan #7 HealthPartners

Silver

(PPO) Robin Select $3,800 HSA Silver

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-813-3887

Annual Out of Pocket Expenses:

Individual Family

$3,800 $7,600 Annual Deductible

$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$376.56
$427.40
$481.24
$672.54
$1,021.98

$664.63
$715.47
$769.31
$960.61

$952.70
$1,003.54
$1,057.38
$1,248.68

$1,240.77
$1,291.61
$1,345.45
$1,536.75

$288.07

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$753.12
$854.80
$962.48
$1,345.08
$2,043.96

$1,041.19
$1,142.87
$1,250.55
$1,633.15

$1,329.26
$1,430.94
$1,538.62
$1,921.22

$1,617.33
$1,719.01
$1,826.69
$2,209.29

$288.07

Toc - Plan #8 HealthPartners

Expanded Bronze

(PPO) Robin Select $8,000 HSA Bronze

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-813-3887

Annual Out of Pocket Expenses:

Individual Family

$8,000 $16,000 Annual Deductible

$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$284.47
$322.87
$363.55
$508.06
$772.05

$502.09
$540.49
$581.17
$725.68

$719.71
$758.11
$798.79
$943.30

$937.33
$975.73
$1,016.41
$1,160.92

$217.62

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$568.94
$645.74
$727.10
$1,016.12
$1,544.10

$786.56
$863.36
$944.72
$1,233.74

$1,004.18
$1,080.98
$1,162.34
$1,451.36

$1,221.80
$1,298.60
$1,379.96
$1,668.98

$217.62

Toc - Plan #9 HealthPartners

Catastrophic

(PPO) Robin Select $9,450 Catastrophic

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-855-813-3887

Annual Out of Pocket Expenses:

Individual Family

$9,450 $18,900 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$225.34
$255.76
$287.98
$402.46
$611.57

$397.73
$428.15
$460.37
$574.85

$570.12
$600.54
$632.76
$747.24

$742.51
$772.93
$805.15
$919.63

$172.39

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$450.68
$511.52
$575.96
$804.92
$1,223.14

$623.07
$683.91
$748.35
$977.31

$795.46
$856.30
$920.74
$1,149.70

$967.85
$1,028.69
$1,093.13
$1,322.09

$172.39

Quartz

Local: 1-608-644-3430 | Toll Free: 1-800-362-3310 | TTY: 1-800-877-8973

Toc - Plan #10 Quartz

Gold

(HMO) QUARTZ ONE WITH ADVOCATE HEALTH CARE GOLD I402 MAINTENANCE VALUE TIER RX W/DENTAL

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family

$500 $1,000 Annual Deductible

$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$507.99
$576.56
$649.20
$907.26
$1,378.67

$896.60
$965.17
$1,037.81
$1,295.87

$1,285.21
$1,353.78
$1,426.42
$1,684.48

$1,673.82
$1,742.39
$1,815.03
$2,073.09

$388.61

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,015.98
$1,153.12
$1,298.40
$1,814.52
$2,757.34

$1,404.59
$1,541.73
$1,687.01
$2,203.13

$1,793.20
$1,930.34
$2,075.62
$2,591.74

$2,181.81
$2,318.95
$2,464.23
$2,980.35

$388.61

Toc - Plan #11 Quartz

Gold

(HMO) QUARTZ ONE WITH ADVOCATE HEALTH CARE GOLD I410 STANDARD W/DENTAL

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family

$1,500 $3,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$511.95
$581.05
$654.26
$914.33
$1,389.41

$903.58
$972.68
$1,045.89
$1,305.96

$1,295.21
$1,364.31
$1,437.52
$1,697.59

$1,686.84
$1,755.94
$1,829.15
$2,089.22

$391.63

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,023.90
$1,162.10
$1,308.52
$1,828.66
$2,778.82

$1,415.53
$1,553.73
$1,700.15
$2,220.29

$1,807.16
$1,945.36
$2,091.78
$2,611.92

$2,198.79
$2,336.99
$2,483.41
$3,003.55

$391.63

Toc - Plan #12 Quartz

Silver

(HMO) QUARTZ ONE WITH ADVOCATE HEALTH CARE SILVER I308 VALUE TIER RX W/DENTAL

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$541.17
$614.22
$691.60
$966.51
$1,468.71

$955.16
$1,028.21
$1,105.59
$1,380.50

$1,369.15
$1,442.20
$1,519.58
$1,794.49

$1,783.14
$1,856.19
$1,933.57
$2,208.48

$413.99

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,082.34
$1,228.44
$1,383.20
$1,933.02
$2,937.42

$1,496.33
$1,642.43
$1,797.19
$2,347.01

$1,910.32
$2,056.42
$2,211.18
$2,761.00

$2,324.31
$2,470.41
$2,625.17
$3,174.99

$413.99

Toc - Plan #13 Quartz

Expanded Bronze

(HMO) QUARTZ ONE WITH ADVOCATE HEALTH CARE BRONZE I204 VALUE TIER RX W/DENTAL

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family

$3,000 $6,000 Annual Deductible

$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$402.65
$457.00
$514.58
$719.12
$1,092.77

$710.67
$765.02
$822.60
$1,027.14

$1,018.69
$1,073.04
$1,130.62
$1,335.16

$1,326.71
$1,381.06
$1,438.64
$1,643.18

$308.02

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$805.30
$914.00
$1,029.16
$1,438.24
$2,185.54

$1,113.32
$1,222.02
$1,337.18
$1,746.26

$1,421.34
$1,530.04
$1,645.20
$2,054.28

$1,729.36
$1,838.06
$1,953.22
$2,362.30

$308.02

Toc - Plan #14 Quartz

Expanded Bronze

(HMO) QUARTZ ONE WITH ADVOCATE HEALTH CARE BRONZE I205 VALUE TIER RX W/DENTAL

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$391.88
$444.78
$500.81
$699.89
$1,063.55

$691.66
$744.56
$800.59
$999.67

$991.44
$1,044.34
$1,100.37
$1,299.45

$1,291.22
$1,344.12
$1,400.15
$1,599.23

$299.78

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$783.76
$889.56
$1,001.62
$1,399.78
$2,127.10

$1,083.54
$1,189.34
$1,301.40
$1,699.56

$1,383.32
$1,489.12
$1,601.18
$1,999.34

$1,683.10
$1,788.90
$1,900.96
$2,299.12

$299.78

Toc - Plan #15 Quartz

Silver

(HMO) QUARTZ ONE WITH ADVOCATE HEALTH CARE SILVER I320 VALUE TIER RX W/DENTAL

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family

$2,500 $5,000 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$554.04
$628.83
$708.06
$989.51
$1,503.65

$977.88
$1,052.67
$1,131.90
$1,413.35

$1,401.72
$1,476.51
$1,555.74
$1,837.19

$1,825.56
$1,900.35
$1,979.58
$2,261.03

$423.84

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,108.08
$1,257.66
$1,416.12
$1,979.02
$3,007.30

