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Saint Albans, West Virginia 25177

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Highmark Blue Cross Blue Shield West Virginia

Local: 1-888-601-2109 | Toll Free: 1-888-601-2109 | TTY: 1-888-601-2109

Toc - Plan #1 Highmark Blue Cross Blue Shield West Virginia
Expanded Bronze

(PPO) my Blue Access WV PPO Bronze 3800

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-601-2109

Annual Out of Pocket Expenses:

Individual Family
$3,800 $7,600 Annual Deductible
$9,200 $18,400 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
$558.51
$633.91
$713.78
$997.50
$1,515.80
$985.77
$1,061.17
$1,141.04
$1,424.76
$1,413.03
$1,488.43
$1,568.30
$1,852.02
$1,840.29
$1,915.69
$1,995.56
$2,279.28
$427.26
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,117.02
$1,267.82
$1,427.56
$1,995.00
$3,031.60
$1,544.28
$1,695.08
$1,854.82
$2,422.26
$1,971.54
$2,122.34
$2,282.08
$2,849.52
$2,398.80
$2,549.60
$2,709.34
$3,276.78
$427.26
Toc - Plan #2 Highmark Blue Cross Blue Shield West Virginia
Silver

(PPO) my Blue Access WV PPO Silver 7000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-601-2109

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 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
$696.43
$790.45
$890.04
$1,243.82
$1,890.11
$1,229.20
$1,323.22
$1,422.81
$1,776.59
$1,761.97
$1,855.99
$1,955.58
$2,309.36
$2,294.74
$2,388.76
$2,488.35
$2,842.13
$532.77
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,392.86
$1,580.90
$1,780.08
$2,487.64
$3,780.22
$1,925.63
$2,113.67
$2,312.85
$3,020.41
$2,458.40
$2,646.44
$2,845.62
$3,553.18
$2,991.17
$3,179.21
$3,378.39
$4,085.95
$532.77
Toc - Plan #3 Highmark Blue Cross Blue Shield West Virginia
Gold

(PPO) my Blue Access WV PPO Gold 0

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-601-2109

Annual Out of Pocket Expenses:

Individual Family
$0 $0 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
$723.87
$821.59
$925.11
$1,292.83
$1,964.58
$1,277.63
$1,375.35
$1,478.87
$1,846.59
$1,831.39
$1,929.11
$2,032.63
$2,400.35
$2,385.15
$2,482.87
$2,586.39
$2,954.11
$553.76
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,447.74
$1,643.18
$1,850.22
$2,585.66
$3,929.16
$2,001.50
$2,196.94
$2,403.98
$3,139.42
$2,555.26
$2,750.70
$2,957.74
$3,693.18
$3,109.02
$3,304.46
$3,511.50
$4,246.94
$553.76
Toc - Plan #4 Highmark Blue Cross Blue Shield West Virginia
Bronze

(PPO) my Blue Access WV PPO Bronze 8900

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-601-2109

Annual Out of Pocket Expenses:

Individual Family
$8,900 $17,800 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
$523.46
$594.13
$668.98
$934.90
$1,420.67
$923.91
$994.58
$1,069.43
$1,335.35
$1,324.36
$1,395.03
$1,469.88
$1,735.80
$1,724.81
$1,795.48
$1,870.33
$2,136.25
$400.45
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,046.92
$1,188.26
$1,337.96
$1,869.80
$2,841.34
$1,447.37
$1,588.71
$1,738.41
$2,270.25
$1,847.82
$1,989.16
$2,138.86
$2,670.70
$2,248.27
$2,389.61
$2,539.31
$3,071.15
$400.45
Toc - Plan #5 Highmark Blue Cross Blue Shield West Virginia
Expanded Bronze

(PPO) my Blue Access WV PPO Bronze 3800 + Adult Dental and Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-601-2109

Annual Out of Pocket Expenses:

Individual Family
$3,800 $7,600 Annual Deductible
$9,200 $18,400 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
$578.56
$656.67
$739.40
$1,033.31
$1,570.21
$1,021.16
$1,099.27
$1,182.00
$1,475.91
$1,463.76
$1,541.87
$1,624.60
$1,918.51
$1,906.36
$1,984.47
$2,067.20
$2,361.11
$442.60
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,157.12
$1,313.34
$1,478.80
$2,066.62
$3,140.42
$1,599.72
$1,755.94
$1,921.40
$2,509.22
$2,042.32
$2,198.54
$2,364.00
$2,951.82
$2,484.92
$2,641.14
$2,806.60
$3,394.42
$442.60
Toc - Plan #6 Highmark Blue Cross Blue Shield West Virginia
Gold