$1,531.92
$1,681.50
$1,839.96
$2,402.86

$1,955.76
$2,105.34
$2,263.80
$2,826.70

$2,379.60
$2,529.18
$2,687.64
$3,250.54

$423.84

Toc - Plan #16 Quartz

Gold

(HMO) QUARTZ ONE WITH ADVOCATE HEALTH CARE GOLD I420 VALUE TIER RX

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family

$1,000 $2,000 Annual Deductible

$8,500 $17,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$465.47
$528.30
$594.86
$831.31
$1,263.26

$821.55
$884.38
$950.94
$1,187.39

$1,177.63
$1,240.46
$1,307.02
$1,543.47

$1,533.71
$1,596.54
$1,663.10
$1,899.55

$356.08

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$930.94
$1,056.60
$1,189.72
$1,662.62
$2,526.52

$1,287.02
$1,412.68
$1,545.80
$2,018.70

$1,643.10
$1,768.76
$1,901.88
$2,374.78

$1,999.18
$2,124.84
$2,257.96
$2,730.86

$356.08

Toc - Plan #17 Quartz

Gold

(HMO) QUARTZ ONE WITH ADVOCATE HEALTH CARE GOLD I402 MAINTENANCE VALUE TIER RX

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family

$500 $1,000 Annual Deductible

$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$483.78
$549.08
$618.26
$864.01
$1,312.95

$853.86
$919.16
$988.34
$1,234.09

$1,223.94
$1,289.24
$1,358.42
$1,604.17

$1,594.02
$1,659.32
$1,728.50
$1,974.25

$370.08

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$967.56
$1,098.16
$1,236.52
$1,728.02
$2,625.90

$1,337.64
$1,468.24
$1,606.60
$2,098.10

$1,707.72
$1,838.32
$1,976.68
$2,468.18

$2,077.80
$2,208.40
$2,346.76
$2,838.26

$370.08

Toc - Plan #18 Quartz

Gold

(HMO) QUARTZ ONE WITH ADVOCATE HEALTH CARE GOLD I410 STANDARD

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family

$1,500 $3,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$487.54
$553.36
$623.07
$870.74
$1,323.18

$860.51
$926.33
$996.04
$1,243.71

$1,233.48
$1,299.30
$1,369.01
$1,616.68

$1,606.45
$1,672.27
$1,741.98
$1,989.65

$372.97

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$975.08
$1,106.72
$1,246.14
$1,741.48
$2,646.36

$1,348.05
$1,479.69
$1,619.11
$2,114.45

$1,721.02
$1,852.66
$1,992.08
$2,487.42

$2,093.99
$2,225.63
$2,365.05
$2,860.39

$372.97

Toc - Plan #19 Quartz

Silver

(HMO) QUARTZ ONE WITH ADVOCATE HEALTH CARE SILVER I308 VALUE TIER RX

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$515.37
$584.94
$658.64
$920.44
$1,398.70

$909.62
$979.19
$1,052.89
$1,314.69

$1,303.87
$1,373.44
$1,447.14
$1,708.94

$1,698.12
$1,767.69
$1,841.39
$2,103.19

$394.25

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,030.74
$1,169.88
$1,317.28
$1,840.88
$2,797.40

$1,424.99
$1,564.13
$1,711.53
$2,235.13

$1,819.24
$1,958.38
$2,105.78
$2,629.38

$2,213.49
$2,352.63
$2,500.03
$3,023.63

$394.25

Toc - Plan #20 Quartz

Silver

(HMO) QUARTZ ONE WITH ADVOCATE HEALTH CARE SILVER I309 STANDARD

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family

$5,900 $11,800 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$501.62
$569.34
$641.07
$895.89
$1,361.39

$885.36
$953.08
$1,024.81
$1,279.63

$1,269.10
$1,336.82
$1,408.55
$1,663.37

$1,652.84
$1,720.56
$1,792.29
$2,047.11

$383.74

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,003.24
$1,138.68
$1,282.14
$1,791.78
$2,722.78

$1,386.98
$1,522.42
$1,665.88
$2,175.52

$1,770.72
$1,906.16
$2,049.62
$2,559.26

$2,154.46
$2,289.90
$2,433.36
$2,943.00

$383.74

Toc - Plan #21 Quartz

Expanded Bronze

(HMO) QUARTZ ONE WITH ADVOCATE HEALTH CARE BRONZE I204 VALUE TIER RX

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family

$3,000 $6,000 Annual Deductible

$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$383.45
$435.22
$490.05
$684.84
$1,040.68

$676.79
$728.56
$783.39
$978.18

$970.13
$1,021.90
$1,076.73
$1,271.52

$1,263.47
$1,315.24
$1,370.07
$1,564.86

$293.34

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$766.90
$870.44
$980.10
$1,369.68
$2,081.36

$1,060.24
$1,163.78
$1,273.44
$1,663.02

$1,353.58
$1,457.12
$1,566.78
$1,956.36

$1,646.92
$1,750.46
$1,860.12
$2,249.70

$293.34

Toc - Plan #22 Quartz

Expanded Bronze

(HMO) QUARTZ ONE WITH ADVOCATE HEALTH CARE BRONZE I205 VALUE TIER RX

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$373.20
$423.58
$476.94
$666.52
$1,012.85

$658.69
$709.07
$762.43
$952.01

$944.18
$994.56
$1,047.92
$1,237.50

$1,229.67
$1,280.05
$1,333.41
$1,522.99

$285.49

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$746.40
$847.16
$953.88
$1,333.04
$2,025.70

$1,031.89
$1,132.65
$1,239.37
$1,618.53

$1,317.38
$1,418.14
$1,524.86
$1,904.02

$1,602.87
$1,703.63
$1,810.35
$2,189.51

$285.49

Toc - Plan #23 Quartz

Expanded Bronze

(HMO) QUARTZ ONE WITH ADVOCATE HEALTH CARE BRONZE I206 STANDARD

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$356.18
$404.26
$455.20
$636.14
$966.67

$628.66
$676.74
$727.68
$908.62

$901.14
$949.22
$1,000.16
$1,181.10

$1,173.62
$1,221.70
$1,272.64
$1,453.58

$272.48

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$712.36
$808.52
$910.40
$1,272.28
$1,933.34

$984.84
$1,081.00
$1,182.88
$1,544.76

$1,257.32
$1,353.48
$1,455.36
$1,817.24

$1,529.80
$1,625.96
$1,727.84
$2,089.72

$272.48

Toc - Plan #24 Quartz

Silver

(HMO) QUARTZ ONE WITH ADVOCATE HEALTH CARE SILVER I320 VALUE TIER RX

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family

$2,500 $5,000 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$527.63
$598.86
$674.31
$942.34
$1,431.98

$931.26
$1,002.49
$1,077.94
$1,345.97

$1,334.89
$1,406.12
$1,481.57
$1,749.60

$1,738.52
$1,809.75
$1,885.20
$2,153.23

$403.63

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,055.26
$1,197.72
$1,348.62
$1,884.68
$2,863.96

$1,458.89
$1,601.35
$1,752.25
$2,288.31

$1,862.52
$2,004.98
$2,155.88
$2,691.94

$2,266.15
$2,408.61
$2,559.51
$3,095.57

$403.63

Toc - Plan #25 Quartz

Gold

(HMO) QUARTZ ONE WITH ADVOCATE HEALTH CARE GOLD I401 VALUE TIER RX

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family

$2,500 $5,000 Annual Deductible

$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$458.42
$520.31
$585.86
$818.74
$1,244.15

$809.11
$871.00
$936.55
$1,169.43

$1,159.80
$1,221.69
$1,287.24
$1,520.12

$1,510.49
$1,572.38
$1,637.93
$1,870.81

$350.69

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$916.84
$1,040.62
$1,171.72
$1,637.48
$2,488.30

$1,267.53
$1,391.31
$1,522.41
$1,988.17

$1,618.22
$1,742.00
$1,873.10
$2,338.86

$1,968.91
$2,092.69
$2,223.79
$2,689.55

$350.69

Toc - Plan #26 Quartz

Silver

(HMO) QUARTZ ONE WITH ADVOCATE HEALTH CARE SILVER I303 VALUE TIER RX

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family

$7,000 $14,000 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$490.28
$556.47
$626.58
$875.64
$1,330.62

$865.34
$931.53
$1,001.64
$1,250.70

$1,240.40
$1,306.59
$1,376.70
$1,625.76

$1,615.46
$1,681.65
$1,751.76
$2,000.82

$375.06

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$980.56
$1,112.94
$1,253.16
$1,751.28
$2,661.24

$1,355.62
$1,488.00
$1,628.22
$2,126.34

$1,730.68
$1,863.06
$2,003.28
$2,501.40

$2,105.74
$2,238.12
$2,378.34
$2,876.46

$375.06

Toc - Plan #27 Quartz

Expanded Bronze

(HMO) QUARTZ ONE WITH ADVOCATE HEALTH CARE BRONZE I201 VALUE TIER RX

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family

$9,400 $18,800 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$335.64
$380.95
$428.94
$599.44
$910.91

$592.40
$637.71
$685.70
$856.20

$849.16
$894.47
$942.46
$1,112.96

$1,105.92
$1,151.23
$1,199.22
$1,369.72

$256.76

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$671.28
$761.90
$857.88
$1,198.88
$1,821.82

$928.04
$1,018.66
$1,114.64
$1,455.64

$1,184.80
$1,275.42
$1,371.40
$1,712.40

$1,441.56
$1,532.18
$1,628.16
$1,969.16

$256.76

Toc - Plan #28 Quartz

Gold

(HMO) QUARTZ ONE WITH ADVOCATE HEALTH CARE GOLD I403 HSA

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family

$3,500 $7,000 Annual Deductible

$3,500 $7,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$477.07
$541.47
$609.69
$852.04
$1,294.76

$842.02
$906.42
$974.64
$1,216.99

$1,206.97
$1,271.37
$1,339.59
$1,581.94

$1,571.92
$1,636.32
$1,704.54
$1,946.89

$364.95

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$954.14
$1,082.94
$1,219.38
$1,704.08
$2,589.52

$1,319.09
$1,447.89
$1,584.33
$2,069.03

$1,684.04
$1,812.84
$1,949.28
$2,433.98

$2,048.99
$2,177.79
$2,314.23
$2,798.93

$364.95

Toc - Plan #29 Quartz

Silver

(HMO) QUARTZ ONE WITH ADVOCATE HEALTH CARE SILVER I304 HSA

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family

$5,500 $11,000 Annual Deductible

$5,500 $11,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$520.00
$590.19
$664.55
$928.71
$1,411.27

$917.80
$987.99
$1,062.35
$1,326.51

$1,315.60
$1,385.79
$1,460.15
$1,724.31

$1,713.40
$1,783.59
$1,857.95
$2,122.11

$397.80

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,040.00
$1,180.38
$1,329.10
$1,857.42
$2,822.54

$1,437.80
$1,578.18
$1,726.90
$2,255.22

$1,835.60
$1,975.98
$2,124.70
$2,653.02

$2,233.40
$2,373.78
$2,522.50
$3,050.82

$397.80

Toc - Plan #30 Quartz

Expanded Bronze

(HMO) QUARTZ ONE WITH ADVOCATE HEALTH CARE BRONZE I203 HSA

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family

$7,250 $14,500 Annual Deductible

$7,250 $14,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$364.80
$414.04
$466.20
$651.52
$990.04

$643.87
$693.11
$745.27
$930.59

$922.94
$972.18
$1,024.34
$1,209.66

$1,202.01
$1,251.25
$1,303.41
$1,488.73

$279.07

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$729.60
$828.08
$932.40
$1,303.04
$1,980.08

$1,008.67
$1,107.15
$1,211.47
$1,582.11

$1,287.74
$1,386.22
$1,490.54
$1,861.18

$1,566.81
$1,665.29
$1,769.61
$2,140.25

$279.07

Toc - Plan #31 Quartz

Catastrophic

(HMO) QUARTZ ONE WITH ADVOCATE HEALTH CARE CATASTROPHIC I101

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-800-362-3310

Annual Out of Pocket Expenses:

Individual Family

$9,450 $18,900 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$264.86
$300.61
$338.48
$473.03
$718.82

$467.47
$503.22
$541.09
$675.64

$670.08
$705.83
$743.70
$878.25

$872.69
$908.44
$946.31
$1,080.86

$202.61

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$529.72
$601.22
$676.96
$946.06
$1,437.64

$732.33
$803.83
$879.57
$1,148.67

$934.94
$1,006.44
$1,082.18
$1,351.28

$1,137.55
$1,209.05
$1,284.79
$1,553.89

$202.61

Security Health Plan

Local: 1-715-221-9258x19258 | Toll Free: 1-844-293-9624 | TTY: 1-800-947-3529

Toc - Plan #32 Security Health Plan

Gold

(EPO) SimplyOne $3,500 - 30%

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-844-293-9624

Annual Out of Pocket Expenses:

Individual Family

$3,500 $7,000 Annual Deductible

$6,500 $13,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$418.33
$474.79
$534.61
$747.12
$1,135.32

$738.35
$794.81
$854.63
$1,067.14

$1,058.37
$1,114.83
$1,174.65
$1,387.16

$1,378.39
$1,434.85
$1,494.67
$1,707.18

$320.02

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$836.66
$949.58
$1,069.22
$1,494.24
$2,270.64

$1,156.68
$1,269.60
$1,389.24
$1,814.26

$1,476.70
$1,589.62
$1,709.26
$2,134.28

$1,796.72
$1,909.64
$2,029.28
$2,454.30

$320.02

Toc - Plan #33 Security Health Plan

Silver

(EPO) SimplyOne $4,100 HDHP

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-844-293-9624

Annual Out of Pocket Expenses:

Individual Family

$4,100 $8,200 Annual Deductible

$7,050 $14,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$458.09
$519.92
$585.42
$818.13
$1,243.22