(PPO) my Blue Access WV PPO Gold 0 + Adult Dental and Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-601-2109

Annual Out of Pocket Expenses:

Individual Family
$0 $0 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
$743.92
$844.35
$950.73
$1,328.64
$2,019.00
$1,313.02
$1,413.45
$1,519.83
$1,897.74
$1,882.12
$1,982.55
$2,088.93
$2,466.84
$2,451.22
$2,551.65
$2,658.03
$3,035.94
$569.10
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,487.84
$1,688.70
$1,901.46
$2,657.28
$4,038.00
$2,056.94
$2,257.80
$2,470.56
$3,226.38
$2,626.04
$2,826.90
$3,039.66
$3,795.48
$3,195.14
$3,396.00
$3,608.76
$4,364.58
$569.10
Toc - Plan #7 Highmark Blue Cross Blue Shield West Virginia
Expanded Bronze

(PPO) my Blue Access WV PPO Bronze 7100 HSA - Custom Drug Benefit

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-601-2109

Annual Out of Pocket Expenses:

Individual Family
$7,100 $14,200 Annual Deductible
$7,100 $14,200 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
$570.22
$647.20
$728.74
$1,018.41
$1,547.58
$1,006.44
$1,083.42
$1,164.96
$1,454.63
$1,442.66
$1,519.64
$1,601.18
$1,890.85
$1,878.88
$1,955.86
$2,037.40
$2,327.07
$436.22
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,140.44
$1,294.40
$1,457.48
$2,036.82
$3,095.16
$1,576.66
$1,730.62
$1,893.70
$2,473.04
$2,012.88
$2,166.84
$2,329.92
$2,909.26
$2,449.10
$2,603.06
$2,766.14
$3,345.48
$436.22
Toc - Plan #8 Highmark Blue Cross Blue Shield West Virginia
Gold

(PPO) my Blue Access WV PPO Gold 1700 HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-601-2109

Annual Out of Pocket Expenses:

Individual Family
$1,700 $3,400 Annual Deductible
$5,700 $11,400 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
$694.48
$788.23
$887.55
$1,240.34
$1,884.82
$1,225.76
$1,319.51
$1,418.83
$1,771.62
$1,757.04
$1,850.79
$1,950.11
$2,302.90
$2,288.32
$2,382.07
$2,481.39
$2,834.18
$531.28
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,388.96
$1,576.46
$1,775.10
$2,480.68
$3,769.64
$1,920.24
$2,107.74
$2,306.38
$3,011.96
$2,451.52
$2,639.02
$2,837.66
$3,543.24
$2,982.80
$3,170.30
$3,368.94
$4,074.52
$531.28
Toc - Plan #9 Highmark Blue Cross Blue Shield West Virginia
Gold

(PPO) my Blue Access WV PPO Premier Gold 0

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-601-2109

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$6,700 $13,400 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
$737.68
$837.27
$942.76
$1,317.50
$2,002.06
$1,302.01
$1,401.60
$1,507.09
$1,881.83
$1,866.34
$1,965.93
$2,071.42
$2,446.16
$2,430.67
$2,530.26
$2,635.75
$3,010.49
$564.33
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,475.36
$1,674.54
$1,885.52
$2,635.00
$4,004.12
$2,039.69
$2,238.87
$2,449.85
$3,199.33
$2,604.02
$2,803.20
$3,014.18
$3,763.66
$3,168.35
$3,367.53
$3,578.51
$4,327.99
$564.33
Toc - Plan #10 Highmark Blue Cross Blue Shield West Virginia
Gold

(PPO) my Blue Access WV PPO Premier Gold 0 + Adult Dental and Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-601-2109

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$6,700 $13,400 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
$757.73
$860.02
$968.38
$1,353.31
$2,056.48
$1,337.39
$1,439.68
$1,548.04
$1,932.97
$1,917.05
$2,019.34
$2,127.70
$2,512.63
$2,496.71
$2,599.00
$2,707.36
$3,092.29
$579.66
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,515.46
$1,720.04
$1,936.76
$2,706.62
$4,112.96
$2,095.12
$2,299.70
$2,516.42
$3,286.28
$2,674.78
$2,879.36
$3,096.08
$3,865.94
$3,254.44
$3,459.02
$3,675.74
$4,445.60
$579.66
Toc - Plan #11 Highmark Blue Cross Blue Shield West Virginia
Catastrophic