$808.52
$870.35
$935.85
$1,168.56

$1,158.95
$1,220.78
$1,286.28
$1,518.99

$1,509.38
$1,571.21
$1,636.71
$1,869.42

$350.43

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$916.18
$1,039.84
$1,170.84
$1,636.26
$2,486.44

$1,266.61
$1,390.27
$1,521.27
$1,986.69

$1,617.04
$1,740.70
$1,871.70
$2,337.12

$1,967.47
$2,091.13
$2,222.13
$2,687.55

$350.43

Toc - Plan #34 Security Health Plan

Expanded Bronze

(EPO) SimplyOne $6,200 HDHP

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-844-293-9624

Annual Out of Pocket Expenses:

Individual Family

$6,200 $12,400 Annual Deductible

$7,550 $15,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$333.11
$378.07
$425.70
$594.91
$904.03

$587.93
$632.89
$680.52
$849.73

$842.75
$887.71
$935.34
$1,104.55

$1,097.57
$1,142.53
$1,190.16
$1,359.37

$254.82

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$666.22
$756.14
$851.40
$1,189.82
$1,808.06

$921.04
$1,010.96
$1,106.22
$1,444.64

$1,175.86
$1,265.78
$1,361.04
$1,699.46

$1,430.68
$1,520.60
$1,615.86
$1,954.28

$254.82

Toc - Plan #35 Security Health Plan

Bronze

(EPO) SimplyOne $9,100

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-844-293-9624

Annual Out of Pocket Expenses:

Individual Family

$9,100 $18,200 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$291.35
$330.67
$372.33
$520.34
$790.70

$514.23
$553.55
$595.21
$743.22

$737.11
$776.43
$818.09
$966.10

$959.99
$999.31
$1,040.97
$1,188.98

$222.88

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$582.70
$661.34
$744.66
$1,040.68
$1,581.40

$805.58
$884.22
$967.54
$1,263.56

$1,028.46
$1,107.10
$1,190.42
$1,486.44

$1,251.34
$1,329.98
$1,413.30
$1,709.32

$222.88

Toc - Plan #36 Security Health Plan

Catastrophic

(EPO) SimplyOne Protection

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-844-293-9624

Annual Out of Pocket Expenses:

Individual Family

$9,450 $18,900 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$194.56
$220.81
$248.63
$347.46
$528.00

$343.39
$369.64
$397.46
$496.29

$492.22
$518.47
$546.29
$645.12

$641.05
$667.30
$695.12
$793.95

$148.83

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$389.12
$441.62
$497.26
$694.92
$1,056.00

$537.95
$590.45
$646.09
$843.75

$686.78
$739.28
$794.92
$992.58

$835.61
$888.11
$943.75
$1,141.41

$148.83

Toc - Plan #37 Security Health Plan

Gold

(EPO) SimplyOne $1,500 - 25%

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-844-293-9624

Annual Out of Pocket Expenses:

Individual Family

$1,500 $3,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$457.17
$518.88
$584.25
$816.49
$1,240.74

$806.90
$868.61
$933.98
$1,166.22

$1,156.63
$1,218.34
$1,283.71
$1,515.95

$1,506.36
$1,568.07
$1,633.44
$1,865.68

$349.73

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$914.34
$1,037.76
$1,168.50
$1,632.98
$2,481.48

$1,264.07
$1,387.49
$1,518.23
$1,982.71

$1,613.80
$1,737.22
$1,867.96
$2,332.44

$1,963.53
$2,086.95
$2,217.69
$2,682.17

$349.73

Toc - Plan #38 Security Health Plan

Silver

(EPO) SimplyOne $5,900 - 40%

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-844-293-9624

Annual Out of Pocket Expenses:

Individual Family

$5,900 $11,800 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$393.62
$446.75
$503.03
$702.98
$1,068.25

$694.73
$747.86
$804.14
$1,004.09

$995.84
$1,048.97
$1,105.25
$1,305.20

$1,296.95
$1,350.08
$1,406.36
$1,606.31

$301.11

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$787.24
$893.50
$1,006.06
$1,405.96
$2,136.50

$1,088.35
$1,194.61
$1,307.17
$1,707.07

$1,389.46
$1,495.72
$1,608.28
$2,008.18

$1,690.57
$1,796.83
$1,909.39
$2,309.29

$301.11

Toc - Plan #39 Security Health Plan

Expanded Bronze

(EPO) SimplyOne $7,500

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-844-293-9624

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$292.23
$331.67
$373.45
$521.90
$793.08

$515.78
$555.22
$597.00
$745.45

$739.33
$778.77
$820.55
$969.00

$962.88
$1,002.32
$1,044.10
$1,192.55

$223.55

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$584.46
$663.34
$746.90
$1,043.80
$1,586.16

$808.01
$886.89
$970.45
$1,267.35

$1,031.56
$1,110.44
$1,194.00
$1,490.90

$1,255.11
$1,333.99
$1,417.55
$1,714.45

$223.55

Toc - Plan #40 Security Health Plan

Gold

(HMO) Premier $1,500 - 25%

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-844-293-9624

Annual Out of Pocket Expenses:

Individual Family

$1,500 $3,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$528.41
$599.73
$675.30
$943.72
$1,434.08

$932.64
$1,003.96
$1,079.53
$1,347.95

$1,336.87
$1,408.19
$1,483.76
$1,752.18

$1,741.10
$1,812.42
$1,887.99
$2,156.41

$404.23

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,056.82
$1,199.46
$1,350.60
$1,887.44
$2,868.16

$1,461.05
$1,603.69
$1,754.83
$2,291.67

$1,865.28
$2,007.92
$2,159.06
$2,695.90

$2,269.51
$2,412.15
$2,563.29
$3,100.13

$404.23

Toc - Plan #41 Security Health Plan

Gold

(HMO) Premier $3,500 - 30%

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-844-293-9624

Annual Out of Pocket Expenses:

Individual Family

$3,500 $7,000 Annual Deductible

$6,500 $13,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$483.52
$548.78
$617.92
$863.54
$1,312.24

$853.40
$918.66
$987.80
$1,233.42

$1,223.28
$1,288.54
$1,357.68
$1,603.30

$1,593.16
$1,658.42
$1,727.56
$1,973.18

$369.88

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$967.04
$1,097.56
$1,235.84
$1,727.08
$2,624.48

$1,336.92
$1,467.44
$1,605.72
$2,096.96

$1,706.80
$1,837.32
$1,975.60
$2,466.84

$2,076.68
$2,207.20
$2,345.48
$2,836.72

$369.88

Toc - Plan #42 Security Health Plan

Silver

(HMO) Premier $5,900 - 40%

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-844-293-9624

Annual Out of Pocket Expenses:

Individual Family

$5,900 $11,800 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$454.95
$516.36
$581.42
$812.53
$1,234.72

$802.98
$864.39
$929.45
$1,160.56

$1,151.01
$1,212.42
$1,277.48
$1,508.59

$1,499.04
$1,560.45
$1,625.51
$1,856.62

$348.03

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$909.90
$1,032.72
$1,162.84
$1,625.06
$2,469.44