(PPO) my Blue Access WV Major Events PPO Catastrophic 9450 - 3 Free PCP Visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-601-2109

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
$413.66
$469.50
$528.66
$738.80
$1,122.67
$730.11
$785.95
$845.11
$1,055.25
$1,046.56
$1,102.40
$1,161.56
$1,371.70
$1,363.01
$1,418.85
$1,478.01
$1,688.15
$316.45
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$827.32
$939.00
$1,057.32
$1,477.60
$2,245.34
$1,143.77
$1,255.45
$1,373.77
$1,794.05
$1,460.22
$1,571.90
$1,690.22
$2,110.50
$1,776.67
$1,888.35
$2,006.67
$2,426.95
$316.45
Toc - Plan #12 Highmark Blue Cross Blue Shield West Virginia
Silver

(PPO) my Blue Access WV PPO Standard Silver 5900

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-601-2109

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
$704.08
$799.13
$899.81
$1,257.49
$1,910.87
$1,242.70
$1,337.75
$1,438.43
$1,796.11
$1,781.32
$1,876.37
$1,977.05
$2,334.73
$2,319.94
$2,414.99
$2,515.67
$2,873.35
$538.62
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,408.16
$1,598.26
$1,799.62
$2,514.98
$3,821.74
$1,946.78
$2,136.88
$2,338.24
$3,053.60
$2,485.40
$2,675.50
$2,876.86
$3,592.22
$3,024.02
$3,214.12
$3,415.48
$4,130.84
$538.62
Toc - Plan #13 Highmark Blue Cross Blue Shield West Virginia
Gold

(PPO) my Blue Access WV PPO Standard Gold 1500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-601-2109

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
$681.27
$773.24
$870.66
$1,216.75
$1,848.97
$1,202.44
$1,294.41
$1,391.83
$1,737.92
$1,723.61
$1,815.58
$1,913.00
$2,259.09
$2,244.78
$2,336.75
$2,434.17
$2,780.26
$521.17
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,362.54
$1,546.48
$1,741.32
$2,433.50
$3,697.94
$1,883.71
$2,067.65
$2,262.49
$2,954.67
$2,404.88
$2,588.82
$2,783.66
$3,475.84
$2,926.05
$3,109.99
$3,304.83
$3,997.01
$521.17
Toc - Plan #14 Highmark Blue Cross Blue Shield West Virginia
Expanded Bronze

(PPO) my Blue Access WV PPO Standard Bronze 7500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-601-2109

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
$538.65
$611.37
$688.39
$962.03
$1,461.90
$950.72
$1,023.44
$1,100.46
$1,374.10
$1,362.79
$1,435.51
$1,512.53
$1,786.17
$1,774.86
$1,847.58
$1,924.60
$2,198.24
$412.07
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,077.30
$1,222.74
$1,376.78
$1,924.06
$2,923.80
$1,489.37
$1,634.81
$1,788.85
$2,336.13
$1,901.44
$2,046.88
$2,200.92
$2,748.20
$2,313.51
$2,458.95
$2,612.99
$3,160.27
$412.07
Toc - Plan #15 Highmark Blue Cross Blue Shield West Virginia
Silver

(PPO) my Blue Access WV PPO Standard Silver 5900 + Adult Dental and Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-601-2109

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
$724.13
$821.89
$925.44
$1,293.30
$1,965.29
$1,278.09
$1,375.85
$1,479.40
$1,847.26
$1,832.05
$1,929.81
$2,033.36
$2,401.22
$2,386.01
$2,483.77
$2,587.32
$2,955.18
$553.96
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,448.26
$1,643.78
$1,850.88
$2,586.60
$3,930.58
$2,002.22
$2,197.74
$2,404.84
$3,140.56
$2,556.18
$2,751.70
$2,958.80
$3,694.52
$3,110.14
$3,305.66
$3,512.76
$4,248.48
$553.96