$1,257.93
$1,380.75
$1,510.87
$1,973.09

$1,605.96
$1,728.78
$1,858.90
$2,321.12

$1,953.99
$2,076.81
$2,206.93
$2,669.15

$348.03

Toc - Plan #43 Security Health Plan

Silver

(HMO) Premier $4,100 HDHP

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-844-293-9624

Annual Out of Pocket Expenses:

Individual Family

$4,100 $8,200 Annual Deductible

$7,050 $14,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$529.47
$600.94
$676.65
$945.61
$1,436.95

$934.51
$1,005.98
$1,081.69
$1,350.65

$1,339.55
$1,411.02
$1,486.73
$1,755.69

$1,744.59
$1,816.06
$1,891.77
$2,160.73

$405.04

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,058.94
$1,201.88
$1,353.30
$1,891.22
$2,873.90

$1,463.98
$1,606.92
$1,758.34
$2,296.26

$1,869.02
$2,011.96
$2,163.38
$2,701.30

$2,274.06
$2,417.00
$2,568.42
$3,106.34

$405.04

Toc - Plan #44 Security Health Plan

Expanded Bronze

(HMO) Premier $6,200 HDHP

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-844-293-9624

Annual Out of Pocket Expenses:

Individual Family

$6,200 $12,400 Annual Deductible

$7,550 $15,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$385.01
$436.98
$492.04
$687.62
$1,044.90

$679.54
$731.51
$786.57
$982.15

$974.07
$1,026.04
$1,081.10
$1,276.68

$1,268.60
$1,320.57
$1,375.63
$1,571.21

$294.53

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$770.02
$873.96
$984.08
$1,375.24
$2,089.80

$1,064.55
$1,168.49
$1,278.61
$1,669.77

$1,359.08
$1,463.02
$1,573.14
$1,964.30

$1,653.61
$1,757.55
$1,867.67
$2,258.83

$294.53

Toc - Plan #45 Security Health Plan

Expanded Bronze

(HMO) Premier $7,500

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-844-293-9624

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$337.76
$383.35
$431.65
$603.23
$916.66

$596.14
$641.73
$690.03
$861.61

$854.52
$900.11
$948.41
$1,119.99

$1,112.90
$1,158.49
$1,206.79
$1,378.37

$258.38

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$675.52
$766.70
$863.30
$1,206.46
$1,833.32

$933.90
$1,025.08
$1,121.68
$1,464.84

$1,192.28
$1,283.46
$1,380.06
$1,723.22

$1,450.66
$1,541.84
$1,638.44
$1,981.60

$258.38

Toc - Plan #46 Security Health Plan

Bronze

(HMO) Premier $9,100

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-844-293-9624

Annual Out of Pocket Expenses:

Individual Family

$9,100 $18,200 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$336.75
$382.20
$430.35
$601.42
$913.91

$594.36
$639.81
$687.96
$859.03

$851.97
$897.42
$945.57
$1,116.64

$1,109.58
$1,155.03
$1,203.18
$1,374.25

$257.61

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$673.50
$764.40
$860.70
$1,202.84
$1,827.82

$931.11
$1,022.01
$1,118.31
$1,460.45

$1,188.72
$1,279.62
$1,375.92
$1,718.06

$1,446.33
$1,537.23
$1,633.53
$1,975.67

$257.61

Toc - Plan #47 Security Health Plan

Catastrophic

(HMO) Premier Protection

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-844-293-9624

Annual Out of Pocket Expenses:

Individual Family

$9,450 $18,900 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$224.87
$255.22
$287.37
$401.60
$610.27

$396.89
$427.24
$459.39
$573.62

$568.91
$599.26
$631.41
$745.64

$740.93
$771.28
$803.43
$917.66

$172.02

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$449.74
$510.44
$574.74
$803.20
$1,220.54

$621.76
$682.46
$746.76
$975.22

$793.78
$854.48
$918.78
$1,147.24

$965.80
$1,026.50
$1,090.80
$1,319.26

$172.02

Aspirus Health Plan

Local: 1-866-631-4611 | Toll Free: 1-866-631-4611 | TTY: 1-866-631-8597

Toc - Plan #48 Aspirus Health Plan

Silver

(HMO) HMO Silver 7500

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-866-631-4611

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

$8,400 $16,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$497.80
$565.00
$636.19
$889.07
$1,351.03

$878.62
$945.82
$1,017.01
$1,269.89

$1,259.44
$1,326.64
$1,397.83
$1,650.71

$1,640.26
$1,707.46
$1,778.65
$2,031.53

$380.82

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$995.60
$1,130.00
$1,272.38
$1,778.14
$2,702.06

$1,376.42
$1,510.82
$1,653.20
$2,158.96

$1,757.24
$1,891.64
$2,034.02
$2,539.78

$2,138.06
$2,272.46
$2,414.84
$2,920.60

$380.82

Toc - Plan #49 Aspirus Health Plan

Expanded Bronze

(HMO) HMO HDHP Bronze 6250

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-866-631-4611

Annual Out of Pocket Expenses:

Individual Family

$6,250 $12,500 Annual Deductible

$7,250 $14,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$398.41
$452.20
$509.17
$711.57
$1,081.30

$703.20
$756.99
$813.96
$1,016.36

$1,007.99
$1,061.78
$1,118.75
$1,321.15

$1,312.78
$1,366.57
$1,423.54
$1,625.94

$304.79

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$796.82
$904.40
$1,018.34
$1,423.14
$2,162.60

$1,101.61
$1,209.19
$1,323.13
$1,727.93

$1,406.40
$1,513.98
$1,627.92
$2,032.72

$1,711.19
$1,818.77
$1,932.71
$2,337.51

$304.79

Toc - Plan #50 Aspirus Health Plan

Bronze

(HMO) HMO Bronze 9450

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-866-631-4611

Annual Out of Pocket Expenses:

Individual Family

$9,450 $18,900 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$366.39
$415.85
$468.24
$654.37
$994.37

$646.68
$696.14
$748.53
$934.66

$926.97
$976.43
$1,028.82
$1,214.95

$1,207.26
$1,256.72
$1,309.11
$1,495.24

$280.29

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$732.78
$831.70
$936.48
$1,308.74
$1,988.74

$1,013.07
$1,111.99
$1,216.77
$1,589.03

$1,293.36
$1,392.28
$1,497.06
$1,869.32

$1,573.65
$1,672.57
$1,777.35
$2,149.61

$280.29

Toc - Plan #51 Aspirus Health Plan

Gold

(HMO) HMO Gold 2400

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-866-631-4611

Annual Out of Pocket Expenses:

Individual Family

$2,400 $4,800 Annual Deductible

$6,500 $13,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$518.33
$588.31
$662.43
$925.75
$1,406.76

$914.86
$984.84
$1,058.96
$1,322.28

$1,311.39
$1,381.37
$1,455.49
$1,718.81

$1,707.92
$1,777.90
$1,852.02
$2,115.34

$396.53

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,036.66
$1,176.62
$1,324.86
$1,851.50
$2,813.52

$1,433.19
$1,573.15
$1,721.39
$2,248.03

$1,829.72
$1,969.68
$2,117.92
$2,644.56

$2,226.25
$2,366.21
$2,514.45
$3,041.09

$396.53

Toc - Plan #52 Aspirus Health Plan

Catastrophic

(HMO) HMO Catastrophic 9450 with 3 free PCP Visits

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-866-631-4611

Annual Out of Pocket Expenses:

Individual Family

$9,450 $18,900 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$265.23
$301.04
$338.97
$473.70
$719.84

$468.13
$503.94
$541.87
$676.60

$671.03
$706.84
$744.77
$879.50

$873.93
$909.74
$947.67
$1,082.40

$202.90

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$530.46
$602.08
$677.94
$947.40
$1,439.68

$733.36
$804.98
$880.84
$1,150.30

$936.26
$1,007.88
$1,083.74
$1,353.20

$1,139.16
$1,210.78
$1,286.64
$1,556.10

$202.90

Toc - Plan #53 Aspirus Health Plan

Expanded Bronze

(HMO) HMO HDHP Bronze 7200

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-866-631-4611

Annual Out of Pocket Expenses:

Individual Family

$7,200 $14,400 Annual Deductible

$7,200 $14,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$396.85
$450.42
$507.17
$708.77
$1,077.05

$700.44
$754.01
$810.76
$1,012.36

$1,004.03
$1,057.60
$1,114.35
$1,315.95

$1,307.62
$1,361.19
$1,417.94
$1,619.54

$303.59

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$793.70
$900.84
$1,014.34
$1,417.54
$2,154.10

$1,097.29
$1,204.43
$1,317.93
$1,721.13

$1,400.88
$1,508.02
$1,621.52
$2,024.72

$1,704.47
$1,811.61
$1,925.11
$2,328.31

$303.59

Toc - Plan #54 Aspirus Health Plan

Expanded Bronze

(HMO) HMO Bronze 7500

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-866-631-4611

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$390.45
$443.16
$499.00
$697.35
$1,059.68

$689.14
$741.85
$797.69
$996.04

$987.83
$1,040.54
$1,096.38
$1,294.73

$1,286.52
$1,339.23
$1,395.07
$1,593.42

$298.69

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$780.90
$886.32
$998.00
$1,394.70
$2,119.36

$1,079.59
$1,185.01
$1,296.69
$1,693.39

$1,378.28
$1,483.70
$1,595.38
$1,992.08

$1,676.97
$1,782.39
$1,894.07
$2,290.77

$298.69

Toc - Plan #55 Aspirus Health Plan

Silver

(HMO) HMO Silver 5900

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-866-631-4611

Annual Out of Pocket Expenses:

Individual Family

$5,900 $11,800 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$496.50
$563.53
$634.53
$886.76
$1,347.51

$876.33
$943.36
$1,014.36
$1,266.59

$1,256.16
$1,323.19
$1,394.19
$1,646.42

$1,635.99
$1,703.02
$1,774.02
$2,026.25

$379.83

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$993.00
$1,127.06
$1,269.06
$1,773.52
$2,695.02

$1,372.83
$1,506.89
$1,648.89
$2,153.35

$1,752.66
$1,886.72
$2,028.72
$2,533.18

$2,132.49
$2,266.55
$2,408.55
$2,913.01

$379.83

Toc - Plan #56 Aspirus Health Plan

Silver

(HMO) HMO HDHP Silver 5400

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-866-631-4611

Annual Out of Pocket Expenses:

Individual Family

$5,400 $10,800 Annual Deductible

$5,400 $10,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$504.98
$573.15
$645.36
$901.89
$1,370.50

$891.29
$959.46
$1,031.67
$1,288.20

$1,277.60
$1,345.77
$1,417.98
$1,674.51

$1,663.91
$1,732.08
$1,804.29
$2,060.82

$386.31

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,009.96
$1,146.30
$1,290.72
$1,803.78
$2,741.00

$1,396.27
$1,532.61
$1,677.03
$2,190.09

$1,782.58
$1,918.92
$2,063.34
$2,576.40

$2,168.89
$2,305.23
$2,449.65
$2,962.71

$386.31

Toc - Plan #57 Aspirus Health Plan

Gold

(HMO) HMO Gold 1500

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-866-631-4611

Annual Out of Pocket Expenses:

Individual Family

$1,500 $3,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$517.76
$587.66
$661.70
$924.72
$1,405.21

$913.85
$983.75
$1,057.79
$1,320.81

$1,309.94
$1,379.84
$1,453.88
$1,716.90

$1,706.03
$1,775.93
$1,849.97
$2,112.99

$396.09

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,035.52
$1,175.32
$1,323.40
$1,849.44
$2,810.42

$1,431.61
$1,571.41
$1,719.49
$2,245.53

$1,827.70
$1,967.50
$2,115.58
$2,641.62

$2,223.79
$2,363.59
$2,511.67
$3,037.71

$396.09

Toc - Plan #58 Aspirus Health Plan

Expanded Bronze

(HMO) HMO Bronze $0 Medical Deductible

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-866-631-4611

Annual Out of Pocket Expenses:

Individual Family

$0 $0 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$392.02
$444.94
$501.00
$700.14
$1,063.93

$691.91
$744.83
$800.89
$1,000.03

$991.80
$1,044.72
$1,100.78
$1,299.92

$1,291.69
$1,344.61
$1,400.67
$1,599.81

$299.89

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$784.04
$889.88
$1,002.00
$1,400.28
$2,127.86

$1,083.93
$1,189.77
$1,301.89
$1,700.17

$1,383.82
$1,489.66
$1,601.78
$2,000.06

$1,683.71
$1,789.55
$1,901.67
$2,299.95

$299.89

Toc - Plan #59 Aspirus Health Plan

Silver

(POS) POS Silver 5900

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-866-631-4611

Annual Out of Pocket Expenses:

Individual Family

$5,900 $11,800 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$568.52
$645.27
$726.57
$1,015.38
$1,542.97

$1,003.44
$1,080.19
$1,161.49
$1,450.30

$1,438.36
$1,515.11
$1,596.41
$1,885.22

$1,873.28
$1,950.03
$2,031.33
$2,320.14

$434.92

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$1,137.04
$1,290.54
$1,453.14
$2,030.76
$3,085.94

$1,571.96
$1,725.46
$1,888.06
$2,465.68

$2,006.88
$2,160.38
$2,322.98
$2,900.60

$2,441.80
$2,595.30
$2,757.90
$3,335.52

$434.92

Toc - Plan #60 Aspirus Health Plan

Expanded Bronze

(POS) POS HDHP Bronze 6250

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-866-631-4611

Annual Out of Pocket Expenses:

Individual Family

$6,250 $12,500 Annual Deductible

$7,250 $14,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$438.50
$497.70
$560.41
$783.17
$1,190.10

$773.95
$833.15
$895.86
$1,118.62

$1,109.40
$1,168.60
$1,231.31
$1,454.07

$1,444.85
$1,504.05
$1,566.76
$1,789.52

$335.45

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$877.00
$995.40
$1,120.82
$1,566.34
$2,380.20