ADVERTISEMENT

CareSource

Local: 1-833-230-2099 | Toll Free: 1-833-230-2099 | TTY: 1-800-982-8771

Toc - Plan #16 CareSource
Silver

(HMO) CareSource Marketplace Low Premium Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 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
$715.48
$812.07
$914.38
$1,277.84
$1,941.80
$1,262.82
$1,359.41
$1,461.72
$1,825.18
$1,810.16
$1,906.75
$2,009.06
$2,372.52
$2,357.50
$2,454.09
$2,556.40
$2,919.86
$547.34
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,430.96
$1,624.14
$1,828.76
$2,555.68
$3,883.60
$1,978.30
$2,171.48
$2,376.10
$3,103.02
$2,525.64
$2,718.82
$2,923.44
$3,650.36
$3,072.98
$3,266.16
$3,470.78
$4,197.70
$547.34
Toc - Plan #17 CareSource
Gold

(HMO) CareSource Marketplace Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

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
$842.35
$956.06
$1,076.51
$1,504.42
$2,286.12
$1,486.74
$1,600.45
$1,720.90
$2,148.81
$2,131.13
$2,244.84
$2,365.29
$2,793.20
$2,775.52
$2,889.23
$3,009.68
$3,437.59
$644.39
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,684.70
$1,912.12
$2,153.02
$3,008.84
$4,572.24
$2,329.09
$2,556.51
$2,797.41
$3,653.23
$2,973.48
$3,200.90
$3,441.80
$4,297.62
$3,617.87
$3,845.29
$4,086.19
$4,942.01
$644.39
Toc - Plan #18 CareSource
Silver

(HMO) CareSource Marketplace Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

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
$711.66
$807.73
$909.50
$1,271.02
$1,931.44
$1,256.08
$1,352.15
$1,453.92
$1,815.44
$1,800.50
$1,896.57
$1,998.34
$2,359.86
$2,344.92
$2,440.99
$2,542.76
$2,904.28
$544.42
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,423.32
$1,615.46
$1,819.00
$2,542.04
$3,862.88
$1,967.74
$2,159.88
$2,363.42
$3,086.46
$2,512.16
$2,704.30
$2,907.84
$3,630.88
$3,056.58
$3,248.72
$3,452.26
$4,175.30
$544.42
Toc - Plan #19 CareSource
Expanded Bronze

(HMO) CareSource Marketplace Bronze First

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

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
$590.72
$670.46
$754.93
$1,055.01
$1,603.19
$1,042.62
$1,122.36
$1,206.83
$1,506.91
$1,494.52
$1,574.26
$1,658.73
$1,958.81
$1,946.42
$2,026.16
$2,110.63
$2,410.71
$451.90
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,181.44
$1,340.92
$1,509.86
$2,110.02
$3,206.38
$1,633.34
$1,792.82
$1,961.76
$2,561.92
$2,085.24
$2,244.72
$2,413.66
$3,013.82
$2,537.14
$2,696.62
$2,865.56
$3,465.72
$451.90
Toc - Plan #20 CareSource
Silver

(HMO) CareSource Marketplace Low Deductible Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$4,000 $8,000 Annual Deductible
$9,200 $18,400 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
$736.51
$835.94
$941.26
$1,315.40
$1,998.88
$1,299.94
$1,399.37
$1,504.69
$1,878.83
$1,863.37
$1,962.80
$2,068.12
$2,442.26
$2,426.80
$2,526.23
$2,631.55
$3,005.69
$563.43
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,473.02
$1,671.88
$1,882.52
$2,630.80
$3,997.76
$2,036.45
$2,235.31
$2,445.95
$3,194.23
$2,599.88
$2,798.74
$3,009.38
$3,757.66
$3,163.31
$3,362.17
$3,572.81
$4,321.09
$563.43
Toc - Plan #21 CareSource
Silver

(HMO) CareSource Marketplace Core Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 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
$725.48
$823.41
$927.16
$1,295.70
$1,968.94
$1,280.47
$1,378.40
$1,482.15
$1,850.69
$1,835.46
$1,933.39
$2,037.14
$2,405.68
$2,390.45
$2,488.38
$2,592.13
$2,960.67
$554.99
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,450.96
$1,646.82
$1,854.32
$2,591.40
$3,937.88
$2,005.95
$2,201.81
$2,409.31
$3,146.39
$2,560.94
$2,756.80
$2,964.30
$3,701.38
$3,115.93
$3,311.79
$3,519.29
$4,256.37
$554.99
Toc - Plan #22 CareSource
Gold