$1,212.45
$1,330.85
$1,456.27
$1,901.79

$1,547.90
$1,666.30
$1,791.72
$2,237.24

$1,883.35
$2,001.75
$2,127.17
$2,572.69

$335.45

Toc - Plan #61 Aspirus Health Plan

Expanded Bronze

(POS) POS Bronze 7500

Benefits & Coverage Plan Brochure Provider Directory

Customer Service Phone: 1-866-631-4611

Annual Out of Pocket Expenses:

Individual Family

$7,500 $15,000 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]

Age

Individual

Individual
1 Child

Individual
2 Children

Individual
3+ Children

Child
0-14

21
30
40
50
60

$446.62
$506.91
$570.78
$797.66
$1,212.12

$788.28
$848.57
$912.44
$1,139.32

$1,129.94
$1,190.23
$1,254.10
$1,480.98

$1,471.60
$1,531.89
$1,595.76
$1,822.64

$341.66

Age

Couple

Couple
1 Child

Couple
2 Chidren

Couple
3+ Children

Child
0-14

21
30
40
50
60

$893.24
$1,013.82
$1,141.56
$1,595.32
$2,424.24

$1,234.90
$1,355.48
$1,483.22
$1,936.98

$1,576.56
$1,697.14
$1,824.88
$2,278.64

$1,918.22
$2,038.80
$2,166.54
$2,620.30

$341.66

‡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 Florence County here.

Florence County is in “Rating Area 13” of Wisconsin.

Currently, there are 61 plans offered in Rating Area 13.

Top

2024 Obamacare Plans for Florence County, WI

Plan Browser: 61 Plans

HealthPartners

Local: 1-952-883-5900 | Toll Free: 1-855-813-3887 | TTY: 1-952-883-6060

1. Gold Robin Oak $1,000 w/Copay P-S Gold

2. Gold Robin Oak $1,500 w/Copay P-S Gold

3. Silver Robin Select $3,600 Plus Silver

4. Silver Robin Select $5,900 w/Copay P-S Silver

5. Expanded Bronze Robin Select $6,350 Plus Bronze

6. Expanded Bronze Robin Select $7,500 w/Copay P-S Bronze

7. Silver Robin Select $3,800 HSA Silver

8. Expanded Bronze Robin Select $8,000 HSA Bronze

9. Catastrophic Robin Select $9,450 Catastrophic

Quartz

Local: 1-608-644-3430 | Toll Free: 1-800-362-3310 | TTY: 1-800-877-8973

10. Gold QUARTZ ONE WITH ADVOCATE HEALTH CARE GOLD I402 MAINTENANCE VALUE TIER RX W/DENTAL

11. Gold QUARTZ ONE WITH ADVOCATE HEALTH CARE GOLD I410 STANDARD W/DENTAL

12. Silver QUARTZ ONE WITH ADVOCATE HEALTH CARE SILVER I308 VALUE TIER RX W/DENTAL

13. Expanded Bronze QUARTZ ONE WITH ADVOCATE HEALTH CARE BRONZE I204 VALUE TIER RX W/DENTAL

14. Expanded Bronze QUARTZ ONE WITH ADVOCATE HEALTH CARE BRONZE I205 VALUE TIER RX W/DENTAL

15. Silver QUARTZ ONE WITH ADVOCATE HEALTH CARE SILVER I320 VALUE TIER RX W/DENTAL

16. Gold QUARTZ ONE WITH ADVOCATE HEALTH CARE GOLD I420 VALUE TIER RX

17. Gold QUARTZ ONE WITH ADVOCATE HEALTH CARE GOLD I402 MAINTENANCE VALUE TIER RX

18. Gold QUARTZ ONE WITH ADVOCATE HEALTH CARE GOLD I410 STANDARD

19. Silver QUARTZ ONE WITH ADVOCATE HEALTH CARE SILVER I308 VALUE TIER RX

20. Silver QUARTZ ONE WITH ADVOCATE HEALTH CARE SILVER I309 STANDARD

21. Expanded Bronze QUARTZ ONE WITH ADVOCATE HEALTH CARE BRONZE I204 VALUE TIER RX

22. Expanded Bronze QUARTZ ONE WITH ADVOCATE HEALTH CARE BRONZE I205 VALUE TIER RX

23. Expanded Bronze QUARTZ ONE WITH ADVOCATE HEALTH CARE BRONZE I206 STANDARD

24. Silver QUARTZ ONE WITH ADVOCATE HEALTH CARE SILVER I320 VALUE TIER RX

25. Gold QUARTZ ONE WITH ADVOCATE HEALTH CARE GOLD I401 VALUE TIER RX

26. Silver QUARTZ ONE WITH ADVOCATE HEALTH CARE SILVER I303 VALUE TIER RX

27. Expanded Bronze QUARTZ ONE WITH ADVOCATE HEALTH CARE BRONZE I201 VALUE TIER RX

28. Gold QUARTZ ONE WITH ADVOCATE HEALTH CARE GOLD I403 HSA

29. Silver QUARTZ ONE WITH ADVOCATE HEALTH CARE SILVER I304 HSA

30. Expanded Bronze QUARTZ ONE WITH ADVOCATE HEALTH CARE BRONZE I203 HSA

31. Catastrophic QUARTZ ONE WITH ADVOCATE HEALTH CARE CATASTROPHIC I101

Security Health Plan

Local: 1-715-221-9258x19258 | Toll Free: 1-844-293-9624 | TTY: 1-800-947-3529

32. Gold SimplyOne $3,500 - 30%

33. Silver SimplyOne $4,100 HDHP

34. Expanded Bronze SimplyOne $6,200 HDHP

35. Bronze SimplyOne $9,100

36. Catastrophic SimplyOne Protection

37. Gold SimplyOne $1,500 - 25%

38. Silver SimplyOne $5,900 - 40%

39. Expanded Bronze SimplyOne $7,500

40. Gold Premier $1,500 - 25%

41. Gold Premier $3,500 - 30%

42. Silver Premier $5,900 - 40%

43. Silver Premier $4,100 HDHP

44. Expanded Bronze Premier $6,200 HDHP

45. Expanded Bronze Premier $7,500

46. Bronze Premier $9,100

47. Catastrophic Premier Protection

Aspirus Health Plan

Local: 1-866-631-4611 | Toll Free: 1-866-631-4611 | TTY: 1-866-631-8597

48. Silver HMO Silver 7500

49. Expanded Bronze HMO HDHP Bronze 6250

50. Bronze HMO Bronze 9450

51. Gold HMO Gold 2400

52. Catastrophic HMO Catastrophic 9450 with 3 free PCP Visits

53. Expanded Bronze HMO HDHP Bronze 7200

54. Expanded Bronze HMO Bronze 7500

55. Silver HMO Silver 5900

56. Silver HMO HDHP Silver 5400

57. Gold HMO Gold 1500

58. Expanded Bronze HMO Bronze $0 Medical Deductible

59. Silver POS Silver 5900

60. Expanded Bronze POS HDHP Bronze 6250

61. Expanded Bronze POS Bronze 7500

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For information on subsidies to make your coverage affordable, you must take one of the following actions:

Obamacare Providers, 61 Plans and 2024 Rates for Florence County, Wisconsin

Obamacare Rates and Providers for Other Years

How To Sign Up for Obamacare in Wisconsin for 2024

Where's the Wisconsin Health Care Exchange?