(HMO) CareSource Marketplace Core Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 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
$823.60
$934.78
$1,052.56
$1,470.94
$2,235.24
$1,453.65
$1,564.83
$1,682.61
$2,100.99
$2,083.70
$2,194.88
$2,312.66
$2,731.04
$2,713.75
$2,824.93
$2,942.71
$3,361.09
$630.05
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,647.20
$1,869.56
$2,105.12
$2,941.88
$4,470.48
$2,277.25
$2,499.61
$2,735.17
$3,571.93
$2,907.30
$3,129.66
$3,365.22
$4,201.98
$3,537.35
$3,759.71
$3,995.27
$4,832.03
$630.05
Toc - Plan #23 CareSource
Silver

(HMO) CareSource Marketplace Diabetes Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 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
$741.76
$841.89
$947.97
$1,324.78
$2,013.13
$1,309.20
$1,409.33
$1,515.41
$1,892.22
$1,876.64
$1,976.77
$2,082.85
$2,459.66
$2,444.08
$2,544.21
$2,650.29
$3,027.10
$567.44
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,483.52
$1,683.78
$1,895.94
$2,649.56
$4,026.26
$2,050.96
$2,251.22
$2,463.38
$3,217.00
$2,618.40
$2,818.66
$3,030.82
$3,784.44
$3,185.84
$3,386.10
$3,598.26
$4,351.88
$567.44
Toc - Plan #24 CareSource
Gold

(HMO) CareSource Marketplace Diabetes Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$1,000 $2,000 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
$873.75
$991.70
$1,116.65
$1,560.51
$2,371.34
$1,542.16
$1,660.11
$1,785.06
$2,228.92
$2,210.57
$2,328.52
$2,453.47
$2,897.33
$2,878.98
$2,996.93
$3,121.88
$3,565.74
$668.41
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,747.50
$1,983.40
$2,233.30
$3,121.02
$4,742.68
$2,415.91
$2,651.81
$2,901.71
$3,789.43
$3,084.32
$3,320.22
$3,570.12
$4,457.84
$3,752.73
$3,988.63
$4,238.53
$5,126.25
$668.41
Toc - Plan #25 CareSource
Silver

(HMO) CareSource Marketplace Low Premium Silver Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 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
$722.45
$819.97
$923.28
$1,290.29
$1,960.71
$1,275.12
$1,372.64
$1,475.95
$1,842.96
$1,827.79
$1,925.31
$2,028.62
$2,395.63
$2,380.46
$2,477.98
$2,581.29
$2,948.30
$552.67
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,444.90
$1,639.94
$1,846.56
$2,580.58
$3,921.42
$1,997.57
$2,192.61
$2,399.23
$3,133.25
$2,550.24
$2,745.28
$2,951.90
$3,685.92
$3,102.91
$3,297.95
$3,504.57
$4,238.59
$552.67
Toc - Plan #26 CareSource
Gold

(HMO) CareSource Marketplace Gold Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

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
$850.19
$964.96
$1,086.54
$1,518.43
$2,307.40
$1,500.58
$1,615.35
$1,736.93
$2,168.82
$2,150.97
$2,265.74
$2,387.32
$2,819.21
$2,801.36
$2,916.13
$3,037.71
$3,469.60
$650.39
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,700.38
$1,929.92
$2,173.08
$3,036.86
$4,614.80
$2,350.77
$2,580.31
$2,823.47
$3,687.25
$3,001.16
$3,230.70
$3,473.86
$4,337.64
$3,651.55
$3,881.09
$4,124.25
$4,988.03
$650.39
Toc - Plan #27 CareSource
Silver

(HMO) CareSource Marketplace Silver Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

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
$718.63
$815.64
$918.40
$1,283.46
$1,950.35
$1,268.38
$1,365.39
$1,468.15
$1,833.21
$1,818.13
$1,915.14
$2,017.90
$2,382.96
$2,367.88
$2,464.89
$2,567.65
$2,932.71
$549.75
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,437.26
$1,631.28
$1,836.80
$2,566.92
$3,900.70
$1,987.01
$2,181.03
$2,386.55
$3,116.67
$2,536.76
$2,730.78
$2,936.30
$3,666.42
$3,086.51
$3,280.53
$3,486.05
$4,216.17
$549.75
Toc - Plan #28 CareSource
Expanded Bronze

(HMO) CareSource Marketplace Bronze First Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