Wisconsin Medicaid Expansion: Do I Qualify for Medicaid Under the ACA?

Wisconsin Has Not Expanded Medicaid

Get Help Finding a Health Insurance Plan in Wisconsin

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More Information

HealthPartners

(PPO) Robin Oak $1,000 w/Copay P-S Gold

Annual Out of Pocket Expenses:

Individual Family $1,000 $2,000 Annual Deductible $8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

(PPO) Robin Oak $1,500 w/Copay P-S Gold

Annual Out of Pocket Expenses:

Individual Family $1,500 $3,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

(PPO) Robin Select $3,600 Plus Silver

Annual Out of Pocket Expenses:

Individual Family $3,600 $7,200 Annual Deductible $8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

(PPO) Robin Select $5,900 w/Copay P-S Silver

Annual Out of Pocket Expenses:

Individual Family $5,900 $11,800 Annual Deductible $9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

(PPO) Robin Select $6,350 Plus Bronze

Annual Out of Pocket Expenses:

Individual Family $6,350 $12,700 Annual Deductible $9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

(PPO) Robin Select $7,500 w/Copay P-S Bronze

Annual Out of Pocket Expenses:

Individual Family $7,500 $15,000 Annual Deductible $9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

(PPO) Robin Select $3,800 HSA Silver

Annual Out of Pocket Expenses:

Individual Family $3,800 $7,600 Annual Deductible $7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

(PPO) Robin Select $8,000 HSA Bronze

Annual Out of Pocket Expenses:

Individual Family $8,000 $16,000 Annual Deductible $8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

(PPO) Robin Select $9,450 Catastrophic

Annual Out of Pocket Expenses:

Individual Family $9,450 $18,900 Annual Deductible $9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

Quartz

(HMO) QUARTZ ONE WITH ADVOCATE HEALTH CARE GOLD I402 MAINTENANCE VALUE TIER RX W/DENTAL

Annual Out of Pocket Expenses:

Individual Family $500 $1,000 Annual Deductible $9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

(HMO) QUARTZ ONE WITH ADVOCATE HEALTH CARE GOLD I410 STANDARD W/DENTAL

Annual Out of Pocket Expenses:

Individual Family $1,500 $3,000 Annual Deductible $8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

(HMO) QUARTZ ONE WITH ADVOCATE HEALTH CARE SILVER I308 VALUE TIER RX W/DENTAL

Annual Out of Pocket Expenses:

Individual Family $0 $0 Annual Deductible $9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

(HMO) QUARTZ ONE WITH ADVOCATE HEALTH CARE BRONZE I204 VALUE TIER RX W/DENTAL

Annual Out of Pocket Expenses:

Individual Family $3,000 $6,000 Annual Deductible $9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

(HMO) QUARTZ ONE WITH ADVOCATE HEALTH CARE BRONZE I205 VALUE TIER RX W/DENTAL

Annual Out of Pocket Expenses:

Individual Family $0 $0 Annual Deductible $9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

(HMO) QUARTZ ONE WITH ADVOCATE HEALTH CARE SILVER I320 VALUE TIER RX W/DENTAL

Annual Out of Pocket Expenses:

Individual Family $2,500 $5,000 Annual Deductible $9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

(HMO) QUARTZ ONE WITH ADVOCATE HEALTH CARE GOLD I420 VALUE TIER RX

Annual Out of Pocket Expenses:

Individual Family $1,000 $2,000 Annual Deductible $8,500 $17,000 Maximum Out of Pocket Per Year

Monthly Premiums:

(HMO) QUARTZ ONE WITH ADVOCATE HEALTH CARE GOLD I402 MAINTENANCE VALUE TIER RX

Annual Out of Pocket Expenses:

Individual Family $500 $1,000 Annual Deductible $9,000 $18,000 Maximum Out of Pocket Per Year

Individual Family

$1,000 $2,000 Annual Deductible

$8,000 $16,000 Maximum Out of Pocket Per Year

Individual Family

$1,500 $3,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Individual Family

$3,600 $7,200 Annual Deductible

$8,900 $17,800 Maximum Out of Pocket Per Year

Individual Family

$5,900 $11,800 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Individual Family

$6,350 $12,700 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Individual Family

$7,500 $15,000 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Individual Family

$3,800 $7,600 Annual Deductible

$7,500 $15,000 Maximum Out of Pocket Per Year

Individual Family

$8,000 $16,000 Annual Deductible

$8,000 $16,000 Maximum Out of Pocket Per Year

Individual Family

$9,450 $18,900 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Individual Family

$500 $1,000 Annual Deductible

$9,000 $18,000 Maximum Out of Pocket Per Year

Individual Family

$1,500 $3,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Individual Family

$0 $0 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Individual Family

$3,000 $6,000 Annual Deductible

$9,000 $18,000 Maximum Out of Pocket Per Year

Individual Family

$0 $0 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Individual Family

$2,500 $5,000 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Individual Family

$1,000 $2,000 Annual Deductible

$8,500 $17,000 Maximum Out of Pocket Per Year

Individual Family

$500 $1,000 Annual Deductible

$9,000 $18,000 Maximum Out of Pocket Per Year

Individual Family

$1,500 $3,000 Annual Deductible

$8,700 $17,400 Maximum Out of Pocket Per Year

Individual Family

$0 $0 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Individual Family

$5,900 $11,800 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Individual Family

$3,000 $6,000 Annual Deductible

$9,000 $18,000 Maximum Out of Pocket Per Year

Individual Family

$0 $0 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Individual Family

$7,500 $15,000 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Individual Family

$2,500 $5,000 Annual Deductible

$9,400 $18,800 Maximum Out of Pocket Per Year

Individual Family

$2,500 $5,000 Annual Deductible

$7,000 $14,000 Maximum Out of Pocket Per Year

Individual Family

$7,000 $14,000 Annual Deductible

$9,100 $18,200 Maximum Out of Pocket Per Year

Individual Family

$9,400 $18,800 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Individual Family

$3,500 $7,000 Annual Deductible

$3,500 $7,000 Maximum Out of Pocket Per Year

Individual Family

$5,500 $11,000 Annual Deductible

$5,500 $11,000 Maximum Out of Pocket Per Year

Individual Family

$7,250 $14,500 Annual Deductible

$7,250 $14,500 Maximum Out of Pocket Per Year

Individual Family

$9,450 $18,900 Annual Deductible

$9,450 $18,900 Maximum Out of Pocket Per Year

Individual Family

$3,500 $7,000 Annual Deductible

$6,500 $13,000 Maximum Out of Pocket Per Year