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
$597.69
$678.38
$763.85
$1,067.48
$1,622.13
$1,054.92
$1,135.61
$1,221.08
$1,524.71
$1,512.15
$1,592.84
$1,678.31
$1,981.94
$1,969.38
$2,050.07
$2,135.54
$2,439.17
$457.23
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,195.38
$1,356.76
$1,527.70
$2,134.96
$3,244.26
$1,652.61
$1,813.99
$1,984.93
$2,592.19
$2,109.84
$2,271.22
$2,442.16
$3,049.42
$2,567.07
$2,728.45
$2,899.39
$3,506.65
$457.23
Toc - Plan #29 CareSource
Silver

(HMO) CareSource Marketplace Low Deductible Silver Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$4,000 $8,000 Annual Deductible
$9,200 $18,400 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
$743.48
$843.84
$950.16
$1,327.85
$2,017.79
$1,312.24
$1,412.60
$1,518.92
$1,896.61
$1,881.00
$1,981.36
$2,087.68
$2,465.37
$2,449.76
$2,550.12
$2,656.44
$3,034.13
$568.76
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,486.96
$1,687.68
$1,900.32
$2,655.70
$4,035.58
$2,055.72
$2,256.44
$2,469.08
$3,224.46
$2,624.48
$2,825.20
$3,037.84
$3,793.22
$3,193.24
$3,393.96
$3,606.60
$4,361.98
$568.76
Toc - Plan #30 CareSource
Silver

(HMO) CareSource Marketplace Core Silver Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 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
$732.45
$831.32
$936.06
$1,308.14
$1,987.85
$1,292.77
$1,391.64
$1,496.38
$1,868.46
$1,853.09
$1,951.96
$2,056.70
$2,428.78
$2,413.41
$2,512.28
$2,617.02
$2,989.10
$560.32
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,464.90
$1,662.64
$1,872.12
$2,616.28
$3,975.70
$2,025.22
$2,222.96
$2,432.44
$3,176.60
$2,585.54
$2,783.28
$2,992.76
$3,736.92
$3,145.86
$3,343.60
$3,553.08
$4,297.24
$560.32
Toc - Plan #31 CareSource
Gold

(HMO) CareSource Marketplace Core Gold Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 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
$831.44
$943.68
$1,062.58
$1,484.95
$2,256.52
$1,467.49
$1,579.73
$1,698.63
$2,121.00
$2,103.54
$2,215.78
$2,334.68
$2,757.05
$2,739.59
$2,851.83
$2,970.73
$3,393.10
$636.05
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,662.88
$1,887.36
$2,125.16
$2,969.90
$4,513.04
$2,298.93
$2,523.41
$2,761.21
$3,605.95
$2,934.98
$3,159.46
$3,397.26
$4,242.00
$3,571.03
$3,795.51
$4,033.31
$4,878.05
$636.05
Toc - Plan #32 CareSource
Silver

(HMO) CareSource Marketplace Diabetes Silver Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 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
$748.73
$849.80
$956.87
$1,337.22
$2,032.04
$1,321.50
$1,422.57
$1,529.64
$1,909.99
$1,894.27
$1,995.34
$2,102.41
$2,482.76
$2,467.04
$2,568.11
$2,675.18
$3,055.53
$572.77
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,497.46
$1,699.60
$1,913.74
$2,674.44
$4,064.08
$2,070.23
$2,272.37
$2,486.51
$3,247.21
$2,643.00
$2,845.14
$3,059.28
$3,819.98
$3,215.77
$3,417.91
$3,632.05
$4,392.75
$572.77
Toc - Plan #33 CareSource
Gold

(HMO) CareSource Marketplace Diabetes Gold Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2099

Annual Out of Pocket Expenses:

Individual Family
$1,000 $2,000 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
$881.59
$1,000.60
$1,126.67
$1,574.52
$2,392.63
$1,556.00
$1,675.01
$1,801.08
$2,248.93
$2,230.41
$2,349.42
$2,475.49
$2,923.34
$2,904.82
$3,023.83
$3,149.90
$3,597.75
$674.41
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,763.18
$2,001.20
$2,253.34
$3,149.04
$4,785.26
$2,437.59
$2,675.61
$2,927.75
$3,823.45
$3,112.00
$3,350.02
$3,602.16
$4,497.86
$3,786.41
$4,024.43
$4,276.57
$5,172.27
$674.41

‡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 Kanawha County here.

Kanawha County is in “Rating Area 2” of West Virginia.

Currently, there are 33 plans offered in Rating Area 2.

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2024 Obamacare Plans for Kanawha County, WV

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